In the inaugural episode of PsychNews Special Report, Dr. Adrian Preda interviews Dr. Marta Mudd, author of the Special Report featured in the January 2025 issue of Psychiatric News, discussing the intersection of nutrition and mental health. They explore Dr. Mudd's journey into psychiatry, the importance of nutrition in psychiatric care, and the gaps in education regarding nutritional interventions. The conversation highlights common nutritional deficiencies in psychiatric patients, the challenges of integrating nutrition into practice, and practical strategies for psychiatrists to engage patients in dietary changes. Dr. Mudd emphasizes the significance of overall diet quality and the potential benefits of interdisciplinary collaboration between psychiatrists and dietitians.

Transcript for Audio

[00:00:00] Dr. Adrian Preda: Hello and welcome to the first episode of Psych News Special Report, a new monthly podcast from Psychiatric News produced for the APA's Medical Minds Channel. I'm Dr. Adrian Preda, Editor in Chief of Psychiatric News and a Professor of Clinical Psychiatry and Human Behavior. Preda, at the University of California, Irvine School of Medicine.

Each month on Psych News Special Report, we sit down with the author or authors of that month's Psychiatric News Special Report. These in depth features explore clinically relevant topics at the core of psychiatry and mental health care, providing insights that bridge research and practice. In this episode, we are joined by Dr. Martha Mudd. The author of Using Nutrition as a Therapeutic Modality, which appears in the January issue of Psychiatric News. Dr. Mudd holds both an M.D. and a Ph.D. in Nutritional Neuroscience. She's currently the chief resident in psychiatry at McCall Medical Center at Northwestern University in Chicago, where she pursues her passion for integrative psychiatry, a holistic approach that combines medication management, nutrition, psychotherapy, and exercise.

Dr. Mudd, welcome to the podcast.

[00:01:21] Dr. Marta Mudd: Thank you for having me.

[00:01:23] Dr. Adrian Preda: Let's start by getting to know you a bit better. Where did you grow up and what led you to a career in psychiatry?

[00:01:30] Dr. Marta Mudd: I'm originally from Poland, um, but I moved to Northern Illinois at a young age and mostly grew up in Northern Illinois, but then moved around a bit for school.

Um, I knew I wanted to be in medicine, and I knew that I loved the brain from a really young age. Um, so I went to a small liberal arts school in Connecticut to study neuroscience, and it was there that I really discovered my passion for medicine and scientific research. I was in a cognitive neuropsychology lab with Dr. Sarah Raskin, and then that landed me at an MD PhD program at the University of Illinois Urbana Champaign. Where I studied the effects of nutrition on healthy brain aging with Dr. Aaron Barbet. And as a hardcore neuroscientist, um, when I transitioned to my clinical years, I always thought I'd end up being a neurologist, but I knew I was wrong as soon as I did my psychiatry rotation when I was a medical student.

I think as a scientist, I was really drawn to the fact that we still have so much to learn about the brain and how mental illness manifests. And as a clinician, I really loved that. Because we don't always understand the underlying illness that we're treating, we really focused on improving symptoms and quality of life.

And I realized that psychiatry was a place where lifestyle interventions, like nutrition and exercise, could really make a profound difference. And I fell in love with it, and I haven't looked back since.

[00:02:49] Dr. Adrian Preda: That's great. Not during medical school. You worked as a group fitness instructor. Teaching cycling, weight training, and high intensity interval training classes.

Has fitness always been an important part of your life?

[00:03:06] Dr. Marta Mudd: Honestly, no. I was very studious as a child. And it wasn't until college and graduate school that I really realized the benefits of exercise. I don't think I thought too much about the benefits for mental health and wellness overall, but I think I was inherently drawn to it for those reasons.

And, uh, the group fitness work really started out as a way for me to make a few extra dollars. I was a graduate student without a lot of resources, but really quickly, uh, it turned into something much bigger for me. I was able to share my passion for exercise and the benefits of exercise with others. Um, and since then I've dropped the group fitness gig, but I still like to practice what I preach with my patients.

