Change Your Diet, Change Your Mind

Dr. Georgia Ede

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The advice herein is not intended to replace the services of trained health
professionals, or be a substitute for medical advice. You are advised to
consult with your health care professional with regard to matters relating to
your health, and in particular regarding matters that may require diagnosis
or medical attention.

Copyright © 2024 by Georgia Ede

Cover design by Jim Datz

Cover photographs © Getty Images and Shutterstock
Cover copyright © 2024 by Hachette Book Group, Inc.

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Library of Congress Cataloging-in-Publication Data

Names: Ede, Georgia, author.

Title: Change your diet, change your mind : a powerful plan to improve
mood, overcome anxiety, and protect memory for a lifetime of optimal
mental health / Georgia Ede, MD.
Description: First edition. | New York : Balance, 2024. | Includes
bibliographical references and index.
Identifiers: LCCN 2023036570 | ISBN 9781538739075 (hardcover) | ISBN
9781538739099 (ebook)
Subjects: LCSH: Mental health—Nutritional aspects. | Nutrition—
Psychological aspects. | Mood (Psychology)—Nutritional aspects.
Classification: LCC RC455.4.N8 E34 2024 | DDC 616.85/270654—
dc23/eng/20230911
LC record available at https://lccn.loc.gov/2023036570

ISBNs: 9781538739075 (hardcover), 9781538739099 (ebook)

E3-20231208-JV-NF-ORI
 Contents

Cover
Title Page
Copyright
Dedication
Introduction

Part 1: Rethinking Brain Food

CHAPTER 1: What Causes Mental Health Problems?

CHAPTER 2: The New Science of Hope

CHAPTER 3: Why Most Nutrition Guidelines Are Wrong
CHAPTER 4: A Guided Tour through Your Brain
CHAPTER 5: The Magic of Brain Metabolism

Part 2: Our Descent into Dietary Madness

CHAPTER 6: The Perils of Processed Foods: Inflammation and Oxidative
Stress
CHAPTER 7: Metabolic Mayhem: The Invisible Hormonal Roller Coaster
CHAPTER 8: Insulin Resistance: Your Brain’s Silent Enemy
CHAPTER 9: The Promise of Ketogenic Diets for Mental Health

Part 3: The Whole Truth about Whole Foods

CHAPTER 10: Meat: The Original “Superfood”
CHAPTER 11: Eggs and Dairy: Nature’s Growth Formulas
CHAPTER 12: Grains, Beans, Nuts, and Seeds: Consumer Beware

CHAPTER 13: Fruits and Vegetables: Distinguishing Friend from Foe

CHAPTER 14: Superfoods, Supplements, and the Antioxidant Myth
CHAPTER 15: The Plant-Based Brain: Going Out on a Limb

Part 4: Hope Is on the Menu

CHAPTER 16: The Quiet Diet Approach
CHAPTER 17: Quiet Paleo

CHAPTER 18: Quiet Keto

CHAPTER 19: Quiet Carnivore
CHAPTER 20: You Can Do It! Practical Tips and FAQs

CHAPTER 21: Meal Plans and Recipes

Acknowledgments
Discover More
About the Author
Appendix A: Recommended Tests
Appendix B: Selected Resources
Appendix C: Essential Micronutrients and Brain Metabolism
Notes
 To my brilliant partner Suzi Smith for expertly
illustrating, co-researching, co-editing, and co-
miserating this book with me. Without your ability to help
me see the forest for the trees, this manuscript would
have been little more than a glorified list of molecules I
happen to find fascinating that nobody else cares about.

And to anyone out there who feels like they’ve tried

everything already: please don’t give up. If you’re willing
to try one more thing, hope is on the menu.
Explore book giveaways, sneak peeks, deals, and more.

Tap here to learn more.

 INTRODUCTION

On the night of December 23, 2019, a sudden attack of agitation jolted

Karl from a deep sleep.
“I felt like a deer in the headlights.”
Unable to shake the restlessness with his usual relaxation and breathing
techniques, he headed out into the night and walked… for eight miles… but
to no avail. “It was like a startle response that wouldn’t go away.” From that
night forward, these unsettling feelings would continue to come and go;
they’d leave him in peace for a day or two only to repeatedly revisit him for
as long as twenty-four hours, depriving him of sleep and compelling him to
walk up to twenty-five miles at a time with little to no relief.
In early February 2020, he sought help from his primary care doctor,
who told him his physical exam and blood tests were normal and
recommended a melatonin supplement for insomnia. Melatonin did help
with sleep, but the agitation simply waited until dawn to overtake him.
The situation had become unmanageable. Karl knew he had to do
something, but he was dead set against psychiatric medications. About
fifteen years earlier, he’d sought help for mood and attention issues from a
private specialty clinic where he underwent a psychiatric evaluation,
including sophisticated brain imaging. Thousands of dollars later, he
walked out with three psychiatric diagnoses and three prescriptions: Effexor
for depression, Klonopin for anxiety, and Adderall for ADHD. After
starting low dosages of these medications, he began to feel “super-human,
highly focused, and full of energy” and became uncharacteristically
arrogant and extroverted. Adding marijuana into the mix to cope with these
uncomfortable manic side effects only made the behaviors worse, and he
eventually found himself on the brink of divorce.
It was under those dire circumstances that a psychiatrist diagnosed him
with bipolar II disorder and urged him to take a mood stabilizer. He instead
decided to stop all three medications, joined Marijuana Anonymous, and
found another doctor who was willing to work with his wife to monitor his
behavior, agreeing to try a mood stabilizer if any signs of mania re-
emerged. From then on, Karl committed himself to a combination of
cognitive-behavioral techniques and cycling one hundred miles per week as
his “therapy and medication.” This plan was helpful in managing his mood
for more than a decade, but it proved no match for the agitation that struck
him that December.
Needing a new way forward, Karl turned to the internet and happened
upon low-carbohydrate dietary approaches to mental health conditions, so
he reached out to me in March 2020 for a nutritional psychiatry evaluation.
His whole life long, Karl had been eating a “standard American diet”
full of processed foods, which meant large quantities of refined
carbohydrates (sugar, flour, and processed cereals) and refined vegetable
oils, so there was plenty of room for improvement. In my mind, there were
several dietary strategies worth considering: a paleo diet of meat, seafood,
poultry, fruits, vegetables, nuts, and seeds; a whole-foods, low-carbohydrate
diet; or even a plant-free “carnivore” diet, which contains virtually no
carbohydrate at all. Karl chose the carnivore diet because he hoped it would
bring the fastest relief.
At that point, his score on the PHQ-9, a screening test for depression,
was 15 on a scale of 0 to 27 (with 27 being the most severe), and his score
on the GAD-7, a screening test for anxiety, was 17 on a scale of 0 to 21
(with 21 being most severe).

AN UNORTHODOX REMEDY
After thirty-nine days on his new diet, both his GAD-7 and PHQ-9 scores
had fallen to zero. He messaged me: “Just another awesome week without
any symptoms of anxiety, agitation, or depression. Nada, zilch, none…
yeah!! Overall, I am consistently feeling better than I have for my entire
life.”
Psychiatric medications rarely eliminate all symptoms and virtually
never produce the empowered joy evident in Karl’s words. After a lifetime
of eating a standard American diet, switching to a diet consisting entirely of
beef, pork, eggs, and cheese appeared to have completely reversed his
mood disorder. Ironically, the only problem he encountered was that despite
eating three to four pounds of fatty animal food per day, he couldn’t regain
the ten pounds he’d lost during that three-month period of agitation.
Therefore, to restore healthy weight, support athletic performance, and add
variety, I advised him to relax his diet to include about 100 grams per day
of carbohydrate from whole foods—which he did by adding in some plain
yogurt and root vegetables like potatoes. After remaining completely well
on this plan for over a year, he began broadening his diet to include a
greater diversity of whole foods, and for the past year, he has continued to
remain well so long as he avoids refined carbohydrates and processed foods
and keeps his carbohydrate intake low on days when he doesn’t exercise.
He is thriving on this simple diet, enjoys eating this way, and remains
symptom-free a full three years later.
Whether this remarkable story reflects the unique and irreproducible
experience of one man or holds larger lessons that may apply to others, it
certainly challenges and inspires us to ask new questions about psychiatry,
nutrition science, and the relationship between the two:

• Could some psychiatric illnesses be partly, largely, or even entirely

dietary in origin?
• What is it about the standard American diet that may be contributing
to poor mental health?
• How many people might be able to reduce, avoid, or eliminate the
need for psychiatric medications using dietary strategies?

THE ACCIDENTAL NUTRITIONIST

Having practiced psychiatry for more than twenty years, I know all too well
the shortcomings of medication-oriented care. Even well into the twenty-
first century, the practice of prescribing psychiatric medications continues
to be a frustrating trial-and-error process fraught with potential
complications. Unpredictable, confusing, and sometimes dangerous drug
reactions can occur, especially when more than one drug is started at a time,
when drugs overlap during transitions, when drugs are layered on top of
each other to manage side effects or address residual symptoms, or when
drugs are discontinued too quickly. While skilled, thoughtful use of
medications absolutely improves quality of life for some people and does
prevent some hospitalizations, injuries, and suicides, all too often this relief
of suffering comes at the expense of side effects such as drowsiness, sexual
dysfunction, weight gain, apathy, and high blood sugar.
We can and must do better, and I am convinced that modern nutritional
psychiatry is the way forward.
This conviction did not come naturally to me. If you had told me
twenty-five years ago that I would be practicing nutritional psychiatry I
would have looked at you as if you had three heads. I loved the “hard
sciences” of medicine like biochemistry, physiology, and pharmacology and
believed that the ability to prescribe medication was the hallmark of a “real
doctor.” I viewed the work of nutrition specialists and lifestyle-oriented
practitioners with great skepticism.
I would later come to understand that these arrogant attitudes were
rooted in sheer ignorance.
Nutrition courses were not required to earn my bachelor’s degree in
biology. In four years of medical school, we received only a few hours of
nutrition education, and in four years of psychiatric residency training,
nutrition wasn’t mentioned once. We were taught that the biological roots of
mental illness were due to imbalances in brain chemicals—
neurotransmitters such as serotonin and dopamine. I therefore emerged
from residency thinking of the brain largely as a bag of neurotransmitters
designed to be manipulated with medications, and off I went to the quaint
Cape Cod town of Woods Hole to prescribe.
Don’t get me wrong—I was fortunate to have also been taught strong
psychotherapy skills from some of the best psychiatrists in the field, so I
took thoughtful life histories, explored deeper issues that contribute to
emotional distress, and developed meaningful relationships with my
patients. During those early years on the Cape, I poured my heart and soul
into my work and learned invaluable lessons from the hundreds of people I
had the privilege of connecting with who came to me for help. As time went
by, however, it became painfully obvious that true healing and full recovery
were rare.
Looking around at respected colleagues and mentors, some of whom had
been in practice for decades, I noticed the same pattern: Everyone’s
practices were filling up with people who weren’t getting better. We met
with patients to provide support, write prescription refills, and try to instill
hope, but most of us had quietly come to view mental illnesses as chronic,
mysterious, and incurable.
It had never crossed my mind that food might be important to mental
health. Like many women, I viewed my own food choices simply as a
means of weight control. I ate a low-fat, high-fiber diet largely comprised of
skinless chicken breast, fish, vegetables, whole grain cereals, soy milk,
hummus, fat-free yogurt, and Diet Coke. I counted calories and exercised
religiously. Then, in my early forties, I developed a variety of perplexing
new symptoms, including migraines, fatigue, bloating, body aches, and
stomach pain. Multiple specialists found nothing wrong, and sophisticated
test results were all normal. None of the doctors asked me what I ate, so I
left their offices with generic printouts advising me to follow the same low-
fat, high-fiber diet I was already eating.
Unwilling to accept these symptoms as my new normal, I started
instinctively experimenting with my diet. I began a food and symptom
journal and looked for patterns. After about six months of trial-and-error
changes, to my complete surprise, I arrived at a highly unorthodox, mostly
meat diet, feeling better than I had ever felt in my life. Not only had the
pain and fatigue disappeared, but my mood, concentration, and productivity
had improved as well. I’d never thought of myself as having much
difficulty in these areas, but there was no question that this unconventional
way of eating was good for my brain.
As a psychiatrist, I became intensely curious about the relationship
between food and brain health and began to wonder whether dietary
changes might help some of my patients. As a middle-aged woman, I
became concerned that my strange new mostly-meat diet was going to kill
me. Since the diet that restored my health was high in animal protein and
animal fat, and contained only small amounts of the few plant foods that
didn’t seem to bother me, my head was full of new questions. Will I get
cancer if I don’t eat enough vegetables or fiber? Are some fruits and
vegetables more important than others, or do I need to eat a wide variety for
best results? Which ingredients within red meat make it more dangerous
than white meat? How do cholesterol and saturated fat damage the heart—
and do they damage the brain as well?
I needed to get to the bottom of these questions, so I started studying
nutrition. In addition to completing a graduate course in human nutrition at
the Harvard School of Public Health, I combed the Harvard library database
for primary research studies, devouring articles not just about nutrition
topics like nutrients, digestion, and metabolism, but also about botany,
anthropology, toxicology, animal husbandry, and agriculture. What I
discovered was that nearly everything I thought I’d known about nutrition
was wrong.

