The Dr. Hyman Show - How The Ketogenic Diet Supports Metabolism, Cancer Therapy, And Mental Health

Episode Date: November 20, 2023

This episode is brought to you by Rupa Health, AG1, and Paleovalley.  While the ketogenic diet is often thought of as a diet to help people lose weight, it has a much broader application with therapeutic benefits that help to reset metabolism and restore mitochondrial function.  Researchers have found that a ketogenic diet can be a potent tool in cancer treatment as well as in neurodegenerative disorders and mental illness. In today’s episode, I talk with Mark Sisson, Dr. Sarah Hallberg, Dr. Christopher Palmer, and Dr. Patrick Hanaway about how a ketogenic diet can be used as a treatment for serious health conditions. Mark Sisson is the founder of the popular daily health blog Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. The late Dr. Sarah Hallberg was a medical director at Virta Health, a fellow of the Aspen Institute’s Health Innovator Fellowship, and a member of the Aspen Global Leadership Network. She was also the Medical Director and founder of the Medically Supervised Weight Loss Program at Indiana University Health Arnett and an adjunct professor of clinical medicine at the Indiana University School of Medicine. Dr. Christopher Palmer is a psychiatrist and researcher working at the interface of metabolism and mental health. He is the Director of the Department of Postgraduate and Continuing Education at McLean Hospital and an assistant professor of psychiatry at Harvard Medical School. For over 25 years, he has held leadership roles in psychiatric education, conducted research, and worked with people who have treatment-resistant mental illnesses. Dr. Patrick Hanaway is a board-certified family physician and trained at Washington University. After 10 years as Chief Medical Officer at Genova Diagnostics, Dr. Hanaway became the Chief Medical Education Officer for the Institute for Functional Medicine. In 2014, Dr. Hanaway was the founding Medical Director of the Cleveland Clinic Center for Functional Medicine. This episode is brought to you by Rupa Health, AG1, and Paleovalley. Access more than 3,000 specialty lab tests with Rupa Health. You can check out a free, live demo with a Q&A or create an account at RupaHealth.com today. Head to drinkAG1.com/HYMAN to receive 10 FREE travel packs of AG1 with your first purchase. Paleovalley is offering my listeners 15% off their entire first order. Just go to paleovalley.com/hyman to take advantage of this deal. Full-length episodes of these interviews can be found here: Mark Sisson Dr. Sarah Hallberg Dr. Christopher Palmer Dr. Patrick Hanaway

Coming up on this episode of The Doctor's Pharmacy. There is no dietary requirement for carbohydrate in human nutrition. Yes. There is no such thing as an essential carbohydrate. I'm not suggesting that we should never consume them, but the reality is we don't need them because we have this elaborate and elegant mechanism that takes stored body fat and, in the absence of any food, allows us to live for five, six, seven days, not just survive, but thrive. Hey everyone, it's Dr. Mark. They say knowledge

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So if you want to take ownership of your health, it starts with AG1. Get 10 free AG1 travel packs with your first purchase. Go to drinkag1.com forward slash hymen. That's drink AG1, the number one, dot com forward slash hymen. Check it out. And now let's get back to this week's episode of The Doctor's Pharmacy. Hi, this is Lauren Fee and one of the producers of The Doctor's Pharmacy podcast. The ketogenic diet has become very popular in recent years as an approach to weight loss, but it also has a much broader application with significant therapeutic benefits. Healthcare practitioners are now using

the keto diet with much success in patients with severe mental illness, cancer, type 2 diabetes, and more. In today's episode, we feature four conversations from the doctor's pharmacy about how the ketogenic diet impacts metabolism and has far-reaching benefits for many health conditions. Dr. Hyman speaks with Mark Sisson about what the keto diet is and how it affects your body physiologically, with Dr. Sarah Hallberg about using the keto diet to address type 2 diabetes, with Dr. Christopher Palmer about how the keto diet may help mental illnesses like schizophrenia and bipolar disorder, and with Dr. Patrick Hannaway about using the ketogenic diet to support cancer treatment. Let's jump in. Ketogenic diet is a diet

that basically recognizes that we have not set ourselves up to become good at burning fats, and so we need to eliminate that one fuel that we've sort of relied on relentlessly for 10,000 years, that regular supply of carbohydrate at every meal. And if we reduce or eliminate carbohydrates for a certain period of time, the body responds, the epigenetic response of the body to turn on certain enzyme systems and upregulate certain gene systems that will build the metabolic machinery to burn fat at a higher rate and more efficiently. And what that looks like is that we have these little powerhouses in our muscles and other cells that are called mitochondria. And that's where the fat combusts. That's where the fat burns. Well, people who are what we call sugar burners and are reliant on

carbohydrate every couple of hours to get through the day, they never really, the body just has no reason to build more of these furnaces, of these little powerhouses. And so you get by with, as long as you continue to eat, you know, a breakfast of waffles and or pancakes and or toast and then have a bagel. The American breakfast is basically sugar for breakfast. Sugar for breakfast and, you know, promoted by then the cereal industry and Anita Bryant back in the, you know, you've got to have your orange juice. That's right.

Oh, yeah. And then that sets you up for a horrible day. That's a prescription for early death is cereal and orange juice. Absolutely. And yet, that's how I grew up. Me too. Everyone, you know, everyone. Captain Crunch.

Yeah. So the- The American Heart Association says that Twix are actually a heart-healthy food. Dr. Michael Smith I know, and Cheerios and whatever. It's like… Dr. Michael Smith Cocoa puffs. Dr. Michael Smith No, it's beyond… But by the way, the American Diabetes Association…

Dr. Michael Smith Because they're low in fat. Dr. Michael Smith The Diabetes Association used to say that, you know, you can have your favorite dessert as long as you continue to take your meds too. So it's a crazy… Dr. Michael Smith Just take more insulin. Dr. Michael Smith That's right. So we go back to this, you know, if I want to develop metabolic flexibility,

I have to take away the carbohydrate as a source and kind of prompt, gently prompt my body to respond by becoming better at burning fat. And we call it fat adapted. And when you become fat adapted and your muscles start to get comfortable burning fat as the primary source of fuel while you're moving about your day, not just sitting around doing nothing but while you're walking and then eventually while you're exercising. And you get to the point where you can derive 85, 90% of your energy requirements from fat if you become good at this. Your body fat or the fat you're eating?

Exactly. Your body fat or the fat you're eating. Exactly, right. Yeah. So people talk about card loading. You only store about 2,500 calories. Yeah. But for fat, you probably got 30,000, 40,000 calories of fat on your body. Absolutely. It's a lot bigger energy store. By the way, 30,000 calories of fat, that's just like 10 pounds. Right.

I got that. Right. You know? So, I mean, and I could walk 300 miles without eating. Right. Not that I'm going to or want to, but I could. You are? Okay.

Theoretically. So the idea is to develop this metabolic flexibility. Both those things don't sound fun to me. No, no, no. Of course not. Walking 200 miles or not eating. This is all hypothetical. But when you become metabolically flexible, you're able to derive all this energy from your stored body fat. And then an amazing thing happens, which is the liver, when you withhold carbohydrate, which becomes glucose eventually through the digestive process, when you withhold carbohydrate... And just to be clear for people, when you say carbohydrate, you mean refined starchy carbs.