And I really like to make exercise a daily habit. Um, I found a lot of joy, um, and wellness and long distance running. And that, that requires a pretty regimented training schedule, but I've found that setting that time aside for myself every day really clears my mind for the day and helps me feel well from day to day.

And I realize that's not everybody's cup of tea, but I think just getting out and moving your body, that's what really matters.

[00:04:09] Dr. Adrian Preda: And you have a Ph. D. in Nutritional Neuroscience. Can you explain what that field encompasses and how it informs your work?

[00:04:19] Dr. Marta Mudd: Absolutely. So, really what this area of research does is it examines how nutrition can impact the nervous system.

And in my work, what I did was I looked at how we can use nutrition like particular nutrients or groups of nutrients to slow or prevent brain aging in healthy older adults. Um, so in our projects we looked at how blood biomarkers of individual nutrients or groups of nutrients Those are thought to reflect dietary intake are related to cognition and underlying structure and function within the brain.

So an example of that work, we looked at how a particular balance of anti inflammatory and pro inflammatory fats was related to memory performance and that relationship was then related to structure of a particular region of the brain known to be implicated in memory performance. So we were really building these three way relationships and trying to create a link between nutrition, Cognition, or maybe in psychiatric terms, we might think about signs or symptoms, structure or function of underlying brain regions.

I mean, I really love the work, um, but at the time I was a little bit of a black sheep. The neuroscience crowd thought I was too nutrition focused and the nutrition crowd thought I was too neuroscience focused. Um, but since then that field has evolved enormously and it's so exciting to see how much the work has expanded.

[00:05:40] Dr. Adrian Preda: So you are a pioneer.

[00:05:42] Dr. Marta Mudd: Yes, you could say that.

[00:05:44] Dr. Adrian Preda: So let's, uh, let's talk about your special report, uh, Using Nutrition as a Therapeutic Quantality. What inspired you to write about this topic for psychiatricians?

[00:05:54] Dr. Marta Mudd: Well, I really love teaching, and I have this expertise in nutritional neuroscience from my graduate work, and I have this interest in lifestyle interventions in psychiatry, and I wanted to start incorporating nutrition management in my own clinical practice, but I also wanted to teach others how to do it.

And I think that's especially important because we as physicians get such limited training in nutrition. Only about 40 percent of medical schools actually meet the recommended guidelines for nutrition education and preclinical curricula. And so to try to help fill that gap, I created a curriculum on nutritional management within psychiatric practice and actually taught that to several groups of residents at my program.

And as part of creating that curriculum, my program director and I published a paper in the Journal of Nutrition earlier this year where we called for nutrition training, um, for psychiatry trainees. Long story short, that paper led me to this report and my goal here was just to disseminate that curriculum to a broader audience and what I hope can be in a more impactful way.

[00:06:54] Dr. Adrian Preda: And you know, you point out that there, uh, there are many things that have been done on this topic. Lots of studies that are demonstrating there is a connection between nutrition and mental health. And yet, as you point out, nutrition is readily incorporated into a psychiatric practice. Why do you think this gap exists?

[00:07:15] Dr. Marta Mudd: So I think that gap really exists because a couple of different reasons. But I think the main one is because we just don't get very good training, um, as psychiatrists and nutritionists. Like I pointed out, only about 40 percent of medical schools are reaching those nutrition guidelines in preclinical curricula.

So we don't really get it in medical school and then we don't really see it done. And then Um, in our training, in our clinical practice, and so we're just not prepared to do it. Um, I think the other piece of it is that the clinical guidelines in this area are, um, by and large lacking. I think that there's a lot of evidence in the, um, scientific literature that would support this practice, but there hasn't been much translation of those guidelines.

So I think that those are really exciting areas potentially to improve.

[00:08:08] Dr. Adrian Preda: And I realize that I'm asking you to speculate by why do you think that is we have the evidence, but we don't have the guidelines.

