A Harvard Psychiatrist Rethinks Mental Health As A Metabolic Disease with Dr. Christopher Palmer

Coming up on this episode of the Doctor's Pharmacy. Children with high levels of insulin resistance starting at age nine are five times more likely to be at risk for schizophrenia or bipolar disorder by the time they turn 24.

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Hi this is Lauren one of the producers of the doctor's Pharmacy just a.

Quick note before we get into today's show that there are some audio issues.

In the first few minutes of this.

Episode they resolve quickly from there welcome to the doctor's Pharmacy I'm Dr. Mark Hyman and that's Pharmacy with an F a place for conversations that matter and if you ever suffered from depression, mental illness, or know anybody who has, this is a very important podcast because it's going to completely disrupt the paradigm of psychiatry with a physician who is at the center of the bastion of traditional medicine, Harvard Medical School and University. And we're going to have an incredible conversation with Dr. Christopher Palmer, who's a psychiatrist and researcher working at the interface of metabolism and mental health. He's the director of the Department of Postgraduate and Continuing Education at McLean Hospital and an assistant professor of psychiatry at Harvard Medical School. For over 25 years, he has held leadership positions in psychiatric education, has done lots of research, he's worked with people who have treatment-resistant mental illness, and he's been pioneering the use of medical ketogenic diets in the treatment of psychiatric disorders, among other things. He's conducting research in this area, treating patients, writing, speaking around the world on this topic. and he's really interested in the role of metabolism and metabolic interventions on brain health. Welcome, Christopher.

Thank you. Thanks, Mark, for having me.

So, we were just chit-chatting before the podcast and I actually had come across your work from a friend and said, hey, this is really great stuff. I'm excited you're getting on this train of thinking about how we treat the brain, not just the mind. as a way of treating psychiatric illness and disrupting the paradigm of psychiatry. And I said, well, hey, why don't you kind of have a look at my old book I wrote like 14 years ago called the UltraMind Solution? And you're like, okay. And then you read it. And then you were like, Hey, wait a minute. This is really similar to what I wrote. And I promise I didn't steal your work. And it made me laugh because, you know, the truth is the truth. And if you're a clinician, if you're a scientist, and you observe what's in front of you instead of what you think you're going to see. And a lot of time, you know, people who are in traditional medicine or any field get kind of in a narrow view of their world and can't see beyond the borders of what they traditionally were trained in. R.D. Lang said, scientist who's a very well-known psychiatrist said, scientists can't see the way they see with their way of seeing. But somehow you did. And you're really breaking through in a conversation around mental health that I don't think is really very popular right now and it's not really well known. And then we're going to get into it because I think for me, this is really how we should be thinking about mental health. The old diagnoses, the DSM-5, which is how we categorize psychiatric illness, doesn't really give us a lot of ways of thinking about the causes of mental illness. They just tell us what it is. Like you're sad and hopeless and helpless. Okay, you're depressed. Oh, you're, you know, you're anxious and nervous and you're scared of mice. Well, you have anxiety. That doesn't really tell you what's going on and you really have come across this. So, we're really in a crisis now. I mean, according to the World Health Organization in 2017, about 800 million people on the planet suffer from mental health problems. And that's like 10% of the world's population, one in four experience depression at some point in their life. So, let's start with asking you, what are the real causes of mental illness and why are mental health problems so hard to treat and why has psychiatry sort of, in my view, been so much struggling with this burden of mental illness and not been able to treat it well?

So, the current answer, and we'll likely get into the, my evolved answer, but the current answer from the field is that no one knows what causes mental illness. what we know are risk factors. So some people are passionate about one risk factor over another. So some people will say mental illnesses are chemical imbalances and so the obvious treatment is a chemical to rebalance your chemicals. You know, another common paradigm is stress and trauma and there's no doubt that trauma and neglect, abuse in childhood can cause mental disorders. not only in childhood but all throughout life. And other people talk about hormones, other, you know, so all of the risk factors end up getting lumped into what we call the biopsychosocial model, which says there are biological, psychological, social factors. They all come together to result in mental illness. And this applies to all mental disorders, even something like schizophrenia and bipolar disorder, even though most people think of those as biological disorders, psychological and social factors play a role. But the real answer is nobody knows how they all fit together. And I think that speaks to one of the reasons why these disorders are so hard to treat right now is because we don't know really what we're doing. We don't know what we're treating. We see symptoms, we see risk factors, but we don't know how they all fit together and we don't know what the underlying pathology is.

That's right. I mean, I bet you hit on on it because when I went through psychiatric training as a doctor and as a family doctor, which I went through a number of rotations, I was like, wow, this is really odd. All we're doing is describing symptoms. We're not talking about the cause. What's the cause? And what's the why? You know, it's basically a phenomenological description of symptoms and tells you nothing about the reason. And it's very circular. So it's a chemical imbalance. Well, okay, what causes that chemical imbalance in the first place? and, and in my career, I have really had the most extraordinary discoveries as a clinician, because I'm not a researcher. Well, at Cleveland Clinic, we do research, and I'm involved with that, but I'm not, you know, a traditionally trained researcher. And I just kind of was shocked to see when, and I think the same thing happened to you when you get into the story, when you start to treat patients in a different way through diet and lifestyle, some of the root causes, and they get better. You're like, holy cow, what is going on here? How could this happen? And how come I never learned about this in medical school? And then going on the rabbit hole and once you see it, you can't unsee it. And so tell us about how you discovered, as a traditionally trained psychiatrist at Harvard and McLean's, which is one of the top psychiatric hospitals in the world, how you kind of flipped your view and came up with this model of brain energy, which is this new book that you put out, which is really extraordinary and everybody should get it. It's really out now and it's really an important book in psychiatry, especially coming from someone in your position.

