My first book came out at a difficult time. A publication date of August 2020 meant that a carefully planned rollout was totally wrecked during the height of the COVID-19 pandemic. The situation in the world was evolving so rapidly that it took some time for virtual book tours and remote keynote talks to solidify, and I was left to worry that my work to communicate the importance of nutritional psychiatry would go unnoticed. Dwarfing that worry was the stress of being a frontline physician during such a terrifyingly uncertain time.
Thanks to the heroic efforts of my amazing publication team, my book launch didn’t sputter as I feared it would. The pandemic brought additional attention to both mental health and food—after all, many of us were left with nothing to do but eat and worry, worry and eat. As the book found success, I should have been delighted about how it was helping people around the world better understand the relationship between the food they eat and the inner workings of their brain. But though I felt grateful that people were reading and learning from the book, the burden of those early days of the pandemic didn’t lift. If anything, it got heavier. Strange as it may seem, with every accolade, news feature, TV appearance, and positive review, I felt a huge panic about what was next. Thinking about how to keep the momentum going wasn’t exciting and fulfilling; it was scary. I felt like I couldn’t do it.
As a psychiatrist who has spent years diagnosing anxiety in others, I know how to recognize the signs. I had felt them before too, when I was diagnosed with cancer and facing a daunting schedule of chemotherapy and other treatments. That was my first obvious struggle with my own mental health, and when I experienced the true power of nutritional psychiatry. Food helped me ease my anxiety and support my medical treatment, which provided the blueprint of my work today.
But this felt different. Instead of staring down a deadly disease, I was being invited to be a guest on television programs and podcasts, becoming colleagues and friends with some of my medical and media heroes, like Deepak Chopra. When I made myself step back and gain some perspective, I knew I should feel lucky and elated and grateful. But somehow the overwhelm and anxiety were the emotions that prevailed. To complicate matters further, despite paying attention to my food and finding time to exercise, I began to gain weight, due in part to stress and anxiety, but also to the aftermath of chemotherapy wreaking havoc on my metabolism. Though I fought with my self-consciousness, I could not shake the feeling that gaining weight somehow undermined my points about healthy nutrition, which further compounded my anxiety about appearances and talks.
As time went by, it seemed like nothing was working. My usual self-care practices, mindful eating, meditation, yoga, and other forms of exercise all felt like drops in an ocean of anxiety. I worked hard to keep my nutrition consistent, but the way I was feeling was like I had gone on a French fries–and–doughnuts regimen. At times, my anxiety bubbled up over these ongoing issues and I felt totally hopeless, stopping exercise for days and then losing track of my nutrition. Worries about the pandemic along with everything else disrupted my sleep, as coronasomnia reared its head. Everything combined into a cycle of angst, stress, and anxiety that continued to feed itself.
When it came time to start planning a new book, I immediately knew what subject I wanted to write about: anxiety. The world’s most diagnosed mental health condition had arrived on my doorstep, and I hoped that by learning more about the cutting-edge research into the connections between nutrition and anxiety, I would be able to both help myself manage my own anxiety and shed light on such an urgent and complicated topic for others. Through my clinical work and my research for the first book, I already knew about how intertwined anxiety was with the gut microbiome, but as I started compiling articles and drafting the earliest parts of this book, I found myself taken aback at how anxiety is tied in with so many different aspects of physical health, including immunity, inflammation, leptin response, and metabolism.
This research made me grapple with the deeper layers of what anxiety does to the body and brain. Studying how tightly anxiety is connected to metabolic disruption gave me some insight into how my anxiety had helped make my metabolism go awry, leading to my stubborn weight gain. And learning about how anxiety is interlinked with the appetite hormone leptin gave me a basis for understanding why my anxiety had caused me to wolf down my meals but somehow left me less satiated even though I was eating more. This was a painful reminder that even healthy foods can be harmful when they aren’t eaten in moderation.
Working on the book gave me the fortitude to redouble my efforts to take small steps toward quashing my anxiety, trusting that the sum of small, simple actions would have a big effect on how I was feeling. Once they were allowed under COVID restrictions, I booked regular massages and other spa treatments to help alleviate stress. I discovered a fun type of squeezable scented clay that I carried in my purse when I traveled to use as a stress ball when things were feeling tense. I chose a relaxing lavender and a soothing ocean scent, since the ocean has always been a calming place for me. (You can find my recipe for homemade Lavender Play Dough here.) I relearned alternate nostril breathing, a yogic breath exercise that calms and relaxes, and began to practice it daily. I went to see a Transcendental Meditation teacher to sharpen my skills, which had been feeling dull. Since I had felt disconnected from yoga, I learned qigong, an ancient Chinese movement practice that gently involves the whole body, with the goal of lowering inflammation in the brain and body. Eventually, I was able to restart my morning sun salutation yoga, which I’d always used to welcome the day with positive energy.
To stem the tide of a seemingly endless set of obligations and appearances, I invested in a time management system for my iPad, which helped me organize my relentlessly busy days. I began to push back on deadlines proposed by media for submitting a quote or an article, and I began to agree to appear on podcasts only on days that worked well for my busy hospital schedule.