RETHINKING BRAIN FOOD

I was genuinely shocked to learn that there is absolutely no science (or
logic) behind recommendations to eat plant-based diets, balanced diets,
high-fiber diets, low-cholesterol diets, or diets containing whole grains,
low-fat dairy products, or rainbows of fruits and vegetables. At best, these
ideas represent well-intentioned guesses based on deeply flawed,
unscientific food questionnaires; at worst, they are intentional distortions of
the facts designed to protect professional reputations or serve political and
commercial agendas, not to protect and serve public health.
The truth about nutrition is this: Meat is not dangerous, vegan diets are
not healthier, and antioxidants are not the answer. So, where can we look
for answers?
The good news is that hiding underneath that mountain of biased,
confusing guesswork are clear, elegant, compelling scientific principles
about nutrition that make intuitive sense, work in clinical practice, and
stand the test of time. Do we know everything we wish we knew? No. Do
we know more than enough for you to substantially improve your brain
health starting today? Absolutely.
Most of us have been feeding our brains improperly our entire lives,
therefore we have no idea how much better we can feel and how much
more we can expect of ourselves if we eat right.
Most books about nutrition and mental health ask you to pin your hopes
on plant superfoods (which do not work) and supplements (which often
profit the author), often without showing you how to improve the overall
nutritional quality of your diet from the ground up in ways that will
minimize your need for supplements. These books often also recommend
Mediterranean diets or plant-based diets for optimal brain health without
explaining the very real risks of these dietary strategies. It saddens me to
see so many people working so hard to make good food choices, not
realizing those choices are based on bad information—information that can
damage the brain over time and increase risk for serious problems with
mood and memory. By focusing on the right whole foods, customizing your
carbohydrate intake to suit your metabolic needs, and eliminating common
food sensitivity culprits, you can greatly improve not only your mental
health, but your whole health.
I believe that many of the emotional and cognitive issues we have come
to expect as normal, genetic, or permanent can be prevented, eased, or even
reversed with good nutrition. If you don’t want to take medication, don’t
respond to medication, can’t tolerate medication, or can’t access
medication, there are innovative dietary strategies you probably haven’t
tried yet that can help medication work better, counteract certain medication
side effects (such as weight gain), or in some cases reduce or even eliminate
the need for psychiatric medication.
My goal in writing this book was to take the confusion out of nutrition
and replace it with science, simplicity, and common sense; to teach you
how to think for yourself about food so you can make your own informed
choices and find what works best for you and your family.

A NEW WAY FORWARD

This book is divided into four parts.
In part 1, I’ll show you how sloppy, unscientific research methods have
led to flip-flopping headlines, illogical guidelines, and public confusion
about what we’re supposed to eat. The problem is that most brain food
researchers study nutrition from the outside in, by questioning people about
their eating habits and then trying to guess how their food choices might be
affecting their mental health. This flawed approach is why some of us
dutifully top our morning oatmeal with blueberries, choose plant-based
patties over hamburgers, or wash handfuls of supplements down with kale
smoothies. We’re told that these habits will protect our brains, but not only
are these strategies very unlikely to help, they can even work against us. In
this book, we will look at nutrition from the inside out by discovering what
the brain needs to function at its best and then using that list of ingredients
to redefine what a brain-healthy diet should look like.
In part 2, we’ll explore the dietary roots of our global mental health
crisis. You’ll see exactly how our modern ultraprocessed diet contributes to
brain inflammation, hormonal imbalances, neurotransmitter imbalances,
emotional instability, depression, and dementia—and how focusing on the
right whole foods and customizing your carbohydrate intake can restore
internal harmony and reveal your best self. For those of you who need more
relief, there is an entire chapter dedicated to the promise of ketogenic diets
for psychiatric disorders.
In part 3, I take you on a guided tour of the fascinating world of food.
We’ll weigh the risks and benefits of different foods groups, learn how they
affect the brain, and sort out which ones are essential and which ones are
optional so you can make informed choices about what to eat. I’ll introduce
you to some of the devilishly clever natural chemicals lurking within grains,
legumes, nightshades, and certain other plant foods that can work against
optimal brain nutrition and function, but I will also help you identify kinder,
gentler plant foods so you can find the mix that works best for you.
In part 4, I boil down all of the information laid out in previous sections
into three dietary strategies—all of which can be customized to your food
preferences, health circumstances, and personal goals. Since changing how
we eat is hard, you’ll find meal plans and recipes for each one, along with
plenty of tips and tools to support your success. I am nutritionally pro-
choice and want everyone to have a seat at the table, so regardless of your
dietary preferences, you will find the information you need to optimize your
diet for better mental health.
My hope is that this book will ignite your curiosity about food and the
brain, empower you and your family to live happier, healthier lives, and
bring you peace of mind.
 PART 1

RETHINKING BRAIN FOOD

 CHAPTER 1

What Causes Mental Health Problems?

Every solution to every problem is simple. It’s the distance between

the two where the mystery lies.
—Derek Landy, Skulduggery Pleasant

We are in the midst of a global mental health crisis.

Nearly one billion people are living with a mental health disorder,1
including one in five of the world’s children and adolescents.2 Every year,
700,000 people take their own lives, and suicide is now the second leading
cause of death among people in their teens and twenties. Depression and
anxiety alone cost the global economy nearly three billion dollars a day.3
And these numbers don’t include the countless people with milder mental
health concerns like brain fog, irritability, and joylessness. Psychiatric
problems of all kinds are becoming so commonplace that we are beginning
to think of poor mental health as normal and inevitable.
Between 2007 and 2018, while I was serving as a psychiatrist at Harvard
University and then at Smith College, my seasoned colleagues and I
observed a most disturbing trend: It was becoming increasingly common
for first-year students to arrive on campus already taking one, two, or even
three psychiatric medications. Requests for specialized support for learning
and emotional disabilities were rising so fast that it was difficult to
accommodate everyone’s needs. More and more students were showing up
at campus mental health clinics in crisis, requiring emergency psychiatric
hospitalizations, leaves of absence, or academic withdrawals. The sense
among clinicians on the front lines is that the mental health of our young
people is increasingly brittle, and research supports our observations.
According to a 2018 American College Health Association report, more
than 40 percent of students “felt so depressed they had difficulty
functioning,” and more than 60 percent had experienced “overwhelming
anxiety.”4 A 2018 study conducted by the American Association for
Suicidology observed a nearly tenfold increase in non-suicidal self-injury
among first-year college students over only a seven-year period.5 In the
UK, declarations of existing mental health problems among university
students have risen by a staggering 450 percent in just the past decade.6
Crumbling mental health isn’t just a problem among young people on
college campuses. Ohio State University Professor Hui Zheng conducted a
study across nine generations, from the Greatest Generation (born between
1900 and 1924) to Generation Y (born between 1981 and 1999), and
observed that both the mental and physical health of all generations born
since the 1950s has been declining across all sex and racial groups.7
If you are a fellow mental health professional, you don’t need statistics
to tell you how challenging things have become. Everywhere I’ve worked
—clinics, hospitals, universities—I’ve encountered the same issues:
Practitioners overwhelmed by large, complex caseloads, and patients
frustrated with wait times that are too long for appointments that are too
short. Administrators try to ease the burden by hiring more staff, offering
group appointments, and training peer counselors, but there never seems to
be enough time or resources to meet the growing needs of the people we are
trying to serve. It’s like trying to fight a wildfire one teaspoon of water at a
time. Meanwhile, everyone is working so hard that there’s no time to stop
and ask: Why is our mental health deteriorating? Is there anything we can
do about it, or do we simply accept it as inevitable?
If we are to have any hope of reversing this tragic trend, we need a
better understanding of the root causes of psychiatric disorders.

IN SEARCH OF UNDERSTANDING
The brain is our most mysterious organ. Sequestered deep within the skull
and possessing no nerve endings, we can’t see it, touch it, or feel it working,
so questions about what causes mental illness and unwellness have baffled
us for millennia. Some ancient civilizations believed that those suffering
from mental illness were possessed by demons or being punished by God
for their sins, calling for spiritual treatments such as exorcism and prayer. In
the Middle Ages, psychiatric symptoms were blamed on a buildup of vile
bodily fluids that needed to be relieved with leeches or laxatives.8
By the mid-1900s, these beliefs had given way to theories about the root
causes of mental illness that continue to dominate our thinking today:
stress, childhood trauma, chemical imbalances… and, of course, your
mother.
These theories have their merits but are ultimately unsatisfying.

The Stress Factor

In the early 1800s, it was thought that people with mental illness had
inherited incurable weaknesses that left them unable to adapt to the
mounting stresses of a rapidly industrializing society. As prominent British
psychiatrist Dr. Henry Maudsley wrote in 1867, “an increase of insanity is a
penalty which an increase of our present civilization necessarily pays.”9 As
a result, most nineteenth-century psychiatrists served largely as stewards of
asylums, where people could be sheltered from the daily pressures of
modern living. Without effective treatments, residents in their care were not
expected to improve and lived out their lives on the grounds of psychiatric
hospitals.
Could the pressures of today’s lifestyle—social media, injustices related
to race and gender identity, growing economic inequality, and gun violence,
to name a few—help explain the decline in mental health we are currently
experiencing? Perhaps, but are the stresses of our time really more
challenging than those of Maudsley’s era? One could argue that the world
has always been a stressful place. And just as industrialization,
globalization, and information technology pose new challenges that make
some aspects of our lives more stressful, they also bring new conveniences
that make other aspects of our lives such as transportation and
communication less stressful. Stress certainly can contribute to poor mental
health, but stressful obstacles are part and parcel of daily life. The question
is: Why do some of us embrace new challenges while others struggle to
face them?

The Mind-Brain Divide

Most nineteenth-century psychiatrists appeared to have little interest in
brain biology, so it would be neurologists who would first explore this new
scientific frontier. Locked away in their chambers of bone, the brains of the
living defied direct examination, so neurologists of the 1800s focused their
microscopes instead on the brains of the departed. By studying specimens
from individuals with speech impediments and other obvious neurological
conditions, early neurologists learned enough about brain anatomy in only a
couple of short decades to begin creating a map of its functions. However,
when they inspected the brains of former asylum residents, they couldn’t
identify any structural abnormalities—these brains looked completely
normal.10
Psychiatrists would therefore enter the twentieth century trying to
understand the mind rather than the brain, relying on their powers of
observation and imagination to diagnose and treat mental illnesses. It was
during this period that Austrian neurologist Dr. Sigmund Freud developed
his influential theory that psychiatric suffering arose from repressed
fantasies and traumatic early childhood experiences buried deep in the
unconscious that could be unearthed through psychoanalysis, founding a
branch of psychiatry that continues to thrive to this day. I value modern talk
therapy and have been incorporating it into my clinical work for more than
twenty years, but I have yet to see psychotherapy alone put any case of
serious mental illness into remission.

