Feel Better, Live More with Dr Rangan Chatterjee - A Brand New Way to Understand and Treat Mental Health Problems with Dr Chris Palmer #396

Episode Date: October 24, 2023

My guest today has spent his entire career, trying to understand mental illness.  What’s really causing it – and how can we better manage it.   Dr Chris Palmer is Director of the Department of Postgraduate and Continuing Education at McLean Hospital, Massachusetts and an Assistant Professor of Psychiatry at Harvard Medical School.    In today’s episode, he shares some of the profound insights he's gained over almost 30 years as an academic psychiatrist. He combines years of clinical, neuroscience and metabolic studies into one unifying idea: that mental disorders are not caused by a chemical imbalance. Instead, they are metabolic disorders of the brain, caused by dysfunction in our mitochondria.   It’s a theory that connects physical, mental and emotional health, and it’s the topic of his excellent new book, Brain Energy. Chris doesn’t deny the roles trauma, psychological and social factors can play in poor mental health. But he explains the link between these factors and our metabolism, and how diet and lifestyle interventions can help. Excitingly, Chris explains that making changes to our diet and lifestyle actually offer far more hope for long-term remission than existing treatments, which generally aim to only reduce symptoms.   As Chris reveals, his own experience with trauma and mental illness is what drives him to try and help millions of people around the world who are still suffering. Chris is advocating for a transformation in the way we view and treat mental health. And, if that happens, it won’t just help ease an epidemic of depression, anxiety and other conditions – it also has the potential to address all of the chronic diseases that are underpinned by metabolic dysfunction.   Chris is knowledgeable, passionate and articulate. I thoroughly enjoyed my conversation with him and I hope you enjoy listening. CAUTION: This podcast discusses ketogenic diets. Always consult a qualified healthcare practitioner before making any drastic changes to your diet. Support the podcast and enjoy Ad-Free episodes. Try FREE for 7 days on Apple Podcasts https://apple.co/feelbetterlivemore. For other podcast platforms go to https://fblm.supercast.com. Thanks to our sponsors: https://exhalecoffee.com/livemore https://drinkag1.com/livemore https://vivobarefoot.com/livemore Show notes https://drchatterjee.com/396 DISCLAIMER: The content in the podcast and on this webpage is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified healthcare provider. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

Wake up, traditional academic mental health neuroscientist professionals. Wake up. Look at the evidence. Look at the detailed evidence at the cellular level. Mental health and metabolic health are inseparable. This research has just been hiding in plain sight. When people really understand the detailed science of it, it has the potential to completely transform the mental health field, reduce suffering, improve millions of people's lives, and potentially save billions of dollars. Hey guys, how you doing? Hope you're having a good week so far. My name is Dr. Rangan Chatterjee, and this is my podcast, Feel Better, Live More. My guest today has spent his entire career trying to understand mental illness,

what's really causing it, and how can we better manage it. Dr. Chris Palmer is Director of the Department of Postgraduate and Continuing Education at McLean Hospital, Massachusetts, and an Assistant Professor of Psychiatry at Harvard Medical School. In today's episode, he shares some of the profound insights that he's gained over almost 30 years as an academic psychiatrist. He combines years of clinical neuroscience and metabolic studies into one unifying idea, that mental disorders are not caused by a chemical imbalance. Instead, they are actually metabolic disorders of the brain caused by dysfunction in our mitochondria. It's a theory that connects physical, mental,

and emotional health, and it's the topic of his excellent new book, Brain Energy. Now, Chris doesn't deny the roles that trauma, psychological, and social factors can play in poor mental health, but in our conversation, he explains the link between these factors and our metabolism and how diet and lifestyle interventions can help. Excitingly, Chris explains that making changes to our diet and lifestyle actually offer us far more hope for long-term remission than existing treatments, which generally only aim to reduce symptoms. As Chris reveals, his own experience with trauma and mental illness is what drives him to try and help millions of people around the world who are still suffering. Chris is advocating for a transformation in the way we view and

treat mental health. And if that does happen, it won't just help ease an epidemic of depression, anxiety, and other conditions. It also has the potential to address all of the chronic diseases that are underpinned by metabolic dysfunction. Now, today's conversation is a little bit longer than my usual conversations, but I honestly think it is worth it. There is so much value within it. And of course, this is a topic that affects many, many people. Chris is knowledgeable, he's passionate, and he is extremely articulate. I thoroughly enjoyed my conversation with him. I hope you enjoy listening. I hope you enjoy listening.

I wanted to start by asking you about this mental health epidemic. Clearly rates of all kinds of mental health dysfunction, mental health disease are going up. But in your view, where do you think we're going wrong? I think the primary place we're going wrong is that right now, the mental health field is still struggling to understand what exactly causes mental illness. And without knowing precisely what causes it, we have a lot of treatments, but our treatments for the most part are symptomatic treatments, meaning that they can reduce symptoms of the illness. So an antidepressant can improve symptoms of depression, but we're not really curing

depression with our treatment. We're not always putting it fully into remission. always putting it fully into remission. And people end up oftentimes with chronic illnesses, with chronic depression that waxes and wanes. It comes and goes. Sometimes it gets better with an antidepressant and maybe somebody could be better for two years, but then the depression comes back and then we have to increase the dose

or change the medication. And people often have low grade symptoms of depression, even when they're doing relatively well with an antidepressant. It's not fully getting rid of all of the symptoms. And I think that is probably one of the biggest places that we go wrong. You've been practicing for 27 years. Paint a picture for us as how you were practicing 27 years ago, 25 years ago, 20 years ago, compared to how you practice today. You know, what happened to shift your perspective? So when I first began my career, when I was, you know, in my fourth year of residency, I was the chief resident of

psychopharmacology. And what that meant was that I did consultations on treatment-resistant patients. So people who had schizophrenia, bipolar disorder, chronic unrelenting depression, personality disorders, you name it, but they were chronically ill. They had been in and out of hospitals. They had tried numerous medications. And my role was to overseam a team of consultants. And we would try to come up with what are the next rational medications to try in order to try to get people better. And at that point, I was persuaded by the field that if we can just find the right pill, we can get people better and we can get them all the way better. Maybe put their illnesses into remission, change their lives, improve their lives,

reduce their suffering. That was the goal. Our goal was to help people. And the tool that we had was find the right pill. And I went along that way for a few years, hoping that if I could find the right pill, maybe augment it with the right psychotherapy, maybe sometimes augment it with electroconvulsive therapy or transcranial magnetic stimulation. Well, TMS actually didn't exist back then, but ECT did, and we were certainly using it then. So maybe if we augment in rare cases, but if we can just find the right pill, that was really the goal. If we can just find the right pill, we can get people better. And after several years of that, I quickly began to become discouraged and demoralized that for 95 plus percent of the patients that I was

seeing, we weren't finding the right pills. We would find the right pill that might work for three months or a year, sometimes even two or three years. Even in the highly functioning people that I was treating, the business executives and others, I could get them better for a couple of years. But then something would happen and the pill would stop working or the pills would stop working. And we were right back where we started and people were in and out of hospitals. Their lives were sometimes devastated. I mean, they were taking their pills religiously and they would have horrible depressive episodes or manic episodes or psychotic episodes that were ruining their lives, even though they were compliant with treatment. It would disrupt everything. They had to take

time off from work. Sometimes they got fired from jobs. Some of them lost relationships. Divorces were happening. Boyfriends and girlfriends were breaking up with people over these episodes. Boyfriends and girlfriends were breaking up with people over these episodes. And I was frustrated and demoralized. Like why aren't we finding the right pills for all these people? And I quickly began to realize, I don't think that's gonna be the answer.

Yeah. It's interesting that if you go back to root cause thinking, you know, you and me are both very passionate about trying to get to the root cause of our patients' problems. But often when we're thinking about a problem and we're not sure we've got the right solution, I always think, well, what's the belief I need to hold in order for me to think the way that I'm currently thinking? And then if I apply that through the lens of what you've just said, it's the belief is that this patient has depression. It's a thing that they've got. And that the only way to manage this is by finding the right pills. And if this pill is not working,

it simply means I haven't got the right pill yet or the right combination of pills. But if you go back upstream and go, well, hold on a minute, what if the depression is a symptom of something else? else, right? What if pills are just one way to tackle the symptoms? What if there were other ways to tackle these symptoms? Because we don't get taught that in medical school, really, do we? We don't get taught that. The model, to me at least, and in primary care, we see a ton of mental health problems, right? But the model usually is some combination of medications and psychotherapy. It is. And I think the medication piece, many mental health professionals will defend it as a root cause issue. And in their mind, the root cause of mental illness is a chemical imbalance in the brain. It is a neurotransmitter imbalance. And some people have a serotonin imbalance.

And so they do well with serotonergic medications like Prozac or Paxil or others. like Prozac or Paxil or others. And other people might have a neurotransmitter imbalance related to norepinephrine or dopamine. And so they may do better with other types of antidepressants or stimulant medications. People with psychotic disorders like schizophrenia and bipolar disorder, their problem is too much dopamine. And so we need to block the dopamine receptors in their brain,

and that will bring about an antipsychotic effect. And so I think many of the mental health professionals, in their minds, they think they are after the root cause. It's a chemical imbalance, and we just need to figure out which chemicals in which patients, and we just need to figure out which chemicals in which patients and if we can just rebalance our chemicals appropriately and that means finding the right medication or combination of medications at the right doses, in the right timing, maybe sometimes at night, sometimes in the morning, maybe three times a day. If we can just find that perfect combination,

we can balance their chemicals appropriately and they will be in remission and they will live happily ever after. And the reality is that's all hogwash. None of that's true. true many people who are listening right now or watching this have heard that depression for example is down to a chemical imbalance so i need to correct that chemical imbalance and if i can correct it i will no longer have depression you're saying that's hogwash yeah help us understand that. So the antidepressants do relieve suffering and do improve symptoms in some people, but I actually don't think they're working in the ways that many people think they're working. It's much more complicated than most people think. So many psychiatrists even to this day will think that chemical imbalance is occurring in the brain.

So there's a norepinephrine imbalance or a serotonin imbalance somewhere in the brain. And this pill is going to correct that imbalance in those brain cells and that'll restore normal health. That's not at all the way the pills work. So for serotonin, for instance, 90 to 95% of the serotonin in the human body is actually produced in the digestive tract, not in the brain. And then that leads to this whole exploding area of research, the gut-brain connection, the gut microbiome, what influence

is it having on our brains? And the more research that we're getting, the more we're uncovering that, whoa, this is a huge field. The gut actually plays a huge role in brain function and brain health. And so we need a more comprehensive, holistic way of understanding what is Prozac or Zoloft doing, there's a high likelihood that in fact it's probably affecting the function of the gut. And that is somehow getting transmitted to the brain and affecting how the brain functions. brain and affecting how the brain functions. The research that I've been doing over the last seven years strongly suggests something much broader than that. And that is that although we are

focused on individual neurotransmitters, or sometimes we're focused on hormones, mental illness is due to stress. And that's about cortisol. It's cortisol. Mental illness is a cortisol problem. And we actually have a fair amount of evidence that people with chronic mental disorders do have cortisol dysregulation, but it gets tricky really fast. Some people have too much cortisol. Other people have too little cortisol. So we know cortisol dysregulation might be playing a role for some people, but how does that work? Right now, our field is just essentially shooting in the dark, trying to understand it all. Yeah, it's, right? It's a serotonin imbalance, right? That's

what causes depression. So I can give you something to correct that, boom. But in many ways, that's because of the scientific method by its very nature is reductionist, right? A lot of the time we have to narrow things right down to study one thing and try and go, you know, can this explain it or not? But maybe it's multiple different inputs and in different patients those inputs are in differing amounts, right? So the way i approach pretty much all chronic health problems is the patient comes in of course i listen to the symptoms and in my head i'm trying to put together what are they saying i'm always always thinking what really is driving this how has this come about didn't just happen

overnight what what are the inputs into this person's life over a number of years that means today they've come in complaining of these symptoms? And in my head, there's seven or eight core things I look at. Food, exercise, sleep, stress, and that stress could be physical stress or emotional stress or trauma. and that stress could be physical stress or emotional stress or trauma. I look at things like how much time are they spending outside? What is their vitamin D level like? I think about environmental toxins.

I think about chronic infections that they may have had and may still be underlying some sort of immune system dysfunction. And I'm always thinking about are any of these relevant here? And if so, can I manipulate them? Can I help a patient impact them? And I personally have been using that approach very successfully, whether it be with someone with a mental health problem or with an autoimmune disease or with type 2 diabetes. It's what is the root cause? And I kind of feel there are certain insults that the body can get, right? There's not that many. Of course, there's infinite amount of toxins that we could talk about, but they all come under these broad categories. And then with those insults,

the body, depending on your genetic susceptibility, depending on your individuality, susceptibility depending on your individuality, with those same inputs, you might get type 2 diabetes. With those same inputs, someone else might get depression. With those same inputs, someone else might be diagnosed with an autoimmune disease. I don't think these things are quite as separate as they've been made out. We get taught about these ICD-10 codes, or you've got depression, you've got type 2 diabetes, you've got heart disease, as if these things are completely separate. And I think we're learning more and more that beyond mental health, and I know your focus is primarily on mental health issues, but you can expand your theory, which I want you to outline very shortly. I think you can expand it beyond mental health. It can also cover type 2 diabetes, obesity, and even Alzheimer's, I would say.

