Dr. Chris Palmer: Could Breaking Up with Sugar Be the Key to Addressing Both Mental and Physical Health?

Imagine a world where the key to mental wellness lies not in a pill bottle but on our plates. In the recent podcast episode, Dr. Chris Palmer, a renowned psychiatrist and researcher, offers insights into this intriguing field known as metabolic psychiatry. The discussion traverses his groundbreaking work on the potential of dietary interventions for mental health disorders, focusing particularly on the ketogenic diet.

Dr. Palmer emphasizes that this diet, though initially designed to treat epilepsy, is a metabolic intervention that profoundly affects brain function. Therefore, its potential in treating mental health disorders cannot be overlooked.

The podcast delves into the critical question: could breaking up with sugar be the key to addressing both mental and physical health? It’s not an easy journey. It involves understanding your nutritional needs, battling withdrawal symptoms, and most importantly, persisting past the three-month mark. But the rewards could be a transformation in mental health.

In conclusion, the episode encourages us to view nutrition not merely as a means of maintaining physical health but as a crucial player in mental health. It opens up a discussion on the potential of dietary interventions for mental health, sparking interest and curiosity about this nascent field. It invites us to join the movement to revolutionize mental health, one dietary intervention at a time.

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Transcript

Speaker 1: 0:04

Welcome to the Kick Sugar Coach podcast. Join me each week as I interview experts who will share the science of sugar, sugar addiction and different approaches to recovery. We hope to empower you with the information and inspiration, insights and strategies you need to break up with sugar and fall in love with healthy, whole foods so you can prevent and reverse chronic disease, lose weight, boost your mood and energy. Feel free to go to my website for details on my coaching programs and to access free resources kicksugarcoachcom. I'm here today with Dr Chris Palmer and I'll read his bio here.

Speaker 1: 0:45

He's a psychiatrist and a researcher working at the interface of metabolism and mental health and brain health. He's the director of the Department of Pro-Graduate and Continuum Education at McLean Hospital and an assistant professor of psychiatry at Harvard Medical School. He's been pioneering the use of medical ketogenic diets in the treatment of psychiatric disorders. He's been conducting research in this area. He's been treating patients, so he's clinically involved in this medical intervention, this ketogenic medical intervention. He writes and he speaks around the world and he has a new book coming out called Brain Energy. It's going to be published in November, but you can get it, you can pre-order. So I'm going to plug the heck out of this book, because if Dr Palmer wrote it, we want to read it. So go out and get your copy. Welcome, dr Palmer.

Speaker 2: 1:34

Thank you, florence, it's great to be here.

Speaker 1: 1:38

So I think it's been two years since we've had a chance to connect, because I think on our last summit you weren't available. So I'm really excited to know you're two years further along this journey of using nutrition as a therapeutic intervention in the treatment of mental illness issues. So I'm wondering what new clinical stories of success you have for us and what new science there is, and maybe even what your own research is showing up. But why don't we just start out by saying how did you become interested as a psychiatrist who is usually so heavily trained and pharmaceuticals are the only real solution to mental illness management, and how did you become interested in nutrition as an intervention?

Speaker 2: 2:20

So it's a great question. And I trained at, and I'm actually the director of continuing education for the largest psychiatric, harvard hospital, so I'm in charge of educating mental health professionals on the state of the art practice of psychiatry. So I am well versed in psychopharmacology, medication, psychotherapies, other types of things, ect, tms, everything else. And the reality is I am an advocate for those treatments because they do work for some people and I am an advocate for people you know knowing about those treatments and accessing those treatments in the hopes that they might help. But the real answer in the mental health field is that we there is a lot of room for improvement. Far too many people, in fact the majority of people who seek mental health help do not get better with our treatments. They just don't. I wish it wasn't so. I wish I had better, a better story to tell on behalf of my profession, but I don't. You know, mental disorders are the leading cause of disability now in the world and depression just bread and butter, plain old depression is the leading cause of disability on the planet. And you know, we have all these antidepressants and we have psychotherapies and we have ECT and TMS and ketamine and psychedelics and all sorts of other things, you would think they would work right. Unfortunately, they fail to work for far too many people because a lot of these people who are disabled have gotten many of those treatments and they just don't work. So I have been painfully aware of this for well over 30 years being a practicing psychiatrist and student resident, because I've seen people shuffle through the mental health system and not get better, and so I've always been passionate about looking for better solutions. I, you know, I've been using low carbohydrate or ketogenic diets for about 20 years in clinical practice in treatment resistant depression and have seen it work not uncommonly. My career really took a left turn, so to speak, and really kind of veered off when I helped my patient with schizoaffective one of my patients with schizoaffective disorder try to lose weight using a ketogenic diet, and I really only set out to help him lose weight. I had no notion that it would help him with his psychotic symptoms, but lo and behold, after two months his psychotic symptoms dramatically improved. That man went on to lose 150 pounds, move out of his father's home and just so many successful things that I really thought were impossible, and so since then this field is really exploding. The great news is that you know, I don't look at this as a weight loss diet and I sometimes will talk about its relationship to insulin and insulin resistance, and then that does tie in with diabetes and diabetes management, but so I could speak to that.

Speaker 2: 6:12

But really I focus very, very heavily on the use of the ketogenic diet in epilepsy, and the reason that I do that is because epilepsy is a brain disorder. Nobody questions whether it's real or not. It's a real brain disorder. We can actually measure it and the ketogenic diet can stop seizures even when medications or surgery fail to do so. And the reality is we use epilepsy treatments since psychiatry all the time. So I have been publishing every time I talk about this.

