The Dr. Hyman Show - How Does Ultra-Processed Food Affect Our Mental Health? with Dr. Shebani Sethi

Episode Date: September 30, 2020

How Does Ultra-Processed Food Affect Our Mental Health? | This episode is brought to you by Thrive Market, Bioptimizers, and the Pegan Shake Currently, one in five Americans live with a mental illness, and these rates have been tracking alongside increases in metabolic disease. Yet, conventional psychiatric care does not typically include discussion of food or an assessment of metabolic dysfunction, obesity, or insulin resistance in the evaluation or treatment of mental health conditions. On this episode of The Doctor’s Farmacy, I was happy to sit down and talk with Dr. Shebani Sethi about the relationship between mental health and metabolic disease, and how we are gradually coming to understand that inflammation, oxidative stress, and insulin resistance may represent important root causes of many chronic brain illnesses, including many psychiatric disorders.  Dr. Shebani Sethi is a double board-certified physician in Obesity Medicine and Psychiatry. She is the Founding Director of Stanford University's Metabolic Psychiatry program and Silicon Valley Metabolic Psychiatry, a new center in the San Francisco Bay Area focused on optimizing brain health by integrating low carb nutrition, comprehensive psychiatric care, and treatment of obesity with associated metabolic disease.  This episode is brought to you by Thrive Market, Bioptimizers, and the Pegan Shake. Right now, Thrive is offering all Doctor's Farmacy listeners an amazing deal. Select a free gift from Thrive Market when you sign up for a 1 year membership. And, any time you spend more than $49 you’ll get free carbon-neutral shipping. Just head over to thrivemarket.com/Hyman.  My new favorite magnesium is from a company called Bioptimizers—their Magnesium Breakthrough formula contains 7 different forms which all have different functions in the body. There is truly nothing like it on the market. Right now you can try Bioptimizers Magnesium Breakthrough for 10% off, just go to bioptimizers.com/hyman and use the code HYMAN10 at checkout. The Pegan Shake features a combination of collagen, pumpkin, and pea protein with healthy fats from my two favorites: MCT oil which is great for fat burning and brain power as well as avocado oil. I’ve also included acacia fiber to help with gut motility and digestion. Check it out at getfarmacy.com/peganshake. Here are more of the details from our interview:  How Dr. Sethi Dalai came to study and understand the need for metabolic psychiatry (7:02) The connection between mental health and inflammation, and how ultra-processed food affects the brain (11:44) Rising rates of binge eating, obesity, and addictive eating are coinciding with the rise of ultra-processed foods (15:29) How diet drives hormonal responses in the brain (22:21) Targeting inflammation to treat mental illness (31:02) Dr. Sethi Dalai’s experience treating eating disorders, infertility, schizoaffective disorder, and more with diet (35:15) Treating psychiatric issues using the ketogenic diet (47:59) Why American’s metabolic health is particularly problematic when it comes to COVID-19, and how to protect yourself (56:22) The influence of diet on attention deficit disorder (ADD) and autism (1:01:15) The prevalence of undiagnosed insulin resistance and how to test for it (1:07:34) Learn more about Dr. Shebani Sethi, metabolic dysfunction and mental health, and the free online resource her group is creating at metabolicpsychiatry.com. Follow Dr. Sethi Dalai on Twitter @ShebaniMD. Join the Metabolic Psychiatry group on Facebook at https://www.facebook.com/groups/MetabolicPsychiatry.

Coming up on this episode of The Doctor's Pharmacy. So the rates of obesity and binge eating and addictive-like eating are rising alongside the increasing dominance of ultra-processed foods in the modern food environment. And there are several mechanisms as to how this works. Hey everyone, it's Dr. Hyman. Supplements are one of those things that I'm always being asked about. Is it worth spending money on them? Do we need them if we really eat well? And can your body even absorb them? And the answer to most of these questions is, it depends. There are definitely

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let's get back to this week's episode. Welcome to the doctor's pharmacy. I'm Dr. Mark Hyman, and that's Pharmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. And if you've struggled with mental illness and are looking for some new insights about why we struggle as a society and individuals with this overwhelming burden of depression, anxiety, and more, then this conversation is going to matter to you because it's with an extraordinary physician, Dr. Shabani Sethi Dalai, who's a Stanford and Duke-trained double board certified physician in obesity medicine and psychiatry. So just stop and think about that for a minute. Obesity medicine and psychiatry, they don't seem connected, but you're going to find out exactly how they are connected. She's the founding director of the Stanford University's Metabolic Psychiatry Program

and the Silicon Valley Metabolic Psychiatry Program, a new center in San Francisco Bay Area focusing on optimizing brain health by integrating low-carb nutrition, and we're going to talk about that, comprehensive psychiatric care, and treatment of obesity associated with metabolic disease. She's just an extraordinary physician. She's been, I think, leading the way in redefining what psychiatry is because for so long we've created this stigma of mental illness as sort of a problem that is an emotional problem, but it might be in many cases a biological problem, and it might be related to what we're eating. So I really want to welcome you,

Shabani, to the podcast, and thank you so much for joining us today. Thank you very much for having me, Dr. Hyman. So you have kind of an interesting background. You have, you know, trained at the best institutions in the world, and you have somehow come to the conclusion that our psychiatric problems may be related to metabolic issues. And you coined this term metabolic psychiatry, which really, when I first saw that, I was so excited because I wrote this book 12 years ago called The Ultra Mind Solution about how the body affects the mind. We know about the mind-body effect,

but nobody really talks about the body-mind effect. And most psychiatrists think about the brain as sort of disconnected from the rest of the body, and you treat the brain, but what about what's going on south of the neck? It doesn't get much attention. And you've really taken a very different approach. So why don't you tell us, how did you come to this idea that we should be treating psychiatric issues with nutrition and through metabolic approaches? Yeah, that's a great question. So early on, I knew I wanted to do medicine. And when I went into medicine, I saw that there were a lot of conditions that weren't necessarily addressed with nutrition.

