The Mikhaila Peterson Podcast - January 11, 2023


Harvard Doctor Chris Palmer Recommends Diet for Mental Disorders ｜ Chris Palmer EP 177


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1 hour and 24 minutes

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145.37

Word count

12,221

Sentence count

503

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Transcript

Transcript generated with Whisper (turbo).
Hate speech classifications generated with facebook/roberta-hate-speech-dynabench-r4-target .
00:00:00.000 We prescribe medications that cause premature death.
00:00:04.640 Read the package inserts, it's right there.
00:00:06.740 The ketogenic diet helps people lose weight,
00:00:09.760 get rid of their diabetes,
00:00:11.240 or improve their insulin sensitivity,
00:00:13.320 lower their risk for cardiovascular disease,
00:00:16.460 helps them get off of medications,
00:00:18.960 helps them start functioning in life again.
00:00:22.360 I really don't give a shit if their LDL goes up a little.
00:00:25.380 I just don't.
00:00:26.280 Anybody who is going to get worked up about their LDL going up a little bit
00:00:30.760 in the context of all of that other stuff is an absolute positive idiot.
00:00:36.980 And they are inhumane.
00:00:38.700 They are inhumane that they would let people suffer and writhe in mental pain
00:00:43.640 and be disabled by their illness and not offer them an effective treatment.
00:00:48.420 That is just inhumane.
00:00:50.100 dr chris palmer welcome to my podcast thank you michaela peterson for having me this is great i
00:01:01.580 am so excited to be talking to somebody from harvard who's discussing diet as a treatment
00:01:08.340 for depression this is crazy i've been waiting for this to happen for a while well wait no
00:01:14.140 wait no longer I am here okay amazing yours I have followed your story for several years and
00:01:22.320 your story is a perfect representation of the science that I have been pursuing because I've
00:01:29.880 been trying to explain the science of stories like yours and other people's so that we can get
00:01:37.080 the mental health field to take this seriously amazing okay fantastic well for anyone who isn't
00:01:43.000 familiar with you, although I've seen you on a ton of podcasts recently, can you describe a bit
00:01:48.240 about who you are and what you do? So I'm Chris Palmer. I have been a psychiatrist at McLean
00:01:54.680 Hospital and Harvard Medical School for over 27 years now. My day job is actually, I am the director
00:02:05.520 of the Department of Postgraduate and Continuing Education. So I oversee educational programs for
00:02:14.200 McLean Hospital and Harvard. And I've been doing that for over 20 years. I have over 15 years of
00:02:21.140 experience as a neuroscience researcher, working in the fields of addiction and sleep. And I've
00:02:29.180 always had a private practice of psychiatry. So I tend to treat treatment-resistant patients,
00:02:38.820 a wide variety of disorders, schizophrenia, bipolar, chronic depression, personality disorders,
00:02:46.300 anxiety disorders, substance use disorders. But the unifying theme of the patients that I work
00:02:52.100 with are that they have treatment-resistant disorders, which means they have already been to
00:02:56.880 at least five or six different psychiatrists therapists other people they've usually been
00:03:02.280 on dozens of meds they've tried psychotherapy for years or decades they've sometimes had ect or tms
00:03:10.040 already and then they come to me and was like can you do anything for me uh and the reason i'm on
00:03:17.760 your podcast the reason i have a book because i've been really interested in the role of diets in
00:03:25.240 particular low-carbohydrate and ketogenic diets in the treatment of mental disorders, but serious
00:03:32.960 mental disorders is really my focus. I can definitely help people with mild depression,
00:03:37.700 anxiety, or burnout, but I'm treating patients with schizophrenia and bipolar disorder,
00:03:43.700 people who are chronically disabled, having hallucinations, delusions, and finding success
00:03:51.680 and restoring their health, getting them off all meds, and many of them living happily ever after.
00:03:59.340 Yay for that. That's great. Okay, I've got a question just about that. For people,
00:04:04.920 it's kind of specific, but for people who you see that are suffering from hallucinations,
00:04:10.080 are they ever not medicated and still suffering from hallucinations?
00:04:14.760 Or are they always medicated and suffering from hallucinations?
00:04:17.560 So, you know, right, you know, at this point, I have lots of people who are non-medicate, who used to suffer from hallucinations.
00:04:27.300 They are off all meds, and they are now symptom-free.
00:04:31.840 As a rule of thumb over my career, I've seen a wide range.
00:04:37.720 So I see people, when they first get diagnosed, no medications, something happens out in the
00:04:46.640 real world to them, and they develop their first psychotic episode.
00:04:51.780 They start having hallucinations, delusions, often in the context of some mood symptoms
00:04:58.180 as well, whether it's a manic episode or a depressed episode.
00:05:01.900 um and then they usually get brought into an emergency room police get called something
00:05:08.480 happens uh and then they usually end up in the hospital i've done hospital inpatient work um for
00:05:16.360 for years uh and in that context i would see them either in the emergency room and maybe even be the
00:05:24.760 first person to prescribe medications or i would be their inpatient psychiatrist and taking care
00:05:31.580 of them or I would become their outpatient psychiatrist and start treating them you know
00:05:36.700 somebody else treated them in the hospital and then I kind of take over as their outpatient
00:05:43.220 psychiatrist so I've seen a whole range interesting that sounds like a stressful job
00:05:47.300 it can be um I'm actually pretty passionate about this work and helping people and uh
00:05:57.420 trying to get them all the way better. And, uh, so
00:06:02.340 it can be stressful. I mean, I've definitely, especially when our treatments don't work for
00:06:10.780 people and that occurs a lot more often than most people realize, certainly not you, but
00:06:16.300 I think you get it. A lot of people don't get it. They think that our treatments are supposed to
00:06:24.460 work. And then I have patients coming into me in tears or angry, yelling at me, whatever,
00:06:31.260 like, why isn't this working? You're giving me pill after pill and none of them are working
00:06:36.540 and they're giving me side effects or they're making me gain weight or they make me feel like
00:06:40.680 a zombie. This isn't working. Do something. You're supposed to be the expert. Why aren't you doing
00:06:46.600 something. I have families, parents of these bright children who were like stellar college
00:06:56.820 students. Their lives are decimated and just disintegrating in front of everyone's eyes.
00:07:02.900 And the parents are looking at me like, what are you doing? Why aren't you getting my son or
00:07:08.960 daughter better? Like, what are you doing? And I have to be the one to like look them in the eye
00:07:15.540 and say, we don't know, or this is the best we've got. That's where I was. I'm in a very
00:07:22.660 different place now. And hopefully we'll get to talk about all that. But that's where I was for
00:07:28.420 over 20 years. So how do I want to start this? Maybe let's start with, could you describe what
00:07:36.680 a ketogenic diet is for anyone who isn't familiar with it? So a ketogenic diet, most people know it
00:07:42.780 as a trendy weight loss diet. And my interest in it is really more as an epilepsy treatment.
00:07:52.800 So it turns out the ketogenic diet, at least one version of it was developed a hundred years ago,
00:08:00.760 specifically by a physician for one and only one purpose. It was actually developed to stop
00:08:06.100 seizures. And it was developed to mimic the fasting state because the doctors at that time
00:08:12.660 knew that fasting or at least had reason to believe that fasting can stop seizures but the
00:08:18.880 problem with fasting is that if you fast for too long you starve to death and that's not a very
00:08:23.900 good treatment so um so dr russell wilder invented the ketogenic diet with the purpose of trying to
00:08:32.440 trick the body into thinking that it was fasting when it really wasn't but providing enough
00:08:38.060 nutrition so that the person was not starving, and even so that young children could grow and
00:08:44.660 thrive on a ketogenic diet. But he wanted to see if it could stop seizures. And lo and behold,
00:08:52.160 it worked. And for a while, it was actually the mainstay treatment for epilepsy. In the 1920s and
00:09:00.040 30s, it was one of the mainstay treatments for epilepsy. And it stopped seizures in about 50%
00:09:05.840 of people with epilepsy. It reduced seizure frequency and another 35%. So about 85% pretty
00:09:14.620 good response rate. And then there were about 15% of people for whom it did not seem to work for
00:09:21.860 whatever reason. And it fell out of favor when we got all these medications and, but then it got,
00:09:31.860 it came back. And it's widely used as an epilepsy treatment. The reason that was so critical to me
00:09:38.640 as a psychiatrist is we use epilepsy treatments in psychiatry all the time. Tons of pills that
00:09:44.320 we prescribe are actually epilepsy treatments. And a lot of them are names people know,
00:09:51.300 Valium, Klonopin, Vanex, and others, benzodiazepines. All of those are seizure treatments.