Speaker 2: 6:50

Every time I publish, every time I talk to a neuroscientist about this, I always talk about all of the neuroscience that we know about the ketogenic diet and how it stops seizures, and we know a lot. So it changes neurotransmitters, it decreases brain inflammation, it, you know, regulates ion channels like calcium signaling, it changes the gut microbiome, it improves insulin resistance. It does so many things and that gets the attention of researchers, neuroscientists and clinicians and so in the last, you know, several years, there really has been a significant increase in the number of publications in respected neuroscience and psychiatry journals, either sharing case reports, case series, small pilot trials, but mostly, at this point, mostly review articles. So reviewing the neuroscience of what do we know about the ketogenic diet, what do we know about these mental disorders and how it's kind of a match made in heaven Like this is such an obvious treatment. We should be doing this. It's like it's been around for 100 years. We have so much evidence, it's just so obvious. So in my mind, it's fantastic that we have the support of leading neuroscientists and psychiatrists. They all get this is not quackery, this is not left field.

Speaker 2: 8:33

Again, we're not looking at it as a diet per se. We're looking at it as a metabolic intervention that profoundly affects the intervention that profoundly affects brain function. The great news is that we have clinical trials now getting underway. So there are at least four clinical trials Actually five clinical trials that I'm aware of of the ketogenic diet for schizophrenia and or bipolar disorder. There's another clinical trial that may be starting within the next year of the ketogenic diet for major depression. One clinical trial wrapping up in the UK of the ketogenic diet for depression, although I have not been privy to the results of that yet, so I'm not sure how that's going to turn out, but they were using a telemedicine kind of online platform actually to deliver the ketogenic diet to people with clinical depression. We have a publication from Verda actually the Verda trial who have been studying a cohort of people with diabetes type two diabetes over five years now and they just released a study showing that the ketogenic diet can help improve symptoms of depression in people with diabetes.

Speaker 2: 9:56

The conundrum, the confound with that, I guess, is that these patients were also losing weight and they were improving their diabetes control. So a lot of researchers and others are going to challenge that kind of validity Is that really a treatment for the depression or is that a treatment for diabetes? And they kind of think of them as separate. I actually think of them as one in the same that if we can control glucose regulation, we're better controlling metabolism and that results in better brain health. So I think that they are inseparable, but the research community right now does not. They don't see it that way, so they would want to tease apart Like is it really just people are feeling better because they have a less severe case of diabetes, or maybe they're on less medicine or something else, but that's just a whirlwind tour.

Speaker 2: 10:54

Actually, since you and I've talked, the National Institute of Alcohol Abuse and Alcoholism they this, our government, the United States taxpayer dollars funded a study of the ketogenic diet for alcoholism and, lo and behold, it was a positive study. The ketogenic diet helped alcoholics detox from alcohol on less medication. They had to take a lot of drugs On less medication. They had fewer withdrawal symptoms even though they were getting less medication. They craved alcohol less and they did brain scans that showed it improved brain metabolism and it decreased brain inflammation. And so these researchers demonstrated that something like a dietary intervention, the ketogenic diet can help people with alcoholism.

Speaker 2: 11:46

And most people don't think of alcoholism as a disorder related to diet. It's a disorder related to poor choices or addiction or the reward pathways in the brain, like whatever. But that's not diet Like that's alcoholism. And yet these researchers put the science together again. They looked at all the science of the ketogenic diet. They looked at all the science of alcoholism and they're like, oh my gosh, match made in heaven, we might be able to really do something for these people. They did the study. The study was positive, so the field is really growing quite rapidly. Just in the last month, I attended two meetings the Metabolic Health Summit, and there was a pre-conference, a private retreat that included 50 leading psychiatrists, neuroscientists and biotech industry that all came together to talk about metabolic psychiatry. I actually think we are right on the cusp of a major transformation in the mental health field, one that I am extraordinarily excited about.

Speaker 1: 13:13

Fantastic. I'm going to pray a little bit of devil's advocate here, because we all know of stories that people who broke up with ultra-processed foods they get onto whole foods and they're depression-less. That was my story personally. I had quite significant stretches of severe depression in my 20s. I clean up my diet. I just never came back. Now I wasn't clinical, I wasn't on medications and I wasn't even formally diagnosed. But we know anecdotally that people's depression and moods stabilize and they get so much better when they just eat whole foods and get off the ultra-processed foods. How do we know that it isn't just the removal of the ultra-processed foods from the diet that obviously a ketogenic diet does that is helping to create breakthroughs in mental health management or improvement of symptoms, if not the reversal of symptoms versus like paleo, versus like a whole food plant base. Is there any science that suggests that there's something unique and particularly effective about the ketogenic diet in terms of mental health?

Speaker 2: 14:20

It's a great question. The real answer is we don't yet have enough data for different people with different types of disorders or different severity of disorders. We really don't. It is a question that I have pondered quite a bit, especially in my clinical practice. I will say for the record, I have had some patients a young patient in particular, that you and I talked about a little bit before we got on.

Speaker 2: 14:57

I've had a young patient he was, I think, 12 when we started the intervention. He was showing signs of depression, adhd and now possible emerging bipolar disorder. Because he had a strong family history of severe mental illness, including bipolar schizophrenia, clinicians were pushing to put him on mood stabilizers. Family did not want to go that route and instead wanted to try some metabolic treatment. We tried two interventions with him. We used light therapy and we got rid of sweets. He was very stressed at school, had taken to coming home from school and having an ice cream cone or candy bar or something and then would have his dinner and then would have dessert. The after-school treat was to deal with the stress of the day. The dessert was a treat because he deserved it. There are lots of people in the world, lots of young people in the world who are eating similarly. It's why not? It tastes good, it's great. He wasn't even clinically overweight, but he was developing a gut. Many of us, at least in the healthcare field, know that if you're developing abdominal obesity, even if you are relatively thin otherwise, that that is a very worrisome sign for insulin resistance and metabolic syndrome. It's actually one of the criteria for metabolic syndrome. That, to me, was a signal that his metabolism and, more specifically, insulin resistance, might be playing a role in this. We actually have several research studies showing that insulin resistance does appear to play a clear and direct role in the development of bipolar disorder and schizophrenia and chronic depression. We have several studies to call upon to inform that.