Absolutely. And it's interesting because I came to the exact conclusion that you just outlined, but I came to it as an academic psychiatrist trying to understand what on earth causes schizophrenia? What causes bipolar disorder? How can we understand chronic unrelenting depression? How do these things fit together? What is happening in the cells of the brain? What are all of the clues that we have? And how can I put them together

to understand the larger picture? And in exactly the way you just described, that the same insults might lead to depression in one person and type 2 diabetes in another. For those who don't know this, mental illness is completely enmeshed with other chronic metabolic disorders. So people with mental disorders on average are much more likely to develop obesity, type 2 diabetes, cardiovascular disease, Alzheimer's disease, and other types of disorders like that. On average, people with mental disorders die early deaths. Men lose about 10 years of life. Women lose about seven years of life. And this is for all diagnostic categories. This is for ADHD and simple anxiety disorders and depression. The people with the serious mental disorders, like bipolar disorder and schizophrenia, depending on what study you look at, they're losing

usually anywhere from 10 to 25 years of life on average. And so it is all connected. But I came at it as an academic psychiatrist, really focused on the brain, but trying to look at the bigger picture. Wait, there's a gut-brain connection. What exactly is the gut doing to brain function? What is happening in cells? And at the end of the day, I was led to these tiny things in our cells called mitochondria. And it turns out we have a tremendous amount

of science and evidence to support that potentially metabolic dysregulation or mitochondrial dysfunction, there are lots of terms we could use. And they mean slightly different things. So I don't mean to try to make this simple. But if we understand metabolic dysfunction, that actually helps us understand why the brains of people with mental illness are malfunctioning and causing symptoms of chronic mental illness. And then I tried to explore,

well, what on earth would cause that? And I was led to everything you just listed. Yeah. There's just so much I want to unpack with you. I genuinely want this episode to be really practically useful for people because of how many people are suffering at the moment with their health, beyond mental health, right? A couple of things I just want to clarify there. You just mentioned that people suffering with mental illness are more likely significantly to develop a whole host of

other conditions like type 2 diabetes and obesity. Do we know which way that relationship goes? And what I mean by that is, do we know if people who have obesity or are carrying too much weight, for example, are they more likely to develop mental health problems as well? So that's the first thing I just want to clarify. Yes, they are all strong bi-directional relationships. So people with diabetes are more likely to develop mental disorders, a wide array of them. We best studied our depression and anxiety disorders. People with diabetes on average, about twice as likely to develop depression, but when they get it, it lasts four times longer.

People with cardiovascular disease, heart attacks, strokes, much, much more likely to develop depression, anxiety symptoms, three to five times more likely in many series. People with obesity, research paper just came out, I think, two weeks ago. People with obesity, more likely to develop a wide range of mental disorders, anywhere from 50% more likely up to over 300% more likely, ranging from psychotic disorders to depression and anxiety to ADHD to nicotine dependence. If you're obese,

you're more likely to become dependent on nicotine, meaning you're more likely to become a smoker or a vapor. Yeah. I mean, it's fascinating. And I guess many people will jump to the conclusion, I imagine, when you talk about the relationship between people with obesity being more likely to develop depression and anxiety. I guess some people go, yeah, I get that. That's to do with stress, right? They maybe have been fat shamed. They are living in a society whereby being overweight can be looked

down upon, people can say nasty things at school, as an adult, you may be discriminated against. So people may go, that's a psychological issue, right? That's why they're also developing depression and anxiety. But your central thesis, to me at least, is that all mental disorders are metabolic disorders of the brain. Yes. Right? I'm just going to repeat that. All mental disorders are metabolic disorders of the brain. Now, we have covered metabolic dysfunction before on this podcast, right? But usually, we talk about it in relation to obesity or type 2 diabetes. But you're saying something that to many people is going to be hugely provocative, that actually mental disorders are metabolic disorders of the brain. So, Dr. Palmer, what do you mean by that?

So there's a lot to unpack. And maybe the first place to start is defining what is a mental disorder. Because right now, DSM does, you know, the way we usually think about mental illness is the diagnostic and statistical manual or the ICD codes. We've got these labels, things like depression, anxiety, schizophrenia, anorexia, alcoholism, or alcohol use disorder is the official name. Most people know what those things mean.

And when I say them, most people have a clear picture of what I'm talking about. Depression, yeah, we kind of know what that is. Depression, yeah, we kind of know what that is. Anxiety, we kind of know what that is. But in fact, DSM doesn't always distinguish between trauma reactions or normal reactions to adversity and brain disorders.

So let me give you a clear example. So if a man was married and had two kids whom he loved dearly and his wife and children were killed tragically in an auto accident, tragically in an auto accident, he would become depressed, potentially even suicidally depressed. He may feel like my life is over. I have no reason to live. I want to join them. I'm a man of faith. I know that they're in heaven and I'm ready to join them in heaven. I can't bear to live without them. I don't consider that a brain disorder. In fact, I would say if that man did not become depressed,

he probably does have a brain disorder. It would be highly unusual for him to not become severely depressed. Not necessarily suicidal. depressed. Not necessarily suicidal. How long does that man get to be depressed before DSM says he has a brain disorder? He's got 13 days. He gets 13 days to get over it. So on day 14, if he is still struggling and still feels low and doesn't feel that life is worth living. He now has major depressive disorder. So that would be reasonable from the profession to diagnose him with major depressive disorder 14 days after his family and wife have died.

Yes. And that means maybe he's got a serotonin imbalance now, and maybe he would benefit from some Prozac. Maybe psychotherapy, maybe some grief therapy. Any common sense mental health clinician should know that. And his brain disorder does not get distinguished from somebody else who has had chronic, unrelenting suicidal depression for 20 years. Who says, I don't know why I'm depressed. That man at day 14 gets lumped into the same category as somebody else who I think does have a brain disorder. If you're suffering from chronic, unrelenting depression for 20 years, and I ask this person, why are you depressed? And they say, I have no idea.

I don't know what's wrong with me. I just cannot snap out of it. On the surface, I know I have a decent life, but I am miserable. I'm never happy. I'm always so pessimistic. I think maybe I'd rather be dead. I think that person has a brain disorder, but DSM doesn't distinguish those categories. So if we go back to your theory that all mental disorders are metabolic disorders, of course, making sure we're making the correct diagnosis of a mental disorder is, of course, very,

very important. So using that example, the gentleman who's lost his family in a car accident, the gentleman who's lost his family in a car accident, who I think all of us would say rightfully, you know, feels sad, depressed, maybe suicidal. You're not saying that's a metabolic disorder. No, I'm saying that is the normal human being. That's exactly. He doesn't have a disorder.

That's what we would consider a normal response to a very, very tragic, unfortunate situation. Yes. Just like a child being bullied and teased relentlessly on the playground is going to be anxious. But what if that person, just to sort of, you know, follow this example through, right? So that man, 14 days after, could be diagnosed with major depressive disorder if they went to see a psychiatrist and they would be entitled to make that diagnosis based upon the current guidelines. But let's say they didn't make that diagnosis. They thought, okay, listen, I don't need to put a label on this guy. He's really struggling at the moment. You know,

you can keep coming to see me. We'll get him some counseling. We'll try and give him some support. And what if six months later, he's still struggling, right? Six months later, he can't get out of bed. He feels indifferent about life. He's got no motivation to go to work. He can't gain pleasure in that weekend game of football that he used to play with his mates every week and have fun right at some point presumably things change in his body from that severe stressor that may put him into the category of having a brain problem or a brain energy malfunction? Yes. Just taking a quick break to give a shout out to AG1, one of the sponsors of today's show. Now, if you're looking for something at this time of year to kickstart your health, I'd highly recommend that you consider AG1. AG1 has been in my own life for over five years now. It's a science-driven daily health

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Usually, they offer my listeners a one year supply of vitamin D and K2 and five free travel packs with their first order. But until the end of January, they are doubling the five free travel packs with their first order. But until the end of January, they are doubling the five free travel packs to 10. And these packs are perfect for keeping in your backpack, office, or car. If you want to take advantage of this limited time offer, all you have to do is go to drinkag1.com forward slash live more. That's drinkag1.com forward slash live more. You know, we all have normal reactions to adversity in that example that we just discussed. And there is a period of time

over which most people will move on. It doesn't mean most people will forget. I don't mean to be cold and heartless. This man is going to grieve the loss of his wife and children for years to come, if not the rest of his life. But he should be able to go on with life. He should be able to begin to function again. It doesn't mean he has to go out and get remarried or start a new family or anything else. But he should be able, as you said, to get himself to work, to be able to not think about the deep pain and grief that he went through for at least periods of time during the day, where he should be able to be productive in some way. He's got to start moving on. And the reality is that is normal too. The

majority of human beings do move on from tragedy. They figure out a new life. They figure out a new way, maybe even to respect and honor their loved ones, recognizing my loved ones would not want me to be essentially dead now. They would want me to go on. They would want me to continue doing my career because that has more impact on the world. And so there are lots of ways to manage grief and get over it. I don't

mean to be cold and heartless about this, but at some point, if he is unable to cope, then we do classify that as a brain disorder. And I believe it is a brain disorder. And I believe it is a brain disorder. His brain is not adapting. His brain is not coping with the adversity and moving on and becoming adaptive to a new life. And when we look at that, when we look at all of the biological research that we have done over many decades now, it's not that we don't know a lot in the mental health field, in the neuroscience field. We do know a lot. And when we look at that, and this is about all the brain scans that we've done on these

patients, about biomarkers that we've been measuring. We look at that. The central problem is that parts of his brain are metabolically compromised. That the initial trauma or stress of losing your family actually takes a huge metabolic toll on people. And I'm not saying that that is a quote-unquote disorder, but it is a major stressor to the system.

And that stressor can push some people over the edge into what we would later define as a disorder. And most people, however, are resilient. And most people can get through that stressor and move on and recover. But it's really about allowing an appropriate amount of time. It's allowing recovery, sometimes supporting and facilitating recovery.

So I don't at all mean to say this man doesn't need treatment or doesn't deserve treatment. He certainly deserves talk therapy, but he might start needing nutritional advice. He may let his nutrition slip. He might need substance abuse advice because he may start drinking himself to sleep every night to deal with the loss and coping. And now he's got an alcohol use disorder. And now he may need treatment to get off the alcohol or to be able to sleep and get back to normal. So we can help him restore his health.

But to come back to your earlier question, mental disorders or metabolic disorders of the brain, what I'm arguing is that decades and decades of research all point in the same direction. And that, you know, if you ask these fundamental questions like, well, if there is even a neurotransmitter imbalance, what could possibly cause it? I mentioned cortisol dysregulation. If there are problems with cortisol, too much, too little, what would cause that? Women know this well. Women's hormones, estrogen, progesterone, can have profound impacts on mood for some women. That can happen around the time

of menstrual periods. It can happen around the time of pregnancy and postpartum. And it can also happen around the time of menopause. Fluctuations in these hormones can cause depression, anxiety. It can cause depression, anxiety. It can cause OCD. It can cause psychosis. It can cause bipolar symptoms. So all of these mental symptoms can be exacerbated by all of these different things. And when we look at that research

and try to put it together in one coherent way, the easiest way, the easiest nutshell to explain it is that they all involve metabolism in brain cells and there is somehow metabolic compromise in those brain cells. What does that mean, right? Metabolic compromise in brain cells, right? A lot of people understand metabolism to be something to do with energy, how we generate energy. And your book is called Brain Energy, right? And so, you know, really in layman's terms, what do you mean when you talk about this problem with metabolism in brain cells? Because I actually love your theory. I actually think it does pull everything together really, really beautifully. And I really want people to get this and understand it because we're going to get to all these kind of

treatments, all these things, all these changes that we can make in our lives with or without doctors that can make a huge difference. And actually, the science can be quite complicated if we go into all the different pathways, but a lot of the actual practical applications are not that complicated, which is what I love about it. So yeah, let's just really get clear. What do you mean when there's this kind of metabolic compromise in a brain cell? So most people think of metabolism as burning calories in the way you said, and they think about it as it relates to obesity and maybe type 2 diabetes, maybe cardiovascular disease. But that's where metabolism begins and ends. For most people,

it's about weight. And if you have a slow metabolism, you're probably way too much. And if you have a rapid metabolism, you're probably thin. So, number one, it turns out that that's not always true. But much more importantly, metabolism is so much more than that. So, in a basic sense, a basic definition is metabolism is, you know, it's universal to what we call living organisms. So this goes from single-celled bacteria or yeast all the way up to humans. food and maybe oxygen and some other things and turn it into energy or building blocks that we use to make new cells or maintain our cells. So when we eat food, our cells break down that food and either turn it into a cell membrane or a protein or a neurotransmitter or a hormone that gets released. So some of the food that we eat gets turned into physical things, us, what we are.

But the bulk of the food that we eat actually gets turned into energy. And that is in the form of something called ATP. And energy is what makes us work. That was what makes, it's actually what makes life. Because as soon as there's no energy, even if we still have the structure of cells, even if we still have our DNA, if there's no energy, that is the definition of death, is when we stop making energy. And so, this process of metabolism, building blocks and energy affect so many things.