Thank you. I think the real turning point for me was it started probably 20 years ago with my own health. I had metabolic syndrome when I was in my 20s. I ended up changing my diet to a low carbohydrate diet, getting rid of a lot of processed foods, a lot of sugars, other things. And I noticed a significant change in my mood and energy state. And I began thinking, maybe this could be helpful for people with treatment resistant depression. And so probably 18 years ago, I started using dietary interventions in people with treatment resistant depression, and sure enough had some luck. But for the most part, I wasn't really blown away with that because it's depression. And yeah, eating a better diet, maybe some people feel better. It just didn't seem like it was as mind-blowing to me as what happened to me in 2016. So, yeah, 2016, I have a patient, he'd been a patient of mine for eight years with, you know, diagnosed with what's called schizoaffective disorder, which is a cross between schizophrenia and bipolar disorder. And he was absolutely disabled and miserable and tormented by his illness. He had hallucinations, delusions, every day of his life, absolutely tormented by them, could barely leave his house, was chronically paranoid, convinced that people were trying to hurt him. So that's why he stayed home. It was just safer. He couldn't ride on a bus because he was convinced that everybody there was reading his thoughts and trying to hurt him. And this man had tried pretty much all of our standard treatments, numerous antipsychotic medications, mood stabilizers, antidepressants, stimulants, everything else. and nothing was working. And for the most part, he's not unusual. That is the standard of care in our field, tragically. It's most people with that diagnosis are like that. They don't get that much better ever.

Right. It just is how they have to live their whole lives. You just kind of give them medication and kind of manage their symptoms. It's basically, you know, the anti-psychotics like thorazine. Now they have better versions of it, but essentially it's. not much has changed since the 60s when they just used, we call them major tranquilizers. We just sedate them so they're not, you know, kind of going nuts.

So they're not causing trouble. And, you know, and to be fair, it's better than putting them in jail. It's better than letting them die. But for sure, it certainly does not restore people's health, and it does not restore people's lives. And there is no doubt Every clinician in this field and every patient and family member who know anyone with these types of disorders know that we have a long way to go and we need better solutions. So anyway, he asks for my help to lose weight. And so I'm pretty familiar with low carbohydrate ketogenic diets. He had already tried like three or four other types of weight loss methods without success. So we decided to try a ketogenic diet for weight loss. And at that point, even though I'd been using it in people with depression, I had no notion whatsoever that this would help his chronic psychotic disorder. Those are very different things in my mind, completely different illnesses.

And.

Within two weeks, not only would they start losing weight, but I noticed this antidepressant effect. And in him it was pretty remarkable. he was. He didn't look so sedated anymore. He was making more conversation, making better eye contact in a way that I'd never really experienced with him. Then I thought to myself, wow, that's really interesting. Here's this antidepressant effect that I've seen before. That's. That's really remarkable. And it's great that he's losing weight and feeling better, but he was still psychotic. He was still delusional, still hallucinating. I It was probably about six to eight weeks later that he just spontaneously said, you know those voices that I hear all the time? I'm like, yeah, I know about them. I think they're going away. I think they're getting better. And the really striking thing to me.

Was.

Shortly after he said that, a week or two after he said that, he said, you, know how I always thought that there were all these Rich families conspiring against me that they had targeted me and that they were tormenting me on purpose. I'm like, oh yeah, I know about that. Are we going to talk about that? I'm thinking to myself, Are we going to talk about that again for the millionth time? And he says, I don't think that's true anymore. As I think about it, as I say it out loud, it sounds kind of crazy now. And I don't think that's really happening. And maybe it never was. And maybe I really do have schizophrenia like everybody's been saying all along. And maybe it's getting better. And so that man went on to lose 150 pounds and he's kept it off to this day. His life in many ways was transformed. He was able to move out of his father's home. He was able to participate in school again and complete a certificate program. He was actually able to get up in front of a live audience and perform improv. And this was a man that couldn't be on a bus. He couldn't go to a movie theater because he was terrified that people were out to get him. And that completely transformed everything I knew because I was initially just in disbelief. Like, this can't be happening.

Yeah. Don't confuse me with the facts. My mind's made up. It must be a spontaneous remission, right?

Exactly.

Maybe he never really had schizophrenia.

It was interesting because I actually, he was working with a psychologist as well and his father is very involved in his care. And I had to ask both of them several times. Are you seeing what I'm seeing? I'm having a hard time believing what I'm seeing. He is dramatically transforming in ways that I've never seen with other people. And am I kind of seeing something that's not there? Am I going crazy? What is happening here? And they were all like, Absolutely, it's happening. So I ended up doing a pretty quick literature search. And at that point, I only knew keto and low-carb diets as weight loss interventions. I also knew that they helped it with diabetes, but I had no idea that the ketogenic diet had been used for 100 years in the treatment of epilepsy.

Yeah, for sure.

And, I didn't know that at the time. And so, once I realized that, I.

Could- you- know why? Because we don't really learn anything about nutrition in medical school.

Exactly.

No, and- Because nutrition has nothing to do with disease, of course, right?

Exactly. And the tragic part about that in particular now that I am kind of an expert on the ketogenic diet for mental illness, the tragic part about that is this is an evidence-based treatment. We have two Cochrane reviews that demonstrate that we have had more than enough research, clinical trials, demonstrating that the ketogenic diet can stop seizures even when pills and surgery don't. We have more than enough evidence on this.

That'S the last resort is diet. After all the drugs and surgery don't work, then we try diet.

Yeah. And let's try diet even. Yeah. Even though.

I mean, diet could be dangerous. You might, you know. Yeah.

They might end up losing weight. We wouldn't want that. So once I realized that I started using this intervention in many other patients, and, you know, it was not across the board. It was not a miracle cure for everyone. I will fully state that and disclose that.

Yeah.