And there was a lack of training in the medical education system with obesity as well as nutrition. And with psychiatric conditions, I saw a lot of overlap with nutritional deficiencies and insulin resistance and even higher rates in that population versus the general population. And we know in the general population, it's even, it's pretty, pretty bad already in our country. So the relationship between mental health and metabolic disease is, is bidirectional, which means if you have a mental illness, you're more likely to have metabolic disease and vice versa. And if you have a metabolic disease, you're more likely to have metabolic disease and vice versa. And if you have a metabolic disease, you're more likely to develop a mental illness. You're more likely

to have a heart attack, for example, if you have depression, and you're more likely to develop depression after you have a heart attack. So these observations that I made really put questions in my mind as to there must be something more to what we're doing that needs further investigation. And I believe that there are metabolic issues that are not necessarily addressed within the field that I think needs to start occurring. We need to start including that in the way that we diagnose and treat and evaluate disease. Yeah. I was thinking you were talking earlier about this idea of comorbidities, which is a term we use in medicine to describe diseases that occur in the same

patient. So if you have high blood pressure, diabetes, depression, reflux, we call these comorbidities. But we were talking earlier about how they may not really be unrelated, that in fact, they may be very connected. And it sounds like from your observations, you made the conclusion that maybe it wasn't a coincidence, that the fact that people who were overweight or unhealthy also had mental health issues, maybe there was a relationship, nutritional deficiencies, metabolic issues. You talk a lot about insulin resistance. So how did you come to sort of understand that that was really going on, that the biology of that was something that was real? So I originally started off with an interest in learning about nutrition and metabolic issues

in obesity. And I wanted to treat obesity. And then I saw that in a lot of the patients, there were psychiatric conditions in those patients. So I started to veer into the realm of psychiatry and got very interested in that. So what happened was that when I was treating metabolic dysfunction, not necessarily obesity, but metabolic dysfunction, which is problems with blood sugar or insulin resistance or high blood cholesterol, I saw improvements in quality of life, in mood, in anxiety symptoms, in psychiatric symptoms, essentially. And that really got me interested in what is this relationship? Why is this occurring? And got me interested in treating these patients in a slightly different way than standard of care, really integrating the understanding of

what metabolic dysfunction is. And I then started a clinic and I started to do research. And that's how my path started. And I started early on developing this clinic in residency training. Which is incredible because when you look at the level of mental illness in society, it's one of the biggest causes of disability. And one of the biggest costs is depression and anxiety. And I remember when I was seeing patients early on, treating them for insulin resistance and prediabetes and other issues or gut issues or other factors that were going on related to autoimmune disease or inflammation, and we would get them healthy, they would sort of

say, wait, you know, my depression went away. My anxiety went away. My panic attacks are gone. My bipolar disease is better. My ADD is better. And I'm like, well, how did that happen? And then you begin to go down the rabbit hole and you begin to look at the biology of what's happening. And one of the, I think the greatest discoveries around mental health is that it's an inflammatory problem very often, that the brain is inflamed, but the brain can't say, ouch, like you have a sore throat or a swollen ankle. It manifests as all these psychiatric symptoms. So I'd love it if you sort of take us down the road of how inflammation is connected to mental illness and what the approaches that you're using to help

correct that. Sure. So that's, you know, quite an important question. And, you know, when we talk about how nutrition affects the brain and specifically focusing on reducing that sugar and processed foods and refined carbohydrates to improve mental and physical health, we know that consuming excessive amounts of sugar, processed foods, and refined carbohydrates lead to obesity, metabolic problems, fatty liver, heart disease, even cancer. There is evidence for this. And the body is really one whole system. And what happens in the body also affects the brain. The brain has a delicate balance of neurotransmitters or chemical messengers with more sugar and processed foods. These levels really become unbalanced and they're significantly off. So I'm talking about- So wait, wait. So your brain chemistry gets screwed up when you eat processed food and sugar, is what

you're saying? Yeah. Yeah. And I'm talking about ultra processed food also in particular, because I do think that there's a difference between processed food and ultra processed food. Ultra processed food is like the real sugar, the cookies, the cakes, the chips, the potato chips. It's kind of highly processed things versus minimally processed foods, maybe some oils, vegetables that are frozen. That's a little bit different than ultra-processed

food. And so the research is showing differences between those things in the brain yeah and you need the right raw ingredients for chemical reactions to occur in the brain and elsewhere like vitamins and minerals and nutrients you need proper functioning you know of the brain you need proper speed of transmitting signals your brain is composed of electrical cells, and it's a complicated web of signaling molecules. Those cells need fat to develop and to function properly, so you need those omega-3s in your diet.

And if you eat sugar and ultra-processed foods, the chances are that you're likely not getting those important nutrients, those vitamins and minerals, for those important are that you're likely not getting those important nutrients, those vitamins and minerals for those important reactions that you need, nor are you absorbing them. The most people with metabolic dysfunction actually have nutritional deficiencies and are malnourished. So you're saying it's people who are overweight and obese often are very malnourished and vitamin and nutrient deficient. Yes, that's right.

That's sort of a paradox, right? Right, right. They're eating all this food. Why are they nutritionally deficient? But they're actually among the most malnourished. They are, unfortunately. They're looking in all the wrong places for the nutrients. They eat more and more food.

I think a study from Kevin Hall and others showed that if you let people eat as much as they want and you give them ultra-processed food versus whole foods, they'll eat about 500 calories more a day of ultra-processed food because they'll keep eating and they're hungry and they keep driving. And you talk a lot about that in your work, about the biology of what these do to your brain in terms of dopamine and the addiction reward pathways in the brain that make you literally become addicted to these compounds and how that affects you. Right. So the rates of obesity and binge eating and addictive like eating are rising alongside the increasing dominance of ultra processed foods in the modern food environment. And there are several mechanisms as to how this works some which act directly on the brain and some that indirectly act through hormonal signaling so our body is very complicated and the brain is connected

to the body and we used to learn in medical school that you have this blood brain barrier that you get across it but that not, it's like the Berlin Wall. But in reality, it does leak, right? And there are things that do cross. It's more like a coffee filter, you know, it's a sip. Right. Yeah, so ultra-processed food and sugar decrease our dopamine receptors and make us eat more compulsively. Much like addictive drugs, the highly processed foods, they trigger dopamine reward pathways and they invoke addictive-like behaviors, which have been well documented and include intense cravings, includes feelings of withdrawal when cutting down on ultra-processed food, continuing to eat these things despite knowing the adverse consequences to it,

and repeated attempts to try to quit. I'm describing addiction here, basically, and the consumption of larger quantities over time than intended. People go, it's like emotional eating. It's not really biological, it's true addiction. What you're saying is this is really a true biological addiction, just like heroin or cocaine or alcohol, that you get withdrawal, you get cravings, you get increased need for more and more of the substance

to receive the same pleasure. You downregulate the receptors for pleasure, so you have to take more of the stuff to actually stimulate that reward pathway. And it's really this vicious cycle that people get into, and then they blame themselves and they feel guilty, you know, for doing it. And they think they just have no willpower, but you're saying it's much bigger than that. Yeah, that's exactly right. It's so sugar is an addictive substance. It's not just something we say it has a straightforward neurochemical basis

in the brain, just like any other drug. And I think of sugar as a, it's a recreational food. It's not a food that's essential for survival. We make sugar, you know, through the process of gluconeogenesis, through other foods that we consume. And so it's really about excess carbohydrates. It's not- I call it sugar a recreational drug. I've never heard anybody say it, but I always write down in my book, sugar is a recreational drug. It's like if you like tequila, it's fine, but not breakfast, lunch, and dinner

in the quantities we're having in America. Exactly. Yeah. And we also, actually, I would like to share a story about this. Just during the era of COVID, since we're in it, just to give context as to why I wrote about this and why I'm working on this as well and continuing to feel motivated to continue to do my work,

is the shelter-in-place order had come a couple of months back for my county, and I'm in California. I live in Menlo Park. When it was announced, my husband, he's an infectious disease physician at Stanford, and I'm a psychiatrist and a medicine physician, as you mentioned. We both felt doubly invested in this pandemic. We went to our neighborhood Safeway grocery store, and we saw many people loading up their carts with Pop-Tarts, Hawaiian Punch, popcorn, anything ultra processed, basically. And they weren't loading up their carts with fresh vegetables or, you know, they were out of cookies at the grocery store. Yeah. Cookies and toilet paper. And toilet paper, exactly. And there were still, you know, produce left in the store.

