The Best of Both Worlds: Unpacking the Brain–Body Connection

A conversation with Dr. Emily Smith, PhD

[This blog post is an excerpt from a podcast episode. You can watch the full episode here!]

For those short on time, here’s how you can use the insights from this interview right away:

1.  Help change the conversation

• Model person-first language (e.g., “they have anxiety” not “they’re anxious”).

• Avoid framing health struggles (both physical and mental) as laziness or lack of effort.

• Reinforce the idea that health challenges and diagnoses do not define a person.

2. Normalize having conversations early

• Talk about mental health the same way you would physical health.

• Create and cultivate spaces (e.g., at home, in classrooms) where youth feel safe speaking up without judgment.

• Identify resources, including potential supports within your community, that you can share with those who want to learn more.

3. Support healthy lifestyle habits without shame

• Encourage sleep, balanced nutrition, and physical activity as a way to improve your overall health, not just fitness or appearance.

• Avoid fear-based messaging! Instead, focus on long-term wellbeing and daily functioning.

• Pay attention to changes in motivation, sleep, mood, or social withdrawal that could indicate potential worsening health.

For those interested, let’s dive into the conversation a little deeper…

NATE: Prior to getting into the facts, because I want to know a lot more about this, I'd love to first go into some myths here because metabolic health, we talk a lot about this. I think most people think, you know, obesity and things like that. And then of course, mental health is among the general public, it's like a separate area of research and medicine, but you work at the intersection of these. What are some things that most of us just don't understand or that we maybe do understand but in the wrong way? 

EMILY: Yeah, I think that's a really important question. I think one of the main things that I want to address right off the bat is that people are not their illness, and it's important to talk about illnesses in the way that someone has an illness. They are not, you know, ‘schizophrenic’. They're not ‘psychotic’. They have psychosis or they have schizophrenia. And that's a really important distinction to make because it colors how we approach these conversations within the community and it really does impact how patients view themselves, and that can impact the trajectory of their treatment and their illness course. 

And I want to really dispel the myth that people with severe mental illness, so that encompasses schizophrenia spectrum disorders, major depressive disorder, and bipolar disorder, that they're lazy or that they aren't doing what they should to take care of themselves. I want to emphasize that often the medications that they're on, they will develop metabolic problems that then impact their ability to carry out day-to-day functioning. So what a lot of people don't know is that metabolic illnesses such as obesity and insulin resistance can actually affect cognition. They can affect your ability to engage normally within the community. And so that's something that isn't always really realized or talked about: that these metabolic impacts can directly impact the ability of your brain to function. So that's something that I really want to get out there and make sure people know that these are truly connected. 

And then one other thing I want to dispel is that people think that if you're on a psychiatric medication that oh, your symptoms are magically taken care of. You should be fine, you should be able to function, and if you don't, then that's on you. That's your fault. You need to try harder. Actually, in the specific case of schizophrenia spectrum disorders, the medications we have are pretty good at treating psychosis and ‘positive symptoms’, which are things like hallucinations and delusions, but they actually don't really have much of an effect on what we call ‘negative symptoms’, which are things related to motivation, pleasure, low mood, fatigue. So it can be very difficult for individuals even if their psychosis is treated to again function normally day-to-day. So that's something else I want to dispel as a myth that medication solves all—it doesn't.

NATE: So much to unpack there and I think you hit the nail on the head in regards to the view of the public on these things. These are things that people don't necessarily remain aware of whenever they might be passively or actively judging someone and their surroundings. And forgive me if I'm asking a question that has no answer, I have to ask it because I know that anyone listening has this question with what you've described about some of these medications having their own effects. So, you know, we have the symptoms from the disorder itself and then we might have secondary symptoms from the medication. Is there a solution for this? You know what I mean? If someone is in a position where they might need or greatly benefit from a medication yet it's going to have these downstream metabolic effects that might decrease their quality of life. What are we typically telling these people in clinical environments?

EMILY: Well, as you said, there might not be a one-size fits all. There might not be a true answer for this, but it is typically quite a risk–benefit trade-off that happens. So, one thing that we've noticed in the field is that some of the most efficacious antipsychotics, and I'll focus on antipsychotics because that is my area of expertise, but some of the most efficacious ones also tend to have the highest risk for metabolic side effects. There is potentially something underlying in terms of mechanisms that these medications are affecting both of these pathways, and it's hard to tease those out. So, when it comes to choosing a medication to put a person on initially, it's really important to have a discussion with them about the risks and benefits of the different kinds of medications that we have. It's still not perfect, but the field is trying to move towards engaging patients actively in their antipsychotic choice, but in general there's no real way of getting away from these metabolic side effects because antipsychotics do remain the gold standard treatment for these conditions. So, we're still relying on these really tough medications for patients to take. And I think ultimately, it comes down to having that discussion with them right off the bat and kind of putting in place precautions in terms of lifestyle as well as adjunctive medication. So, it's now common practice to co-prescribe metformin, which is an anti-diabetic medication to individuals either when they start antipsychotics or early on in their journey with antipsychotics to try to help mitigate those metabolic risks. There is no pure solution yet. I think we need a better mechanistic understanding to get there, but we're working on it. That's what we're trying to do. 