00:09:57.140 um and so you know i the short version is that i ended up and trying to help one of my patients
00:10:07.680 with schizoaffective disorder lose weight and uh i had no thought that it would do anything for his
00:10:15.980 psychiatric symptoms but he went on a ketogenic diet within a couple weeks started getting an
00:10:24.640 antidepressant effect within about two months got a powerful antipsychotic effect. Hallucinations
00:10:32.440 were melting away. Delusions were melting away. And that sent me on a, that sent my whole career
00:10:41.700 on a new path. It gives me goosebumps. That's so cool. Okay. That is so cool. It's so exciting
00:10:49.820 hearing about this just out there and having medical professionals use it as a form of
00:10:58.260 treatment. I think in my case and my dad's case, in my case in particular, I think when he went
00:11:05.960 on antidepressants, it actually helped him. But I went on antidepressants and it helped me for like
00:11:12.080 a year. And then it just didn't really help. Like it numbed me, but it didn't really help. And I
00:11:19.560 just got worse and worse and worse and worse and worse and i've been unbelievably frustrated with
00:11:25.900 the medical system because like i i never went into an office and said you were supposed to help
00:11:30.900 me this is your fault but um but i probably thought that so it's really exciting to see
00:11:39.400 something that and it's funny we've been using the ketogenic diet you know like you said for
00:11:44.040 100 years and it kind of fell out of favor because there was a pill which is a lot easier than
00:11:49.040 adhering to a diet. Have you had a difficult time getting your patients to adhere to a diet,
00:11:54.080 particularly when they're very ill? For some patients, absolutely. And I definitely have
00:11:59.180 patients who either didn't even want to try it and or they tried it for a few days or something
00:12:07.960 and they just couldn't do it. And, you know, I didn't have the intensive resources that some of
00:12:16.760 them I think need in order to be able to do the diet you can't admit them to any program where
00:12:22.920 they will administer the diet right now for the most part I didn't even have you know I now have
00:12:28.760 dieticians that work with me but you know over over the years you know for a long time I didn't
00:12:35.580 even have dieticians or anybody else who would support it was just me as a solo practitioner
00:12:40.580 recommending these treatments however i have so yes it does not not everybody can do the diet
00:12:50.760 but i have patients with chronic schizophrenia and bipolar disorder people who are actively
00:12:58.240 hallucinating delusional one woman was stuck in a chair staring at the wall all day every day
00:13:09.800 She was like locked in and could not function.
00:13:16.700 She was on massive doses of psychiatric meds.
00:13:19.840 She was wetting her pants because she was so overdosed on psychiatric meds.
00:13:27.020 And she and her boyfriend at the time kind of came to me again in one of these angry states.
00:13:34.920 Like, you've got to do something.
00:13:36.920 like she she can't function she's overwhelmed with hallucinations and delusions you have to
00:13:44.520 do something and she had been my patient for many many years she had already tried everything under
00:13:52.640 the sun she'd been on over 30 medications she'd been in and out of hospitals in residential
00:13:57.480 treatment programs she had already had electroconvulsive therapy i think twice at that
00:14:02.340 point so had done every standard treatment and when they kind of came to me in this angry state
00:14:12.520 i was like you know what you guys have to do the ketogenic diet um and i was saying this to the
00:14:19.680 boyfriend too like you've got to help her do this diet i mean obviously she is severely impaired
00:14:25.980 she really belonged in a hospital is where she belonged if we could get a hospital to deliver
00:14:32.420 appropriate care but they would have simply put her on more and more medicines um and essentially
00:14:38.640 made her comatose uh and at the end of the day she was able to do the diet took about three months
00:14:48.800 for her you know a couple weeks for her to come out of this kind of almost catatonic state where
00:14:54.920 She was just staring at the wall all day.
00:14:57.740 Took several months, about three months for the hallucinations and delusions to start
00:15:02.780 going away.
00:15:04.740 She is now a completely new person.
00:15:09.800 She went to the Metabolic Health Summit with me on stage and told her story.
00:15:15.860 She is now a graduate student getting the top grades in her class.
00:15:22.380 She is now engaged.
00:15:24.420 She actually, that boyfriend actually was trouble.
00:15:26.720 So she got rid of him and she's, she's got a new life, new fiance.
00:15:33.700 Like things are dramatically better for her.
00:15:38.820 She is not a hundred percent recovered because we're still trying to get her
00:15:42.440 off all the meds that she had been on.
00:15:44.880 And we continue to make progress.
00:15:48.100 I know, you know, it is not an easy process to get off meds.
00:15:51.900 It can be a disaster and it can be dangerous.
00:15:55.940 People can get suicidal.
00:15:57.320 They can get more psychotic, all sorts of things.
00:16:00.920 But we're getting there.
00:16:04.060 And she's functioning and she is developing a new life.
00:16:07.880 Wow.
00:16:09.220 That's an incredible story.
00:16:11.580 Congratulations.
00:16:12.740 Thank you.
00:16:13.280 Well, congratulations go to her because she's the one who's doing it.
00:16:16.160 She's the one who's recovering.
00:16:17.820 And I am just glad that I could help her.
00:16:21.900 Wow. That's great. That's great. So you said, at least for this patient, I would say, let me see how to formulate this question. Well, how long does it take on average for somebody to start recovering from, say, psychotic or depressive symptoms on the ketogenic diet?
00:16:40.920 You know, for a lot of people, I start to notice antidepressant effects, usually within the first two weeks.
00:16:55.860 It can be variable, and different people have different responses, especially based on the different meds that they might be taking.
00:17:04.200 I mean, some people can be on one or two meds.
00:17:06.640 Other people can be on 14 meds.
00:17:08.740 those meds are affecting them in profoundly different ways. And some of those meds are
00:17:13.980 actually interfering with the effects of the ketogenic diet or preventing ketosis. So it
00:17:20.840 can make it harder to do the diet. Usually for the antipsychotic effects, they take longer.
00:17:30.520 Most of my patients, I begin to see an antipsychotic effect, usually around the six to
00:17:37.680 eight-week mark. And for some people, it can be three to four months. Like that woman I just
00:17:43.460 described, it really was three months before her hallucinations started going away. So it's
00:17:51.040 variable, but those are kind of the averages that I see. For somebody in that state, that sounds
00:17:57.180 like a very long time because every day is a very long time. But in the greater scheme of things,
00:18:02.880 that's not very long especially given you're supposed to try a medication out for like six
00:18:08.500 weeks right at minimum so yeah okay i mean the time course yeah the time course that it takes
00:18:15.800 to respond to the ketogenic diet is similar to the time course that it takes to respond to
00:18:21.140 medications antipsychotic meds almost never even begin to work even if they work for people
00:18:27.820 they almost never begin to work until about six to eight you know well about four to six weeks
00:18:34.460 in but that's only beginning and then like the three months the four month mark is where you
00:18:40.420 start getting the full benefits is what we usually tell people in psychiatry and so in a way the
00:18:46.560 ketogenic diet is nothing different it's um but it's using very different strategy that i believe
00:18:53.940 has enormous long-term upside potential for actually healing the brain and healing the
00:19:03.300 person, even allowing them to get off meds. And then again, live happily ever after, fully recover.
00:19:12.800 Whereas the medications that we're prescribing, you know, I know you experienced this and
00:19:21.220 I've seen many patients who experience this, and the long-term longitudinal studies suggest that
00:19:28.040 this might be happening. When people are on meds long-term, they tend to have chronic disorders,
00:19:36.240 meaning that their symptoms never go away. The symptoms will come and go. Sometimes they'll get
00:19:42.260 worse. Sometimes the symptoms will progressively get worse, morph into new symptoms. So somebody
00:19:48.240 could start with depression. Now they've got bipolar. Now they've got schizoaffective. Now
00:19:55.280 they've got schizophrenia. And oh, by the way, along the way of that trajectory, they're also
00:20:01.760 developing OCD and panic disorder and substance use disorders and eating disorders and sleep
00:20:09.040 problems and all sorts of other symptoms. And people can end up with all of these diagnostic
00:20:15.320 labels, they can become disabled by their psychiatric disorders, despite getting boatloads
00:20:25.880 of treatment. And I am really passionate about changing that, that our field needs to change.
00:20:34.460 And our field needs to change based on science, not just these anecdotes that I've shared.
