Christopher M. Palmer, MD: What is Causing the Rise in Depression, Anxiety and ADHD? | TUH #042

Being depressed is not a mental illness. Being depressed for no good reason is a mental illness.

It's so fascinating to me that you have areas of medicine that think this is somehow not connected to this.

From depression, anxiety, PTSD or substance use symptoms.

I get this image of a bicycle wheel with all of these spokes that have all of these conditions. Add, adhd, ocd, manic depression, bipolar, all of these conditions. But they all kind of meet at one hub. We know too that cancer cell are metabolically sick cells. There is evidence that it can be turned back into a metabolically healthy cell.

It is tragic because actually the United States has one of the highest rates of antidepressant use in the world.

Ultimate Human doctor Christopher Palmer is an md. He's made significant contributions in the field of psychiatry. He focuses on the intersection between metabolic health and mental health. He has over 25 years of experience as an academic physician. He holds various roles within the administrative, research, educational and clinic settings, primarily at McLean Hospital and Harvard Medical School. Dr. Palmer has been a pioneer in exploring the use of ketogenic diet as a treatment for mental health disorders.

You heard that right.

The ketogenic diet as a treatment for mental health disorders. Proposing that many psychiatric conditions may be metabolic disorders of the brain. His works led to the development of the Metabolic and Mental Health program at MCC McLean Hospital, aiming to further research and provide metabolic treatments for mental health conditions. Dr. Palmer's groundbreaking work is encapsulated in his book Brain Energy, which is a must read where he introduces the brain energy theory of mental illness. This theory suggests that mental disorders are closely linked with metabolic dysfunctions. Challenging the traditional diagnostic categories and offering new avenues for the treatment that focus on on metabolic health for long term improvement rather than merely symptom management.

High aging, biohacking, longevity and everything in between.

And today you are in for a real treat.

Right before the podcast started, Dr. Palmer was actually blowing my mind with not conventional therapies which are becoming more and more popular, having a dramatic impact on it.

So huge, huge question, huge question. And I could go on for days on that, so I'll try to do it concisely. So for people who don't know, we actually do have a mental health epidemic and it's a growing crisis. Prior to the pandemic, about 1 billion people on the planet in any given year suffered from a mental or substance use disorder. And that represents about 13% of the world's population. But in the in Western countries such as the United States, rates are even higher. About one in five people suffer from mental disorder in any given year. If you look at lifetime prevalence, it's about 50%. One in two people will meet criteria for a mental illness at some point or another during their life. Wow.

Oh, wow. And in the country that is the biggest spender on health care worldwide. That is astounding to me.

It is tragic because actually the United States has one of the highest rates of antidepressant use in the world, and we also have one of the higher rates of depression in the world. So it's not surprising that we're using so many antidepressants because our people are more likely to be depressed. But clearly antidepressants aren't solving the problem. And so the pandemic happened and there's no doubt that took a toll. And things are even worse today. We don't have exact figures. At the peak of the pandemic, the CDC was doing annual household survey or monthly household surveys, actually. And at one point during the peak, almost 50% of Americans said that they were suffering from depression, anxiety, PTSD or substance use symptoms. 10% of all Americans surveyed of a representative sample, 10% at the peak said they had seriously considered killing themselves in the last 30 days. And among people 18 to 25, because they didn't interview children, people 18 to 25, one in four said that they had seriously considered taking their life.

18 to 25 year olds.

Wow.

So we have a crisis and we do have a lot of treatments. And as an academic psychiatrist, I am not going to back down from that. We do have treatments and the treatments do work for millions of people. We've got antidepressants, antipsychotics, mood stabilizers, anti anxiety medicines. We've got psychotherapies, we've got group therapy, we've got addiction recovery treatment programs, we've got ketamine, we've got psychedelics, we've got ect, tms, we've nerve implants that, you know, will stimulate certain nerves like your vagus nerve. We've got deep brain stimulators, we have treatments.

Right.

And these treatments actually do work.

I just got paralysis of analysis.

Literally. Did they really do work?

Yeah.

The tragic news is that they fail to work for tens, if not hundreds of millions of people every year. There are people who are getting treatment after treatment. They are getting pill after pill. They are talking and talking and talking in psychotherapy and group therapy offices, and they are not getting better. And we have a crisis. And this crisis is across the board. A lot of people think this is just about depression. Well, yeah. Rates of depression in 2023 reached an all time ever recorded high. 2023, 2023. Just last year, Gallup poll does an annual survey and that annual survey showed that rates were increasing steadily prior to the pandemic. The pandemic saw a huge jump and then it stabilized and things are on the rise again. So in 2023, all time ever recorded high of current prevalence and lifetime prevalence. But it's not just depression. Anxiety disorders in children and adolescents have tripled over the last 15 years. Rates of autism spectrum disorder have quadrupl in the United States in the last 20 years. Rates of bipolar disorder have doubled in adults in the last 20 years. They're up exponentially in children and adolescents. So we're talking about all of these different mental illnesses that most people think are completely separate from each other. They must have different causes. They're not the same thing. And yet the rates of all of them are increasing in exponential ways.

Wow.

And the one just bottom line nutshell, for people who are scratching their heads trying to figure out what in the hell's going on at the exact same time, rates of obesity are skyrocketing and rates of diabetes and pre diabetes are skyrocketing. And I don't think that those things are separate coincidences.

