How Does Metabolism Affect Mental Health? | Metabolic Psychiatry with Dr. Chris Palmer

[Music] mental disorders are metabolic disorders the brain and what that means that the science gets overwhelmingly complicated fast there is no question about it but if you do a deep dive into these tiny things in our cells called mitochondria you actually can begin to understand what would cause a neurotransmitter system to be come imbalanced why do patients with mental disorders have higher levels of inflammation and why do higher levels of inflammation cause mental disorders how does trauma and stress play into mental illness why do drugs and alcohol play such a critical role for in in illness [Music] good afternoon everyone thank you so much for joining us um we're really uh delighted to see you all with us for this event that's being presented in uh in collaboration with mind health 360 uh tonight's guest is Harvard psychiatrist Christopher Palmer and he's joined in conversation uh with Kirkland Newman the founder and editor of mind health 360 and the host of the mind health 360 show um we delighted to have you both with us Kirkland over to you thanks so much thanks um for having us thanks to Dr Christopher Palmer who's one of my heroes and thanks to the halto academy for hosting these wonderful events so just to let you know a little bit about um Dr Palmer who is has really taken the mental health World by storm um and is really revolutionizing mental health I think in a big way um and so we're really excited to to have him here he's a Harvard psychiatrist and researcher working at the interface of metabolism and mental health he's the founder and director of the metabolic and mental health program and the director of the Department of postgraduate and continuing education at McLean Hospital and an assistant professor of Psychiatry at Harvard Medical School for almost 30 years he's held administrative educational research and clinical roles in Psychiatry at McLean in Harvard he's been pioneering the use of the medical ketogenic diet and the treatment of Psych psychiatric disorders conducting research in this treating patients writing and speaking around the world on his topic on this topic most recently he's proposed that mental disorders can be understood as metabolic disorders affecting the brain which has received widespread recognition in both National and international media outlets and his book Brain energy I have to say is a masterpiece so Dr Palmer welcome um and I'm just so thrilled with the work that you're doing and we'll have about 45 minutes to talk and then we'll open up to questions but we there's no need to go into the sort of mental health epidemic and the fact that um you know we're really struggling to treat mental health there's such a mental health crisis we know that one in 10 people have a mental illness 50% of Americans have a mental illness at some point in their lives one in three people experience an anxiety disorder in their lifetime um and you know you are a conventional psychiatrist who has discovered what you call a unifying theory of mental and neurological illness and that is the brain energy Theory and you know it is such a revolutionary way to approach mental health you show that there's a common pathway for all metabolic psychiatric and neurological disorders which revolves around metabolism and mitochondria and your approach is is really proving revolutionary in terms of fantastic outcomes so tell us a little bit how did you discover this what took you from being a conventional psychiatrist to coming up with this Theory which is such so groundbreaking the real answer is I could talk about that for probably hours on end the the short version is that you know I think that some of the first Clues were from my own personal experience that I had actually suffered from mental illness when I was a kid and an adolescent and young adult um and different diagnoses I had OCD I had chronic depression I had suicidality I had other things and when I was in my 20s even though I was normal weight I was exercising regularly and I was following a super lowfat diet I had metabolic syndrome um and I ended up changing my diet to AOW carbohydrate diet in El Las Stitch effort to see if it could improve my metabolic syndrome and I noticed dramatic Improvement in my mental health um within probably two or three years I started using that approach in some patients with treatment resistant mood disorders and personality disorders anxiety disorders and for some of them it was incredible the the results were incredible for the most part I laid low with all of that because I didn't understand the mechanism I wasn't really that that interested in trying to figure out a mechanism I recognized that this sounds like quackery I want to keep my job I don't want to lose my license I'm just gonna shut up about this and just treat the patients in front of me and still using very standard traditional approaches um including medication Psychotherapy ECT TMS all of it but for some Pat patients who were interested in changing diet or exercising or using other lifestyle interventions I was using them and then everything changed in 2017 when I helped one of my patients with schizo effective disorder lose weight and we ended up trying a ketogenic diet for a variety of reasons and within two to three months his psychotic symptoms were melting away his hallucinations and delusions were receding in a way that I had not seen in the eight years that I treated him and this man had been on clapene he had been on numerous antipsychotics he had been on lots of other classes of medications he had been in and out of hospitals including mlan Hospital which is top ranked Psychiatric Hospital in the nation here in the United States he had been in high-end residential treatment program so this man got the best of the best care and he was still ill and yet a change in his diet was making his symptoms go away and that told me okay I can't stay quiet about this I H like I almost have a moral ethical obligation to report this to the world but I also recognize no one will believe it so I need to understand the science and it was really that Journey that started in 2017 I have now treated over a hundred patients myself myself I'm collaborating with researchers around the world clinical trials are underway so I don't want anybody to think this is Chris Palmer's anecdote it it is way way Beyond Chris Palmer's anecdote that started the journey for me to not only treat more patients and see lifechanging remission of illness recoveries um but also to do a deep dive into the science and I set out on a path to just understand the science of how on Earth could the ketogenic diet treat something like a serious mental disorder and I ended up in a whole new place which was developing the metabolic and mitochondrial theory of mental illness which is amazing and one of the things you really point out in your book is sort of the common pathway the commonalities between psychiatric and metabolic disorders and you know you you say first of all that there are commonalities between all these different mental disorders whether we're talking about OCD ADHD depression anxiety schizophrenia bipolar I mean any mental disorder increases our chance of having another mental disorder from between two and 30 times according to your book which to you suggests a common Pathway to most um mental and neurological disorders and in fact you talk about the research of Caspian Moffet who talk about the P Factor right and so they say there is one common pathway but they couldn't identify what this was whereas you have come up with this Theory which identifies that P Factor as being you know and I quote from your book mental disorders are all metabolic disorders of the brain so how did you come up with this Theory