Speaker 2: 17:19

The intervention that we designed for this young man was get rid of the sweets at least during the school week and use this light box. That changed everything for him. He didn't have to do the ketogenic diet. I didn't want to start with the ketogenic diet because it is very restrictive. It's really difficult to do for a child in school. Most school systems won't see that as even an accommodation, even for kids with epilepsy. It can be difficult for them to get access to a ketogenic diet in different situations. I didn't want to go that route, but I had it in the back of my mind. This kid might need a ketogenic diet or a more intensive dietary intervention, but he didn't. He didn't need that. He did well with. Let's get rid of the sugar during the week. You can still have a treat on the weekend if you really want, but let's get rid of the sugar during the week and let's use the light box. That was enough.

Speaker 2: 18:25

I very strongly believe that different diets can play a role for different people. As you said, some people might do extremely well on a whole food plant-based diet. If they are doing well on a whole food plant-based diet, I'm all for it. I am all for it. But other people don't do well on that. If they're not doing well, if they're not improving their health in the way they want to whether that's weight loss, whether that's reversal of diabetes or whether it's addressing a mental health problem if they're not responding to that dietary intervention, I am a huge fan of well, let's try something else. Let's not give up Again.

Speaker 2: 19:13

I think about dietary interventions in a lot of ways. One purpose of diet is just to be eating a healthy diet, getting all your nutrients and eating healthy foods and also eliminating the bad stuff, the processed foods, the junk food, high sugar, specific types of fat, trans fats or easy, low hanging bad fat. But there are other types of dietary interventions. Some people do have vitamin or nutritional deficiencies. Some people have allergies or autoimmune disorders. They might not tolerate gluten, they may not tolerate dairy, they may not tolerate other things. So people are allergic to nuts Guess what? They shouldn't have nuts. So there are tons of categories about different dietary interventions for different human beings who have different needs and different health conditions.

Speaker 2: 20:15

But I really do see fasting and the ketogenic diet is in a league of their own, and fasting is the perfect example. It's no diet, it's the absence of any diet, it's the absence of any food, and that's what the ketogenic diet actually is modeled after. Is how can we mimic that? How can we mimic the fasting state? So both fasting and fasting mimicking diets like the ketogenic diet do this have profound effects on human metabolism and that affects the way your brain works, the way your gut works, but the way everything works All your hormones, neurotransmitters, everything is affected by the fasting state or a state of ketosis, and so I really do put that in a category of its own, and I think it's a tremendously powerful intervention that I don't think all human beings need, but I think it's a really powerful intervention that we can use when needed.

Speaker 1: 21:26

Oh my gosh, I really love that distinction. So, if I heard you correctly, what you're saying is we all agree across the diet wars, which you and I both agree. We don't want anything to do with it. But we all agree that we need to get the older processed and processed food, the junk, out of our bodies. And then you need to kind of figure out an experiment with what whole food diet might address vitamin and mineral deficiencies, that the whole food diet can help heal the body and replenish the body of the vitamins and minerals it needs and phytonutrients and all the whole shebang, fatty acids and amino acids and all the things that needs to thrive. And if you still are seeing psychiatric or mental health issues and that whole food diet isn't addressing that, you can bring in a ketogenic and fasting protocol or intervention to see if that can heal.

Speaker 2: 22:25

At the next level, yes, that's precisely how I think about it, and I'm a big fan of using the least invasive, most effective intervention. Now, sometimes people don't have the luxury of time. So that young man that I described, that was the least invasive and ended up being a highly effective. I was prepared to have to do more, but I was like let's start with just get rid of the sugar, let's see what happens. And sure enough, he actually lost some. He was growing in height, but he lost his gut. The gut went away, which was a wonderful sign to me, because I knew that the insulin resistance is improving and all we had to do was get rid of the sugars. During the week we introduced the light box, and the light box improves sleep, and better sleep improves diet and improves metabolism. So I'm not convinced that it was only getting rid of the sugar, but that's the only change we had to make in his diet. But other people need other things, yeah.

Speaker 1: 23:39

And did that little guy struggle? Like, did he did his eyeballs ball out of his head when you said no sugar? And what did his family think of that? Like, that's hard for a kid to do, isn't it?

Speaker 2: 23:48

It is. So again, he was facing a pretty bad situation. He was miserable, he was very depressed. He would kind of describe himself as depressed, sometimes suicidal, sometimes homicidal. If a teacher really pissed him off, he would be I want to kill her. I don't think he meant it, but the school was like threatening we can't have this language at our school and I'm like OK, kid, stop, don't say things like that, that's not allowed. He had never heard anybody or animals or anything else. I was not concerned that he was actually going to do anything, but he was clearly distressed and looking for help and begging for help.

Speaker 2: 24:35

With these kind of cries for help, he um, and he was being offered medications that both he and the family knew have very sometimes concerning side effects. They can sedate people, they can cause a lot of weight gain, they can cause insulin resistance and, again, as a psychiatrist, more than 50% of the people who go on those medications do not get better, and that is just a fact. I'm not trying to be a heretic against my field, I'm not trying to be cruel, I'm not trying to deprive people of mental health treatment. That is just a fact, if you look it up.

Speaker 1: 25:26

That's fact, when you say more than 50%, that's a little vague. So that means 50% of people are served by them.