The Psychiatric Medication Revolution

The biological branch of psychiatry didn’t emerge in earnest until the 1930s
and 1940s, with the accidental discovery of a number of experimental
treatments for schizophrenia and other serious mental illnesses. These
strange and horrific new interventions, which included insulin coma
therapy, the lobotomy, and a primitive, crude form of ECT
(electroconvulsive therapy), did help some people, but injured (and
sometimes killed) many more, causing all of these methods to eventually
fall out of use. These desperate tactics are just a few of the many inhumane
skeletons in psychiatry’s closet, so when psychiatric medications burst onto
the scene in the mid-twentieth century,11 they were welcomed with open
arms.
These early drugs included lithium—a long-forgotten mineral with
mood-stabilizing properties12—and chlorpromazine, the first antipsychotic
medication. Originally developed in France in 1952 to calm patients before
surgery, chlorpromazine (marketed under the brand name Thorazine)
proved useful in reducing agitation, delusional thinking, and hallucinations
in some individuals with schizophrenia.
Psychiatrists accustomed to relying on physical restraints and other
undignified methods of keeping people safe and calm experienced
chlorpromazine as nothing short of revolutionary. As Dr. Robert Cancro,
then chair of psychiatry at the New York University School of Medicine,
reflected in 2000: “It is difficult to communicate to younger colleagues the
miracle that 150 to 300 mg of chlorpromazine a day appeared to be to the
house officers [psychiatry residents] of 1956.… Finally, we were like other
doctors in that we had a treatment that actually worked. It was truly an
intoxicating time.”13
Researchers believed that chlorpromazine worked by blocking the
activity of dopamine—a neurotransmitter that brain cells use to
communicate with each other. The novel idea that emotional and behavioral
problems could be caused by chemical imbalances in dopamine, serotonin,
and other neurotransmitters captured the imaginations of clinicians and the
general public alike. This exciting new neurotransmitter theory of mental
illness pulled psychiatry out of the dark ages and into the modern medical
age. Over the ensuing decade, a firehose of pharmaceuticals would be
aimed at everything from major mental illnesses to the minor stresses of
everyday life. These innovative chemicals included clozapine (Clozaril) for
psychosis, imipramine (Tofranil) for depression, methylphenidate (Ritalin)
for hyperactivity, diazepam (Valium) for anxiety, and meprobamate
(Miltown) for nervousness. Although rarely prescribed today, meprobamate
was a trailblazing tranquilizer that first normalized the practice of taking
pills to ease minor psychological discomfort. As Dr. Jerome Groopman
wrote in The New Yorker, “Approved in 1955, meprobamate (marketed as
Miltown and Equanil) was hailed as a ‘peace pill’ and an ‘emotional
aspirin.’ Within a year, it was the best-selling drug in America, and by the
close of the fifties one in every three prescriptions written in the United
States was for meprobamate.”14
Those pioneering drugs of the 1950s and 1960s are all still around. In
fact, although many new drugs have been developed since then, none of
them work in truly new ways; they are all just safer or reimagined versions
of the originals.15 Even cutting-edge treatments like transcranial magnetic
stimulation (TMS) and psychedelic-assisted therapies, such as ketamine and
psilocybin treatments, target neurotransmitter imbalances in the brain.

Strengths and Weaknesses of Standard Psychiatric Care

Since the 1950s, the neurotransmitter theory of mental illness has
dominated the landscape of biologically minded psychiatrists, whereas the
stress and trauma theories have continued to prevail among psychosocially
minded psychiatrists, but all psychiatrists are trained to take all of these
theories into consideration. We are taught that it is your unique stew of
biological, psychological, and social ingredients that produces your
thoughts, emotions, and behaviors, and it is this biopsychosocial model of
the origins of mental illness that we have in mind when we meet with you
for the first time to conduct a one-hour standard psychiatric evaluation. In
addition to asking about your symptoms, we also ask about your family
history, medical history, relationships, worldview, and your work and home
environment, to create a three-dimensional impression of your life that puts
your symptoms into context.
To make a formal psychiatric diagnosis (which insurance companies
require), we turn to a 1,000-plus-page reference book called the DSM
(Diagnostic and Statistical Manual of Mental Disorders) to see if your
symptoms match any of the hundreds of diagnoses it contains. Even if you
happen to fit neatly into any of its official diagnostic boxes, the DSM offers
no guidance about how we should treat your symptoms, let alone any
biological clarity about what might be causing them.
In the absence of clear treatment guidelines, we use the information
gathered during your interview to formulate a biopsychosocial theory of
your case—essentially, an educated guess about what might be causing your
symptoms. We use this to develop your personalized treatment plan, which
often includes medication (to address chemical imbalances) and some form
of counseling, such as psychotherapy (to process stressful life experiences)
or cognitive-behavioral therapy (to change negative thought and behavior
patterns).
A real strength of the biopsychosocial model is that it values your
human story—a story that psychiatrists believe plays a major role in your
emotional and physical well-being, and that medical professionals in other
fields may not have time to explore. Most psychiatrists I know, myself
included, truly enjoy this aspect of the work. We love paying quality
attention to all the little details and nuances of your history, piecing them
together, and sharing impressions that we hope you will find helpful. Most
people who come to us for help also enjoy the process and find therapeutic
value in being seen, heard, and understood on a level that goes beyond
symptom lists and diagnostic tests. These precious intangibles of the
biopsychosocial model are what set psychiatry apart from other branches of
medicine and make it such a rich and rewarding profession. However, a
serious shortcoming of this approach is that our current diagnostic
framework lacks the biological specificity we need to be confident in the
medical elements of our assessments and treatments. The main difference
between psychiatrists and other mental health professionals is that
psychiatrists are medical doctors, and therefore we are uniquely qualified to
assess and treat the “bio” elements of your biopsychosocial story—the
biology behind your symptoms—yet this is the piece we understand the
least.
We are taught that some people are born with differences in genes and
neurotransmitters that make them more susceptible to depression,
psychosis, or severe anxiety—particularly when under extreme stress or
after suffering a traumatic life experience. Yet, even as we enter the second
quarter of the twenty-first century, we still have no telltale genetic tests to
offer you and no reliable way to measure your brain’s neurotransmitter
activity. The brain has a separate circulatory system, so we can’t evaluate its
biochemistry by drawing blood from your arm and running simple
laboratory tests. These obstacles to understanding the inner workings of
your brain leave us little choice but to resort to guesswork when making
medication recommendations. In comparison to other fields of medicine,
the practice of psychiatry still feels like more of an art than a science; we
can’t tell you what is causing your symptoms, so we can’t tell you which
medication is most likely to help.
Another challenge we face is that psychiatric medications don’t work as
well as we’d like. The best studies available find that approximately 50
percent of people with depression benefit from standard antidepressants—
which sounds good, until you learn that approximately 40 percent of people
improve with placebo alone.16 Furthermore, the degree of improvement is
minuscule (on average, an increase of a mere two points on a fifty-two-
point depression symptom scale), and more than half of clinical trials find
no benefit at all.17
Medications prescribed for bipolar disorder and schizophrenia perform
better, but still leave too many without meaningful relief. One-quarter of
people with serious mental illness benefit from antipsychotic medications,
which is about twice as many as improve with placebo alone.18
Approximately one-third of people with bipolar disorder respond to mood
stabilizers,19 but nearly half of those who initially experience relief from
medication-supported interventions continue to experience recurrent mood
episodes despite continuing treatment.20 Why are so many people
“treatment-resistant”? Are they failing treatment, or is treatment failing
them?
The fact that medications let so many people down tells us that
neurotransmitter imbalances represent only one small piece of the
biological puzzle. We must be missing something, because seventy-plus
years of sophisticated pharmaceuticals engineered specifically to target
neurotransmitter imbalances have clearly failed to stem the tide of our
growing global mental health crisis.
There are times when psychiatric medication can be life-changing and
even lifesaving. If you are in crisis, the right medication could help you
hold on to your job, stabilize a fragile relationship, stay in school, keep you
out of the hospital, or even prevent you from taking your own life.
Unfortunately, the price you pay for these benefits may include side effects
that reduce your quality of life, such as drowsiness, sexual dysfunction, or
dulled emotions; and side effects that reduce your length of life such as
obesity, cardiovascular disease, and type 2 diabetes.
It’s not that there is no truth whatsoever to the neurotransmitter theory of
mental illness; neurotransmitters play important roles in our mood, memory,
and concentration circuits. The question is: What causes neurotransmitters
to become unbalanced in the first place?
To improve the safety and effectiveness of our treatments, we need to
better understand what is happening inside the brains of people with mental
illness. We now have sophisticated modern imaging techniques that use
magnets or radiation to peer inside the brain and observe its chemistry in
action, but these are complicated, expensive, and invasive tests not
available to most people, and we are only beginning to understand how to
interpret their findings. Fortunately, while we await further advances in
neuroscience research to help us get better at zooming in on the brain’s
inner workings, there is much we can learn by zooming out and reminding
ourselves that the brain is part of the body.

As Goes the Body, So Goes the Brain

Just as our mental health has been spiraling downward in recent decades,
so, too, has our physical health.
In the United States, cases of heart disease nearly doubled between 1990
and 2019,21 and the percentage of Americans with obesity has nearly tripled
since the 1960s.22 Globally, the percentage of adults with type 2 diabetes
doubled between 1980 and 2016, and body weight has been steadily rising;
between 1975 and 2015, obesity rates worldwide more than doubled among
women and more than tripled among men.23 People with obesity, type 2
diabetes, and cardiovascular disease are also far more likely to have
psychiatric disorders like depression, bipolar disorder, and schizophrenia,
and this is no coincidence.
While all of these physical and mental health conditions may seem
unrelated to each other, they commonly occur together and share many of
the same underlying abnormalities, the most important being inflammation,
oxidative stress, and insulin resistance.24
Inflammation and oxidative stress are part of your immune system’s first
responder network, so it is normal and healthy to have a certain degree of
both, but excessive inflammation and oxidative stress can be very damaging
to every cell in the body—and brain cells are no exception.
Insulin resistance (which is often called “prediabetes”) is a common
metabolic disorder in which insulin doesn’t work as well as it should. If you
have insulin resistance, your body will need to produce more than the usual
amount of insulin to try to keep your blood sugar (and brain sugar) levels
stable and in a healthy range, so your insulin levels will tend to run too
high. Over time, high insulin levels can make it more difficult for your
brain to turn glucose (blood sugar) into energy.
It just so happens that our industrially ultraprocessed diet is a powerful
promoter of inflammation, oxidative stress, and insulin resistance—all of
which are just as dangerous for the brain as they are for the rest of the body.
In the long search for biological root causes of mental illness—a search that
has been focused almost exclusively on neurotransmitters for nearly
seventy-five years—inflammation, oxidative stress, and insulin resistance
have emerged as an unholy trinity of destructive forces that help to explain
why those neurotransmitter imbalances occur.
We readily accept that diet plays a major role in the health of the rest of
the body—why should the brain be any different? The foods we eat provide
the construction materials we need to build healthy, resilient brain cells and
the fuel we need to energize them. If we don’t eat the right foods, none of
our cells will develop or function properly, and any number of things can
and will go wrong—including many things no medication can address.
Medications can and do change brain chemistry, and they have their
place, but I’m convinced that the most powerful way to change brain
chemistry is through food, because that’s where brain chemicals come from
in the first place. Neurotransmitters are made from food, the brain cells that
pass them back and forth to communicate with each other are made from
food, and even the salty soup that surrounds them is made from food.
Optimal mental health requires that your whole brain be made of the right
stuff, so if you have a mental (or physical) health problem of any kind, the
first place to look isn’t your medicine cabinet, it’s your pantry. This advice
holds true whether you view mental health conditions as primarily
biologically driven or psychosocially driven, because, as we’ll see in the
coming chapters, the way we eat has a profound impact on brain
development, neurotransmitters, stress hormones, inflammation, antioxidant
capacity, brain energy production, brain aging, and brain healing.
There is only so much you can do to reduce your exposure to stress, and
nothing you can do to change the genes you were born with or the
childhood you experienced, but you can change your diet—and changing
your diet can change your mind.
 CHAPTER 2