And in the mental health field, it's really important to break it down in its kind of simplistic way. And in the mental health field, it's really important to break it down in its kind of simplistic way. So one thing, starting from birth or starting even before birth, metabolism is influencing cell development, the development of our brains and our nervous systems. Metabolism is also influencing the structure and function of those cells. And metabolism, if there are chronic problems with metabolism, cells can actually begin to shrink, shrivel up, and die. And that ends up being associated with neurodegenerative disorders like Alzheimer's. But those two middle ones, the structure and function of cells, are critically important. And in a nutshell, what I'm saying is that metabolic dysfunction results in problems with the structure and or function of cells.

And that is how we can understand mental illness. At its core, we should think about mental disorders as a malfunctioning brain, a brain that is doing something or failing to do something that it should be doing. So it's either doing something that it shouldn't be doing. Easy example of that is somebody who has a panic attack for no good reason. They're sitting quietly in their home, minding their own business. And out of the blue, they have anxiety or panic. That's a malfunctioning anxiety circuit in someone's brain. And other people's brains may fail to do things that they should be doing. So some people have cognitive impairment or memory impairment or brain fog is a big term these days. You're just not thinking clearly. That represents your brain not quite firing on all cylinders.

The cells and networks aren't doing exactly what they're supposed to be doing. When we call those disorders mental disorders, I'm arguing that the root cause of that in the overwhelming majority of cases, and I suspect probably all cases, is metabolic dysfunction. I wonder if you could give us an example, maybe a case from your practice where someone had a mental health diagnosis

and then you, by helping them dramatically change metabolism maybe through diets i know many people associate dietary changes or the ketogenic diet with your work and i know your work is much more than just diets but maybe that will be a really nice way to help people understand just how powerful what you're saying can be. Yeah. So, you know, I've now had many cases that are quite extraordinarily and exceptional, but I think one that I'll share with you, just somebody that I did a case report on and I spoke with her at one point just to share with people the power of what this means. Because a lot of people know that diet, exercise, yeah, that's probably good for maybe mild anxiety. Sure, that'll help people feel better or mild depression.

But I'm also talking about serious, horrible, debilitating, treatment-resistant mental disorders like schizophrenia. And so I think I'll describe to you the case of a woman. I changed her name in the book, but she actually gave me permission to use her real name. And in honor of her, I'm going to use her real name. Her real name is Doris. Doris had a horrible childhood out of the gate. A lot of abuse and trauma. She undoubtedly suffered from depression and post-traumatic stress disorder.

At the age of 17, she began having hallucinations and delusions and was diagnosed with schizophrenia. Over the ensuing decades, she tried numerous different antipsychotics, mood stabilizers, antidepressants, and other medications, but none of them stopped her symptoms. She was a chronic, paranoid schizophrenic in every way. She was tormented by hallucinations and delusions. She gained massive amounts of weight. She was unable to function on her own. She ended up getting a court-appointed guardian.

She had people come into her home to help her pay bills with grocery shopping. Why? Because she was schizophrenic. That's what happens to people with schizophrenia. Between the ages of 68 and 70, she was miserable, hated herself, hated her life, and tried to kill herself at least six times and was hospitalized for those suicide attempts. And in fact, that's not unusual. Many people with schizophrenia die by suicide. It's torture.

And at the age of 70, she was referred by her primary care doctor to a weight loss clinic at Duke University where they just so happened to be using the ketogenic diet. And for whatever reason, she decided, I'll give it a shot. And so she went to this weight loss clinic run by Dr. Eric Westman. And within two weeks, not only did she start losing weight,

but she began to notice dramatic reductions in her auditory hallucinations. Within months, all of her symptoms of schizophrenia were in full remission. Within months, all of her symptoms of schizophrenia were in full remission. Within six months, she got off all of her psychiatric medications and remained in remission from schizophrenia. Doris went on to live for another 15 years. Symptom-free, medication-free, out of psychiatric hospitals, no more psychiatric professionals,

no more suicide attempts. She also lost 150 pounds and kept it off. Sadly, Doris passed away last year of COVID pneumonia at the age of 85. I mean, that's just, it's such an incredible story. A whole lifetime of pain. A whole lifetime, well, up to the age of, what, 70, where she's struggling, where she has people to help her, she's suicidal, paranoid schizophrenia and all the kind of discrimination

in society that comes along with that. I mean, sure, we talk about mental health a lot these days, but for many years, and even now, there's quite a lot of discrimination against people who are suffering like that. I've seen it. I've seen it in patients. And what's really interesting about that story is that she had trauma, right? So it's not as if you're necessarily saying, and I want to really clarify this, you're not saying that trauma didn't exist, that this was due to highly processed foods and junk food that caused metabolic dysfunction. And when we then changed her diet, her symptoms get better. You're not saying that. What you're saying is that there was a series of stresses in her life. Trauma, maybe there was some substance use,

maybe there was poor diet, maybe there was a variety of inputs that meant she had symptoms consistent with paranoid schizophrenia. Everything that the medical profession has available to it was thrown at her and nothing really stuck. Yet she goes to a weight loss clinic. She's probably not even thinking about her schizophrenia. She goes to something seemingly unrelated. What's weight loss got to do with my mental health problem? Yet by going on a ketogenic diet, she loses weight and she goes into complete remission. That is absolutely remarkable. How do you explain that? And how does your theory help us understand biochemically

what might have been going on there? So there's a lot to unpack. And I just want to share another personal part of her story. The last time I spoke with her, she actually almost begged me to share her story. She said, please tell my story far and wide. Tell anyone who will listen because if my story can spare even one person, the torment that I experienced for decades, it will be worth it. So please just tell my story to anyone who will listen. listen. And so the first thing I want to say is Doris is not an anecdote. We now have numerous people who have been able to put their bipolar disorder and schizophrenia into remission

using the ketogenic diet. We have at least, I think, 10 controlled trials underway. controlled trials underway. So this is a rapidly expanding field. This is not quackery. This is not nonsense. But when I first saw my own patient recover using a ketogenic diet, and when I began to accumulate more cases and talk to more people like Dr. Westman, like Doris, and talk to more people like Dr. Westman, like Doris, to try to understand what's happening here. Initially, I was perplexed that this doesn't make sense. And the godsend that I had was that the ketogenic diet is actually an evidence-based treatment for epilepsy. It is a 100-year-old treatment that, unbeknownst to most people,

most people have heard of keto as like the fad diet. It's that all-meat diet where people just eat hamburgers and bacon, and it's really bad for your heart, and nobody should do that keto diet. It's really dangerous. That's what heart and nobody should do that keto diet. It's really dangerous. That's what most people know of the ketogenic diet. Well, the reality is the ketogenic diet was first developed by a physician 100 years ago for one and only one purpose, to stop seizures. And so it's been around for 100 years. We have a tremendous amount of research on it. We have two Cochrane reviews, which are kind of the gold standard in the medical field

for rigorous meta-analyses to answer the question, does this intervention actually work and how well is it supported? And we've got at least two Cochrane reviews that strongly suggest the ketogenic diet is in fact an evidence-based treatment for childhood and adolescent epilepsy. In adults, the research literature is less compelling, but we also have a tremendous amount of neuroscience literature trying to understand what? A diet? How does a diet stop seizures? Because this diet can stop seizures even when medications fail to.

Even in patients who've tried numerous anticonvulsant medications and their seizures don't stop, sometimes the ketogenic diet can stop their seizures. So researchers, biotech companies, pharmaceutical companies have been trying to understand what is this diet doing? And so we know a lot about it. The diet changes neurotransmitters. It decreases inflammation broadly, including brain inflammation.

It changes the gut microbiome. And some researchers actually think these changes in the gut microbiome might be its primary mechanism of action. And then that leads to this gut-brain connection. It reduces insulin and glucose levels, meaning it improves insulin signaling or reduces what many people call insulin resistance. It improves that. One of the things that I ended up being led to in all of this research, though,

was I was trying to put the whole puzzle together in the best way I could. And I was led to the fact that this diet improves mitochondria in two different ways. Pretty broadly, it stimulates a process that gets rid of old and defective mitochondria, and it stimulates many cells to produce more mitochondria. So that after somebody has done a ketogenic diet for several months or several years, many of their cells in their body and brain actually have more healthy mitochondria than they did before they started the diet. And what that means in my mind is that those cells become metabolically healthier or more metabolically resilient. And for some people, like Doris, that can mean the difference between health or illness.

I mean, so much to unpack there. You're right, people have heard of the ketogenic diet, and it appears to be quite a controversial diet for a variety of reasons. And of course, a ketogenic diet can be done in a variety of different ways. But let's just start with epilepsy for a minute. You mentioned that it's been studied now for over 100 years, and I've heard you say in another talk that the ketogenic diet may well be the most studied diet we have when it comes to brain function. Yes. So I think many of us are aware that it can help some people with epilepsy. epilepsy. So my first question there is, do you feel today in 2023, if somebody is diagnosed with epilepsy, that as part of real informed consent, they should be told that, look, there's a whole variety of things that we could offer you. There are these medications here, but there's also something called the

ketogenic diet, which would require you to do A, B, and C, because I don't think that's happening. But it seems like we should be offering that. We should at least be saying this is an option. we should be offering that. We should at least be saying this is an option. I agree. People should know. Because sadly, tragically, I know people who have treatment-resistant epilepsy

and are never even told that the ketogenic diet is a treatment option. By no means am I suggesting everybody must do the ketogenic diet. It's a choice. And it's a difficult choice. There's no question in my mind. Taking a pill is much easier than doing this diet. And if you can take a pill that does not give you many side effects, that does not have many adverse effects on your health, and it can completely and fully stop your seizures, I would probably go with that. I would probably go with that. It's so much easier than being on a rigorous medical version of the ketogenic diet. But I have met people who have, one person has a son who is in a chronic vegetative state because he has 20 to 50 seizures every day. He doesn't talk. He can't function.

He can't go to school and people didn't even talk about the ketogenic diet with this family and this man saw me give a presentation on the ketogenic diet for mental health conditions and approached me like

could that be an option for my son and I'm thinking how is it possible that this wasn't offered to you? This is in fact, one of the gold standard treatments for treatment resistant cases. And let me explain that. So if you have tried three epilepsy medications and are still having seizures,

three is not a whole lot. If you've tried three epilepsy meds and you're still having seizures, if the doctors prescribe another epilepsy medication, the chances of you becoming seizure-free are close to zero. Very close to zero. The chance if you get instead, instead of trying a fourth medicine, if you try the ketogenic diet

your chances of becoming seizure free are about 33 percent another 33 percent probability that you'll have a significant reduction in your seizure frequency for about a third of the patients, it doesn't seem to work. It's not always clear to me whether that's because the patients maybe aren't doing the diet right or maybe there are other factors involved. So it's not a panacea. It doesn't work perfectly for everyone.

I'm not here at all to say that. But 66% of patients get significant improvement and a third of patients become seizure free. Yeah. I mean, it's incredible. And again, I want to reiterate, it's not for everyone. And clearly, it can be very challenging for some people. It's too hard to do in the long term. They can't make it fit their lives. But of course, if your life is being really, really severely affected by seizures, for example, you may go, well, wait a minute, this is pretty hard, which is harder. And we can't make that decision. We as physicians just simply have to offer options, help patients make those decisions for themselves. So I think that's really

interesting regarding epilepsy. A wider point there for me, Chris, which I'm always keen to when I'm lecturing healthcare professionals or when I'm talking on this show is whenever we talk about lifestyle, okay, lifestyle is a tricky word, isn't it? Because it can imply blame sometimes. And I certainly want to use the term, don't use it to imply blame. But when you talk to people about changing certain lifestyle behaviors, if they can, whether it's diet or movement or sleep or stress, and I recognize that many people have got challenging lives and it can be hard to do so. People will often say, yeah, prevention is better than cure. Yeah, it's all about prevention. And hey, I don't dispute that. But we can also use lifestyle change as part of

our treatment. And I think this is the missing link. A lot of the time in this conversation around changing our lifestyle, it always comes down to prevention sure let's prevent things if we can but also lifestyle can be a very powerful treatment and i think what you just said about epilepsy and the ketogenic diet shows that that's a lifestyle behavior change yes it's a medical diet in that context but that is making quite a dramatic change to your dietary choices and seeing a huge therapeutic effect on your health. So that's just another point I wanted to highlight. Yes. And if I can even just add just a little bit to what you just said, just to make sure your listeners really get it. bit to what you just said, just to make sure your listeners really get it.

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have a journal or you don't actually want to buy a journal, that is completely fine. I go through in detail all of the questions within the three-question journal completely free on episode 413 of this podcast. But if you are keen to check it out, all you have to do is go to drchatterjee.com forward slash journal or click on the link in your podcast app. I'm not at all saying that children with epilepsy are eating bad diets and that's why a ketogenic diet is helping them. And likewise, I'm not saying people with schizophrenia are eating bad diets, and that's why a ketogenic diet is helping them. So let me give you a couple of clear examples. People can develop seizures after getting a chronic serious infection.

People can develop schizophrenia after getting a serious infection as well. Both of them can be consequences of a serious infection. That infection is wreaking havoc on cells throughout the body. And in some people, it leaves those cells metabolically vulnerable. Those cells have higher levels of what's called oxidative stress, and they're not functioning properly anymore. And that results in seizures or schizophrenia symptoms in some people. So the cause, the root cause was actually an infection. They could have been following a perfectly healthy diet. But the treatment can, for some of them, be a ketogenic diet because the ketogenic diet is kind of a metabolic reboot, if you will, or it's a metabolic therapy. an alternate fuel source in the form of ketones, but also by reducing inflammation,

changing the gut microbiome, changing hormone levels, actually changing gene expression, changing mitochondrial function. So it's doing a wide range of things. But the soundbite nutshell is it's changing metabolism or healing metabolism broadly. And that can restore health in some people.