You know, it reminds me of, I get this image of a bicycle wheel with all of these spokes, right, that have all of these conditions. Add, adhd, ocd, manic depression, bipolar, all of these conditions. But they all kind of meet at one hub. I have a feeling that's what we're about to find out. We are, but you have to buy my book.

No, no, no. I will give you all of the information I possibly can.

Million copies just got sold. So I, I, I, I, I love where I feel like this is going. I didn't mean to cut you off, but I, you know, you, you really touch on what seems to be disparate things going on, disconnected things in the human body. Obesity, mental illness. And now we're seeming to bring bring.

These together and we need to bring them together. And we've got a tremendous amount of evidence that already brings them together. And so we know that people with mental illnesses, on average, chronic mental disorders such as chronic depression, bipolar disorder and schizophrenia, two to three times the rates of obesity going forward. We know that they have two to three times the rates of developing type 2 diabetes. We know that they are more likely to die early deaths from cardiovascular disease. We know that they're more likely to develop Alzheimer's disease. That's Been well known. But all of those relationships go in the reverse. People with obesity have 50 to 350% increased risk for developing a wide range of mental illnesses, all the way from anxiety, depression, ADHD to psychotic disorders like bipolar disorder and schizophrenia. People with diabetes more likely to develop. It doesn't matter which type, Type one, type two, take your pick. People with diabetes are more likely to develop mental illnesses. Which ones? Almost all of them.

Well, I read it, I read it, I read a study about almost a nine fold increase between type two diabetics and Alzheimer's. The incidence of Alzheimer's and type two diabetics.

Yeah, it's. And, and we have increasing evidence that Alzheimer's disease is a quote unquote metabolic disorder. And we've long known that all the risk factors for Alzheimer's disease are in fact metabolic in nature. So if you have cardiovascular disease or cardiovascular risk factors, those increase your risk for Alzheimer's. If you have type 2 diabetes, as you just mentioned, that increases your risk. If you have obesity in midlife, that increases your risk. And actually the APOE4 gene, the APOE4 gene allele that we know increases risk for Alzheimer's disease. If you actually do a lot of kind of deep dive into what is that doing? It's actually helping to regulate the transportation and metabolism of cholesterol and fats. And, and it is central to mitochondrial function. And so even the risk genes that people are just born with are impacting metabolism and specifically brain metabolism. And then that's increasing your risk for developing all of these different disord.

And you know, we know too that cancer cells are metabolically sick cells. They were a healthy cell that had interrupted cellular metabolism. In a metabolically sick cell, there is evidence that it can be turned back into a metabolically healthy cell or it can continue to progress. Sometimes the immune system recognizes it and eats it, you know, through cellular autophagy. But and sometimes in a weakened immune system, you know, it sort of slips by and is allow. But I, I, I'm, I'm really drawn to your, your, your, your brain energy theory of mental illness. And I'd like to go down that road a little bit because what, what is the brain energy theory and how does, and how does that impact mental illness?

So the brain energy theory is trying to answer a millennia old question of what causes mental illness. And the answer that most of the leading psychiatrists and neuroscientists will tell you today is that no one knows. It's just too complicated. All we know are risk factors and we put the risk factors into something called the biopsychosocial model. And we say that there are biological, psychological and social factors that all come together to cause mental illness. And they include things like genetics or epigenetics. They include things like neurotransmitters. Those are the chemicals and the chemical imbalance theory. Hormones play a role, but they also include psychological and social things. Trauma, rape, stress, childhood adversity, loneliness. All of those things play a role in mental illness, too. But if you ask these leading psychiatrists and neuroscientists, how do all of those things fit together to result in a wide range of mental disorders? Because all of those factors, everything that I just listed, plays a role in all of the mental disorders. Mom, Schizophrenia, bipolar, autism, depression, adhd, trauma and adversity increase risk for all of those things. But neurotransmitters, hormones, genetics also increase risk. How does it all fit together? Right now, nobody knows. What I propose in the brain energy theory is that based on cutting edge research over the last 20 years in the metabolic and mitochondrial biology fields, once and for all, we can finally answer that question of how those things fit together. And what I'm arguing is that mental disorders, meaning the brain disorders that we call mental illness, that those are due to metabolic dysfunction impacting the brain.

When you say metabolic dysfunction, for the people watching this podcast that don't understand, they understand metabolism as how many calories do I burn? Yeah, right. I think that's probably the fundamental basic. Understand if I have a high metabolic rate up or more calories, if I've had low metabolic rate, I burn less calories. But give a little bit more context to metabolism. When you talk about, what do you mean my metabolism?

So I think you're right. Most people don't really have a. A good appreciation or understanding of what metabolism is. So they think it's burning calories and. Or they think that it relates to metabolic syndrome. So it's about obesity, diabetes, or heart attacks.

Right.

And that's what metabolism is, and that's what metabolic health is. But in fact, metabolism is fundamental to the definition of living organisms. It's the process, a simple definition. It's the process of taking food and other things, nutrients, oxygen, and turning it into energy. Usually we call it ATP or building blocks for cells. Sometimes that process gets turned into heat. So energy building blocks, heat, and managing the waste products of it. And it is foundational that actually some biologists will say, for instance, viruses are not living organisms. Why are they not living organisms? Because they cannot do metabolism on Them by themselves, they take over another cell. They have to use another cell's metabolism in order to reproduce and thrive. And therefore, some biologists will say, by definition, because they can't do metabolism themselves, they are not.