You don't mean broccoli, right? Okay, so we can make that distinction. I mean all carbohydrates, but I'm going to put a big asterisk by broccoli and say that when you go keto, you can eat as much vegetables as you want. That's right. Okay, so green leafy vegetables. And they're all carbohydrates. But they're locked in a fibrous matrix. So what we're talking about is how accessible is the amount of sugar or the carbohydrate that you take in real time to the body.

And if it's made less accessible because it's locked in a fibrous matrix, as in the case of broccoli, that's fine. Or any vegetable. Any vegetable. I mean, you know, for picking on my favorite vegetable. So you not only become good at burning fat, but then the body starts to – you create these ketones in the absence of glucose. And people will typically say, well, you know, I'm feeling woozy because my blood sugar is low. My brain isn't working because my blood sugar is low.

That's why they feel like they need to have a meal. That's why they feel like they need to have a snack because they have these wild blood sugar swings throughout the day because they've been so dependent on a regular supply of carbohydrate to keep their glucose up. Well, when you cease doing that for some length of time, the body gets wise and the brain goes, well, look, I know how to burn ketones. I just haven't done it for a long time. So the brain becomes quite

adept at deriving energy from ketones. The whole theory that you need glucose to fuel your brain, that's a false? That's correct. You don't need, like one of the things that it's become kind of a- Because it's supposed to use 25% of all the glucose, right? 25% of your energy. Right, that's different than what I learned in medical school. But you're saying that's wrong. No, so the brain, let me put it one way, which is that there is no dietary requirement for carbohydrate in human nutrition.

Yes. So you should just unpack that because there are essential amino acids with protein. There are essential fatty acids from fat. But there is no such thing as an essential carbohydrate, and we don't need them. Correct. Now, we don't need them, and I'm not suggesting that we should never consume them, but the reality is we don't need them because we have this elaborate and elegant mechanism that takes stored body fat and in the absence of any food allows us to live for five, six, seven days, not just survive, but thrive and be mentally alert and to be willing and able to hunt for the source of food. Because remember, throughout most of human history, we didn't have three square meals a day.

We had food, and then we didn't have food. And so the design of the system, and again, this elegant system, phase one of the system says the brain, when it comes across food, you've got to overeat because you don't know where the next source of food is going to be. And so when you overeat, you take the excess amount of energy that is in the food and you store it as fuel that you get to carry around on your body. By the way, conveniently located right over the center of gravity, the belly, the butt, the hips, the thighs. It's such an elegant system that we would be able to carry this fuel with us for long

periods of time and not worry about, oh my God, it's noon and I'm going to get hangry because there's no food around or there's no deli nearby or there's no taco truck. You have the ability to use that fat for energy. You just, you'd use that fat for energy, and that's how the system's designed. So, unfortunately, we get to today where we've lost the ability to, so we're very good at storing fat, and we still are wired to overeat. But because there's like 200 genes that protect us from starvation, but none that help us deal with abundance and excess.

So it's an artifact of civilization. So we kind of have to override that with our cognition. But one way to do that, again, is to use a ketogenic way of eating for some period of time. Again, not necessarily for the rest of your life. What is keto? Define keto. So keto to me is cutting carbs back to 50 grams a day or less. Which is what is 50 grams in terms of a food? Like a bagel? Yeah, pretty much like a bagel with some jam on it and you're already over the top. Or any, like if you got rid of bread, pasta, cereal, rice, cookies, candies, cakes, sweetened beverages, sweetened drinks, and all you had was, oh my gosh, real food. Broccoli, Brussels sprouts, cauliflower, salads.

You would be fine. You would be within that 50. You'd be hard pressed. Could you have grains and beans? No. So you don't have grains and beans on a true keto diet. Now, we'll talk about what pedo looks like. Pedo, okay.

Or paleo keto, or what are we going to call it? Your pegan version of keto. What's it going to be? Keegan. Keegan, okay. Keegan, it's a Keegan diet. It's like a keto vegan? I have a friend who's a keto vegan. Yeah, yeah. So you can do it for sure. It takes some adherence to this. At the end of a couple of weeks though, you have shifted your metabolism to one of greater efficiency and... So it takes like three weeks to adapt to it.

You need to make sure you have enough fluids and sodium and magnesium because otherwise you feel the keto flu. And some people still get the keto flu, but it's not like the flu. It's just... You feel achy and tired and crap. That's your brain going, where's my glucose, dude? Right. And until the brain kicks in and says, wow, these ketones are amazing,

the liver can make up to 750 calories a day worth of ketones. Wow. Like, chew on that for a second. That's unbelievable, right? So when you look at how we're designed for survival, if you look at— I mean, not from diet, but just from your fat stores. Correct. Yeah. Yeah.

So we have this stored body fat, and when we cut off, just theoretically, if, like, say you do a fast, which we can talk about what that looks like, but you do a five-day fast, you become a closed loop. It's amazing that you—that the body takes fat out of storage, combusts some of it in the muscles to get you through your day, and people who do five-day fasts, they work out, they'll exercise, not, you know, hard, heavy, but so you combust some of that fat in the muscles. Some of that fat, you know, as you take that, those triglycerides, and you strip out the glycerol, becomes a backbone to make enough glucose through gluconeogenesis to supply whatever amount of brain cells do require some glucose.

It's not a big number. It might be 40, 50 grams a day. The liver makes ketones. The brain thrives on ketones. The brain prefers ketones. Yeah, the brain does way better on fat than on sugar. Well, on ketones, yeah, because the brain doesn't burn fat, but it burns ketones. Ketones are derived from fat.

Are derived from fat. So you have this substrate, this fatty, this fat substance that then can become combusted by itself as fat. Part of it can be used to actually make glucose if needed. That's why you don't have an external need for carbohydrate and glucose. And then you can make up to 750 calories a day worth of ketones. Now, one of the best things that happens in this scenario is that, again, epigenetics at work turns on genes that cause the body to spare amino acids and spare protein. So whereas normally, on a day-to-day basis, you might eat a big meal and you might have more protein than you need, and then your body has to kind of go through this work to deaminate it and pee it out because it's too much. You don't need that much. And so

when you become this closed loop, this closed system, the only reason you need the amino acids are for structural, for repair, for building and repairing things. You don't want to combust. So people have a false idea about keto, that it's all like steak and bacon and cream and all this stuff. It's not necessarily that. No. In fact, you can eat too much in the way of, well, I mean, a lot of people who first come to keto do so because they, I heard that I can eat 4,500 calories a day and not gain weight.

You know, and I'm like, well, yeah, some of the science shows that, but that's horrible. Bad idea. That's a bad idea because, first of all, if you want to burn off your stored body fat, eating 4,500 calories a day will never tap into your stored body fat. That's just trying to prime the pump with this external source of fuel that's fat that's circulating through your bloodstream.

And that amount of calories, because you're not generating insulin, which is a nutrient storage hormone, the nutrients have nowhere to go. The body has to figure out, how do I burn this stuff off? I can't store it as fat. So the body undergoes this thermogenic high heat kind of thing. Well, that's so powerful because people don't understand that if you don't have insulin, which is only produced by eating carbohydrates or protein, can also increase insulin.