Speaker 2: 25:33

No, I'm using more than 50% very generously to the mental health field. So in a longitudinal study of people with chronic depression or with depression, major depression seeking treatment, the patients were about a little less than 500. Patients enrolled in this multi-site study followed for 12 years. They were all getting the best treatment available medications, psychotherapy, whatever. They were completing weekly questionnaires on how their depression was doing. 90% had continuing symptoms of depression on and off throughout the 12-year period. So that's a lot more than 50%. If we look at an illness like schizophrenia or bipolar disorder, the results are even worse and everybody knows the outcomes for those patients is much worse than those with just plain old depression. So the reality is we have a lot of work to do in the mental health field to improve our treatments and to better serve our patients. Mental health clinicians know this. They're just as frustrated as I am. They want help. They want tell us what can we do. But show us science, show us rigor. We don't just want quack ideas. We don't just want because everybody's got an idea.

Speaker 2: 27:00

There are lots of people out there selling supplements and crystals and healing energies and all sorts of things. The people selling them promise you you're going to get miraculous results, and of course we don't. And those people have been around time immemorial. People have been around selling snake oil. That's where the term comes from Snake oil salesman. Snake oil was supposed to cure whatever ale of you and it didn't work. And so mental health professionals are justifiably skeptical of new claims.

Speaker 2: 27:44

But again, so I've seen this intervention. I've seen dietary interventions work in profound ways for many people. I have collaborated with researchers who are also seeing the same results. I've collaborated with clinicians who've seen the same results, and I have heard from patients around the world. I literally I get like on a weekly basis. Sometimes I get emails from Germany, from Russia, from Australia, from all over the United States and Canada and all over of patients sharing their stories with me about how profoundly better they are because they did a dietary intervention.

Speaker 2: 28:25

And I'm hearing about the ketogenic diet because that's kind of my claim to fame. That's what I do. But interestingly, I actually reached out to some leading proponents of the whole food plant-based diet to say, hey, could you share some stories of serious mental illness being cured by your diet with me? You're the leader in this field, and they didn't have stories to share with me For better or worse. I'm not going to name names, but I did reach out. I was actually hopeful that, like, share your stories and then I can even include them in my book. And they didn't have any to share.

Speaker 1: 28:59

So is it possible that they haven't done the research? Is it just that it's not there?

Speaker 2: 29:05

The data that they collected.

Speaker 2: 29:07

So they certainly didn't do the research, but I was hoping that they would give me at least an anecdote or two of you know that somebody contacted them. Oh, I tried the whole food plant-based diet and my longstanding bipolar disorder is in remission now. Maybe those people exist. If they do, I welcome you. Please email me, share your story. I'd love to at least hear it. I'm not necessarily going to publish it because I don't know you and I can't verify that story, but I'd at least like to know, as a clinician and researcher, if that's happening out there. But I'm not hearing that and seeing that and I've actively looked for it. So I do think there's something special about the ketogenic diet. I'll say you can do a vegetarian or vegan ketogenic diet. So this isn't about meat versus plant-based diets. I would prefer to not be part of that war.

Speaker 2: 30:00

I'm a big fan of freedom, dietary freedom to choose plant-based, omnivore or animal-sourced food diets. If you want to be a carnivore, that's great, and if that's improving your health, even better, congratulations. I applaud your effort. If you are doing a plant-based diet and it has dramatically improved your health, equally congratulations. That's great. I don't want to stand in your way. I don't want to knock you down. I am an omnivore myself. I eat both plant and animal-sourced foods. I do tend to try to only stick to whole foods, real whole foods, no chemicals or anything else. But that's working for me. But whatever, some people listen to me maybe and think maybe you need a different diet. I'm not Dr Palmer, be crazy.

Speaker 1: 30:56

So my next exciting question for you is that, given the research that you're doing and the anecdotal application of nutritional interventions, what does this tell us about what mental illness is Like? The cause of mental illness?

Speaker 2: 31:12

So that is actually a perfect segue into my book, for better or worse. So I actually started writing the book, maybe like six years ago, and I was starting to write a book on the ketogenic diet for psychiatry, and I quickly realized this is going to go nowhere. I might be able to sell this to the keto community, but they're already sold on this. I don't need to sell them on the ketogenic diet and its mental health benefits. I want to sell the world on this. I want to sell mental health professionals. I want this treatment offered in mental psychiatric hospitals. I want this treatment offered in therapy offices, in psychiatrist offices. I want to offer it in primary care doctors offices if they are treating mental health clinicians or conditions. And so I quickly realized, okay, nobody's going to buy this ketogenic diet thing for mental illness, Even with all the epilepsy literature that I've got. It's just too hard of a sell. I need to dig deeper. I need to really figure out. What on earth is this diet doing? What can I really say about all the science and how does the science line up? And, more importantly, I asked exactly the question you asked me what can this tell us about mental illness, when I saw it work for a chronic psychotic disorder. I really was blown away, Even though I myself had been on a ketogenic or low carb diet for like 15 years at that point and I knew it improved my mood and my energy. But I don't have a psychotic disorder and I wasn't really using it in patients with psychotic. I was using it in patients who were depressed and in my mind at the time I was like depression is very different than schizophrenia. They have nothing to do with each other. They're totally different disorders, and so that was like the first thing that I had to reconcile in my mind is how can I make sense of this? Schizophrenia is so different than depression. And yet, as I started reflecting on our field and the treatments we use, there's a lot of overlap in the medications that we use for depression and for schizophrenia, even, and for bipolar disorder, and so it led me on this journey to do a deep dive of put everything that I know as a psychiatrist and neuroscience researcher, put everything I know together.