They understand metabolism as, how many calories do I burn? Right. I think that's probably the fundamental, basic understanding. If I have a high metabolic rate, I burn more calories. If I have a low metabolic rate, I burn less calories. But give it a little bit more context to metabolism when you talk about, what do you mean, my metabolism?

So I think you're right. Most people don't really have a. A good appreciation or understanding of what metabolism is. So they think it's burning calories and. Or they think that it relates to metabolic syndrome. So it's about obesity, diabetes, or heart attacks.

Right?

And that's what metabolism is, and that's what metabolic health is. But in fact, metabolism is fundamental to the definition of living organisms. It's the process, a simple definition. It's the process of taking food and other things, nutrients, oxygen, and turning it into energy. Usually we call it ATP or building blocks for cells. Sometimes that process gets turned into heat. So energy building blocks, heat and managing the waste products of it. And it is foundational that. Actually some biologists will say, for instance, viruses are not living organisms. Why are they not living organisms? Because they cannot do metabolism on them by themselves.

They take over another cell's metabolism.

They have to use another cell's metabolism in order to reproduce and thrive. And therefore, some biologists will say, by definition, because they can't do metabolism themselves, they are not living. And so in that sense, metabolism is ridiculously complicated.

Right?

It involves many of our genes, all of these chemical pathways and hormones and enzymes and methylations, signals and everything. And so in that sense, some people will say, well, Chris Palmer, you're not really telling us anything that useful. If you're saying that mental disorders are somehow or another related to metabolism, but you're using that kind of a broad definition of metabolism, that it's everything in biology, then what are you really telling us that's not really useful? In fact, I think it's extraordinarily useful. And when we look at, like, when you ask common sense questions, well, what exactly controls metabolism in the human body? If it's this really complicated orchestra of all of these different pathways and things going on, what, what, where is the hub? Or how can we understand what is controlling or regulating metabolism? If you ask metabolic scientists that question, you'll probably get different answers from all of them. So there's by no means what I'm saying is scientific fact. It's certainly not widely agreed upon. But what I'm saying I think many people would agree with and some scientists would absolutely, passionately agree with. So I just want to paint that picture that what I'm saying is not universally accepted, but I think we've got very strong evidence for it. I would answer the question what controls metabolism? By saying is these tiny things in our cells called mitochondria? And that when we look at all of the evidence that's accumulated over the last 20 years about what are mitochondria doing, we can actually not only understand metabolism and metabolic health, but we can once and for all connect all of the dots of the mental illness puzzle, the biological, psychological and social factors, and we can put them all together to understand why would the brain malfunction in a way that causes symptoms that we call mental illness. And once we understand that big picture, it's kind of see the forest from the trees is what I'm saying. Yes, there are lots of trees and there are weeds and there's dirt and there are animals and insects and all sorts of things in that forest. So yes, it gets really complicated and messy fast. But let's see the forest from the trees. And when you see the forest from the trees, the answers become obvious and they're not that difficult. And they're things that you and your audience already know about what I, what.

I like about where this is going. And it's, it's, and it's often what I try to do for people with like diet, nutrition, lifestyle, spiritual, well being, all of these different avenues that they go down because you can get paralysis of analysis is just keep simplifying it and you're getting down, you know, we're through the cell wall now through the cytoplasm into an organelle, through the walls of that organelle and we're inside of the mitochondria and we're saying this is where metabolism occurs and this may be the genesis of, or at least partially the genesis of all mental disease and disorder. Am I overstating that?

I would. I think what you said is true, but I'm worried that people won't fully understand how that fits together because they're still fixed on trauma or drugs and alcohol. And what the hell does that have to do with the inside of mitochondria? Right. And so maybe if it's helpful, another way to phrase what I'm trying to let people know is that I, so I'M not talking. I guess first and foremost, I need to clarify that mental symptoms can be normal. Human reactions in the right place and the right time, all of the symptoms of mental illness can be normal. If you lose a loved one, you are going to be depressed. If you're not depressed, there's actually something wrong with you. There's something abnormal about your brain. So being depressed is not a mental illness. Being depressed for no good reason is a mental illness. So if those same pathways in the brain that code for depression or that trigger the depression response, if they start misfiring, that is mental illness. Same with anxiety. Everybody gets anxious, but not everybody has panic attacks out of the blue for no reason. So I think first and foremost, I need to make clear I'm not talking about normal human suffering. That's normal human suffering. The answers and solutions are obvious. If people are suffering because their country is at war, the solution is stop the war. It's not go into their mitochondria and fix their mitochondria. Fixing their mitochondria is not going to do anything. When your country is being bombed, your loved ones are being slaughtered and killed in front of your eyes, the solution is obvious. But when people have mental disorders, their brains are malfunctioning. Their brains are causing crippling depression for no good reason. Their brains are causing panic attacks or hallucinations or delusions or mood episodes or hyperactivity or inability to concentrate, inability to remember things. Their brains are not functioning properly. Those are the things that I call mental disorders. And in order to understand that, we need to understand why would the cells in the brain malfunction? That's ultimately what we're trying to answer. Why would those cells malfunction? And right now, the leading theory is a neurotransmitter imbalance, a chemical imbalance. Too much dopamine, too much serotonin, too little dopamine. That's the answer. But if you get into details of why would that neurotransmitter imbalance exist, what causes it? Why does it wax and wane? Why does it come and go? Why wasn't it there from birth?