If you don't have insulin, you can't gain weight. Yeah. So if you're a type 1 diabetic, the classic symptoms are polyphagia meaning you eat everything in sight and you lose weight yeah so they could eat 10 000 calories a day yeah and lose weight because they have no insulin which is required to store the fat on your body so the best way to get your insulin down is to cut out the starchy carbs and to eat more fat. Reasonable amounts of protein. And more fat and reasonable amounts of protein.

Yeah. So you don't make it up with, you know, you don't make the calories up with extra amounts of protein. Yeah. So 20%? Okay. I mean, I prefer to deal with hard numbers, like what's a good number for protein. Maybe it's 75 grams a day for a man as a minimum number, and maybe it doesn't exceed 120. Within a range there, you're going to be fine.

And then because the body is so efficient, again, at conserving amino acids, protein, that it doesn't even matter meal-to-meal or day-to-day. It might be on a four-day cycle. If you get 300 grams of protein in a four-day cycle, you're good because it'll just figure out with the different various protein sinks that we have in the body how to keep it and not pee it out. So back to this closed loop that I'm talking about.

So you're combusting fat in the muscles. You're making a little bit of glucose through gluconeogenesis. You're making a little bit of glucose through gluconeogenesis. You're making ketones. Now we figure out that you don't really need that many calories to get through a day. Like we assume if we do that math that's online, you plug in your number and your height and your weight or whatever and your activity level from 1 to 5, and you come up with some number. Oh, it says I can have 2,700 calories a day or 3,200 calories a day for maintenance. No bearing whatsoever on reality. We probably, if you, again, if you do the math, if we, for long periods of time, if we say that protein,

protein shouldn't even have a calorie assigned to it. It's like, it's structural. You don't burn protein, so why would you even assign a value of four calories per gram to protein? Right, but it can turn into sugar. It can. If you eat excess amounts. It can. So, you know, and I guess if you burn it in a bomb caloroon, you get some amount of thermic effect. So how do you know if you're doing a ketogenic diet properly? Well, the main thing is, can you go a meal or two, skip a meal or two, and just feel just fine? And if you can...

It cuts hunger. So ketones, it cuts your hunger. The number one benefit from all of this is getting control of hunger, appetite, and cravings. That's what everyone reports when they finally hit that keto zone. So it's not bad willpower that people want to crave and eat other food? It's just biology, right? It's biology. It's absolutely biology. And people come to this point pretty quickly where they go, Jesus, Mark, three meals a day is just too damn much food. I just don't feel hungry. I feel like I'm overeating at three meals a day. And so typically what they do is skip breakfast. They wake up in the morning. I have a cup of coffee. I go about my day. I do a hard workout. I'm like, not only do I not need to eat, I don't feel compelled to eat. I don't want

to eat. And I might have my first meal at one o'clock or one thirty. It's like time-restricted eating. It's what it is. And so then you get to the point where you're eating maybe two meals a day. And then from there, it's like even those two meals feel like if I have two regular, what would have been in the old days, regular meals, now it's like I'm going to have lunch, kind of a smaller lunch, because I want to enjoy a regular dinner. If I have a regular lunch, then I won't be hungry for dinner. It's amazing how hunger dissipates in this context.

Hey, everyone. It's Dr. Mark here. We all have food emergencies every once in a while when we need some quick convenient calories in between meals and that's why it's a good idea to have some healthy options on hand for when you need them. I do all the time and you might think that grabbing a couple of protein bars would be the perfect portable healthy option but you know that most quote health food bars on the market today are filled with refined sugar, weird artificial sweeteners, sugar alcohols. There's a serious need for actually healthy protein bars. And thankfully, my friends at Paleo Valley have come through. They've created superfood bars, which are loaded with nutrients without added

sugars. Their delicious superfood bars are sourced from only the highest quality organic ingredients while avoiding any harmful sugars you'll see in all the rest. Right now, Paleo Valley is offering my listeners a deal. You can get 15% off the entire store at paleovalley.com forward slash hymen. So be sure to stock up on your food emergencies today. That's paleovalley.com forward slash hymen. I spent a year, an entire year, literally with my nose in the literature, because what I was really being asked to do was solve the unsolvable problem, right? Obesity. We all know it can't be solved. And so I spent a year reviewing the literature and was shocked.

I was really shocked when I did that to find there's no evidence for the low-fat diet. Yeah. Hold the phone. What is going on? So the party line and the science just didn't match up. Didn't match up. And so I really realized that the best data existed for a low-carb approach. And that's how we opened the clinic.

Because, you know, we built it from scratch and it opened as a low carb. This is in Indiana, right? Lafayette, Indiana. And we opened it from scratch as a low carb clinic. And so that was a big change and a pivot from the standard of care. But we really quickly had another pivot because it was overnight that we realized, wait a minute, people are losing weight, but the bigger issue is that they don't have diabetes anymore. And this was happening instantaneously. Like within a week, people could come off of hundreds of units of insulin. It was crazy. And back to the books I went, okay, who's doing this? Where is this happening? Where is this in the guidelines? And, you know, of course.

A big fat nothing. Yeah, you know, you get the cricket in the back of the room, right? Like this was not happening with some, as you know, notable exceptions. And so I got angry. I was really angry because, you know, seeing people whose lives have been transformed with your advice. I mean, it's not me who did it. My patients deserve all the credit and did the work, but it was on advice that we were giving them is incredibly motivating. Right. And I tell you, it's what gets me up every day. And I wanted to see this change. There was no reason that this should only be able to be given to the

patients who are coming to my clinic. This is something that everyone needed. So when you say low carb, what do you mean? So I started out with under 50 grams a day, generally speaking. And since then, for patients with type 2 diabetes have lowered to at least an initial starting of under 30 total grams a day. We don't use net carbs. We use total carbs. So if you add a lot of psyllium to your Wonder Bread, it doesn't work? No.

That's right. That's right. Because I would say that the number one important thing about what we do is that it's a whole foods based diet. So does that mean no vegetables? No, I would consider vegetables. Because those are carbs, right? Well, exactly. But you can do a lot of non-starchy vegetables and still stick.

So you could have three cups of broccoli? Absolutely. Absolutely. Yeah. But you want to make sure you butter the heck out of them, right? Or put olive oil on them or something. See, I think it's actually a high carb diet by volume, right? And I suppose that's a way to look at it, right?

Maybe that would be less intimidating to people. You're eating a high carb diet. A high carb by volume. I like that. I always say it's basically by calories, it's it's it's basically by calories it's high in fat by volume it's high in carbs i like that i'm gonna use that please can i can i please do because it is an act i mean you car and i might be actually carbs are probably among the most important foods we eat which are plant foods and and specific plant foods that are non-starchy

vegetables yes yes i mean we definitely i mean we encourage five serving that are non-starchy vegetables. Yes, yes. I mean, we definitely, I mean, we encourage five servings of non-starchy vegetables a day. And people say, well, wait a minute, you know, you can't do that. But as I just said, yes, you can, right? You can do that and still stick with your carb limit. It's not that difficult, actually. So because of the major results that we were seeing with diabetes i pivoted into research and this is an atkins which is high protein no absolutely and the problem with protein is it turns to sugar if you eat more than you need for your protein correct yeah correct so this is a low carb high fat moderate protein whole foods intervention. Sounds yummy.

