CGPR: You have a distinctive background as a physician, chef, and lifestyle medicine specialist. How did that path come together?
Dr. Polak: I’m a family physician, but midway through my medical training I decided I also wanted to become a chef. I enrolled at Le Cordon Bleu, completed my culinary education, and then returned to finish my medical degree. That dual background led me to the Institute of Lifestyle Medicine at Harvard Medical School, where I became the first lifestyle medicine fellow.

CGPR: Psychiatrists often acknowledge that nutrition matters for mental health but feel it falls outside their scope of practice. Is that perception accurate?
Dr. Polak: That hesitation isn’t unique to psychiatry. But I’d push back on the premise. Psychiatrists already ask about sleep, exercise, and substance use as part of routine care. Diet is no different. You don’t need to be a nutritionist to ask a patient what they’ve been eating, whether they’re cooking at home, or whether they’re relying on fast food. Those questions take two minutes and can yield clinically significant information. Epidemiological data link dietary patterns, particularly Mediterranean-style diets, to reduced rates of depression and cognitive decline (Lassale C et al, Mol Psychiatry 2019;24(7):965–989; Scarmeas N et al, Lancet Neurol 2018;17(11):1006–1015). Inflammation, heavily influenced by what we eat, is increasingly recognized as a contributor to both mood disorders and neurodegeneration (Upthegrove R et al, JAMA Psychiatry 2025;82(10):1030–1046). Psychiatrists are already thinking about inflammation in the context of treatment resistance and metabolic side effects. Nutrition fits naturally into that framework.

CGPR: You’ve mentioned the Mediterranean diet. Is that the dietary pattern you recommend most strongly for older adults with psychiatric concerns?
Dr. Polak: The Mediterranean diet has the strongest evidence base, particularly for depression and cognitive aging, so it’s a natural reference point. But I’m cautious about leading with it as a label in clinical conversations. For many patients, especially older adults whose eating habits are deeply established, being told to follow a “Mediterranean diet” can feel abstract, culturally mismatched, or simply overwhelming. I prefer to work with the principles rather than the brand. I recommend more vegetables, whole grains, legumes, and fish, and less ultra-processed food. A patient can understand “try to eat fish twice this week” far more readily than “adhere to a Mediterranean diet.”

CGPR: What are the most common nutritional gaps you see in older patients?
Dr. Polak: Protein is the most underappreciated gap, and there’s a practical reason for it. Grains and fruit are easy. You can cut bread or grab a piece of fruit with almost no preparation. Protein usually requires cooking. The patients most at risk are older adults who live alone, lack energy, or don’t see the point of cooking for one. Adequate protein helps maintain muscle mass and strength, supporting mobility and reducing fall risk. Beyond protein, I frequently see deficits in vitamin B12, folate, and sometimes iron and vitamin D. Psychiatrists already know B12 and folate well as standard considerations in mood and cognitive workups. These deficiencies often develop gradually and present subtly, as mild fatigue, low mood, or cognitive sluggishness that’s easy to attribute to aging or depression rather than nutrition. Iron deficiency, for example, can cause fatigue even before anemia develops, a finding that won’t show up unless you’re looking for it.

CGPR: What clinical cues should prompt a closer look for these nutritional deficiencies?
Dr. Polak: A patient who lives alone, spends most of their time watching television, relies heavily on takeout, and rarely cooks is a patient with a high likelihood of nutritional gaps. Social isolation and sedentary behavior are proxies for poor dietary patterns in older adults. Once those cues are present, labs are the natural next step. Annual bloodwork is already standard for older adults, as glucose and lipid panels are routine. Folate, B12, iron, and vitamin D can be added to that panel. I’d screen B12 proactively in any patient who identifies as vegan or vegetarian and consider screening more broadly in patients with unexplained mood symptoms, cognitive complaints, fatigue, or significant weight loss.

CGPR: For B12 and folate specifically, what dietary sources should psychiatrists recommend?
Dr. Polak: B12 is found primarily in animal-based proteins. Beef is the most concentrated source, but eggs, dairy, and other meats contribute meaningfully as well. For older patients who are vegan or vegetarian, supplementation is often necessary. Older adults absorb B12 less efficiently due to reduced gastric acid production. I’d flag those patients for proactive B12 screening. For folate, the answer is green leafy vegetables: spinach, lettuce, cabbage, kale. Pre-washed bags are convenient, though patients should rewash greens at home given periodic contamination recalls. One nuance worth raising is that fresh home-cooked beef and ultra-processed beef products are nutritionally quite different. Much of the literature’s concern about red meat applies specifically to processed forms like deli meats, hot dogs, and packaged meat products, which are associated with higher risks of cardiovascular disease and colorectal cancer. Ground beef falls in the middle, as it’s mechanically processed but without the additives and preservatives of ultra-processed meats, making it a reasonable home-cooked option, particularly for older adults who find ground beef easier to chew and prepare than whole cuts.

