The Art of Manliness - The Brain Energy Theory of Mental Illness

00:00:00.000 brett mckay here and welcome to another edition of the art of manliness podcast

00:00:10.740 mental illnesses of all kinds are on the rise yet we seem no closer to being able to treat

00:00:15.460 them effectively we're only able to treat the symptoms of mental illness but aren't often

00:00:19.680 able to put the illness into remission because its root cause has been a mystery my guest

00:00:23.980 however believes he knows exactly what the root cause of mental illness is and thus how to finally

00:00:28.280 resolve it for good his name is dr christopher palmer he's a harvard psychiatrist and the author

00:00:32.760 of brain energy a revolutionary breakthrough in understanding mental health today on the show

00:00:37.540 chris unpacks his theory of mental illness which basically comes down to this if your brain cells

00:00:42.100 aren't getting enough energy they're not going to function properly he explains how numerous and

00:00:46.660 seemingly diverse mental illnesses from anxiety and depression to adhd and alcoholism actually all

00:00:52.100 have a common pathway metabolic disorders while we typically think of metabolism as related to the

00:00:57.540 physical body it also greatly affects the mind and chris explains how you can have the kind of

00:01:02.000 metabolic problems that cause mental illness even if you're not overweight chris then shares how

00:01:06.560 certain lifestyle changes like switching to a ketogenic diet may be able to completely cure mental

00:01:11.480 illness after show's over check out our show notes at awim.is brain energy

00:01:15.800 all right dr christopher palmer welcome to the show thank you brett for having me so you are a

00:01:38.020 assistant professor of psychiatry at harvard medical school and you got a new book out called brain

00:01:42.540 brain energy where you lay out this new theory about a potential underlying cause of all mental

00:01:49.380 illness depression anxiety ocd even bipolar disorder it's really interesting but before we get into the

00:01:56.020 theory let's talk about why treating mental illness has been so difficult because you know mental health

00:02:02.460 is something society has been focusing more on uh we're talking more about it we're researching it more

00:02:07.840 you know millions billions billions of dollars have gone into studying it but more and more people are

00:02:14.160 struggling with mental illness the numbers keep going up so why has mental illness been so hard to treat

00:02:19.660 the end of the day the real reason is because nobody can say for sure what causes mental illness

00:02:28.480 all we know are some of the factors involved we know that neurotransmitters seem to play a role

00:02:35.840 hormones genetics and epigenetics inflammation but also psychological and social factors things like

00:02:44.660 trauma and stress and substance use and all of these things seem to play a role in mental illness but

00:02:53.840 nobody knows how they all come together nobody knows how they impact the brain to result in what we call

00:03:00.600 mental illness and so largely all we have are treatments that were usually discovered through serendipity

00:03:09.720 so you know the first antipsychotic medication was actually being used for anesthesia the first

00:03:17.620 antidepressant discovered was actually an anti-tuberculosis treatment and so these medications were

00:03:25.160 discovered through serendipity and we largely still don't fully understand how they work or why they

00:03:33.260 decrease symptoms but for the most part what is clear is that our treatments only decrease the

00:03:41.340 symptoms for the most part we don't have cures for mental illness and this even includes things like

00:03:49.120 psychotherapy that when somebody is suffering from post-traumatic stress disorder or even chronic

00:03:55.500 depression psychotherapy more often than not does not cure mental illness and so we are largely just

00:04:04.700 scrambling just throwing any treatments we can think of at people with mental illness but the sad reality

00:04:13.420 is when you look at the overall treatment outcomes and i don't say this lightly i'm a harvard psychiatrist

00:04:19.860 i take this field very seriously and more importantly i take the suffering of people with mental illness quite

00:04:26.460 seriously and for people who are getting effective help that's great and i'm not here anything away from

00:04:34.400 you if your medications are working for you that's fantastic if psychotherapy has cured you

00:04:40.780 that's fantastic i don't want to take any of that away but for most people with mental illness who get

00:04:49.040 treatment well over 50 percent of people who get treatment for mental illness they do not get

00:04:57.040 remission of illness meaning their illness is no longer there and even if they do get a remission

00:05:06.600 it is almost always short-lived meaning it can go away for six months or a year or so but the symptoms

00:05:14.460 are going to come back and you're going to have to be changing pills or finding a new psychotherapist

00:05:21.160 or doing something different because your illness is a chronic debilitating illness and you know although

00:05:29.060 that sounds really bleak and abysmal and pessimistic it is the reality and for anybody who questions that

00:05:38.220 the reality is that mental disorders are now the leading cause of disability

00:05:42.820 in the united states and on the planet and it's not because people aren't getting treatment it's because

00:05:48.540 our treatments are failing to work

00:05:50.500 and the number one disabling disorder of all psychiatric disorders it's not schizophrenia

00:05:58.080 it's not bipolar it's plain old simple depression depression disables more human beings than any

00:06:07.500 medical illness including heart failure cancer back pain all physical disorders depression disables

00:06:18.060 more people than anything else on the planet yeah and as you said there's what when people treat

00:06:24.560 mental illness there's basically there's two i guess in the history of mental health there is two

00:06:30.560 approaches there's there's a physiological approach and then there's the psychological so like the mind

00:06:36.100 body and so the body part is like well you know that what's going on is your brain uh it's not making

00:06:42.640 enough neurotransmitters so we'll give you a a drug that will help and that helps some people right

00:06:48.200 because maybe that that is a symptom they have lower serotonin for example maybe maybe we don't know

00:06:52.820 but then other there's another field of cancer well no it's not a a body or physiological thing it's just

00:06:58.460 it's a psychological though your mind it's got uh maladaptive thoughts so if you do talk therapy

00:07:04.440 that will help well it helps some people and that's the thing it's like it's hit or miss like you know

00:07:09.760 the the medication might help someone but not help another person and then talk therapy might help

00:07:15.100 somebody but not the other person and it's because there's doctors are just having to figure out well

00:07:20.860 what's the uh the symptom that we need to reduce you're not actually treating the underlying cause