based on your research and what does it actually mean what what is you know the sort of essence of this theory for the lay person so I think the most important thing to say is that this research is really about integrating all of the existing research that we currently have it is not new in some ways it should not be revolutionary it is simply looking over the past Century with all of the data we have accumulated all of those neuroimaging studies that we have been doing tirelessly all of the genetic studies that we've been doing based on the human genome what exactly do those genes do what are they doing that increases risk for neuros psychiatric disorders but also looking at psychological and social factors we know that trauma and childhood adversity increase risk for essentially all of the mental disorders depending on what phase of Life they occur in so you know something like autism spectrum disorder has to begin early in life but if abuse and Trauma begin very early in life that dramatically increases risk for even autism spectrum disorder but we also know that trauma and adversity early in life increase risk for all of the metabolic disorders obesity type 2 diabetes cardiovascular disease and premature mortality so this theory is about looking at things that we already know to be true the social determinance of Health all of the risk factors for mental health and putting it together in a coherent way and at the end of the day the sound bite is what you mentioned that mental disorders are metabolic disorders the brain and what that means that the science gets overwhelmingly complicated fast there is no question about it but if you do a deep dive into these tiny things in our cells called mitochondria you actually can begin to understand what would cause a neurotransmitter system to become become imbalanced why do patients with mental disorders have higher levels of inflammation and why do higher levels of inflammation cause mental disorders how does trauma and stress play into mental illness why do drugs and alcohol play such a critical role for in in illness um so in some ways it's about confirming but better understanding what we already know but once you see the big picture once you truly see the forest from the trees it opens up entirely new treatment strategies like dietary interventions like interventions that are focused on improving metabolism or metabolic Health interventions that are focused on improving mitochondrial health and so some of these are common sense lifestyle strategies but there are biotech companies actively seeking new medications that will do this that will play a role in this there are supplement companies and vitamins and other interventions that we can use red light therapy cold therapy saunas there are so many treatments that are available that we can use um so I think it's important to try to understand the big picture because it really does open up an entirely new world for people with mental illness totally and and so just cycling back a bit just to define a few things so you know me metabolism you know which is so crucial to this Theory so metabolism according to your book is the process of turning food into energy or building blocks for growing and maintaining cells as well as the appropriate and effici efficient management of waste products it's how our cells work and how we allocate different resources to cells to ensure our survival and one of things I loved about your book was you know how you talk about trauma and the stress response and how essentially what happens is that you know when we're in flight or flight when we're in a survival mode when we have chronically High cortisol from childhood trauma or adverse childhood experiences this detracts from our our rest digest rip um functions which are so essential metab metabolically and so the stress response has a very heavy metabolic toll it diverts energy and resources from you know the the really important functions of cleaning up our cells and detoxing our bodies Etc and so you talk a lot also in your book about underactive brain cells and overactive brain cells and sort of absence so can you explain sort of in the context of underactivity or overactivity in the brain and the stress response and metabolism and I know that's not a particularly specific question but if you can sort of touch on that so I think I think one of the important things is that there are there are many paradoxes in this Theory and one of the most prominent paradoxes is that if we go to the level of a cell if a brain cell is metabolically compromised few different things can happen and in terms of the immediate future of that cell so the next day two things can happen to that cell one is that or actually three things I guess can happen to that cell one is that it could function normally even though it's metabolically compromised maybe the demands on that cell are not that great and so it is able to perform its normal usual functions and that means if somebody has a metabolically compromised brain circuit under times of tranquility and low stress they may seem normal they may not have symptoms they may be fine then as soon as they are stressed that increases the toll or when you put increase demands on those brain circuits to do something um then the system can actually the cells can actually become underactive or overactive so underactive basically means as you stress those cells because they are metabolically compromised they can't keep up with demand they don't have enough ATP if you want to think about it in the simplistic way they don't have enough energy they can't do what they're supposed to do and that's the way most people would think about a metabolically compromised cell but the Paradox is that the cells and the Brain circuits can also become hyper excitable or overactive and because they require energy to turn off and that means that cells can actually do things that they are not supposed to be doing and it's a rule of thumb that means they can produce Sensations or experiences or cognitions that are not normal and that could be a panic attack for no reason that could be a psychotic symptom such as a delusion or a hallucination that could be um you know OCD symptoms and then the underactive brain cells can show themselves in other ways so underactive brain cells can show themselves in terms of memory impairment or deficits or lack of motivation or inability to pay attention those types of things um and in many ways the way that I came to that was again integrating I didn't just make it up out of thin air I I'm trying to integrate all of the Neuroscience that we've got we know with certainty people with mental disorders have underactive brain regions and overactive brain regions and we need an explanation of why but we also need an explan of why does it wax and wne if it is a permanent neurotransmitter deficiency or if it is a permanent change in neurotransmitter receptors we would not expect it to wax and wne and yet it does the symptoms do wax and Wayne for schizophrenia bipolar depression panic attacks all of the symptoms wax and wne for the most part and we need an explanation and in fact the metabolic theory of mental illness offers coherent explanations based on everything we know so sleep deprivation and stress and all of these other things can trigger symptoms um there it gets more complicated than that because there can be neurodevelopmental problems there can be neurodegenerative problems cells can die and atrophy as a result of metabolic dysfunction and those are the ways to help us understand both neurodevelopmental and neurodegenerative disorders so would you say for instance so neurodevelopmental disorder being for instance ADHD right which is sort of a huge problem in our societies all our kids are way overmedicated with ADHD meds how do you