And why does it have a trigger? I mean, you know, I mean, why doesn't have an obvious trigger? Because what you're saying about, you know, depression is obviously there are times where you can point to a specific trigger, loss of a loved one, normal human life events that should result in depression. Like you, your normal reaction would be to be depressed if this event happened to you. But very often, and, and we see this in our clinics, in my clinical team deals with this all the time. We see people suffering from massive anxiety or bouts of depression, mood, numbness without a trigger, like, they're not afraid of heights. And they. And they get triggered by walking to the edge of a 30th floor balcony. They're not claustrophobic, and they have to step on a crowded elevator. They are feeling these sensations of terror or fear without the presence of a fear. Yes. And I think this is the direction that you're going.

That's the direction I'm going. And so bringing it back to mitochondria, at the end of the day, the fundamental question we have to answer is, why is the brain malfunctioning? And really, we have to answer, why are the cells in the brain malfunctioning? And what I'm saying is that there is a central theme. It gets complicated fast. But the central theme, the simplest way to explain it, is that the cells do not have enough healthy mitochondria. And that when cells have enough healthy mitochondria, they, in fact, will almost always function properly. They will do what they are supposed to do. They will repair themselves. They will maintain themselves. They will keep up with demand. They will do what they are expected to do. And that when cells begin to malfunction, a unifying theme across numerous disciplines in the medical field is that mitochondrial dysfunction seems to be playing a central role. We know that this is true in obesity. We know that it's true in diabetes. We know that it's true in cardiovascular disease. We know that it's true in autoimmune disorders. We know that it's true in Parkinson's disease and Alzheimer's disease. And guess what? It's also true in people who have what we call mental illness. Their brains are malfunctioning. Those cells are malfunctioning because of mitochondrial dysfunction. And understanding that opens up an entire new world of therapeutic options that you know a lot about.

Yeah. So, I mean, but the exciting thing is that what I think I hear you saying is that this may be fixable.

Yes.

Because I happen to know that mitochondrial dysfunction, in many cases is fixable. We've seen it thousands and thousands of times, not anecdotally, but objectively. And so it begs the question, if I'm watching this podcast and I'm affected by, or a loved one of mine is affected by one of these myriad of conditions that we've been talking about, what are some of the things that I could do, either aside from going the conventional therapy route or if I'M already. If I've already gone the conventional therapy route and I'm not on Adderall, vyvanse, Ritalin, antidepressants, SSRIs, what have you, what are some things that I could do to augment that to, to, to support maybe the. The other side of the equation, the mitochondrial health.

So the, it's, it's actually, I'm. I'm almost. I almost want to say the. Really.

I love that you're about to say keto diet.

The great news, but almost the tragic news, because it. These solutions are so simple and obvious. I say this all the time.

People attack me. There's a huge headpiece in the Daily Mail today and, and saying that I'm trying to oversimplify.

And that's the thing that. And that's what makes this so incredible. There is so much human suffering. And sometimes the solution could be, look at your diet and clean up your diet. Sometimes the solution could be get better sleep. Sometimes the solution could be lay off the substances that are harming your mitochondria. Sometimes the solution could be, you know, the obvious ones, stress reduction, get out of traumatic relationships. So on the surface, all of those things sound like generic health and wellness tips. A lot of people are gonna say, we already knew that, Chris. We already knew all of that.

We didn't need to listen to this podcast Healthy.

But. But that's not gonna do anything for schizophrenia. That's not gonna do anything for bipolar disorder. That's not gonna do anything for my kid with serious adhd. Serious adhd, That's a neurodevelopmental disorder. He's got a legit disorder. His psychiatrist told me so. And everything I've read says that. And what I'm saying is that those legitimate crippling brain disorders, whether we call them neurodevelopmental, whether we call them severe mental illnesses, whether we call them mild mental illnesses like depression, anxiety, whether we call them brain fog, burnout, whatever, whatever you're experiencing, they all represent your brain not functioning properly. And at the end of the day, we can in fact, get a lot of those people better through simple solutions. The devil is in the details. And so I am not by any means saying if schizophrenic people just ate a little more broccoli, we would cure their schizophrenia. It's not that simple.

Right?

And so I'm not saying generic health and wellness diet advice. Eat a healthier diet, add a little more fruits and vegetables to your diet, and that'll fix you up. That is not true. I can assure everyone that is not true. It will not. Maybe it'll work for one or two people on the planet, if lucky, but for the majority of people, that type of an intervention, that type of a change in diet is worthless. And I don't want people to come away from this thinking, just, if I eat a better diet, like eating more broccoli, that that's going to fix everything. But the solutions are, in fact, identifying. Do you have food sensitivities? Do you have reactions to food? Are you able to tolerate and process carbohydrates in a normal way compared to other people? And, and so the devil gets in the details. And. Or the devil is in the details, but we can use to give people examples of what I'm talking about. So for some people, just cleaning up your diet.