You know, it wasn't like they ran out of produce. No. So here I was. It wasn't a run on broccoli. No. Here I was at the checkout counter, and I was thinking to myself, you know, staring at the person's car in front of me that is full of the recreational food, as I mentioned, and the food that's not necessary for survival and detrimental to our health, I thought to myself, this is certainly not preparing them for the pandemic

or helping their immune system and, if anything, weakening it. And this is our local Safeway. This is the heart of Silicon Valley. So in this context, it wasn't about affordability or access. That is what motivated me to kind of get that public message out on this topic. Yeah, you did write a great article on The Hill, and I read it, and you really talked about the way in which the pandemic we're facing is much more serious because of the underlying chronic disease pandemic we have in our society, where it's driven by this

ultra-processed food that makes us overweight and sick and causes all these underlying chronic inflammatory issues like diabetes and heart disease and high blood pressure, which are really the same mechanisms. If you look at the mechanisms of high blood pressure, heart disease, and diabetes, it's insulin resistance, it's oxidative stress, it's inflammation, and it's the same thing that's affecting our psychiatric illnesses, which is so fascinating. And most people don't think about using the doorway of food to help treat the brain. And you're doing that in your research and in your practice. So tell us some of the kinds of things you're seeing in your patients using this approach, because it's pretty radical. You're going all the way

sometimes to ketogenic diets with these patients with bipolar disease, schizophrenia, depression. It's fascinating. Yes. What I have noticed is that a lot of my patients that come for psychiatric treatment and evaluation, a lot of them have prediabetes and diabetes. And when I look up the statistics on this in our country, 44% of adults today in our country are either pre-diabetic or they have diabetes. And I wonder to myself, what is that doing to our brain? We know that affects all these different organ systems, the liver, the pancreas,as the heart but what is that doing to the brain right and so uh i'm happy to talk more about my research and patient care um but one thing that i that i felt i didn't completely answer uh before was kind of how these hormones affect the brain with the addictive how does it drive inflammation and all that?

Yeah. Yeah. So kind of going back to that, you know, so I was talking about the definition of addiction and we know that hormones like insulin and leptin, which is the hormone that tells us we're full, it sends a signal to our brain, and ghrelin that tells us that we're hungry. These hormones modify natural and drug reward pathways in the brain. I mean, they have so many effects on the brain. Our hunger hormones go awry and it can actually increase the reactivity itself of the dopamine system. And so this happens when we consume that excess sugar and the excess carbohydrates in our diet. And they cause these rapid shifts in blood glucose

and insulin levels, similar to other addictive substances. So my approach in patient care has been to work on this system to decrease these shifts that occur in our blood sugar and our hormone levels to kind of go back to the homeostatic state that our body and our brains were meant to be in. And so I treat the metabolic dysfunction and I look at how that improves both metabolic issues as well as psychiatric outcomes. Yeah. So it's fascinating. So you're basically, you're treating the body to fix the brain, right? You're dealing with these physiologic changes that have to do with our diet and nutritional psychiatry that most psychiatrists aren't thinking about. I mean, most psychiatrists are thinking about, you know, psycho-emotional issues,

they're thinking about medication and prescribing antidepressants, but they don't really work as well. And I, you know, I just found that the amount of benefit you get by addressing these underlying factors is so much greater than you get with medication, which are marginally effective for most people. I think, you know, unless you have really severe depression, but I think the data is just not that exciting about these drugs, right? I mean, they can be helpful for people and they can be lifesaving, but there are also other doorways that you're exploring, which seem to be way more fruitful. Is that your experience? So, you know, the field has come, you know, a long way.

There's a lot of research that's been done on the biological piece and neuroscience and looking at, you know, obviously the serotonin hypothesis, but that's a hypothesis and an observation from like 30 years ago. And all of these research and money has been thrown on developing drugs, but we're not necessarily addressing some of the root causes of, of why are these chemicals imbalanced? And so that's an important question that I and others are trying to study

through research studies and clinical trials. And like you said, we know that although our medications are necessary and life-saving for many, they have undesirable side effects that can worsen metabolic health. And while it's helping in one domain, it may in some people also be hindering improvement in psychiatric symptoms, especially if the metabolic health is poor. So psychiatric treatment is never going to be a one-size-fits-all approach. Mental health conditions are varied. They're heterogeneous,

and they have different phenotypes or presentations. We don't have a single mutation or a gene that we can point to or a lesion. There's no no smoking gun it's a complex relationship of multiple genes and environment and unfortunately a metabolic assessment is not part of that routine care and stigma certainly plays a role in this obesity stigmatized and so is mental health education about nutrition metabolism is lacking in medical education. Most psychiatrists recognize this relationship. They do? They understand the connection between food and mood?

They're starting to. They understand that there are side effects with psychotropic medications. I think they don't necessarily have the expertise to treat it or address it. They don't know necessarily what to do about it. But most psychiatrists that I speak with, and my department certainly has been very supportive of this idea, and someone has to do the research and someone has to do the work to kind of move the field forward. And there is a growing body of other researchers working on this. And we hope, you know, that evidence-based research has to be done to kind of change the mainstream standard of care. Yeah, no, I mean,

you were talking about metabolic psychiatry. I was also noticing that Harvard had a whole department of nutritional psychiatry, which is, you know, seems like bookends on the country. I don't know the rest of the psychiatric world is thinking about this. But you mentioned earlier that you work with Bruce Ames, who's an incredible biochemist and nutritional scientist from California, one of the most published sort of scientists in the world. And I spent a lot of time with him. And he talks about this whole idea of a metabolic tune-up and that so many of our biochemical

reactions are regulated by vitamins and minerals and that so many of our biochemical reactions are regulated by vitamins and minerals and that each of us have different needs for different components of those vitamins and minerals. I remember one guy, I was sitting in my office one day working on something. I was thinking I might have been working on that book and I was talking to somebody about folate and B12 and B6. He said, oh yeah, I had really bad depression and I took some of these B vitamins and I just went away. And I think, you know, there are some people who have a higher need for, for example, folate or B6 or B12 based on these genetic variations that Bruce Ames talks about that really are so prevalent. In fact, one third of our entire genome codes for enzymes and

those enzymes all need helpers, which are vitamins and minerals. And we don't really pay much attention to that. So when I look at depression or psychiatric illness, you know, I see so many different things that are going on there, whether it's insulin resistance and prediabetes or vitamin D deficiency or folate insufficiency or zinc or magnesium, all these various nutrients play a role in brain function. And they're not something we really learn about when we learn about psychiatry, right? Is that changing? I think that is changing. There's a complex relationship between metabolic dysfunction and nutrition, food, mental health. And I want to start off

by saying that the idea of food as medicine is not a new concept in the field of nutritional psychiatry has really grown over the past few decades by several prominent psychiatrists and researchers. However, the focus has largely been looking at specific foods or supplements, eliminating certain things from the diet, the microbiome, you know, or looking at the Mediterranean diet, for example, affecting depression symptoms. And these are all very important questions, but what I thought was missing and why I named our clinic and our group's work metabolic psychiatry is to distinguish that this is a study of how treatment of metabolic dysfunction can affect psychiatric symptoms. Yeah.