explain that in terms of your metabolic Theory so the so essentially it comes down to mitochondria and all of the roles of mitochondria now this may seem like shocking news to most people because there has been an explosion of research over the last 20 years that has completely shattered our understanding of mitochondria they are doing so much more in cells than any scientist ever ever imagined and if you don't know that fact that I just said that is why this may all seem incredible and like quackery even but if you do understand all of the different roles that mitochondria are playing then we can start to piece things together and so in the in the in the form of neuro developmental conditions like ADHD or like autism spectrum or other things mitochondria and Metabolism are playing crucial roles in the development of brain networks and in many ways that makes sense if brain networks are growing and thriving and branching out they require metabolic resources in essence they require food and oxygen because they have to grow new stuff they have to grow new cells they have to Branch out they have to make more neurotransmitters more hormones more dendrites more axons they are growing and thriving and so you have to feed them and if there is a problem with metabolism or more specifically if there's a problem with mitochondrial function there can be problems in the ways that those processes are occurring which can result in sometimes for some people permanent lifelong deficits so ADHD usually is not in my opinion a permanent lifelong deficit but something like autism spectrum can be that social skills appear to go through developmental window during which humans need to acquire social skills and we acquire what we get what we acquire whatever we acquire and if we don't get or whatever social skills we get at a certain time are the social skills we are left with for the rest of our lives and that in my mind May in fact be a permanent irreversible process us and in some ways it makes so much sense because social skill deficits or social skill differences in people with Autism they don't wax and Wayne people don't have good days in which they're socially skilled and bad days in which they have social deficits their social skills are pretty constant throughout time and that suggests that their brain is wired in a permanent and fixed way that way way and therefore it's unlikely that we're going to undo that or change that however for the other symptoms if a brain network is simply less strong than it should be um maybe because it didn't get adequate metabolic resources we may in fact be able to make that brain Network stronger we might be able to IND in other words what we would be doing is inducing neuroplasticity and if we can induce neur plasticity and help those brain regions Thrive and become more normal if you will and the important news like I could talk about it as a neuroscientist and I could talk about it in a Cell Biology way the reason that's important is because we can help people recover from what we call mental illness we can improve their lives and reduce their symptoms and reduce their suffering 100% and that's what we're going to get to um and before we go there because I there there are a couple of important things so so you've talked a little bit about ADHD we know for instance you talk about permanent versus recoverable you know and that leads me to think about dementia and Alzheimer's which we also know it has very strong metabolic and mitochondrial components so how do you explain dementia and whether it's recoverable or not in terms of your mitochondrial Theory so so diens is an ongoing process that actually is occurring over a period of decades and um and it starts with metabolic compromise in cells of the brain and it it's not just the neurons it's asites and other cells as well but metabolically compromised brain cells will begin to malfunction and therefore it shouldn't be surprising that the very first Hallmark signs of dementia almost always are psychiatric symptoms depression new onset depression in somebody 75 years old is almost always the first sign of Dementia in that patient if you follow them longitudinally even if they don't currently have significant memory impairment five years later there is a very high likelihood they will have dementia and what those types of studies have told us over the last 20 years is that new onset psychiatric symptoms are the first sign of impending dementia and so that starts with metabolic compromise but if metabolic compromise continues cells begin to shrink and then they can die if cells are shrinking if they are still alive there is hope for recovery living cells can heal it's called neuroplasticity if you've got a weak muscle due to a broken bone in a cast you can build that muscle up again and I think about it in the same way with brain cells so if somebody has very early signs of dementia if their memory is beginning to fail if they are showing other signs of psychiatric symptoms there is a very good chance that if we use metabolic approaches to treatment we might be able to slow that process and or possibly reverse that process now the challenge is that once brain cells have died once they have died there are few exceptions in the human brain in which stem cells can regenerate can generate new cells um hip campus and but there are very limited examples of that and so once brain cells are dead for the most part we're not going to resurrect them and that means that at some point in the process of dementia there will be brain tissue that is permanently lost now that doesn't mean we can't use metabolic approaches to slow the rest of the brain tissue loss possibly even reverse some of it we might be able to salvage some cells that are not yet dead so I think it really depends on where the person is on that spectrum of atrophy versus Cell death got it and so you mentioned all the roles of mitochondria and I just wanted to read a few out from your book you know they help regulate metabolism they help produce and regulate neurotransmitters which I had no idea about they help regulate immunity and inflammation um they help make release and respond to hormones they help create reactive oxygen species and clean it up they they do fusion and fishing so they grow and they go back together they play a primary role in genetic expression and so they can turn you know they're very important epigenetic factors essentially in turning genes on and off and they're obviously involved in cell growth and differentiation they eliminate old and damaged cells and they really modulate neuroendocrine metabolic inflammatory and transcriptional resp response to acute physiological stress so they're so important now tell me one of the things you do in your book which I think is brilliant is you talk about what impacts metabolism in mitochondria what creates mitochondrial dysfunction and then the flip side of that is that is the solution essentially so whatever damages mitochondria and harms metabolism you can then reverse and use to treat and to improve mitochondrial function function and Metabolism so can you give us sort of the top key things that really harm mitochondrial function and then how do we reverse it and and fix um their their function essentially so I I think some of the top things are diet and the details get really complicated fast in terms of what diet and so if you're looking for like tell us the one food to eat and that'll solve all of our problems it's not that simple so it's about foods that we eat foods that we shouldn't foods that we should be eating that maybe we're not foods that we shouldn't be eating that we are eating how much food we're eating the so diet exercise or lack thereof sleep is critically important lack of sleep is really bad and I put I would say the other huge category