Speaker 2: 34:06

Then do a ridiculous deep dive into what on earth do we know about this ketogenic diet? Because it's being used not just in epilepsy, it's being used for weight loss, it's being used for diabetes and it's even being pursued as an Alzheimer's disease treatment potentially. I'm like, oh my God, this just makes it even more unbelievable. I sound like I'm selling snake oil One diet for weight loss, diabetes, mental illness which mental illness? Gosh, a lot of them. I don't know how many am I going to say. We've got alcoholism, bipolar schizophrenia, depression. People are talking about eating disorders using it there. We're talking about using it for Alzheimer's.

Speaker 2: 34:56

How am I going to put this all together? How does it make sense? But that was my mission. I've really spent the last six years on that mission and I have been relentless in the research. This is going to make me sound crazy, but the honest answer is at some point along the way, I was completely blown away with what I think I have discovered. And what I think I've discovered is that is a way to put all of the existing evidence that we have in the mental health field, all of the existing evidence on biological, psychological and social causes of mental illness, into one unifying theory. That theory centers on metabolism. The quick bullet conclusion is that I believe the only way that we can truly understand mental illness is in the context of metabolism. In order to understand metabolism, you have to understand mitochondria.

Speaker 2: 36:18

I'm not going to go into super detail but I will at least share that with you and let you know my book is going to do a deep dive in mental. That's what my book is. My book is a.

Speaker 2: 36:34

I basically take people on this journey that I have been on my entire career. The book starts with a lot of stuff that everybody kind of knows about mental illness Biological, psychological, social factors, stress, neurotransmitters, cortisol, genetics. It runs in families, Trauma, substance use All of those things play a role in mental illness and we know those things are all true. I'm not at all trying to tear them down, I'm trying to make sense of it. I'm trying to put them together in one coherent way. And so the book starts with here's where we are in the mental health field and it kind of highlights and here's why we need something different. This is failing to work for far too many people. Mental disorders are the leading cause of disability, even with the best treatments we have to offer.

Speaker 2: 37:41

And then I take people on a journey that I have gone on really my whole career, but in particular this deep dive that I've done for the last six years to try to put it all together and take people on a journey through metabolism and what metabolism really is. It's a lot more than just burning calories. In order to understand metabolism, you have to understand mitochondria, and so I could do a deep dive, like a really deep dive, into mitochondria and all the roles they play in human health and cell function, and then how we can put that all together to understand in a fairly straightforward way all of the symptoms of mental illness and then, most importantly, going through just all of the contributing causes and risk factors for mental illness and what we can do to intervene. And there are lots of things we can do to intervene. Diet is clearly one of the things, but my book is about much more than diet. Metabolism is about much more than diet, and but these things are you kind of already know, everybody already knows them. They're the things that we all know are good for general health sleep, stress reduction, don't use too much, don't use recreational drugs, don't use too much alcohol, don't smoke.

Speaker 2: 39:10

But inflammation plays a role, Stress plays a role, Trauma, relationships, having a sense of meaning and purpose.

Speaker 2: 39:20

Spirituality can play a big role for some people.

Speaker 2: 39:24

And I tie it all together and, at the end of the day, come to the conclusion that mental disorders are metabolic disorders of the brain. So if you really want to understand mental disorders, you have to understand metabolism and mitochondria, and my book takes you through that. But the flip side is, if you really want to understand metabolism and metabolic disorders, so if you really want to understand how to lose weight more effectively, if you really want to understand how to better control your diabetes, if you really want to understand how to prevent a heart attack or how to prevent Alzheimer's disease, we have to start talking about mental health more, Because mental health plays a profound role in all of those, and that can mean depression, anxiety, stress, trauma, sleep addiction. All of those things play a profound role in your metabolic health. So mental health and metabolic health are inseparable and we really need to merge the field of metabolic health with mental health and I think then we can truly begin to help all of the people the world who are suffering from mental and metabolic disorders.

Speaker 1: 40:52

Oh my gosh, that is so clear and so profound. Thank you for that. If I'm listening to this call and somebody has a mental health issue and they're like, okay, okay, I'm kind of open to this, I'm persuaded, I'm willing to give it a try. Where would they start with the ketogenic diet? And I just wanted to get a little bit practical, because there's so many different versions of it and people think ketogenic diet, they think maybe a big juicy burger with cheese and guacamole and bacon, but there's so many different ways of doing it. So what are your recommendations? If someone came to you to say where do I start? What does fasting look like? What do I eat? What would you say?

Speaker 2: 41:35

So the first thing I would say is I need more information, I need to know what condition you're trying to treat. If you're trying to treat mild to moderate depression or anxiety, if you are not a danger to yourself, so that means you're not hurting yourself in any way, you're not at risk for suicide, those thoughts aren't going on, that you're just trying to improve your mental health. You feel stressed, you feel burned out, you feel somewhat depressed or anxious. That, to me, is the easy case, and I don't say that to minimize the distress that people in that situation are experiencing. But their safety isn't in danger and they're not having psychotic symptoms, they're not suicidal. So, as a psychiatrist, that is an easy case to me. Again, not trying to minimize suffering or compare real cases with not real cases. I'm not trying to do any of that. So if you have those symptoms, I would actually start with the way you and I talked about a little bit ago, which is let's get rid of the processed foods. How about go try a whole food diet? How about go try a whole food diet? I would work with the person or I would recommend that the person figure out what kind of a whole food diet they want to be on. If they feel strongly and passionately about trying a whole food plant-based diet, I would say let's start there If they feel passionately about. Well, no, I've heard good things about this keto diet, so I want to do that. And okay, let's try the whole food keto diet. If you want to do paleo, let's try that, Because for some people, that can be enough.

