S2 E7: Kristin Kirkpatrick on How Food Affects Mood
With all the fad diets and complex studies out there, it can be hard to know what to eat. So how does nutritionist Kristin Kirkpatrick use her Fuel Well program to help those recovering from addiction and mental health issues at the Meadows campus in Wickenburg, AZ? And what can that teach us about how food affects our mood?
Kristin Kirkpatrick: Hi, I’m Kristin Kirkpatrick, I’m a senior fellow with The Meadows and I’m also a registered dietitian.
David Condos: Kristin, thank you so much for being with us.
Kristin: Thank you for having me.
David: Yes, so let’s start with your story, your background, what led you to be interested in nutrition and the recovery world.
Kristin: My story starts pretty young in life as I think most people do. I was a teenager, my eating habits were awful. I was overweight, probably obese. My blood sugar was off the charts and I had to go see an endocrinologist. That endocrinologist sent me to a dietitian, and when I saw that dietitian, that dietitian was essentially telling me not to eat the foods that I love to eat as if that were an easy thing to do.
David: Just seemed like a big list of “no’s.”
Kristin: Right, it was a big list of “no’s” and it was things I already knew. I knew I shouldn’t have the candy, I knew I shouldn’t have all the fried foods. There wasn’t a question in my mind whether I should have it or not, the question is how do I not have it? I think at that young age I made that connection. Not to say I was a full-blown food addict, but there was a definite connection there about, “I can’t believe this person is just telling me not to have that.” I wish I could not have it, but I need more than just this person telling me not to have that. That insight really led me to want to take a career in dietetics, which I eventually did.
David: Did you eventually incorporate that in your life and you saw a difference and that’s what led to that?
Kristin: Yes, absolutely, and just a concept of eating better and feeling better, but the other thing that I learned is that it doesn’t happen overnight. When people say, “How long did it take you to lose the weight?” I’ll often say, “It probably took me ten years and I’ll let you know when I figure it out how to maintain it.”
David: It’s a long-term goal.
Kristin: It’s a long-term goal, and so that’s why I was saying when I present that if you’re sitting in the audience, anything that impacted you from a food perspective as a child will always be underlying. It will always be hiding, it’s like a little bit of your devil. I definitely want to grab something that’s not good for me because it was a comfort-food. So if I have stress and anxiety, macaroni cheese sounds pretty good, a salad doesn’t. These are all concepts that are very normal, this is what we crave, but how do we take that concept and then make it something that’s not the norm for the patients that are dealing with true addiction with trying to go through recovery with depression, with anxiety.
How does food not become the drug of choice when their drug of choice is taken away.
David: Yes, so that replacement.
David: You started getting into describing your professional career and how you got into that. I know you got some interesting experiences along the way. One of them was in DC working with health policy reform.
Kristin: Yes, so I had the opportunity to work with what was then the American Dietetic Association. Our whole goal was to try and pass MNT, which is Medical Nutrition Therapy so that dietitians could provide insurance coverage for things like diabetes, coronary heart disease, things like that. Really interesting, very much of an eye-opener. I was 25 at the time. An eye-opener because I got to work with these amazing nutritional professionals. Also, an eye-opener because I saw the very powerful aspect that lobbying has on the food industry. We were an organization that is meant to help people eat better.
People who we had to have conversations with in order to try and get funding and things like that, it was interesting perspective. It was probably the first step and how I realized I wanted to be more on the patient’s side than the policy side.
David: So you were up against some pretty big foes or big obstacles?
Kristin: Not so much big obstacles, but just lobbying is also about fundraising. I think the organization does a great job, but from a lobbying perspective, a little bit of a surprise from someone who is 25 and has rose-colored glasses who we would take money from, which food companies and things like that in order to be able to get our mission to be sent that we knew would help people and it did. It was a huge initiative, but it’s like you have to dance a little bit with the devil in some aspects. So that was a real big eye-opener, but also an eye-opener that I feel that nutrition and how we look at food has to come from our health professionals, it has to come from our home, our family life, our parents, things like that.
I don’t think the government is going to be the right person or entity rather in most cases to communicate that because there’s so much bias.
