My guest today is Harvard medical physician Dr. Chris Palmer. Dr. Palmer has extensive experience in psychotherapy and psychopharmacology. Paying close attention to the impact of the ketogenic diet on epileptic patients Dr. Palmer started exploring improving the lives of people suffering from mental illness with the same nutritional approach. The ketogenic diet is the most well-studied diet by neuroscientists for epileptic patients for 100 years. Dr. Palmer explains that it’s not just the body that has a metabolic function but so does the brain. His latest book, Brain Energy, is an extensive science book for the general public. He treats patients with mild symptoms of depression, OCD, and eating disorders to patients who have severe conditions of bipolar disorder and schizophrenia. He has renewed his energy and excitement about the possibilities of truly helping people in the field of mental health not just with medication but with lifestyle. Enjoy!
Listen to the episode here:
- Journey to Studying the Mind [00:06:05]
- People are not Getting Better [00:14:57]
- Mental Illness Episodes Triggers [00:18:13]
- The Link Between Food and Mental Health [00:21:10]
- Brain Energies [00:24:03]
- Metabolic Brain Disorders [00:31:10]
- Treating Insulin Resistance [00:35:31]
- Opening Minds [00:40:01]
- Mental Health in the Advent of Social Media [00:47:23]
- Chronic vs Mild Mental Disorders [00:53:56]
- Communicate with Healthcare Providers [01:00:50]
- Starting a Mental Health Movement [01:05:45]
How We Are Changing the Mental Health Space at the Interface of Metabolism & Psychiatric Disorders with Harvard Psychiatrist Dr. Chris Palmer
“As a clinical psychiatrist, I have been frustrated as hell for decades. I’ve been frustrated as hell because our current treatments fail to work for far too many people and that is the reality. Why are people not getting better? I’m giving them the pills like I was taught. I’m doing psychotherapy like I was taught. If you look at the long-term studies, if you look at the overwhelming body of literature, it’s not just me that’s not getting people better but it is the mental health field that’s not getting people better. Our current treatments don’t work that well even for bread-and-butter diagnoses like depression.”
“The most shocking thing was that 6 to 8 weeks into the diet, it didn’t happen overnight, he spontaneously reported that his long-standing hallucinations were going away and his paranoid delusions were also going away. He began to realize they weren’t true and probably never have been. This man went on to lose over 160 pounds and keep it off to this day. Check success for weight loss. Much more importantly, he was able to do things he had not been able to do since the time of his diagnosis. He could start going out in public and not being paranoid and terrified. He was able to complete a certificate program and was even able to perform improv in front of a live audience.”
“I’ve now seen, treated, or corresponded with dozens and dozens of patients with chronic treatment-resistant mental disorders like schizophrenia, bipolar disorder, chronic depression, OCD, and others who have put their illnesses in full and complete remission off of psychiatric medications by using dietary and other lifestyle strategies.”
My guest is Dr. Chris Palmer, he is a Harvard Medical School physician, and has extensive experience in psychopharmacology and psychotherapy. What Dr. Palmer has been concentrating on for a long time is working at the interface of metabolic disorders and what most of us know as mental disorders. A lot of people don’t think that these things are related and that there is a lot of scientific evidence linking these.
The other thing he’s been looking at that’s pretty old is the ketogenic diet to help navigate this and use that to support people’s mental health. You and I hear the word keto and we think it’s a diet that’s been pushed on us to get ripped, lean, build muscle, lose weight, or things like that and it’s not. It’s a 100-year study diet by neuroscientists who were trying to help patients manage epilepsy and seizures. They don’t have a ton of margin for error because it was like, “Ketones for the brain to support the brain.” Keeping people in ketosis was so important.
Now, Dr. Palmer is saying, “We’re seeing that the ketogenic diet can be a treatment for psychiatric disorders.” He’s experienced that in his own practice. Yes, he does see people with mild depression, OCD, or things that would be considered more mild or manageable. He also has extreme people who are navigating bipolar disorder, schizophrenia, or things like that. He’s certainly not saying, “Everybody, eat steak. Get off all your meds.” What he is saying is that there is a strong correlation and that we can start to understand that our body has a metabolic function but so does our brain.
He has a new book called Brain Energy. What he says is this is a science book for the general public. I love his passion and enthusiasm. He’s bulletproof. He says to me in the show, “I’ve never seen anyone thriving on twelve medications.” I’m like, “Your peers.” He’s like, “I meet them with the science.” I appreciate that. I don’t want to get woo-woo like the next person. It’s people like Dr. Palmer who can break it down and say, “This is what is happening in your microbiome with your insulin levels and in the metabolic function of your brain.”