It is. That's right. And it's funny because people say, oh, I just couldn't do that. I can't give up my bread. And my first response to that always is the same. It's spoken like someone who's never given up bread. Because wait until you taste bacon-cooked Brussels sprouts or some of the things that you- things i saw someone made a macadamia keto bread the other day and i thought it was really good i mean you can do so much with a whole foods low

carb high fat uh meal plan i mean the diversity uh can be immense and which is great and important because then it can reach across other cultures as well, right? So it can work with our kind of standard American fare, but we can also modify things for different cultural backgrounds as well that can still stick with the same premise, low carb, high fat, moderate protein. So is that keto or are we talking about some variation of that? No, it winds up being a ketogenic diet, meaning that the way that we do our macronutrients are very specifically and intentionally

to get people into nutritional ketosis. That means you have to measure their blood level with a finger stick and it has to be over 0.5 or 0.3. Yes, we're not 100% sure. We are still trying to work out what is the best level because we had initially always been going for 0.5 millimole of beta-hydroxybutyrate. And I still think overall that's our general goal. But what we kind of see is that that looks like some other people can do just

fine and still reverse their type two diabetes, lose weight, feel good, maybe even a little less than that. And I think that there's going to be so much more in the next few years that we learn about beta hydroxybutyrate. I mean, we've already, just in the last few years, increased our knowledge of this remarkable hormone, really, in our body. And I think that we're going to learn more what other potential benefits outside of just type 2 diabetes reversal from having elevated ketones. And so, in a sense, what you're kind of saying is that type 2 diabetes is a disease of carbohydrate intolerance. It absolutely is a carbohydrate intolerance. And that affects a lot of people. What about people who are overweight who don't have diabetes? Are they also insulin

resistant? Oftentimes, not 100%, right? And again, it goes back to treating everyone individually. But I think just recently, there have been a couple of studies that have come out that said you know we we had this idea for a very long time that you could be fit and fat right yeah what about that that was like a big you know sounds like you know my mom said if it sounds too good to be true it probably is right right is that true is that true for this yeah i think that the longer term studies are panning that out that maybe they're in a honeymoon period right where they're still metabolically healthy, but that eventually it catches up with them. And what we get into is issues with metabolic health, you know, then prediabetes and into type

two diabetes. So, you know, we need to be dealing with this and we need to be dealing with this as early as possible um so early as possible in each individual case you know the the quicker we let people know you have a diagnosis of pre-diabetes this is what you need to do to reverse out of that condition easier it's going to be for them but do they need to be keto too or they could get rid of it with more milder changes yeah i think early on people don't necessarily have to be in nutritional ketosis and that's again one of those things i think with ketone bodies that we're going to be working out in a few years who need to do that who can benefit even if they're

not producing um higher levels of beta hydroxybut, you know, it's just a little bit above normal, okay, for some? I mean, I think the answer is likely yes, but we don't know the exact on that yet. So it's sort of what Benjamin Franklin said, you know, an ounce of prevention is worth a pound of cure. So by the time you have type 2 diabetes, you need the pound of cure. Right. That's right. That's right.

And can we avoid that, right? By catching people earlier. I mean, can these people, once you sort of reverse the type 2 diabetes and they get healthy and they're more metabolically resilient, can they start to eat more carbohydrates? So the term I like to use for that is metabolic flexibility, right? And so when someone starts, we don't really know if they're going to regain some metabolic flexibility but i will tell you that many people do and meaning that even say they reverse their type 2 diabetes with under 30 total grams of carbs a day they regain some metabolic flexibility and they can go up from there now that doesn't mean they're going to go back to 200 carbs a day because this is a reversal this is not a cure you go

back to the way you were eating it's going to come right back but it doesn't mean necessarily that you couldn't increase it to some degree and it's not only how much we increase it but what we increase it with so someone has managed to reverse their type 2 diabetes less less than 30 grams a day. They want to add some, so they add 30 grams of sugar. You know, bad idea, right? What are those 30 grams? What do we want to be aiming for?

Could be a sweet potato, maybe. I mean, or berries, you know, that would be another one. More nuts in their diet, things like that. So we have to be cautious how much we add back in, and we have to be cautious of what the composition is that we add back in. But what we find is that many people can regain some metabolic flexibility.

And the people who can't generally, who don't regain that metabolic flexibility, that's because they really don't have the beta cell function. Beta cells are the cells of our pancreas that produce insulin. And the longer you've had type 2 diabetes, the more likely you are to have beta cell burnout, really. And that creates a condition called insulinopenia. And you can't recover that and well you know i i believe that many of our patients start out with significant insulin apnea and some of them regain some of it and some of them don't and this brings up a whole nother research question that's really important which is you know how quickly do we have

to get to people um what are the characteristics of people who will regain more function than others and we don't have the answers to that yet. But depending on how much insulin your body is still able to make is going to be a big determinant in what your eventual metabolic flexibility is going to be. Yeah, it's pretty profound what you said earlier, which is that you have people in a week getting off 100 units of insulin. I mean, that sounds insane, right? And if you tell physicians that, who have never seen this for themselves, they're likely to not believe you. Yeah. But it's so profound. And it's, it's not just like, we see it routinely in clinic and in my practice, I've seen it. It's amazing. It's amazing. And it's not something that's just this, oh,

once in a thousand patients, this is a regular occurrence. You take carbohydrates away, which truly are what is driving the root cause of this problem. And it literally can resolve itself in a matter of days to weeks. This is an evidence-based treatment we have two cochran reviews that yes demonstrate that we have had more than enough research clinical trials demonstrating that the ketogenic diet can stop seizures even when pills and surgery don't yes um we have more than enough evidence on this that's the last resort is diet after all the drugs and surgery don't work, then we try diet. Yeah, then let's try diet. Even though... Because diet can be dangerous. You might, you know... Yeah, they might end up losing weight. We wouldn't want that.

So, once I realized that I started using this intervention in many other patients and, you know, it was not across the board. It was not a miracle cure for everyone. I will fully state that and disclose that. Yeah. But it was dramatically effective and sometimes even more effective for other patients that I used it with. And I was putting what I always thought of as chronic mental disorders, schizophrenia, bipolar disorder, and others into full complete remission, sometimes getting people off all their meds, and they were remaining in remission for years. And I ended up getting connected with other patients who had found their way to this

intervention either through other clinicians or on their own. And some of these patients, you know, the most striking case was somebody who had been in remission for, you know, at the time was about 12 years. And she was 70 years old. It suffered from schizophrenia for 53 years. And her schizophrenia went into full, complete remission off all medications for 12 years. And those things don't happen in psychiatry right now. I mean, Chris, what you're saying is basically the world is not flat. You're like Christopher Columbus, and everybody else is actually saying the world is flat because it looks flat.