are toxic substances and those can be things that are irrefutable smoking cigarettes large doses of alcohol large doses of marijuana are toxic to the human brain and that is really undeniable whether smaller doses of alcohol and marijuana can be acceptable and I don't need to go there and debate that but um so the treatment for a lot of those is obvious so we can use dietary strategies but again I'm I'm using the ketogenic diet with with patients who have very serious treatment resistant chronic mental disorders in the same way that neurologists use the ketogenic diet to stop seizures in patients with treatment resistant epilepsy and the neurologists don't think of themselves as lifestyle medicine physicians they are trying to stop seizures and they are using anything and everything in their power to do that and when I talk about the ketogenic diet I actually think about it in the same way I'm not saying the ketogen enic diet is the best diet for all humans to be on I'm not saying everybody needs a ketogenic diet I definitely don't believe that um but I'm saying that the ketogenic diet can be a powerful Intervention when needed or when indicated many other dietary strategies Mediterranean diet reducing processed foods all of those things can play a role um in terms of exercise that's fairly obvious in straightforward get some movement don't sit all day terms of sleep sleep deprivation is a critical factor in the exacerbation and even the beginning of new mental disorders and so um but we know that sleep deprivation triggers so many mental disorders really across the whole Spectrum mood disorders psychotic disorders personality disorders Eating Disorders substance use disorders all of them get worse with sleep deprivation and so adequate sleep is really critical and then reducing toxic substances I think one of the most disruptive parts of my theory that I was actually not allowed to fully kind of express my real strong opinions on um but the most disruptive part of my theory is that we in Psychiatry prescrib medications that cause metabolic arm that is undeniable we prescribe medications that cause massive weight gain that cause type 2 diabetes that increase all of the biomarkers of cardiovascular disease and that cause premature mortality certainly in the elderly the FDA here in the United States has all of those warnings right on the package insert and so one of the challenges is well then Chris Palmer then your theory must be wrong because those medications are so good um well no that's actually the disruptive part of this theory is that um we we need to understand that in some cases the me the very treatments that we are prescribing for people can in fact be toxic substances to mitochondria and metabolism and therefore we need to be mindful of that and we need to develop a comprehensive treatment plan now for any of you who are clinicians or patients or family members you should you you all need to hear this do not stop your psychiatric medications on your own do not do that cold turkey it is a disaster it's a recipe for death it's a recipe for suicidality for psychosis for Mania do not stop your medications on your own however we might want to slowly reduce medications in a thoughtful and Safe Way um and we might want to prescribe medications that might be harmful to metabolism for shorter durations of time instead of telling patients you're going to be on this for the rest of your life we might only want to use it for a few months through a psychotic crisis when the patient is a danger to themselves or others we may very well use antipsychotics still but we might start to think about them the way with the way we think about chemotherapy chemotherapy can be life-saving but we are delivering poison we are trying to poison the cancer without poisoning the patient and in some ways I think that we need to refine our understanding of what we're doing in Psychiatry refine our understanding of the medications that we're prescribing and hopefully come up with better treatment strategies that ultimately promote health and healing and recovery and remission well well especially if you know if if you look at your your theory of metabolism and mitochondria and brain energy essentially as as Professor lustig would say you know these are these are essentially foodable or lifestyle rather than drugable and so lifestyle interventions and dietary interventions and sleep and exercise um are seem to be much more effective in terms of regulating metabolism and improving mitochondrial function than any pill that you can ever take and so I think you know that's really important to realize and I'm curious though as to why what are the mechanisms for instance of this ketogenic diet why does it work well um in terms of improving mitochondrial function if that's the way it works and also I I'm slightly conscious that you know maybe some people don't understand the concept of mitochondria ATP and so mitochondria sort of the power the batteries the Energy power cells inside our cells and they produce ATP which is sort of the the energy but as as you point out they do so much more so how do these dietary interventions especially the ketogenic diet work in terms of metabolism and mitochondria to to be so effective so I actually really hear your question is almost two separate questions and one is how do generic dietary interventions or dietary patterns impact metabolism and mitochondria and that may be more applicable to the masses and to General Health and Wellness kind of recommendations but then the other question that I hear is what about this ketogenic diet what is special about it and what is it doing because the ketogenic diet is actually mimicking the fasting state so we are actually mimicking no food we're mimicking no diet now obviously no diet and and actual fasting water fasting produces similar results but you can only fast for so long before you starve to death so the ketogenic diet in a way is almost trickery that it's a way to to to trick the body into thinking that you're fasting when you're really not so we can provide it enough nutrition but we're getting the benefits of the fasting State and so interestingly for for those who don't know this we know more about the effects of the ketogenic diet on the brain than we do any other dietary intervention and that's true because neurologists neuroscientists biotech companies pharmaceutical companies and others have been studying the ketogenic diet understand how on Earth does this diet stop seizures when our medications don't stop the seizures because they're looking for new mechanisms of action and so we actually know a wide range of things it the ketogenic diet is changing neurotransmitters it's decreasing inflammation brain inflammation it is changing gene expression it's changing hormones it's doing all sorts of things but Central to my thesis the primary target is that it is improving mitochondrial function through two processes one is called mitophagy which is the process of getting rid of old and defective mitochondria and replacing them with new ones and the other is something called mitochondrial biogenesis or the production of new mitochondria so bottom line when people are on a ketogenic diet for months or years their cells will actually have more healthy mitochondria at the end of the day and I believe that is the magic of the ketogenic diet that it helps those cells function more properly now getting back to the generic dietary recommendations we know that lots of sugar and processed foods are really bad for mitochondria and cells high levels of high fructose corn syrup are actually changing mitochondrial biology in adverse ways um alarmingly artificial sweeteners are increasingly being implicated in all sorts of bad things so we have we have good epidemiological data people who consume