But it was dramatically effective and sometimes even more effective for other patients that I used it with. And I was putting what I always thought of as chronic mental disorders, schizophrenia, bipolar disorder, and others into full complete remission, sometimes getting people off all their meds and they were remaining in remission for years. And I ended up getting connected with other patients who had found their way to this intervention either through other clinicians or on their own. And some of these patients, you know, the most striking case was somebody who had been in remission for, you know, at the time was about 12 years. And she was 70 years old. It suffered from schizophrenia for 53 years.

Wow.

And her schizophrenia went into full complete remission off all medications for 12 years. And those things don't happen in psychiatry right now.

I mean, Chris, what you're saying is basically the world is not flat. You're like Christopher Columbus and everybody else is actually saying the world is flat because it looks flat. We have these diseases, they don't go away, they're chronic, there's no cure for them. And it's remarkable when you start to see it. In essence, it's like you're saying, well, I, I, it's like saying, well, I saw someone who's fully autistic, and now they're not. That, that's the level of drama of this case. It's, it's, and I've seen the same thing over and over and over again for decades, because by doing functional medicine, you just get to the root cause. And, and the thing that, that you, you know, I want to drive home is that you really are dealing with some of the underlying biology of the inflammation in the brain. and whether it's autism or Alzheimer's or ADD or depression or schizophrenia, if you biopsy the brains, they're all inflamed. Now the causes can be different. That's why the ketogenic might work for some, not others. Maybe another person might have another issue. They may have, for example, heavy metals or a toxin that's causing a problem. And if you don't deal with that, then maybe they tune all day, every day, and they're tuna fish sandwiches, that's their diet at home. But we have to kind of get to the root cause. But when you start to sort of broaden your net and look at the, uh, the overlying framework, you're really dealing with this this brain inflammation. And what you're saying is so revolutionary because when you look at the economics and the disability of mental illness, it far surpasses any other illness heart disea, cancer,abetes, Alzheimer's. It is the single biggest cause of disability and costs. I think I read a study recently that ninety five trillion dollars are going to be spent over the next 35 years on chronic illness. And a lot of that, the majority of that is for the disability that goes associated with depression and mental illness. It's not necessarily being in the hospital and the loss of productivity to society. Like you said, this guy was just sitting at home, couldn't do anything. Now he's a productive member of society. What is the cost of that? Hey, everyone, it's Dr. Mark. I I don't think there's anything better than waking up feeling super rested, relaxed, and energized. When we get high quality sleep, that's the norm. But without it, our simple day-to-day tasks can seem impossible and our health suffers. That's why I'm always looking for ways to upgrade my sleep routine and bamboo sheet sets from Cozy Earth is my new favorite way to get an amazing night's rest. You might be surprised to learn that many types of bedding out there contain toxins that can off-gas into your air and absorb into your skin. Do you want to sleep on formaldehyde? I don't either. So I know that Cozy Earth's products are certified to be free from harmful chemicals and that's why I love them. Sleep actually impacts every part of our health. It helps us maintain a healthy weight by balancing hormones and blood sugar, provides time to detox our brains, lets our muscles and organs rest and repair, but so many of us don't get enough sleep or the right quality of sleep to allow the body to do all these important things. Better sleep is the cornerstone of better health and is something we all have the power to work on. I know nice bedding can feel like a big investment, so Cozy Earth makes it super easy to try out their products with a 30-day free trial and a 10-year warranty. Plus, right now they're offering the best sale price ever with 40% off. Just go to CozyEarth.com, use the code MARK40 at checkout, and that's CozyEarth, C-O-Z-Y-E-A-R-T-H.com with the code MARK40, and check out. I know you'll love these sheets as much as I do. Now let's get back to this week's episode of the Doctor's Pharmacy. So let's talk about what it taught you about the biology of the brain, because you were trained as a psychiatrist, you didn't learn much about that other than the neurochemistry of neurotransmitters and using psychiatric drugs which modulate neurotransmitters, which is good, but you probably didn't learn that much about how to address toxins or the gut microbiome or diet or nutritional deficiencies or hormonal imbalances or any of that. So how did you begin to unpack that? And what is the view that you have now that you wrote about in your book, Brain Energy, that talks about the biology of what goes wrong. Because once you understand that, then you have a roadmap in order, which allows you to actually create a treatment plan that can work and be reproducible.

Yes.

And I, by the way, before, before I let you go on, I just want to point out that the ketogenic diets also work in autism and Alzheimer's and, and in many, in IV, epilepsy and, and I've, and I've seen this also in schizophrenic patients, so It's really powerful.

It is. I just want to highlight even though the disorders you just mentioned are all very serious disorders and I was talking about schizophrenia a little bit ago, I want to just highlight one of the things you said. Depression is the leading cause of disability. Most people think of depression as a fairly straightforward illness and we have tons of antidepressants and we've got psychotherapy and we've even got shock treatments and we've got so many treatments available. they have to be effective, right? Well, actually, wrong. The majority of people with depression, bread and butter depression, are not getting better with our current treatments. And it's not because they're not getting treatment, it's because our treatments fail to work for far too many of them. And so I think that You know, it was really interesting because the way that I went about unpacking all of.

This.

Was, you know, I started with the neurology literature and because this is an anti-seizure treatment and we use anti-seizure treatments in psychiatry every day in tens of millions of people. And so that was really low hanging fruit and it was a great resource to tap into because we've got 100 years of clinical and neuroscience evidence on the ketogenic diet. diet and what is it doing to the brain? And so I could tap into that and lo and behold, sure enough, the ketogenic diet rebalances neurotransmitter imbalances. It decreases brain inflammation. It changes the gut microbiome in beneficial ways. It.

Gets people off gluten.

Yes, it gets people off gluten. It gets people off lots of other toxic foods probably. It improves insulin signaling and insulin resistance in most people. And so it has a wide range of effects. But still, this is where the field of psychiatry is. It's like all of these different things. And so I went on a deeper search for how do these connect? Because at first I started off with a mission to how am I going to convince other mental health clinicians to use the ketogenic diet for serious mental disorders because nobody's going to believe this. They're just not going to believe it unless I can present a clear and plausible mechanism of action based on science. Nobody's going to buy this. And this miraculous treatment that I am seeing in front of my eyes is going to go wasted. And so I kind of felt like I'm an academic.