The New Science of Hope

People are fed by the food industry, which pays no attention to

health, and are healed by the health industry, which pays no attention
to food.
—Wendell Berry, Sex, Economy, Freedom, & Community

Our diet has undergone radical changes in the past century. Born in 1910
and raised in a rural New England farm town, my grandmother ate two soft-
boiled eggs and buttered toast every morning for breakfast, ground her own
hamburger with a medieval-looking device she clamped to the kitchen
counter, and kept an old coffee can full of bacon fat by the stove for
cooking. By the time she passed away in 1993, all three of these foods were
falling out of favor with the American public and had been officially
condemned as dangerously unhealthy. The first U.S. Dietary Guidelines,
released in 1980, warned that saturated fat and cholesterol caused obesity
and heart attacks, so they advised Americans to “moderate your use of
eggs,” “limit your intake of butter,” and “trim excess fat off meats.”1
Food manufacturers sought to capitalize on these new food rules by
flooding the market with fat-free sweets and cholesterol-free fats like corn
oil, canola oil, and margarine.2 By blaming modern health epidemics such
as obesity, type 2 diabetes, and heart disease on saturated fat and
cholesterol, the U.S. Dietary Guidelines drove us away from nutritious
whole foods like meat and eggs and right into the arms of the ultraprocessed
food industry. Like a perfect storm, the powerful forces of food
industrialization, growing anti-meat sentiment, and fat and cholesterol
phobia collided and have been feeding on each other for the past fifty years,
dramatically transforming our nutritional way of life. Since most other
nations pattern their food guidelines after the U.S. guidelines, this shift
away from animal fats and toward refined carbohydrates and vegetable oils
meant that the whole world was about to take part in a grand nutrition
science experiment—with devastating consequences.
Characterized by an abundance of calorie-dense, nutrient-poor foods and
beverages,3 the so-called standard American diet (I’ll take the liberty of
referring to this as the “SAD diet” going forward), isn’t just an American
problem anymore—this modern atrocity has been exported to all four
corners of the Earth, endangering the physical and mental health of people
everywhere.
Unfortunately, we don’t have much concrete information about the
mental health of people prior to the modernization of our diet, but what
little we do have suggests that our mental health was more robust in the past
than it is today.
Industrial globalization has made it difficult to locate people in this
century who eat entirely off the land, but in the middle of the last century,
there were still pockets of dietary sanity to be found. In a 2003 paper titled
“Nutrition and Schizophrenia,” University of Sheffield psychiatrist Dr.
Malcolm Peet highlighted interesting studies from Taiwan, Tonga, Trinidad,
Papua New Guinea, Malawi, and Australia’s Gold Coast, all of which
suggested that schizophrenia was far less common in people who fed
themselves by hunting, fishing, and subsistence farming.4 As Dr. Peet
wrote: “It is remarkable that studies of truly indigenous populations are
virtually unanimous in reporting very low rates of schizophrenia.”5 For
example, signs of schizophrenia were exceedingly rare among non-
Westernized Pacific Islanders in the 1950s. Of 60,500 inhabitants examined,
researchers identified only two individuals with psychotic behavior (0.003
percent), whereas the prevalence of psychosis among Europeans of the
same time period was sixty-seven times higher (0.2 percent).6
Of course, food isn’t the only difference between modern Western ways
of life and the lifestyles of these Indigenous groups, and observations of this
nature don’t represent hard evidence of a connection between modern diets
and our mental health crisis; unfortunately, that level of evidence doesn’t
exist. It is simply food for thought: Perhaps serious mental illnesses don’t
need to be as common as they have become.
NUTRITIONAL PSYCHIATRY AND THE
MEDITERRANEAN DIET: A BETTER WAY FORWARD?
The relatively new specialty of nutritional psychiatry was established on
the belief that the deterioration in the quality of our diet is largely to blame
for the deterioration in our mental health.
For the prevention and treatment of depression and other mental health
conditions, most thought leaders within this budding field recommend
changing from the SAD diet to the Mediterranean diet. Although vaguely
and inconsistently defined, the Mediterranean diet has recently been
described as being:

• high in whole grains, vegetables, fruit, nuts, legumes, and olive oil
• moderate in seafood, poultry, eggs, low-fat dairy, and red wine
• low in sweets, red meat, and processed meats7

The story of how the Mediterranean dietary pattern and its familiar
“whole grains good, animal fats bad” philosophy became implanted in our
collective psyche is told masterfully by investigative journalist Nina
Teicholz in The Big Fat Surprise.8
Part wishful thinking, part wild guess, the Mediterranean dietary pattern
essentially began as a romantic theory about what we should eat, inspired
by cherry-picked aspects of cherry-picked Mediterranean traditions, and
propped up by unscientific studies conducted in the 1950s and 1960s by Dr.
Ancel Keys, a University of Minnesota researcher who believed that
saturated fat caused heart disease. (We will see what makes studies like his
unscientific in chapter 3.)
The creators of the Mediterranean diet didn’t start with a thoughtful
examination of the nutritional risks and benefits of individual foods, use
that information to design a dietary pattern, and then test that pattern in
human clinical trials to see if it improved health. Instead, they observed that
people living in countries along the north shore of the Mediterranean Sea
generally seemed to be healthier than Americans, assumed that some of the
differences in the way they ate must be responsible for their superior health,
and then designed a dietary pattern that they thought represented the
healthiest aspects of those culinary traditions. Among the important
revelations in Teicholz’s book is that Professor Walter Willett (a prominent
nutrition researcher who was chairman of the Harvard School of Public
Health at the time) prematurely declared the Mediterranean diet to be a
healthy eating pattern in 1993—seven years before the diet would first be
tested in human clinical trials.9
The Mediterranean diet has since been extensively tested in dozens of
human clinical trials for physical health conditions such as obesity,
cardiovascular disease, and type 2 diabetes, and has consistently
outperformed the SAD diet, earning the trust of the medical community and
nutrition policymakers alike. As for mental health conditions, although
studies testing the Mediterranean diet’s potential to prevent or treat memory
and cognitive health issues have produced mixed results,10 three clinical
studies have now demonstrated that switching from a poor-quality SAD diet
to the Mediterranean diet can improve symptoms of clinical depression
when added to standard psychiatric treatment (medication and/or
psychotherapy).11 The science is clear: The Mediterranean diet is healthier
than the SAD diet, so if you currently eat a SAD diet, switching to the
Mediterranean diet would be a solid step in the right direction.
What makes the Mediterranean diet healthier than the SAD diet? Is it the
nuts? The olive oil? The red wine? We really don’t know. Those who
advocate for the Mediterranean diet speculate that it is superior to the SAD
diet because it is lower in saturated fat, trans fats, and added sugars; richer
in essential nutrients; higher in fiber; and chock full of colorful fruits and
vegetables brimming with phytonutrients—naturally occurring plant
chemicals believed to have unique anti-inflammatory and antioxidant
properties.12 However, there are so many differences between these two
dietary patterns that there is no easy way to determine which aspects of the
Mediterranean diet are responsible for its health benefits.
Almost any change you make to the modern atrocity that is the SAD diet
is bound to make it healthier. In other words, just because emerging
evidence supports the idea that the Mediterranean diet is better for the brain
than the SAD diet doesn’t necessarily mean that it is the best diet for the
brain—and there are good reasons to suspect that it is not. A few examples:
 • The grains and legumes that form the foundation of the Mediterranean
diet are nutrient-poor themselves, and even contain antinutrients that
interfere with our ability to access certain essential minerals.
• The Mediterranean diet frowns on some sources of refined
carbohydrate such as sweets, while celebrating others, such as bread
and pasta.
• The Mediterranean diet encourages the consumption of alcohol.

But the Mediterranean diet’s biggest blind spot is that it pays far too
little attention to metabolic health. In other words, it contains too much
carbohydrate for people with insulin resistance to safely process, resulting
in higher insulin levels that can damage brain metabolism over time. The
word “metabolism” refers to the complicated collection of chemical
reactions our cells use to turn food into energy. Since the brain is an energy
hog, if its metabolic machinery can’t generate enough power to meet its
needs, it can and will malfunction.

Metabolic Health Is the Missing Link

After decades of standing still, the field of psychiatry is taking a quantum
leap forward. A revolutionary new way to think about mental health is
changing the way scientists study mental illness, transforming the way
psychiatric professionals approach clinical care, and empowering
individuals and families to improve their mood, concentration, and memory
—often reducing or even eliminating the need for psychiatric medication.
The breakthrough realization of our time is that robust metabolic health is
essential to robust mental health.
Within only the past five years or so, an exciting new subspecialty of
psychiatry has emerged called metabolic psychiatry. This term was coined
by Stanford University psychiatrist Dr. Shebani Sethi, who defines it as “a
new subspecialty focused on targeting and treating metabolic dysfunction to
improve mental health outcomes.”13
Investigators in this field are discovering that what many psychiatric
conditions have in common is that the brain has trouble burning glucose for
energy. One of the most important obstacles to brain energy flow is insulin
resistance, a serious metabolic disorder that is reaching epidemic
proportions in many places around the world. Diets too high in refined
carbohydrates like sugar, flour, fruit juice, and cereal products promote the
persistently high insulin levels that lead to insulin resistance. Therefore, as
counterintuitive as it sounds, the more sugar your diet contains, the harder it
becomes for your brain to use it.
High blood glucose and insulin levels are a deadly one-two punch for
the brain. Repeatedly flooding the brain with too much glucose triggers
unrelenting waves of inflammation and oxidative stress, damaging your
brain’s delicate architecture and overwhelming its mitochondria—the tiny
engines inside your cells that work tirelessly to turn glucose into energy.
Repeatedly bombarding the brain with too much insulin can lead to insulin
resistance, which makes it increasingly difficult for insulin to enter the brain
where it is needed to help turn that glucose into energy. The high-glucose,
low-insulin brain struggles to generate the power it needs for peak
performance, resulting in a slowly mounting brain energy crisis.
The empowering news is that you can control your glucose and insulin
levels yourself—and rather quickly, too—simply by changing what you eat.