00:20:40.600 we we have dozens and dozens of patients now we have five clinical trials underway already
00:20:47.160 yes and so this is this is about transforming the mental health field five clinical studies
00:20:56.020 underway right now yes actually even more than that because there are five clinical trials
00:21:03.680 underway for bipolar disorder and schizophrenia there are additional clinical trials that i
00:21:09.700 am also aware of for alcoholism for post-traumatic stress disorder for depression um and those are
00:21:21.080 the ones that come to me off the top of my head alzheimer's disease certainly uh and and you know
00:21:26.180 we've got a robust evidence-based already in epilepsy wow yay okay that's great well i i feel
00:21:34.960 like once there are a number of studies people can start quoting out there this whole industry
00:21:40.240 is going to change rather rapidly because doctors are trying to help people and they don't have the
00:21:44.900 tools right now that would help a lot of people i think it'll change fast what do you think how
00:21:49.960 fast do you think it'll take the world to take the ketogenic diet seriously as a way of treating
00:21:55.860 depression and mental disorders. So if you look at the usual trajectory of implementation
00:22:07.820 of an evidence-based treatment, on average, when researchers publish a study
00:22:16.640 that strongly suggests or proves that a treatment works, even if that treatment works
00:22:26.440 really well, on average, it is 17 years before that treatment is recommended to people in
00:22:37.520 clinical practice. I have reason to fear that that will not happen with the ketogenic diet.
00:22:48.400 And the reason I have reason to fear that is for a few reasons. One is we have dozens and dozens
00:22:57.880 of clinical randomized controlled trials published in the best medical journals available
00:23:05.260 of the ketogenic diet for weight loss, and yet, and those clinical trials show the ketogenic diet
00:23:15.360 is almost always equal to, if not superior to, a low-fat diet or calorie-restricted diet or some
00:23:26.280 other diet, and yet the majority of clinical clinicians will not recommend ketogenic diet
00:23:35.380 for weight loss. Likewise, we have dozens and dozens of clinical trials of the ketogenic diet
00:23:41.460 for type 2 diabetes, and yet the majority of clinicians will not recommend low-carbohydrate
00:23:48.120 or ketogenic diets for their patients with type 2 diabetes. We have had a century of research of
00:23:55.900 ketogenic diet for epilepsy. And the majority of people, we have two Chakrin reviews, which are the
00:24:03.280 gold standard of evidence in the medical field. And the majority of people with treatment-resistant
00:24:10.280 epilepsy are not even told about this treatment option. So I decided long ago, about five years
00:24:20.620 ago. My scientific path went ketogenic diet for serious mental illness. I began collaborating
00:24:32.020 with researchers around the world. We've had several case reports and case series. We've had
00:24:39.400 small clinical trials published, some that I've participated in, some other researchers have done
00:24:46.300 completely independent of me, all suggesting the same results. We have had numerous scientific
00:24:54.300 articles outlining the neuroscience of the ketogenic diet and why this should be taken
00:25:00.860 seriously for people with mental illness or serious mental disorders. And those have been
00:25:08.240 published in some of the leading neuroscience and psychiatric journals, again, by leading
00:25:14.160 psychiatrists and neuroscientists um so i went that way but i went much much deeper
00:25:24.160 and because at the end of the day schizophrenia is not supposed to go into remission
00:25:29.720 according according to the current psychiatric dogma once you're schizophrenic you're schizophrenic
00:25:36.080 for life and once you're bipolar you're bipolar for life and you certainly have to take medications
00:25:42.780 for the rest of your life and there's there there's no ifs ands or buts about that that is
00:25:48.660 fact according to the most psychiatrists and what i was seeing is i was seeing people get
00:25:55.840 fully better off their meds and going on to live happy healthy lives sometimes for years or decades
00:26:04.640 And I was like, this says that what we are telling people in psychiatry cannot be 100% true because I'm seeing all of these exceptions to the rule right in front of me.
00:26:19.540 There's no way in hell this can be true.
00:26:22.880 And so I was more intrigued with what can we learn?
00:26:27.600 What can we learn from these cases that might help us better understand mental illness?
00:26:34.640 that as a, and now, so now I'm way beyond ketogenic diet as a treatment. I'm a hundred
00:26:40.580 percent in support of it. I'm not never abandoning it. I'm never leaving it behind,
00:26:44.080 but I'm moving on from ketogenic diet as a treatment. Now I'm going, I'm pursuing
00:26:48.820 what causes mental illness. Yeah. Yeah. And how does it, how does it make sense that a diet 0.99
00:26:56.260 could change it? And how does it make sense that some of the meds that we prescribe
00:27:02.880 cause weight gain. They cause diabetes, and yet in clinical trials, they supposedly reduce the
00:27:13.740 symptoms of these illnesses. How can I, as an academic psychiatrist, make sense of that?
00:27:20.660 And that is ultimately the path that I've been on for about five or six years. And that's what led
00:27:32.240 to me writing this book, Brain Energy, that it really outlines the metabolic theory of mental
00:27:40.800 illness. And what I'm arguing is that mental disorders are metabolic disorders.
00:27:47.480 To get back to your question, like when are we really going to see this implemented in real life?
00:27:53.420 I decided five years ago, the field of psychiatry is not going to change on its own.
00:27:59.440 the field of psychiatry is not going to go down without a fight because the field is based on
00:28:09.520 billion-dollar pharmaceuticals and the field is based on hospitalizations and whole systems of
00:28:17.800 care and this new way of understanding mental illness will be highly disruptive and you know
00:28:28.540 that's a business term disruption the personal computers disrupted the typewriter industry
00:28:35.220 if you were in the typewriter industry you didn't want to hear about personal computers and you
00:28:41.420 didn't want to talk about them and you did everything you could to squash them because
00:28:46.360 they're going to put you out of business my belief is that the metabolic theory of mental illness
00:28:52.840 will be highly disruptive in the mental health field.
00:28:56.940 And I am hoping to start a grassroots movement.
00:29:00.640 I think the only way we will get change,
00:29:04.040 the only way we will help other people
00:29:06.720 suffering from chronic depression, anxiety,
00:29:10.020 bipolar disorder, schizophrenia,
00:29:12.020 help them fully recover
00:29:13.460 in the ways that both you and your father have
00:29:17.360 is through a grassroots movement.
00:29:20.680 But it's gotta be a grassroots movement
00:29:22.640 based on science, based on evidence, based on putting it all together so that we can understand
00:29:29.880 very clearly how exactly do these medications work? Why would they reduce symptoms in the short
00:29:39.560 run? But also, why should we be terrified about what we might be doing to people in the long run
00:29:45.600 with these very medications. Your story is not unusual. I felt better for a year
00:29:52.920 and then everything started falling apart. And then more symptoms, more side effects,
00:29:59.940 more and more pills. And your story is not unusual. Your story is actually
00:30:06.080 a hell of a lot more common than most people realize. And we need to change that. But we're
00:30:13.620 going to need people. We are going to need people to get upset about this. Why would they get upset?
00:30:20.740 Because either they're suffering from a mental disorder themselves, they're trapped in this
00:30:25.140 system right now, or they have a loved one. They have a son or daughter or husband or mother or
00:30:30.760 father. They have somebody being tormented by these symptoms, not getting better with current
00:30:36.560 treatments. And we need all of them to rise up and start demanding change.
00:30:42.500 Here, here. I completely agree. I completely agree. When I first started using, so I didn't
00:30:51.000 know about the ketogenic diet or the paleo diet or anything, but when I first started cutting out
00:30:55.420 foods and I went into remission, I was probably on a ketogenic diet. I was eating a lot of meat
00:31:02.980 and fish and greens, and that was basically it. And that took about three months because I was
00:31:09.760 trying to get the arthritis under control and that took about three months and one day my depression
00:31:13.600 went from being depressed to not depressed and it happened in a day about three months in and i was
00:31:19.240 like what even is this reality that i've never experienced before it was so different that it
00:31:28.320 was mind-boggling and i was ecstatic and then i went off of my medication too quickly i just
00:31:36.660 stopped taking them i was like i stopped taking the immune suppressants i stopped taking um the
00:31:41.820 pills i was taking at night for pain i stopped taking everything stopped taking adderall for
00:31:46.640 fatigue and all that was fine and then i stopped taking the ssri and like my entire life fell apart
00:31:53.100 again and i was like how is this possible so you you looking into why this works is extremely
00:32:01.140 interesting because I don't think anyone, wow, how about instead of that, what have you found
00:32:07.140 out about why the ketogenic diet or being in ketosis helps mental disorders?