a lot of artificial sweeteners are more likely to have a broad range of mental disorders those are based on human studies epidemiological so we can't do randomized controlled trials at this point where we have half the people drink diet coke and half the people drink regular Coke that would probably never be approved by an Ethics board but in animal models we do know that something like aspartame which is ubiquitous in our food supply why in all the diet products the diet sodas and diet candy and other things aspartame increases the risk for anxiety disorders in mice and we know that it does that we've got brain Imaging that the amydala becomes hyp excitable in these mice that genetic changes are occurring the devastating news at least in the mice is that this gets transferred for two generations of additional mice even though the baby mice and the grandbaby mice are not exposed to aspartame so if your mother or your grandmother drank a lot of diet cocacola that means you may be at higher risk of an anxiety disorder because of her use of Diet Coke and God only knows what other substances are in our food supply that we just have no idea about and the microplastics that are in our food supply we know that those are doing all sorts of things including impairing mitochondrial function causing higher levels of inflammation and the microplastics are ubiquitous in our water supplies and everything else so unfortunately diet gets really complicated fast the great news is that we can clean it up and just eat real Whole Foods that's the recommendation eat real whole foods that is the key and you talk about fiber the importance of fiber to make berate and the importance of berate for mitochondrial function but in the keto diet there's not as much fiber so how do you explain that the keto diet is so um amazing for the brain if it's lacking in fiber and therefore in berate and there you know it or would you say that that's the wrong interpretation of the ketogenic diet I so I would say two things so one is it can definitely be the right interpretation of a ketogenic diet and for other people it's definitely not the right interpretation so there are people who are on vegan and vegetarian ketogenic diets they are getting more than enough fiber from plant sourced Foods um there are people on kind of omn or ketogenic diets which is usually what I recommend to people um which means that they might be eating a protein Source they might be eating sources of healthy fat but they are also eating low carbohydrate vegetables spinach lettuces asparagus cauliflower broccoli which all have more than enough fiber so for some ketogenic diets there's no question that the but the other thing is that the keto enic diet produces ketones and ketones are also a source of fuel for mitochondria and it may very well be that some people can do well on say a carnivore diet which has very little if any fiber it may be that some people can do well on that because the ketones and the fats from their diet are fueling the colonos ites and helping them function normally reducing inflammation and other things and speaking of inflammation what is the relationship because we all know that there's this huge correlation between mental health disorders and inflammation and we know now that you know depression anxiety bipolar all involve in inflammatory mechanism what is the relationship between metabolism mitochondria and inflammation it is all bidirectional um so I tend to think about it as a circle most people think of things as linear relationships so you get say Lyme disease that causes inflammation that causes your brain to malfunction and that's a line most of biology doesn't work in linear relationships instead it works in circles so you may get Lyme disease that causes inflammation that causes mitochondrial dysfunction that can cause your immune cells to now malfunction that can be a chronic source of inflammation that can allow the lime disease to not the the spet to not be cleared from the body and now you've got chronic Loop and so we have very good data actually a paper just published today 2013 in uh March 13 2024 in nature the mitochondrial complex one is instrumental in neuroinflammation um so mitochondria in micral cells plays an instrumental role in chronic neuroinflammation now this has implications for things like multiple sclerosis but also for schizophrenia bipolar alcoholism everything else so sometimes there's a clear cause of inflammation such as an infection long covid other things but other times when cells are metabolically compromised if your cells are metabolically compromised from a poor diet that will cause chronic inflammation and we know that that occurs that chronic lowgrade sterile inflammation is occurring in most at higher frequency at least it's not 100% of all patients but it's more likely to occur in patients with essentially all of the mental disorders but also owe all the metabolic disorders obesity diabetes cardio vascular disease um cancer that um these patients with metabolic compromise are more likely to have higher levels of inflammatory biomarkers understood and then to moving quickly before we go to the audience questions to the psychosocial um aspect so you talk about trauma and I was very interested to read the um Rachel Yehuda studies about intergenerational trauma affecting mitochondria um and the Gen IC expression in Offspring can you explain that a little bit and the role of trauma and acce in relationship to this mitochondrial dysfunction essentially so again I want to start with the common sense empirical observation so we know that high levels of trauma and adverse childhood experiences increase risk for essentially all of the mental disorders they also increase risk for obesity type 2 diabetes and cardiovascular disease and premature mortality so we need understand so those are facts they're called the social determinants of Health we have an abundance of data on that and we need to pull our heads out of the sand and reconcile that how is it that trauma can cause all of the metabolic disorders and the mental disorders and how does that work and increasingly we have evidence so this is probably one of the weaker areas of evidence like with hormones and neurotransmitters and infections those are easy to study and we can use animal models to study those trauma and stress are harder to study and it's harder to specifically attribute biological changes to the trauma but again the the the large epidemiological studies I just shared with you paint a very powerful signal of wait there's something probably here we do have evidence trauma and stress I think you kind of alluded to this a little bit earlier even so trauma and stress in the near in the short run they increase metabolic rage and they do that as a survival mechanism so that is through sympathetic innervation that is through catac colomines it is through cortisol and other things cortisol itself when you take isolated cells in a Petri dish and add cortisol the mitochondria actually start producing more energy in response to cortisol itself and in a way this makes sense it makes intuitive sense the organism is on high alert the organism needs to fight or flee that means we need energy ready to go we need energy mobilized we need glucose levels to be higher we need our heart rate to be higher we need to be ready to fight or flee and that is all adaptive there's nothing pathological about any of that however when it goes on for a prolonged period of time it starts to take a toll and resources are being diverted to this high heart rate these higher levels of glucose everything being ready to fight or flee even if you don't need to fight or flee um just being ready to is taking a toll um and in a in a simplistic way it's diverting energy that should be going toward maintenance functions