00:07:25.420 you're just trying to reduce symptoms so people have a functioning life absolutely i mean i think most

00:07:33.560 mental health clinicians who are treating patients are desperately hoping to treat the underlying

00:07:39.320 cause you know i think the mental health clinicians who are prescribing pills are hoping

00:07:43.620 to address that chemical imbalance and i think the psychotherapists who are delivering psychotherapy are

00:07:49.600 hoping to you know relieve the trauma in that person so that the person can let go of their trauma

00:07:57.680 and move on with their life but again when we look at the treatment outcome studies

00:08:04.500 even with the best of intentions even with the best efforts from all of these clinicians i'm not here

00:08:12.920 to fault any of them i i you know i'm one of them we're all doing our best but our current model of

00:08:22.120 mental health and mental illness and how to treat it is failing miserably and the other problem with

00:08:31.640 mental illness is there's no objective criteria right there's not like a an mri scan where you

00:08:36.180 can look on someone's brain who comes in with depression say yeah you've got depression i mean

00:08:40.600 there's been some studies saying that you know parts of the brain might light up less if you have

00:08:44.380 depression but that there's nothing definitive about or there's not a blood test you could take and

00:08:49.160 say yeah you've got ocd and so it's it's really you have to talk to the patient and it's like it's

00:08:55.080 there's subjective things in there and you can't downplay the subjective because if someone feels awful

00:08:59.720 you have to take them on their word but it gets tricky because like you're trying to a doctor's

00:09:04.360 trying to figure out well he says this if we do this will it change the outcome so that's the other

00:09:09.280 hard thing there's no definitive test for mental illness unlike cancer where you can look and say well

00:09:14.180 you got a tumor or there's a blood test and we still see the cancer there absolutely and it's really

00:09:20.360 interesting because if there is a definitive abnormality identified it's no longer considered a mental

00:09:27.140 illness so for example people with cancer often have mental symptoms they often can get severely

00:09:35.080 depressed and fatigued they can have concentration difficulties they can even have symptoms consistent

00:09:40.700 with like cognitive impairment even so far as dementia they can get delirious where they're

00:09:46.880 hallucinating or delusional and we don't call that a mental illness because we know that they have

00:09:54.280 cancer and they're getting cancer treatment and both cancer and its treatments can sometimes cause

00:10:00.380 those symptoms so in those cases we don't call it mental illness and so the sad reality is that

00:10:08.240 the people for whom we can't identify an objective cause we we put them in the category of mental disorders

00:10:16.660 so the goal is if if we could find an underlying common pathway for mental illness there was this would

00:10:23.080 allow us treatment could be more effective right because you could find the underlying thing and

00:10:28.100 let's start getting into your theory here the the first connection i'd like to make is that one thing

00:10:32.560 you note for potential underlying pathway for mental illness is that mental illnesses depression anxiety

00:10:39.820 ocd bipolar they all there's some overlap there what do you mean by that what are some examples of

00:10:45.440 overlap with mental illness so you know on the surface you know dsm it makes sense so dsm describes

00:10:56.100 different diagnostic categories ocd depression schizophrenia alcohol use disorder or alcoholism and

00:11:03.520 anorexia nervosa most people know what those things mean and they paint very different pictures of the

00:11:10.860 types of people that have those disorders the symptoms that those people are having and the

00:11:17.080 treatments that might be effective for those people and so on the surface dsm makes sense but when you

00:11:23.600 actually look at real people who have mental illness first and foremost it turns out that most people 0.67

00:11:31.140 have more than one certainly most people who are getting treatment do so on average one study found that

00:11:38.000 people getting treatment for mental health had three and a half different diagnoses so right there we

00:11:45.340 start to see some breakdown in these diagnostic distinctions so for example you could have

00:11:52.680 schizophrenia or anorexia but if i look at a group of people with schizophrenia they're much much more

00:11:59.420 likely to also have depression on top of their schizophrenia they're also more likely to have anxiety on top of

00:12:05.840 their schizophrenia and weight i thought those were different disorders with different causes

00:12:11.100 now a lot of people think well if you were schizophrenic wouldn't you be depressed and anxious

00:12:15.620 but it's not so simple because it turns out that people with depression and anxiety are actually more

00:12:21.680 likely to go on to develop schizophrenia too but if i look at a group of people with anorexia

00:12:27.360 they're also more likely to be depressed and anxious and you're like well well yeah i guess that makes sense

00:12:35.200 too but wait i thought these were all different disorders and now i'm looking at these different

00:12:40.360 people and clearly the schizophrenic person is having hallucinations and delusions and the person with

00:12:46.020 anorexia is starving herself or himself but and so those are clear differences but a lot of the other

00:12:54.960 symptoms and comorbid diagnoses start to overlap i think much much more important is that when we look at

00:13:03.380 root causes for mental illness because we do know some genetics is a clear example we have identified

00:13:10.520 some high risk genes for mental illness and most people think well you know they must be specific

00:13:20.080 to specific disorders like there must be some schizophrenia genes and some bipolar genes and some depression

00:13:25.820 genes and some anorexia genes but in fact that's not true at all and we know this we've had the human

00:13:34.100 genome mapped for over 20 years the top researchers have been on this we have had artificial intelligence

00:13:41.720 on the job we know with certainty there is not one gene in the whole human genome that confers risk for

00:13:51.280 any one specific mental disorder instead one gene confers risks for lots of different mental disorders

00:13:59.920 so one gene might confer risk for schizophrenia and depression and bipolar disorder and alcoholism

00:14:08.520 and epilepsy and cognitive impairment so when we look at a root cause like that it starts to you know

00:14:18.440 the the diagnoses really start to overlap a lot and when you start to look at all of that kind of

00:14:24.560 scientific data and all of the research that we have it turns out that mental illnesses are actually not

00:14:31.020 that distinct from each other after all even though the symptoms can be wildly different i'm not here to say

00:14:38.800 that psychosis is the same thing as depression those represent different areas of the brain malfunctioning

00:14:45.920 or they different represent different degrees of malfunction in the brain but they are actually