00:32:12.620 So at the end of the day, the quick version is that I have come to the scientific conclusion,
00:32:19.360 not based on speculation, not me making up some cockeyed theory. I looked at all of the existing
00:32:27.700 evidence. And that's all I used. I looked at all of the existing evidence, decades and decades of
00:32:33.500 clinical evidence, neuroscience research, genetic research, metabolic research. So research on
00:32:41.940 obesity and diabetes, but neurological research as well, research on epilepsy and Alzheimer's
00:32:50.740 disease. Because initially I was just completely perplexed. Like why the hell would a epilepsy
00:32:58.620 treatment work for psychiatry? But actually it's not just the keto diet, it's all these meds. Like
00:33:03.860 we've got dozens of anti-epilepsy. So I knew that I had to go there. I knew I had to go all of it.
00:33:10.700 At the end of the day, when you put all of that research together, there is one and only one
00:33:15.660 conclusion. And that is that mental disorders are metabolic disorders of the brain. In order to
00:33:22.420 understand what that means, you know, a lot of people think of metabolism as burning calories.
00:33:28.240 And it's related to your diet. And that affects your weight. So metabolism is all about diet,
00:33:35.960 and burning calories and your weight. In fact, yeah, metabolism is definitely related to those
00:33:44.000 three things, but it is so, so much more than that. Metabolism is a fundamental biological
00:33:52.000 process that is actually fundamental to all living organisms. And it's actually part of
00:33:58.300 the definition of what we call living organisms. So you have to understand this overwhelmingly
00:34:04.520 complex thing that we call metabolism. And at first, it's overwhelming and it's complex.
00:34:11.940 but if you kind of ask some basic questions like well what controls metabolism
00:34:16.940 then you actually led to these tiny things in all of our cells called mitochondria
00:34:23.920 and when i did a deep dive into the science of mitochondria
00:34:30.700 that's when my mind was blown because that's when i could connect all of the dots of the
00:34:38.980 mental health field. This is exciting. The mitochondria play a role in neurotransmitters
00:34:46.180 like serotonin and dopamine. Mitochondria play a role in hormone production and regulation like
00:34:53.000 cortisol and estrogen and testosterone. Mitochondria turn inflammation both on and off
00:35:01.340 and play a direct role in immune system function. Mitochondria actually are the primary
00:35:08.460 regulators of gene expression in the cell nucleus. And I could keep going on, but when you
00:35:16.640 do this deep dive of science into mitochondria and you understand all of their roles, and then you
00:35:24.640 ask basic common sense questions like, well, what would happen if mitochondria weren't functioning
00:35:29.780 properly? You actually can begin to understand the whole mental health field, all of the science
00:35:37.640 Why people with mental diagnoses also have physical problems like autoimmune disorders, chronic pain, you know, migraine headaches, fibromyalgia, chronic fatigue syndrome, all sorts of other.
00:35:57.360 there are actually 50, at least 50 different physical medical diagnoses that occur much
00:36:04.480 more commonly in people who also have mental disorders. And what I'm saying is that they're
00:36:10.800 not all unique. The common thread among all of them is metabolism and more specifically
00:36:17.160 mitochondria. And once you understand that, you can kind of see the big picture.
00:36:22.500 you can understand what's going on but much much more importantly we can start implementing
00:36:28.500 treatments that will heal people like the ketogenic diet that's fascinating that's so
00:36:35.800 interesting okay um have have you had patients that go on a ketogenic diet and still have food
00:36:42.360 sensitivities so they still need to identify problematic foods on the diet and it yeah
00:36:49.980 yeah okay what were you gonna say well i was just gonna say does that seem to happen more to people
00:36:56.600 who are sicker or do you not see a correlation i think i do see a correlation the people who have
00:37:04.220 extreme food sensitivities um and the way i think of food sensitivities kind of like an allergy
00:37:10.900 um so it's you're sensitive to a food that causes kind of inflammation somewhere usually in your gut
00:37:20.080 and then that can lead to kind of a permeable gut or a leaky gut um but it's basically an
00:37:29.400 inflamed gut and the gut is actually really the gut is an endocrine organ a lot of people don't
00:37:35.980 realize that. But the cells that line your gut are actually secreting all sorts of hormones and
00:37:42.800 neuropeptides that play a profound role in metabolism. And when those cells become inflamed,
00:37:51.800 that means that your hormone system is off balance now. And that can cause all sorts of problems.
00:38:01.480 I think everybody's heard about the gut brain connection. So the gut is communicating with
00:38:06.460 the brain, but it's, you know, a lot of people want to focus on just one thing. They want to
00:38:13.340 say, so, so Dr. Palmer, what you're really saying is it's all inflammation, right? And I'm like,
00:38:17.600 no, that's not what I'm saying. Dr. Palmer, what you're really saying is it's all, it's all the
00:38:21.220 gut. It's all leaky gut. I'm like, no, that's not what I'm saying either. But yes, inflammation is
00:38:25.880 part of it yes leaky gut is part of it for some people but but there can be people who have
00:38:34.180 metabolic problems primarily because of trauma and abuse we know so we know so that's that is
00:38:44.740 the thing that got me the most excited about this theory is that it connects biological
00:38:50.580 with psychological and social stressors.
00:38:54.020 And we know that psychological and social stressors
00:38:56.860 play a role in mental illness.
00:38:59.520 And interestingly, they also play a role
00:39:02.880 in metabolic disorders too.
00:39:05.320 So people who have really horrible childhoods,
00:39:08.840 lots of abuse and other adversity in life,
00:39:13.540 they are more likely to have mental disorders.
00:39:16.340 That's not surprising to most people,
00:39:18.120 but it's across the board, mental disorders.
00:39:20.120 It's not just PTSD. They're also more likely to have depression and personality disorders and
00:39:26.000 anxiety disorders and alcoholism and heroin addiction and suicidality. But also, guess what?
00:39:32.280 They're also more likely to have bipolar disorder and schizophrenia. Pretty much all of the mental
00:39:38.820 disorders other than maybe the neurodevelopmental disorders, which those either occur when you're
00:39:44.840 developing or not. But on top of that, they're also more likely to have obesity, diabetes,
00:39:52.560 premature cardiovascular disease, and they're much more likely to die early deaths.
00:39:57.940 Wow. That's a bit... I mean, if you think about it, I guess, intuitively,
00:40:04.720 then yeah, you can see how that makes sense. Especially if you think of an animal,
00:40:08.180 an abused animal, then that animal is going to grow up and be sickly. You can kind of understand
00:40:12.620 that. But I was always taught that, uh, any type of depression, at least that ran in my family
00:40:19.340 was because of a chemical imbalance, right? Like, and it was just that, and then I've had people
00:40:25.640 come to me and they're like, well, you had an autoimmune disorder. Like maybe that contributed
00:40:28.540 to the depression. And it was like, at that point I was like, no, it's a chemical imbalance. This
00:40:33.560 is before the whole diet thing happened, but, um, that's nuts. So what do you think happens to
00:40:40.100 people, you know, on a more biological level, what happens to people when they suffer from
00:40:44.860 abuse? How does that contribute to health issues later? So the, the, the quick answer is that abuse
00:40:53.500 leads to a heightened stress response or self-defense response. So your, your body ends up
00:41:05.600 kind of allocating a lot of your metabolic resources like even just glucose and fatty
00:41:12.640 acids and other metabolic resources to your fight or flight system and why is it doing that because
00:41:19.760 your life is threatened or at least you think your life is threatened so if you're if you've got
00:41:26.320 somebody beating the shit out of you or raping you or other things you should feel like your
00:41:32.880 life is threatened because it in fact it is threatened and so you are gonna go into this
00:41:39.760 hyper fight or flight mode that is not a disorder that is your body fighting for its survival your
00:41:48.120 body is saying alert red alert like somebody is trying to kill me and take my life and what but
00:41:56.860 what that means is that all of like any kind of rest and repair activity that your body should be
00:42:03.380 going undergoing is put on hold so good sleep is now off the table you should not be sleeping well
00:42:12.420 if somebody is beating you up on a regular basis why because because they might sneak into your
00:42:19.020 room at night and try to bash your head in you should not be sound asleep you should wake up
00:42:26.060 when you even hear that somebody touching the doorknob you hear somebody touching the doorknob
00:42:32.060 you should be awake so you can try to defend yourself or run or at least like put your arms
00:42:37.140 up or whatever to try to save your life but if you're not sleeping soundly it means that your
00:42:44.320 body is falling into a state of disrepair it's using all of its energy and resources for defense
00:42:51.600 for self-defense. And it's not spending the resources on maintenance and repair and growth
00:42:58.880 and health. And if that occurs over a long period of time, those people will slowly but surely
00:43:08.720 develop metabolic and mental health problems. And it runs the gamut of all sorts of problems.