toward restoring cellular health and brain health doing repairs detoxifying cells all of that instead of diverting sending resources to do that work the resources are being used for self-defense um and there are lots of granular details there are these things called stress granules that was kind of a pun um that that actually you can do a deep dive into some of the science of how exactly does this play out at the cellular level the good news is that we've got a lot of evidence that it does in fact play out but it's a way to help us understand that and then the treat but the treatment then again in my mind instead of just sending people to trauma informed therapy and have them talk about their trauma for some people that works and it works great and I don't want to stand in the way of that and if trauma informed therapy helps people heal and recover and go fully into remission I'm 100% for it but anybody who's in the mental health profession knows there are so many patients that that just doesn't work for they talk and talk year after year after year about their trauma and they are debilitated they are debilitated with both psychiatric symptoms and metabolic health symptoms they are more likely to be gaining weight they are more likely to be developing type 2 diabetes they are more likely to be developing cardiovascular disease and they on average are dying early deaths and what I'm saying is that we can more effectively help them if we target metabolism and mitochondria and we can do that through lifestyle interventions like Diet exercise sleep others but we may want to use supplements vitamins uh m andrial modulators red light therapy there are so many options that this Theory opens up and I like I feel like this is all available today let's do the studies let's get this going Let's help people now for the clinicians listening or for the patients we don't need regulatory approval for most of these treatments these are things that are available today you can try them yeah as a science I understand we're not going to get these treatments into clinical practice until we have more of an Evidence base and so I say let's start developing that evidence base now let's help these people heal and recover now and in your book you're absolutely brilliant about all the different lifestyle interventions that we can use and you talk about for instance the science of relaxation and the relaxation response and how that has been shown with blood samples to improve mitochondrial function reduce re active oxygen species Etc so you know I think it's so important to to look at your book and see the the many interventions that we can have and just before I go into these questions and there are quite a few um you know our current lifestyle is so overstimulated with screens and I worry about our children and our adolescence and the amount of stimulation that they're getting how do you then and you know this increase in ADHD so you have have a theory in your book which is very interesting so are they is their mitochondrial energy and their metabolic brain energy being drained by this over stimulation and or are they drawn to these screens as they may be drawn to drugs or alcohol in order to medicate a lack of metabolic energy in the brain and I I think the real answer is it's probably both I think again Vicious Cycles that somebody might come out of the womb due to maternal infection or maternal poor metabolic health so a woman who is overweight or obese has type two diabetes and gets an infection while she's pregnant is at higher risk that child is at higher risk of having a wide range of neuros psychiatric disorders including ADHD now so that child come out already predisposed the child's done nothing wrong there no shame no blame nothing and the poor woman she didn't know any better she's just doing the best she can so this this is not about blaming and shaming this is about understanding but this child comes out of the womb predisposed ADHD now is developing symptoms of ADHD the ADHD is going to make the child much more likely to go to the screen because the screen is fast-paced it's engaging you it it's it's designed for people with poor attention that's the people who are creating screens and the content that we see on these screens are creating it for a low attention span and so that child is now engaged with that now that child is not learning how to sit with his own thoughts he's not learning how to sit still he's not learning how to read he's not learning how to engage with other humans and make eye contact and have a back and forth conversation and so the screen itself is now contributing to the cycle and and contributing to the weakness of brain circuits or the lack of metabolic resources going to those brain circuits and that makes them even more vulnerable and then it's just a vicious cycle that can perpetuate itself there are many interventions that we can do for those children though interesting uh just in like a few a couple in a nutshell so couple would definitely look at diet obviously getting off that screen so let's start to limit the screen time even if that means a fussy or fidgety child um like that that means educating the parents means educating the parents and in a non-shaming way a non-judgmental way like hey we're all just here to help your child's been diagnosed with ADHD instead of just throwing pill after pill at your child maybe we could try to augment what we're doing or even replace what we're doing with some behavioral and lifestyle strategies that might help your child thrive in the future it's going to be a little more work than just putting a pill in his mouth but it's going to be well worth that work so we've got to we've got to educate the parents get them engaged get them motivated to do the treatments and so we're going to reduce screen time we're going to add exercise we're going to make sure the child is sleeping adequately because a lot of times when people are on screens they're not getting adequate sleep um and again all of that the lack of exercise the lack of Engagement with other humans the um the lack of sleep is all fueling this vicious cycle of neurom metabolic dysfunction so those are easy Common Sense strategies that we can begin to implement and we can start to at least slow the progression and or hopefully reverse the course and help these people heal and Thrive got it so what I'm going to do Dr Palmer is I'm just going to quickly read um all the questions that have come in and then you can answer them according to so the first one is how do you increase metabolism if blood illness causes inflammation of blood blood vessels which in turn reduces energy levels so maybe actually I'll try and just rapid fire um so that's the first one so if you've got a blood illness causing inflammation I would want to know what that blood illness is and there are different types of blood illnesses so a blood illness to me could be an infection a virus a bacterium a parasite um a blood illness could potentially be a hormone imbalance or something so it could be a toxic substance mercury poisoning microplastic poisoning other things um so I would want to understand what the root cause of that illness is see if we can address it um and if we can address it then that will help reduce the inflammation which will in turn start to break this vicious cycle and help people heal and recover but um but again all of the strategies that we've been talking about diet exercise sleep but vitamins supplements light therapy other things um all of those can be anti-inflammatory in the right circumstances and can also help to break the Vicious Cycle so it's anav vasitis um okay so thank you for this interesting talk my question is is it a diet that leads to the mental disorder or a mental disorder that leads to metabolic problems regardless