We have these diseases. They don't go away. They're chronic. There's no cure for them. And it's remarkable when you start to see it. And essentially, it's like you're saying, well, it's like saying, well, I saw someone who's fully autistic and now they're not. That's the level of drama of this case. I've seen the same thing over and over and over again for decades because by doing functional medicine, you just get to the root cause.

And the thing that I want to drive home is that you really are dealing with some of the underlying biology of the inflammation in the brain and whether it's autism or Alzheimer's or ADD or depression or schizophrenia, if you biopsy the brains, they're all inflamed. Now, the causes can be different. That's why the ketogenic might work for some, not others. Maybe another person might have another issue. They may have, for example, heavy metals or a toxin that's causing a problem. And if you don't deal with that, then maybe they tuna all day, every day in their tuna fish sandwiches, that's their diet at home. But, you know, we have to kind of get to the root cause. But when you start to sort of broaden your net and look at the overlying framework, you're really dealing with this brain inflammation. And what you're saying is so revolutionary because when you look at the economics and the disability of mental illness, it far surpasses any other illness, heart disease, cancer, diabetes, Alzheimer's.

It is the single biggest cause of disability and cost. I think I read a study recently that $95 trillion are going to be spent over the next 35 years on chronic illness. And a lot of that, the majority of that is for the disability that goes associated with depression and mental illness. It's not necessarily being in the hospital and the loss of productivity to society. Like you said, this guy was just sitting at home, couldn't do anything. Now he's a productive member of society. What is the cost of that? So let's talk about what it taught you about the biology of the brain because you were trained as a psychiatrist. You didn't learn much about that other than the neurochemistry of neurotransmitters and using psychiatric drugs which modulate neurotransmitters, which is good,

but you probably didn't learn that much about how to address toxins or the gut microbiome or diet or nutritional deficiencies or hormonal imbalances or any of that. So how did you begin to unpack that? And what is the view that you have now that you wrote about in your book, Brain Energy, that talks about the biology of what goes wrong? Because once you understand that, then you have a roadmap which allows you to actually create a treatment plan that can work and be reproducible yes and i think by the way before before i let you go on i just want to point out

that the ketogenic diets also work in autism and alzheimer's and and in many in avi epilepsy and and i've and i've seen this also in schizophrenic patients. So it's really powerful. It is. You know, I just want to highlight, even though, you know, the disorders you just mentioned are all very serious disorders, and I was talking about schizophrenia a little bit ago, I want to just highlight one of the things you said. Depression is the leading cause of disability. So this, you know, most people think of depression as a fairly straightforward illness. And we have tons of antidepressants and we've got psychotherapy and we've even got shock treatments and we've got so many treatments available, they have to be effective, right? Well, actually, wrong. of people with depression, bread and butter depression, are not getting better with our current treatments. And it's not because they're not getting treatment, it's because our treatments

fail to work for far too many of them. And so, I think that, you know, it was really interesting because the way that I went about unpacking all of this was, you know, I started with the neurology literature. And because this is an anti-seizure treatment, and we use anti-seizure treatments in psychiatry every day in tens of millions of people. And so, that was really low-hanging fruit. And it was a great resource to tap into because we've got 100 years of clinical and neuroscience evidence on the ketogenic diet and what is it doing to the brain. And so, I could tap into that and lo and behold, sure enough, the ketogenic diet rebalances neurotransmitter imbalances it uh decreases brain inflammation it changes the gut microbiome in beneficial ways it uh you know it's people off gluten yes it gets people off gluten it gets people off lots of other toxic uh foods probably it uh it improves insulin signaling and insulin resistance in most people. And so, it has a wide range of effects. But still, this is where the field of psychiatry is.

It's like all of these different things. And so, I went on a deeper search for how do these connect? Because at first, I started off with a mission to how am I going to convince other mental health clinicians to use the ketogenic diet for serious mental disorders? Because nobody's going to believe this. They're just not going to believe it. Unless I can present a clear and plausible mechanism of action based on science, nobody's going to buy this. And this miraculous treatment that I am seeing in front of my eyes is going to go wasted. And I, so I kind

of felt like I'm an academic. You might lose your job. Yeah, that's, I did worry about that many times. I wouldn't go to jail like Galileo, but you might lose your job. I worried about that. The good news now is that I have the full support and endorsement of McLean Hospital, actually. That's unbelievable. They are very enthusiastic and supportive of this. See, when I heard about what you're doing, I just said the happy dance. I was like, and I've been telling everybody, I'm like, wow, finally, somebody's getting it where it counts.

That's awesome. So, the way that I ended up coming to the science is I ended up focusing on mitochondria and mitochondrial function and more broadly what we call metabolism. And so, I came at the science from that perspective and ultimately viewing mental disorders as metabolic disorders of the brain. And that in order to understand metabolism, you have to understand mitochondria. But in fact, you have to understand everything that you have known about for decades, functional medicine, how it's all interconnected, how diet, toxins, hormones, the gut, stress, all of that come together to result in illness.

So, functional medicine has been doing this for decades and yet I was holed up in my, you know, Harvard position and evidence-based medicine. And so, we didn't learn a lot about functional medicine. And certainly, functional medicine protocols are not being used in psychiatric hospitals. For the most part around the world, most psychiatric hospitals are not using these protocols or this paradigm. But at the end of the day, even looking at mental disorders as metabolic disorders, which revolve quite a bit around mitochondria and mitochondrial function, I ended up coming to the same conclusions that you did. It's quite extraordinary. And I don't know if you're aware of this, but right at Harvard, there is Uma Nadu, who has a whole department of nutritional psychiatry

talking about the microbiome and the brain. And there's another physician who's been on my podcast at Stanford. They have a department of metabolic psychiatry. So it's starting to happen. And more and more psychiatrists are becoming aware of the data, because there is data. There's a lot of literature now that supports this notion. So when I look at sort of the mitochondria, it's really about metabolism and energy. And so I'd like you to sort of unpack how that actually connects to psychiatric diseases.

Because I first heard this concept when I talked to Martha Herbert, who's a psychiatrist, sort of neurologist, sorry, a neurologist. And I think she's also worked around psychiatry, I might be wrong, who was treating autism. And she was doing brain scans on these autistic kids. She saw their brains were swollen and inflamed on biopsies with these kids got killed on a car accident or something. And see these brains are just full of inflammatory cells and the immune cells, the white blood cells called the glia and she also called what they have a metabolic encephalopathy she said that that autism is just

not a brain disorder it's a systemic disorder that affects the brain and and it's what i hear you saying that psychiatric illness for the most, is a systemic disorder that affects the brain. And the causes can be many. Like it could be your diet. It could be your microbiome. But I was with a gentleman this weekend whose family was a Hungarian Jew whose family was killed in the Holocaust. He says, I don't know, 150 members of my family were killed in the Holocaust.