No, you might lose your job.

Yeah, I did worry about that many times.

You probably wouldn't go to jail like Galileo, but you might lose your job.

I worried about that. The good news now is that I have the full support and endorsement of McLean Hospital, actually.

Amazing.

They are very enthusiastic and supportive of this.

See, when I heard about what you're doing, I just said the happy dance. I was like, and I've been telling everybody, I'm like, Wow, finally somebody's getting it where it counts.

That's awesome. So the way that I ended up coming to the science is I ended up focusing on mitochondria and mitochondrial function and more broadly what we call metabolism. And so I came at the science from that perspective and ultimately viewing mental disorders as metabolic disorders of the brain. And that in order to understand metabolism, you have to understand mitochondria. But in fact, you have to understand everything that you have known about for decades, functional medicine, how it's all interconnected, how diet, toxins, hormones, the gut, stress, all of that come together to result in illness. So functional medicine has been doing this for decades. and yet I was holed up in my Harvard position and evidence-based medicine. And so we didn't learn a lot about functional medicine. And certainly functional medicine protocols are not being used in psychiatric hospitals for the most part around the world. Most psychiatric hospitals are not using these protocols. or this paradigm. And so, but at the end of the day, even looking at mental disorders as metabolic disorders, which revolve quite a bit around mitochondria and mitochondrial function, I ended up coming to the same conclusions that you did.

It's quite extraordinary. And, you know, I don't know if you're aware of this, but right at Harvard there is Umanadhu who has a whole Department of Nutritional Psychiatry talking about the microbiome. and the brain. And there's another physician who's been on my podcast at Stanford. They have a department of metabolic Psychiatry. So it's starting to happen, and more and more psychiatrists are becoming aware of the data because there is data. There's a lot of literature now that supports this notion. So when I, when I look at sort of the mitochondria, it's really about, you know, metabolism and energy and, and, and it, it's, it's sort of, I'd like you to sort of unpack how that actually connects to psychiatric diseases. Because, you know, I first heard this concept when I talked to Martha Herbert, who's a psychiatrist, sort of neurologist, sorry, a neurologist. And I think she's also board certified psychiatrist, I might be wrong, who wasn't treating autism. And she was doing brain scans on these autistic kids. She saw their brains were swollen and inflamed on biopsies with these kids got killed in a car accident or something. And see, these brains are just full of inflammatory cells and the immune cells, the white blood cells called the glia. And she also called what they have a metabolic encephalopathy. healthy. She said that, that autism is just not a brain disorder. It's a systemic disorder that affects the brain. And, and it's what I hear you saying, that psychiatric illness, for the most part, is a meta systemic disorder that affects the brain now. Now, and the causes can be many, like it could be with your diet, it could be your microbiome. But I, I was with the gentleman this weekend whose family was a Hungarian Jew whose family was killed in the Holocaust. He says, I remember, I know 150 members of my family were killed in the Holocaust. I know everybody's name. and I've lived in a constant state of trauma and stress my whole life. And, you know, I was like, wow, this is the epigenetics of this. And Scientific American just came out with a paper, not a paper, but an article, sort of documenting some of the research in New York after 9 11, where they saw women who were pregnant when 9 11 happened. Their children were, were incredibly affected by the stress and Trauma that happened to the mothers when they were pregnant and was registered in Gene expression patterns and epigenetics and in cortisol levels and cortisol receptor function. And I was like, wow, this this data is really coming along in this. So there's a lot of things that can affect it, but often the psychiatric problems are so misdiagnosed and mistreated, honestly, and it creates so much suffering. And so what you're talking about is really a revolution.

It is. It certainly was for me, and it certainly is for psychiatrists that I speak with. I don't think they've really considered this. the reason that I am so passionate about mitochondria in particular is because.

They.

Actually are responsible for much more than just energy production. So most people know mitochondria as the powerhouse of the cell. And so they create ATP, which is our energy source. And there's no doubt they do that and they are instrumental in that role. And without that, we would not live. but they actually do so much more than that. So they are primary regulators of hormones, for instance, key hormones like cortisol, estrogen, testosterone, progesterone and others. That the production of those hormones actually begins inside mitochondria and as those hormones travel through the body and influence cells throughout your body, the primary influence ends up converging on mitochondria. And so in many ways, the reason that I became ridiculously excited about this theory is because it is a way to connect all of the dots, the biopsychosocial models of mental illness, it is a way to connect all of them. So mitochondria are instrumental in neurotransmitter function, neurotransmitter production, the release of neurotransmitters, the influence of neurotransmitters. They play a significant and powerful role in inflammation, but inflammation in turn affects mitochondria. And so it all, at least in my mind, once I started diving deeper, I was kind of flooded with all these questions. But wait, it can't be this simple. This is too simple. There's no way that this complex issue and the complexity of psychiatry and the brain, there's no way it can end up being this simple. And for the last five years, I have tormented myself in some ways with questions like, if this is really true, then this should be true, or that should be true, or this should be true. And at the end of the day, everything in my mind seems to converge on these issues.