00:14:51.740 not as distinct as most people believe okay so let's get into the theory in brain energy and so this idea

00:15:00.560 that the all these mental illnesses they have there's something in common there there's overlap so

00:15:04.640 suggest that there's some underlying thing that's causing all of them and the argument you're making is that

00:15:09.940 that thing could be metabolic ill health and now we're going to dig into the details of how this

00:15:15.920 works i think it's really interesting but first you point out this idea that metabolism and mental

00:15:21.260 illness are connected this isn't a new idea we've other scientists have you know decades ago have kind of

00:15:26.380 made that suggestion how did they make that connection like where does that connection come from that

00:15:30.360 okay if you have depression then you have something wrong with your metabolism what how did that

00:15:36.220 connection happen so interestingly those connections go back centuries so in the 1800s it was well

00:15:46.240 documented that diabetes and insanity run in the same families and insanity was the term they used for

00:15:57.860 what we would now call schizophrenia and bipolar disorder largely but the researchers noticed that

00:16:05.340 in one family there seems to be a much higher likelihood of both diabetes and psychotic symptoms and it goes

00:16:19.280 both ways so if you have somebody with psychosis and they have children those children are more likely to

00:16:25.400 go on to develop diabetes but vice versa if you have somebody with diabetes and they have children

00:16:32.000 those children those children are more likely to not only develop diabetes but also develop a psychotic

00:16:37.920 disorder beginning in the 1940s we have had an accumulating and growing body of evidence that there are

00:16:47.140 metabolic abnormalities in the brains and bodies of people with mental disorders especially the chronic

00:16:54.060 serious mental disorders but it goes across the board depression anxiety PTSD all the way to bipolar and

00:17:01.580 schizophrenia you know we've done all of these brain imaging studies pect scans spec scans functional MRI

00:17:10.620 guess what those scans are measuring they're measuring brain metabolism so all of those studies are showing

00:17:17.700 differences in metabolism and cutting-edge research over the last 20 years has gotten much more specific

00:17:26.280 and granular all the way down to genes specific risk genes all the way down to the cellular level

00:17:33.160 identifying innumerable metabolic problems in people with mental illness so yeah just refresh your

00:17:40.780 metabolism is just your body's way of using energy or taking food and converting into energy and i think

00:17:45.940 people typically when they think about metabolism they think about things like diabetes because your

00:17:50.680 insulin is not working right or your cells aren't responsive to insulin or obesity if you have a

00:17:56.120 problem with obesity something's wrong with your metabolism where it's storing more fat than using the

00:18:00.020 energy but a point you make is that the big metabolic conditions we typically think of like diabetes

00:18:05.520 obesity even cardiovascular problems if you look at these people who are getting treated for those

00:18:10.760 issues oftentimes they have their there's mental health issues going on there right depression anxiety some

00:18:17.460 other serious ones and you know it's a it's correlation right so people would say well you know of course

00:18:23.480 someone who had a heart attack is going to be depressed right you had a heart attack but you said well

00:18:28.500 you're saying well hold on here well maybe there's something else going on there like maybe there's an

00:18:32.580 under like there's a connection beyond just having a heart attack but maybe the heart attack

00:18:37.300 and the depression has an underlying underlying cause it's that metabolism absolutely and we have an

00:18:44.600 abundance of evidence this is not speculation at all we have decades of research looking at the

00:18:51.180 connection for instance between heart attacks and depression and the you know as you said on the

00:18:59.520 surface a lot of people are like well if you had a heart attack wouldn't you be depressed and as

00:19:03.760 intuitive as that seems it the relationship actually goes the other way too people with depression

00:19:10.660 are twice as likely to have heart attacks and people with all chronic all mental disorders all of them

00:19:18.700 across the board whether they're chronic or not all mental disorders on average they die early deaths

00:19:26.100 on average men are losing 10 years of life women are losing seven years of life and guess what they're 0.59

00:19:33.460 all dying of the primary number one cause of death in the mentally ill across the board whether you've

00:19:41.180 got anxiety adhd schizophrenia bipolar alcoholism the number one cause of death is heart attacks

00:19:48.980 but in the mentally ill they are occurring almost a decade earlier on average so i think a lot of people

00:19:55.960 want to be thinking this is how does metabolism affect your mental health because i think most people think

00:20:01.280 metabolism they think well diabetes blood sugar weight gain so how does the metabolism affect your brain

00:20:07.800 what's going on there so at the end of the day metabolism you know is as you said it's about

00:20:14.200 taking food and oxygen and turning it into energy or building blocks that get used to maintain or grow cells

00:20:21.180 and energy and building blocks are essential to the function of all cells and that includes brain cells

00:20:29.560 if your brain cells are not getting enough energy or they aren't getting enough nutrients

00:20:35.740 guess what they aren't going to function properly and at the end of the day that is the easiest

00:20:43.180 simplest way to i can explain my theory is that if your brain cells aren't getting enough energy

00:20:50.540 they aren't going to function properly and that that malfunction can paradoxically be one of two

00:20:59.020 things cells can actually become underactive but cells can also become overactive or something we call

00:21:07.100 hyper excitable and and those two states kind of under activity of a cell or over activity or

00:21:16.040 hyper excitability of a cell can result in all of the symptoms all of them that we call symptoms of

00:21:23.800 mental illness so that is the easiest way for us to understand symptoms of depression or post-traumatic

00:21:30.780 stress disorder or even schizophrenia well what you do in this book you kind of walk people through

00:21:36.480 is how metabolism affects these different underlying causes of what we typically think of mental illness

00:21:41.800 so for example neurotransmitters right like you know there's something off with your dopamine or

00:21:46.720 serotonin but you point out research that metabolism plays a role in our neurotransmitters how does metabolism

00:21:54.040 affect our neurotransmitters so at the end of the day you know when metabolism is extraordinarily

00:22:01.080 complicated and in order to really start to understand what controls metabolism or what it means to have a

00:22:10.100 metabolic malfunction you actually have to start to go to this other level of the cell in these tiny

00:22:16.700 little things in most of our cells called mitochondria and mitochondria actually help us understand the