David: Because it’s just not going to be effective?
Kristin: Not that it won’t be effective, but there’s bias in the industry, there’s lobbying, and so as long as you have lobbying, you never know what the advise is, the advice that is truly evidence-based or if the advice is coming because there’s big pockets.
David: Because they pay for it.
David: Another experience that you had was working with public television to get your show The New Rules of Food out into living rooms across America. How did that come about? What do you hope people took away from you?
Kristin: I had done a lot of TV up until then, health shows and things like that. One of the things I was always trying to do with my messaging to my patients is I was always trying to help them realize that you could still have food you like. I tell people when I present, never tell a patient not to have a certain food because it’s what was told to me, and they’re highly ineffective. For me, The New Rules of Food was an opportunity to allow people to understand how they can get more nutrient density in their diet, and also understand that you’re going to be doing pretty well if that’s what you do 80% of the time.
David: So like you don’t have to worry about getting it 100% of the time and be really down on yourself.
Kristin: Right, because no one can do that, it’s not realistic, and so for my patients when I see people saying, “I love ice cream, I’m never going to have it again,” they not only have it again, but they will eventually binge on it because it was something that becomes taboo and in their head, becomes something that is bad. Instead of really looking at, “This is bad and this is good,” we need to look at things that are nutrient-dense and lacking of nutrients, and try and focus on the ones that are nutrient-dense most of the time, and then every once in a while, have the things that we know aren’t going to be good for us.
It’s not the cookie or the fast-food burger or that kind of thing that we have every once in a blue moon that makes us fat and sick as a nation, it’s when we’re doing it as a norm, on a regular basis.
David: That’s interesting how you’re saying…Just saying, “This is bad, this is good,” psychologically, that’s not effective.
Kristin: Right, absolutely. Right, not effective. Food is so powerful. If you look at the studies and you look at some of the areas in the brain that are hijacked by things like sugar, sugar’s a great example of this. I could tell a patient till they’re blue in their face that heroin is not good for you. Everyone knows that, but if you talk to people that are heroin addicts, they have it once and they wanted it again. Sugar is very similar to that in that there are areas in the brain that open up that make you feel calm, that make you feel good. Of course you’re going to want that food again.
That’s going to make you feel good, and it’s going to be hard to break that cycle of having too much of it. No one has a problem with having too many carrots, but you have a problem with having too many pieces of licorice or pick your poison. I always tell my patient, “For you it’s licorice, for someone else it’s a pizza.”
David: You’re starting to get into some of your presentation that you just gave here at the US General Training Conference in Scottsdale, Arizona on food and mood and the connection you’re starting to talk about. Specific to this context with mental health, addiction treatment, what is that connection, what can you tell us about it?
Kristin: The connection is huge so there’s a components of mental health called a nutritional psychiatry. That probably came out about a decade ago. People weren’t really talking about it a lot, and really, I don’t think the conversation truly started until maybe about two or three years ago. What we know now is that there have been at least a decade or more studies that have looked at the connection between certain dietary indicators, things like foliate, vitamin D, omega-3 fatty acids and how they related to lessening symptoms of depression, maybe even the prevention of certain low-level depression, things like that.
I think that the connection is very clear. We also have clear connections on the opposite end that’s more negative. Things like fast food, things like sugar, things that are like junk food tend to increase depressive symptoms, tend to increase anxiety, things of that nature. I think the reason the Meadows is so groundbreaking in bringing this entity to their treatment is because I don’t think we are in a place where we can have treatment and not talk about diet because diet is the one thing you can’t choose not to engage in every day. You can choose not to exercise and you don’t have to manage your stress if you don’t want to, you can never choose not to eat because that eventually leads to death.
There’s only so many days you go before you die. You have to eat and I think that’s one of the reasons, it’s like the only thing in the world you absolutely have to do daily.
David: Everybody’s doing it, and so if you can make small changes to that, then it will add up.
Kristin: Right, and the understanding of the powerful impact it has on mental health. To think that your diet doesn’t have any effect on how happy or sad you are is just wrong.
David: You were alluding to the work you do with The Meadows. You’re a senior fellow there and a part of that is the Fuel Well program that you developed.