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Shake. This shake is designed to support your blood sugar and keep you feeling full and satisfied while giving your body the best information and nutrients to thrive. I know you're going to love it as much as I do. Check out the PeeGan Shake at getpharmacy.com forward slash PeeGan Shake. That's Get Pharmacy with an F, F-A-R-M-A-C-Y forward slash PeeGan Shake. Now let's get back to this week's episode of The Doctor's Pharmacy. If a majority of us are suffering from obesity, type 2 diabetes, insulin resistance, metabolic syndrome, what is that doing to our brain? We know that these diseases affect multiple things. Mental illness rates have increased over the past 20 years, in fact, doubled. We know that mental illness like depression, bipolar disorder, psychosis, they're strongly associated with

inflammation. That research is really indisputable. And research is also showing that there's an energy deficit in these brain illnesses and the mitochondria, the energy powerhouses of our cells are not functioning optimally, causing changes in brain signaling itself. And the thought is, if we can target inflammation, insulin resistance, the abnormal blood sugar, et cetera, as a method to improve mental health symptoms, then we can really improve our patients' lives further. And again, mental illness has many different causes, but even if we, you know, can 5 5 to 10% of people have an improvement in these symptoms with this method, then I think that would be a pretty

significant improvement of the overall mental and physical health of our country. I think it's a lot more than 5 to 10%. I mean, when you think about that, the most amazing thing you just said to me is such a paradigm shift, which is that depression is inflammation in the brain. And that when you look at autopsy studies and when you look at the biology of this disease, the brain's on fire. And it's also on fire in autism, in Alzheimer's, in schizophrenia, and a lot of these disorders that we think of as mental disorders, but are actually brain disorders that are manifestations of inflammation that show up differently in different people. And the question is, what's driving that inflammation? And I think diet clearly is probably the biggest factor, which makes it an incredible thing to use to actually alter the course of these diseases because it's an easy tool to change

and actually get a result. And that's what you're talking about, your therapeutic use of, you know, metabolic medicine to actually fix psychiatric problems, which is pretty amazing. Yeah. And I'm glad that you bring that up because I do want to clarify that with inflammation, it's not a complete clear picture. We know that there's inflammation, but there have been studies showing that treatment with anti-inflammatories, for example, in patients that have inflammation, but not necessarily depression, can actually cause depression symptoms. So that's kind of a little bit of a paradox, right? Do you mean like Advil or do you mean like the interferon, the treatments for MS or?

Yeah, I think it was interferon. I'd have to look back at the studies, but there have been studies that have shown differences, you know, generally with some of the psychiatric symptoms when you're trying to combat inflammation or reduce it. But in people that have metabolic dysfunction, I think it's a different story. And that's what I'm trying to study further. So we have to be careful and cautious also, because otherwise we do a little bit of guesswork if we're not looking at it carefully. You've got the microbiome. People are talking about antibiotics causing depression because it destroys the microbiome. And then the microbiome

is another huge source of inflammation. So you're talking about diet and you've got the gut microbiome and you've got environmental toxins and nutritional deficiencies. And all these factors are affecting our brains in ways that we actually have a doorway to fix. And I'm so excited that, you know,

at Stanford and places like Harvard, they're actually looking at these issues now because we do have a pandemic of mental illness. And it occurred to me when you're talking that, you know, as we've seen this rise in mental illness, it's the same curve as obesity and diabetes, right? It's the same curve. Maybe they're related. Yeah. And I think that's what is interesting about that. And even with eating disorders, we were seeing more in that population too. And you mentioned something about, you mentioned about patients and how they've benefited. And what I'd like to share is that some of my patients with eating disorders, for example, which traditionally you don't want them to go on a diet, right? You want to prevent them from exacerbating their condition with binge eating,

for example. But what I'm finding is that if you tell them not to be afraid of the fat, for example, if they increase the fat in their diet, that's improving their binge eating. They're reducing their binge eating. And all the studies with diet in the past have been like low calorie diets. It hasn't been looking at and low fat, right? And not the quality of the diet itself. So that's another interesting area of study, which I'd like to pursue. You know, I had a patient who couldn't get pregnant for years, had a history of bulimia, and I found that she was iron deficient and insulin resistant. And once we treated that, she was able to get pregnant,

and she cried in my office with a joyous outcome. Another patient who was an athlete suffered from anorexia nervosa and hadn't had period in months. And I emphasize the fat and the brain needs the fat. And when she increased her saturated fat intake, hadn't had period in months and I emphasize the fat and the brain needs the fat. And when she increased her saturated fat intake, you know, I don't tell you to decrease saturated fat. So her symptoms significantly improved and her menstruation returned. And so there are a lot of things with diet that we can do to significantly improve patients' outcomes. And two additional patients I'll just briefly mention, while I was in my training, they had schizoaffective disorder,

and they went completely off just ultra-processed foods. That's like schizophrenia, right? I mean, that's more like where they have psychotic behavior, which you think of as not really an emotional issue, but really a more structural brain problem, but you're seeing that changes with that. Hallucinations, specifically, these patients had anterior hallucinations. And hear voices. Yeah. And with schizoaffective, they also had the mood component with rage and, you know, that

raging behavior, I guess it's known. So that would be, you know, something that's very interesting I guess it's known. So that would be something that's very interesting that requires further study too. And the quality of life significantly improved for these patients, which is really fascinating. So yeah, I was digging into some of your research and you're looking at doing ketogenic diets for things like schizophrenia and bipolar disease, which to me is fascinating because, you know, we think of those conditions as less treatable than depression. You know, you can do talk therapy for depression, but you can't really talk your way out of psychosis. So