but especially in the latter case would changing the diet be even possible so it's a great question and I think both are true again think vicious cycle as opposed to linear relationships so poor diet can lead to poor mental health but poor mental health due to trauma and childhood adversity can lead to metabolic problems even if the child is eating a good diet you can feed that child the cleanest diet whatever that is in your mind and if that child is being abused and tormented that child is at high risk for a mental disorder and once that child develops a mental disorder they are much more likely to develop all the metabolic disorders as well in that latter case can changing the diet be possible and can it help yes that is the good news we're talking about breaking Vicious Cycles so Cycles can start anywhere in the circle and then perpetuate and so is it possible it is one of the questions that I most commonly ask is Dr Palmer how can you get anybody to stick with a diet let alone somebody with schizophrenia that's impossible those people can't do diets and what I'm here to tell you is please please please do not underestimate people's determination to get better give give them a chance give have some faith in them and that means they deserve some support and encouragement and if they fall off the wagon if they break the diet don't give up on them don't you're gonna stand behind them just like if you're trying to get an alcoholic to stop drinking alcohol we don't say stop drinking that's the that's the end of my intervention the the the the intervention is clear we have we have tools and strategies and support and education and all sorts of things for them and there's no reason why we can't do it for these people and some dietary interventions even if a poor diet wasn't the root cause some dietary interventions like fasting intermittent fasting ketogenic diets and others can restore health because it's not it's about restoring mitochondrial Health exactly thank you Dr Palmer for explaining such complex Concepts in such a simple way my question is I'm a woman in my 40s is there a way to figure out my brain cell Health through scans for instance and then work out which diet whether the keto diet or some other diet I should follow for optimal mental health so it's a great question so Daniel Aman has spec scans that he offers through the Aman clinics um and uh his scans are actually measuring brain metabolism so they are in they are delivering a tracer um I talked with Dr aan he said after I read your book I turned to my chief scientific officer and said you know that Tracer that we're injecting into people does that have anything to do with mitochondria and his chief scientific officer laughed and said yes 70% of it is going into mitochondria that's precisely what we are measuring with our spec scans is we are measuring mitochondrial activity so his spec scans are measuring areas of lower metabol Health do you need a spec scan is less clear so it's nice to get that information but I'm not convinc a lot of people can't afford it so I just want to make clear I don't think you most people need it you know whether your brain is working well or Not by by like if you're thriving if you can remember things if your mood is good you probably don't have a brain metabolism problem or at least not one significant enough that you need to like address it if things aren't going well for you if you're having psychiatric or neurological symptoms then we already know we we've got a problem and now we need to come up with strategies can that brain scan inform whether a keto diet or some other diet is optimal no unfortunately we are not anywhere there we don't have genetic studies we don't have biomarker studies our field desperately needs that wants that but right now we can cannot prospectively say who will do best on what dietary patterns because dietary patterns can depend on your gut microbiome and we we know from lot from just even relatively small but very rigorously done studies one person can eat a banana and have a massive spike in blood glucose and then and another person can eat that same banana and have just a tiny increase in blood glucose and it it almost certainly involves the gut microbiome and levels of inflammation and hormones and so so many other complicated things so unfortunately it leads to a universal thing that I do say there is not a one siiz fits-all diet for All Humans for all health conditions we need to think in creative and open-minded ways and let people know that we will keep trying different dietary patterns until we find one that optimizes your health how will you know what's right your symptoms will get better your biomarkers will get better if you have high blood pressure and you try a new dietary pattern and your blood pressure comes down keep doing it that's a great that's a great biomarker of an improvement in your metabolic Health if your blood sugars normalize if you're pre-diabetic and now you're no longer pre-diabetic keep doing whatever inter you did got it apologies I miss on the talk and wondered whether you covered anything to do with relieving menop symptoms and in fact we haven't really spoken about the relationship between metabolism mitochondria and hormones and there's a big chapter in your book on that um which is fascinating but just to answer this lady's question um you know I guess the Rel relieving menopause symptoms using a sort of mitochondrial metabolic approach maybe definitely so so we know that estrogen so if you don't know this all of the steroid hormones are actually produced by mitochondria they they produ they control the first step in the synthesis of steroid hormones so those include cortisol estrogen testosterone and progesterone so but then steroid hormones go on to have effects on mitochondria and other cells and there's no doubt estrogen is a master regulator of brain metabolism m in men and women this is not a female thing but yes it definitely applies to women especially when they're going through menopause but it also applies to men estrogen is a brain metabolism regulator and so unfortunately when women go through menopause if they are vulnerable not all women have problems some women do just fine through menopause but if a woman is vulnerable to brain metabolism problems that means that as the estrogen goes down her brain is more likely to experience metabolic dysfunction which may reveal itself in the form of neuros psychiatric symptoms and that could be depression anxiety in some cases it could be bipolar disorder in some cases it could be migraine headaches and other things but um are there Strate IES yes I think if we focus on brain metabolic health so that's a broad category and there are many interventions diet exercise sleep stress reduction maybe reducing harmful substances and harmful substances is really important for this one some women may have been smokers all their lives and they think well I can tolerate smoking I never had problems before and now they go through menopause and they're still smoking and now they've got really bad symptoms I would actually say to that woman well you can't handle smoking anymore your brain can't handle Smoky anymore maybe you could handle it before but now with menopause you can no longer handle it so for some people just cleaning up lifestyle can make a big difference there's no doubt um using exogenous hormones hormone replacement therapy and others are definitely options I would ask you to consult with a medical professional who knows how to use them safely and wisely make sure we're paying attention to cancer risk and other things but um they can play a role for a lot of women got it so we just have time for a couple more questions um this has been fascinating thank you is there a way to balance a good diet with food taste and texture