00:22:24.440 connections between metabolism and brain function so to answer your specific question what does metabolism

00:22:32.500 have to do with neurotransmitters I'm going to focus on metabolism but more importantly on

00:22:38.900 mitochondria which are these master regulators of metabolism and it turns out that mitochondria are

00:22:44.880 instrumental in producing the building blocks that make neurotransmitters so they produce the building

00:22:52.040 blocks and the energy required to make serotonin and dopamine and norepinephrine and GABA and

00:23:00.120 acetylcholine and other neurotransmitters but they also are directly involved in the release and the

00:23:11.200 regulation of these neurotransmitters and when researchers take mitochondria out of a cell but

00:23:18.320 kind of infuse artificially infuse energy or ATP into that cell the neurotransmitters actually do not get

00:23:27.200 released so it turns out that mitochondria are playing a critical role not just in metabolism but

00:23:34.680 in brain function broadly gotcha okay so the mitochondria can be off in that it's not it's not

00:23:42.200 producing enough energy right or it's producing too much so like the hyper excitability would be

00:23:47.880 something like bipolar disorder when you're having a manic phase like the cells your mitochondria is

00:23:52.580 probably producing too much energy for the cells in your brain and example of it being not enough be

00:23:57.700 like depression is that right it starts to get to it so hypomania and our mania is the one clear

00:24:05.560 example of the brain actually producing too much energy broadly almost every other disorder is actually

00:24:13.460 not producing enough energy and one of the paradoxes of this theory based on rigorous science and

00:24:21.860 you know decades of clinical observation one of the paradoxes is that when a cell is energy deprived

00:24:28.000 it can actually become overactive which is counterintuitive but cells have kind of an on cycle

00:24:39.280 and they have an off cycle they they get turned on but they also get turned off and energy is required

00:24:47.820 to do both of those things so cells needing energy to get turned on that kind of makes sense to most

00:24:54.200 people most people will get that but one of the paradoxes is that once a cell gets turned on it

00:25:01.200 actually has to have enough energy to turn itself off and that is a paradox because that can result so a cell

00:25:10.780 can get turned on and be on very weekly maybe it's only really operating at 60 capacity but it may not

00:25:18.980 have enough energy to fully turn itself off and that results in hyper excitability which can result in

00:25:27.960 some of the symptoms of mental illness we're gonna take a quick break for a word from our sponsors

00:25:32.340 and now back to the show so sometimes brain cells don't get enough energy and paradoxically this means

00:25:47.240 that they can't turn off which leads to them being to have hyper excitability right and then hyper

00:25:54.040 excitability can lead to mental illness do we know what it is about the hyper excitability of brain cells

00:26:00.700 that causes something like depression because like your depression you think well there's low energy

00:26:04.840 so what's going on there yeah it's a great question hyper excitable means that that cell is doing

00:26:11.960 something in an exaggerated way or it's doing something at the wrong time when it really shouldn't

00:26:20.000 be doing that so let me give you an easy example that i use in the book and that is pain so pain is a

00:26:28.540 normal human sensation we all experience it whenever we injure ourselves but people who have pain

00:26:36.280 disorders have hyper excitable pain nerves or hyper excitable pain systems in their brain and what

00:26:44.800 that means is that they experience pain for no good reason or if they just twist or turn the wrong way

00:26:52.880 they can experience excruciating pain and that pain can go on for minutes or hours even it just doesn't

00:27:01.420 stop all of those are representations of a hyper excitable pain system so when we think about something like

00:27:09.900 depression depression is actually hardwired into the human brain it is a normal human emotion

00:27:18.220 depression it is and and it is hardwired in our brains it's actually hardwired in the brains of

00:27:24.320 many other animals like rats and mice and those serve as models for researchers who are trying to

00:27:31.220 understand depression so like pain depression is a normal thing but when it gets turned on for no reason

00:27:41.000 or when it fails to stop or when it kind of gets you know going in an exaggerated way those can all be

00:27:50.560 reflections of a hyper excitable depression kind of pathway or depression system in the human brain and so what

00:28:00.200 that means is that if your depression systems or networks are hyper excitable that is somebody who will

00:28:06.760 experience depression for no good reason and or they might experience depression for a clear reason

00:28:12.620 maybe somebody was mean to them or somebody scolded them but they have a hyper kind of exaggerated

00:28:21.240 response that they get super depressed and it lasts for days or hours whereas most people would you know

00:28:28.840 move on and be able to to be okay with that okay so a metabolic ill health can cause a neurotransmitter

00:28:36.740 imbalance and also another thing that you know psychologists psychiatrists know that influence mental

00:28:43.360 illness are hormones cortisol thyroid hormone testosterone estrogen but that's also driven by metabolism correct

00:28:52.620 absolutely yeah so one of the things that is so wonderful about this theory is that it connects all of the

00:29:01.160 dots that we know in the dots that we know in the mental health field so it turns out that you know

00:29:06.740 mitochondria again play an instrumental role in the production of key hormones like cortisol estrogen and

00:29:14.020 testosterone but a hormone like thyroid hormone like you mentioned actually plays a critical role in

00:29:20.900 metabolism and the function of mitochondria even a hormone like insulin which most people think of as a

00:29:28.020 diabetes thing it turns out insulin is actually located throughout the brain and plays a powerful

00:29:33.920 role in the way your brain functions and also plays a powerful role in brain metabolism okay so we would

00:29:41.240 have with insulin like how does it influence mental illness or mental health do we know that we do so we we

00:29:48.260 have again so that's probably one of the clearest connections that goes back to the 1800s this connection

00:29:54.980 between diabetes and mental illness we know that people with type 2 diabetes or even type 1 diabetes are

00:30:02.180 much more likely to develop mental disorders and pretty much all of them across the board depression

00:30:09.000 ptsd substance use disorders but also bipolar and schizophrenia you know over the last 20 years we have

00:30:17.260 neuroimaging research showing that people with bipolar disorder and schizophrenia have abnormalities and insulin

00:30:23.580 signaling in their brain here's a very clear study that i just want to share with people that really