Speaker 2: 43:34

Now, again, I want to look at all the other things. If they're not sleeping well, if they're using drugs, if they're really stressed, if other things are going on, I'm going to advise them to also take care of those other things at the same time that they're changing their diet. But start there. Give it at least two months. You're not going to see results right away and in fact, for most people, the first week or two can be really, really difficult.

Speaker 2: 44:03

Sugar withdrawal, carbohydrate withdrawal, processed food withdrawal whatever we want to talk about, People are going to have cravings, they're going to be irritable, they're going to feel hungry. They're going to feel like, ah, this food that I'm eating is just not satisfying. I need whatever you crave or whatever you're giving up. So if you are giving up carbohydrates and you're on a low-carb or ketogenic diet, you're really going to crave those carbohydrates initially and I'm going to encourage you to get through that.

Speaker 2: 44:37

Come up with a plan, maybe develop a support system, have somebody who can help support you through this and then give it a couple months, see if it works. If it doesn't work, move on, or adjust more or do your diet more intensely, restrict, do something to improve upon your diet. But again, there are lots of choices. If somebody comes to me says I really want to do a ketogenic diet, so when I have people with serious mental disorders I'll do the other extreme, Serious mental disorders, and they want to do the ketogenic diet, my first strong recommendation is that you're going to work with your mental health professional. Why? Because you have a serious disorder and you deserve help.

Speaker 2: 45:26

You deserve safe, competent help, and so I just want you to at least work with your mental health professional and let them know you want to try this intervention Now. If your mental health professional says, well, I don't know how to coach you on this, I don't, that's fine. Just make sure that they're okay with you trying this and that you two are going to talk about your mental health symptoms and that your mental health professional is going to help keep you safe through it, no matter what happens. And so that might mean adjusting your medications. That might in rare cases, it might even mean a hospitalization if something goes wrong, but that they're on board. And then, if you really want kind of the medical grade version, I would actually recommend you work with a licensed dietitian and find a ketogenic dietitian. I have a few on my website who are working with psychiatric patients, but there are lots of others around. Charlie Foundation has some listings of dietitians that you could reach out to, and they know the diet like the back of their hand. So they're going to give you meal plans, help you monitor ketones, they're going to help you monitor lab values, look for nutritional deficiencies, all those things, and I would try it for three months at least, and then after three months, do an assessment with your mental health clinician, with the dietitian, with your family your girlfriend, boyfriend, husband, wife, whatever. Do an assessment and figure out is this diet working and is it worth it? I don't want you to ask that question is it worth it before three months? Because if you ask that question on day four you're going to say no, it's not worth it. If it's not worth it, I can't imagine living my life without whatever. I'm so irritable and hungry and this diet sucks. There's no way I could ever be happy on this diet. That's what I hear a lot. So I prepare people for that. If they can get to the three month mark, and especially if their symptoms dramatically improve, that's when most of the patients that I work with will say I can't imagine going back, like, yeah, this diet is kind of hard sometimes, but I'm doing it and my life has been transformed and I can't imagine going back to eating the way I ate before and suffering and being disabled. So three months, a lot of the cravings have gone away.

Speaker 2: 48:10

At that point People have figured out a routine, they've figured out meals that they are comfortable with. They've figured out how to manage going out if they need to go out. Sometimes people just fast when they go out. It's like they'll have a glass of water. If they're out with friends or family or whatever and just eat their meals at home, other people will pack something with them.

Speaker 2: 48:32

If it's a place you're going and you can pack a meal, or I advise people to just eat before you leave, even if you're going to dinner with friends, maybe you eat dinner before you go so that you're all set. Then you can just have water or something or a small little appetizer or salad or whatever you can. But you're not going to be starving and find yourself in a situation where you don't have any good choices, because if you're starving and then you've got the peer pressure, everybody's saying oh, you're doing so. Well, you can go off the diet, go ahead, just this one cheat, it's fine. You might find yourself eating pizza or something and then things can fall apart rapidly. So I hope that's enough, but I'm happy to answer other questions.

Speaker 1: 49:24

That's great. I think that's very good. So I am wondering. So it's just so clear that it seems that there's something about carbohydrates that are implicated in addiction right with alcohol for sure, obviously food addiction and there's such a hard sell. To my own brain that's something like a whole food, like rice or oatmeal or something that historically, our ancestors ate and seemed to be eating just fine. So why now is there such an epidemic of people who seem to be carb intolerant and addicted to them and mentally ill because of them and all those sorts of things? Do you have a theory on that or a comment on that?

Speaker 2: 50:15

I do. So I applaud you for asking that question, because a lot of people aren't asking that question and they just say, well, carbohydrates are toxic, but they ignore the reality that you just mentioned, which is well then, how can we explain all the people in China who have been eating rice for millennia? All of them don't have a mental illness and, in fact, the rates of metabolic syndrome and metabolic disorders were pretty low in China. The rates of mental illness were actually pretty low in China. As China has westernized, all of the rates are skyrocketing. But they were eating rice all along. So I don't think I personally don't think we can blame the rice. It doesn't make sense to blame rice because it's been around, and that's why I look at something like a ketogenic diet, or even a low carb diet, in a different light. It's not about good foods versus bad foods. It's about impacting metabolism. So there are lots of things that can impact metabolism and, again, this is where mental and metabolic converge.

Speaker 2: 51:49

So a study just got published, I think, maybe like a week or two ago. They were raising monkeys on a standard American diet, but half the monkeys were stressed intentionally stressed and half the monkeys were not. The monkeys who were stressed, were much more likely to develop type two diabetes. Now, type two diabetes means insulin resistance. They were all the monkeys were getting the same diet, exact same diet. The only difference was a psychological or social problem stress increased risk for type two diabetes.