Right.

Lay off the junk food, lay off the sugar. Eat a little more broccoli.

Yeah.

That may help their depression or their anxiety or their ocd.

Right.

It will not help schizophrenia.

Right.

I can almost assure people it probably won't help schizophrenia.

But I have heard you talk about a specific case that you had in 2016 with a morbidly obese patient. I was fascinated by it. I watched your podcast on Andrew Huberman and who's a. I'm a huge fan of Andrews. And, and, and you described a patient that I want to mislabel the disorder, had a major schizophrenic disorder. I forget the exact category of his schizophrenic disorder, but he had a schizophrenic disorder. And essentially what he came to the realization one day that I might be able to get a girlfriend if I could lose weight. He was morbidly obese, and for whatever reason, he was highly motivated to lose weight. And paraphrasing your story, but then you, as his clinician came on board and thought, okay, I'm going to help him lose some weight. And his disorder was relatively progressed because he heard voices. As I recall, he had this paranoia that there were families that were watching him. And so we were talking about somebody who was mentally ill.

Yes. Severely mentally ill.

Severely mentally ill. And. And this, you know, you sort of credit this patient as being one of the sparks that lit the fire for you to really start taking a deep dive.

Absolutely.

And I want to. I want to talk about that journey because here was a morbidly obese patient with a very severe mental illness that, as I recall, was drug resistant.

Yes.

He'd been on every kind of antipsychotic and conventional therapy of the time. And yet he was just absolutely tormented. And the weight loss journey sparked the journey to fixing his mental. Severe mental condition.

Yes.

Okay, I want to make sure that I summarize that accurately.

All of that is accurate. And so for a variety of reasons, we ended up deciding to try a ketogenic diet. And that was initially mind blowing to me when I saw the results. Within two weeks, he was losing weight, and I started noticing tremendous mood improvement. But within two to three months, he just started spontaneously reporting that his chronic auditory hallucinations were going away. The voices that he heard in his head were going away, that he was no longer paranoid. He. As he thought about it, that didn't. It sounded kind of crazy. He started recognizing that maybe he's had schizophrenia all along. So that man went on to lose £160, has kept it off to this day. He was able to complete a certificate program, perform improv in front of a live audience, go out in public without being paranoid. He moved out of his father's home for a while. That man started something that has been transformative. He, you know, some people will say, well, that's just an anecdote. And I've had a lot of people say, oh, maybe he was vitamin B12 deficient or something, and that's what fixed him.

Right.

And, yeah, that all of. Yes, I can think of hundreds of reasons that may have played a role. Maybe he was gluten sensitive and that was the magic ingredient. But in fact, we now have hundreds of patients with schizophrenia, bipolar disorder, chronic depression, and other disabling illnesses. Hundreds, if not thousands of patients coming forward, sharing their stories. Some of them are written up. We have case reports, pilot studies that have already been published. We have between 12 and 15 controlled trials occurring throughout the United States and throughout the world, including at prestigious universities like Harvard, Oxford, Johns Hopkins, Stanford, that. So for. For any of your listeners who don't know this, a lot of people know the keto diet as that fad diet to lose weight, and the American Heart association hates it. They think it's a toxic diet. It's going to give everyone heart attacks. Nobody should do it. So there's a good chance that any of your listeners have probably heard from their doctors or healthcare professionals. They should not do a ketogenic diet. It's dangerous. It's not a sustainable diet. It's, you know, don't do it. So unbeknownst to most people, the ketogenic diet is actually a 100-year-old treatment for epilepsy.

Yeah, epilepsy yeah.

And it can stop seizures even when medications and surgery fail to stop seizures. And the reason that's so important to me as a psychiatrist is because we use epilepsy treatments in psychiatry every day, in tens of millions of people, we use medications that were actually initially developed for epilepsy. Depakote, Tegretol, Lamictal, Neurontin or gabapentin, benzodiazepines. All of these medicines are actually seizure medicines. But we use them in psychiatry for a wide range of mental illnesses. Bipolar disorder, schizophrenia, depression, anxiety, eating disorders, substance use disorders, dementia. We use them for everything. And so in many ways, using the ketogenic diet to treat serious mental illness is nothing new. It just happens to be using a dietary intervention to treat a brain condition that we call mental illness. But the science is there, the evidence is there. The kind of, the way that we practice psychiatry, the way that we think about psychiatry, this is not new, innovative. It's just something that's been hiding in plain site. And sometimes when I talk with, like, leading researchers, clinicians, when I talk with them about this and I point out everything I just pointed out, they say, duh, yeah, why, why haven't we been using this diet in people with mental illness? The next question always is, well, nobody can do that diet. That diet is just way too hard. And people with mental illness, they're weak and they're vulnerable and they're lazy and they're unmotivated and they're disorganized, and there's no way in hell they could do a ketogenic diet. Well, the, the reality, the wake up call that I have for all those people is that I am getting lots of patients with chronic serious mental disorders who have been disabled by their illnesses, who are poor because of their illnesses, who have been unemployed for years or decades because of their illnesses, and maybe.

Even more importantly, drug resistant and drug resistant.