“Psychiatrists already ask about sleep, exercise, and substance use as part of routine care. Diet is no different. You don’t need to be a nutritionist to ask a patient what they’ve been eating.”
Rani Polak, MD, Chef, MBA

CGPR: What about checking vitamin D in older adults?
Dr. Polak: Vitamin D deficiency is extremely common in this population for several reasons, including reduced sun exposure, decreased skin synthesis efficiency with age, low dietary intake, and limited consumption of the foods richest in vitamin D, primarily fatty fish and fortified dairy products. The links between vitamin D deficiency and depression, cognitive decline, and even dementia risk are biologically plausible and supported by observational data, though the interventional evidence from supplementation trials has been more mixed (Ronaldson A et al, Psychol Med 2022;52(10):1866–1974; Goodwill AM and Szoeke C, J Am Geriatr Soc 2017;65(10):2161–2168). My clinical approach is to screen routinely in older adults and particularly those who are housebound, institutionalized, or living in northern climates with limited sun exposure. When deficiency is identified, I prioritize food-based sources when possible. Home-prepared, nutrient-dense meals provide a broader range of vitamins and minerals, though I use supplementation as needed to correct deficiencies. Fatty fish is the strongest dietary source, which creates a nice overlap with the omega-3 conversation.

CGPR: We’ve been talking about what patients eat. What about how they engage with food? Can the process of cooking itself be therapeutic?
Dr. Polak: This is something I feel strongly about and think is underappreciated. An RCT of our culinary medicine program found that home cooking emerged as a genuine coping strategy during the COVID-19 pandemic (Silver JK et al, Nutrients 2021;13(7):2311). Participants described a sense of control and structure during a destabilizing time. For older adults facing isolation, loss of role, and diminished purpose, cooking offers more than nutrition. It can bring some routine back into the day and create moments of connection, like cooking for a grandchild or sharing a meal. It also engages the mind and leaves patients something tangible at the end, which can matter when other ways of contributing feel less available. Not everyone can cook independently. But even small roles, like choosing recipes, helping with simple tasks, or being part of a shared meal, can help maintain a sense of agency and connection. I’d encourage psychiatrists to ask not just what patients are eating, but how they’re engaging with food in daily life.

CGPR: For patients who genuinely cannot or will not cook, how do you adapt your recommendations?
Dr. Polak: I think in tiers based on what a patient can realistically do. If energy or motivation are low, I start with no-cook options: canned chickpeas, pre-washed greens, cherry tomatoes, mini cucumbers, carrots, whole-grain bread, or alternatives like tortillas, rice noodles, or rice paper. Canned legumes and fish are quite nutritious. I’ll often ask what they ate yesterday, as this helps me suggest small upgrades. Cost comes up a lot. Pre-cut and pre-washed foods are helpful, but they’re more expensive and spoil quickly, which can be tough on a fixed income. Frozen vegetables are a great middle ground, as they’re affordable, longer-lasting, and microwaveable. Raw options like carrots, tomatoes, and cucumbers are easy too. And “cooking” doesn’t have to mean the stove. Microwaving, blending, and simple mixing all count. Patients who are uncomfortable using the stove can still microwave oatmeal, a baked potato, or vegetables. Smoothies with frozen fruit and a simple blender are another easy, nutrient-dense option.

CGPR: How do you approach patients with physical limitations or reduced independence?
Dr. Polak: When someone stops cooking, I think about whether there’s a new physical barrier. It’s important not to assume patients can’t cook, as many can with the right adaptations. I remember a stroke patient who couldn’t chop hard, raw vegetables; we worked around this by pre-cooking to soften them first. For patients with more capacity, I introduce batch cooking and freezing, which can expand options with minimal effort. I also involve caregivers when needed, focusing on shared tasks: Someone might help with prep or shopping, while the patient still assembles or heats meals. The goal is to keep food preparation doable while preserving as much independence as possible.

CGPR: Can you walk us through recommending batch cooking in practice?
Dr. Polak: The phrase I use with patients is “cooking while you’re not in the kitchen.” I’m talking about foods that require very little active effort but make multiple meals, like roasting a tray of vegetables or baking several portions of fish at once. You might spend 10–15 minutes prepping, but the oven does the rest. That cognitive reframe, from cooking as active labor to more of a background process, is often more impactful than any specific recipe. In terms of staple foods, I consistently return to a short list: chicken breast, fish, and tofu; orange lentils that cook in three minutes; and whole-grain couscous and bulgur that just need boiling water. Vegetables are essential. For patients with lower energy, I often suggest options with a longer shelf life like carrots, beets, and cabbage. Once patients have two or three of these in their refrigerator, they have the skeleton of multiple meals.