00:30:31.080 drills this home for everybody and why this matters you know one study looked at 5 000 kids and followed them

00:30:39.720 from the ages of 1 to 24 and they found that the kids who had the highest levels of insulin resistance

00:30:46.140 since beginning at age 9 were five times more likely that's 500 percent more likely to develop

00:30:53.820 bipolar disorder or schizophrenia or be at risk for those disorders 500 percent more likely that is not

00:31:04.800 trivial and that kind of information gives us clear strategies to possibly prevent mental illness in young

00:31:15.340 people it also gives us you know lots of treatment options as well well another cause or symptom that

00:31:25.100 mental health practitioners have been treating in recent years to decrease mental illness symptoms is

00:31:30.900 inflammation so there's been research showing that people with you know major depression for example

00:31:36.060 are some people some of them are highly inflamed and inflammation goes back to metabolism correct

00:31:42.900 absolutely so metabolism influences inflammation and inflammation influences metabolism now you know

00:31:52.720 everybody's heard inflammation that's what that's the cause of everything that ails us these days

00:31:57.860 and yes in fact people with mental disorders are more likely on average to have higher levels of

00:32:04.320 inflammation but i'm here to argue that inflammation in and of itself is neither necessary nor sufficient

00:32:12.040 meaning inflammation can't explain all mental illness and not all people with mental illness even have

00:32:19.020 higher levels of inflammation at least not that we can measure so inflammation is an important factor

00:32:24.920 it clearly plays a role for some people but i don't think in and of itself it is the key instead we have to

00:32:33.620 rise above that and see the broader connections through what we call metabolism and mitochondria

00:32:39.660 okay so i think people are seeing here now that metabolism it underlies a lot of these things

00:32:45.120 it connects a lot of these things that we often treat as disparate things so let's talk about like i mean

00:32:50.740 what what are the things that mess up our metabolism and then maybe we can walk through some of these things

00:32:56.660 and how you've used you know diet or exercise or reducing stress to not only fix people's metabolism

00:33:04.880 which can help their diabetes or obesity or cardiovascular but it also fixes or can treat

00:33:11.780 the mental illness so let's talk about diet for example how does our diet mess up our metabolism

00:33:16.720 and in turn can cause mental illness yeah so i think everybody knows if you eat a bad diet

00:33:25.260 you're more likely to become obese or diabetic so i think most people intuitively know a bad diet

00:33:33.040 can mess up metabolism what i think most people probably don't know is that a bad diet can also lead to

00:33:40.620 higher rates of mental illness so i just mentioned that study in kids so a bad diet can lead to insulin

00:33:47.980 resistance which can then go on to lead to much higher rates of bipolar disorder and schizophrenia

00:33:54.380 but much much more common are depression and anxiety disorders and other types of disorders

00:34:03.060 so a bad diet can do all of those things and what do i mean when i say a bad diet

00:34:08.820 i mean a diet that causes metabolic dysfunction so a diet that causes higher levels of inflammation

00:34:16.660 inflammation or a diet that impairs hormonal status or a diet that impairs mitochondrial function

00:34:24.500 and you you're probably wondering well what the hell are you talking about chris palmer like what what

00:34:29.960 does that mean what is a bad diet well a bad diet can include a lot of highly processed foods

00:34:38.180 that are high in sugar high in fat that's kind of the deadly combination is that sweet spot lots of

00:34:47.160 sugar and lots of fat that is not a good diet for any human being on the planet or animal on the planet

00:34:53.980 for that matter but you know unfortunately we have added all sorts of chemicals and processed things

00:35:00.760 you know i i i outlined some of the literature on trans fatty acids those actually are really

00:35:08.040 horrible for physical health like heart attacks but they're also really horrible for mental health

00:35:14.020 they result trans fatty acids have been found to result in higher rates of depression irritability

00:35:20.240 even alzheimer's disease in people so again so mental symptoms and so clearly our diet you know

00:35:29.100 it's not rocket science in a way i think everybody understands what you eat can affect your heart

00:35:36.640 like in a very clear and concrete way like what you eat can actually clog up the arteries of your heart

00:35:44.120 and result in a heart attack on some level it's kind of a no-brainer to just understand that what you

00:35:51.880 eat can also affect your brain if it's affecting your heart it's probably affecting more than just your heart

00:35:58.700 it's going throughout your body and the brain happens to be connected to everything and and the brain is

00:36:05.460 actually one of the more energy consuming organs and so a lot of what you eat a lot of those calories

00:36:13.400 and substrates and all the breakdown products a lot of that's going up to your brain to fuel your brain cells

00:36:19.920 well another thing you point out in this the diet section of how what we eat can influence our mental

00:36:26.960 health or because it's in its influence our metabolism is that doctors have known for a long

00:36:33.020 time that if you want to treat epilepsy one thing you can do is do fasting or like a ketogenic diet

00:36:40.100 right there's something about a ketogenic diet that reduces epilepsy symptoms particularly in children

00:36:44.660 they know this with kids and again that shows like well there's a metabolic thing going on there

00:36:48.680 right absolutely to drill some of this home and make it like real for people to help them understand

00:36:57.440 it might actually be helpful to share a story if i may yeah sure that'd be great you know i think most

00:37:03.200 people understand that if you eat a healthy diet it might help depression or anxiety or even adhd symptoms

00:37:09.220 i think most people get that but what i'm saying is that diet especially a dietary intervention like the

00:37:15.300 ketogenic diet can actually impact what most people think is an incurable chronic mental disorder

00:37:21.920 so you mentioned we have decades of research showing that the ketogenic diet for instance can stop

00:37:28.460 seizures that's a real thing seizures are real and people can actually die from them and so doing

00:37:35.340 a specific type of a diet like the ketogenic diet can actually stop seizures but the work that i've been

00:37:42.040 doing over the last six years is using the ketogenic diet in people with chronic serious mental illness

00:37:47.540 and so the story that i'll share with you as a woman i used a different name i used fake names for

00:37:53.300 everybody in the book but she actually gave me permission to use her real name so in this interview