I know everybody's name. And I've lived in a constant state of trauma and stress my whole life. And, you know, I was like, wow, this is the epigenetics of this. And Scientific American just came out with a paper, not a paper, but an article sort of documenting some of the research in New York after 9-11, where they saw women who were pregnant when 9-11 happened, their children were incredibly affected by the stress and trauma that happened to the mothers when they were pregnant and was registered in gene expression patterns and epigenetics and in cortisol levels and cortisol receptor function and i was like wow this is the data is really

coming along in this so there's there's a lot of things that can affect it but but often you know the psychiatric problems are so misdiagnosed and mistreated, honestly, and it creates so much suffering. And so what you're talking about is really a revolution. It is. It certainly was for me, and it certainly is for psychiatrists that I speak with. I don't think they've really considered this. The reason that I am so passionate about mitochondria in particular is because they actually are responsible for much more than just energy production. So, most people know mitochondria as the powerhouse of the cell. And so, they create ATP, which is our energy source.

And there's no doubt they do that and they are instrumental in that role. And without that, we would not live. But they actually do so much more than that. So, they are primary regulators of hormones, for instance, key hormones like cortisol, estrogen, testosterone, progesterone, and others, that the production of those hormones actually begins inside mitochondria. And as those hormones travel through the body and influence cells throughout your body, the primary influence ends up converging on mitochondria. And so, in many ways, the reason that I became like ridiculously excited about this theory is because it is a way to connect all of the dots, the biopsychosocial models of mental illness, it is a way to connect all of them.

So, mitochondria are instrumental in neurotransmitter function, neurotransmitter production, the release of neurotransmitters, the influence of neurotransmitters. They play a significant and powerful role in inflammation. But inflammation, in turn turn affects mitochondria. And so it all, at least in my mind, once I started diving deeper, I was kind of flooded with all these questions. But wait, it can't be this simple. Like this is too simple. There's no way this complex issue and the complexity of psychiatry and the brain, there's no way it can end up being this simple. And for the last five years, I have tormented myself in some ways

with questions like, if this is really true then this should be true or that should be true or this yeah yeah and um and at the end of the day everything in my mind seems to converge on these issues yeah well it's so true because you know I was reflecting on a guest we had on a previous podcast who's a pediatric neurologist, trained at Harvard, Oxford. She works at University of San Diego now. And she did brain imaging, functional MRI imaging of the brain in autistic kids and found they had energy problems, that mitochondrial energy deficits were evident in the brain

of autistic kids. And that by giving them mitochondrial nutrients, basically the cofactors and helpers that actually help you turn food and oxygen and energy, like CoQ10, for example, or B vitamins, and just some really simple things that are brain expensive, that these kids would literally get better from autism. That's not to say that all autism is just caused by these nutrition deficients or mitochondrial issues, but it's one of the things that we see. So there's a lot of people coming at this from a lot of different areas. You're in the psychiatric lane, but the neurological lane is seeing this too. And so is pretty much every other

issue. I mean, whether it's your weight or whether it's heart disease or diabetes or Alzheimer's or Parkinson's, so many diseases are really related to mitochondrial dysfunction. So it's great. It's really amazing. And I think that this is such a breakthrough. And I think, you know, there's how besides the ketogenic diet, are you approaching addressing mitochondrial function? Because for example, in autism, they're using these mitochondrial cocktails and supplements to help. So, and that's where when I read your book, I was a little embarrassed. Because if you want the roadmap to, if you want the self-help version of how can I fix my mitochondria, I feel like your book, Ultramind Solution, is that roadmap. It involves improving your diet, exercise plays a role, stress reduction plays a role, toxins can play a role, hormonal

dysregulation can play a role. And these can be wildly different in different people. And I think that's, you know, it's a point that you made in your book. It's a point that you make commonly. And so, it's not that there is a one-size-fits-all solution for people. So, one person could have an autoimmune thyroid disorder and have, you know, a horribly low thyroid hormone. And that person will suffer from both metabolic and mental symptoms. And fixing that problem is replacing thyroid hormone or somehow addressing the autoimmune disorder and correcting that. Another person could have an autoimmune disorder, you know, related to intrinsic factor, and they could have malabsorption of vitamin B12. Regardless of what they're eating, that person too could have both metabolic and mental symptoms or disorders as a result of

vitamin B12 deficiency. And the treatment for that might be vitamin B12 injections because they can't absorb B12. So, very different treatments. But you're addressing the same root problem or the same root cause, which is metabolic, in my mind, metabolic dysfunction or mitochondrial dysfunction. But lots of different things can cause mitochondrial dysfunction. And so, that's the way I'm thinking about it is I, in my mind, mitochondria are front and center. But there are hundreds of different inputs that have numerous effects on the brain, resulting in very different symptoms. Some people might have ADHD. Other people might have depression. Others might have seizures. And others might have schizophrenia.

And that probably depends on a variety of factors. What are the different components or environmental factors that are contributing genetics or you know other things we may not even understand them yes right yeah it's it's so true and i i just remember being in my clinic you know looking at the patients i saw and not really treating their psychiatric problems but they would come in with autoimmune disease or digestive problems or arthritis or whatever, migraine. And I would just do what I did and they would get better from other stuff. Like you're saying, you were treating this guy's weight loss and schizophrenia got better. And I was like, wow, I call myself the accidental

psychiatrist. I never intended to figure this stuff out, but I could not ignore what was in front of me. And I had a patient with ADD once who was so severe, and he had really terrible inflammatory symptoms as well, asthma and allergies and gut issues and migraines. And, of course, the doctor who was treating him, the psychiatrist, just treated ADD with a stimulant and ignored the other things because, of course, they're not related. Of course. But I treated it. I just cleaned up his diet i gave him some vitamins like clean up his gut i you know very simple things and the mother brought home his homework and we'll post in the show notes because it's pretty impressive about his homework before and after two months just of changing these few things and these kids often have what we call dysgraphia they're handwriting you can't read it he's 12 years old it old. It looks like somebody who's got some kind

of severe disorder with writing or something. I don't know. And it went from severe dysgraphia to perfect penmanship in two months. And I'm like, holy crap, what is going on in the brain? How does it go from being chaotic and disorganized and asynchronous, to being completely coherent. And it was really a mind-blowing concept for me and that's where it gave me the idea of the book. I don't know if you know this, Chris, but the origin of functional medicine was in psychiatry from Abraham Hoffer. I did not know that.

Yeah. So, I'm going to tell you this quick story and then I'm going to dive in some more of your work. I don't want to take too much of a sidetrack, but it's fascinating. Abraham Hoffer was a Canadian psychiatrist who treated schizophrenia. And he sort of somehow got the idea that there was some abnormal molecules going on in the brain and that it was related to some kind of nutrient problem. So he gave high dose of niacin and zinc and B6 and magnesium. And many of these patients would improve or get better.

And so he began to write about this, talk about this. And then he was friends with Linus Pauling. And Linus Pauling is a two-time Nobel Prize winner. He discovered the structure of proteins and he almost discovered the, well, he kind of did discover the double helix of the DNA and he told his son about it, but then they went, his son went to London and hang out with Watson and Crick and they kind of took it. That's a whole other story. And then he wrote an article in Science Magazine, which, I mean, Science, which is a very prominent medical journal, which I don't know if you've actually seen, it's called Orthomolecular Psychiatry, written by Linus Pauling.

Have you seen that? I have, actually, yes. Yeah, well, that was the genesis of that. And essentially, the idea was that we could correct ortho means to straighten and molecular means molecules to straighten the molecules of the brain by using high doses of nutrients to move chemical reactions to their completion. Now, it was a very simple idea, and it was super complicated paper, very scientific, but it sort of started this process.

