Current APA President Ramaswamy Viswanathan, M.D. Dr.Med.Sc. joins us to discuss his journey to psychiatric leadership and the early life events that inspired him to make a lifelong commitment to lifestyle medicine. Research suggests healthy lifestyle behaviors and habits promote mental health and wellness and can be used to both prevent and treat mental health conditions including anxiety, depression, bipolar spectrum disorders, posttraumatic stress disorder, and psychotic disorders.

Transcript for Audio

Erin Connors (0:02 - 0:31): Hello, and welcome to the very first edition of Mental Health Pathfinders. My name is Erin Connors, and I'm Associate Director of Media Relations for the American Psychiatric Association. I'll be your host.

Every month, we'll share a new podcast featuring members who are helping to chart a course to the future of mental health care. So thanks for joining us. For our very first show, I'm thrilled to welcome Dr. Ramaswamy Biswanathan, the current president of the American Psychiatric Association. Thank you so much for being here today.

Dr. Ramaswamy Viswanathan (0:32 - 0:34): Thank you for inviting me.

Erin Connors (0:34 - 0:40): You know, let's start out with you telling us about yourself and your path to becoming the president of the American Psychiatric Association.

Dr. Ramaswamy Viswanathan (0:42 - 1:56): Yes, I actually was born in India. And when I was two years old, my father suddenly died of a heart attack, sudden heart attack. And my mom was left to bring up five children.

And so that made a tremendous impact on me. And that's, you know, to this day, one of my sad feeling is I do not have any memory of my father. I also have witnessed the struggles of my mother.

So that really sparked in me also the concept of resilience and interest in people and how they overcome obstacles. And of course, I went to medical school in India, then came to the United States for further training. And I recognized also advocacy is very important and networking with other professionals is important to advance the field and have a wider range.

And through the district branch and the assembly, and then ultimately through the board, and now I'm the president of the association.

Erin Connors (1:57 - 2:05): That's wonderful. And you've made lifestyle medicine the theme of your presidency this year. Why did you make the decision to make that your theme?

Dr. Ramaswamy Viswanathan (2:06 - 3:30): As I mentioned, part of it is from my own history. But early on, you know, I also began looking into how, you know, people can avoid premature death and not only that question of longevity, also, you know, having a high quality life. And then if you look into the literature, it's really in the United States, about 80% of the health expenditures is spent on diseases attributable to unhealthy lifestyle choices.

And so I kind of recognized by really addressing it, we can have a very profound impact on the lives of so many people. This is true both for us physicians, as well as our families and our friends. There are a number of lifestyle factors which we can improve upon.

And there's a lot of evidence also showing that lifestyle really is helpful. And especially when it comes to our patients, our psychiatric patients, their lifespan is about 10 to 25 years shorter than their peer groups, so without mental illness. So it's important for us to pay attention to that.

Erin Connors (3:30 - 3:44): And I think that's really smart for people that may be a little bit afraid to come forward for care for mental health issues. You know, thinking bigger in a way that they can actually look at lifestyle changes instead of something else first.

Dr. Ramaswamy Viswanathan (3:45 - 4:32): Actually, it's not either or. It's important to do both of our straightforward psychiatric treatments, you know, psychotherapy, medication where needed, and also environmental changes where they are needed, and other interventions, you know, like neuromodulation. But irrespective of what we do, there is always room for integrating lifestyle interventions for most people.

We are always deficient in some area of lifestyle, and it's important to pay attention to improve it. It will influence our quality of functioning, our fitness, as well as our physical and mental health.

Erin Connors (4:33 - 4:36): And I understand there are six pillars involved in this. Can you tell us about those?

Dr. Ramaswamy Viswanathan (4:36 - 4:58): Yes, the conventionally recognized six pillars are physical activity, nutrition, stress mitigation, social connectedness, sleep, you know, restorative sleep, and avoidance of harmful substances like smoking, excessive alcohol use, or other drug use.

Erin Connors (4:58 - 5:02): Is there one that stands out to you as being the most important pillar?

Dr. Ramaswamy Viswanathan (5:03 - 5:28): Actually, all the six pillars are equally important. And that's the reason, you know, like no matter how good you are in two or three, you know, you should still not neglect the other pillars. And one has to have a balanced thing, and invariably people will be deficient in one or other, and people need to work on improving it and pay attention to all the six pillars.

Erin Connors (5:28 - 5:33): Yeah. And in your experience, is there one that maybe people struggle with more than others?

Dr. Ramaswamy Viswanathan (5:34 - 7:27): Yes. When it comes to the two areas we can talk about, nutrition and physical activity. Nutrition has two components.

One is what to avoid, and the other one is equally important, is what you eat. For most people, what to avoid is more difficult. So, I think in the beginning, you know, it's important to focus on what to eat also.

And so, that's easier for people to do. And even in terms of what you eat, there are some things which you do which can have a big payoff. For example, the easiest thing for most people to do is eating nuts and just a handful of nuts every day.