00:37:58.440 i'm going to use her real name her real name is doris doris was diagnosed with schizophrenia when she was 17

00:38:04.240 years old she had daily hallucinations and delusions over the ensuing decades she tried numerous

00:38:11.460 antipsychotic and mood stabilizing medications but none of them worked to stop her symptoms they did

00:38:17.600 cause her to gain a lot of weight doris was tormented by her illness and between the ages of 68 and 70 0.72

00:38:25.120 she tried to kill herself at least six times when she turned 70 her doctor referred her to a weight loss

00:38:31.900 clinic at duke university where they were using the ketogenic diet and for whatever reason she decided

00:38:37.580 to give it a try within two weeks not only did she start losing weight but her hallucinations and

00:38:45.100 delusions started going away within months all of her symptoms of schizophrenia were in full and complete

00:38:52.200 remission within six months she was off all her psychiatric medications and remained in full and complete

00:39:00.220 remission doris went on to live for another 15 years medication free symptom free out of hospitals no more 0.99

00:39:13.040 psychiatrists or psychologists no more suicide attempts when i last spoke with doris she said she was happy to be

00:39:23.120 alive and she actually asked me pleaded with me to share her story with anyone who would listen in the hopes that

00:39:32.080 her story might help even one other human being sadly doris passed away this past january at the age of 85 of 0.97

00:39:42.240 covid pneumonia i want to let people know doris is not alone i now have dozens of cases of similar patients

00:39:52.860 achieving seemingly miraculous recoveries from what we know is what we currently think of as chronic mental

00:40:01.280 disorders there are clinical trials underway at least five controlled clinical trials some of the

00:40:07.660 leading psychiatrists and neuroscientists are hot on this trail but i'm passionate about making these

00:40:13.820 treatments and these in this theory and this information available to people now because people want help now

00:40:21.660 that's really powerful so i mean it's a perfect example you treat a metabolic condition

00:40:25.700 you treat the mental illness and that was just the diet intervention changing to a ketogenic diet

00:40:30.620 and that's again to say you know ketogenic might not be for everybody right like i don't want i don't think

00:40:36.220 you don't want to give the impressions like well you know if you have depression going to keto diet it'll cure

00:40:40.660 depression maybe but that's something you have to talk to a psychiatrist or psychologist about

00:40:45.740 so we've been talking about how mental illness may be caused by metabolic problems and how these

00:40:52.400 metabolic problems can be caused by things like poor diet and things like that and i think when most

00:40:57.640 people think about metabolic problems we associate them we associate with things like you know obesity

00:41:02.700 and diabetes as we discussed but we probably all know people who are they got a healthy weight

00:41:08.920 they seem to eat a healthy diet but still deal with things like depression so what's going on there

00:41:15.220 if mental illness is possibly caused by metabolic problems why are there some people who don't have

00:41:21.640 the typical metabolic problem markers nonetheless experience mental health issues so the first thing

00:41:29.620 that i want to clarify in that in this person that you're saying is depressed so i want to understand

00:41:35.120 is this a normal depression or is this a depression disorder and so in the way that i described pain and

00:41:44.960 hyper excitability same deal goes for depression so depression can be a normal response to adversity

00:41:51.960 so if if a kid is getting bullied and teased relentlessly or if somebody just got dumped by the love of their

00:42:00.360 their life they are going to be depressed that is all normal they do not have a brain disorder they are

00:42:08.240 having normal reactions to adversity it doesn't mean they don't need help i think a lot of those people

00:42:16.200 do need help but the help is obvious and common sense it is human compassion and support whether that

00:42:23.940 is through friends family whether it's through a psychotherapist really doesn't matter to me

00:42:29.620 but that person needs compassion and support because they you know are experiencing adversity in their

00:42:38.180 life if we're talking about somebody who has depression for no good reason or that depression is really

00:42:45.620 exaggerated and unrelenting then i'm going to say that person does have a brain disorder

00:42:51.360 and that that brain disorder is due to a metabolic problem in their brain and i'm really glad you brought

00:42:59.460 up this point about well doesn't a metabolic problem mean people are fat and diabetic well people who

00:43:08.520 are overweight or obese do on average tend to be more metabolically unhealthy and certainly people with 0.87

00:43:16.480 diabetes type 2 diabetes are more metabolically unhealthy but there are many other causes of metabolic problems

00:43:26.040 in the human body so let me give you a clear example that will hopefully kind of help people understand

00:43:34.740 this so one of the other causes of metabolic problems are toxins things that are toxic to these things in

00:43:43.380 our cells called mitochondria and they cause any toxin will cause metabolic problems and one clear easy to

00:43:52.440 understand example is smoking cigarettes so smoking cigarettes is actually associated with weight loss

00:44:00.820 on average people who smoke cigarettes weigh less than people who don't smoke cigarettes so this is not a weight

00:44:10.880 issue anymore this is a smoking issue and yet we know with certainty based on decades of research people who smoke

00:44:21.780 cigarettes are more likely to have heart attacks and strokes those are metabolic disorders they're also

00:44:30.480 interestingly more likely to have insulin resistance and develop type 2 diabetes even though most people think of

00:44:40.420 insulin resistance and type 2 diabetes as being related to weight or obesity smokers even though they're thin

00:44:49.060 tend to develop higher rates of insulin resistance and diabetes but guess what else smokers are more likely

00:44:57.520 to develop depression so one study actually followed over 14,000 Korean adults over several years and they measured

00:45:08.960 whether they were smokers and or whether they were depressed and the people who were not depressed but they

00:45:16.020 were smokers were much much more likely to go on to develop depression in the subsequent years however the reverse

00:45:26.060 association was not found so people who were depressed were not necessarily more likely to go on to become smokers and so the researchers in that study concluded

00:45:35.960 concluded that smoking seems to cause or contribute to an increased risk for the development of depression

00:45:44.460 so if i summarize all of that one metabolic toxin smoking cigarettes results in higher rates of cardiovascular disease

00:45:56.160 insulin resistance type 2 diabetes and depression even though smokers weigh less