The Ketogenic Diet Is Powerful Metabolic Medicine

Reimagining mental health disorders as metabolic disorders has opened the
door to exciting new treatment approaches, the most powerful of which is
the ketogenic diet.
Ketogenic diets are very-low-carbohydrate, moderate-protein, high-fat
diets that stimulate your body’s ability to burn fat—and to turn some of that
fat into ketones, which your brain can burn for energy. For brains that have
lost some of their ability to use glucose properly, ketones are a godsend,
because they help bridge the energy gap created by brain glucose
processing problems.
Some people think of the ketogenic diet as a weight loss diet—and yes,
it can help you burn excess body fat. Some people think of the ketogenic
diet as a diet for type 2 diabetes—and yes, it is a very effective way to treat
type 2 diabetes because it reliably lowers blood glucose levels, reduces or
eliminates the need for diabetes medications, and can even put type 2
diabetes into sustained remission.14 But did you know that the original
intended purpose of the ketogenic diet was to stabilize brain chemistry?
In 1921, long before anticonvulsant medications were available, the
ketogenic diet was invented to treat children with epilepsy. More than a
dozen quality clinical trials have since demonstrated that ketogenic diets are
safe and effective in both children and adults with epilepsy, cutting seizure
activity by more than half in more than 50 percent of cases, and completely
eliminating seizures in 10 percent or more.15 The ketogenic diet has shown
promise in many other neurological conditions as well, including multiple
sclerosis, Parkinson’s disease, and migraine headaches.16 This strong
evidence base in neurology is good news for psychiatry, because, as I see it,
the line between neurology and psychiatry is imaginary. The brain isn’t
divided into neurology cells and psychiatry cells—it is one organ. It stands
to reason that if a particular treatment benefits neurological brain disorders,
it should also benefit psychiatric brain disorders. Emerging evidence looks
very promising, and scientific interest in this area is suddenly exploding.
Psychiatric conditions are neurological conditions—it’s just that their
symptoms were historically considered to be more psychological than
biological. A powerful case in point is bipolar disorder, a serious mood
disorder that includes periods of mania (unusually high energy) that are
typically followed by periods of deep depression. Bipolar disorder and
epilepsy share many common underlying features—in fact, many of the
medications we prescribe to treat bipolar disorder are anti-seizure
medications. If a ketogenic diet can stabilize seizures in people with
epilepsy, it stands to reason that it may also stabilize mood swings in people
with bipolar disorder, and this is the line of reasoning that led me to begin
incorporating ketogenic diets into my clinical work more than ten years
ago. So, is the ketogenic diet the best diet for the brain?
We could attempt to answer this question by testing ketogenic diets
against Mediterranean diets, vegetarian diets, SAD diets, and the countless
other dietary patterns one can imagine, but this would be a daunting
proposition, so instead, let’s take a step back and ask a different question:
What does a brain-healthy diet need to accomplish?

WHAT IS A BRAIN-HEALTHY DIET?

I propose that for any dietary pattern to be considered brain-healthy, it must
fulfill all three of the following criteria:
1. It must NOURISH the brain by including adequate amounts of all
essential nutrients.
2. It must PROTECT the brain by excluding damaging ingredients.
3. It must ENERGIZE the brain in ways that support healthy metabolism
for a lifetime by keeping blood sugar and insulin levels in a healthy range.
These are the principles I used to create the dietary strategies I share
with you in this book, and these very same principles apply to the rest of the
body as well. All of our cells require the same nutritional care, which is
fortunate, as eating a different diet for every organ we possess would be
inconvenient, to say the least.
The Mediterranean diet nourishes the brain better than the SAD diet, but
it could be even more nutritious. It also protects the brain better than the
SAD diet because it discourages ultraprocessed foods and limits certain
types of refined carbohydrate, but it could be even safer.
Ketogenic diets reliably lower glucose and insulin levels, so they are
very effective at addressing insulin resistance, and they excel at energizing
the brain because they generate ketones that the brain can use as a
supplemental fuel source, but their ability to nourish and protect the brain
can vary tremendously depending on food choices.

The Quiet Diet Approach

The limitations of these dietary patterns led me to create three new dietary
patterns for you to explore: Quiet Paleo, Quiet Keto, and Quiet Carnivore.
I call these diets “quiet” because their food lists have been uniquely
modified to target root causes of mental health conditions by quieting
inflammation, oxidative stress, and high insulin levels. These plans are also
lower in natural irritants and toxins and easier to digest than the standard
paleo, keto, and carnivore diets you may already be familiar with, so they
are much less likely to bother you if you have food sensitivities or poorly
understood health conditions such as chronic fatigue, fibromyalgia, and
irritable bowel syndrome. Recognizing that not everybody wants or needs
to adopt a ketogenic diet to improve their mental health symptoms, I’ll
show you how to figure out where you stand on the insulin resistance
spectrum, help you customize your carbohydrate intake to your metabolic
needs, and present you with a variety of other brain-healthy changes to
choose from.
Quiet Paleo: Like standard paleo, this plan allows meat, seafood,
poultry, eggs, fruits, and vegetables and excludes grains, legumes, dairy,
refined carbohydrates, alcohol, vegetable oils, and ultraprocessed foods.
(These excluded foods jeopardize brain health by interfering with nutrient
access, disrupting energy flow, and promoting inflammation and oxidative
stress.) However, a key difference is that Quiet Paleo limits plant foods to a
special list of what I call “kinder, gentler” fruits and vegetables that are not
only lower in sugar, but also lower in the chemicals that plants use to
protect themselves from predators.
Quiet Keto: Like all ketogenic diets, this plan is very low in
carbohydrate, moderate in protein, and high in fat, but Quiet Keto is based
on the Quiet Paleo food list (minus the higher-carbohydrate fruits and
vegetables), so it combines nutritional quality with metabolic quality, giving
you the best of both worlds.
Quiet Carnivore: Like most carnivore diets, this plan is plant-free (and
therefore free of plant toxins), but Quiet Carnivore also discourages
common animal food sensitivity culprits like eggs, dairy, and processed
meats. Quiet Carnivore can be particularly helpful if you have unrecognized
food sensitivities, gut damage, autoimmune conditions, and other stubborn
or mysterious syndromes that haven’t responded to other dietary
interventions.
After the initial discovery phase, if you find that your mental health has
improved on one of these plans, you can then try expanding your food list
to find the least restrictive and most enjoyable diet you can tolerate.

Change Your Diet, Change Your Mind

It breaks my heart to see people struggling with mental health problems
who have tried a dozen or more medications or years of psychotherapy but
have never tried changing their diet in any way. Or worse yet, to see people
faithfully following what they’ve been told is a brain-healthy diet of whole
grains, legumes, nonfat dairy, blueberries, dark chocolate, and red wine yet
continuing to feel depressed, confused, anxious, or unstable—believing
they are already doing all they can, when there is SO much more they can
do. Whether you are dealing with a serious mental illness like
schizophrenia, or an everyday mental health concern like irritability, I want
you to know there is hope.
Changing your mind with diet requires changing your mind about
diet. And the first step on that journey is to clear your mind of any
preconceived notions you may have about food so we can start fresh. Let’s
take a closer look at where mainstream beliefs about nutrition come from so
you can decide for yourself if they are deserving of public trust.
 CHAPTER 3

Why Most Nutrition Guidelines Are Wrong

Published and true are not synonyms.

—Brian A. Nosek, Jeffrey R. Spies, and Matt Motyl, “Scientific
Utopia”

The good ship Salisbury had a grave problem on her hands. In the spring
of 1747, she had left the port of Plymouth, England, with a crew 300 men
strong.1 After just eight short weeks at sea, at least 30 of her sailors had
contracted scurvy, a disease that killed an estimated two million mariners
between the sixteenth and nineteenth centuries.2 In what may have been the
world’s first controlled trial in clinical nutrition on record, naval surgeon
Dr. James Lind took it upon himself to conduct a simple experiment. As he
tells it:

I took twelve patients in the scurvy, on board the Salisbury at

sea. Their cases were as similar as I could have them. They
all in general had putrid gums, the spots and lassitude, with
weakness of their knees… and had one diet common to all…
water-gruel sweetened with sugar in the morning; fresh
mutton-broth often times for dinner; at other times puddings,
boiled biscuit with sugar, and for supper, barley and raisins,
rice and currants, sago and wine, or the like.3

He divided the twelve men into six pairs, and administered the following
treatments to see which, if any, might be helpful:

Pair #1: One quart of cider per day

 Pair #2: Twenty-five drops of dilute sulfuric acid three times per day
Pair #3: Two spoonfuls of vinegar three times per day
Pair #4: One half-pint of seawater per day
Pair #5: Two oranges and one lemon per day
Pair #6: A medicinal paste of garlic, mustard seed, radish root, balsam
sap, and gum myrrh

Per Dr. Lind:

The consequence was, that the most sudden and visible

good effects were perceived from the use of oranges and
lemons; one of those who had taken them, being at the end
of six days fit for duty.… The other was the best recovered of
any in his condition; and being now deemed pretty well, was
appointed nurse to the rest of the sick.4

Lind’s results provided evidence that fresh citrus fruits could cure
scurvy. Almost 400 years later, his protocol still stands as a fine example of
the scientific method. Defining the scientific method can be surprisingly
difficult, but its bedrock principles can be summarized in this definition of
science itself, taken from the Oxford English Dictionary: “the systematic
study of the structure and behavior of the physical and natural world
through observation and experiment [emphasis mine].”5
We would have to wait nearly two centuries for Hungarian scientist Dr.
Albert Szent-Györgyi to identify the curative chemical stowed within those
oranges and lemons as vitamin C, which earned him a Nobel Prize in 1937.
This juicy revelation was just one of many vitamin discoveries made during
the so-called “Vitamin Era” of the 1930s and 1940s, all made possible by
the Chemical Revolution—the development of laboratory techniques that
allowed researchers to isolate and study vital food molecules for the first
time in human history.6
When President Eisenhower suffered a heart attack in 1955, public fear
of cardiovascular disease shifted the focus of diet research away from
micronutrients (vitamins and minerals) to macronutrients—fat and
cholesterol, to be exact—ushering in the era of politicized nutrition in
which we still find ourselves today. In an attempt to understand how
complex dietary patterns cause or prevent things like heart attacks, nutrition
research largely lost its way in the second half of the twentieth century,
veering away from solid scientific methods grounded in experimentation in
favor of a wholly unscientific method grounded in guesswork called
nutrition epidemiology. Most mainstream views about food and health (such
as the belief that plant foods are healthier for us than animal foods) spring
from nutrition epidemiology studies, so it’s important to understand the
serious shortcomings of this type of research and how it compares to other
nutrition research methods.

MODERN NUTRITION RESEARCH METHODS

Studying the relationship between diet and disease is no easy task, and all
nutrition research methods have their shortcomings, but some methods are
far more reliable than others. When you see a nutrition headline, knowing
something about the kind of study that was used to generate that headline
can help you quickly decide if the headline is worth your attention.
Scientists sometimes disagree about which types of evidence are most
reliable, but the pyramid below represents a common ranking order.