how does this approach work for those disorders? Because those seem a little bit more intractable, but you're seeing real changes. Yeah. So a ketogenic diet is that higher fat, low carb, moderate protein diet, and it shifts the body metabolism to utilize fatty acids. So other words, you're burning fat and ketones as the primary source of energy rather than glucose or carbs. And they're well known for being, you know, powerful in epilepsy, in diabetes, in obesity, and insulin resistance. And now newer research is showing some improvements in some of the neurodegenerative conditions, Alzheimer's disease, autism. And so some of the possible mechanisms include energy metabolism and reducing inflammation, reducing that oxidative stress. And oxidative stress is, I like to think of it as the burden to the cell, the environmental

burden to the cell. And so it's an intervention that's worth studying for other psychiatric illnesses. And we think the diet does similar things in the brain to what psychiatric medications do like mood stabilizers. So in these patients that I saw through my training, I saw improvements when they went on this particular diet. That's actually why I got really interested. So who was prescribing? Were they doing it on their own

or was there a psychiatrist who said you should try a ketogenic diet? This was a clinic that they came to specifically for weight loss because they were on psychiatric medications. They had some side effects from that. They had weight gain. They wanted to improve. They already had a baseline poor metabolic state from before the diagnosis of schizophrenia, but they wanted to get an improvement with that. So they were placed on a ketogenic diet for treatment of insulin resistance, treatment of obesity, and these side effects from the medication. But what was interesting is that, you know, there have been some reports about even gluten sensitivity in schizophrenia. And so ketogenic diets are gluten-free diets. Yes, they are.

Yeah. So this was, that's another, you know, added dimension of it. But I think there are a lot of possible mechanisms that, you know, I've mentioned. And so what I am studying right now is I'm enrolling patients in a clinical trial, looking at how this ketogenic diet intervention, which is really an anti-inflammatory metabolic intervention, how it affects individuals with bipolar disorder or schizophrenia, where we often prescribe these mood stabilizers or neuroleptics for symptom control. And I'm also looking at obesity and metabolic dysfunction in these patients. And so while the trial is still ongoing, the early results are promising or encouraging, and patients have been really thrilled with their results. And there have been patients who've

been able to reduce their medication dose and they've proved their health overall. And so- And it's really striking when you think about it, because there has not been a lot of advances in schizophrenic care since I've been a doctor. I mean, there's better medications, but it's still the same old antipsychotic medication, which will often have a lot of side effects. And this is a radically different idea. I mean, I think I read once that about 17% of schizophrenics have elevated gluten antibodies, and about 20% of autistic kids do. And gluten is something that causes damage to the gut,

that causes inflammation in the brain. And, you know, I think that these are all patterns that connect, and you're connecting dots that haven't really been connected before in the field of psychiatry. And it's really, it's pretty stunning because if what you're saying is true, and I believe it is, because I've seen this in my practice over the last 30 years, that the doorway to the brain is really through food and through your metabolic pathways and optimizing those, it often is more effective than medication. And the side effects are all good ones, right? Like weight loss and energy.

So it's pretty exciting. You know, the other thing you sort of mentioned that I don't want to skip past is you talked about energy in the brain. So we talked about inflammation and you talked about mitochondria and energy. These are the little energy factories in the brain. And it made me think of one of these researchers from Harvard.

I think that was in San Diego, Suzanne Goh. I don't know if you've heard of her. She's a pediatric neurologist who studied autism. And she's done very sophisticated studies in the brain looking at the energy deficits in autistic kids' brains, which are, by the way, also infl inflamed and if you have inflammation it also causes damage to the mitochondria so it's sort of a vicious cycle and she found by giving these kids mitochondrial support nutrients like CoQ10 and carnitine and various compounds that the mitochondria need to function she was able to help

these kids improve their autism and I I'm wondering, you know, in some of these metabolic disorders where there are energy deficits in the brain, in psychiatry, if that would be a fruitful area for research, or if there's any research on that, looking at using mitochondrial therapies to approach and treat psychiatric issues. I think that's a really great question. And I don't know the research on that. I don't know whether there's been a focus on that, but I think that's a really important question and something I would love to look into further. Well, you know, we know that there's mitochondrial deficits in autism. We know there's mitochondrial deficits in Alzheimer's and Parkinson's. Parkinson's is a huge area where, you know, mitochondrial therapies have been used.

ALS, there's a lot of mitochondrial issues and therapies that are used. So, you know, it's something we don't really learn about in medical school. We don't learn about mitochondria in the sense of how to treat them. We don't learn about inflammation in the brain or how to really treat that. We don't learn about inflammation in the brain or how to really treat that. We don't learn about nutrition. All the things that seem to be the most relevant now as science advances are sort of gaps in our training. And now we sort of have to put the pieces back together to try to sort through what to do. And I mean, functional medicine is really a map for helping us figure that out.

And that's why I found it so effective. And like I jokingly said, you know, I called myself the accidental psychiatrist because I was treating people for all these physical issues and their mental problems get better. You know? Yeah. Yeah. It's really interesting. It's fascinating. I, yeah, I don't, I am not an expert in, you know, kind of the nutritional supplements and how that affects mitochondrial, you knowrial function.

And so I really focus on the metabolic part of treating metabolic dysfunction and how that improves how your brain kind of self-corrects some of that mitochondrial dysfunction. Yeah. Well, talk about the ketogenic diet in mitochondria because it's really one of the key ways that it works is by improving the function and health of the mitochondria in the brain and also reducing inflammation, which seems kind of paradoxical because you think, oh, I need a high fat diet. That seems like very inflammatory and bad, but it turns out it's the opposite.

So can you explain how that works in the biology of how the ketogenic diet is affecting the brain? Yeah. So with the mitochondria specifically? Well, in every way, all of it, all of it. Intimate resistance in the brain, inflammation, oxidative stress, mitochondrial function, all those things that we know now are the underlying biology of brain disorders. How does a ketogenic diet influence those? Yeah, so we'll give an example of, in particular, the clinical condition, you know, food addiction or binge eating.

Yeah. Right? So the ketogenic diet. By the way, how prevalent is that? I mean, when you say food addiction, is this like 10% of the population, 30%, 2%. So ultra-processed food addiction is about 40%, 50% in patients with obesity and about 40%, 50% similar to patients with binge eating disorder. So if you're overweight, 40% of the people who are overweight or binge eating have this issue.

Right. That's a lot. And considering 75% of us are overweight, this is probably the biggest addiction in America. This is the big addiction in America. That's right. And yeah, the ketogenic diet is stabilized as blood sugar,

as I mentioned, but you avoid these hormonal shifts and that's really a big, we think that's a big reason because that affects the dopamine reward system in the brain. And what we also know about binge eating disorder in particular and ultra processed food addiction is that the functional connectivity, which is really the amount of connections between your nerve cells, networks in the frontal lobe, which is responsible for your planning and your executive functioning, and even within the reward pathway, the reward processing, these networks are actually a lot less. That functional connectivity

in people's brains are less. So that's the adult in the room. So the adult in the room that is managing your impulses, your basic impulses, is not functioning because of the food you're eating, right? So you can't make good executive decisions based on the dysfunction in your brain is what you're saying. Well, what we do know is that imaging studies show that these folks have less connectivity. I don't know that anyone's proved that it's related to what we're eating or metabolic functions per se, but that's something that we hope to learn more about. But the grownups left the building basically. Yeah. But what's really interesting is that the ketogenic diet increases expression of that miracle grow that you described in your book, that BDNF.