00:46:05.060 so we need to stop thinking about metabolic problems as a weight issue because it is much more than just weight

00:46:13.800 well another toxin obvious one would be alcohol as well right

00:46:18.580 absolutely and believe it or not people who drink high amounts of alcohol are more likely to what have heart attacks

00:46:28.980 they're also more likely to develop type 2 diabetes interestingly they're more likely to develop mental disorders

00:46:37.220 including depression so again one metabolic toxin alcohol we know with certainty based on decades of research

00:46:46.740 is a mitochondrial poison and that is poisoning your metabolism and that can result in both mental and metabolic disorders

00:46:57.540 and then other things too you talk about in the book that could affect metabolism but you might not see someone with the obvious signs that they have a metabolic issue like weight gain

00:47:06.280 if you're lonely right i think there's studies that show that your likelihood of cardiac problems goes up

00:47:12.360 insulin resistance also goes up and that can cause things like depression as well

00:47:16.960 absolutely so everybody knows that loneliness could be associated with depression that just kind of makes sense

00:47:24.980 and that's usually what people think but loneliness as you mentioned also results in higher rates of metabolic disorders

00:47:32.480 heart attacks strokes and actually premature death and so that is one of the major themes of brain energy

00:47:41.380 is that mental and metabolic

00:47:45.000 are interchangeable

00:47:47.420 and closely

00:47:49.120 and you know

00:47:50.440 closely related

00:47:51.760 and interconnected

00:47:53.720 that we can't talk about mental symptoms or mental disorders without talking about metabolic

00:47:59.680 but we also can't talk about metabolic disorders like heart attacks or even obesity without thinking about mental symptoms and mental disorders

00:48:10.420 okay so even if you're not overweight you can still have metabolic problems because there are metabolic disruptors that don't show up in weight gain

00:48:19.480 things like smoking and drinking can damage your metabolism

00:48:23.140 something else that can damage your metabolism is stress and lack of sleep

00:48:28.480 a lack of exercise can damage your metabolism

00:48:31.600 and you know that's why exercise can improve mental health

00:48:35.280 so a bunch of things beyond diet can affect metabolism

00:48:38.460 and that in turn can affect your mental health

00:48:41.980 how do you imagine this brain energy theory

00:48:45.640 of mental health

00:48:46.940 you know will change how doctors diagnose and treat people with mental illness

00:48:51.340 I mean I guess example I mean right now like most people if they go to a psychiatrist