David:Tell us about that, why did you decide to make that program?
Kristin: The Fuel Well program, it wasn’t really me, it was the fact that they saw this need, the fact that they knew that, okay, we are the best at what we do in terms of treatments, and how do we enhance that? The logical explanation was, well, every day we do everything right with these patients behind closed doors or in group sessions or wherever the case may be, and then they leave and they walk into the cafeteria, and does that have an impact on the treatment that they’re getting elsewhere and are we doing that right? The whole goal of Fuel Well was not to say you’re no longer going to have these foods on the menu anymore because they’re bad but really was to provide choice.
What we did was we looked at the menus, we looked at everything that was offered to the patients, and we said we need more omega 3s, we need more whole grains, we need more of these foods, and also we’re going to try and limit some of these other foods. There’s still choice. You could still walk into a Meadows cafeteria and say, “I don’t want to eat a Fuel Well program meal today,” and not do that, but at least these patients have the choice and at least now we can have the conversation with them about it. It’s hard to have a conversation about something like food and then not provide that food as an option.
David: If you want to get into some of the details, what are some of the tenants of the Fuel program?
Kristin: We wanted to try and make at least half of our grains whole grains and we’re going to continue to work towards trying to get 100% whole grain, so taking away things like refined grains, white bonds, white bread, things like that.
David: Because that can hurt their brain chemistry or–?
Kristin: It’s more like what we would find involved in more processed junk food more than anything else. Sugar is a big one, so obviously we have a lot of addiction disorders at the Meadows. If you’re addicted to something else, you’re probably going to be really consumed with maybe addiction of sugar or something like that as well.
David: Kind of that replacement issue.
Kristin: Exactly, the replacement, but also connection with looking at high sugar foods and how that impacts depression, anxiety, et cetera. We wanted to really alter the foods so that we could still provide like sweet things, but really have sugars coming from more anti-inflammatories foods, so like berries, fruits, things like that, so more from a natural source, things like dark chocolate. You don’t want to take away everything. Like dark chocolate has flavonoids. Just having more options in terms of folate. Folate is a big vitamin, a B vitamin that’s related to brain health. Just having more folate, which means having more leafy greens, having more alternatives like that.
Not getting rid of 100% because that would just cause a riot, but getting rid of a lot of the processed red meats. So we still have red meats on the menu, but trying to use more bison, and trying to use more wild beef, and trying to use more grass-fed when we can and things like that. Even just the responsibility of where we’re sourcing the foods
David: Because the nutritional value is different?
Kristin: Yes, nutritional value is different. Really trying to source foods more locally, which is better for the planet really. Fueling well means we want people to feel better and to feel good about what they’re eating, but we’re looking at the bigger picture as well. You can never ignore the planet with food, we used to, but now it’s a conversation that everyone’s having. Those are just the main things, just trying to increase the nutrient density, really trying to reduce significantly ultra-processed foods, tons of chips or fried foods. There’s no frying at The Meadows, just things like that.
We’re trying to give more whole foods-based to really enhance the treatment that they’re getting when they’re not in the cafeteria because there’s just so much evidence and there’s just so much saying that you can’t treat someone for anything mental health, and then just discount what they go home and eat.
David: What’s some of the response you’ve seen from the patients and the staff from the program?
Kristin: I think the response has been really great. When I speak with Brandon, who’s the chef at Wickenburg, he tells me that it’s been nothing but positive. I think when people are given choice and then you have the talent of such amazing chefs that they have at Wickenburg and it tastes good, then there’s no better way to convince someone. I can tell people till they’re blue in the face that like salmon is great, but if I can’t make salmon that tastes good, it’s not going to happen, so I think the response has been good because their chefs are good and they know how to take these products, take these ingredients, and put them together in really a culinary method that is just delicious.
The next step from that is once our patients leave Wickenburg and maybe they’re still going to the IOP or they’re just going to be on their own or they’re going back home someplace else in the country, giving them the tools that they need to be able to implement that same type of diet when they get home.
David: So it’s sustainable.