Yeah, well, it's so true because I was reflecting on a guest we had on a previous podcast who was a pediatric neurologist trained at Harvard, Oxford. She works at University of San Diego now. And she, she did brain Imaging, functional MRI Imaging of the brain in autistic kids, and found they had energy problems that mitochondrial energy deficits were evident in the brain of autistic kids. And then by giving them mitochondrial nutrients, basically the co-factors and helpers that actually help you turn food and oxygen and energy, like CoQ10, for example, or in B vitamins and just some really simple things that are very inexpensive that these kids would literally get better from autism. That's not to say that all autism is just caused by these nutrition deficiencies or mitochondrial issues. It's, it's, but it's one of the things that we see. So there's a lot of people coming at this from a lot of different areas. You're in the psychiatric Lane, but, you know, the neurological lane is seeing this, too. And so is pretty much every other, the other issue. I mean, whether your weight or whether it's heart disease or diabetes or Alzheimer's or Parkinson's. So many diseases are really related to mitochondrial dysfunction. So it's great. It's really amazing. And I think that this is such a breakthrough. And I think, you know, there's how besides the ketogenic diet, are you approaching addressing mitochondrial function? Because, for example, in autism, they're using these mitochondrial cocktails and supplements to help.

So, and that's where when I read your book, I was a little embarrassed. Because if you want the roadmap to, if you want the self-help version of how can I fix my mitochondria, I feel like your book UltraMind Solution is that roadmap. It involves improving your diet, exercise plays a role, stress reduction plays a role, toxins can play a role, hormonal dysregulation can play a role. And these can be wildly different in different people. And I think that's, you know, it's a point that you made in your book. It's a point that you make commonly. And so it's not that there is a one-size-fits-all solution for people. So one person could have an autoimmune thyroid disorder and have, you know, horribly low thyroid hormone. And that person will suffer from both metabolic and mental symptoms. And fixing that problem is replacing thyroid hormone or somehow addressing the autoimmune disorder and correcting that. Another person could have an autoimmune disorder related to intrinsic factor and they could have malabsorption of vitamin B12. regardless of what they're eating, that person too could have both metabolic and mental symptoms or disorders as a result of vitamin B12 deficiency. And the treatment for that might be vitamin B12 injections because they can't absorb B12. So very different treatments. But you're addressing the same root problem or the same root cause, which is metabolic, in my mind, metabolic dysfunction or mitochondrial dysfunction. but lots of different things can cause mitochondrial dysfunction. And so that's the way I'm thinking about it is I, in my mind, mitochondria are front and center. And but there are hundreds of different inputs that that can influence how well mitochondria function and how they're doing. And then the consequences of mitochondrial dysfunction are widespread and they can have numerous effects on the brain resulting in very different symptoms. Some people might have ADHD, other people might have depression, others might have seizures, and others might have schizophrenia. And that probably depends on a variety of factors. What are the different components or environmental factors that are contributing to genetics or.

Other things we may not even understand them. Yes. Right. Yeah, it's so true. And I just remember being in my clinic, you know, looking at the patients I saw and not really treating their psychiatric problems, but they would come in with autoimmune disease or digestive problems or arthritis or whatever, migraine, and I would just do what I did, and they would get better from other stuff. Like you're saying, you were treating this guy's weight loss and schizophrenia got better. And. And I was like, wow, I call myself the accidental psychiatrist. You know, I never intended to figure this stuff out, but I could not ignore what was in front of me, whether and I had a patient with ADD once who was so severe and he had really terrible inflammatory symptoms as well, asthma and allergies and gut issues and migraines. Of course, the doctor who was treating him, the psychiatrist, just treated ADD with a stimulant and ignored the other things because of course they're not related. But I treated it, I just cleaned up his diet, I gave him some vitamins, I cleaned up his gut, very simple things. and the mother brought his homework. And we'll post it in the show notes because it's pretty impressive. Got his homework before and after two months just of changing these few things. And these kids often have what we call dysgraphia. They're handwriting. You can't read it. He's 12 years old. It looks like a, somebody, you know, who's got some kind of severe disorder with writing or something. I don't know. And it went from, like, severe dysgraphia to perfect penmanship in two months. And I'm like, holy crap. What is going on in the brain? How does it go from being chaotic and disorganized and asynchronous, disynchronous to being completely coherent. And, and I, and it was really a mind-blowing concept for me. That's where it gave me the idea of the book. I don't know if you know this, Chris, but the origin of functional medicine was in Psychiatry from Abraham Hoffer.

I did not know that. Yeah.

So I'm going to tell you this quick story. I don't want to dive in some more of your work. I don't want to take too much of a sidetrack, but it's fascinating. Abraham Hoffer was a Canadian psychiatrist who treated schizophrenia, and he sort of somehow got the idea that there was some abnormal molecules going on in the brain and that it was related to some kind of nutrient problem. So he gave high dose of niacin and zinc and B6 and magnesium. And many of these patients would improve or get better. And, and so he began to write about this, talk about this. And, and then he was friends with Linus Pauling. And they, Linus Pauling is a two-time Nobel Prize winner. He discovered the structure of proteins and he almost discovered that, well, he kind of did discover the double helix of the DNA and he told his son about it, but then they went, his son went to London and hang out with Watson and Crick and they kind of took it. That's a whole other story. And then he wrote an article in Science magazine, which I mean, science, which is a very prominent medical journal, which I don't know if you've actually seen, it's called Orthomolecular Psychiatry written by Linus Pauling. Have you seen that? I have, actually, yes. Yeah, well that was the genesis of that and essentially the idea was that we could correct ortho means to straighten and molecules, molecule means molecules, to straighten the molecules of the brain by using high dose of nutrients to move chemical reactions to their completion. Now, it was a very simple idea and it was super complicated paper, very scientific, but it sort of started this process. And then Jeffrey Bland, who was really the father of functional medicine, was a student of Linus Pauling's. And Linus Pauling was kind of thought of as a crackpot later in his life. I mean, I don't know if you're gonna call anybody who won two Nobel to Nobel Prize at Crakbot, but he was kind of dismissed for his ideas about vitamin C and everything. But he was onto something and this is what we're seeing now. So I think your work is so important and your ability to actually communicate this, to look at the science is so important. So talk about how we can think about some of the inflammation process in mental health and metabolic health and what we need to do to fix that. People are listening, well, I hear this, my mitochondria aren't working. inflammations connected, how do I start to address that in myself?