And then Jeffrey Bland, who was really the father of functional medicine, was a student of Linus Pauling's. And Linus Pauling was kind of thought of as a crackpot later in his life. I mean, I don't know if you're going to call anybody who won two Nobel Prizes a crackpot, but he was kind of dismissed for his ideas about vitamin C and everything. But he was onto something. And this is what we're seeing now. So I think your work is so important and your ability to actually communicate this, to look at the science is so important. So talk about how we can think about some of the inflammation process in mental health and metabolic health and what we need to do to fix that. People are listening, well, I hear this, my mitochondria aren't working, inflammation's

connected. How do I start to address that in myself? It's a great question. And, you know, inflammation is, as you know, is a complicated topic because, so there are some clear causes of inflammation. You can get an infection, for instance, and that causes an inflammatory reaction in your body. And lo and behold, we have an abundance of evidence that when a woman is pregnant, if she experiences a serious infection, sometimes even a mild infection, like with the influenza virus, her baby will be at increased risk for mental disorders later in life. If young children experience serious infections, especially if it's serious enough to be hospitalized, they are about twice as likely to develop a mental disorder, oftentimes within three months of that hospitalization. And the mental disorders are not trivial disorders. It's not anxiety

because you are hospitalized. The disorders include things like autism, schizophrenia, mental retardation, obsessive compulsive disorder, and others. And these can become lifelong disorders. And so, we know in those cases, the inflammation appears to be doing something that takes a toll or that changes neurobiology or changes kind of whole body function. And, you know, my hypothesis right now is that inflammation takes a toll on your metabolism, plain and simple. And that it dramatically, we have very good direct evidence that inflammation takes a toll on mitochondrial function. It actually inhibits the function of mitochondria in some brain cells. We have direct evidence for that. And by the way, the brain has got the most mitochondria per cell of any organ in the

body. So it's really important. Yeah, it is. And the brain is exquisitely sensitive to even slight fluctuations in mitochondrial impairment. So whenever people have a metabolic problem, usually the brain is the first organ to suffer. And it might just be trivial symptoms. So, clear causes of inflammation can result in metabolic or mitochondrial impairment and then result in mental symptoms or mental disorders. Even people with, you know, runny noses or hay fever are like 86% more likely to have chronic depression than people without that. So, in some cases, these things are unavoidable. And I just have to say that. I mean, you know, a woman getting an infection while she's pregnant, there aren't a lot of things that she can do to necessarily,

I mean, there are some things she can do to avoid an infection, but it's not going to be 100%. And I don't want to get into a situation where we're trying to blame pregnant women for getting an infection. But you can do something about it when the baby's born, and you can fix the baby. Yes. And you can even do something about it immediately after that infection. So, there are lots of ways to improve metabolism and mitochondrial health. And most of them are lifestyle related. And they include things like diet, removing, as you say, removing the bad stuff from your diet and putting in the good stuff. So easy. It's easy. It's easy.

It's probably more complicated than most people realize because then they question, well, what's the bad stuff? Is it just fat? You know, if I remove fat from my diet, am I going to feel good? No, no, it's not that simple. And it's not as simple as carbohydrates, you know, as somebody who's, you know, using the ketogenic diet. Some will say, if you justogenic diet, some will say,

if you just remove carbohydrates, that will solve all of the world's ills. I don't believe that at all. So, it's about removing bad things from the diet, adding in good things. But it could also include exercise. It can include prioritizing sleep, getting more rest, allowing your body to recover from that process. So, if you are usually a workaholic, if you are highly stressed and you have an infection, maybe it's time to, you know, to just prioritize self-care for, you know, even a month or so after that and really make sure you're getting good nutrition, you're exercising maybe more than you normally even do, getting good rest, trying to decrease stress levels, those types of things, in order to allow your body to reset, in order to allow your body to recover from that assault on it. A couple of years ago, you were diagnosed with stage four laryngeal cancer, which is a big deal. It's a serious cancer and the treatments are rough. And, you know, it forced you to look at how to address this for

yourself, not only in terms of the medical treatments, but in terms of your lifestyle, many other things. So can you share a little bit about how you applied your knowledge of functional medicine to your journey and how it's unfolded for you? And you recently presented an incredible lecture at the annual conference of the Institute for Functional Medicine, where you went through the science around what you did, which led to an incredible recovery and actually looking at you and knowing you for many years, you're healthier now than I've ever seen you in my, my entire experience of you as a friend. So I just sort of blown away by, by what you've learned and what you discovered about, about this journey, about how to deal with cancer and how it could apply to many other people with

cancer. I'm just going to rest in that one for a minute because it's, you know, the personal journey and I've watched you, you know, and for as long as I've known you, I've heard, you know, the stories of being poisoned and what you had to do to move through it. And I was always kind of like, man, I'm glad I don't have to learn things. Be careful what you say. Exactly. So it's interesting. I was reflecting on it this morning. Two years ago tomorrow, I had the biopsy.

You know, two years ago Friday, I had the results, you know, that they give you that. And, you know, I've said, I don't, I think if they had said I had stage three, I would have said, I can deal with this. I can, I got this, you know, and, and like stage four, you start looking at it and, you know, it's like, I didn't have the risk factors, you know, I kind of fit outside the box. So while head and neck cancers, you know, are not, are not prominent, you know, kind of fit outside the box so while head and neck cancers you know are not are not prominent you know of the kind that i have with no risk factors it's like oh you're in like two percent that's of the highest risk of this and you know i'm still what does stage four mean what does stage four mean stage four it means uh it means not only is there cancer, so there's a growth. I got to see it on the side of my vocal cord right there, but there were also lymph nodes.

That's what I felt initially. I felt a lymph node a couple days before, and it was hard. I'm like, oh, that's not good. It's not tender. I thought, oh, maybe I'm coming down with a cold, but the next day it was still there and unchanged. I went in and was seen right away. So I had lymph nodes that were positive. One of them, the one I felt was pretty big, greater than three centimeters.

And there were actually a few small lymph nodes on this side that they picked up on the PET scan. You know, so it's spread metastasis. So what that means is, you know, well, there's a tumor and then they're spread. And generally when they're spread, um, beyond the original tumor, that's, you know, kind of in a generalized term, that's going to be a stage four cancer. Cause it's all, it's, it's, you know, the horse is out of the barn. Can't just cut it out. So, um, I, I got that. And you mentioned that I've been working with the Wairarika people, the Huichol people, and the Sierra Madres for the past 20 years and have been initiated. And I'm right now preparing to go back down to go to some sacred sites and be able to

make my offerings and say prayers, the power of that. But I was planning to go down and the doctor said, well, look, you're going right away. It's not going to change our timing of when we would give you chemo and radiation therapy, so go for it. So that was part of the process. And for me, that was a huge part of the learning of being able to begin to receive help from other people. You know, I'm like a, you know, a bull, you know, I'll just put it on my back. I'll carry it. You know, I can do this, but now this was okay. I'm not helping anybody. I'm receiving help from people. And it was a huge lesson for me. And then lessons also about bringing my voice forward about this part of myself that is like the tender, vulnerable aspect that, you