He’s inspired. He has patients who lose weight. They lessen their dosages and they get off medications. One thing that was pretty funny was he said that some patients were 5 to 7 years and I go, “What would happen after 5 or 7 years?” He goes, “Because they thought they were totally healed, they would go off the diet and have an episode.”
It makes me hopeful because I know a lot of people. We either are managing it ourselves or we know someone who is dealing with depression or a mild version of it. Doctors are quick to hand you a prescription and they’re tough on you. They can be tough on your body and then put you in that cycle. I learned a lot. I laughed. Dr. Palmer is in the real conversation and he’s not afraid to share his point of view. I hope you enjoy.
Dr. Palmer, welcome to the show. Thank you for joining me.
Thank you for having me on the show.
As someone who’s gone to as much school as you have, you’ve earned it, maybe you could share your path and journey to where you are now. I always find it interesting when you have people who maybe get into medicine, a practice, or a field, and then as they go deeper, it brings them into another part of the journey to maybe support their interest maybe even in a way that surprises you. I love to hear about that.
My day job is that I’m a Harvard psychiatrist. I’ve been a psychiatrist for over 27 years. I’ve been involved in a variety of different types of academic medicine. I’ve done neuroscience research for fifteen years. I’m the Director of Continuing Education at McLean Hospital, which is one of the top-ranked psychiatric hospitals in the world. I’ve always done clinical practice. In some ways, I am a tried and true traditional academic psychiatrist. In many other ways, I’m not.
The way that I got involved in some of the work that I’ve been doing, one of my claims to fame is that I’m using the ketogenic diet as a treatment for serious mental disorders and mild mental disorders too but I tend to get the serious patients and the ones with treatment-resistant mental illness. I’ve been using this treatment for many years now. All of it, every step of the way, was serendipity. It started with my own journey years ago when I started a low-carb diet because I had metabolic syndrome. Not only did it get rid of my metabolic syndrome but I noticed dramatic changes in my mood, energy concentration, and sleep.
When I began to notice similar effects in other people who were friends and family who were using the diet, I started to wonder, “I wonder what this could do for people with treatment-resistant depression.” I have a lot of those people in my clinic and they’ve already tried dozens of meds and some of them have tried shock therapy and decades of psychotherapy. I’m like, “We don’t have anything else to try on them. We’re out of options. This seems novel. I’ll try the ketogenic diet on them.” Lo and behold, not 100% of them but for some of them, it worked and worked in a powerful way.
[bctt tweet=”When you restore metabolic health, addictions can go away, or addictions can get a lot better. This includes addiction to things like alcohol.”]
My entire world as an academic psychiatrist was shattered though in 2016 when one of my long-standing patients with schizoaffective disorder asked for my help to lose weight. He was tormented by his illness. He had tried seventeen different medications and none of them worked for his symptoms. He was tormented by hallucinations and delusions and gained a massive amount of weight. He weighed 340 pounds.
I’ve been using this for depression. I didn’t think it would do anything for schizophrenia because that’s a different disorder, that’s hallucinations and delusions. There’s no way that would do anything for that. Lo and behold, within two weeks, not only did he start losing weight but I noticed this powerful antidepressant effect in him too and I thought, “That’s interesting.”
The most shocking thing was 6 to 8 weeks into the diet, it didn’t happen overnight, he spontaneously reported that his long-standing hallucinations were going away and his paranoid delusions were also going away. He began to realize they weren’t true and probably never had been. This man went on to lose over 160 pounds and keep it off to this day. Check success for weight loss. Much more importantly, he was able to do things he had not been able to do since the time of his diagnosis. He could start going out in public and not being paranoid and terrified. He was able to complete a certificate program and was even able to perform improv in front of a live audience.
Out of curiosity because there are people who struggle with this to various degrees. For him, was it that he had no information truly about nutrition? I know this impacts a lot of people. Why did this time, when he asked you for help, he was able to follow through? Was it because you gave him a clear map or he was ready? What did you see as to even why he could do it this time?
The biggest luxury that I had and the benefit to him is that, as a psychiatrist, I have the luxury of seeing him every week for 50-minute sessions. He wasn’t working with a dietician at that point or anything. I was able to coach him, monitor his ketones, and monitor his weight. I was checking blood ketones and blood glucose levels so I could give him clear feedback. It was not a smooth journey, I want to make that clear.
What journey is smooth?
For him, it was even rockier because of his illness. There were times when he went off the diet and would get much more psychotic as a result of going off the diet. He lost a massive amount of weight and that was his initial goal. For him, it was a treatment for his brain disorder. The way that I look at it for any of your readers who may not be familiar with this is ketogenic diet is not only a weight loss diet, it’s an evidence-based treatment for epilepsy.