Yeah, I'm so glad you highlighted that point because we need to look at causes and treatment maybe a little bit differently. You're saying, look, there's a whole variety of different causes, right? But whatever those causes are, you know, in your example of Doris with paranoid schizophrenia, you mentioned she had a traumatic childhood. You're not saying that because the ketogenic diet cured her, that it was a high sugar diet that caused it. You're saying that there was

a combination of inputs in her life that left her with paranoid schizophrenia. And because of those combination of inputs, she had a degree of metabolic dysfunction. Let's try and address that metabolic dysfunction in this case with a ketogenic diet. And by treating the metabolic dysfunction, suddenly all of her symptoms go away. So it's subtly different, but very, very important. So I really appreciate you mentioning that. So what is going on in a ketogenic diet, right? If we take Doris's case, for example, you mentioned some of the things that happen, reduced inflammation, example. You mentioned some of the things that happen, reduced inflammation, less oxidative stress, different gene expression. There's all kinds of things that can happen. But why do we

think it is getting rid of a lot of these symptoms? Is it something to do with the ketones? Is it to do with glucose regulation? Is it to do with noradrenaline levels? I mean, do we know yet what exactly is causing the relief in symptoms? The real answer is we don't know. We have all of those clues. Again, we have a tremendous amount of research and we've got numerous mechanisms of action that are possible. Decreasing inflammation, changing gene expression, all of these other things. But different scientists are in debates with each other about, well, I think it's the gut microbiome, and that's why it's working for Doris. Others might say it's changing the glutamate and GABA ratio, and that's probably

why it's working for Doris. My theory suggests that the central theme is to focus on mitochondria. Because if we focus on mitochondria, we can actually begin to put a lot of those puzzle pieces together. Mitochondria help us connect the gut microbiome and the function of cells. Mitochondria help us understand gene expression or epigenetics. Mitochondria help us understand calcium regulation in cells, quite importantly, because they're a primary regulator of calcium in cells. Mitochondria actually help us understand neurotransmitter imbalances because they play a role in producing and releasing neurotransmitters,

including serotonin, famous serotonin, including dopamine, including GABA and glutamate, mitochondria actually control the first step in the synthesis of cortisol. And so if cortisol is dysregulated, an obvious place to look would be the first step in its synthesis, which is mitochondria. So the reason I'm focused on mitochondria is because we know the ketogenic diet stimulates two specific processes, one called mitophagy, which is getting rid of old

and defective mitochondria and replacing them with new ones. And it also stimulates a process called mitochondrial biogenesis, which is just the production of more mitochondria. which is just the production of more mitochondria. And so in my mind, what happened in Doris's brain cells are that she had brain cells that either had defective mitochondria or insufficient mitochondria to perform their function normally. And so those brain cells became fragile.

They were metabolically compromised. They were fragile. And they would sometimes fire off when they shouldn't, or they would sometimes fail to fire when they should. And that probably occurred widely in different areas of Doris's brain. And that resulted in Doris's specific brain symptoms that we call schizophrenia. And what I imagine the ketogenic diet doing, this is speculation, speculation based on a lot of science. We do have science showing that the ketogenic diet improves mitochondrial function

in the ways that I described. But again, the gut microbiome researchers might argue with me and say, Chris Palmer, no, it's not mitochondria, it's the gut microbiome. So there will be some who take me on, but I believe that if cells have enough healthy mitochondria, they actually will function properly. And that is really one of the critical keys to so many of our chronic, not just mental disorders, but disorders. Yeah, it goes beyond mental health. A lot of people say that mitochondrial dysfunction

is at the root of many cancers. Mitochondrial dysfunction is at the root of Alzheimer's. Mitochondrial dysfunction is the root root of Alzheimer's Mitochondrial dysfunction is at the root of frankly Most of our chronic illness And so let me try and summarise what I've got so far And you can tell me whether I've got this accurate or not You're making the case that in pretty much all mental illness There is some degree of metabolic dysfunction in the brain okay whatever the cause is

it has resulted in the brain not being able to utilize energy properly or as well as we might like and then bringing mitochondria into that conversation, I guess any metabolic dysfunction has mitochondrial dysfunction behind it. It has to. Right, exactly. So effectively, what I think you're saying is that if you are suffering with a mental illness, you have a degree of mitochondrial dysfunction, especially in your brain cells. And therefore, if we're going to try and treat you by looking at root cause, we have to find ways to improve the function of your mitochondria. Yes. Accurate? Yes. Okay. And then if we go back to what I said towards the start, which are these sort of

seven or eight factors that I look at in patients, well, what's really interesting is they all impact mitochondria. They do. Right? The diet you choose to eat, you've mentioned a ketogenic diet, but also a whole food diet for many people will improve mitochondrial function.

Yes. Right? So that's food. Let's go to exercise. You know, one thing I'm doing a lot of in my own life, and I follow these wonderful people on Twitter, Alan Cousins and I think Inigo San Milan, I think, on, you know, what low heart rate training does for our mitochondria, right? So we can manipulate our mitochondrial function through specific types of exercise, right? So

that's food, that's exercise. Sleep affects mitochondria, right? Stress, right? Stress is a big one. I think let's just pause on stress for a minute because a lot of people will understand that traumatic events can lead to mental health problems. And I spoke to Gabor Mate, I think, four times on the show over the last years. And maybe we're going to chat again later this year. And of course, Gabor talks a lot about trauma and the capitalist society in which we're living and the pressure on people and how that is contributing to this mental illness epidemic. Now, then I was thinking this morning, how do we put that through the lens of Chris's model? And I'm thinking, well, presumably the trauma is causing mitochondrial dysfunction. Is that fair to say? Or how would

you put some of Gabor Mate's work or people who say trauma is the cause of mental illness, not metabolic dysfunction, I'm not convinced that those things are mutually exclusive. They can actually fit together if we look at your model, I think. They can. You raise a common concern or misunderstanding about what I'm arguing. So I appreciate this opportunity to explain it. So trauma causes a flood of stress response in a human being. And when people are traumatized,

usually part of that definition involves some kind of a life-threatening circumstance, either real or perceived, that the person thinks that I might die because of this experience. And we have all sorts of adaptive mechanisms that go into play when we think we're going to lose our lives. And so the body goes on high alert. Your heart rate is going to go up. Your entire nervous system is primed to be hypervigilant. You are going to startle at any sound. You are going to run as fast as you can.

You are going to fight as hard as you can. You are going to cower as much as you can. You're going to hide in whatever way you can. You are going to cower as much as you can. You're going to hide in whatever way you can. You're going to do anything possible, but all resources, all metabolic resources, heart rate, blood sugars, endorphins, neurotransmitter, all hands are on deck to save your life. In whatever strategies you end up deciding to use, that takes a metabolic toll. We have an entire body of research documenting that mitochondria are directly involved

in the human stress response. So the human stress response is usually composed of at least four different things. So one is we get a flood of adrenaline. Two is we get cortisol. Everybody knows that. Three, we get an increase in inflammation. And four, we get gene expression changes, at least in the hippocampus. Because our brains are wired to remember this experience for a long time.

Your life is almost threatened. You better remember this. This is salient. So genes are changing to store this memory, to embed this memory forever so that you never forget because this will prime you then to try to avoid danger in the future. So those four buckets, adrenaline, cortisol, inflammation, and epigenetic changes or changes in gene expression are all happening.

Researchers did a study where they genetically manipulated mitochondria in four different ways, and all four of those stress responses were altered, which strongly suggests, if not proves, that mitochondria are playing a role in the stress response. We know from other researchers, they are involved in releasing adrenaline from the cells that release adrenaline. We know they're controlling the first step

in the synthesis of cortisol. So the cortisol release. We know that they're playing a role in epigenetics. We know they're playing a role in inflammation, turning it both on and off. So mitochondria are involved. inflammation, turning it both on and off. So mitochondria are involved. So I could digress and we could get really nerdy and talk about cell biology and biochemistry and all that other stuff, but I know nobody wants to hear that. I'm going to rest on that to say there is an abundance of

research. I am not speculating. This is not a speculation. This is proven pretty well in highly reputable scientific studies published in some of the best journals we got. But I want to take a step back and make this make sense to people. Why would trauma, why should we think about trauma as a metabolic problem? Well, as you said, everybody already kind of intuitively knows trauma, that causes mental illness. Which mental illness is exactly? Is it just PTSD?

Actually, no. Trauma is associated with higher rates of PTSD and depression and anxiety and addiction to alcohol, opioids, and bipolar disorder and schizophrenia. So now we need to be thinking about Doris again. Her trauma likely contributed to her development of schizophrenia.

What else does trauma do? People who have traumatic childhoods are more likely to develop obesity, type 2 diabetes, cardiovascular disease, dementia, and they're much more likely to die early deaths. On average, in one study, people who have six or more adverse childhood experiences, commonly referred to as ACEs,

people who had six or more ACEs die 20 years younger than people who have no ACEs. So trauma affects metabolism. It affects both mental and metabolic health. And we need to connect these dots. I mean, I really appreciate you going through that because I think that's what's powerful about your theory is that it ties all these seemingly separate research areas into one unifying theory.

Because how does trauma actually cause this? A very simple way people can think about this, Trauma is a huge stressor on the body. And we know one of the things that happens when your stress response gets activated is that your blood glucose goes up, right? That is part of the stress response. That helps you deliver more sugar to your brain so that you can actually fight or flee the predator that's trying to attack you. So that's what the body does. And so if you think about trauma through that lens, it's like,

yeah, well, of course there's going to be an impact on our physiology. And then I guess if we follow that thread and think, well, okay then, if we're trying to treat someone who's got some form of mental illness. Okay, you mentioned Doris where, you know, by going on a ketogenic diet, seemingly most things, if not everything, got better. And of course, with some people, it's probably not going to be just one thing. They're possibly going to need therapy for their trauma. But actually also, they may respond to changing their diet as well. Instead of saying, oh, it was trauma that caused it, so you need to deal with your trauma. It's like, no, no, it'll be helpful to see a therapist. And there's, of course, all kinds of modalities that treat trauma. But at the same time, we're pretty sure that you have got some form of

metabolic dysfunction in your brain. So why don't we also help you change your diet? So at least we can keep stable blood sugars, which, you know, in some people are going to help more than others. Like, I guess what the point I'm really trying to elaborate on is that it's not either or, is it? It's like you can change a diet and you can get therapy for your trauma. You don't have to choose which one you're going to do. Absolutely. And I would want to go even just a tiny step further and say, therapy for the trauma may help you deal with some of the psychological aspects, but it may not fully address the physiological aspects. So therapy for your trauma may or may not reduce your risk

for cardiovascular disease, which you are now at risk for because you've had trauma. It may not reduce your risk for obesity. Psychotherapy typically doesn't result in weight loss for most people. Yet trauma increases your risk for developing obesity. And so trauma is having both psychological, social, and physical impacts on your body. And I actually believe that a more comprehensive treatment approach that maybe addresses all of those. So let's address the psychological aspects with psychotherapy. Let's maybe think about the social aspects.

How can you get safe, meaningful relationships again? You know, you may be afraid of people for good reason. You've been hurt. You've been betrayed. You trusted somebody and they hurt you. How can you develop new relationships? People may need help with that. But I think we need to focus on the physiology in order to help people heal their brains and heal their bodies at the same time.

Yeah, I love that. And I guess when trauma happens as a child, you know, we have these windows, don't we, in human development. we in human development, before the age of seven, you are very vulnerable in many ways to the inputs you're getting. We're seeing that the early years are so important for our long-term health. So I guess if you experience trauma at the age of five, then that trauma, yes, it's having a psychological impact, but it's also changing your physiology. And it may well be changing the set point of your nervous system, possibly for good, right? So therefore, let's say you're an adult dealing with the consequences of that trauma. Yes, having psychotherapy to try and

deal with some of that and process it is useful, but you may also need to deal with the fact that your nervous system has been set differently than it might have been set had you not experienced that trauma. And that then could have an impact on your metabolic function or your metabolic dysfunction, and therefore you need to address that as well. You do. And so an easy way to think about it is that when people are immediately traumatized, as I said, your sympathetic nervous system gets revved up.

Your defenses are on high alert, all hands on deck, everything you've got, try to save your life. So blood sugar's going up, heart is pumping as fast as it can or as fast as it needs to at least. Eyes are dilating,

like you are ready to fight, flee, freeze, hide, whatever you're going to do, you are ready to go to save your life. When people are repetitively traumatized or when people experience a horrific, unimaginable trauma, that system can remain on high alert for understandable reason. You may feel like I'm never safe anymore. I can never let my guard down. Those people end up developing problems sleeping because their body is on high alert all the time. It doesn't want you to sleep.