And that has been linked to decreased food intake. And these diets, high in sugar and refined carbohydrates, have been shown to decrease that BDNF expression and actually make you hungrier. So there's something about ketosis or the ketogenic diet that dampens down that reward signaling and the excitatory activity in the brain, which leads to a rise in the GABA inhibition. And interestingly, in addiction, we use medications that increase that GABA inhibition. And so indirectly, the ketogenic diet may be doing something similar to what medications are doing in playing a role in altering that neurotransmission.

Wait, so let me get this straight. So basically, when you eat a diet full of sugar and processed food, it turns off this miracle growing in your brain called BDNF, or brain-derived neurotrophic factor, that makes more connections in your brain and allows your brain to work better and make better decisions. And when you cut that out and you eat a ketogenic diet, you actually increase this miracle grow in your brain. You increase the connections and you get to make better decisions and choices about what you're eating in your life in general. That's right. That's pretty amazing. Yeah, that's, you know, our, so Ashley Gearhart and I have been collaborating on this particular topic,

and she developed the Yale food addiction skill. And so we try to use that in our studies, because we're trying to look at how many of these people are actually identifying as having this ultra processed food addiction and suffering from the binge eating and the food addiction. So, you know, another thing that we know mechanistically with ketogenic diets are that it includes a moderate amount of protein. And that protein has been shown to dampen reward response to processed foods and reduce ghrelin, which is our hunger hormone. So that might be, you know, another possible mechanism. And so there's exciting work being done in that area. So having good quality protein, lots of fat and very, very little starch and sugar. You're talking about like 5%

carbohydrates, right? This is a very, very low carbohydrate diet. Right. So for this, you know, for a ketogenic diet that I'm talking about would be 5-10%, more like 10. So have you seen people with schizophrenia, for example, stop their psychosis and auditory hallucinations by using a ketogenic diet? I have seen two patients that that has occurred with, yes. Yeah. I mean, this may be like eureka, right? I mean, this is not, this is a Nobel Prize kind of stuff, right? I mean, this is a big discovery. It's really fascinating.

I mean, I can't say. I can say I knew you when. There are a lot of other researchers working on this. And, you know, I'm really interested in helping these patients because, you know, I really just felt day after day, just felt that there was something missing and we really needed to address this. I mean, just there's so much heterogeneity, you know, as I was mentioning in psychiatric

conditions, but I do think that there's something more organic about some of the illnesses. And then I think there's different phenotypes, different presentations where we diagnose the same condition, but these strategies may help some people more than others. And many, many years ago, maybe thousands of years ago, you know, we still had documentation of these illnesses, psychiatric illnesses. Before McDonald's. Yes, before McDonald's. So there's something happening.

And also, I'd like to point out that even psychological stress and major events in your life increase inflammation. Yes. So diet is very powerful. Physical movement, lifestyle things are helpful, but I think diet is probably more powerful than some of the other things. And I do think that ultra processed food and sugar is really, really messing up our health. And so I'm pretty worried about this country because I think that we're not recognizing it as a society. It's all around us and we think we're eating healthy food and it's marketed as healthy food, but it's not. I spend a lot of time re-educating my patients about what to eat. It's true. So it seems like our whole definition of mental illness is coming

into question. I remember once having a conversation with Tom Insel, who was the former director of the National Institutes of Mental Health. And I said, what do you think of the DSM-4 at the time? Now it's DSM-5, which is the manual for categorizing psychiatric illnesses. It's based on grouping people together who share symptoms. If you are sad and hopeless and helpless, and you have no interest in life and sex, and this and that, you have depression. And if you have this and that, you have schizophrenia. And he said, well, it's 100% accurate, but 0% valid, meaning that it was very good at grouping people into categories according to symptoms, but it didn't tell you anything about the cause or the mechanism. And what you're doing is you're saying, wait a minute, just because we say you

have schizophrenia doesn't mean we know what's wrong with you, right? Just because we say you have depression doesn't mean we know what's wrong with you. It just means you have these symptoms, and it could be a lot of variables, right? It could be some psychological stress, but it could be also your diet, or it could be a nutritional deficiency, or it could be your microbiome, or it could be a thyroid problem, or it could be gluten, or it could be a nutritional deficiency, or it could be your microbiome, or it could be a thyroid problem, or it could be gluten, or it could be whatever. And we don't learn how to think that way in medical school. And yet this is really where medicine is moving at a pretty rapid pace. When you look at systems biology, when you look at the emerging concepts of network medicine, the body's a network, everything's connected by these biological mechanisms. And the things you

talk about in the show today in some resistance and inflammation and mitochondrial energy issues and oxidative stress, these are the fundamental things that tend to go wrong across almost all diseases that are chronic. And they show up differently in different people. But the doorways to fix them may be very similar, right, through diet and using food as medicine. And that's what you're doing, really. As a psychiatrist, you're using food as medicine in a pretty radical way, which is just so exciting.

And I think, you know, the fact that you're seeing people with schizophrenia stop hearing voices by giving them a different diet, whether it's the gluten or the sugar or the insulin resistance or the inflammation or the upregulation of their mitochondria through the ketogenic diet, all those pathways are active and you're actually activating the body's own healing systems rather than trying to interrupt some pathway or upregulate some pathway, which is what we typically do with drugs, right? So they're much more, you call it, you know, pleomorphic in the sense they have multiple effects.

When you look at the effects of lifestyle and diet, they're so much more complicated than just a single drug pathway, right? It is a lot more complicated than a single drug pathway. I agree with that. You know, one thing is that the SSRIs are, you know, targeting like Prozac, right? They target the serotonin and they increase it in the brain and it's supposed to rebalance your neurotransmitters and it's helpful for, you know, many people, but exercise also helps with depression symptoms. And, you know, one of the ways that we think SSRIs may also be helping is through a different action, and that's anti-inflammatory action. There are some anti-inflammatory component when There is some anti-inflammatory component,

and they measured inflammatory markers with SSRIs that decreased. So it's very interesting mechanistically to kind of understand what we are doing and what we're hitting. That's true. I mean, statins are the same way. It turned out that maybe the effect of statin drugs, the lower cholesterol, aren't from lowering cholesterol. It may be because they're causing a lower level of inflammation. They have a side effect, which lowers inflammation. And I remember one of the big studies called the Jupiter study, they found that if they lowered LDL, but they didn't lower