NATE: And that's what I was going to say. You're out there finding it for us and I think that's amazing. But I'd love to zoom back out I guess for the next few questions, you know what does this mean big picture for society? As a first, I'd love to know, you spent five plus years in a lab studying this and you plan to continue to do so which I really admire, if there was one thing that you wish that everybody in the world could know and really take to heart that you have learned in that five plus years, what would you isolate? And I know that's a difficult question. 

EMILY: It is a difficult question. I think I'm even going to zoom out farther than my research question if that's okay because ultimately one of the biggest lessons that I've learned during my research is kind of what I mentioned before that there's this stigma in our society that people with mental illness are scary or they're different from us. But truly, mental illness is just a condition that people have, similar to how you might have a physical illness. It does manifest in different ways, and it can be a little more complex to understand because it is more personal, but ultimately people are not their illness and it's important to recognize that and treat them as such. People with mental illness, they're just people. They want human connection. They want to be part of the community. They want to be able to live a good life. I don't think it's fair to them as a society for us to alienate them and treat them like these ‘others’. I think that's something that we really need to work on as a society. And it's getting better for sure, but there's still a lot of boundaries and barriers, and there's still a lot of misconception. Particularly the media will often misrepresent people with mental illness, and it's often thought that people with these conditions are violent and dangerous, but actually, the statistics show that people with severe mental illness are more likely to be the victim of violence rather than to perpetrate violence. So, it's just something that I really want people to take away from this conversation if that's the only thing they take away that, you know, people are people and let's treat them like that. 

The one thing I will say that is more related to my research is that the brain–body connection, it exists. There's evidence to support that your mental health can affect your physical health and vice versa. And I think I want people to understand that if people are struggling with either aspect, you can't expect them to be able to function optimally. So I think that's something, again, that we need to just kind of consider as a society and realize that this is something that we need to try to tackle together and make sure that people are supported in their journey.

NATE: I have to ask you yet another very difficult question to bridge from there because at the capsule, one of our big focuses is how we can bring research into the development space like the school system to enhance outcomes. And I think both points you made, we can make a case that it's most important that education on these things take place in our youth so that we don't carry this stigma into adulthood. And then secondly, in caring for our own wellness and that of those around us, we are aware of the brain–body connection and how our habits might moderate this. So here's the tall task for you, the difficult question. If you had unlimited funding, unlimited public support, and you had the opportunity to reform something about the education system or even within communities to emphasize these two points and to raise awareness for these things at a young age, what are some important implementations that you would make based on what you know as a researcher?

EMILY: Yeah, that's a great question. I mean, as a researcher, I would love to see some kind of curriculum change to really emphasize this [brain–body] connection more because right now, at least when I was in high school, for example, we took one health class and we talked about nutrition a little bit, but it was more about, you know, just eat your fruits and vegetables, get your X servings of carbohydrates, X servings of protein, things like that. But it didn't really go into why this is important and how it can impact your life down the road. Because something I do want to emphasize is that these metabolic problems can accumulate over time, and there's a cumulative effect of poor lifestyle and poor dietary habits that can really impact you later in life. So yeah, when you're young, sure, you maybe have the metabolism to eat more fatty foods, eat more processed foods, but there's something happening more at the cellular, mechanistic level that you might not be aware of and that's not manifesting yet, but it could later down the road. And so I'd just love to see something more in curriculums even if it's not a full course, just taking more time to acknowledge this connection, which I think scientists, we can also do better at trying to do outreach to schools and incorporate it that way, but I'd love to see that kind of integrated so that that every student is getting exposed to this information or getting the opportunity to learn about it. Because, as you mentioned, it can impact everyone in the general population as well, and it's something that people don't often think about. Typically, if you're not overtly sick or you're not diagnosed with something specific, they might not necessarily think to take care of themselves in this way and make that connection, but I think it's important for everyone that they do.

And then also in terms of curriculum, I would love to see mental health talked about more. From what I recall, honestly, I only really learned about mental health and mental illnesses in undergrad, and that's because I had a specific course related to psychology and the brain. So, I think it's just something that would again be helpful to help reduce the stigma and make it an easier conversation for people to have within the community if we start early. I think in high school, at least in the upper years, people are mature enough to handle conversations like this. And actually, children and youth are some of the most affected individuals with mental illness. A lot of illnesses start early on, and those times are the crucial moments when you want to diagnose and start treating because again, there are consequences of letting these symptoms continue untreated for a long time. We do see that in the population that our lab works with: that a longer duration of untreated psychosis, for example, can actually make it harder to improve outcomes later down the road. It's really important, I think, to start these conversations early and make sure that people are getting the support that they need in these areas and that they feel comfortable talking about it. Because I think that's something that our society also struggles a lot with: people still aren't feeling comfortable expressing their needs in this way because there is still so much stigma and so much that's not known.

NATE: I love each piece of that. I'm a big believer in the idea that perception plays a major role in recovery and you talked a lot about basically how we view these conditions, either if we ourselves are suffering from them or perhaps we know someone. And I think ultimately that might be the biggest rock, if you will, of early intervention, is kind of shifting this perception. And I think you've given very tangible ways of doing this because this is kind of a buzzword topic where it's like, you know, we need to increase mental health support. We need to increase mental health awareness. Well, there's the blueprint. So, thank you so much for not only the information on the scientific side, but on the call to action really, because I think a lot of people out there really need to hear this.