It's a great question. And, you know, inflammation is, as you know, is a complicated topic because so, so there are some clear causes of inflammation. You can get an infection, for instance, and that causes an inflammatory reaction in your body. And lo and behold, we have an abundance of evidence that if you When a woman is pregnant, if she experiences a serious infection, sometimes even a mild infection like with the influenza virus.

Her.

Baby will be at increased risk for mental disorders later in life. If young children experience serious infections, especially if it's serious enough to be hospitalized, they are about twice as likely to develop a mental disorder, oftentimes within three months of that hospitalization. And the mental disorders are not trivial disorders. It's not anxiety because you are hospitalized. The disorders include things like autism, schizophrenia, mental retardation, obsessive compulsive disorder, and others. and these can become lifelong disorders. And so we know in those cases the inflammation appears to be doing something that takes a toll or that changes neurobiology or changes kind of whole body function. And, you know, my hypothesis right now is that inflammation takes a toll on your metabolism, plain and simple. For sure. And that it dramatically, we have very good direct evidence that inflammation takes a toll on mitochondrial function. It actually inhibits the function of mitochondria in some brain cells, and we have direct evidence for that.

And by the way, the brain has got the most mitochondria per cell of any organ in the body. So it's really important.

Yeah, it is. And the brain is exquisitely sensitive to even slight fluctuations in mitochondrial impairment. Whenever people have a metabolic problem, usually the brain is the first organ to suffer. And it might just be trivial symptoms. So clear causes of inflammation can result in metabolic or mitochondrial impairment and then result in mental symptoms or mental disorders. Even people with runny noses or hay fever, are like 86% more likely to have chronic depression than people without that. So in some cases, these things are unavoidable. And I just have to say that. I mean, you know, a woman getting an infection while she's pregnant, there aren't a lot of things that she can do to necessarily, I mean, there are some things she can do to avoid an infection. But it's not going to be 100% and I don't want to get into a situation where we're trying to blame pregnant women for getting an infection.

But you can do something about it when the baby's born and you can fix the baby afterwards.

And you can even do something about it immediately after that infection. So there are lots of ways to improve metabolism and mitochondrial health and most of them are lifestyle related and they include things like diet, removing As you say, removing the bad stuff from your diet and putting in the good stuff.

So easy.

It's easy. It's probably more complicated than most people realize because then they question, well, what's the bad stuff? Is it just fat? If I remove fat from my diet, am I going to feel good? No, no, it's not that simple. And it's not as simple as carbohydrates as somebody who's using the ketogenic diet. Some will say, if you just remove carbohydrates, that will solve all of the world's ills. I don't believe that at all.

No.

So it's about removing bad things from the diet, adding in good things. But it could also include exercise. It can include prioritizing sleep, getting more rest, allowing your body to recover from that process. So if you are usually a workaholic, if you are highly stressed, and you have an infection, maybe it's time to just prioritize self-care for even a month or so after that and really make sure you're getting good nutrition, you're exercising maybe more than you normally even do, getting good rest, trying to decrease stress levels, those types of things in order to allow your body to reset, in order to allow your body to recover from that assault. on it.

One of the best doorways to the mitochondria is exercise, right? It stimulates the growth of new mitochondria, improves the function of mitochondria. It's quite important and it also cuts down inflammation and activates your antioxidant enzymes. It has so many benefits and we know it's better that they're equivalent to many drugs for depression if you just exercise regularly, vigorously, right? and we know that diet also plays a role. And, you know, one of the challenges, I wonder how do you address this with your colleagues? Because this is something I've found even at, you know, Cleveland Clinic working with some of the researchers are like, well, you know, we can't do everything at once. We can't do diet and exercise and supplements and sleep. And I'm like, we can only do one thing at once because we don't know what's going to work. And I'm like, wait a minute. If you want to grow a nice garden, you don't just go, I'm going to give the water, the plant water only, but no soil or sunlight. and then I'm going to give it sunlight, but no soil or water. It doesn't respect the laws of nature. So how do you kind of battle that within the medical paradigm? Because it's really tough. We're looking for the single drug, for the single disease, or the single outcome, which is a model based on infection, which can work. But even then it's flawed because it depends on the biological terrain and why some people get sick and don't, or why some people die and don't. We see that with COVID not everybody gets sick. as sick or hospitalized or dies, people who are chronically ill or overweight or aged do because their systems don't work as well. So, how do you address this?

I think it's a really- I don't.

Want to get you in trouble when.

You'Re- no, no, no. I kind of chuckled as you were saying your garden analogy because I've used that exact analogy to people as well. and I think most athletes and coaches know this as well, that if you want to become an Olympic champion, it's not only about exercise, it's about exercise and diet and sleep and get rid of any toxins. That means no drinking, no drugging, no.

Anything.

Because you are trying to get your body in prime condition. and it requires a multifaceted approach. And those things are all interconnected and they're all going to relate to whether you can grow your muscles, whether you can get faster, improve your cardiac health, all of those things. And so I completely agree with you and I think it's a huge challenge in our field. To me, the lowest hanging fruit is with the chronic severe mental disorders. I think that if, because right now the prognosis is so abysmal for these disorders and the likelihood that any intervention, whether it's a single intervention or a complex intervention, the likelihood that anything will change the course of these disorders is extremely low in most academic psychiatrists' minds.

It's like autism, right?

Yes. So I actually am hopeful that we can get funding for studies like this using a quote-unquote treatment-resistant population. and maybe design a comprehensive treatment. You'll call it a functional medicine treatment. I'm trying to get mainstream medicine to buy into this, so I might just call it a comprehensive effective treatment. I might call it a metabolic treatment or a mitochondrial treatment. At the end of the day, it's going to be the exact same thing as what you're doing. Sometimes language matters. And so I'm not sure, but I think that we could probably get funding for such a study. I think we would want some of the best practitioners, maybe you included, to really be part of this protocol because we maybe get one or two shots and we don't have to cure everybody. But if we can even get 30% of those people dramatically improved, I think that would get the attention of a lot of people in the mental health field. And again, these disorders are the most disabling disorders. They are some of the most costly disorders to society. So it won't only get the attention of those in the mental health field, it will get the attention of insurance.