Speaker 2: 52:38

How can we understand that? There are actually lots of ways we can understand that, knowing the science that I know. I'll give you the really easy low hanging one cortisol. We know that stress increases cortisol level. We know that cortisol induces insulin resistance. Cortisol makes your blood sugar go up, it makes you secret more insulin and longer term it results in insulin resistance. So we know this with certainty because we can actually give medications that are just like cortisol. They're medications like prednisone and if we give somebody prednisone, they will immediately start getting bloated, they will immediately develop prediabetes and oftentimes they will change their eating behaviors. They'll actually start craving carbohydrates and junk food and they'll start eating more of it, even if they were a quote unquote healthy eater before taking the prednisone. So high levels of cortisol Change your metabolism and can result in insulin resistance, and that can then change your eating behaviors. And now you're off to the races. But lots of other things can cause high levels of cortisol, like trauma and abuse Not just stress, but trauma and abuse. A lot of adverse childhood events can cause high levels of cortisol and you're going to get this similar effects Once somebody is insulin resistant.

Speaker 2: 54:20

I believe that a low carbohydrate or a ketogenic diet is an ideal diet to treat that. So I don't see it as cause and effect. So I don't see low carb diet being an effective treatment. So we know low carb diets are an effective treatment for insulin resistance. That has been proven in innumerable studies. It's been used for a couple hundred years. That is unequivocal and anybody who believes in medical research has to understand that.

Speaker 2: 54:56

This is not quackery. This is not anecdotes. Everybody always says, oh, you're just using anecdotes and these are rigorous, well documented, controlled studies. Low carb diets are an effective treatment, an effective intervention for diabetes and lowering blood sugar. And the reason I think they're effective is because when somebody is insulin resistant, it means that they aren't able to use glucose effectively as a fuel source. So a low carb diet changes the fuel source. You change the fuel source to more fat and ketones and that allows the body to heal, that allows metabolism to heal. It allows cells to kind of repair themselves and get healthier and in some people that can reverse the diabetes or insulin resistance, and then they might be able to even transition to a less restrictive diet Once they are no longer insulin resistant. Then they might be able to transition to a paleo diet or something else that includes plenty of fruit and carbohydrates, but maybe they'll be able to tolerate it better. So it really is kind of.

Speaker 2: 56:12

These questions of cause and effect get people really heated. Not everybody's going to agree with what I just said, but based on my understanding of the science, that's the way I think about it. And and so back to your question. So why do we have such high levels of insulin resistance in the world today? That really is the billion dollar question. What are we going to do to get to date? I have my own speculations. They really are speculations. They're based on a reasonable amount of science, but right now nobody can really say for sure. That is the billion-dollar question.

Speaker 2: 57:03

And if you, you know a lot of people want to just blame oh, it's all the junk food and the chemicals. But in the 1970s, when I was growing up, we had junk food and chemicals. They were called Twinkies and King-Dongs and Ho-Hos and I ate them almost every day. I wasn't obese in the 1970s and the majority of Americans weren't yet obese. In the 1970s we had access to that same food. We had access to horrible processed chemical laden, had trans fats in it. It had sugar, lots and lots of sugar. I drank Kool-Aid. That was my. I remember when I was a kid I could not drink plain water. It was too bland. I hated the taste of water because I grew up on Kool-Aid. Kool-aid was sugar, pure sugar, and some chemicals to color it. So that's what I grew up on. And yet, and lots of other people were eating the same eating and drinking the same stuff that I was, and the obesity rates were much lower then than they are now.

Speaker 2: 58:26

And so in order to really understand what has really happened, we have to understand the complexity of metabolism and what has happened to the human species. And then that gets into all sorts of things hormones and epigenetic changes and chemicals, but it also gets into possibly environmental toxins that are poisoning the metabolism of the human species. And I won't go too far down that rabbit hole because then I start to sound like a conspiracy theorist or whatever, but that's the way I think about it. The real answer to your question why is everybody developing metabolic problems and mental problems? Oh gee, coincidentally, the same time, metabolic problems are skyrocketing, so are mental problems. Why is it all happening at the same time? We don't have clear answers Based on what I've proposed, this connection between mental and metabolic.

Speaker 2: 59:35

It could be all the cell phones, the lack of everybody sitting and looking at screens. Humans aren't interacting with humans anymore. People don't feel loved and appreciated like they used to. People don't have community like they used to. Social media fosters fakeness. It just everybody takes a selfie smiling and then everybody looking at all the great lives that everybody on social media thinks to themselves. My life sucks Like they're taking fancy vacations and they're so happy and they have so many friends, and look at all the likes they're getting. They have lots of support and I'm not getting any of that.

Speaker 2: 1:00:21

Could that be playing a role? Absolutely it could be playing a role, because that induces a stress response. It makes people feel lonely and isolated, and all of those things play a role in metabolic health as well. So there are lots of complicated factors that all come together that might be playing a role. It's probably not just one of them, unfortunately. I wish it was going to be as simple as oh. We finally identify the one and only one cause of the human species going bad Like. Why is the human species developing metabolic and mental problems at skyrocketing rates? Why is our health deteriorating? Why is our lifespan decreasing for the first time in a long time? Those are questions that lots of very smart people are looking into and sadly, the real answer is no one knows for sure yet.

Speaker 1: 1:01:22

Got it Gosh. Really, it just sounds like a perfect storm of all of these different things impacting people in different ways. And if I was to summarize our conversation, what you're basically saying is that you almost see metabolic health as having been damaged from all kinds of angles from sleep, from stress, from toxins, from food culture, malfunction to the lack of exercise, to bombardment of social media and isolation, and all those different things have all come together to create a metabolic breakdown. And that metabolic breakdown shows up in individuals' lives in a variety of different ways. It can be physically through diabetes, it can be mentally, through mental health illness, and on the mental health level, it could be depression, it could be bipolar, it could be schizophrenia, but the same root, it's got the same root and what you're proposing is a place to start as a powerful, underutilized and exciting new therapeutic intervention, is the role of the low-carb, ketogenic diet, because it directly addresses the potential root cause of the metabolic factor in all of this. Is that kind of the way to summarize?