inflammation, there was no benefit. And if they lowered inflammation, and then there was benefit. So I think, you know, the inflammation story is really central to everything that's happening in chronic disease. You know, and I think that's why with COVID-19, we're seeing such a problem in our society, particularly in America, because we are the among, you know, there's a few countries like Mexico, maybe worse, but we're among the worst in terms of our metabolic health. And you wrote about it in your article, like 12% of us down from 19% of us are metabolically healthy. That means 88% are not metabolically healthy and are experiencing some degree of this level of inflammation and even mood and cognitive issues. And so, you know, I think what advice

would you give people who are listening or at home, still struggling with the shelter at home, still struggling with trying to figure out how to get through this and feeling depressed and, you know, filling their shopping carts with Hawaiian punch and pop tarts. Like what should people be doing to protect themselves both physically and mentally? So I would say to, you know, any American listening, whether they have a pre-existing chronic medical condition or not, the single most effective intervention that they can take today, you know, besides not smoking, obviously, especially now, is to not overload their body with that excess sugar and the highly refined carbohydrates. It causes a lot of damage to the body. And we really should be encouraging improvements in health and immunity in every way possible. And we should

look to other ways to increase our dopamine, for example, and improve our immunity. And sleep is really important. Physical movement. We may not necessarily have the same access to the gyms that we do before, but even if you can just move, that's going to be helpful. And getting connected to close friends or family and not feeling that loneliness or the isolation, it's physical distancing is different than social distancing. Yeah, I know it's true. I mean, I think we are, I think, needing to think about different ways to raise our dopamine. I think that was a really brilliant thing you just said. And dopamine is the pleasure, you know, stimulating amino acid in the brain.

It's a neurotransmitter. And we look to stimulate it a lot of different ways. And most of our society uses sugar and starch and processed food to stimulate it. But things like love and connection and exercise and sleep, meditation, yoga, all those things, food and the right kind of food, right? That also is so interesting to me. When you look at the brain biology of what happens to the pleasure center in the brain, when you eat starch and sugar and processed foods, your ability to receive pleasure goes down the more you eat it. So you need more and more of it to get the pleasure, which is

really the sort of definition of addiction, right? Right. I drink a glass of wine, I can barely walk up to my room at night. And some people who are alcoholics can drink a bottle or two, and they're fine. And I think that's what's really going on in our society. Now, if I have a sugar load, I'm like, I feel pretty wired. But it really is a matter of redesigning your biology. And what do you see in your patients? How long does it take them to sort of break out of the sort of pattern that they're in and see the changes? Does it take months? Is it days, weeks? Yes, it really depends on the individual and what they are coming to me with. There's a wide variety of different complications and symptoms.

So usually within a couple of weeks to a month, there's significant improvement in their health. But there are patients that have a little bit more trouble because they've had past trauma or, you know, significant adverse childhood event still affecting them today. And I do think that that takes like talk therapy, as you said, psychotherapy to kind of even get them ready to make any changes in what they're eating, for example. And so for some people, weight can be protective. Weight can be protective for them to feel more secure because of past trauma. That's real. I mean, those are issues that really have to get sorted through.

But the food part is an interesting, you know, therapy that goes along with the talk therapy and other modalities to help people deal with these psychological issues. And it's often not used. And my experience, it just a lot harder to talk through your issues until you get your brain working properly. Yeah, that's exactly right. So what do you think about things like ADD and nutrition? I think you have a number of papers on your site looking at, for example, artificial colors and additives and omega-3s and stuff. But just in terms of general nutritional quality and ADD, are you seeing this sort of epidemic of ADD and autism connected to our diet? I do think it's connected to our diet. And, you know, like I mentioned before, that these conditions are heterogeneous. And I think that the number of cases of autism

over the last 20 years has doubled, even maybe tripled. Both autism and ADHD is just rising. And I don't think that we're giving our brain, we're not feeding our brains the right fuel. And that does affect attention. That does affect attention, that does affect memory, that makes our brain cells more lazy or tired, not working properly. behavioral changes with autism and improvements in memory and concentration is really important. So I think what you're eating is so important for that. Yeah. I don't know if you said you mentioned you read my book, The Ultramind Solution. I don't

know if you saw the case of this little boy who had ADD and his handwriting before and after he got treated. Changed. Yeah. And that was really what got me to write the book was was when his mother brought in his handwriting before and after two months later after he he started changing his diet and fixing his nutritional deficiencies and his handwriting went from completely illegible to really perfect penmanship and i thought was well how did his brain go from being totally chaotic and asynchronous and uncoordinated to being coherent and functional. And I thought, wow, this is incredible. If that is really true, like, you know, you can, people can talk about their behavior and their mood. It's more subjective. But when you see like this objective

reality of handwriting before and after, and it wasn't like he took penmanship lessons, when you know what's actually happening in the brain. And when I went back to look at this kid's history, it was fascinating because he had a lot of inflammation, right? So if you look at all these comorbidities that he had, he had asthma and allergies and eczema and hives, and plus he had irritable bowel, and he had all these sort of physical issues that were inflammatory, but they were coming from his inflammatory diet. And the kid never had a real food in his life. He never even probably saw a vegetable in his life. And he had high levels of trans fats in his blood. He had no omega-3s. He had very low levels of B6. He had low

levels of zinc and magnesium. And it was really pretty striking when we just cleaned up his diet and we got him on some basic supplements, just a multi and fish oil vitamin D. His literally his brain completely changed within just two months and he became functional and his ADD went away and all his asthma went away and his gut issues went away. And, you know, two years later now, you know, he graduated in astrophysics from University of Colorado or something. You know, it's like you go, you know, this kid got kicked out of kindergarten, was on Ritalin for years. And yet this is not something that most psychiatrists even think about doing with their patients, which is so frustrating to me because, you know, as a family doctor and someone who does functional medicine, like this just seems so self-evident.

And your work is just such an example of how things are really changing. Do you find that your colleagues are like, what are you doing Shabani? Or are they like, this is interesting? Or are they, are they giving you a hard time? No, so, so I completely believe that, you know, that story you told me, I can believe that a patient with ADHD has significant improvement after what you treated him with. And my colleagues have been pretty supportive, actually, and very interested to learn more and very open to making that change. In fact, even just last week, we have different clinics based on subspecialties like neuropsychiatric clinic or mood disorder clinic or depression clinic. And the depression clinic and the bipolar clinic and the women's wellness clinics, they all reached out to me and want to collaborate.