CGPR: Does freezing and reheating food meaningfully affect its nutritional value?
Dr. Polak: It’s true that some nutrients are lost in cooking and storage. Heat-sensitive vitamins, particularly certain B vitamins and vitamin C, degrade with cooking and over time in storage. But I encourage clinicians to frame this carefully, because the framing matters enormously for patient behavior. Proteins, minerals like iron, and fiber are unaffected by freezing. Also, the losses are modest and need to be weighed against the realistic alternative, which is often fast food, skipped meals, or nutritionally empty convenience foods. A frozen and reheated portion of home-cooked lentils or chicken breast is nutritionally superior to almost anything a patient would order instead. At the same time, I try to avoid overly rigid or “all-or-nothing” messaging. It’s okay to include ultra-processed foods that a patient enjoys, and it’s certainly better to eat something than to go hungry. The goal is to build on what patients are already doing and gradually improve nutritional quality, rather than impose unrealistic standards.

CGPR: How do you think about fresh fish versus canned fish versus omega-3 supplements?
Dr. Polak: As a general principle, whole food is preferable to supplementation. I recommend supplements only when bloodwork confirms a deficit. If a patient isn’t eating fish, they’re likely eating something less healthy in its place, and adding an omega-3 capsule doesn’t compensate for an otherwise poor diet. Fresh fatty fish like salmon, mackerel, and sardines is the gold standard, providing both omega-3s and vitamin D. Canned fish is reasonable for patients with limited access or budget, though canned tuna tends to have less omega-3 content than fresh alternatives; research suggests its benefits don’t always match fresh fish consumption (Conti S et al, Br J Nutr 2024;131(11):1892–1901). I use canned tuna primarily as a protein source and steer patients toward canned salmon or sardines for fuller nutritional benefit. For vegetarians and vegans, flaxseed, chia seeds, and walnuts contain plant-based omega-3s, though the body converts these poorly to the active forms found in fish; algae-based supplements are the most direct alternative.

CGPR: How should psychiatrists raise the topic of nutrition with patients who haven’t brought it up themselves?
Dr. Polak: The entry point I recommend is simple and non-judgmental: “Can you tell me a little about what your eating has been like lately?” or “Are you cooking at home, or mostly getting food from outside?” From there, you listen for the cues we’ve discussed—including isolation, reliance on takeout, skipping meals, and low energy for cooking—then respond to what you hear. The goal of the initial conversation is to establish that food is something you’re interested in as part of their care, and to identify whether there is one concrete thing they might be willing to try. That might be adding one serving of vegetables per day or even once a week, trying canned chickpeas, or buying pre-washed salad greens. If a caregiver is involved, I broaden the conversation to include them. In those cases, it’s less about individual behavior change and more about what’s realistic within the caregiving setup: who is shopping, who is preparing food, and what feels feasible. Small adjustments still apply, but they may need to be framed at the level of the household rather than the individual patient.

CGPR: For clinicians without time for an in-depth nutrition discussion, is it worth referring to a dietitian or a nutritionist?
Dr. Polak: A brief question and a single concrete recommendation are within every clinician’s reach. But for patients with significant weight loss, multiple deficiencies, or complex medical diets, a referral is worthwhile. I’d recommend a registered dietitian over a nutritionist, as a dietitian is a protected, licensed title; the title of nutritionist is not regulated in most states. For clinicians wanting to build their own foundation, the American College of Lifestyle Medicine (www.lifestylemedicine.org) is a good starting point.

CGPR: If you could give psychiatrists practical takeaways for discussing nutrition with their patients, what would they be?
Dr. Polak: The first is to encourage any movement away from ultra-processed food toward home cooking. Even one or two additional home-cooked meals per week represents meaningful progress, and the benefit isn’t only nutritional. The structure, agency, and accomplishment that come with cooking carry their own therapeutic value. The second is to make recommendations concrete rather than abstract. Don’t say, “Eat more vegetables.” Say, “Buy a bag of pre-washed spinach. Open a can of chickpeas. Mix them with olive oil and lemon.” Tailor the approach to what the patient can realistically manage. And when a patient makes even a small change, acknowledge it explicitly. Behavioral change is hard, and reinforcement from a trusted clinician carries real weight.

CGPR: Thank you for your time, Dr. Polak.