[00:08:14] Dr. Marta Mudd: Yeah, that's a good question. I think, um, Partially, probably because a lot of us don't have training, so no one's doing the translation.

And I think also the other part of it is, this is a pretty new area of research. I mean, as I said, when I started my graduate work, um, I could, I was kind of a black sheep. Um, it was, it was hard to publish the work, um, because it didn't neatly fall into any of the categories that the journals were looking for.

Um, and so. Medicine tends to lag behind science, um, in some ways, and I think that's just what we're seeing here.

[00:08:51] Dr. Adrian Preda: So, let's talk about, um, nutritional deficiencies in psychiatric patients. What are some common nutritional deficiencies of certain individuals with psychiatric disorders? And how might these deficiencies exacerbate mental health conditions?

[00:09:07] Dr. Marta Mudd: Talk about this in two different ways. So one way in which we can talk about this is we can talk about particular nutrient deficiencies in patients with psychiatric illness. So I think the ones we most commonly talk about Vitamin D, vitamin B12, folate, those are the things that we're often checking in our clinical practice to be sure there aren't deficiencies.

And I think that those can certainly play a role. If there's a frank deficiency, we should supplement, um, because we know that those nutrients, uh, have critical roles in the central nervous system. But I actually think the more important piece of this puzzle is actually looking at how are patients overall eating?

What are their dietary habits like? And we know that patients particularly with severe mental illness tend to not intake the macro and micronutrients that they need. And so in that way, they're not getting the, they're not meeting the dietary quality, um, one could say standards that would support their mental health.

[00:10:08] Dr. Adrian Preda: So you're talking about supplementation through dietary supplements, but then there are whole foods, right?

[00:10:15] Dr. Marta Mudd: That's right.

[00:10:15] Dr. Adrian Preda: So whole foods or dietary supplements?

[00:10:20] Dr. Marta Mudd: The, the question of the out. I mean, I always go with whole foods and I actually think that that's really well grounded in the literature. I mean, there was a long time where we were looking at individual nutrients and the impact of individual nutrients on the brain, but over time we realized that it's actually groups of nutrients that have a more profound impact because as humans, we don't eat nutrients in isolation.

We eat groups of nutrients in our diet. Um, and so we found in the literature. that that actually tends to have a much larger impact on when we're looking in neuroscience, cognition, brain structure, and brain function. And, and I would say too, within the literature for psychiatric illness, that that's been the case as well.

So, um, there've been Many studies that have shown that overall diet quality can support mental health. Um, and, and there is a growing body of evidence for individual nutrient supplementation as well, but I think that there are many more limitations when it comes to that.

[00:11:22] Dr. Adrian Preda: How does nutrition interact with other treatment modalities?

[00:11:28] Dr. Marta Mudd: So I see nutrition as one tool in our toolbox. In the ideal world, we would assess nutritional status in every single patient that comes our way because we know that nutritional status has so many health implications, not only mental but also physical, but in the real world it's not possible. And so I think just like we assess appropriateness and potential benefit of psychotropic medications or psychotherapy.

We should really consider the potential benefit of a nutritional intervention for every single one of our patients.

[00:12:00] Dr. Adrian Preda: So, um, as you mentioned, um, there is a gap, uh, when it comes to education, right? Starting with medical schools, then also during psychiatric residency. What are the barriers to implementation?

[00:12:15] Dr. Marta Mudd: Many. Um, I think the first barrier is that medical school curricular already crammed with material and it's simply difficult to, to get everything in there. And I think that unfortunately nutrition tends to fall by the wayside. And then I think once we get past medical school and, and I'm speaking for psychiatrists in particular, we don't, again, we spoke about this earlier.

We don't necessarily have the clinical guidelines to do nutritional management within psychiatric practice. And so there's no clinical guidelines to teach from. Um, and so I think those are probably the, the two ways in which we could intervene, but of course there are barriers there.