Companies.

The government, because, you know, the government providing disability. And so not only is the government providing disability payments to these people, they are failing to get tax revenues from their employment. And I can be the first to say, having worked with these people for well over 25 years, these people are desperate to contribute to society. They want to work. There's this stereotype out there that, oh, depression is the leading cause of disability because everybody's lazy, slacker, and they're just looking for an excuse to be on disability. Let me just maybe disabuse some of the, if any of your listeners are thinking that and thinking, yeah, that's right. Let me disabuse you of a few notions. Number one, they're not living the high life. You're living essentially in poverty on that lifestyle. But this notion of self-respect and autonomy is huge. And I have had schizophrenic patients crying in my office because they just want to work and earn some money to be able to hold their head high and say, I earned some money. And I remember with one of these patients, I tried with her for six months to help her get a job bagging groceries at a grocery store. And at the end of the day, she couldn't do it. And she couldn't do it because her symptoms would get worse. she started thinking that the manager was stealing money. She got paranoid about the manager, started causing trouble, and it was a nightmare. And she got fired. And so I think that if we can demonstrate that even if it requires a complex intervention like water, sunlight, and good soil, if it requires a complex intervention, that maybe we can get people to take this seriously. Yeah, I agree.

I mean, you know, the, the economics are just incredible. I had a couple of thoughts about what you're talking. You know, I don't know if you've ever been in Venice recently. It's just like a homeless city. And, and most of those patients have been let out of psychiatric hospitals. We, we basically shut them all down. We, we boarded them up and we rather than put people in physical straight jackets, we put them in chemical straight jackets. but these people often don't take their medications. So there's a lot of data that says that if you actually give these people housing and you, you know, and imagine if you give them your treatment, what would happen? Well, the costs would go dramatically down, even if we provided housing and food, because they use huge amounts of health care. They go to the emergency room as their major health care source. So it's really a problem for our society. And we just have such a backwards way of dealing with this. Also, you know, it kind of reminded me of colleagues of yours at Harvard I mentioned earlier, to Locasio and Barbasi, Barbasi who wrote a textbook called Network Medicine. And I'd encourage you to get with those guys, they're really in your neighborhood in the same university. And they've basically said, you know, that network medicine, functional medicine, whatever you want to call it, systems medicine, embraces the complexity of multifactorial influences on disease. That means there's a lot of different factors and you can't just treat one. Then they basically said that it offers a different approach to understanding the cause of disease or etiology. It's going to differences in how we treat patients using multiple molecular targets that require manipulation in a coordinated dynamic fashion. So that's a totally different paradigm than we basically have in what we learned in medical school, which is just do one thing. And then of course there's comorbidities, so we treat them all like high blood pressure, diabetes, heart disease, obesity, they're all separate things. We just treat them all with different drugs because they're not related. They're separate things. They're co-morbid, they're not co-anything. They're the same problem just with many different manifestations. So it's so exciting and I've had patient after patient get better. And I've also had people who just read my book, which I wrote so long ago, and it's an old book and I think it's still kind of ahead of its time and it needs to be updated. People said, oh, I read the book and my bipolar disease went away. I'm like, it did, really? That's amazing. I would be shocked. One patient came in and said, what do you need? She's like, I'm good. I'm like, why are you here? I read your book, UltraMind, and I took like nine months to get an appointment, so I just did what it said. And I know I'm better, but I just want to see if you had anything else to say. I'm like, okay. That's kind of a wild, wild, wild journey as a doctor because you can't ignore what's in front of you. And I'm so happy that you actually didn't ignore what actually happened and started to go down the rabbit hole and discover what was really going on. Can you tell us about some other patients maybe that you've had, maybe not schizophrenia, other problems that may be responsive to this and not just, you know, ketogenic diet, but what are the other things that you've done and that are part of your program?

So again, I think, yeah, it, this applies to a wide variety of diagnoses and It applies to all age groups. So, I've had young patients who, you know, from early childhood had signs and symptoms of ADHD, which kind of started transforming into a mood disorder and then a serious mood disorder initially thought of as depression. Then, you know, there's a strong family history of mental illness in this particular person's family.

And.

Quickly transformed into what a lot of people were thinking was bipolar disorder. And this young child was tried on various stimulants for ADHD. They helped for a few days and then quickly started causing severe insomnia, which was making everything worse. Yeah. And And at the end of the day, this child ended up trying this kind of more root cause treatment or what I call a metabolic or mitochondrial treatment. And it was for this child, two interventions we ended up using. So one is this kid was eating a lot of junk food, a lot of sweets because life was stressful. And so parents just, you know, parents didn't like it, but they were like, well, what are we gonna do? Like he is tormented. at school. He comes home in tears and he's always getting in trouble. We're always getting calls from the principal and he wants sweets so we just let him do it. And there's good evidence, good solid evidence now, a study of over 15,000 children, children with high levels of insulin resistance starting at age nine, are five times more likely to be at risk for schizophrenia or bipolar disorder by the time they turn 24.

I didn't know that.

Five times 500%. And, and so we have schizophrenia.

That's a reason to skip your birthday cake. Yes.

We have good evidence that insulin resistance seems to be, seems to come before psychotic disorders, bipolar and schizophrenia. and depression as well, but it wasn't quite as powerful of a signal with depression. And so the first intervention with this kid was let's just cut out the sweets. We didn't do a low-carb or ketogenic diet or anything like that. We just let's cut out the junk food, the sweets in particular during the school week. He can still have them on the weekends. We're not asking for a huge, huge seed change. We're just asking for mild modification to diet. And the second intervention, because his sleep had always been a little bit off, was we used a light box, a bright light therapy every morning.