They're taking their pills, they're doing their therapy, they're shocking their brains with electroconvulsive therapy. They are getting ketamine injections, and they are still disabled. They are still tormented. Their lives are ruined and decimated. I am getting those people to do a ketogenic diet. Why? Because they are fighting for their lives. They will do anything. If they will allow people to shock their brain with electricity, guess what, everyone, they will do a diet, delete avocado. Like, have a little more faith in them. Have a little more faith. Give them the benefit of the doubt.

Yeah, ribeye not so bad, right? Electroshocks to the hypothalamus Little, little more intense. Right.

It, it, it's so frustrating and infuriating to me as somebody who has tried to advocate for these people my whole career.

Right.

It is so infuriating to me when people undersell their determination to improve their lives.

No question.

Yeah. People who just want to lose 10 pounds, it's really hard to get them to stay on a diet to lose 10 pounds.

Yeah.

Because they don't have that much skin in the game. It's not that their lives aren't ruined by weighing 10 pounds. Too much.

Yeah.

It just doesn't matter that much to them. The people I'm working with, they're desperate. They are desperate to get better.

And I'll tell you, you know, anecdotally we have seen, because our clinics and my clinical team treat thousands and thousands of patients, we get about 20,000 new patients a month. So we do have a large pool of patients and a large clinical team. And, and we don't, you know, as a matter of habit, put people on prolonged ketogenic diets, but we do use ketogenic diet resets and 10 weeks, 12 weeks, 14 weeks of, of keto dieting. I was most famously did that with, with Dana White. Brought his triglycerides down from, you know, in the upper 800s to in the 130s, which is kind of a hard concept for a lot of people to get to grasp that you have really, really, really high fat in the blood. So we're going to put you on a high fat diet to bring the high fat down in the blood.

Right. It's shocking.

It's sort of contrary to conventional thinking. Yeah. You're eat mostly fat, a little bit of protein and virtually no carbs, and the fat's gonna go down. But you know, what I've been stumbling upon recently is that getting back to your mitochondrial theories, that in a state of ketosis when the body's using beta hydroxybutyrate as a fuel source and it's. And the mitochondria is making intracellular water and it makes a type of water called deuterium depleted water. It's light water has less. Has one less neutron. And that this water, the absence of this extra neutron, which is created when someone's in ketosis, creating mitochondrial water, water inside of the mitochondria for, for use in the Krebs cycle. That this doesn't break the Krebs cycle, it doesn't damage the motor. And you have this upstaging of mitochondria of which, you know 10% of your body weight is mitochondria. I mean, they're, they're the, not just the powerhouse of the cell. I mean, there are a life force. And so I could see that ketosis, you know, being a way to increase mitochondrial efficiency ties into your theory about metabolic insufficiency being tied to all mental disease. So I guess my, my question to people would be, why not try this? You know what, what is the downside? We know what the downsides are. Some of these medications and SSRIs, amphetamines and what have you, and benzos. What's the downside of a keto diet? And you might lose some, some weight and get sick of avocados.

Right? Yeah. For. And the, the real answer, I have to say this as the clinician, the, the real answer is for people suffering from mild to moderate symptoms that have never been dangerous or life threatening. So adhd, depression, anxiety, brain fog, burnout. Absolutely. There is very little downside. They should try a ketogenic diet, see if it works for them. And that's, it's a, it's a real, no easy, kind of no risk, low risk intervention for the people who have really serious brain conditions that can be life threatening. So epilepsy, schizophrenia, bipolar disorder, suicidal depression. I don't say this to be obstructive. I know people get mad at me for saying this, but I really do want them to work with a clinician, a clinician who understands their illness, who understands ketogenic and other metabolic therapies, other ways to enhance metabolism, who understands any medications that they might be taking and knows how to manage those medications safely, whether we're increasing doses or decreasing doses or get. Trying to get you off those medicines. I want people to do that. And it's not because the ketogenic diet is, quote, unquote dangerous, but it's because their illnesses are dangerous. And because the ketogenic diet is a powerful treatment that does come with some risks early on. The keto adaptation for some people with serious mental illness can actually make their symptoms worse before they get better.

Okay.

I just have to say that and put that out there.

Sure.

And I don't want people to be afraid of it. I just want people to know it and then manage it in a safe way. And that's why I want people to get professional help from somebody who knows how to keep them safe. If a child is seizing, I wouldn't want their parents to have to figure out how to treat that epilepsy on their own.

Right.

Even if they end up using a ketogenic diet. And so likewise with schizophrenia and bipolar. The tragic news, unfortunately, is that since I've been doing this work for the last several years, there aren't clinicians, we don't have clinicians who know how to integrate mental health with metabolic health. And so the reality is a lot of patients are stuck and they're desperate and they are doing it on their own. For some, it's working out beautifully. And I'm hearing from them and they are sharing their stories of recovery. They're sharing that. I mean, some of them are saying, chris Palmer, you saved my life.

Yeah.

And I'm delighted and glad that it's working out for them. But I am aware of patients that get into trouble.

Right.

And it's heartbreaking because I listen to those stories and I think, well, I. I fully understand why you got into trouble. Why didn't somebody do anything about the old. About your sleep deprivation? Or why didn't somebody stop that medicine? Or why didn't somebody do this obvious intervention that any decent mental health professional would know to do? And it's because, well, I couldn't find anybody to work with me. I couldn't find anybody to help me.