[00:12:57] Dr. Adrian Preda: Do you think that there is a role for organizations like the International Society for Nutritional Psychiatry Research?

that could establish these frameworks for integrating nutrition into psychiatry care? I

[00:13:10] Dr. Marta Mudd: think that these organizations can serve as a body within which the evidence can be collected. Um, and so, so it's a place to go, you know, as a trusted source, if you're looking for the information and maybe that's one place where we can start to create some of these clinical guidelines.

[00:13:28] Dr. Adrian Preda: So I'm curious with, with your interest and actually expertise, right? And, uh, you. gone through four years of, uh, a traditional psych residency, were you able to bring some of those experiences and then put them to good use and integrate, have an educational component integrated in, in your psychiatry residency program?

[00:13:49] Dr. Marta Mudd: Yeah, so in, um, because I have this interest, uh, Partially creating this project to teach my psychiatry residents was, was selfish because I wanted the opportunity to really dive into the literature and understand what's there. Um, and so in creating this curriculum, it was a little bit of education for me.

Um, and then I was able to educate my co residents as well. And as far as integrating these things into my clinical practice, I really do think that I'm someone that I think about nutrition for every patient that comes through my door. Um, and if it feels like it is an appropriate potential intervention, and I think that the patient might be amenable to that kind of intervention, I will bring it up as an option in addition to medications and therapy.

[00:14:35] Dr. Adrian Preda: How did your colleagues react to that?

[00:14:36] Dr. Marta Mudd: variably. I'm more enthusiastic than others. Um, I, I think it really depends on the provider's, um, preference for practice, right? Some of us really like using medications and that's the thing that we like to do. And I think some of us like to be, um, think a little bit more outside the box and use medications, but also think about other possible interventions.

So I think it's really going to depend. Um, provider to provider,

[00:15:03] Dr. Adrian Preda: but it seems that the approach that you're advocating is to, uh, is not one thing in the favor of another, but actually, uh, these are complimentary things and there is value, different type of value coming from the different type of interventions.

So it's about having this more holistic perspective.

[00:15:20] Dr. Marta Mudd: That's exactly it. I don't see nutrition as. a substitute for our gold standard treatments, um, especially in patients with serious mental illness. I think that actually appropriateness and efficacy of nutrition as an intervention there is still in question.

Um, but I do think that it's part of the puzzle.

[00:15:38] Dr. Adrian Preda: Do you think that, uh, people might, might, might have a different way of approaching sort of nutritional recommendations? I'm talking about psychiatrists, physicians. Because, rightly or wrongly, they would have the perception that the level of the evidence is not similar to the level of evidence supporting some of the other interventions.

[00:15:59] Dr. Marta Mudd: I think that's a really good point, and certainly, um, a valid one, um, because, um, Like we talked about earlier, this is an emerging area of research and we don't have a lot of really good randomized clinical trials to support, for example, particular supplements or many different kinds of dietary patterns.

I think there's, there's evidence for certain things, but there's not evidence for a lot of things yet. And I anticipate that this will change over the coming years, but I also want to acknowledge that nutrition research is inherently difficult, particularly when we're talking about things like nutritional interventions, because there are a lot of variables to control.

And so it's going to take time.

[00:16:44] Dr. Adrian Preda: Let's switch gears and consider a patient's perspective here. So first. Do we have data about how patients perceive, uh, nutritional interventions, and then what's your own experience with how patients.

[00:16:59] Dr. Marta Mudd: You know, to be honest, I'm actually not familiar with the evidence on patient perception on um, nutrition recommendations.

That's not, um, not really a question that I came across as I was looking through the literature. But I think from my personal experience, I would say just like any treatment modality, this really varies from patient to patient. Some patients love the idea of trying a non pharmacologic approach that can help their mental and physical well being and, and others say they don't have the interest, they don't have the resources, or they don't have the time to change their dietary habits.

Those are very real limitations. So I think, um, as with anything, we have to meet the patient where they are. But, but I do think that the evidence shows that we should at least be considering nutrition for a patient.