00:48:54.320 like man I'm just I've got OCD

00:48:56.260 or severe depression

00:48:58.880 the typical thing as well

00:49:00.640 we'll maybe do some talk therapy do a pill

00:49:02.480 with this brain energy approach

00:49:04.080 kind of walk us through like let's say someone walks into you

00:49:06.500 say I've man I've got major depression

00:49:08.300 potentially major depression

00:49:09.540 what would you do

00:49:10.740 I would actually want to do

00:49:14.240 a comprehensive assessment

00:49:16.040 of all sorts of mental health

00:49:18.480 markers which we currently do

00:49:20.360 anyway so I'm going to look for other types of symptoms

00:49:23.480 OCD symptoms

00:49:24.780 anxiety symptoms

00:49:25.780 psychotic symptoms

00:49:26.860 bipolar symptoms

00:49:28.000 all sorts of them

00:49:29.480 to really get a full picture of brain function

00:49:32.120 but the huge change

00:49:34.780 is that I am now also going to be looking

00:49:37.480 at metabolic markers

00:49:39.620 biomarkers

00:49:40.900 lifestyle factors that we know impact metabolism

00:49:44.020 I'm going to be asking that person about their diet

00:49:46.580 about their exercise

00:49:48.080 about sleep

00:49:49.540 stress levels

00:49:50.640 their use of substances

00:49:52.200 their use of medications

00:49:53.580 and I'm going to be

00:49:56.080 putting all of that information together

00:49:59.240 in one coherent way

00:50:01.540 I'm going to try to understand

00:50:03.380 what are all of the factors

00:50:04.860 that are

00:50:06.420 causing harm to this person's metabolism

00:50:10.320 so that might be a bad diet

00:50:13.400 and poor sleep

00:50:15.040 maybe they're not prioritizing sleep

00:50:17.120 they're on their computer

00:50:18.180 they're staying up all night

00:50:19.640 binge watching Netflix

00:50:21.000 and then they don't get enough sleep

00:50:22.980 I'm going to recognize

00:50:24.820 that those are

00:50:26.440 impairing metabolism

00:50:27.740 and

00:50:29.740 I'm going to try to address those first

00:50:32.160 before I start throwing pills

00:50:33.740 at this person

00:50:34.640 and even

00:50:35.600 probably before I start

00:50:37.220 psychotherapy

00:50:38.120 with this person

00:50:39.380 I'm going to

00:50:40.500 use lifestyle factors

00:50:42.440 for clear and unequivocal

00:50:45.020 metabolic problems

00:50:46.720 and

00:50:47.860 I'm going to see

00:50:49.160 what I get

00:50:49.920 for a lot of people

00:50:51.080 I think that's going to solve the problem

00:50:52.980 and

00:50:54.280 the beauty

00:50:55.680 of this theory

00:50:56.760 is that at the same time

00:50:58.540 I'm addressing their depression

00:50:59.780 I'm also

00:51:00.760 addressing their weight issues

00:51:02.760 I'm also

00:51:03.820 reducing their risk

00:51:05.200 for prediabetes

00:51:06.260 or diabetes

00:51:07.020 I'm reducing their risk

00:51:08.540 for a heart attack

00:51:09.520 I'm making this person

00:51:11.060 a happier

00:51:11.900 healthier

00:51:12.600 person

00:51:13.600 overall

00:51:14.340 I'm treating the whole person

00:51:16.300 not just

00:51:17.700 brain symptoms

00:51:18.780 I'm treating

00:51:19.860 all of it

00:51:20.880 some people

00:51:22.140 may still

00:51:22.960 you know

00:51:23.460 we may go through everything

00:51:24.640 and say

00:51:25.260 well we can't really find

00:51:26.380 anything wrong

00:51:27.440 they're following a good diet

00:51:29.300 they're getting adequate sleep

00:51:30.740 they're not too stressed

00:51:31.880 I'm

00:51:33.260 I'm still open

00:51:34.500 to using

00:51:35.080 antidepressants

00:51:36.240 and talk therapy

00:51:37.220 and psychotherapy

00:51:38.060 and even more invasive

00:51:39.460 treatments

00:51:40.180 like ECT

00:51:41.420 and TMS

00:51:42.280 if those are needed

00:51:43.620 but I think that

00:51:45.420 the metabolic theory

00:51:46.380 of mental illness

00:51:47.140 opens up entirely

00:51:48.240 new ways

00:51:49.140 to think about

00:51:50.300 what's happening

00:51:51.060 all the way down

00:51:52.320 to the cellular level

00:51:53.420 and much more importantly

00:51:55.100 it opens up

00:51:56.020 entirely new ways

00:51:57.220 to treat these disorders

00:51:58.440 and put these disorders

00:51:59.720 into full remission

00:52:01.080 as opposed to

00:52:02.360 just reducing symptoms

00:52:03.580 well you were talking

00:52:04.920 about talk therapy

00:52:05.520 I just had the thought

00:52:06.260 I mean I think

00:52:06.680 what might be going on there

00:52:08.660 why talk therapy

00:52:09.540 is useful

00:52:10.240 we typically think

00:52:11.100 well talk therapy

00:52:11.640 is useful

00:52:11.980 because it helps you

00:52:12.660 get over like

00:52:13.900 maladaptive thinking patterns

00:52:15.340 for example

00:52:15.960 but I think it's

00:52:16.940 what a lot of talk therapy

00:52:18.280 does

00:52:18.480 is like

00:52:18.720 you're talking to someone

00:52:19.880 you have like

00:52:21.000 someone you can trust

00:52:22.040 and talk to

00:52:22.600 which feels good

00:52:23.400 reduces stress

00:52:24.660 you learn skills

00:52:26.740 cognitive skills

00:52:27.960 so that you

00:52:28.820 basically reduce stress

00:52:30.200 which affects metabolism

00:52:32.020 like that's

00:52:32.940 that's what's going

00:52:34.240 that's potentially

00:52:34.800 what's going on

00:52:35.420 yeah

00:52:35.720 absolutely

00:52:36.700 and I think

00:52:38.280 that's a really

00:52:38.800 important point

00:52:39.760 so this theory

00:52:40.740 doesn't replace

00:52:42.040 existing treatments

00:52:43.800 that we know

00:52:44.580 work for some people

00:52:45.840 this theory

00:52:47.040 simply offers

00:52:48.180 a completely new way

00:52:49.840 to understand

00:52:50.700 how and why

00:52:51.900 something like

00:52:52.740 psychotherapy

00:52:53.320 or an antidepressant

00:52:54.720 might be working

00:52:55.420 yeah

00:52:55.820 and I think

00:52:56.480 for someone who

00:52:57.760 is listening to this

00:52:58.780 you know

00:52:59.160 I think this would be great

00:53:00.020 I mean like

00:53:00.460 if someone has like

00:53:01.280 severe mental illness

00:53:02.320 like schizophrenia

00:53:02.840 things like that

00:53:03.780 you'd have like

00:53:04.760 severe interventions

00:53:05.600 like maybe

00:53:06.060 okay we're going to

00:53:06.680 completely switch up

00:53:07.500 your diet

00:53:07.860 try keto

00:53:08.460 of course you want to

00:53:09.500 talk to a doctor

00:53:10.180 about that

00:53:10.780 but even if you don't

00:53:11.940 have any like

00:53:12.760 mental health issues

00:53:14.200 like this

00:53:14.900 I think this information

00:53:15.700 explains like

00:53:16.440 why you should

00:53:17.220 focus about like

00:53:18.380 eating well

00:53:19.100 and exercising

00:53:20.000 and reducing stress

00:53:20.960 because

00:53:21.280 not only is it going to

00:53:22.180 help your body

00:53:22.780 but it's going to

00:53:23.360 help your mind as well

00:53:24.240 absolutely

00:53:25.160 yeah

00:53:26.060 well Chris

00:53:27.180 this has been a great

00:53:27.680 conversation

00:53:28.180 where can people go

00:53:28.860 to learn more about

00:53:29.420 the book

00:53:29.740 and your work

00:53:30.240 the one website

00:53:31.920 I'll direct people to

00:53:32.940 is

00:53:33.320 brainenergy.com

00:53:35.900 so

00:53:36.460 brainenergy.com

00:53:37.580 awesome

00:53:38.520 Dr. Chris Palmer

00:53:39.520 thanks for your time

00:53:39.980 it's been a pleasure

00:53:40.480 thank you Brett

00:53:41.860 for having me

00:53:42.560 my guest today

00:53:43.820 my guest today was

00:53:43.920 Dr. Chris Palmer

00:53:44.640 he's the author

00:53:45.320 of the book

00:53:45.680 Brain Energy

00:53:46.300 it's available

00:53:46.880 on amazon.com

00:53:47.760 and bookstores

00:53:48.180 everywhere

00:53:48.500 you can find

00:53:49.160 more information

00:53:49.580 about his work

00:53:50.020 at his website

00:53:50.720 chrispalmermd.com

00:53:52.600 also check out

00:53:53.420 our show notes

00:53:53.820 at aom.is

00:53:54.700 slash brainenergy

00:53:55.680 where you can find

00:53:56.380 links to resources

00:53:57.220 where you can delve

00:53:57.620 deeper into this topic

00:53:58.660 well that wraps up

00:54:06.920 another edition

00:54:07.540 of the AOM podcast

00:54:08.400 make sure to check out

00:54:09.360 our website

00:54:09.760 at artofmanless.com

00:54:10.840 where you can find

00:54:11.160 our podcast archives

00:54:12.180 as well as

00:54:12.860 thousands of articles

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The Art of Manliness - November 28, 2022

The Brain Energy Theory of Mental Illness

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