Yeah.

And so I just had to wing it. And, you know, it's like people coming to you for your practice. Yeah. You know, a lot of stuff.

Yeah.

You know, a lot of stuff that they don't know.

But I don't know everything, that's for sure.

No, nor do I. Nor does anyone. But they benefit from going to somebody who knows what they're doing, who's at least seen other patients go through it, who knows the upsides and downsides. Who knows this intervention might be the better one for you. You've got different symptoms. I'm going to give you a different intervention that I just gave that other person because I know, because I've seen hundreds or thousands of people. We know what works, we know what doesn't work. And we're going to use our experience, our knowledge, our wisdom to help you.

Right.

And that's what I want for this field. I want there to be professionals.

Yeah.

They don't have to be physicians, they don't have to be psychiatrists. They don't even necessarily have to be mental health professionals. But I want professionals who know what they're doing, who know about metabolic interventions and who know about the dangers of mental health conditions and know how to integrate it all and help people heal and recover.

So is, tell me about where you see this brain energy theory of mental illness going? I mean, do you, do you plan to put this into wide scale practice and educate other psychiatrists and psychotherapists? Are you already doing that? Where does somebody go to get this information other than reading your book? And how could they find a clinician that might have some kind of understanding of this? Because there are a lot of people that will be watching this podcast that either are or have a loved one who is desperate for help with a mental health issue, mental illness issue, and they have already gone as far as they can go in the conventional route and either they've been told to deal with it, to live with it, this is just how it is. I mean, I see this all the time. You're just gonna have to learn to live with this. And so to that person, number one, where do they turn? And, and number two, what is, where do you see this brain energy theory of, of, of a mental illness going in a dream world? How, how would you see your work that you're doing manifested, you know, as a way to impact society?

So the great news is that this is taking off. I'm really happy to hear that this is getting traction.

It is.

And over the last year since I published the book, as I've said, we've got at least 12 to 15 clinical trials of the ketogenic diet for a variety a wide range of mental illnesses underway. This is taking off. I'm really happy to hear that this is getting traction.

It is.

And over the last year since I published the book, as I've said, we've got at least 12 to 15 clinical trials of the ketogenic diet for a wide range of mental illnesses underway. There is one philanthropist family, the Bouzouki family in particular. I treated their son with treatment resistant bipolar disorder and he's better, he's in remission for three years now.

Treatment resistant bipolar.

Wow. Treatment resistant bipolar. This is a very wealthy family that had access to the best of the best. There is one philanthropist family, the Bouzouki family. In particular, I treated their son with treatment resistant bipolar disorder and he's better, he's in remission for three years now.

Treatment resistant bipolar.

Wow. Treatment resistant bipolar. This is a very wealthy family that had access to the best of the best clinicians, they are funding clinical trials. They have started a non profit organization called Metabolic Mind. They are, they have at least the beginnings of a clinician directory. So for some people looking for clinicians, they could go to metabolic mind.org clinicians, they are funding clinical trials. They have started a nonprofit organization called Metabolic Mind. They are. They have at least the beginnings of a clinician directory. So for some people looking for clinicians, they could go to metabolic mind.org and look for information there. But the great news is that I am collaborating with researchers from around the world. Other research groups are getting underway. I currently have the privilege of working at McLean Hospital, which is the flagship hospital of psychiatric Hospital of Harvard Medical School. We are currently ranked number one in the nation and look for information there. But the great news is that I am collaborating with researchers from around the world. Other research groups are getting underway. I currently have the privilege of working at McLean Hospital, which is the flagship by U.S. news & World Report. I don't say that to brag, but I say that because I know we're fighting an uphill battle. You know, we're fighting an uphill battle very much. And the number one ranked psychiatric hospital in the nation is going to be starting the metabolic and mental health program under my leadership and directorship. We are going to have clinical services, we are going to have research program. And so anybody who says this is all quackery, this I have hospital of a psychiatric hospital of Harvard Medical School. We are currently ranked number one in the nation by U.S. news & World Report. I don't say that to brag, but I say that because I know we're fighting an uphill battle. You know, we're fighting an uphill battle very much. And the number one ranked psychiatric hospital in the nation is going to be starting the metabolic and mental health program. I'm skeptical. You just. Well, if it's good enough for the leading Harvard number one ranked psychiatric hospital in the nation who treat treatment resistant mental illnesses, maybe it's good enough for you and your psychiatrist too. But I am hoping to start clinics under my leadership and directorship. We are going to have clinical services, we are going to have research program outside of McLean Hospital. McLean Hospital is a large conservative, academic bureaucratic organization, has its role and so anybody who says this is all quackery, I'm skeptical. You just well, if it's good enough for the leading Harvard number one ranked psychiatric hospital in the nation who treatment ranked number one, I love it. I have no plans of leaving. I love McLean Hospital. I'm going to stay there to do the academic and research work and really advance this theory resistant mental illnesses, maybe it's good enough for you and your psychiatrist too. But I am hoping to start clinics but I am really hoping to start some outpatient scalable clinics. Maybe someday we'll get to the Point where we're treating 20,000 patients a month outside of McLean Hospital. McLean Hospital is a large conservative, academic bureaucratic organization, has its role ranked number one. I love it. I have no plans of leaving. I love McLean Hospital. I'm going to stay there to do the academic and research work and really advance this theory. But I am really hoping to start some outpatient scalable clinics. Maybe someday we'll get to the point where we're treating 20,000 patients.