And I think one of the attendings told me last week that 40% of his patients have metabolic issues and talking about weight gain. And most likely, I think a lot of people have nutritional deficiencies. And we already know the general population has a lot of nutritional deficiencies. So if we look at the population and mental health, we're going to see, you know, even more. So I do think that this is something that's going to change. I'm optimistic. I think you can tell. Yeah, well, you're changing it. You're clearly at the forefront. Are you a lone wolf out there? Are there other people out there in the psychiatric world who are on your same path? I think there are other people out there on the same path. I think that metabolic dysfunction per se is not necessarily looked

at as much compared to nutrient deficiencies or specific vitamins and supplements, for example. But I do think that, you know, the combination, these are all important topics and all important things to work on. So last question, looking forward five, 10 years, how does it feel the psychiatry change? How would you like to see it change in how we treat mental illness based on what you're learning in your research? So I would like to see the change

actually across the board and even in medicine is to focus on nutrition and metabolism. And I think over time, we need to really include that as part of the assessment in the initial history that we take. And we have to have a careful intake history about nutrition and what people are eating for breakfast, lunch, dinner, snacks, their drinks. How they're sleeping, how they're sleeping, you know, how they're looking at food. So I think that should change. And I also think that the treatment of insulin resistance and detecting insulin resistance, because I often find that it's not being detected

and I'm not there, you know, necessarily the doctor that sees them as frequently. And so that's something that I feel needs to change within our whole system. We need to think about, aside from just looking at blood sugar every now and then and thyroid, we also need to look at their fasting insulin level. What is their consumption? What is that early process? The things that make us sick later start early. And it's a gradual process towards decline. And what if we intervened earlier, detected things earlier, asked about things earlier, so that we can prevent what happens later? We know what happens later, right?

So this is just a radical idea, right? The doctors should ask their patients what they eat. That's the future of medicine. Actually, no one can come and see me in my practice unless they fill out a three-day diet record. And then on top of that, you can't get an appointment unless you agree also to see the nutritionist, because if food is medicine, I can't practice without a nutritionist. And the other thing you said was really important, is that the most common disease in America, insulin resistance, the most common problem that affects hundreds of

millions of Americans is not diagnosed 90% of the time by the doctor. That's a shocking stat. I think we're missing a lot of it, unfortunately. I think we're missing a lot of it. And I think, I think we don't necessarily know how prevalent it is as a medical society, perhaps, as a whole. We don't necessarily know how common it is. And it's really common. And every time I mention that statistic, people are shocked. No. Yeah.

And with kids now, too. So, I mean, it used to be that the majority of liver transplants in this country were done because of alcohol cirrhosis. And now the majority are being done because of fatty liver caused by fructose and high consumption of sugar. Even in young adults, which is terrifying. I mean, I was at an obesity conference and there was this guy there who was a pediatric gastroenterologist. I'm like, what are you doing here? He goes, well, you know, we see a lot of fatty liver in kids, five-year-olds.

I'm like, really? That's what we used to see in old people with diabetes, right? Yeah, that's very sad. So make sure you do your three-day diet record. And the other thing is ask your doctor for a fasting insulin. This is something I've been measuring for 30 years, and I almost never see it done by most physicians. And it's probably the most important test because your fasting insulin goes up way before your blood sugar.

And that's something you can easily detect by checking your blood test. And it's an easy blood test. And if your insulin is over 5, you're heading towards trouble. If it's over 10, it's not great. And if it's way more than 10, you're in trouble. So that's an easy thing to measure. And it's something that'll tell you where you're going and it affects your mental health. So I would say to people who are listening, if you have mental health issues, or you know someone with mental health issues, you should really think carefully about the role of food nutrition and how that plays a role in what's going on and experiment because there's really very little harm to cutting out processed

food and sugar. In fact, there's only benefits. And there's even trying something more aggressive, like a ketogenic diet, often with the help of a physician or someone who knows what they're doing can be helpful. But these are simple things that have low risk, high benefit, and they're actually being validated in the research. And your work is just so exciting to me. Shemani, I think, you know, this is really the future of psychiatry and mental health in this country. And I hope that you can become, you know, a bigger voice than you already are, because I think the world needs to hear this. I think our government needs to pay attention to this in terms of our policy of funding research in this area.

So if I can help you get millions of dollars from the NIH, I'm going to do what I can. That would help. I do need some research funding. If anybody's listening, you can find it. Go ahead. I did want to just say, I had a comment to what you were saying is that because people are listening, I want to make clear that it's not just people with obesity that have insulin resistance, but people who are even just normal weight can have this insulin resistance. And so it's really important to, to think about that as you decide whether you want that assessment, because you may not even know that you may be insulin resistant, and you may not even know that you may be

insulin resistant and you may not know that you have a high blood sugar and you think you're eating healthy but there are a lot of foods out there that you think are healthy that are not and have a lot of added sugar in these things so well that's a really important point because a lot of people walking around saying well you know i eat a lot of sugar, but I'm skinny, so it doesn't matter. It doesn't affect me. Well, it does. In fact, about 20 to 40% of skinny people are metabolically unhealthy, meaning they're what we call skinny fat or metabolically obese normal weight. So you look thin on the outside, but you're fat on the inside. And you're maybe not overweight, but you're over fat. And especially around your belly fat, which is what the danger of fat is, it drives all the insulin resistance.

So it's important to, to really have a real look at this for yourself. And, and I think I'm so encouraged by this conversation. I can't even tell you I've been waiting for you for 30 years to talk to you. And now you're doing this incredible work at Stanford. It makes me so happy. That's very sweet. Another just comment is that with excess weight and that visceral fat that you are getting at leaks inflammatory molecules and causes damage in the body as well. And so how much of that is contributing towards mental health and mental health symptoms is also an important question. So I just wanted to mention that because sometimes that fat is not fat you can actually see. It's fat that's built around the organs

and around the arteries and things like that. Yeah. Well, I just want to honor you for your work. I want you to keep at it. I want you to convince all your colleagues. And I want nutritional psychiatry and metabolic psychiatry to be actually the first thing that psychiatrists think of when they're treating patients. And then, you know, medications are useful, but it shouldn't be the first thing we think of, I think, in this situation.

Because it's clear that this is such a powerful intervention when other things often don't even work. That's great. And, Mark, you've had these ideas long, long before. And you've been treating all these patients. And, you know, it's so wonderful. It's really, you know, fresh of breath air to, to meet someone who, who has these ideas and, you know, have them independently. Yeah. Well, you should come learn about functional medicine. I think you would love it. It's exactly what you're doing. And even though you don't know you're doing it. So yeah, great. Great. Thank you so much for being on The Doctor's Pharmacy.

I hope you love this conversation. If you're listening to it and you liked it, please share with your friends and family. Leave a comment. We'd love to hear from you. Subscribe wherever you get your podcasts. And we'll see you next time on The Doctor's Pharmacy. And if you're interested in Dr. Shivani's work, check out her website, metabolicsychiatry.com.

You can find her on the Stanford website as well. There's a whole, just type in metabolic psychiatry. She'll pop up all over the place on Google. So I'm excited to have had you on the podcast and thanks for joining us. Thank you for a great conversation and for inviting me to your podcast. Hey everybody, it's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite

stuff from foods to supplements, to gadgets gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you do is go to drhyman.com forward slash pics to sign up. That's drhyman.com forward slash PICS, P-I-C-K-S, and sign up for the newsletter, and I'll share with you my favorite stuff that I use to enhance my health

and get healthier and better and live younger longer. Now back to this week's episode. Hi, everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast

is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioneritioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.