[00:17:47] Dr. Adrian Preda: What strategies can psychiatrists effectively employ to engage patients in discussions about, uh, nutrition and encourage dietary changes that may benefit their mental health?

[00:17:58] Dr. Marta Mudd: Yeah. So I recognize many psychiatrists might feel uncomfortable with this idea of using nutrition in their practice and Largely because our training doesn't prepare us to do it, but there are existing resources that we can start using to build comfort and familiarity with this practice, and a great place to start is by assessing diet quality.

The USDA MyPlate tool is a perfect starting tool. It can assess dietary intake against USDA recommendations, and then it translates dietary guidelines into practical advice for patients. So, a psychiatrist could have a patient use this tool outside of the visit and then they can talk about the results at subsequent visits to help set goals and track progress.

And for providers that feel like time in visits is so limited and there just isn't time to talk about nutrition. You can consider referring to a dietitian. There's lots of evidence to show that interdisciplinary collaboration in this area can have really positive outcomes on patient care.

[00:18:56] Dr. Adrian Preda: So let's, you know, we talked about general things.

Let's zoom on your personal experience and practice. Um, in your own clinical experience, have you observed notable changes in patients mental health outcomes following dietary interventions?

[00:19:11] Dr. Marta Mudd: Yeah, so in my limited clinical experience as a resident. I've certainly talked about nutritional interventions with my patients.

I, I do typically check for the basic nutrient deficiencies, vitamin B12, folate, vitamin D, make sure we're ruling out reversible causes of patient symptoms. But beyond that, I really like to talk to patients about Uh, diet quality and for patients that are motivated to try to follow particular dietary patterns, we do talk about a Mediterranean style diet because I think that's, that's the diet pattern that is most supported, particularly when it comes to depression and anxiety.

Um, and in these cases, you have an assess whether I think the patient might be open to this kind of intervention. And if they are, we talk about it and we follow up with them. at subsequent visits on how things are going. And I don't, I wish I had a randomized control trial of my own patients. I don't have that yet, but I would say by and large, it's been a well received intervention.

[00:20:12] Dr. Adrian Preda: Two final questions for you. First, What's your favorite food that also happens to have amazing benefits for mental health?

[00:20:22] Dr. Marta Mudd: I will take a bit of a cop out on this one because I want to stay true to what I preach. So I feel best when my plate is full of colorful whole foods because I know I'm getting all the micronutrients, vitamins, minerals.

And macronutrients like proteins from lean sources, healthy fats, carbohydrates from whole grains. And in that way, rather than abiding by a favorite food, I abide by a high quality diet. Um, and I know that from the evidence and my own experience, it's one of the best ways to support my mental health.

[00:20:51] Dr. Adrian Preda: And finally, if listeners take away just one thing from this discussion, what's one simple change they can make to improve their mental health from nutrition?

[00:21:03] Dr. Marta Mudd: I wish I could say there was a magic pill, but the good news is the answer is not that complicated. Focus on overall diet quality. Incorporate lots of fruits and vegetables, whole grains, very lean sources of protein, and limit added sugars and saturated fats. And if you're not sure how to do it, check out the USDA MyPlate app.

It's a great starting place. Um, and if you want more, talk to your provider about a referral to a dietician. Um, there's lots of evidence to show that interdisciplinary collaboration between psychiatrists and dietitians is really how we get the best outcomes. Um, and I think in doing those things, your brain will thank you.

[00:21:41] Dr. Adrian Preda: Dr. Matt, this has been a fascinating conversation. Thank you so much for joining us today. And to our listeners for tuning in to Psych News Special Report. If you enjoyed this episode, please take a moment to rate, review, and subscribe. Your support helps us continue bringing you important discussions on mental health and psychiatry.

And if you found today's conversation insightful, don't hesitate to share it on social media. Let's keep this dialogue going. We'll be back next month with another special report, Deep Dive. Until then, take care.