00:43:15.420 wow um is it possible that somebody could be in a stressful situation and like have these
00:43:23.000 issues sleeping which leads to metabolic metabolic problems and then the stressful situation goes
00:43:28.500 away but their body is stressed because of the state that the stress put them in so then the
00:43:33.840 metabolic disorder doesn't go away even though the stressor so that's why childhood trauma could
00:43:38.100 be an issue even though you're not experiencing trauma at the moment you're still suffering from
00:43:41.600 repercussions. Wow. That's crazy. How young, how young can that start? How like, can that happen
00:43:48.500 before the age of two and then it just screws you up forever? Oh my gosh.
00:43:53.840 So we, we know that infants, when infants are maltreated or abused or neglected,
00:43:59.680 they have an extraordinarily heightened stress response. If you see infants, yeah. If you see
00:44:07.620 infants who are abused or neglected they i mean they're screaming constantly if you look at like 1.00
00:44:15.460 the the most tragic or i shouldn't say the most but one tragic example of that are romanian
00:44:23.920 orphans from you know the 1980s um a lot of romanian orphans were put in orphanages they
00:44:31.380 were never even picked up um somebody would just shove a bottle in their mouth in the crib and like
00:44:38.780 no humans didn't even touch them and you know when when infants are treated that way they go
00:44:47.280 through stages of kind of adaptations if you will i mean first they're just screaming bloody murder
00:44:56.380 because they're trying to get somebody to pick them up and pay attention to them um because
00:45:00.780 their survival depends on it um after a while they actually lose the drive to scream and cry 0.93
00:45:09.640 and they actually become really quiet the romanian orphans many of them would actually 0.99
00:45:16.220 start like banging their heads against the cribs in order to feel something because nobody was 1.00
00:45:24.540 touching them and they would like bang their heads to the point of bleeding and so so these
00:45:31.720 so abuse and trauma affect humans at any point in time here's so that is all horrible doom and 0.63
00:45:42.600 gloom pessimistic shit i get it here here's here's the good news here's the good news folks 0.58
00:45:48.740 in the way that you said what about years later somebody who had a really shitty childhood or 0.67
00:45:56.620 experience or just you know suffered from a rape or a veteran a war veteran who experienced
00:46:04.080 atrocities in the battlefield and comes back tormented with ptsd symptoms if those people
00:46:12.120 aren't recovering years later i mean step one is get the person out of danger get the person into
00:46:18.160 a safe environment, give them their basic requirements, food, shelter, you know, a good
00:46:24.720 safe place to sleep, all of those things. But if years later, they still are not recovering,
00:46:32.820 we can use metabolic treatment strategies to help them recover. That means we can change their diet
00:46:41.160 sometimes to something like ketogenic diet or your lion's diet something we can change their
00:46:48.720 diet try to help their metabolism heal or repair what we're really doing is helping their
00:46:56.860 mitochondria heal and repair but we can also use exercise and stress reduction and other techniques
00:47:05.520 but it's a lot of common sense lifestyle techniques and some that aren't common sense
00:47:11.560 at all. Again, the science of the ketogenic diet is not common sense to most people. Most people
00:47:15.940 don't get it. A lot of people are skeptical about it, but I've outlined all of this science
00:47:21.640 to try to get people to understand it because I think once people understand it,
00:47:27.800 you will become empowered to do something about it. Plus there's just nothing. There's nothing
00:47:34.100 worse than like watching I think watching one of your family members or close friends suffer
00:47:39.960 especially from something like hey their life is good maybe their life is great their life is great
00:47:48.120 why are they I mean you had one patient she's catatonic what's going on and then there's so
00:47:54.480 much anger too associated with like and frustration especially if the person's relatively normal and
00:48:00.220 then they fall into that it's like hey you're a university professor or you're a teacher you're
00:48:06.800 in a good relationship what's wrong with you and then to see the amount they're suffering like
00:48:13.360 nothing like hurts like that it just hurts so much to see somebody suffering like that so if
00:48:18.660 there's an option i'd say well it's a matter of making people believe right and if you've been
00:48:25.060 through the medical system for like 15 years and you've tried everything at some point it's a lot
00:48:30.880 easier not being hopeful anymore like just kill off that hope part of me because i can't keep
00:48:37.220 having this hope and then soul crushing you know failure of whatever i've tried so it's just a
00:48:44.360 matter of i guess getting people hopeful again and again i i am set on not just blind belief
00:48:51.840 that's why i went the path i went because i kind of knew nobody's going to take me seriously i'm
00:48:58.100 seeing these miracle cures from the ketogenic diet and i know that nobody's going to take them
00:49:04.200 seriously it doesn't it doesn't matter that i'm a harvard professor nobody gives a shit they're
00:49:10.040 just going to think i'm a harvard professor who went crazy yeah and and and that's and that's it 0.64
00:49:16.600 that's all they're going to think and they're not going to listen they're not going to take this
00:49:20.180 seriously. And so I recognized I have to go far beyond the ketogenic diet. I have to explain the
00:49:27.560 science of this. I never in my wildest dream set out to kind of create what appears to be a unifying
00:49:37.700 theory for all mental illness that actually integrates the biological, psychological, and
00:49:42.880 social factors into one thing that was never my goal i kind of just stumbled upon it somehow i
00:49:50.480 don't know how and it's kind of like mind-blowing like oh my god what on earth just happened and um
00:49:58.060 but i am hoping that it went once people understand the science of this new theory
00:50:06.720 they're gonna see whoa this you like this is connecting an awful lot of dots and then
00:50:15.400 i've even had people who've like read the book and start to understand the theory they're like
00:50:19.920 i started fact checking you because i was like mind blown myself and i'm like this can't possibly
00:50:25.780 be true so i'm googling all of these things and even googling things that you haven't included 0.59
00:50:31.380 and shit you're right oh my god like like this is real some people need to take this seriously
00:50:39.240 and but once you understand it then you can have hope and it's real hope based on real solutions
00:50:49.160 and practical solutions so i am no way i'm not saying the ketogenic diet is going to cure everyone
00:50:55.740 Because I think if you're a chronic alcoholic, you got to stop drinking the alcohol.
00:51:02.080 That's part of your treatment plan.
00:51:04.340 And ketogenic diet or not is not going to save you from chronic alcoholism.
00:51:10.820 Stopping alcohol is going to be your first step in saving you from chronic alcoholism.
00:51:17.740 but then if you're not fully recovered after you stop drinking, then maybe you can use diet or
00:51:24.860 exercise or sleep or stress reduction or light exposure or lots of other things to heal your
00:51:31.500 body and your brain. Very cool. What would your advice be for someone who wants to stop their
00:51:37.560 medications and try diet? Is there an order in which to do that? How do you do that?
00:51:42.200 So I am going to strongly recommend that you, number one, please don't stop your meds on your own cold turkey.
00:51:50.700 That, in the way that you just described, it can be a nightmare.
00:51:54.760 I have seen so many patients hospitalized or the police get called or some who end up dead.
00:52:06.200 And they just become overwhelmed with mental symptoms, whether it's depression or hallucinations or suicidality. And it just seems, I'm assuming, you know, we don't know because they're dead, but I'm assuming it just seemed like a good decision to go ahead and kill themselves, and they did.
00:52:25.820 so please don't stop your meds cold turkey on your own number one not because i don't want
00:52:31.520 people to get off their meds because i am desperately trying to get a lot of people
00:52:36.020 off their meds but i want to do it in a safe way that they can tolerate that is you know safe for
00:52:42.880 everybody involved um usually when i implement the ketogenic diet if somebody's been stable
00:52:50.480 on their meds for a while even though they're clearly having symptoms because they wouldn't
00:52:54.620 be coming to me if they were totally fine. They probably wouldn't be coming to me. So they're
00:53:00.840 usually coming to me because their things are not okay. And they want to try something different.
00:53:05.920 But if they've been on their meds for a while, I usually don't touch their meds initially.