It certainly doesn't want you to sleep soundly because what if an attacker walks into your room while you're sleeping? You need to wake up. You need to wake up at the sound of a pin drop. That is your body trying to save your life. But unfortunately, if you have gotten past the danger, and that's a big if. So if you have gotten past the danger and that's a big if so if you're a soldier on the battlefield and you're still on the battlefield those are all adaptive responses

and I don't want to interfere with any of them I do want you to wake up at the sound of a pin drop if you are a battered woman still living with your abusive partner I want you to wake up at the sound of a pin drop. Yeah. I don't want you to sleep soundly. He may kill you in your sleep. You cannot be sleeping soundly. You should not be sleeping soundly. You should not be medicating yourself to sleep soundly because you really are in physical danger. But once people are out of the danger and they've been out of danger for a time and their body, their brain should be

readjusting and recognize, wait, it's safe now. I can sleep. The majority of people do that. The majority of people, their body adapts. It adapts to the safety and it allows people to sleep. When people's bodies don't adapt, what I'm arguing is that metabolic dysfunction somewhere in your brain or body is preventing those cells from making the switch to safety mode. And that leaves people with this diagnosis

that we call PTSD. And that leaves their trauma system, their hyper alert safety system on high alert most of the time or all of the time. And unfortunately, we need sleep to repair our body, to store memories, to clear toxins and waste molecules from our brains. When we sleep, all of those things are happening. If you're not sleeping well because your body thinks you are in danger, your body's not repairing itself. It's not healing itself. It's not getting rid of waste products in the ways that it should. And that is taking a toll on your overall health and longevity. a toll on your overall health and longevity. And so in addition to dealing with the psychology of the trauma, part of the psychological work may be just helping the person understand you are safe now. But then the person needs to readjust their physiology. They need to learn how to sleep soundly through the night

without substances, without pills. They need to learn how to reduce their heart rate in the ways that you described. And that might be meditation or mindfulness or stress reduction practices. They can change their diet to try to foster some of this healing. They can maybe do exercise,

movement, other strategies to try to foster all of this, but they need to get their body back into resilient safety mode. Yeah. It's just so interesting and probably don't have time to go into movement in depth, but I know there's many therapists out there who, you know, after trauma, your body gets stuck in certain movement patterns and simply, you know, accessing different movements can also help you heal from some of that trauma or some of that stuckness within your body, which I think is really, really interesting. But just to finish off then on this kind of part where we're talking about, again, going back to your central idea that all mental illness has metabolic dysfunction somewhere at its heart, or pretty much all. And if you've got metabolic dysfunction, you have mitochondrial dysfunction, right? And so we're just going through that list

now of the things in society that potentially can negatively impact mitochondrial function. So we mentioned food, exercise, sleep, stress. We mentioned trauma. What about environmental toxins? So what about things like alcohol, marijuana, cyanide, right? These things are mitochondrial toxins for many people. These things can absolutely contribute to the development of mental illness. So how do you think about toxins when we're thinking about your model? In exactly the way you just described. So all of those things are known mitochondrial toxins, or they have toxic effects on mitochondria. Again, that's not speculative. Decades of research documenting this in some of the best neuroscience and medical journals that we have available. So if people are skeptical or just unaware of this, you can look it

up. The toxicity of alcohol has been known since the 1960s and researchers in the 1960s knew it seems to be toxic to mitochondria and that's how it results in cirrhosis of the liver, for instance. Oxidative stress in the liver results in cirrhosis. That is mitochondrial in nature. And it's also well known that people who are exposed to these toxins can have a wide variety of both mental disorders and also metabolic disorders. They can die early deaths from things like heart attacks. They're more likely to develop diabetes. And, you know, one, so one really good example is actually smoking cigarettes. So smoking cigarettes, you get nicotine, yes, but you also get thousands of toxic chemicals in the smoke.

And those chemicals are toxic to many parts of the cell, including mitochondria. But cigarette smokers are a great example of what I want to illustrate. Because when I say metabolic health, it's not about weight. It's about mitochondrial function. Cigarette smokers are a perfect example of this. So cigarette smokers on average are thinner than non-smokers. They usually do not have a weight issue compared to non-smokers. And in fact, in the 1950s and 60s, cigarette companies advertised to women in particular, keep your slim figure, Slim Jims and other cigarettes that were marketed specifically

to control your appetite way less because nicotine can do that. So cigarette smokers on average don't have a weight problem or they have less of a weight problem than non-smokers do and yet everyone knows they're more likely to have heart attacks well heart attacks that's a metabolic disorder yeah what else are cigarette smokers more likely to get? They're twice as likely to develop insulin resistance and type 2 diabetes, even though they weigh less than non-smokers. So that's now a clear example where if you understand the whole theory, you start to separate type 2 diabetes even from being overweight. It's not necessarily a weight issue.

Yes, weight and obesity do increase your risk dramatically for type 2 diabetes, but they're not the only thing. Toxins to mitochondria across the board increase your risk for type 2 diabetes. What else do cigarette smokers get? Pretty much all of the mental disorders. Cigarette smokers are more likely to develop depression, anxiety, schizophrenia, bipolar, other addictive disorders like alcoholism. They are more likely to develop mental disorders across the board. In your view, because the cigarette smoke is damaging the mitochondria. Yes.

And so mitochondrial dysfunction sits behind the development of mental health problems. It sits behind the development of obesity. of mental health problems. It sits behind the development of obesity. It sits behind the development of type 2 diabetes, dementia, many forms of cancer, if not all, right? And this is what, when I've been thinking about your work, Chris, in preparation for you to come to the studio today, I've been thinking about this really goes beyond mental health. Yes. today, I've been thinking about this really goes beyond mental health. But you almost need to hook it onto mental health so that people can actually think about it. Otherwise, it becomes too broad. It's like, oh, this is everything. Well, kind of mitochondrial health kind of is everything,

isn't it? It is. And in many ways, it's important to hook it with everything else. In many ways, it's important to hook it with everything else. Everything else is going up in prevalence as well. Yes. So, you know, so broadly speaking, you know, we have a mental health epidemic. Mental disorders across the board are rising significantly. A lot of people know rates of burnout are high, rates of anxiety disorders, rates of depression. Rates of depression actually reached an all-time ever recorded high in a Gallup poll just a few weeks ago. All-time ever recorded high for current prevalence and lifetime prevalence.

10 years ago, the lifetime prevalence of major depressive disorder was thought to be 20%. That's now up to 30% of the population. I mean, if we just pause there for a minute, what does that say about us? What does that say about the evolution of humanity that we now have an all-time record here. I mean, it's not good, is it? It's not good. And to go further, it's not just depression. It's anxiety disorders. It's also anxiety disorders in youth. I just saw a study based on outpatient practices in the United States. Tripled. The number of youth who are diagnosed with an anxiety disorder has tripled in about 10 years in the United States. Bipolar disorder.

Bipolar disorder has skyrocketed in youth, largely because it was not recognized, never diagnosed prior to the 1980s. And now it's much more commonly diagnosed. But in adults, in the last 15 years, rates of bipolar disorder have doubled in adults. These are supposed to be fixed lifetime genetic disorders. Genetic disorders don't double in prevalence in 15 years. Yeah. And I just want to point out that, so we've got mental disorders skyrocketing across the board, across a range of diagnostic categories at the exact same time that the rates of obesity, diabetes, and prediabetes are skyrocketing.

And what I'm arguing is they are very much connected at a biological level. And we need to recognize that and think about it because we can treat all of them simultaneously with common sense lifestyle strategies. We do not need to focus only on mental health and have a mental health prevention strategy. And over here, we're going to have an obesity prevention strategy. And over here, we're going to have a diabetes prevention strategy. Let's have a human health prevention strategy using common sense lifestyle strategies like you talk about all

the time. Yeah. I mean, I so agree, Chris. I mean, it's so hard sometimes to get that message across because people consider these things completely separate. And I released my first book back in 2017 in the UK called The Four-Pillar Plan and America called How to Make Disease Disappear. And I outline, you know, the four core things that I felt influenced health the most that we also have a fair degree of control over about changing in our lives, food, movement, sleep, and stress. And what's really interesting over the years, I have had so many messages like you will get from your book that, oh, Dr. Chesh, you know, I put my type 2 diabetes into remission from reading that book. I've cured my depression from reading that book. I no longer

have anxiety from implementing what was in that book, et cetera, et cetera. I.ee if you focus on the creation of health in a human it is amazing how often these seemingly separate diseases start to get better maybe they're not quite as separate as we've thought maybe they're not quite as separate as we've been taught you know and it it's again of course there are some variations that need to happen for particular conditions. I don't mean to denigrate that or, you know, under-emphasize how important that is. But it is amazing how often when you pay attention to the basics and improve metabolic health and mitochondrial function, it's kind of

incredible what kind of symptoms can start to get better, isn't it? It is. Exactly. And I agree with you. If people already have an illness and life-threatening symptoms, I am all for modern medicine and using strategies. If somebody is in diabetic ketoacidosis this is not the time to be talking about lifestyle strategies they need insulin and they need it right away they are in a life-threatening emergency if somebody is having a heart attack they need interventional cardiology to save the day

to clear that artery, to do whatever needs to be done if somebody is psychotic and aggressive or suicidal, if somebody is manic and out of control, they need standard psychiatric treatments to save their lives, to keep them safe, to keep others safe. to keep them safe, to keep others safe. I'm not at all arguing against the use of standard interventional treatments when people's health has deteriorated significantly. But at the same time, all of these basic common sense lifestyle strategies can help people heal and recover from all of those disorders. And more importantly, can definitely play a role in prevention.

Yeah. And if I can, I would love to at least expand on one case just to really drive this home. Because a lot of people I know are probably still skeptical, Like, Chris Palmer, you can't really be serious. What are you talking about? So there was a longitudinal study of 5,000 children from the ages of 1 to 24. Researchers, this was a painstaking study over two decades, two and a half decades.

The children who had the highest levels of insulin resistance beginning at age nine had a five-fold increased risk for a psychosis at risk mental state by the time they turned 24. Oh, wow. That means they were 500% more likely to be at risk for schizophrenia or bipolar disorder.

They were three times more likely to already be diagnosed with bipolar disorder or schizophrenia. So when we are talking about holistic treatments, when we are talking about prevention strategies, preventing a life sentence of schizophrenia potentially, preventing bipolar disorder, which is also a life sentence for a lot of people. Insulin resistance, that's supposed to be diabetes or weight. If we recognize that in children at age nine and intervene appropriately, we might not only be able to help them keep the weight off or prevent obesity, we might not only prevent type 2 diabetes,

because those are clear unequivocal consequences of identifying insulin resistance and addressing it early, but we might also prevent crippling, lifelong, chronic disorders, along with the anxiety disorders and the depression that also accompany people with diabetes, people with obesity. So we're really preventing a wide range of physical and mental disorders using the same treatment strategies. These youth simply have a biomarker that they are beginning to have impairment in metabolic function

or impairment in mitochondrial function. It is a biomarker. It shows us early signs. They are not yet ill. This is a beautiful opportunity to actually see what we can do to prevent all sorts of human diseases that we right now all assume are different. And if we think about that, we think about that as adults. If anyone listening to this right now has ever lost a significant amount of weight and they ask themselves, how did they feel

afterwards? A lot of the time they will tell you, I had more energy, my mood improved, right? Now, that's normally put down, or the energy at least is put down to the fact that, you know, some of the weight has been lost. That's why I've got more energy. But you could also make the case that what you were doing to help you lose weight was possibly, probably improving mitochondrial function. And therefore, that is going to increase your energy. That's also going to improve your mood, right? These things are not necessarily that disparate. So I think that's another way that people can think about it, perhaps. Chris, can I just pause on the schools for a minute? You mentioned how much anxiety is going up in children and teenagers. And as a father myself,

I think about the school system a lot. And one of the things that's really top of mind for me at the moment is the amount of screen time kids are being given at school and in the evenings. So like you, I'm always trying to think about root causes. We know that sleep deprivation will affect how kids can concentrate the next day. It's going to affect how they perform. It's going to affect their focus. It's also going to affect how much empathy they have how creative they are and we haven't really gone deep into sleep yet but you know i'd love to know your thoughts on sleep but the research i'm familiar with shows that sleep deprivation can be causative of mental illness not just associated with causative of we know that keeping your brain stimulated in the evening is going to

make it more challenging to fall asleep. We know that too much light exposure in the evening, bright light exposure, blue light exposure, may be problematic with sleep. And just five years ago, be problematic with sleep. And just five years ago, nobody did any homework on screens, right? So it was possible for people to do their homework and it not be on a screen. Since COVID, I understand that because of lockdown, screens were very helpful at helping people still get an education. But I feel an inertia has set in in many schools whereby oh we can now do everything on screens in the day and in the evenings and I have been extremely worried about how much homework my own son who's now 13 is getting on screens and I'm wondering how is that going to go over subsequent years if that increases that's not going to help him sleep well. That's clearly

going to increase risks of mental illness across a population. So if I think about something that we can do across society that may have myriad effects on rates of mental illness, I kind of feel that schools not giving homework in the evening on screens would be incredibly helpful. You are a Harvard-trained psychiatrist, right? With all your knowledge, with your new book, with the mental energy theory, right? In terms of what I'm just saying now, do you think that screen usage in the evening in kids is going to be contributing to mental illness? 100%. You're right on the money, unfortunately. And interestingly, screen use is also associated with all the metabolic disorders. The more you use screens, the more likely you are to develop obesity, diabetes, cardiovascular disease.