know, within medical science, you know, it's like, I'm going to show my armor and how strong I am, you know, I'm never going to show that that that I'm weak, but you know, here I needed to be able to reveal this aspect to myself and to others. And that was an important part of the journey. So when we talk about the functional medicine model, and we, we talk about looking at antecedents, triggers, and mediators, like, I don't really have any major antecedents, you know, any genetics, any of the major risk factors that antecedents, you know, any genetics, any of the major risk factors that are going on, you know, but there were triggers. There was like a lot of stress in my life and a lot of trying to carry things all myself and not bringing my voice

forth. And, you know, and even though I was doing good things, it wasn't the whole expression of who I am. You know, few people know all these aspects of me, you know, and like they say, your friends are the people who know you for who you truly are and like you anyways. But the, you know, it's like, oh, I can actually reveal myself. So that's a huge trigger, for example, you know, of imbalance. What is cancer? Cancer is growth out of control. And it's also the invitation for transformation. It's like, if you get that and you say, wow, I'm doing things that are so unbalanced, how do I actually transform to what what's going on? And so that was the seed of, of the change of beginning to like, oh, I can live my

life in a different way. In fact, if I want to live, I have to live my life in a different way. And, and I don't really have a choice now within that there's also, and I have no idea and I can have no expectation that doing any given thing means I'll be healthy and fine. And so dealing with that degree of uncertainty, you know, and so I did my thing. You know, I talked to doctors at, you know, Stanford and MD Anderson and Cleveland Clinic and Mount Sinai and Hopkins and in Israel and Mayo and one other, I can't remember UCLA, you know, and they're all saying the same thing. And so I got to, okay, I need to actually do chemotherapy and radiation therapy. That's going to be important, you know, but what are other things that I can do? And I began to, you know, take my knowledge of nutrition and talk to the top people. Now I would say that, that the people I talked to said, Oh, you know, my knowledge of nutrition and talk to the top people now i would say that that the

people i talked to said oh you know ketogenic diet this is what you need to do um and this is a great thing and i i've already prescribed that for patients had done it myself felt comfortable with it well doing that while getting tube feeds because i may not be able to swallow because of the radiation therapy. That's a different thing of trying to get a high fat diet in through a tube, in through a feeding tube. And so we, we, I say we, because my wife Lisa was right there beside me, like, how do we figure this out? Now it turns out that, you know, a ketogenic diet is not the answer for every kind of cancer, but it's really good for cancers where you're doing radiation therapy, um, because it makes the cancers much more radio sensitive

because you're pulling all of the sugar out. And, and so you have this differential stress response. And so I'm like, well, that makes perfect sense. And so we did that. I did that with them and vigor. And as it turned out, I only lost like three pounds, you know, through the whole thing and didn't have to use the feeding tube very much at all. I used it because you just can't taste any food when you're getting radiation and there's no taste. So you're just like and food just there's no taste so you're just like taking food to to to get the nutrients but i did that but i also did another thing which was working with um fasting before chemo and the work of of dr valter longo and you know so we see all of the fasting mimicking diet stuff that's coming out now, but that's actually all derived from their original work in the early two thousands up to 2009 of working with cancer patients and saying,

if we stop giving food before chemotherapy and the chemotherapy, then that's going to slow down the metabolism of the normal cells, but the cancer cells aren't going to be able to slow down their metabolism. And so the cancer will be more sensitive and the normal tissue will be less sensitive. And so we get better tumorigenic effects or tumor lysis effects, and we have decreased side effects from it. And so I went through that. People are saying, really, you're getting chemo every week and you have a feeding tube and you're eating keto and you're not eating any food for two of those seven days. And you think that's going to be okay. Like, I don't know, but I'm going to try it. And turns out it's very okay. well as and as it went through the whole thing through the radiation therapy people were like you're irish you like should be having major burns from the radiation why is that not happening why are you still eating why are you not why are you not losing weight you know and they look at me and i'd share with them and and they'd say, probably not. Don't confuse me with the facts.

My mind's made up. Right. So anyways, the essence of functional medicine is being able to say, let's look at what's going on here. Let's see what the triggers are. Let's see how I can work to modify lifestyle, to slow down, to take time in nature, you know, which has this great effect that also is going to actually be a anti-cancer effect. You know, we can see that the, the, the forest bathing increases the immune system and decreases, you know, the risk of cancer. That's, that's data

that's, that's actually published in Japan in 2009, you know, so like that's already known there. So spending time listening, working with the lifestyle aspects to be able to do that and working with the nutrition and working with, you know, the, the medicine that was there, the radiation and chemo. And so bringing all those together and, and focusing on, on the person, the mental, emotional, and spiritual aspects that are inside the middle of it. Like that's what functional medicine is. So you've heard me talk and I've heard you talk about, you know, Tibetan medicine and, you know, and that is, you know, an aspect of each of these other systems of healing takes the whole person into account. And they're looking at what are the therapeutic approaches from illness to wellness across the whole continuum.

And the mindset, the approach is similar. Now the specifics are going to be different, but, but the mindset is going to be similar. So, you know, I took those nutritional pieces and, you know, I went through, um, it was, uh, seven weeks of radiation every day. Um, and, you know, chemotherapy every week and, you know, PET scan was negative, you know, at three months and at 12 months and the next one will be in a couple of weeks. But, you know, I get scoped every couple of months. They, you know, it was two days ago, they looked down, you know, no lymph nodes, nothing going on and I feel great and I have to continue to work with it. And, you know, also, uh, you know, I, I shout out to our mutual friend who you introduced me to Nalini Chilkoff, who has been helping me

along the way, you know, as, as a, as a guide, you know, to be able to remember, not only remembering the aspect of, of the nutrients and how to be able to optimize the terrain, optimize me. But also to help me, you know, help me with my heart in the process, because after, you know, cancer, this is a hard one to say, but, you know, so after cancer, you know, it's like, okay, what is my life? Where am I going? And, and then what happened in the experience with, with, you know, working with IFM and being called to jump into helping with COVID is I did what I've done before. And I just like put everything into it and it was great and helpful, but all of a sudden it's like, oh, I'm out of balance again. I'm not actually caring for myself.

And so, and so how do I live the life, my life in this world in balance? And those are, those are, are lessons that I'll be continuing to learn. But, you know, I feel like being able to begin to talk about it out loud and to be able to share the importance of having balance in life and being able to connect to myself and to each other and to the natural world in a way that is bringing balance. And that's part of what COVID is teaching us as well.

So I tie these two things together because they're really like both messengers of uncertainty. And you think you have certainty in the world and you don't. You never have. And if you think that you're supposed to be certain about what's going on, how anxious, anxiety provoking is that? Like, I got to know everything about everything ain't going to happen. You know, so how do I rest into the mystery? You know, there are guides and spirits all along the way who will befriend us. Like that's the conversation I'm interested in and being able to explore that, which also fits within this big picture that we call functional medicine and feel blessed because

to me, you know, it's like the modern day manifestation of Tibetan medicine of bringing all these elements together to make sense of it. I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in. 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 professional advice or services. If you're looking for help in your journey, seek out a qualified medical 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 Practitioner database. It's important 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.