00:53:11.100 I start the diet. I make sure they can do the diet. And I make sure that we start to see some
00:53:17.880 benefits from the diet. And again, that can be three or four months for some people.
00:53:23.080 i also want to make sure that the person can actually do the diet and stick with it
00:53:28.100 um because i'm not going to stop start stopping their meds and have them do a diet for four days
00:53:35.980 and then like you know oh i can't do it anymore i like bread too much um it's like well that's
00:53:41.940 not going to work then so you're not really willing to do this treatment because the diet
00:53:46.440 is part of the treatment i really want to stress that it it is you're you're treating your brain
00:53:53.680 by doing the diet you're you're healing your body and your brain and so you've got to be
00:54:02.020 committed to doing it you and and so i want to see evidence that you can somehow do it um and or
00:54:12.980 you know i never give up on people it's not like i tell people do the diet and then go and
00:54:17.560 come back and see me when you're doing it it i'm seeing them all along encouraging offering
00:54:23.760 practical solutions if they fall off the wagon it's like no big deal everybody falls off the
00:54:29.380 wagon don't don't sweat it like we will get you back on the wagon but what usually by about
00:54:38.740 four to six months, if I'm seeing significant improvement in symptoms, it does not at all
00:54:47.260 have to be remission of symptoms. Because unfortunately, I think as you know, the
00:54:53.440 medications can cause symptoms in some people or even a lot of people. And so the full recovery
00:55:00.520 is let's start the diet and then we're going to start tapering meds. And we're going to do that
00:55:08.000 in a safe, controlled way that you can tolerate, and your body and brain are going to tell us
00:55:12.600 how tolerable it is. We're going to do that. But along the way, I'm going to add other things.
00:55:19.480 So I'm going to look at other substances that they might be using that might be causing problems,
00:55:24.900 and we might be getting rid of those substances. I'm going to look at sleep and make sure people
00:55:29.340 are getting good, restful sleep. I might look at light exposure, like avoid screens in the middle
00:55:35.640 the night, get some bright light in the morning. Maybe we're going to look at exercise, get started
00:55:42.300 on an exercise routine if you're not doing that already. So we're going to look at a comprehensive
00:55:46.400 treatment plan. All of those things are common sense. You all, many of your listeners already
00:55:53.100 know them. So they already know all that stuff. So it's not rocket science. I'm not reinventing
00:55:58.940 anything these are just good practical common sense human health things that all humans benefit
00:56:07.320 from doing and slowly but surely we try to get people off their meds and usually once they're
00:56:15.080 off all their meds and they're doing these things that's when i see dramatic full lasting recoveries
00:56:22.700 and then actually people have to go through a grieving period usually too
00:56:28.660 if they've been sick for a long time they get really really sad or really really angry
00:56:39.360 that so much that so much of their life is wasted yeah nobody told yeah and that nobody told them
00:56:48.540 this yeah i like i'm still
00:56:51.640 well it's frustrating right you don't get that back it's crazy oh no i cried again
00:57:02.540 damn it that's like my that's my second episode these psychiatric these episodes that have anything
00:57:09.300 to do with like mental health oh my gosh they get me but yeah no it's it's heartbreaking and
00:57:17.200 some people are stuck like that their entire lives that's so messed up that's so messed up
00:57:24.700 it is messed up and we need to change this and we need help we need help we need everybody to help
00:57:33.480 yeah do you do you get uh do you get any negative feedback from
00:57:40.900 professors at Harvard or any of your colleagues? Honestly, I get asked that a lot.
00:57:50.160 And so far, shockingly, the answer is not yet. I'm waiting for it. I think they're hoping this
00:57:59.860 is all going to go away. Chris Palmer and his little book are just going to disappear
00:58:10.440 into oblivion and nobody's really going to pay attention and nobody's going to know any of this
00:58:18.400 and we'll just go on with the status quo but again like so i've i've gotten some of the leading
00:58:32.340 psychiatrists and neuroscientists to publicly endorse this book and this theory they you go
00:58:41.240 to amazon and they're right there they're in the book they've read the book and they've endorsed it
00:58:47.280 so that is important because it says that i'm not a hundred percent crazy people want to think i'm
00:58:55.400 crazy if people think i've gone too far if people think you know you can't disrupt a whole field
00:59:01.560 Chris Palmer, who the hell do you think you are? And I know there are lots of people who are
00:59:06.140 probably thinking that. I know that I'm not completely crazy because I provided enough
00:59:13.880 solid scientific evidence. I think if this really starts to become disruptive,
00:59:22.400 that's when i will get the pushback um and it will likely come from the forces that have
00:59:33.300 billion dollar products to lose and i can't blame them if i had a billion dollar drug i would be
00:59:41.100 pissed at chris palmer who the hell does he think he is coming along disrupting my billion dollar
00:59:46.280 drug um this is my money and i'm a billionaire and i'm happy and don't don't you come along with
00:59:53.560 some new theory and convince people to get off my drug like you know f you chris palmer and they
01:00:01.160 will and they will send their experts it won't be the drug company coming after me it will be
01:00:06.480 experts in psychiatry and the neuroscience field who will come after me yeah and they will be hired
01:00:12.680 guns by these companies and they will be hired with one primary purpose, discredit Chris Palmer
01:00:20.180 and this theory. This is becoming a threat to our business and our shareholders. And they will
01:00:29.000 start attacking me either on a personal level or a professional level or any level. And I'm
01:00:38.040 I'm sort of ready for them. I mean, in preparing this theory and this book, I was meticulous about lining up my defenses and lining up my arguments.
01:00:49.240 I mean, I realized people are going to attack this. This is crazy. I need to think through every detail and at least kind of line up some arguments.
01:00:58.940 The really great promising news is that, you know, I work at McLean Hospital. It's a Harvard hospital.
01:01:05.920 We're actually currently ranked the number one psychiatric hospital by U.S. News and World Report.
01:01:11.780 The president of the hospital, my boss, the chief academic officer, the board, the chairwoman of the board of trustees, they all know about me and are all supporting me right now.
01:01:25.120 so i feel kind of privileged to work at the hospital i've worked at where they are
01:01:35.300 they're not publicly backing this that's not their job but they also aren't interfering with
01:01:43.240 my ability to talk about it that's or present it if they they kind of i think see it as we are an
01:01:50.580 academic center and academic centers allow for scientific discussion and discourse and we if
01:01:59.120 you've got a theory and you want to present it that's what that's what we do that's what academic
01:02:06.100 psychiatrists and you know academics do is they present ideas they present new theories
01:02:12.160 and go do it like we're not saying we agree with you but we're also not saying we disagree with you
01:02:18.560 you're one of us so we're going to support your right to do that good and i think that's where
01:02:23.220 i'm at so but again i decided a long time ago i'm not taking this to the psychiatric professionals
01:02:31.560 because they won't they won't buy it they'll shoot it down because it's too disruptive so i
01:02:38.320 decided to take this to the people and let the people vote and let the people decide that was
01:02:43.520 wise and obviously it's working you've been on a ton of different podcasts um the book and i've
01:02:50.860 had people who weren't interested in diet at all say oh have you heard of chris palmer like brain
01:02:55.960 energy it's like yeah definitely harvard's talking about diet yeah yeah it's really awesome people
01:03:03.360 who like aren't interested you know because it's kind of easy i think once you're in the paleo
01:03:08.640 community or keto community or that kind of community then if somebody pops up you kind of
01:03:14.320 hear about them but i've definitely heard about you through people who are in like crossfit and
01:03:19.800 don't necessarily think that what you eat matters they're like oh well chris palmer though said
01:03:24.740 maybe it does matter it's like yeah pretty cool and you're like yeah i've been saying that for a
01:03:31.000 year where the hell have you been now you're gonna listen um well maybe a little maybe a little bit
01:03:37.940 to certain people, but no, I'm happy about this. This is great. Okay. Well, I've got one I want
01:03:43.980 to stick in here that I was just, I was just interested to get your opinion on, or do you
01:03:49.300 have an opinion on this new semaglutide drug that celebrities seem to be taking to lose weight?
01:03:57.560 Do you have any feelings about that? Yeah, no. Semaglutide is like, it is,
01:04:01.180 it is in demand and you it's actually there's a shortage of it nationally it can be hard to get it
01:04:08.400 approved you know the the early results right now suggest that semaglutide is highly effective
01:04:19.420 for weight loss it's really a diabetes it was developed as a diabetes drug and uh and then
01:04:27.060 they quickly noticed that a lot of people with diabetes were losing significant amounts of weight.