HIERARCHY OF EVIDENCE
 Let’s begin at the bottom of the pyramid and work our way to the top.
A nutrition case report describes how a particular dietary intervention
(such as a ketogenic diet) affected the health of a single patient, while a
case series describes how a dietary intervention affected the health of
multiple patients who all have a similar health condition—for example, how
a ketogenic diet affected five people who all have early Alzheimer’s
disease. Well-documented case reports often contribute valuable
information that inspires additional research,7 but since they are not formal
scientific experiments, these sit at the bottom of most evidence pyramids.
In nutrition epidemiology (aka “observational”) studies, researchers
gather information about large numbers of people and analyze that
information to look for patterns that may explain health trends in
communities. An example within the world of nutrition would be
conducting a survey of thousands of people about their egg yolk eating
habits and their heart health history, and then sifting through their answers
to see if there might be a connection between the number of egg yolks they
reported eating and whether or not they develop heart disease. The lion’s
share of nutrition studies that make headlines are epidemiological studies,
perhaps in part because they are inexpensive and relatively easy to conduct.
A nonrandomized controlled trial is a scientific experiment in which
volunteers with similar health conditions are divided into two groups—an
experimental group (which changes their diet) and a control group (for
comparison). For example, to test the effects of cholesterol-rich egg yolks
on blood cholesterol levels, you might feed everyone in the experimental
group two egg yolks per day and feed everyone in the control group
something similar that you wouldn’t expect to have any impact on
cholesterol levels—such as two egg whites per day, which are cholesterol-
free. At the end of the experiment, you compare the cholesterol levels of the
two groups to see if the egg yolks seemed to make a substantial difference.
These trials are called nonrandomized because the decision about which
volunteers join which group isn’t made randomly; instead, the researchers
or the volunteers themselves decide who will belong to each group, which
could influence the results. (Dr. Lind’s scurvy experiment would therefore
be considered a nonrandomized controlled trial, as he himself decided
which sailors received which treatment.)
Just below the pyramid’s pinnacle is the randomized controlled trial or
RCT. Widely regarded as the gold standard of scientific research methods,
the RCT is considered the best way to explore whether there is a cause-and-
effect relationship between two items of interest or variables such as egg
yolks and cholesterol levels. Instead of the researchers or the volunteers
themselves choosing who will be on Team Yolk and who will be on Team
White, volunteers are randomly assigned to each group, usually by a
computer, reducing the chance that human bias will influence the results.
The best-designed RCTs are double-blinded, meaning that neither the
volunteers nor the researchers know who is in the experimental group and
who is in the control group.
Proudly perched atop the pyramid pinnacle is the meta-analysis, which
pools the results of multiple RCTs and analyzes them as a group to look for
trends.
A well-designed RCT makes it easier to conclude that a particular
dietary intervention is directly responsible for the results that the
researchers observe because it attempts to minimize other factors that could
muddy the waters. For example: if one of my patients tries a ketogenic diet
for early Alzheimer’s disease and she happens to score better on memory
tests six weeks later, a scientific journal may agree to publish my findings
in the form of a case report—especially if this is the first case of its kind.
However, because the circumstances weren’t controlled, I can’t claim that
the ketogenic diet was responsible for my patient’s improvement. Maybe
she made other changes during that same six-week period that she didn’t
mention or that I chose not to include, such as eliminating junk food or
taking a multivitamin. Maybe she was expecting the ketogenic diet to help
because a family member had responded well to it. (People who believe in a
treatment are more likely to experience benefits—this is called the placebo
effect.) Maybe I had ten patients with Alzheimer’s who tried the diet, and
she was the only one who improved—but I didn’t report the other nine
cases because I wanted to share the most hopeful news.
RCTs seek to minimize variables like these that can muddy the waters.
For example, when researchers in New Zealand conducted an RCT
comparing the ketogenic diet to a low-fat diet in people with Alzheimer’s
disease, they randomly divided twenty-six volunteers into two groups using
randomizing software, gave them all the same dietary instructions, and told
them all to take the same multivitamin supplement. They told the volunteers
Another random document with
no related content on Scribd:
it be remembered that the fleet when at Delos must have heard of
Mardonius’ retirement from Attica, and had also, it would seem,
heard of the march of the home army into Bœotia, their fear strongly
supports the conjecture that they knew that the object of that army
was not to merely guard the passes of Kithæron, but to take the
offensive against the Persian. It is hardly conceivable that, after
Mardonius’ retirement, they should have felt apprehensions of this
nature about the army, had its object been merely the defence of the
Kithæron range, since the enemy had plainly shown by his retreat
from Athens that his main desire was to be north of that range, and
that he would have but little motive for throwing his men against
mere defenders of passes which he had shown that he did not want
to use. Furthermore, the possible intentions of Mardonius in making
Thebes his headquarters may have alarmed the Greeks by
indicating the nature of a policy, not indeed so terrible as that
wherewith the expedition was originally undertaken, but constituting,
all the same, a most serious danger to all the states of Southern
Greece.
Relieved of this fear, they went into battle with a good heart,
feeling, says Herodotus, “that the Hellespont and the Islands would
be the prize of victory.” Not a word of the Ionian towns on the
mainland. The Persian position was indeed too strong in respect to
these.

H. ix. 102.
The march was evidently parallel with the shore,
along it and the level ground in its neighbourhood, and
also along the hillside, cut up, as the hillsides of that land always are,
by numerous water-courses. The result was that the Athenians and
those with them, advancing along the unimpeded level, came into
contact with the enemy before the Lacedæmonians, who were
advancing along the slope of the mountain. If Herodotus’ description
H. ix. 102.
is strictly worded, the Lacedæmonians were engaged
in some kind of a turning movement.
The Athenians were therefore probably guilty of a tactical error in
beginning the attack before the movement was complete.
 The Persians adopted the same form of defence as in the last
fight at Platæa, using their shields as a breastwork; and for some
time the battle was fought without advantage to either side, until the
Athenians and those with them, eager to win the victory before the
Lacedæmonians came up, broke through this barrier and fell in a
mass upon the Persians, who, after an obstinate resistance,
retreated within their fortifications. The Athenians, Corinthians,
Sikyonians, and Trœzenians, however, followed close on their heels,
and seem to have reached the breastwork with the fugitives, so that
it was captured without difficulty. Except the native Persian
contingent, the enemy now took to flight the former, however,
resisted in scattered groups with all the bravery of a great reputation,
—the Old Guard of this Asiatic Waterloo. In this combat two out of
the four Persian generals fell. The Lacedæmonians came up while it
was in progress, and their arrival put the coping stone on the
enemy’s discomfiture. But the assailants, and especially the
Sikyonians, paid dearly for their victory, so Herodotus says; and
Greek historians are not in the habit of exaggerating Greek losses in
battles with barbarians. Meanwhile the disarmed Samians did what
they could to help the Greeks, and, following their lead, the other
Ionians attacked the Persians in the camp. The Milesians, who had
been sent to the peaks of Mykale, now played the part which, under
the circumstances, they might be expected to play. So far from
acting as guides to safety, they led the routed fugitives into the very
hands of the Greeks, and themselves took part with zeal in the
slaughter which ensued. At last Miletus had the opportunity of
avenging its destruction at the end of the Ionian revolt, and it is
certain that the bitterness of the last fourteen years found ample
expression and ample satisfaction on this day of revenge.

H. ix. 104, ad
“Thus,” says Herodotus, “Ionia revolted a second
fin. time from the Persians.”
He makes no comment upon the fact. It
THE FATE OF IONIA.
would have been difficult for him to do so. He
had regarded the first revolt as a conspicuous blunder, probably
because he looked upon it as premature. Even now he sings no
pæan of emancipation. Maybe the Halikarnassian believed that, in
spite of the brilliant success of the year, the permanent freedom of
the Ionian towns could never be secured so long as Persia retained
its hold on West Asia. He wrote with well-nigh a century of
experience behind him; he died a century before there arose a
power upon the Ægean whose unity of strength made it fit to cope
with the dead weight of the Persian power in Asia.
The Athenians were credited by popular tradition with having
played the greatest part in the battle; but it may be suspected that
had Leutychides’ version of the fighting survived, it might have
contained some criticism of the error of a premature attack, to which
the escape of a large part of the Persian army was probably due.
After destroying the enemy’s camp and fleet the Greeks withdrew
to Samos with such booty as they had captured.