That does wonders in terms of lifespan. It increases lifespan by about 15% for even people who are already in an otherwise healthy diet. And also, it cuts down stroke risk and cardiovascular mortality.

And in depressed people, many people are deficient in brain-derived neurotrophic factor, and the nuts boost that activity. And so, potentially, it can help depression. Then the other thing also is people should eat a lot of fruits and vegetables.

Again, that's easy to incorporate in terms of vegetables, cruciferous vegetables like broccoli, cabbage. They have, you know, broccoli, especially, and kale, they serve both as green vegetables as well as cruciferous vegetables, and they can cut down the risk of cancer and also generally are helpful.

Erin Connors (7:27 - 7:29): That's wonderful. And you mentioned exercise as well.

Dr. Ramaswamy Viswanathan (7:29 - 9:25): It's really important. Yeah, when it comes to exercise, people are often stymied by finding the time. And so, you don't have to necessarily do it in a big block of time.

And even if you do exercise in a big block of time, still, it's important to have many exercises throughout the day. You have to build it into your life. So, every minute or two, sorry, every hour or two hours, if you spend a couple of minutes just standing up and walking, that's important because prolonged sitting is not good.

And so, in addition, you know, one way you can actually find time is usually if you can combine two lifestyle beneficial activities together, and they can help each other. And so, like, for example, if you decide to exercise with the body, it does two things. You know, one is it makes it more likely that you will adhere to the exercise.

And the other thing is it also improves your social connectedness. And also, you can make it, you know, more enjoyable. There are studies showing tennis players live about nine years longer than solo runners who live three years longer than sedentary people.

And it's thought, you know, that one explanation for the increased lifespan of tennis players, you know, there are also a lot of variables about who plays tennis and all. But one explanation is the social connectedness. And my personal feeling is, in addition to that, probably people are more adherent to it, you know, because in tennis, you have already made a commitment to play with somebody else.

Probably that also plays a role.

Erin Connors (9:25 - 9:36): Yeah, those social connections are so, so important. So I would also think sleep is a really important thing too, especially people get really stressed out, they start losing their ability to sleep a full night.

Dr. Ramaswamy Viswanathan (9:36 - 11:09): Okay, I'll address both stress and sleep. When it comes to stress reduction, obviously, we have to change the environment, you know, like that is contributing to the stress to the extent we can. But in addition, you know, in terms of the impact of stress on us, relaxation techniques and meditation, these are quite important, like tai chi, dancing, and even, you know, social interactions.

But the problem when it comes to activities like meditation is, again, people struggle with finding the time. And what, you know, I tell people is to find some short time periods throughout the day, you know, every two hours or so you can take a couple of minutes just to focus on your breathing. And that will have a big payoff.

And probably one should do it even if you devote 20 minutes in a day to exercise, I think still it's important to de-stress throughout the day. And sleep, one has to really, most people need to protect at least seven hours of sleep. And so it's important to follow routines, you know, much of our behavior is easier if we follow routines, you know, even exercise, if you have a set time, you know, like tennis, there is a routine because you have set times which is committed to others.

So if sleep, you know, if you make sure you fall asleep by a particular time, and also it's important to have a consistent wake up time. And if you try to adhere to it, that will help sleep.

Erin Connors (11:10 - 11:20): Such great advice for all of us. Now, you've been traveling internationally for the APA and speaking about lifestyle medicine. Have you seen this message like really resonate with this international audience?

Dr. Ramaswamy Viswanathan (11:21 - 12:36): Yes, definitely. In fact, it's very encouraging to encounter the very enthusiastic response wherever I have lectured. And I was the keynote speaker for the Royal College of Psychiatrists at UK at Edinburgh.

And after that speech, you know, not only immediately many people told me how much they liked it, I even received emails from them. And apparently they also made a recording. And the members who attended the actual lecture, they also kind of saw the recording again.

And this time, you know, one of them actually made his wife watch it. And, you know, both of them are incorporating lifestyle interventions. And I also, I have lectured in Australia.

Again, there was an enthusiastic response. And in Papua New Guinea, the Cardinal of Papua New Guinea and Solomon Islands, you know, he was in the meeting as well as some senior mental health officials, senior government officials. And they all loved what I had to say because they found it very applicable to their country.

So in Philippines and in India, again, the response has been enthusiastic.

Erin Connors (12:37 - 12:49): Wonderful. Well, Dr. Vis, thank you so much for being here today. This is such an important reminder to everyone that's listening just to take that extra moment and take good care of yourself.

It's good for your body. It's also good for your mind.

Dr. Ramaswamy Viswanathan (12:49 - 13:07): Oh, thank you. Thank you. And I hope many people will look at their lifestyle and their lifestyle and incorporate, you know, many of the interventions, not only that I mentioned here, but also the APA will be publishing a lot on it.

So thank you again for giving me this opportunity.

Erin Connors (13:07 - 13:19): Absolutely. And to our listeners, please join us again for our next edition of Mental Health Pathfinders. You can find us at psychiatry.org slash podcasts or your favorite podcasting platform.