01:04:31.860 So now it is also a weight loss drug or it's becoming a weight loss drug. I do have one
01:04:38.200 patient who's on it and just increased his dose and is actually losing more weight and his blood
01:04:43.800 sugars are coming down even more, even though he has been on a ketogenic diet for a long time.
01:04:51.000 he's been on a ketogenic diet for a long time and it was in and of itself was not enough
01:04:57.520 but that's where i feel like you know there's more to health and metabolic health and mental
01:05:04.680 health than just the diet you have to have good sleep we just found out he's got horrible sleep
01:05:10.860 apnea um and that was never addressed um and you've got to decrease stress and you've got to
01:05:17.980 manage other substances and prescription meds, and he's on several. And so it's really a
01:05:24.260 combination of all of those things. You know, if you had, you're a perfect example. If you had
01:05:30.580 stayed on all of your meds and the diet, there's a chance the meds may have prevented you from
01:05:37.640 having a full and complete recovery. And, and so I think, I think it is the combination of
01:05:45.160 different strategies that are effective. But I think my, you know, so for people who need to
01:05:54.020 lose weight, can semaglutide be helpful? Yes, it can. Do I think it is really the full answer for
01:06:03.920 all of our health problems? Absolutely not. There is a reason we have an obesity epidemic.
01:06:11.480 it probably relates to the foods we're eating and or environmental toxins or something about
01:06:19.560 our lifestyle everybody's on their phone and said like whatever it is everybody's and a lot
01:06:25.120 of people like focus on one and only one of those things and say it's all that that's what it is
01:06:30.300 it's fine they could have their opinion i actually think it's probably a lot of those things
01:06:35.460 so it's a combination of all the chemicals and other stuff in our diet and the way our foods
01:06:41.900 have changed and they're super high in carbohydrates and we went through this whole
01:06:45.980 low-fat thing and we're now going to this whole everybody should eat only plants and avoid meat
01:06:53.440 and that's i don't see that as necessarily being a path to health um so we've got lots of problems
01:07:01.600 with diet but the environmental toxins if you really do a deep dive into those those don't
01:07:06.980 look pretty either oh yeah they're probably not helping us um and semaglutide isn't removing any
01:07:16.580 of those factors semaglutide is just helping people lose some weight but if you're still
01:07:23.180 exposing yourself to a toxic diet if you're not changing what you're eating you're still exposing
01:07:30.700 yourself to whatever it is whether for the people who think it's all carbs fine for the people who
01:07:36.980 think it's plant-based foods fine for the people who think it's animal sourced foods it doesn't
01:07:41.720 matter i i don't pick pick whatever part of the diet you hate taking a pill doesn't necessarily
01:07:48.280 change your diet it doesn't necessarily mean you're eating less of those toxic food sources
01:07:54.240 and and so i'm worried that we might be getting some short-term weight loss
01:08:01.620 maybe for several years even but that over time we're going to see the exact same thing that we
01:08:09.620 have seen with gastric bypass surgery gastric bypass surgery works wonders there is no question
01:08:18.760 about it. People lose massive amounts of weight in the first couple of years. But if they don't
01:08:26.580 change anything else, the weight starts coming back. And Al Roker is like a poster person and
01:08:33.180 very public about his experience with that, for that. And he then finally found the ketogenic diet
01:08:39.560 to definitively put his weight under control.
01:08:46.800 But so I'm worried that stomach glutide
01:08:49.640 is going to be the same deal.
01:08:51.180 That yeah, everybody's all psyched about it right now,
01:08:53.540 just like they were about gastric bypass surgery.
01:08:56.040 But if we don't address the root problem,
01:08:59.500 the problem's going to come back.
01:09:01.540 I can get behind that.
01:09:03.420 I can get behind that.
01:09:05.160 Do you get concerns from patients
01:09:07.200 or how would you address the concerns
01:09:08.800 about the ketogenic diet impacting cardiac health negatively?
01:09:12.800 So the longitudinal studies that we've got, and we've got plenty, we have dozens and dozens
01:09:21.900 of weight loss trials, trials for people with type 2 diabetes, of low-carb and or ketogenic
01:09:32.060 diets. And the overwhelming majority of those studies show that if you do a comprehensive
01:09:39.600 cardiovascular risk assessment, cardiovascular risk goes down with the ketogenic diet.
01:09:48.300 That means HDL levels improve, go a little bit higher. Triglycerides usually plummet.
01:09:57.760 That's a good thing.
01:09:58.680 Blood pressure usually comes down very nicely.
01:10:01.940 That's a great thing.
01:10:04.160 People lose a lot of weight.
01:10:06.200 That's a great thing.
01:10:07.360 Levels of inflammation come down.
01:10:09.000 That's a great thing.
01:10:11.720 The thing that, of course, the cardiologists focus on is, but LDL goes up sometimes.
01:10:17.100 Well, LDL is one of many biomarkers that plays a role in cardiovascular disease.
01:10:24.720 if you believe that LDL cholesterol is directly linked, and as I think you and many of your
01:10:30.220 listeners know, that is controversial, and some people don't believe that, and some people don't
01:10:36.300 believe the evidence base for that. I don't even need to go there. Even for somebody who is tried
01:10:43.400 and true, no, LDL really does play a role in cardiovascular disease. Even if you really firmly
01:10:49.860 100 convinced of that cardiovascular risk still goes down with ketogenic diet and i mean the
01:10:58.120 virtus study cool you know has been going on for over five years ketogenic diet for people
01:11:03.560 with type 2 diabetes high risk for heart attacks overall their risk has gone down nice i like how
01:11:12.380 this can be in the scientific literature it's so much easier than being like well worked for me
01:11:16.720 such a bad argument it unfortunately yeah we that's i think that's one of the things i bring
01:11:24.700 to the keto low carb community is i'm like focused on science and like and i'm i'm almost like a
01:11:30.660 lawyer too i'm like how am i going to defend this like i i already know what the opposition is going
01:11:36.040 to say and how they're going to attack me so what how can i line up some science to defend this
01:11:42.420 position. And I think these are 100% defensible positions. In the mental health field, make no
01:11:49.760 mistake, we prescribe medications that cause people to gain massive amounts of weight. We
01:11:56.400 prescribe medications that cause type 2 diabetes. We prescribe medications that cause heart attacks.
01:12:02.400 It's right on the package insert. I'm not being paranoid or conspiracy theorist by saying this.
01:12:07.380 We prescribe medications that cause premature death.
01:12:12.320 Read the package inserts.
01:12:13.740 It's right there.
01:12:16.000 The ketogenic diet helps people lose weight, get rid of their diabetes, or improve their insulin sensitivity, lower their risk for cardiovascular disease, makes them feel a hell of a lot better, helps them get off of medications, helps them start functioning in life again.
01:12:37.380 I really don't give a shit if their LDL goes up a little.
01:12:40.740 I just don't.
01:12:43.000 And anybody who is going to get worked up about their LDL going up a little bit in the
01:12:49.000 context of all of that other stuff is an absolute positive idiot, and they are inhumane. 0.97
01:12:56.060 They are inhumane that they would let people suffer and writhe in mental pain and be disabled
01:13:02.260 by their illness and not offer them an effective treatment.
01:13:05.700 that is just inhumane you can tell i'm a little worked up sorry i'm worked up i i completely
01:13:13.200 agree i'm worked up i know like what about i get that all the time too what about the long-term
01:13:18.860 health impacts like the short-term health impact was i was gonna die so if the long-term health
01:13:25.700 impact is i'm happy for quite a while i like the long-term health impact is yes yes you're alive
01:13:33.280 You're alive and thriving and not, not tormented by symptoms and not disabled by symptoms.
01:13:41.920 And yeah, who cares?
01:13:45.240 Who do I want research to really answer these questions?
01:13:50.300 Yes, I do want research.
01:13:51.860 Yeah, me too.
01:13:52.320 Because, because if I could tweak your diet somehow to give you even more of an edge,
01:13:57.920 I would love to know that.
01:13:59.460 And I would love to know to just be able to give you the information.
01:14:02.540 Like if you do this version of the lion's diet, you're going to have these kinds of outcomes.
01:14:08.120 If we can tweak these biomarkers, you might even get better results or live longer.
01:14:13.280 I would love that information.
01:14:16.180 But again, we need a grassroots movement to get funding for those studies because the powers that be are not going to fund those studies right now.
01:14:23.700 This is very true.
01:14:25.120 Okay.