Kristin: Sustainable, right, so I don’t just want to feed you these wonderful things while you’re here, and then when you go home, you have no clue how to do that. Really trying to ramp up, I think, in the next year or so what does the educational piece look like so that we’re still focused on the treatment of recovery, addiction, trauma, et cetera. That’s still the main focus of the Meadows as it always will be, but this is a component that patients can take with them as well.
David: Looking back at all your research, all your work, what have your years studying this, working with this, what has that taught you about nutrition that you didn’t know before, what has it changed your mind about?
Kristin: I think the more complex nutrition gets, and it’s complex because there’s experts everywhere, number one. There’s experts on Instagram that people listen to and come into my office and say, “I’m following this person’s diet,” I’m like, “What?” It’s complex because of that. It’s complex because we’ve gone from having so many products in the grocery store to now millions of products. We know from studies that having more choice has not made us healthier, it’s made us more unhealthy.
David: Some of it is marketed as “diet.”
Kristin: Absolutely, like smoke and mirrors and things like that. At the end of all of it, and everything we’ve known, and all the studies, the back to basics approach tends to be the best one. Whole foods, eating real food. I said in the presentation that I always quote Michael Pollan that real food is something that is found in nature, fed from nature, and will eventually rot.
If you do nothing but eat real food 90% of the time, you’re going to be pretty good because real food is nutrient-dense, you’ll be fuller longer, and that’s a very basic approach, but I think people want more specifics and that’s what’s made this industry so much more confusing and fuzzy because they want specific diet plans and they want to lose 20 pounds within five days.
David: It doesn’t work like that.
Kristin: It doesn’t work like that.
David: We’ve been talking before we started recording about the intermittent fasting and like how you can even just change the way you eat, when you eat, and still have that choice. Talk about why that works, how it works.
Kristin: There’s been a lot of studies on fasting. Obviously, the fasting components are not appropriate for patients at The Meadows that are dealing with disordered eating of any kind, especially the eating disorders, but even patients that just have disordered eating and they’re dealing with another addiction. For the most part, we’ve seen benefit in intermittent fasting, specifically, time-restricted eating because of the fact that it is more in line with how we are supposed to eat as humans. We’re not meant to eat around the clock, we are meant to eat more like our ancestors did, going all the way back to cavemen and they didn’t eat around the clock either, so it’s more in relation to our circadian rhythm.
That’s why for my patients who are really struggling with changing the type of food they eat, I will just change the timeframe and that usually is a good first step towards getting them in a healthier place.
David: For someone who wants to dive in even deeper on this, what’s one or two books, resources? I know we have your book, Skinny Liverhere.
Kristin: Yes, Skinny Liver, throw that one out.
David: Maybe that and another one?
Kristin: There was a book that I mentioned in the presentation called the Inflamed Mind, which is all about depression and anti-inflammatory diet. I think that’s a really important one and an interesting one because it deals specifically with that. I absolutely love Michael Pollan because he is a back to the basics type of writer and a back to the basics approach, so I think The Omnivore’s Dilemma, which is an old book, we’re talking 20 plus years now, it’s still one of the best books. Not because it makes you decide whether or not I want to be vegan or not, but just takes a hard look at the food industry so people could be more aware of how their food is getting to their plate.
David: All right, well, Kristin, thank you so much for your time.
Kristin: Thank you.
David: Just to leave our listeners with one last thing, what’s your favorite piece of advice? Something that’s meant a lot to you, something that you want to pass on.
Kristin: One thing I probably say at every single solitary appointments, because everyone asked about portion control, what are the best tactics for portion control? I always tell people to eat until you are no longer hungry, not until you’re full, which is a very different concept. If you just, again, think about how you look at food, if you’re eating to fullness and getting to the point where you’re bingeing, what does that say? What are you trying to feed? Whereas if you’re eating to simply nourish, you’re probably going to be in a better place in terms of mental health completely.
David: Kristin Kirkpatrick is a registered dietician nutritionist based in Denver, Colorado. In addition to serving as a senior fellow with The Meadows, she’s also the author of the best-selling book, Skinny Liver. Learn more about her book, her PBS television series and more at http://kristinkirkpatrick.com.