It is removing... There was one study, a report that just came out a couple of months ago that looked at cell phone use in youth. And the younger the child is when the child gets his or her first cell phone, the more likely that child is to develop a mental disorder. so that is one practical easy takeaway for parents hold out as long as you can do not get your child a cell phone because there was a clear unequivocal linear it's rare that you get such a striking linear dose response curve. The more years the child had a cell phone, the more likely the child was to have a mental illness. So that is something you can really easily do. And some of the billionaires who helped develop cell phones refused to get their children's cell phones because they knew that these are not just tools to call people. These are made to be highly addictive screens that engage people and encourage them to come back. So we have fairly good data of strong correlations, at least,

between cell phone use and both mental and metabolic disorders. I think that's enough for now. Screens are doing a few things. So screens are having a toxic effect on sleep in exactly the way you just delineated. on sleep in exactly the way you just delineated. Screens are also depriving people of engaging in the real world, whether that's through mindfulness, so engaging with your own body and just being mindful or meditating, just being aware of you, you yourself, whether it's engaging in the physical world, going out and exercising or playing with others, but probably most importantly, it is depriving people of human contact, human relationships with each other. And so,

even if you're on Zoom with a friend, it is not the same thing as being in person with that friend. When two humans are together, they see each other. They see each other's entire body. You respond to a lot of nonverbal cues. You can make eye-to-eye contact. You can make eye-to-eye contact. And whether you realize it or not, those things have powerful effects on our brains.

Our brains are hardwired to crave that. We crave human connection because human connection is about survival. It's about survival. It's about safety, that we are programmed to stay with other humans, to be with our family, with our tribe. We are programmed. Any parent knows this. Your kid is clinging to you in a crowded place or something. That's all programmed, but your kid is not clinging to a screen. Your kid is clinging to a human, a living organism. And when we look at screens, we're not getting those same inputs. And I think our brains perceive that. And we have an epidemic of loneliness right now.

And I think screens contribute to that epidemic. Oh, good question. If we engage with other humans, even for a tenth of the time that we're on screens, it would probably get rid of a lot of the loneliness epidemic. Yeah. Just on that sort of screen use in the evening, I think there's two other factors. Well, two things to mention. two other factors, well, two things to mention. One is, and why I'm so against schools giving homework on screens to children. And I'm very open to hearing, you know, alternative viewpoints.

Some teachers may make a case on, you know, some people will say that it's a tech heavy world now. We need to get our kids ready for it. We need them skilled and able to use all this technology so that they can enter the job market. But my argument would be, yeah, sure, do that in the day. Do that in the morning where it's going to have less impact on your circadian rhythm. Don't do it in the evening. Do not send home, do not send children home asking them to go on brightly lit screens that we know can play havoc with your sleep like at what cost you give a good education like it's like what what's the point of a good education if the cost of that is mental illness it doesn't make any sense to me or cognitive impairment or cognitive impairment we need to think about these children's

brains developing. Yeah. And we need to foster, again, whole person, whole child care. So, if you're trying to educate a child and that child is malnourished, you're fighting an uphill battle.

You're not going to be very successful. And the intervention that's going to be most important is nourishing that child and I agree with you excessive screen exposure may in fact be adversely affecting neurodevelopment broadly and that may have effects not just on mental health

but on cognitive health, on people's ability to function in society with other humans, to work on teams, to work in service sectors, if they're expected to serve other humans in any way, whether you're a physician, a nurse, or an engineer working on a team with other engineers. You need to be able to deal with other humans. And I think that needs to be factored into a well-rounded educational plan. And so I completely agree with you. I don't think any kid nowadays is going to come out of school

not knowing how to use technology. I don't think that kid nowadays is going to come out of school not knowing how to use technology. I don't think that's our biggest fear. I think the other problem for parents is that a lot of social activities are on screens. So let's say your child loves to play computer games. And the school is also sending homework on screens. That's pretty much the entire evening is being spent on screens, possibly messing up your circadian biology, which of course means they're going to retire the following day and struggling the following day. So I know we've sort of spent a bit of time here, but I think

it's really, really important if we're talking about mental illness, we're talking about mental illness rates going up, what are some structural societal things we can get right to make it less likely? I would say for me, and of course I'm biased because of the age of my own children, I would say not giving homework on screens would be right up there. If you were in front of a school board at the moment and they said, Dr. Palmer, we think it's important that our children are doing two hours of homework a night on screens. Give me your top three reasons why not, what would you say? I would say, number one, there's no evidence to the best of my knowledge that that is going to improve their life skills, their cognitive

abilities, their even aptitude scores. There's a whole body of research actually on homework in general, documenting that homework actually does not improve success in life. It does not improve SAT scores. It does not, you know, in the United States, it doesn't, it does not result in the gains that everybody thinks it does. So that's number one. Number two, again, if you want your child, your student, to be alert, attentive, participating, engaged, and well-behaved the next day in class, you want that child to get a good night's sleep. If you are demanding two hours of screen time homework, and that results in that child not sleeping as well, you're going to see this child chronically as less optimal than that child is truly capable of being.

You're going to see that child as maybe a little bit behaviorally disturbed, maybe dozing off every now and then, maybe a little fidgety. Maybe he's got ADHD now because of sleep deprivation. He's a little restless. And if you just got him a decent night's sleep on a regular basis, he wouldn't be restless. But now we're going to medicate him for his ADHD, and then he's going to probably need an antidepressant soon for his anxiety and depressive symptoms. And so I'm going to focus on that. And you asked for three. I don't know if I gave you three. Well, that's fine. I guess I wanted backup from your expertise, because I feel very, very strongly about it. And I think across society,

I think it would be a great topic for teachers to engage in. I'm sure many are already. But again, I think it's this inertia that's set in post-COVID across society. You mentioned how important social connection is, right, for our well-being. One thing that's happened a lot over COVID is that people started doing their social activities on screens because of lockdowns, whether it be their yoga class or whatever it might be, and they are still doing it now on screens. They haven't gone back to that in-person yoga class, which has so many powerful benefits. So through the lens of mitochondrial dysfunction, through the lens of all mental disorders are metabolic disorders,

how does loneliness affect that? Again, lots of empirical research showing at a minimum correlations and we have some very good emerging data on actually the biology and mechanisms of action. So broadly speaking, people who are lonely are more likely to have some kind of mental symptoms, depression, anxiety, something. That's common sense. Most people, I think, understand that and recognize that. What's less well understood is that people who are chronically lonely or score high on loneliness surveys are also more likely to have metabolic disorders, including heart disease and including dementia.

The United States Surgeon General just issued a report, I think a month or two ago, loneliness increases risk for depression, anxiety, cardiovascular disease, dementia, and premature mortality. So people die earlier deaths if they are lonely. So that is consistent with the theme that I'm arguing, that mental health and metabolic health are inseparable. So you can have one factor, loneliness,

that drives both mental and metabolic problems. Do we have any evidence that that's influencing metabolism or mitochondrial function? We do have some. In particular, we know that loneliness is associated with an increased stress response. And so we go back to everything that I said about the stress response, all four of the major buckets of the human stress response

are impacted specifically by mitochondria and or impact mitochondrial function. We have other lines of evidence showing increased inflammation, which is one of the hallmarks of the stress response. And there are actually specific, some research studies have shown there are specific types of immune cells that get activated from loneliness. And genetic expression can change after loneliness. And that loneliness confers, so they've done some prospective studies, even in animal models, including primate models,

that loneliness increases risk, not just for depression, but also for infections and not being able to fight off infections appropriately. So it's impacting metabolic health broadly. There is no way to understand that by excluding mitochondria. Can I say it's 100% exclusively mitochondria? No. There are lots of pathways with human biology,

but mitochondria are absolutely impacted and playing a role in all of that. And the consequence, again, is aligned with my broad message. Mental health and metabolic health are inseparable. One factor, loneliness, increases risk for both. We can look at all of the factors. increases risk for both. We can look at all of the factors. A bad diet increases risk for all of it. Metabolic and mental disorders. Inflammation from an infection increases risk for all of it.

Smoking cigarettes, a toxin, increases risk for all of it. It is, you know, in some ways, this research has just been hiding in plain sight. Like, how did we not recognize this? And yet, when people really understand the detailed science of it, it has the potential to completely transform the mental health field, reduce suffering, improve millions of people's lives, improve the health of millions of people,

and potentially save billions of dollars. We can take people who are disabled now from mental disorders and turn them into productive taxpaying citizens. We can give them, not only reduce their suffering and their pain, but give them back their dignity and self-respect. I sit with these people day after day, year after year for 27 years. A lot of people think, you know, oh, well, if I had disability, that would be great.

I could just lay around all day and do nothing and get a check. Well, the reality is that people on disability are usually living poverty-level lives. That's not anything you want to really strive for. But I have sat with schizophrenic patients in tears, desperate to just hold some kind of a job so that they can earn a little bit of money, so that they can hold their head high and say, I made some money. I can do something useful. I want to be useful.

These people are desperate to contribute to society, to contribute to their families. Yeah. It's really powerful. Really, really powerful. Let's talk about diets. You mentioned the ketogenic diet and you mentioned the case of Doris and how that particular diet for Doris was life-changing. So if we just zoom out and look at mental health or mental illness more broadly, one of the things that people can do to improve their metabolic health and their mitochondrial function, which in turn may improve some of their mental health symptoms, is change their diet. Does everyone have to go keto? No, absolutely not. So, you know, diet is such a controversial area.

Some people want all plant-based, other people like vegetarian, other people like animal sourced foods. People get really worked up and passionate about diet. Different cultures have different dietary patterns and dietary customs. Diet ends up impacting so much of society. We have celebrations around diet, around holidays, religious practices sometimes include specific diets. So by no means is there a one-size-fits-all diet for all humans or all human health. And so even with the ketogenic diet, there are vegan versions of it, vegetarian versions. You can do an Asian-influenced version. You can do all sorts of customs, practices, foods, spices. It can be added or subtracted to result in a diet that might be right for you.

As a rule of thumb, the diet advice that I give people often say, so what's your diet advice? My diet advice is there's not a one-size-fits-all diet for everyone. That's my advice. Not a one-size-fits-all. I need to know more. I need to know who are you? What are you dealing with? fits all. I need to know more. I need to know who are you? What are you dealing with? Some people might need to lose weight. We have an obesity epidemic. Other people may need to gain weight. I deal with people who have anorexia nervosa. I deal with people who are severely depressed and emaciated. I've dealt with cancer patients after their chemotherapy and radiation. They can lose tremendous amounts of weight. The dietary intervention for them is to help them gain weight, but to put on healthy tissue, not just gain lots of fat,

but to gain some muscle, lean tissue as well while they're gaining weight. So different people need different diets. The general rules of thumb that I endorse broadly, eat real whole foods. Get rid of as much processed food as you can. Don't drink any calories. You don't need to drink calories. Liquids that you consume, yes, you need liquids. They ideally are going to be water, they ideally are going to be water, unsweetened coffee, unsweetened tea, whether it's black tea, green tea, other types of tea, tea, coffee, water. There was a Harvard study that just came out in the last six months documenting that at least for people with type 2 diabetes, those who consumed primarily water, tea, and coffee had better outcomes

than people who consumed anything else. If you can, try to get off of sweetened everything. Try to get away from added sugar, but also added artificial sweeteners. New evidence is coming out that artificial sweeteners may in fact not be safe and may in fact not be good for metabolic health and mental health so the World Health Organization

just issued a report two months ago I think actually strongly against artificial sweeteners broadly and documenting that they may have adverse effects on obesity and diabetes. The mental health literature is more sparse,

but we have one animal model published in a very prestigious journal documenting that aspartame in mice induces anxiety. And that, unfortunately, is transmitted transgenerationally to their offspring. So aspartame is found in most diet sodas. So Diet Coke, if you like Diet Coke, that's zero calorie. It's supposed to be good for you. Well, we have an anxiety disorder epidemic

and we have at least animal model data very clearly unequivocally showing that aspartame increases risk for anxiety symptoms and that that gets transmitted from parents to children. And from recollection, the amount of aspartame in that study, it wasn't that high, was it? that gets transmitted from parents to children. And from recollection, the amount of aspartame in that study, it wasn't that high, was it? No, that was, it was, they used the dose,

a dose in mice that would be kind of equivalent to somebody who drinks several diet sodas a day. So it was doable. But people, so to be clear, I always take the precautionary principle. I have never been a fan of diet drinks. I've never recommended them to my patients. I know it's a very controversial area and people love to say, no, drink them them there's no evidence it's better than the full fat at least it's going to help people lose weight and for me it's always been look we just don't know enough yet it's i think it's better to try and avoid the stuff if you can some people

will hear you talk about that study and go well that's a mouse study yeah right it is a mouse what the hell has that got to do with humans is what some people might say to you. How would you respond to that? And what I would say is that if you are drinking sugar-sweetened beverages, and you cannot stop, and you are overweight or obese, and God forbid you're pre-diabetic or diabetic, and you say, I might be able to switch to diet sodas, but I'm not going to drink water, unsweetened tea, or unsweetened coffee.

Then I would say, yes, please go ahead and switch. The World Health Organization actually just came out and said, don't bother switching. You're not going to improve your health. So I would probably say at this point, consuming a lot of sugar is potentially more toxic to your health than consuming artificially sweetened beverages. However, what I would really say is this. Yes, if you're somebody who wants to hold out for more data, great. Hold out for more data.