H. ix. 106. The action of the Ionians at Mykale had raised the
whole question of the future of the Asiatic Greeks.
There was a large section in the fleet who saw,—what the sequel
proved to be correct,—that the European Greeks were not in a
position to maintain the freedom of continental Ionia against the
Persians for an indefinite space of time. That would have meant the
maintenance of a large garrison within the various towns, such as
the highly composite Greek alliance could not regard as within the
realm of practical politics. It was consequently proposed to tranship
the Ionians en masse to the European shore, and to leave Ionia to
the Persian. The strategic position of the Ionian cities was indeed
fatally weak.
But, after all, it would hardly be the strategical question that
presented itself to the Greeks gathered at Samos. What they did
know was that these Ionian cities had failed to resist conquest by
Lydia and Persia, and had failed in one tremendous effort to throw
off the Persian yoke; and that one of the conspicuous causes of
failure had been the difficulty of sustained united action. Of the
commercial advantages and their causes, they were probably as well
aware as the best instructed modern student with the best maps at
his disposal.
 It was, no doubt, this balance of advantage and disadvantage
which led to the division of opinion in the council as to the best
H. ix. 106.
course to be pursued. The Peloponnesians were in
favour of planting the Ionians on the lands of the
medized Greeks at home. To this proposal the Athenians offered an
uncompromising resistance, and claimed that they alone had the
right to decide the matter, since the Ionians were colonists of their
own. The claim was a shadowy one; but the resistance was
successful. It is noticeable, however, that the Asiatic Greeks who
were in the first instance received into the alliance were Samians,
Chians, Lesbians, and the other islanders, but none of the
inhabitants of the cities of the mainland. Thus were sown the seeds
of that famous Delian League which was destined in the near future
to play so great a part in the history of the fifth century.
Throughout Greek history the Hellespontine region is the link
between Europe and Asia. To it the Oriental seeking to win empire in
Europe ever turned, while the European, whether on the defensive
or the offensive against the power of the East, was at all times
H. ix. 114.
anxious to secure its possession. And thither now the
fleet from Samos sailed, under the impression, says
Herodotus, that it would find the bridge in existence. If such an
impression did actually exist with the Greeks at this time, the fact
bears strong evidence to the silence and desertion which in these
years brooded over that highway of the nations—the Ægean. The
fleet was delayed on the voyage by adverse winds, and was obliged
to anchor for a time at Lektos. Thence it sailed to Abydos, where the
Greeks discovered for the first time that the bridge was no longer in
existence.
Hitherto Leutychides and the Spartans with him had shown in this
expedition an enterprise peculiarly foreign to them; but now once
more a fatal national characteristic began to reassert itself. Whether
because of that homesick conservatism of the
THE FLEET SAILS
TO THE
race which made it averse to ventures far
HELLESPONT. beyond its borders, and anxious when
engaged in them to get quit of the matter in
hand at the earliest possible opportunity, or from a lack of
intelligence which failed to grasp the proper issue of a situation,
Sparta was ever wont to leave her tasks unfinished, especially if they
demanded absence far from home. And so it was now. On the plea
that the only object of the expedition to the Hellespont had been to
ensure the destruction of the bridge, they renounced all idea of
further operations for the time being, and set sail for home. It may be
doubted whether they genuinely believed that the disappearance of
the bridge had removed all necessity for further action in this region.
The Athenians, at any rate, under their leader Xanthippos, saw that
the peril from Persia must ever be recurrent, if that power continued
to hold the Thracian Chersonese, that tongue of land which in both
ancient and modern times, though for different reasons, has ever
been of the greatest strategical importance to Mediterranean
powers. They determined therefore to clear the enemy out of this,
their tête-du-pont in Europe.
The chief strategic position in the peninsula at that time was
Sestos. It lay on the European side of the great ferry of the
Hellespont at Abydos, and so commanded the main route from Asia
to Europe.
As a place of great military importance, it was the strongest
fortress in those parts; and on the news of the arrival of the Greeks
at the Hellespont, the Persian population from all the neighbouring
towns collected thither under the command of Artauktes, the
governor of the region. He was a man who had got an evil reputation
among the Greeks owing to sacrilegious behaviour of the grossest
character, peculiarly calculated to arouse their most fierce
resentment. The arrival of the Greeks in the Hellespont had been so
unexpected that he was taken unawares, having made no
preparations for a siege. But the inexperience and incapacity of the
Athenian assailants in the attack on walled towns, despite the
reputation they enjoyed among their fellow-countrymen, who were
themselves hopelessly impotent in this department of the art of war,
caused the siege to drag out a weary length, until the wane of
autumn brought with it that severity of wintry weather from which all
the lands within reach of the inhospitable Euxine suffer at that time of
year.
 The Athenian soldiers and sailors began to weary of the
apparently endless blockade, and demanded of their leaders that
they should be taken home once more. This request Xanthippos and
his captains refused, saying that they must bide where they were
until either the town were taken or the Athenian Government sent for
them. So they continued to bear their hardships as best they could.
Meanwhile the besieged, reduced to the last extremity of want, ate
even the leathern straps of their beds. At last, in desperation, the
Persian portion of the inmates of the town escaped by night through
the besiegers’ lines at a point where there were but few men on
guard; but here their success ended. The natives of the Chersonese
who were in the town informed the Athenians by signal of their flight,
and the latter started in hot pursuit. One body of the fugitives made
its escape to Thrace, to meet with a miserable fate at the hands of
the wild tribes of that region; but the main body, under Artauktes,
was overtaken by the Athenians near Ægospotami, and after an
obstinate defence, such as survived, including Artauktes, were
brought back as prisoners to Sestos. A tale which Herodotus tells
shows that the Persian commander had some apprehension with
regard to the retribution which his sacrilegious conduct might bring
upon him; for he made an offer to Xanthippos to pay one hundred
talents’ compensation for the outrage, and two hundred talents’
ransom for himself and his son. To this offer Xanthippos turned a
deaf ear.
The punishment inflicted on the Persian was a blot on Greek
civilization. He was nailed to a board, and his son was stoned to
death before his eyes. The Greek nature was capable in moments of
revenge of inflicting the death penalty in wholesale fashion on
enemies who had excited its bitter resentment; but the torture of a
captured foe was wholly alien to the spirit of the people. Doubtless
the Persians, with the ineradicable cruelty of
END OF THE
CAMPAIGN.
the Oriental, had given many precedents for
such a form of revenge; but whether that be so
or not, this particular act was inexcusable in a people who claimed
for themselves a standard of civilization infinitely higher than that of
the world around them.
 With the capture of Sestos the campaign of this famous year
ended, and with it the great war for the liberation of European
Greece. Many years were indeed fated to pass before the present
struggle ceased. But from this time forward the war entered upon a
new phase, in which the Greek was the assailant. Hitherto he had
been acting purely on the defensive; even the expedition across the
Ægean had been but an act of the great drama which was being
played in Greece. The West had triumphed over the East in one
great effort, wherein the success had been rapid and striking. But
henceforward the tide of success was destined to flow more slowly,
—so slowly, indeed, that ere the end came, victor and vanquished
alike had sunk into decay, and alike had fallen into subjection to that
newer, broader, and more vigorous but less genuine Hellenism which
Macedonia evolved from her heritage in the older type.
 CHAPTER XIII.
THE WAR AS A WHOLE.
It is often an invidious task to examine the causes which lie behind
any great series of events in military history, because the most
efficient of them are in the majority of cases due to human error
rather than to human power. The historian of peaceful development
is not exempt from the necessity of compiling such records of frailty,
but by the very nature of things such tasks fall more frequently to
one who narrates the story of periods at which the sanity of the
sanest is troubled by the nervous tension involved in participation in
events whose issues and their results lie in the immediate, not in the
distant future. The errors of war may not be greater, but they are less
remediable than those of peace. There may be time to arrest the
latter’s slow decay; but the swift and often fatal stab of a lost battle is
the work of a moment. Men have in all ages been conscious of the
gravity of this truth; and the consciousness of it, apart altogether
from the inevitable physical fear, has rendered them less capable at
such times of the calculations of reason, or even, in some instances,
of common sense.
The great Persian War was of a special type. In the majority of
cases in which races and empires have come into collision, each
side has had some practical acquaintance with the resources,
devices, and fighting qualities of the other; and in many cases such
experience has been intimate and prolonged.
UNDETERMINED
But when the Persian and the Greek of Europe
FACTORS.
came into collision in 480, such experience
can hardly be said to have existed on either side; or, in so far as it
did exist, it had been misleading. In only two instances had the
European Greek come into contact with the Persian on the field of
battle, and in both of them the same Greek state, the Athenian, had
alone been represented in the conflict. But, furthermore, the
instances had, from a military point of view, been indecisive, if not
actually fallacious. At Ephesus, in the first year of the Ionian revolt, a
small contingent of Athenians had been present on the defeated
side, when the Persians fell on the expedition which had burnt
Sardes. Of the battle practically nothing is recorded save the result;
but this much may be assumed with certainty,—that a fight in which
a small body of European Greeks had been defeated in partnership
with hastily raised levies of Ionians could not possibly afford any
experience worth calling such to either of the sides who were
destined to take part in the war of twenty years later. The Ionians of
Asia, long under Persian rule, must have been very deficient in
military training when compared with the Greek of Europe. Darius
had, indeed, made use of them in the Scythian expedition, but in that
instance had employed them to guard the lines of communication. It
is manifestly improbable that the Persian Government would
encourage any advanced system of military exercises in a people
whose position at the very borders of the empire would have
rendered them, if accustomed to the use of arms, very dangerous
subjects.
Marathon was the other instance. It is a battle of problems, a
problem among battles, whose data are woefully imperfect. The only
thing about it which seems clear is that, for some reason which can
only be conjectured, it formed but an imperfect test of the fighting
capacity and methods of Greek and Persian respectively.
Thus, for all practical purposes, when the two races came into
conflict in 480 they were, militarily speaking, unknown quantities to
one another, and each had to learn how best to meet the strategy
and tactics of the enemy. The consequence was inevitable. Both
sides made grave mistakes of commission and omission; and it may
be even said that the victors made more than the vanquished,
though not of such a fatal character. The Corinthians were not
indeed wrong when in later days they summed up the causes of the
issue of the war by saying that “the Persian was the rock on which
he himself made shipwreck;” for of the two main reasons which led
to the final victory of the Greeks, one was undoubtedly the fatal
nature of the mistakes which the Persians made. They seem, relying
on their prestige, and on their enormous numbers, to have held their
adversaries too cheaply; and from this fundamental error all their
other errors were generated.
Knowledge after the event renders it very difficult to appreciate
the circumstances of any particular date in history, and the difficulty
is all the greater if the events of the time immediately succeeding be
of such a nature as to completely change those circumstances. Such
is markedly the case in the instance under consideration. The mental
attitude of the Persian towards the Greek power after 479 is well
known to the modern world; and it is recognized indeed that a great
change must have been brought about in it by the events of that and
the preceding year; but the extent of the change is not perhaps
realized, because the very real nature of the grounds of confidence
with which Persia entered upon the war are not sufficiently taken into
consideration, and the efforts made by Herodotus to bring this
confidence into prominence are too apt to be regarded as aiming at
the greater glorification of his own race.
And yet the grounds for that confidence are plain. In a long and
almost unbroken series of wars the Persian had conquered Western
Asia. He had never met with the race which could face his own upon
the set field of battle, and this, not in an experience of a few years,
but of half a century. He might indeed feel that he had been tried in
the balance of warfare and not found wanting. Man’s success
against him had never been more than temporary.
It now remains to be considered why this confidence was ill-
grounded.
The Persian had never seen the Greek heavy-armed infantryman
at his best, well disciplined, and fighting on ground suited to his
tactics, save perhaps at Marathon, when the test was probably
regarded as unconvincing. Herodotus points
ARMS AND THE
out the superiority of his panoply to that of the
LAND.
comparatively light-armed Persian. There is
much more of the empirical than of the scientific in the lessons of
war; and the experience of all ages points to the fact that an army
which enjoys a noticeable superiority over its enemy in respect to
weapons will in all probability, if other things be equal, come off
victorious. Such exceptions as history can adduce to this rule are
rather apparent than real, and are, in the vast majority of cases, due
to the possessor of the superior arms adopting tactics either
unstated to them, or wholly at variance with the nature of the region
wherein fighting is being carried on. The Greeks at Platæa made a
mistake of the latter kind, which was only annulled by a greater
mistake made subsequently by the other side.
In this great war, then, the two most efficient causes of its issue
were (1) the undue confidence of the Persian, giving rise to fatal
mistakes; (2) the great superiority of the Greek panoply. A third, of a
negative character, may perhaps be added, namely, that the nature
of the country did not permit of the invader making use of his most
formidable arm,—the cavalry. The second and third causes may be
included in that wider generalization which has been already
discussed;—the West on its own ground must have prevailed over
the East.
The immediate preliminaries of the actual invasion of Greek
territory bring into prominence the high state of efficiency which must
have been attained in the military organization of the Persian empire.
Leaving out of consideration the difficulties to be overcome before
the huge mixed force was collected at Sardes (which town became
for the time being, in place of Susa, the prime military base of the
empire), the organization which enabled this great army to be
brought without accident, or, in so far as present knowledge goes,
without a hitch of any kind, over the eight hundred miles of difficult
country which separated its base from Middle Greece, must have
been the outcome of a highly effective and highly elaborated system
evolved by a people whose experience was indeed large and long,
but who must also have been gifted with that very high form of
mental capacity which is able to carry out a great work of this nature.
The secret of success,—it may almost be said of possibility,—in the
present instance was the employment of the fleet for commissariat
purposes. It was a method of advance not new to Persian
campaigning, the first instance of its employment going back as far
as the time of the invasion of Egypt by Cambyses.
 On the Greek side organization on so huge a scale was not called
for. Numbers were smaller, and distances in comparison
insignificant; and only at the end of the campaign, when the Athenian
fleet was engaged in the blockade of Sestos, had a long period of
absence from the commissariat base to be provided for. Still, what
was done must have been done on a system; and the system cannot
be supposed to have been a bad one, for there is no hint of its ever
having broken down. It was in all probability most severely tried
when it became necessary to keep up the supplies of the great host
during the weeks it remained at Platæa. Such mention of it as occurs
in Herodotus’ narrative is of a purely incidental character. It was a
side of the war in which he was not likely to take any great interest,
even if he could have obtained much information on the subject, or
have appreciated the significance of such information as he did
obtain. The disaster to the commissariat train in the pass of
Dryoskephalæ is the most prominent of the rare instances in which
Herodotus mentions anything connected with this department of the
service. His reference to a signalling system extending through
Eubœa at the time of Artemisium,—a line of communication which