Speaker 2: 1:02:30

Everything you said, up until the very last thing, I 100% agree with. And you kind of just summarized my book. And so no, which is great, because my book is, that's not the secret. So my book actually dives deep, goes into mechanisms, provides science and evidence to support all of this. It's not just a theory. I'm calling it a theory, but it is a theory based on decades of hardcore research that all comes together. I look at my book as all coming together.

Speaker 2: 1:03:04

The reason I slightly disagree with that very last statement is because a lot of people see me that way, that Chris Palmer is all about the ketogenic diet or low-carb diet, and that's the intervention that everybody should be on. And I just want to say I will never back down from the ketogenic diet is a powerful, powerful intervention. I will continue to use it, probably till the day I die. I will continue to promote it, I will continue to talk about it. I think it is a powerful intervention, but it's not the only intervention and, in isolation, if we ignore all of the other things that you listed, if we ignore it all and just say, well, ketogenic diet should cure everyone, right? I'm going to be like no, no, if they're not sleeping if they're taking their phones to bed with them and only prioritizing five hours of sleep, and so they're really only getting four hours of sleep and they've got noise going on while they're sleeping and they've got a light on in the room and they're drinking excessively and they're vaping all the time, but they're on keto. Do I think that that person is going to have optimal mental and metabolic health? Absolutely not. They're going to have probably quite impaired metabolic and mental health, and so those other interventions are equally important.

Speaker 2: 1:04:36

The great news about the ketogenic diet, though, is that it really is kind of like a metabolic reboot, so to speak. If you want to reboot, if your computer is not working and you don't quite know what's wrong with it, you reboot, and a lot of times that solves the problem. It's kind of sort of the way I look at the ketogenic diet. It's a metabolic reboot, and it can fix so many problems that we really, as scientists, don't know exactly which cells are the problems occurring in Exactly. Is it a fuel source issue? Is it a mitochondrial issue? Is it a hormone issue? Where is the problem? If you do the reboot, everything kind of works its way out and the system. What's happening in ketosis. It really is a reboot. We're stimulating autophagy, we're stimulating all sorts of things. So I'll never back down from the ketogenic diet as a powerful intervention or a low-carb diet as a powerful intervention. But they aren't the only interventions and we as a diet community, we as health advocates, need to take a more comprehensive metabolic, mental approach to health and wellness.

Speaker 1: 1:05:59

Got it. I love that and I will end here because I have the sense you and I could talk all day. This was an amazing interview, Dr Palmer, so crystal clear, Like one of the best I've done with you In the addiction field. It's the exact same thing that in my early days of trying to unhook from my own twinkie addiction, I just thought if I could just unhook from these processes for fine carbohydrates, that everything would fall into place and that all of my issues would disappear, that carpet stains would just resolve themselves. Like I just thought it was the one hit wonder, the bullet, the magic, the silver bullet.

Speaker 1: 1:06:42

And then you realize, once you get cleaned and sober and you eat whole foods and you know that, oh my gosh, that was just the beginning of the journey of recovery. That abstinence is first for sure so that you're freed up mentally and physically and energetically, et cetera, to start to do the deeper recovery work. And that's what you look at your sleep and your exercise and your childhood trauma and how to reframe negative thoughts. You start to bring in all these others more holistic interventions. But it's so tempting to think that one thing is going to magically solve it all and it's really great to be reminded, both for people who are looking to heal their metabolism, that it isn't just about going on keto and calling it done. It's not just about getting abstinent and calling your recovery done as an addict. So that's the beginning of a journey of multiple different interventions that just continually upgrade the quality of our life and the health of our brain and our mental health.

Speaker 2: 1:07:39

Yes, that is extraordinarily well said.

Speaker 1: 1:07:43

Thank you very much for your time. Dr Palmer, Do you have any final words you want to share before we wrap up?

Speaker 2: 1:07:50

I think the only final word I'll say is that my book launches November 15, but I am already working with the coalition of people. We want to change the mental health field. Access to mental health care is abysmal, right now.

Speaker 2: 1:08:07

In the United States, if you want to find a psychiatrist, more often than not you have to pay out of pocket. A lot of people can't afford to pay out of pocket. Insurance doesn't cover it. The research funding is paltry, especially given that mental disorders are leading cause of disability and, as I've said, our current treatments have poor outcomes for far too many people.

Speaker 2: 1:08:30

We need to transform the mental health field like in a huge way, and the only way that's going to happen is not through my book. The only way that's going to happen is through a grassroots movement, and so, if you are equally passionate about changing the mental health field, if you are a loved one, have suffered relentlessly and are sick and tired of suffering and being told you have a chronic disorder and there's nothing more we have to do, I could really use your help and for right now, at some point I will have a website, brainenergycom but it is not live right now, so for now, go to chrispalmermdcom. If you sign up for my newsletter or if you follow me on Twitter, those are the two easiest ways to learn about how you can get involved with the movement. But we really want to change the mental health field and we are going to need a lot of people to do that.

Speaker 1: 1:09:31

Thank you very, very much. Thanks everybody for tuning in.

Speaker 2: 1:09:36

Thank you.

Speaker 1: 1:09:41

Thanks for tuning in this week. If you would like more interviews, more information and more inspiration on how to break up with sugar, go to my YouTube channel, kicksugarcoach or my website KicksugarCoachcom. See you next week.