In the meantime, the world is sinking. Look at the health of the human population. Skyrocketing rates of obesity, diabetes, and mental disorders. If you want to wait for the definitive data to come in for you and your family, well, good luck to you. I hope you are spared, but there's a good chance you are going to drown with everyone else. sugars, beverages, or desserts, or candy. There's no reason to assume that that is good for human health. And that gets into this concept of, do some people become addicted to processed foods or sweetened foods? I mean, sugar's been around for millennia, but we didn't always have the obesity epidemic that we have. You know, grandmothers would make pies and cookies at holidays

for millennia probably, at least hundreds of years. We didn't have an obesity epidemic. People could stop eating grandma's cookies. They can't stop eating the highly manufactured processed foods that are designed to be consumed repetitively. And so whether we call that food addiction, whether we call it addiction to highly processed, ultra processed foods, whether we call it just, you can't eat just one, like the Lay's potato chip commercial says, however you want to think about it is less relevant. But what I would say is,

you know, and I say this as somebody who grew up on Kool-Aid and junk food. I actually grew up, I could not stand the taste of water. It was too plain for me. up, I could not stand the taste of water. It was too plain for me. I was raised only drinking Kool-Aid. That's all I would drink for a liquid. I guess I would sometimes drink milk, but it was usually sweetened. It was chocolate milk, something. I had to put some kind of syrup in it because plain milk was too plain. So I don't mean to sit here in judgment. I don't mean to sit here as high and mighty as I know everything. I've been there.

I've been in a place where I was addicted to those foods. And what I can tell people is if you really make a commitment to try to give them up, the first two to three months are going to be really, really rough. And you're going to have cravings and you're maybe going to be irritable and you're maybe even going to think life's not worth living without sweets. How could I possibly go on with life if I don't have sweets? But if you can get through three months of it, your whole perspective will change. I promise you. You can get over those addictive cravings.

They will go away. And life oftentimes will be so much better. You'll notice, wow, my brain fog went away. Wow, my sleep is getting better. I didn't even know I had a mental problem, but now I feel so sharp and I feel so much better. Who knew? And so just try it for three months.

And your taste buds will change. They will. What you consider tasty and nourishing will completely change. But Chris, what if someone says, well, yeah, you grew up on that stuff and you turned out all right. You went to Harvard. You've been a psychiatrist for almost three decades. Why should I not drink fizzy drinks every day? Why should I not feed that to my kids? Because you turned out okay and you drank them. because you turned out okay and you drank them. Oh, well, I have a long sob story that I'm happy to go into if you want.

We probably don't, I don't know if we have time for that or not, but I did not do okay on the Kool-Aid and the junk food. I had a long history through childhood and early adulthood of chronic mental illness, OCD. I had all sorts of trauma and adversity in my life. My mother developed a psychotic disorder. I went to live with her for a while.

We were homeless together for a while. I actually left home before I finished high school. I was completely on my own. And all the while I'm drinking my fizzy drinks and my Kool-Aid and my junk food. I am not well at all in terms of mental health. in terms of mental health. And then by the time I was in my 20s, I had metabolic syndrome. I had prediabetes. I had horrible lipids. And I had high blood pressure. And it just kept going higher and higher. And my doctor kept trying to push me on pills. And I realized if I go on pills for all of these things in my 20s, I'm going to have heart attacks when I'm in my 40s or 50s. And that is what prompted me to change my diet. I recognized I can't do this.

This is a path to nowhere. And that was actually one of the first clues to me that changing diet can actually improve mental health. Because I changed my diet just trying to get rid of my metabolic syndrome, recognizing I can't be having high blood pressure. And I don't want to be on pills for it. I need to control this some other way. You went on a low carb type diet, didn't you? From what I understand. I did. I did. And I had been religiously practicing a low fat diet,

which was highly recommended at the time. Now it included a lot of processed foods, but I wasn't told that those were harmful or dangerous. So I was eating pastries, but they were no fat pastries. So that was good for you. And I was eating, you know, big bowl of no fat ice cream, because that's good for you. Nobody told me it wasn't. And yet my metabolic syndrome was getting worse. Everything was getting worse. And eventually I ended up on a low carbohydratecarbohydrate diet. And again, the adaptation was tough.

The first month was particularly tough. But after three months, my metabolic syndrome was completely gone. But in addition, I also noticed dramatic improvement in my mental health, my sleep, my cognition, my mood. Everything was getting better. dramatic improvement in my mental health, my sleep, my cognition, my mood, everything was getting better. And so back to your original question, I didn't turn out okay, actually.

If I had stayed on that path, I probably would have had my first heart attack by now. I don't take any medication for metabolic anything these days. I don't take any prescription medicines. And I'm in my 50s. And so I turned out okay because I recognize the power of lifestyle interventions and proper diet and exercise and other things. Yeah, I appreciate you sharing that. First of all, I think it's incredibly inspiring for people to know that it's never too late to change, right? You can make a change. Doris in her 70s made a change and transformed the quality of her

life. You made a change in middle age and transformed the quality of your life, weight, high blood pressure, metabolic syndrome, mood, everything's getting better. So I appreciate you sharing that. And to me, that really, it helps me understand a lot because one of the things I really like about you, Chris, and I can really feel it when you're talking to me here, but I can also feel it online in your tweets. So this feels personal. It feels like you really, really care. You don't have to do this, right? You don't have to go around the world spreading this message, right? And I'm sure you sometimes face, I guess, criticism or opposition, but as many of us do when we try and share messages online these days. But I really get that sense that you, not only because of your own health,

but from what you've seen, you've seen people in desperate states and you've seen that sometimes the tools we have simply don't help very well. So you are seeking out a different way. You're trying to build the evidence base and you try to share it with the world. I am. And I think the thing that most passionately drives me is that, you know, I'm literally hearing from thousands of people, I'm literally hearing from thousands of people, many of them sharing success stories. Yeah. That they read my book or they heard me on a podcast or they read some article that featured my work. And they made one or two or three changes, fairly straightforward.

They did it on their own because their doctor didn't know anything about this. Their doctor said, no, you need another pill or you need more psychotherapy. But they heard me and they made some changes and they reach out in gratitude with, I can't even count the number of people who have said, you saved my life or you changed my life. And this is a wide range of human beings. I'm hearing from physicians who have read my work. One burned out physician who said he was ready to retire from clinical practice, heard me on a podcast, made three changes, diet, sleep, exercise,

and he no longer wants to retire. He's no longer burned out. He loves his practice again. He had no idea that his mental health could be related to diet, sleep, and exercise. Another physician just reached out to me yesterday. Chronic lifelong depression anxiety got treated by the world experts in depression and anxiety got somewhat better heard me on a podcast read my book implemented two changes has a new life and is full of enthusiasm. And I think the thing that drives me is I recognize millions more people need to know this.

People are suffering needlessly. Lives are destroyed. And so I'm like constantly trying to figure out how do I get the message to them? So I'm like constantly trying to figure out how do I get the message to them? How do I get the message to their clinicians so that their clinicians can learn about this? It's not that hard. You know how to do it. I know how to do it.

We can teach them. It really isn't that hard. You know, I thought things would, you know, not solely because of this, but I don't know how much you know about my career, Chris, in 2015 and 2017 I made a series of BBC documentaries that have gone around the world to over 70 countries now and I would basically go and live alongside families who had been sick most of them had been under GPs or specialists. Most of them were on medications, but they were still struggling. And I would go in with TV cameras for four to six weeks and see if I could help them. And in every single case,

their conditions were either put into full remission or they were significantly better. And I didn't use a single drug. It was all done through small changes to their lifestyle. And there was one particular case, and I don't think this one's on YouTube anymore, unfortunately, but there was one particular lady who had been suffering with severe panic attacks and anxiety for years. And it was affecting how she felt about herself, her interactions with her family. She was a mother.

And, you know, we discussed various things. But one of the things she ended up doing, because she actually loved to cook, but she hadn't cooked in years. She was just self-medicating with alcohol all the time, frankly. And just about four to five weeks of a completely whole food diet. And I think at the time, I think I may have given her the Whole30 book, which is a kind of paleo type diet. She wanted to, and she was cooking some of the recipes from it. I'm not kidding you. Four to six weeks, 70 to 80% reduction in symptoms, right? 70 to 80%. That wasn't keto, right? It wasn't measuring ketones. It wasn't tracking anything. It was just simply, let's cut out all the takeaways,

all the highly processed foods. Yes, she had help and support because I was there. There was TV cameras there. So of course, I recognize that people can struggle to make these changes. They can be hard. They often need supports. Often their friends and their family and their work colleagues, maybe it's working against them because they've been exposed to foods that they're not wanting to consume, yet they can't resist. But nonetheless, to see that kind of dramatic improvement and that went out to five million people in the UK on television right and I was thinking this is great people are seeing just how powerful this is back in probably 2017 we're six years on now and I still do not believe from what I know talking to colleagues if someone is coming in with a mental health problem

to colleagues, if someone is coming in with a mental health problem to their healthcare professional, I think in the vast majority of cases, diet is not coming up, right? It's not being brought up. It's probably the same in America. And even, you know, let's rewind back to 2017. I'm sure you're very familiar with Professor Felice Jacker's SMILES trial, right? very familiar with Professor Felice Jacker's SMILES trial, right? Randomized control trial showing us that in this group, a small group, I think it was 67 patients from recollection, statistically significant changes for people who've already been diagnosed with moderate to severe depression by going on a modified Mediterranean diet. Absolutely remarkable. Mediterranean diets. Absolutely remarkable. Yet, this really speaks to your point, which is what drives you to keep trying to drive home this message, is that people are going to their healthcare professionals and they're still not hearing this information. Exactly. And I think

that the problem for me lies in that they hear it on a podcast or they read it in a book and then they go to their healthcare professional to validate the information. Hey, doc, listen, I heard this podcast last week, they were talking about diet and mental health and how it might be helpful. What do you think? Oh, no. And the healthcare professional will often say, and I understand it's from the training, it's how they've been taught. Oh no, diet's got nothing to do with it, right? I don't know what that was, but diet's got nothing to do with it. No, we'll work on your medications. We'll see if we can get you another referral or whatever it might be. And I'm not saying that with judgment. It's just so frustrating that people are suffering. How many Dorises are out there,

just so frustrating that people are suffering. How many Dorises are out there, right? How many Dorises are out there whose lives are being decimated by metabolic dysfunction and potentially maybe a diet not even as extreme as a ketogenic diet, maybe something easier to implement for people. What if that was to change things? And sometimes you don't need a complete revolution, do you, to the diet? And sometimes you don't need a complete revolution, do you, to the dot. Sometimes it's small tweaks that can make quite a big difference. So went on a bit of a rant there. I didn't mean to, but I like if you're very, very passionately about this, Chris. Yeah, no, I 100% agree. And I applaud all you do. And again, it's just heartbreaking to think that you have somebody who knows what you know, dedicate himself for four to six weeks to help someone improve their life and you can

transform their lives. Imagine if we had a whole healthcare system with teams of professionals doing that on a regular basis. We don't need to move into people's lives with TV cameras. We could have a dietician assigned to patients when appropriate. It doesn't have to all come from the physician. It can come from psychologists and therapists. It can come from health and wellness coaches. There are lots of professionals that we might, and these aren't lifelong treaters necessarily. Sometimes people only need three to six months or even one month to get started. They just need the education and the support. They need to change their habits, get in the rhythm, know how to do it themselves, and

then they can live happily ever after independently on their own. In the mental health field, this is particularly relevant because unlike other fields, we in the mental health field have hospital systems and residential treatment programs that keep people long-term. There is no reason why mental health patients many of them can't get exactly what you did in the BBC series they're living in group homes there's no reason why that group home staff

can't learn these tools and techniques and put everybody there on an appropriate diet and an appropriate movement plan or exercise routine. Let's get rid of the screens after 4 p.m. Let's make sure everybody gets to bed at a decent time, wakes up at a decent time. Let's get rid of the toxic substances like smoking and alcohol and marijuana and other things.

And instead of just housing them for life, maybe we actually help them recover and move out and live happily ever after. Now, will some of them relapse if they don't have that kind of support? Maybe. But some of them might not. Why not give them the chance? Why not give them the chance of recovery and remission and living a normal, healthy, productive life? I want to talk briefly just about ketosis and MCT oil and whether patients have to go or certain patients have to go into ketosis in order to heal. Before that, I just want to share a very quick story with you, which relates to what you just said. And I'm sharing it. I used to share it on the podcast because I wrote about it in my first

book, but I haven't shared it for a little while. But I just want to share it to show people that even small changes sometimes can make a big difference. Again, I called this patient in the book. I had permission to share the story, someone called Devin, who was 16 years old and had ended up in the ER at the weekend after harming themselves. And I was the GP. I saw the patient in the week with a letter from A&E or the ER explaining what happened and saying, could you start Devon on antidepressants and explain what had happened. And without going into the whole story, essentially, I was really confused because I thought I know this family pretty well over the years.

I never had detected anything. What on earth has gone on where this 16-year-old has ended up trying to harm themselves? And so I've been trying to figure out what was going on. First thing I identified was heavy, heavy social media use. And again, I explained to them that I thought this could be playing a role here. Would they be interested in me helping them change this? And this guy was desperate, right? He tried to harm us. I said, okay, sure. Do you think it'll make a difference? I said, look, I don't know, but I really think it could make a difference. And so over a period of four weeks, we got him to not be on his phone at all for social media or

anything for one hour before bed and for one hour in the morning. I gradually moved him up to that point. And little by little, he started to show signs of improvement. And then when I was asking about his diet, it was a classic teenager's high sugar, highly processed junk food diet. He was having sugary cereals in the morning. And it was really obvious that he was getting hungry a lot of the time. So I didn't know all the science that I now know. What I said to him was, look, you're getting hungry a lot. I understand because of how you're eating, every two hours when you're feeling hungry, it's not just a hunger problem. It's also a stress problem in the body.