In the morning, yeah.

In the morning. And that has been demonstrated to help regulate circadian rhythms, improve metabolic function. We even have some randomized controlled trials of light therapy showing that it is an effective evidence-based treatment for bipolar depression. So we ended up having him use a light box. Yeah. And those two interventions alone were enough to turn everything around for this kid. Within one month, he was not throwing tantrums at school anymore, was dramatically improved. And within a year, he was getting straight A's. And within two years, he was taken off of his, you know, school accommodations and IEP plan. because the high school that he started going to was like, why is this kid even on an IEP? He's getting the top grades in the class. He's so well behaved and he's like a model student. Who the hell put this kid on an IEP?

And like, what's an individualized education plan, which they use for special ed kids, right?

Yes, exactly. And you know, who did this? And what were they doing to him at this old school? Because he so great. And so that's a clear intervention of we used a dietary, a modest dietary intervention of kind of in the category of removing the bad. And he was clearly getting some good. He was getting vegetables, at least some of the time. He was getting, but he wasn't restricted complete, it wasn't a sea change in diet. Would he have done better with a sea change in diet? Probably. Probably, but he and parents weren't willing to make that, weren't willing to do that. And so sometimes you have to meet people where they're at and small incremental change and then you go from there. And, you know, it's interesting, I got to know Thomas Insel, who was the.

Head of the National Institute of Mental Health. And I said, so what do you think of the DSM categorization? That's the psychiatric manual that describes disease. Okay, you have ADD if you hit these symptoms, you're depressed if you hit these symptoms. he's, I think it's a, has 100 accuracy, the 0% validity. I mean, it's great at describing the symptoms and diagnosing, grouping people into categories based on symptoms, but it doesn't tell you anything about what's going really going on underneath the hood and the cause. And I was like, wow, that's brilliant. That you're the head of the National Institute of Mental Health. He got it. He understood. And he's, he's really a Visionary. But as a nation, we are troubled with mental illness today. And you're talking about diet and the brain inflammation. And I, so I come at it through, you know, the food system and the inflammatory diet that we're eating and how it inflames our brain, but also flames our behavior. And we're seeing increasing divisiveness and conflict and hostility, as well as just, you know, the opioid crisis and depression and, I mean, it's just all of it. ADD and kids, I think, what is it, like one in 10 kids has ADD. and maybe more and 14% are on medication and antidepressants. I mean, there was that one kid in class who was kind of trouble when I was a kid in the 60s. Now it's like half the class has gone some kind of medication, whether it's for obesity or depression or ADD. It's pretty frightening and it's almost like a slow moving tsunami that we kind of have been blindsided by. The medical system hasn't quite caught certainly our government policies haven't caught up in terms of Medicare reimbursement, Medicaid reimbursement for what we do. And, you know, if you look at the cost of a schizophrenic patient to society, the health insurance costs, their chronic illnesses, they're high utilizers of care, you know, the government could literally pay for their food and housing and that would basically be saving money, right?

It's like, oh, and it just, even if we just look at the cost of one antipsychotic prescription for, you know, or their cocktail, because most of them are on a cocktail of prescription medications, usually at least three medications. And if they're on those three medications, those often cost, you know, anywhere from 20 to $100,000 a year. And with that kind of money, yes, we could easily provide all the food they need and want, and we could likely provide housing and job training and so many other interventions with the goal, you know, as a psychiatrist, my primary goal is to reduce human suffering. So let's just start there. Let's just make their life less miserable and help alleviate their symptoms. If I put on my, you know, kind of business hat or politician hat, let's save money. Let's restore this person's health so much that they are going to be gainfully employed. And not only are they no longer going to be a financial burden to society, they are going to be generating work product and they are going to be generating tax revenue. for the system. And again, in the process, they get their dignity and their self-respect. And it is just such an obvious win-win for everybody involved.

So beautiful. Yeah. Well, if anybody listening is a policy maker, is a business owner, is a philanthropist, and has any bells going off, about someone in their family, in their world, or in their company, or cares about the health of our nation, please contact Dr. Palmer and help him because he's doing God's work. This is so important. In your book, Brain Energy, a Revolutionary Breakthrough in Understanding Mental Health and Improving Treatment for Anxiety, Depression, OCD, PTSD, and More, including psychosis, schizophrenia, autism, I'm sure all of it. It's such a great everybody should get a copy. It's published by Penguin Random House. It's available everywhere you get books. It's just, it's such important work, Chris, and I'm just so pleased to be able to chat with you about it, to share this with the world. I literally could talk to you for six hours and maybe more. And I really want to get together with you to brainstorm about how we address this because, you know, it's one of the things that breaks my heart is this sort of unnecessary suffering. I mean, there are certain things we can't do. fix, right? We just can't like, you know, you're born with some deformity or whatever, maybe you can do some surgery, but like this is a solvable problem and we know what to do and maybe we don't have all the answers, but with a little extra help and funding we can get them and it's a national crisis. It's a, you know, it's a crisis and and thank you for the work you do. Thank you for being such a visionary and good luck if you need any help committing your college, just call me. I've been at this for a long time. I'm happy to come chat with them too and share stories and case reports. And I'll send you a few case reports in autism and ADD and I think they'll be kind of Alzheimer's just to see the way that this has been approached from a functional medicine perspective. So thanks for listening everybody. If you love this podcast, share with your friends and family. If you've struggled with mental health issues, actually use some of these modalities or approaches. Tell us about them. We'd love to hear a subscriber wherever you get your podcast. And we'll see you next week on the doctor's Pharmacy. Thank you. Hey, everybody, it's Dr. Hyman. Thanks for tuning into the doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff, from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks. P I C K S and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer.

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