01:14:25.380 I think I have one question based off what you were just talking about.
01:14:28.700 You said we prescribe medications that cause some of these side effects because they're
01:14:32.380 listed on the bottle.
01:14:34.000 One of the, so I was put on antidepressants when I was 12.
01:14:37.060 So I didn't understand the difference between the depression and what a side effect was.
01:14:41.420 I just thought everything I experienced was a new health problem, which wasn't how it
01:14:47.340 was in reality.
01:14:48.180 A lot of them were side effects.
01:14:49.580 But one of the side effects I think I had was I was never full at all.
01:14:54.800 I was absolutely starving all the time.
01:14:58.220 uh, in a way that I'd go out for dinner and I'd feel physically full, like unbuttoning my pants
01:15:02.880 full. And I can remember being so hungry that I'd have to be like, okay, take the food away
01:15:07.880 or I'll keep eating it. Like just no control. And I am a very self-disciplined person. So
01:15:13.920 it wasn't because of that. Um, have you, do you think the weight gain associated
01:15:18.860 that can be associated with SSRI use is because people get hungrier or do you think it's something
01:15:25.260 else? I think it can, I think that it can be different mechanisms of action. And again,
01:15:35.060 we don't really have good, robust science to answer that exact question. The thing that we
01:15:42.060 do have good, robust science on is a lot of people on SSRIs gain massive amounts of weight,
01:15:48.940 or at least a little bit of weight. That is not controversial. That is not anecdotal.
01:15:54.500 you know, one of the ways they attack all of this is, oh, it's just an anecdote. That's not an
01:15:58.660 anecdote. People, a lot of people gain weight. Not everybody does. And some people go on SSRIs
01:16:04.900 and they swear that their life is much better. And that's great. I'm not here to take that away
01:16:10.500 from them. I'm not here to stand in their way. They can keep taking their SSRI or other psychiatric
01:16:16.900 medications. I'm not here to take any of that away. I'm here to empower people with other options,
01:16:22.680 with other treatment strategies
01:16:24.280 if what you're doing isn't working.
01:16:27.260 I'm here to do that.
01:16:28.960 The SSRI, the SSRIs,
01:16:32.320 we have strong reason to believe
01:16:34.680 like 90, 95% of the serotonin in the human body
01:16:38.540 is actually found in the digestive tract.
01:16:41.660 So serotonin is regulating appetite
01:16:44.640 and feeding behaviors
01:16:46.260 and nutrient kind of sensing throughout the body.
01:16:50.300 And it does this actually in a whole range of species, all the way down to like worms and stuff.
01:16:57.520 Worms have serotonin that it's regulating their whole body metabolism.
01:17:04.480 So we know that serotonin is regulating whole body metabolism in humans, or at least playing a role in it.
01:17:12.460 And when you take a pill that is causing massive shifts in serotonin levels all the way down to the synapse, it shouldn't be shocking to anyone that that might dysregulate normal metabolic controls, which include hunger, which include feeding behaviors,
01:17:39.200 but also include metabolism broadly so some so i think for some people it can be exactly what
01:17:47.340 you described i've become ravenous i can't seem like crazy and i think for some people it is that
01:17:55.640 there is no doubt in my mind i have talked to other people who are highly trustworthy
01:18:02.260 the dependable, responsible, disciplined people who swear to me, I am not eating more calories.
01:18:10.440 I swear to you, I'm not. And yet I'm gaining weight. And I believe them. I believe they are
01:18:17.320 not eating more calories. I don't think they're lying to me. I don't think they're fooling
01:18:20.820 themselves. I don't think it's subconscious. I don't think they're just not tracking their
01:18:24.280 calories. I believe them. I think they're telling me the truth. And in that case, I think the
01:18:29.900 medication is probably plummeting their metabolism, their metabolic rate, so that they are burning
01:18:35.680 fewer calories, so that even if they're still eating the same 1,500 or 2,000 calories a day,
01:18:43.340 that they're burning it less efficiently. And that means more calories to store this fat.
01:18:51.060 That's crazy.
01:18:52.480 It is crazy.
01:18:54.620 Wow. Like for me, I think, I mean, maybe both could have been going on. I know I started
01:18:59.460 eating less and less. It took a while too. After I stopped taking medication, I was eating tons of
01:19:05.120 food and losing weight on the like keto paleo diet. And then when I switched over to the carnivore
01:19:11.080 diet, I was eating tons of food and losing weight initially. Although then I was overeating and I
01:19:18.200 started gaining weight, which is normal. Like if you're eating 2,400 calories a day and you're me,
01:19:22.820 you should be slowly gaining weight. And that was because my appetite still hadn't normalized. I
01:19:28.380 was still hungry. And then at some point, I think it was kind of like eight months into the diet,
01:19:33.120 I was like, oh, you know, two thirds of my hunger is gone suddenly. Like, okay, that's handy. That's
01:19:39.440 great. So it's weird. It's weird out there. I really, really appreciate what you're doing.
01:19:46.120 I think you're onto something. I don't think you're going to be crushed because it works too
01:19:49.580 well. So there is no crushing it. And one person whose life you change will tell like,
01:19:57.120 200 people about it for the next five years or the rest of their life. Because it's so crazy to go
01:20:06.320 from the I'm fucked forever and nothing will help me and I've tried everything to I'm healthy in
01:20:13.860 maybe what, six weeks? That's short, but even three or four months or just the possibility of 0.89
01:20:21.240 that happening changes people's lives. So I don't think there's any crushing it. It works too well.
01:20:25.080 You can't crush that.
01:20:26.340 Yeah.
01:20:26.760 No, I agree.
01:20:27.820 I agree.
01:20:28.540 Now I want to spread it.
01:20:30.400 I want this offered to people when they get involuntarily hospitalized.
01:20:36.420 Yeah.
01:20:37.260 Instead of ice cream.
01:20:38.840 Here's some ice cream.
01:20:40.160 That's going to help you feel better.
01:20:42.340 I'm involuntarily hospitalized.
01:20:44.760 Ice cream doesn't help.
01:20:46.540 It just makes like everything work.
01:20:48.860 It's crazy what they feed people in there.
01:20:50.880 It is, it is dumbfoundingly sad. It's just sad looking at what they get. I mean, it's almost all carbohydrates and, you know, pancakes for breakfast or just a box of cereal with some milk and yeah, mac and cheese and other things and ice cream and cookies and brownies.
01:21:20.880 And, yeah, I want these treatments in place of medications at some point, you know, and not for the dangerous situations, for people who are about to assault someone or kill themselves.
01:21:38.280 Yes, I think that some of our standard treatments are still going to be required because they are a danger to themselves or others and we have to keep them safe.
01:21:47.360 but you know right now none of this is being offered to anybody it's not being offered on
01:21:54.540 an inpatient unit it's not being offered on an outpatient basis it's not being offered to anyone
01:22:00.220 and when they hear you or me talk about it they're laughed at for you know what crazy person are you
01:22:09.780 listening to and that is what I'm hoping that's what I'm hoping the book can change
01:22:17.300 is it just provides tons of scientific evidence it's a science book and i kind of want to apologize
01:22:23.860 for that and not apologize for it because it's kind of like if you hate science i'm really sorry
01:22:29.220 you're gonna feel like why the hell is he talking about all this nothing science um but i did it
01:22:36.460 because i want people to take these treatments seriously and i want to give people hope and
01:22:40.980 empower them. Well, thank you. If people don't follow you online, where can they go now? And
01:22:48.960 definitely check out the book, Brain Energy. It's probably available everywhere. And if you have a
01:22:56.100 relative or something that's skeptical of diet, it might be a way for, it might be able to help
01:23:02.420 you back up the diet argument. I've been going on about diet for years. Here's a Harvard doctor
01:23:08.180 who can explain why it works check it out anyway where are you on social media the easiest place
01:23:15.680 for people to find me is either one of two websites so either brainenergy.com
01:23:22.160 um which has information about the book and lots of podcasts and articles and uh we've got a
01:23:30.420 newsletter and we really are hoping to start a grassroots movement so if you want to be involved
01:23:35.280 in this and create change, please go there and at least sign up. Let us know about you and let us
01:23:40.560 know you want to be involved. For people who are interested in more of some of the detailed
01:23:46.520 research that I've done on the ketogenic diet in both lay press and or academic articles or more
01:23:54.880 about clinical practice and stuff, they can find me at chrispalmermd.com. Great. Thank you very
01:24:01.620 much for coming on. Thank you, Michaela, for having me.