issues and could there be a link between the two and I wonder if she's maybe or talking sensory processing issues um does that make sense that's what I would assume so so there are definitely people who you know um uh even with avoidant restrictive feeding um and and other kind of Eating Disorders there are people who have trouble with food tastes and textures um and the real answer is yes it's a challenge there's no I'm not going to give you a simple cookie cutter kind of recipe I want to level with you yes of course it's going to be challenging to figure out what foods can we eat and how can we optimize this person's metabolic and mitochondrial Health but what I want to empower you with is knowing that the food that they are putting into their mouths and in their bodies is probably playing a profound role in the eating disorder itself and those people are stuck in in a vicious cycle those people are eating the wrong Foods that's that may be causing gut inflammation that might be affecting their brain function including their feeding centers and their hunger centers and their sensitivity to food textures and tastes and that is causing a cycle and so we may need to really be diligent about figuring out can we find a solution can we work with the person with food taste textures that they can tolerate for now in the hopes that we will restore health so that maybe two years from now they'll be able to tolerate a more normal diet with more with with more varied food tastes and textures there is no doubt that that can happen for a lot of people I know people for whom that has been the case they were stuck in a vicious cycle of an eating disorder um or restrictions around certain foods and in by restoring their metabolic Health they got to a point where they became much more tolerant of changes in diet and they could go out to eat with friends and family for the first time ever and um so although it can be frustrating and although it can take some time and detective work to figure out what can we how can we do this it's worth the effort and I just want to say you're not wasting your effort There's real reason to think that changes in diet could play a powerful role in some of these patients and it is so unfair because of course if you're metabolically compromised you're craving sort of quick fixes and sugar and of course that's what you go for right and that's the worst thing that you can have absolutely um so as um you were saying that sleep deprivation is not good for mental health if you're someone who suffers from regular poor sleep despite good sleep hygiene what else should you try is medication or melatonin worthwhile in the short term or does it make it worse so medication can be helpful for people with acute stress induced insomnia so if if you are traveling and you have jet lag and you know that medication can help you get back on a regular sleep cycle go ahead and use it if you're going through a really stressful or traumatic event and you're unable to sleep and medication can help you sleep I'm all for it but if you have chronic sleep problems even with good sleep hygiene what that tells me is that there is something wrong metabolically or mitochondrially there is something wrong and um and I would really encourage you try to figure out what that something wrong is and fix it now for some people it could be a light exposure thing so it the the simplest solution I have is use bright light therapy every morning to try to regulate your circadian rhythm and then that means two hours prior to bedtime no minimize light exposure no computers no television no phone you probably are thinking that would be so boring yes it would be boring and you'll it'll be so boring that you might get sleepy and want to go to bed and and then guess what you'll go to bed you'll give into your body cues and you'll go to bed and Hope you'll get a good night's sleep um now substance use plays into poor sleep so if you're drinking caffeine Beyond 10: a.m. stop drinking caffeine Beyond 10: a.m. um and that's in all forms of caffeine so coffee tea soda um does is that a universal rule for All Humans no if you are able to drink coffee in the afternoon and not have any problems go ahead keep doing it but if you're having trouble sleeping then maybe you need to pay attention to your substance use use of alcohol is horrible for sleep and sleep um sleep cycles so if you're drinking alcohol at all I would encourage you to give up alcohol for at least two weeks and see if that can normalize your sleep if your sleep normalizes after that two we period and then you reintroduce alcohol and you have trouble sleeping again well now you've got a decision to make you know what the problem you know what's causing it and you have to decide would I rather sleep or would I rather drink alcohol um or can you find the right balance can you drink less or could you drink other types of things or you know so it gets complicated fast but those are some very straightforward strategies that I've seen work countless times and a very final question which is more sort of a comment about adult ADHD and the ability to hyperfocus versus get getting distracted by other things you know I guess how do you explain that in terms of your metabolic energy um Theory you know this sort of ability to hyperfocus versus the distractability and the fact that ADHD is not just neurodevelopmental some people have it for their whole lives so some people do have it and um for their whole lives the um the ability to focus on things is regulated by brain circuits and again what I'm arguing is that when brain circuits are metabolically or mitochondrially compromised they can become overactive and underactive so they're not one cell is not simultaneously overactive or underactive but one cell in the course of a day could be underactive for 90% % of the time and then hyperactive for 10% of the time and so the hype I'm I'm wildly speculating now and I just want to make that clear like I don't think we really fully understand why are people with ADHD able to hyperfocus when they're unable to focus at other times but that Paradox that I just described at least offers one possible explanation um that uh it I mean I could come up with other possibilities the real an the real answer is no one knows the real answer is we don't fully understand why that happens what we do know is that it does happen it is a thing and people with ADHD can sometimes not always but some people with ADHD can have sustained periods of hyperfocus and Hyper productivity and if they're doing something really useful and productive like schoolwork or a business project or work product it can be extraordinarily useful if on the other hand they're playing a video game with hyperfocus um I'm not sure that that's really serving them or Society all that well agreed Dr Chris Palmer you are amazing thank you so so much for your time thank you to the health to Academy thank you for to you you are wonderful your book Brain energy is a must-read I have to say and keep doing the wonderful work you're doing in the world and we're all incredibly grateful to you for pioneering this approach and changing lives and revolutionizing mental health so thank you [Music]

Channel: The MindHealth360 Show

Views: 6,278

Keywords: How Does Metabolism Affect Mental Health?, Metabolic Psychiatry, Metabolism and mental illness, The impact of metabolic disorders on mental health, How metabolic changes influence mental health conditions, mental health, mental health and addiction, mindhealth360, kirkland newman, Chris Palmer, Brain energy, Anxiety, Depression, OCD, ptsd, ADHD, Dementia, Metabolism and mental health, Brain metabolism, Metabolic brain function, How does metabolism impact mental health

Id: IvJRVKLd7AI

Length: 76min 55sec (4615 seconds)

Published: Wed May 15 2024