was in all probability carried to the Hellenic base in the Saronic gulf,
—shows that there was a certain amount of elaboration in the
organization on the Greek side.
When it is borne in mind that the Greeks
STRATEGY AND
were in this war carrying on operations on a
TACTICS.
scale infinitely exceeding anything of which
they can have had experience, it must be admitted as remarkable
that, whatever the defects of their military policy, whatever the
mistakes they made, they managed to evolve out of their experience
of operations on a small scale a system of organization which was
applicable to the great operations of this war, and which did not in
any known instance lead to a breakdown which can be attributed to
defect in the system itself.
Of the strategy and tactics of the war itself little can be said which
has not been already said in previous chapters; still, it may be
convenient to collect together the considerations on this question
which are suggested by the history of the two years’ campaigning.
 Before doing so it is perhaps necessary to define as clearly as is
possible the distinction between strategy and tactics, and that not
merely in respect to the application of the terms themselves, but also
to a not unimportant difference which may exist between the ways in
which they may be employed.
Strategy is a term usually applied to the larger operations of war
prior to or intervening between such times as armies are in close
contact with one another.
When close contact takes place, and battle is immediately
imminent or in progress, the name tactics is applied to the operations
which then ensue, and which are necessarily on a smaller scale than
those to which the term strategy is applicable.
A further and important distinction is this:⁠—the operations known
as tactics are the outcome of full consciousness on the part of the
commander or, it may be, of the trained soldiers who employ them,—
that is to say, that he or they know not merely what to do, but why to
do it. The knowledge acted upon is in a sense scientific, though the
reasons for the act may be various:⁠—either that the operation has
proved effective in the past, or that the tactics of the enemy demand
it, or that it is called for by the nature of the ground. It is in respect to
the last reason that tactics and strategy are most nearly comparable;
and it is manifest that it is more easy to draw conclusions as to the
results of action on a small area of country, all of which may be
comprehended in one view, than in a large area such as would form
the theatre of strategical operations.
The operations of tactics are so much more mechanical than
those of strategy that it is difficult to conceive of them as being
unconsciously carried out.
With strategy that is not the case. It may be conscious or
unconscious. The strategical conditions of a country such as Greece,
or indeed of any country, must ever be fundamentally the same,
though liable to modification by the introduction of some great
novelty into the act of war, such as long-range missiles. An army
operating in Greece or elsewhere may fulfil the strategical conditions
of the country consciously or unconsciously. It fulfils them
consciously if it appreciates them,—that is to say, if its movements
are determined by them; but it may fulfil them unconsciously even if
its movements are determined by considerations which cannot be
said to rest on any strategical basis.
It is a very important question in the war of 480–479 whether
either or both of the two sides operated with a conscious or
unconscious strategy. Beyond question many of their operations
were strategically correct. This every one who is acquainted with the
story of the war must admit; but many of the greatest writers of
Greek history have silently or expressly assumed that the agreement
between the operations and the strategical conditions of the theatre
of war was due to the circumstance that, in a country of such
pronounced characteristics as those of Greece, the physical
conditions were so marked that the strategical conditions might be
fulfilled from motives wholly unconnected with them. This might
undoubtedly be the case; but was it so?
Two great strategic designs are apparent in the main plan of the
invaders:⁠—
(1) To create a diversion in the Western Mediterranean by stirring
up Carthage to attack the Sicilian Greeks, and so prevent aid from
that quarter reaching the mother country;
(2) To make fleet and army act in co-operation, and, furthermore,
by means of the fleet, to maintain the command of the Ægean and
its sea-ways.
On the side of the defence no plans of such magnitude are
apparent; for the very good reason that the preparations to meet the
invader were made too late for the carrying out of any far-reaching
design, even had so composite a resisting force admitted of anything
of the kind.
The first strategic action of the Greeks was
THESSALY AND
THERMOPYLÆ.
the expedition to North Thessaly. That was
undoubtedly conscious strategy. It was
undertaken under the supposition that the Vale of Tempe was the
only entrance into the country; and had this supposition been correct
the strategy was sound enough. The mistake made was
topographical, not strategical.
It was again sound strategy which made the Greeks, when they
discovered their error, retire from a position which was indefensible
with the numbers present with them. Even had their available force
been much larger than it actually was, it would have been a mistake
to try to defend a mountain line traversed by several passages. A
successful attempt of that nature is rare in history, because the
assailant is able to choose the passage on which his main attack
shall be directed, whereas the defender has to distribute his force at
all the possible points of assault. Moreover, the passage once
forced, the assailant can generally threaten the lines of
communication of the bodies of troops defending the other passes.
Thermopylæ and Artemisium display most clearly the strategy of
the two contending sides. It did not perhaps demand much
knowledge or much intelligence to fix upon Thermopylæ as a point of
defence. It would be difficult to mention any other great highway in
the world on which a defensive position so strong by nature is
afforded. It was, on the other hand, a great strategic blunder on the
part of Sparta that, having sent a small force to the pass, she did not
later forward reinforcements. That was no doubt part of a still greater
strategic blunder,—the desire to concentrate the defence at the
Isthmus. The three days’ fighting at Thermopylæ proved conclusively
that, had an adequate force been present there, the army of Xerxes
would in all probability never have carried the pass. Sparta and the
Peloponnese generally neither did, nor wished to, appreciate the
immense strength of the position.
Did the Persians make a mistake in their assault on the pass? It
would seem not. They did not at first know of any way of turning it.
They had to take it, because it was the only route by which they
could get their baggage train past Mount Œta. That is the difficulty of
Greek campaigning. There are perhaps many routes in the country
along which a light marching force in moderate numbers can make
its way; but those by which troops with the ordinary paraphernalia of
an army, and in numbers too large to live on the country, can go, are
very few.
 The Greeks learnt a lesson from their homeland,—a lesson which
Xenophon expressed in striking language to the ten thousand
Greeks when they began their famous retreat: “My view is that we
should burn our waggons, that our baggage train regulate not our
231
march, but we go by whatever way be expedient for the army.” In
the present instance Xerxes was confined to the one route: he had to
assault the pass, because in the then state of his knowledge of the
country he could do nothing else. That he or his generals
appreciated the importance of the path of the Anopæa so soon as
they were informed of it is shown by the employment of the best
troops in the army for its seizure and use.
It is, however, fairly questionable whether the direct assault on the
pass formed part of the original Persian design at Thermopylæ. The
delay of several days which took place before the actual assault was
delivered, taken in connection with the contemporary events at
Artemisium, suggests that it was originally intended to wait until the
forcing of the Euripus by the fleet made it impossible for the Greeks
to maintain their position in the pass for fear of the landing of a force
in their rear. If such were the design, it was one which bears
testimony to the strategic capacity of him who conceived it. It was
brought to nought by a factor outside all human calculation, the
storm which broke upon the fleet when anchored at the Sepiad
strand.
It was indeed at this period of the war that both the contesting
parties gave conspicuous proof of their appreciation of the strategic
conditions of the region in which their operations were being carried
on. In point of conception there was little to
GENIUS AND
EXPERIENCE.
choose between the plans of the assailant and
that of the defender, but in point of execution
the Greek plan was wrecked by the deliberate failure of those who
were responsible for the land section of the general defence. That of
the Persian was upset by causes beyond human control. It is
noticeable that the invaders seem to have arrived at Thermopylæ
with a fair working knowledge of the region of the Malian gulf and the
North Euripus, and it must be suspected that the heralds sent to
Greece to demand earth and water acted when there in a twofold
capacity.
Whatever failure overtook the Greek defence at this time of the
war was due not to the plan, but to the way in which it was carried
out. The design to hold the land force of the enemy at Thermopylæ
and his fleet at Artemisium was excellently conceived. It was almost
certainly the work of Themistocles. Whether honest or dishonest, he
was gifted with that rare genius which enables a man to take in the
necessities of a situation vast beyond anything within his experience.
The other Greek commanders were men of an ordinary kind, who
would in all probability have frittered away the defence in a series of
measures such as their limited experience dictated, or, still more
probably, have concentrated at the Isthmus, where the strength of
the land position would have been more than negatived by the
weakness of the position at sea.
Eurybiades, the commander-in-chief, is unfortunate in the setting
in which he appears in the history of the time. His must have been
an unenviable and difficult part. The diplomacy he had to employ in
order to accommodate contending policies would seem to both sides
a proof of vacillation. Herodotus’ picture of him is not wholly
sympathetic; and yet it makes it quite clear that he was intelligent
enough to appreciate the genius of the man who was technically his
subordinate, and diplomatic enough to give the advocates of the
Northern policy a victory without provoking a fatal outbreak among
the advocates of a different design. Nor is this a small tribute to the
man’s capacity. The Peloponnesians, and especially the Corinthian
opponents of the war-policy of Themistocles, were not people who
could be kept in order even by the strong hand of Sparta, unless
history draws a very misleading picture of the circumstances within
the Peloponnesian league; and the man who captained the Greek
defence through the troubles within and without of the year 480
cannot have been lacking in ability, even though he had at his side a
pilot of the genius of Themistocles.
The failure to support Leonidas at Thermopylæ utterly changed
the strategical conditions on which the design of the defence had
been hitherto founded, and the practical surrender of the other
defensive lines north of the Isthmus completed the wreck of the plan.
The Greek fleet on its return to Salamis found that no effort had been
made, and no real intention had existed, to send an army even into
Bœotia. It is noteworthy, however, that if the fleet really did suppose
that the army was in Bœotia, and was not undeceived on this point
until it arrived at Salamis, its commanders made a great mistake in
not holding the narrows at Chalkis, and thus preventing the landing
of Persian troops in rear of the most eminently defensive passage in
Bœotia, that long strip of narrow land between Helicon and Kopais
which extended from Chæroneia to Haliartos.
The strategy which was forced upon Themistocles by the state of
things which he discovered in existence on his return to the Saronic
gulf was the strategy of despair. The position taken up at Salamis
could only be justified on the plea that there were no other narrow
waters between it and the Isthmus where the Greek fleet could be
sheltered from the disadvantage of meeting a more numerous fleet
in the open, a large portion of which, the Phœnician, was probably
superior to it in manœuvring power. Furthermore, if the Persian
commanders took the view that the fleet at Salamis must be
defeated before an advance to the Isthmus were attempted, and
detained their ships on the Attic coast, then the Persian land army,
unaccompanied by the fleet, would be rendered incapable of any
sustained attack on the fortifications which the Peloponnesians had
erected. But that “if” was one of terrible
SALAMIS.
significance, and the evidently nervous desire
of Themistocles to bring about a battle must have been due to his
recognition of the precarious position in which the Greeks would be
placed supposing that the Persian fleet did choose to ignore them at
Salamis. The most fatal weakness in an altogether dangerous
situation was that a large portion of the population of Attica was on
Salamis Island, and could not possibly be left to the mercy of the foe.
How it came about that the Athenians gave such hostages to
fortune, instead of removing them to the coast of Argolis, can only be
conjectured. The probability is that the interval between the arrival of
the Greek fleet at Salamis and that of the Persian at Phaleron had
been too brief to render it possible for the whole Attic population to
be transported across the Saronic gulf.
 The blunder which led Xerxes to attack the Greeks at Salamis
was fatal alike tactically and strategically. He had the game in his
own hand, if he could only have recognized the fact; but in his
confidence of success with the forces at his disposal, he wished not
merely to out-manœuvre but to capture the whole Greek fleet.
The results of Salamis were immediate. The defeat and moral
disorganization of the Persian fleet made it incapable of maintaining
its position on the west side of the Ægean, though in point of
material damage, relative to numbers, it is probable that it had not
suffered more severely than the fleet which had been opposed to it.
Its departure withdrew, as it were, the keystone of the Persian plan
of invasion; and the whole edifice of design fell into ruin which was
incapable of repair, though the wreck was not so complete as to
render it impossible for Mardonius to make use of the materials in
the ensuing year. The blow had fallen on the indispensable half of
the invading force; and, bereft of the aid of the fleet, the land army
could no longer maintain itself in a country whose natural resources
were wholly inadequate to supply its wants.
According to the account followed by Herodotus, Themistocles
proposed that the Greek fleet should immediately take the offensive
on the Asian coast. The evident confusion of the story as to date
renders it difficult to say whether the proposal was a wise one or not.
It was, however, rejected by Eurybiades, who up to that time had
displayed sound common sense; and if it was really made at the
date to which Herodotus attributes it, there can be little doubt that
Eurybiades was right. The time for offensive operations had not
come; for anything of the nature of a reverse on the Asian coast
might have restored once more all the evils of the previous situation
in Greece; and it is quite possible that some argument to this effect
put forward by Eurybiades has been translated into the form of his
answer to Themistocles as given by Herodotus.
The actual design which Mardonius had in his mind when he
persuaded Xerxes to leave with him in Thessaly the most effective
part of the army of invasion is beyond conjecture at the present day.
Possibly he had at the time no very definite plan, but was content to
guide, and be guided by, events. His retirement to Thessaly was
certainly due to the question of commissariat. The country was
infinitely richer than the rest of Greece, and, besides, he had to
organize a new line of communications along the North Ægean
coast. With this intent, probably, Artabazos accompanied the retreat
of Xerxes as far as the Hellespont. The winter gave Mardonius time
to form his plans for the next campaign, and though Herodotus does
not profess to know what the plans were, the operations during the
summer of 479 give something more than a clue as to their nature.
Mardonius seems to have formed a design of two alternatives.
He knew, on the one hand, that unless the Persian fleet could be
brought back across the Ægean, an attack on the Isthmus would be
hopeless, if not impossible; in other words, the complete subjugation
of Greece was out of the question. But so long as the Greek fleet
remained as powerful as at that moment, it was also hopeless to
expect the return of the Persian; and the first problem he had to
solve was how to rob the Greek fleet of its strength.
With this intent, negotiations were opened with Athens, through
the medium of Alexander the Macedonian. When this line of action
proved ineffective, he brought pressure to bear upon the Athenians
by once more invading their territory and occupying Athens. This
again had no effect, except to make them even
DESIGNS OF
more stubborn in their refusal to treat.
MARDONIUS.
The first alternative plan had failed at its
outset, so he now resorted to the second.
After burning Athens and committing devastation in Attica he
retired into Bœotia, using Thebes as his base of operations.
There are two remarkable facts in connection with this movement
The disaster at Salamis, and the consequent retirement of the
Persian army to Thessaly, had not shaken the loyalty of Bœotia to
the Persian cause, and this despite the fact that the Bœotians were
not at the end of 480 deeply committed either to the Persian, or
against the Greek. Bœotians had, indeed, been present in Xerxes’
army when it invaded Attica; but there is nothing whatever on record
which can favour the supposition that the Bœotians had actually