A month. I love to be, I would love to, I'd love to go out to our patient community and say hey, because we, we don't hold ourselves out as a mental health clinic, you know, we're wellness bio optimization but we definitely see again anecdotally we have not done too man, I would love to, I'd love to go out to our patient community and say hey, because a, you know, a controlled randomized trial. But when you get enough data and I come from a big data background, I was a more mortality expert with large life insurance, probabilistic expert and we used large data. We, we don't hold ourselves out as a mental health clinic, you know, we're wellness bio optimization. But we definitely see again anecdotally we have not done to predict mortality very accurately, I might add. And we would put people into pools of a thousand lives and we would put them on a mortality curve and we would predict their month of death accurately enough that large financial institutions would put tens of millions of dollars in risk on these, on these predictions. But what we have seen again massively anecdotally, but in large, in a large population is when we've fixed the hormones and we fix the metabolic issues, we do reduce C reactive proteins, we, we reduce inflammation in the liver. We imply, you know, a controlled randomized trial. But when you get enough data, and I come from a big data background, I was a more mortality expert with large life insurance, a probabilistic expert and we used large data prove the hemoglobin A1C we created to predict mortality very accurately. I might add at a greater level of insulin sensitivity in the body, the patients lose weight, that one of the biggest things that they report is an improvement in their mental health. And I won't say that we treated patients with drug resistant severe mental disorders but everything else that you could imagine add adhd, ocd, reported periods of feeling depressed, what we would call mood numbness, flat affect where people just don't have any positive motivation towards much of anything and they're like dude, I am on fire. I feel amazing. And, and the intention wasn't for them to feel amazing. It was to fix biomarkers in their blood and you fix them and you see it. So I mean there's, I'm, I'm absolutely. And we would put people into pools of a thousand lives and we would put them on a mortality curve and we would predict their month of death accurately enough that large financial institutions would put tens of million. Delighted to hear that the allopathic community, the conventional community is maybe recognizing your work and now of dollars in risk on these, on these predictions. But what we have seen could become.

More.

Mainstream. Absolutely. And, and so back to, to your, your, your metabolic theory and mental disorders and, and brain health. So aside from ketogenic dieting, what are you, what are some of the things that you're investigating or what are some of the key nutrients that you're seeing that you, that you're either supplementing with or encouraging people to take? What are some of the other activities you encourage them to engage in that, that are having a positive impact on.

On mental. Most of us have a very difficult time meeting our protein needs and certain protein sources like whey protein and others can be as little as.

20% absorbable. This again, massively, anecdotally, but in large, in a large population is when we've fixed the hormones and we.

Fix them. This is 99 absorbable and it has all of the essential amino acids that the body needs to build lean muscle, to recover, to improve our exercise performance and most importantly to repair after we have intense exercise. So this is called perfect amino by Body Health. It's, it's like I said, 99 absorbable. It only has 2 calories. Eventually the caloric intake has virtually.

Metabolic issues. We do reduce C reactive proteins. We, we reduce inflammation in the liver, we improve the.

Hemoglobin A1C. We create a no caloric intake. It will not break a fast. It tastes amazing. You mix it in water. I take this literally every single morning. If you're working out in a free fasted state, you have to take a full spectrum amino acid prior to your workout to preserve your lean muscle and make sure that you're recovering properly. And again, it will not break your fast. So the caloric impact is virtually zero. You get all of the full spectrum amino acids. It tastes wonderful. I use it every single day. You can go to body health.com ultimate that's bodyhealth.com ultimate and look for the perfect aminos. They actually come in capsules. If you're on the go. Or it becomes in several flavors that they make in a powder, which.

I love. A greater level of insulin sensitivity in the body, the patients lose weight. That one of the biggest things that they report is an improvement in their mental health. And I won't say that we, we treated patients with drug resistant severe mental disorders, but everything else that you could imagine, add, adhd, ocd, reported periods of feeling depressed. What.

We were. It's flavored with natural means of flavoring. So there's no artificial sweeteners in here. So this is one of my absolute favorite products. Give it a try. If you're working out at all, you need a full spectrum amino acid, go to bodyhealth.com forward/ultimate. That's bodyhealth.com forward slash ultimate. I love their lab tested products. You can actually see the absorption rate for all of their products. They've got great electrolyte protein combinations. My favorite is the perfect Aminos. Bodyhealth.com ultimate. And now back to the ultimate.

Human podcast. So the, the real answer, as I think you already know, there's a whole world of options and, and there's not a one size fits all solution. And I don't say that to frustrate people because they hear that. I think some people hear that and think. So you're saying it's impossible? Just tell me, Dr. Palmer, just tell me the three steps to get rid of my.

Son'S schizophrenia. Yeah, you call mood numbness, flat affect, where people just don't have any positive motivation towards much of anything. And they're like, dude, I am on fire. I feel amazing. And, and the intention wasn't for them to feel amazing, it was to fix biomarkers in their blood. And you.

Fix them. I'm like, no, it's not that simple. It's not.

That simple. Four avocados, a little bit of olive oil and.

A ribeye. Yeah, I'd like to know.