As for my diet, I cut back from 3 cups of coffee per day to 1 and gently increased the amount of water I was drinking to offset dehydration, which can worsen anxiety. I updated my beloved grandmother’s golden chai recipe by adding more anxiety-relieving spices, and I made a point to drink it every day. This helped ground me in a positive childhood memory, as well as providing my brain with healing bioactive phytochemicals. Along with reminding myself to eat mindfully and chew my food slowly, I recognized I may have a form of leptin resistance and began to address that through stress management and my food choices. While I did not restrict calories, I was careful not to eat the French fries or other unhealthy choices my friends or family ordered when we were able to eat together again. I leaned into cruciferous vegetables, which are satiating and help offset the hunger pangs that an imbalanced appetite hormone can create. I ate as many leafy greens as I could—both for salads and for a nourishing smoothie on my workout days. I began to carry a healthy nut mix in case I was hungry and came across a tempting doughnut! I urged myself to get back in touch with my love of cooking, developing some of the recipes that appear in this book and finding some new favorite foods like the purple sprouting broccoli that is pictured on the cover.
The combination of these anxiety-lowering techniques did help me feel more grounded, and I regained the ability to live in the moment and focus on the task at hand. But I still didn’t feel quite whole until I experienced two different, personal events.
Though I have always worked hard in my own therapy to shed the anxiety surrounding my experience with cancer, I didn’t quite understand how deeply it was rooted in my unconscious. Several times each year, I went in for my tests and exams. In the middle of writing this book, I went in as usual for one such checkup. As she looked over the results, my doctor looked at me and said, “I’ve got great news; your tests are normal and we’re graduating you out of the follow-up clinic and into the survivorship clinic.” I looked at her with surprise and elation but simultaneously teared up. As I tearfully thanked her, I felt as though a massive weight had been physically lifted off my shoulders. My heart slowed to a normal pace, my breathing became more regular, and as I stood up, I felt light and free.
When you’ve lived through an illness like cancer, you wake up every day after your initial diagnosis wondering if you will survive. At first, it’s a conscious and visceral worry. As you persevere through stages of care and treatment, it lessens in volume, but it persists as something you live with every time you take a breath. You move through your day and your life, and over time perhaps you learn to ignore it, but it remains beneath the surface. Hearing my doctor say those words freed me from mental shackles that I’d gotten so used to that I barely understood they were there. The tightly wound screw in my chest was loosening, and daylight somehow seemed brighter. That evening something changed when I ate dinner. I was less hungry, but food tasted better. I was able to eat slowly and mindfully and had no trouble understanding when I was full.
As I moved through those next few days feeling significantly calmer, I had a chance meeting that provided another crucial bit of understanding to help free me from anxiety. I was meeting a friend for dinner, and she asked if she could bring along a healer who had really helped her. I was a bit skeptical, but my reduction in anxiety after getting my good news made me feel more open to new and different experiences. As it turned out, he and I took to each other almost instantaneously. As we spoke over dinner, he deduced something profound about my life, my background, and my trauma—something I have always kept well hidden.
I grew up in South Africa under apartheid. While apartheid policies that separated whites and Blacks are well-known, Indian families were also kept separate, living under inferior conditions. As a child, I could not go to the same playgrounds or amusement parks as my white peers, and I had to attend separate schools that were subpar compared to white facilities. I don’t think I truly understood what that meant at the time—I’m not sure a child truly can understand such naked hatred and prejudice. But the healer was able to piercingly see into my soul and mobilize some emotions I had never been able to fully form before. When you grow up in a society that judges your every action by your skin color, you develop a deep sense of shame. You try to hide yourself. It made me feel like success would lead to being targeted and it was safer to hide. Even though I was valedictorian in school, captain of my sports team, a ballet dancer, and a pianist, it seemed like my accomplishments meant little, superseded by my skin color. My proud parents kept an album of my many award certificates, trophies, and medals, but to white South African society, I was of no consequence.
I slowly began to understand this same feeling was at the root of my current struggles with anxiety too. It was a humbling reminder of the complexity of the human mind. While those around me cheered on my book and my work, a painful hollowness lingered inside. But for the first time, it seemed as though I could bring that hollow feeling to the surface and make it whole. Sometimes it takes a bold person who leaps in and calls out a problem, bringing it to conscious attention.
Understanding and relieving myself of the burdens from my experience with cancer and my childhood trauma gave me the final tool to unlock my anxiety and metabolic struggles. The pressures of a successful book and the fears of living through a global pandemic both felt clearer and more possible to navigate with my new outlook. And finally, I was able to help my metabolism reset as I cleared the way to ease my anxiety. I was returned to my normal weight and once more felt that I could enjoy life without the looming specter of worry.
All of this is to say that I wrote this book out of concern and compassion for my patients and professional curiosity about an exciting and engaging field of science, but I also wrote it out of the pain of personal experience. I was seeing more anxiety every day in my clinical work, reading about it on the news, seeing more suicides being reported than ever before in my career. But I was living the struggle too. Mental well-being is for everyone; anxiety doesn’t discriminate, and it can affect any one of us. The ability to fight against anxiety should not be reserved only for those who have access to good health care. We need more accessible solutions that don’t require prescriptions and insurance. Food and nutrition are valuable tools that can get us many steps closer to relieving anxiety, alongside other treatments and breakthroughs. Eating is something every person must do every day. We cannot afford to neglect such a basic way to strive for good mental health.
If you are feeling anxious, you are not alone. In this book, we will learn how fundamentally anxiety is connected with your brain and body, and how you can harness the power at the end of your fork to calm your mind with food.