Your sugars are going up. Two hours later, your sugars are crashing. That's releasing a cascade of stress hormones like cortisol, like adrenaline. That's also potentially impacting your mood. It's really what my diet might be impacting this. I say, hey, listen, I don't know 100%, but I've got a strong suspicion that it is. All I did with this ham, I didn't go all paleo. I didn't go all whole food. I just said, listen, instead of having sugary cereal in the morning, if you can have something, let's say eggs and avocado, right? Keep your blood sugar stable, maybe take some nuts around with you. I know there's issues now with schools and nut allergies. Okay, this is right. So just trying to caveat that, but this is what I said to him at the time,

right? When you're hungry, snack on that, that will keep your blood sugar stable. I am not kidding you, right? That completely transformed his life, those two things. That's all I did. Six months later, I got a letter from his mum because I hadn't seen him for a while saying, Dr. Chastity, you've completely changed his life. He's now happy. He's engaging with his friends. He's engaging with his communities. He's well, right? And I've done a quick summary version of that story Because I didn't change everything I changed two things And I think that everything I did with him Speaks to the theory you outline in Brain Energy

It all fits with that And I think one of the most important things Is also at the age of 16 Instead of labelling him And then for the rest of his life, he knows, oh, I have depression, right? I empowered him to help him realize, oh, wow, there are things in my life, there are things in my behaviors that are impacting my mental state. He may relapse again at some point. He may fall into old patterns, but he got a deep understanding at 16 that, oh, how I live my life absolutely

influences my mental state. So I hope you don't mind me sharing that story, but I think it really speaks to your work and also how simple it can be sometimes. Absolutely. No, thank you for sharing the story. And actually, you know, stories like that are the thing that have empowered me to keep going because you already figured that out with him. You may or may not have understood fully like what is causing the depression in his brain

exactly at the cellular level, at the serotonin level or norepinephrine level or whatever, like what exactly is causing it and will this really work? But you did two simple interventions And they helped and transformed his life. And I come at it again as an academic psychiatrist saying, I've been studying and just immersed in the neuroscience literature, trying to understand what causes depression in kids like that? What causes suicidality? How can we understand it? How can we better intervene? What pills should we use? What psychotherapy should we use? Right now, the mental health field would largely ignore your story. And they would say,

that's one anecdote. And who knows why he got better? Lucky him. But we deal with real depression. Dr. Chatterjee, we deal with real depression and we need powerful serotonergic medications or mood-stabilizing medications or psychotherapies. Those are evidence-based treatments. And what I'm hoping to do with my work is bridge those two fields to say, wake up, traditional academic mental health neuroscientist professionals. Wake up.

Look at the evidence. Look at the detailed evidence at the cellular level. Look at the detailed evidence at the cellular level and you can understand why a change in diet and a change in social media use and improvement in sleep. I'm guessing improvement in sleep. Why those things could put into remission a horrible case of major depressive disorder with suicidality. So that's a really serious disorder. And you put it into remission. And he kind of sort of lived happily ever after, at least in the follow-up time that you got. Yeah. And the thing is, look, does that happen every time? No. But did it happen that time? Yeah. Right. And does it happen every time? No. And then we need to be looking for other causes.

We need to be looking for, okay, if we start with the framework that this is a metabolic problem in the person's brain. So again, we're excluding this kid as being bullied and teased, or this kid is madly in love with somebody who's not reciprocating his love. Because, you know, Romeo and Juliet, that's a classic, everybody. That is not a brain disorder. It is not a brain disorder if you're madly in love with somebody and they don't like you back. It is normal to be depressed. And the treatment for that might be psychotherapy. The treatment for that may just be friends and family helping you through that crisis in life. So I'm not saying those people have metabolic disorders

of their brain. I think they're just normal human beings going through normal human suffering. They're just normal human beings going through normal human suffering. But if we really think it's a metabolic problem, and diet and cell phone use and sleep don't do it, I'm going to be looking for, are you using substances? Are you smoking marijuana? Are you using alcohol? Are you taking any prescription meds that might be harming your metabolism?

Do you have an infection or do you have signs of chronic inflammation? Do you have an allergy? Do you have gut problems? If you have gut symptoms and maybe there's something going on in your gut, you've got inflammation there, maybe that needs to be addressed. Maybe you're allergic to certain foods. So there are lots of things that we can try, but it's not rocket science. It's not rocket science. Not to say that everybody should be able to heal themselves without the help of a medical professional, because I think sometimes it is complicated. Yeah, yeah, for sure. And sometimes medical professionals do need to be helpful

and help you think through all of the different complicated things that could be going on. But to medical professionals, this shouldn't be rocket science. This is what we're trained in and we can do this. Yeah. And I just want to make clear, like none of us are saying that, oh, just do one, two, three things with your lifestyle. Suddenly you have no mental illness anymore. And none of us are trying to say that. I think we're just trying to broaden the conversation and say these things all need to be looked at as part of the treatment strategy, right? We shouldn't just be looking at one area. We should be looking in all these areas and seeing what we can influence and manipulate. I just want to very quickly, if we can, just finish off on that thought about diet, MCT oil, and keto.

And the reason I'm bringing it, I think the take-home message to people is, with respect to diet, is as you mentioned, let's try and cut out the sugars and go to whole foods and see what happens, right? Obviously, that patient, Doris, went on a ketogenic diet. Now, of course, we don't know what might have happened had she just done a whole food diet rather than a keto diet, but there is quite a bit of research on ketogenic diets. In your experience, do some people with certain problems need to go those few steps further beyond just whole foods and actually drastically cut out carbohydrates to help encourage ketosis, maybe take MCT oil and things like that. Just help us understand at the end here, Chris, if you can, is that sometimes

needed in your experience? It is. So the easiest place to start is just with what we know in epilepsy because we have a robust literature and I am a mental health professional. I'm not an epilepsy specialist. So some might say, why are you talking about epilepsy? The reality is we use epilepsy treatments in psychiatry all the time.

And there's a lot of overlap between the basic pathophysiology. So when researchers scan the brains of people with epilepsy, they're very, very similar to the brains of people with mental disorders. People with epilepsy also have much higher rates of mental disorders broadly across the whole board. Schizophrenia, bipolar disorder, depression, anxiety, suicidality, all of it. So what we know from the epilepsy literature is the Mediterranean diet does not stop seizures. It doesn't. So there is something unique and special about carbohydrate restriction. The two evidence-based treatments for

epilepsy are the ketogenic diet, and there are a lot of different versions of it. You can supplement with MCT oil. You can do different ratios. Again, you can do vegan, vegetarian, omnivore, carnivore, lots of different versions of these diets, Or a low glycemic index diet. So low glycemic index diet is a more whole foods diet, but you're getting rid of pretty much grains and sugars. And you're getting rid of a lot of high glycemic index fruit. So you're probably not eating bananas or pineapple.

And that works for epilepsy. And that works for epilepsy. And that works for epilepsy. It does not appear to work as well as the ketogenic diet, but for some people it works and that's all they need. And it's easier to do than the ketogenic diet. So it's a kind of a form of a low carb diet that's working. And sometimes it's not enough and they have to go full keto. Much easier. And exactly like the patient that you described, the young man, I've had people where all I did was remove sugar from the diet,

and that was enough, or remove processed foods, and that was enough. But for patients with epilepsy, which is a very serious brain disorder with very serious, sometimes life-threatening symptoms, the two evidence-based treatments are low glycemic index diet and ketogenic diet. I have reason to believe that that probably is also going to apply to people with bipolar disorder and schizophrenia. I see their disorders as a more serious metabolic brain disorder than somebody with mild anxiety or somebody with even depression. And for those

patients then, if you feel that they need a full-on ketogenic diet, do you measure ketones? I do. How do you do that? So if it's at all possible, and some patients just can't afford it, but if it's at all possible, I measure blood ketones using a blood ketone monitor. So that's just like a glucose meter for people with diabetes. They prick their finger, they get a little drop of blood, and they measure it. They prick their finger, they get a little drop of blood, and they measure it. If people can't afford that, you can do urine ketone strips, but I definitely strongly recommend testing for ketones one way or another.

And what level do you want? If I'm treating somebody with bipolar disorder or schizophrenia, I'm typically looking for ketones greater than one at a minimum, ideally greater than 1.5. In the blood. So in the blood. My ideal is 1.5 to 3 in a blood meter for beta-hydroxybutyrate. And the reality is I've had a lot of patients who actually do amazingly well when they have their ketones at like 1.7 to 2 or 3 and when they drop down to 0.6 for instance

which is still ketosis but just a much lower level their psychotic symptoms or their bipolar symptoms might start to come back. So you can actually see a correlation between symptoms in these patients and their ketone level? On individual patients, yes. Across studies, so like in the epilepsy literature, neurologists have actually been studying this for decades, trying to see, is there a clear correlation? Should we be prescribing a certain ketone level for everyone? And they don't see that pattern across patients. So it's bio-individual is what we're saying, is that for

some patients, some patients might get a robust clinical response at a ketone level of 0.5. And they may say, I'm in remission. And if they do, I'm going to say, great, keep doing what you're doing. And we're good. But if they get to 0.5 and they say, my hallucinations are still prominent or I'm still having depressive symptoms or suicidal symptoms, I'm going to push the envelope. I'm going to try to get them to a higher level of ketosis

by modifying the diet. The modifications are usually to add more fat, maybe in the form of MCT oil, and or further restrict carbohydrates and or protein. So it gets complicated quickly. This is something that I do not recommend people do on their own. If you're trying to treat epilepsy, please don't do that on your own. And if you're trying to treat schizophrenia and bipolar disorder with a medical ketogenic diet, I actually routinely

say, please don't do it on your own. You deserve competent medical Yeah. And a physician or a dietician or other trained healthcare professional, there are lots of professionals who really know how to do this and they can help you and they can help monitor your symptoms for your serious brain disorder and help you hopefully get a recovery.

Chris, it's just amazing hearing all this information. The book is just fantastic. And I think for anyone who wants to learn more, there's a lot of science and there's a lot of research. There's a lot in there that will help people. Any psychiatrist or professional who is looking after people with mental health problems, I think would absolutely benefit from understanding that. Patients, people with mental health problems, I think would absolutely benefit from understanding that. Patience, of course, as well. And I think, Chris, we've opened up so many doors during this conversation. I don't think we've closed them all. So hopefully that means that I might be

able to tempt you for a part two at some point in the future to continue discussing this. Just to finish off, Chris, for someone who's feeling inspired by what you've said, by your work, but feels, I don't know where to start, what would you say to them? I don't mean to try to sell the book at all, but I do want people to understand the big picture and all of the different factors that can play a role. Because it's not just diet. It's diet and sleep and exercise and substance use and toxin exposure and other things. So I want people to understand that big picture if you can. People can go to a website, brainenergy.com.

We're developing, I've got a team of volunteers right now. We're just trying to develop some articles and give resources because we are hearing from literally thousands of people around the world who want more. We've got a self-assessment that people can do for free where I walk people through some of the biomarkers or some of the symptoms that you should be on alert for. you know, my hormones are off balance and I should talk to my doctor about getting tested or, you know, maybe, you know, getting hormone replacement therapy if appropriate or indicated. So website, I think if people follow us on the website and or follow on social media, a lot of the people following me on social media

are doing these treatments. And they are there and ready to help reach out. Like I see this happening all the time. Like I cannot give medical advice on Twitter. You can't, we physicians cannot give medical advice, but you'll find lots of peers on Twitter. You can't, we physicians cannot give medical advice, but you'll find lots of peers on Twitter and other social media channels who will give you their advice. Take it with a grain of salt because they're not medical professionals, but you should not have to be alone in this fight. If you are fighting for a recovery

from a serious mental illness, you can get a lot of support from people. And yeah. Yeah. Well, Chris, I think you are tirelessly doing incredible work. You're giving so many people across the world hope that's coming on the show. Thank you for having me on the show. Thanks so much. Thank you for having me on the show. Thanks so much. Really hope you enjoyed that conversation. Do think about one thing that you can take away and apply into your own life.

And also have a think about one thing from this conversation that you can teach to somebody else. Remember when you teach someone, it not only helps them, it also helps you learn and retain the information. Now, before you teach someone, it not only helps them, it also helps you learn and retain the information. Now, before you go, just wanted to let you know about Friday Five. It's my free weekly email containing five simple ideas to improve your health and happiness. In that email,

I share exclusive insights that I do not share anywhere else, including health advice, how to manage your time better, interesting articles or videos that I'd be consuming, and quotes that have caused me to stop and reflect. And I have to say, in a world of endless emails, it really is delightful that many of you tell me it is one of the only weekly emails that you actively look forward to receiving. So if that sounds like something you would like to receive each and every Friday, you can sign up for free at drchatterjee.com forward slash Friday Five. Now, if you are new to my podcast, you may be interested to know that I have written five books that have been bestsellers all over the world, covering all kinds of different topics, happiness, food, stress, sleep, behavior change and movement, weight loss, and so much more. So please do take a moment to

check them out. They are all available as paperbacks, eBooks, and as audio books, which I am narrating. If you enjoyed today's episode, it is always appreciated if you can take a moment to share the podcast with your friends and family or leave a review on Apple Podcasts. Thank you so much for listening. Have a wonderful week and always remember, you are the architect of your own health. Making lifestyle changes always worth it because when you feel better, you live more.