It can stop seizures even when other medications and other treatments don’t stop seizures. In that way, it’s nothing new in psychiatry because we use epilepsy treatments all the time. When people are using it for brain disorders like epilepsy, they can’t cheat. They can’t cheat weekends because the seizures come right back. A cheat day means seizing. For him, a cheat day meant psychosis, which was not pretty.
That’s important, what you’re saying. Everybody loves to put things in a box so it’s the keto diet, Atkins diet, and all these things. It’s important for people to understand. It’s been close to 100 years of real understanding of what a ketogenic diet and the impetus was not that you can be slim and rich, it was for, specifically, epilepsy. It’s important for people to separate. It happens to be called the keto diet. However, it’s about eating a certain way where you can get these positive effects whether it’s mental health or cognitive. Yes, you can have weight loss and things like that. It’s important.
Sometimes things get trendy and people are like, “If I eat a sweet potato, am I going to be kicked out of ketosis?” They get psycho and it becomes all of these things around, “I don’t touch carbs.” At a certain point, that gets almost unhealthy in its own way. I appreciate that there’s so much that is known about this specific diet, I would imagine almost more than any other diet. When you say that, in 2016, it shattered, I get that it would open up all these possibilities.
I am also curious because sometimes a lot of us in whatever we’re doing, it’s like, “This is how we do it.” There are the norms and these are the practices. I want to talk about the book that you have. How do you go from saying, “I was traditionally trained.” Maybe you’re more open-minded too, “We might need to course correct or change things.” I would imagine your peers aren’t like, “Great job, Chris. This is such a good idea.” How do you find the courage or the confidence to say, “I’m going to follow this and talk about it even more.”
There’s so much that you talked about that I could unpack but the quick version is that, As a clinical psychiatrist, I have been frustrated as hell for decades. I’ve been frustrated as hell because our current treatments fail to work for far too many people and that is the reality. Why are people not getting better? I’m giving them the pills like I was taught. I’m doing psychotherapy like I was taught. If you look at the long-term studies, if you look at the overwhelming body of literature, it’s not just me that’s not getting people better but it is the mental health field that’s not getting people better. Our current treatments don’t work that well even for bread-and-butter diagnoses like depression.
Where I was coming into this with is an underlying sense of frustration. Why can’t we do better? Why can’t we get people all the way better? Why can’t we restore their lives? I’ve resigned myself that that’s never going to happen in my lifetime. Because the brain is so complicated, there’s no way anybody’s going to figure this out, and certainly not in my lifetime. I certainly didn’t think it might be me. That’s where I was.
It wasn’t just this patient. I’ve now seen, treated, or corresponded with dozens and dozens of patients with chronic treatment-resistant mental disorders like schizophrenia, bipolar disorder, chronic depression, OCD, and others who have put their illnesses in full and complete remission off of psychiatric medications by using dietary and other lifestyle strategies. That is the thing that upended my world. Diagnoses like bipolar disorder and schizophrenia are not supposed to go into full and complete remission period.
Even with treatment, even with medications, they’re supposed to be chronic lifelong disorders. We know that our treatments don’t cure anyone of bipolar disorder or schizophrenia. They don’t go into full and complete remission. I was seeing patients who were getting off medications and were in complete remission, sometimes for years, and one patient for fifteen years.
For an understanding for the householder like me on this topic, if you say for 15 years or even 5 years somebody goes into remission, do they get maybe triggered into an episode? Is there loss or something occur that sometimes can happen? Is it chemical or hormonal? What would kick someone into either an episode or for something to change?
There are lots of things that can trigger an episode of mental illness. Anybody who’s already had a mental disorder is going to be at higher risk for developing that same disorder again sometime in life. If they go off their treatment plan or whatever it is, they are at higher risk for that thing coming back. There are lots of things that can trigger it like if you’re using the ketogenic diet as your treatment strategy and going off the ketogenic diet.
I’ve had patients who were like, “I’m better now. I can eat whatever I want. I’m going to have a pizza party and I’m eating pizza.” Within twelve hours, they were a psychotic mess in bed, disabled, and paralyzed from their mental symptoms. For other people, it can be sleep deprivation for whatever reason. It can be sleep deprivation due to stress but it could be sleep deprivation due to traveling and jetlag. It could be sleep deprivation due to drug or alcohol use or something else.
Sleep deprivation, we know, triggers episodes. Stress can trigger episodes. Using substances can sometimes trigger episodes, especially recreational drugs. There are lots of things that can trigger them. The good news is that all of you know that already. Everything I’m saying is obvious common sense. People can learn how to take care of themselves and do it.
They have a way back. It’s funny, you use the word common sense. We always joke that common sense is not so common, it’s everywhere. We see the way the world runs. It’s like banging yourself on the head with a hammer and wondering why you have a headache. We see a lot of that behavior in our world. I want to go back to you. Part of your job, I would imagine, is reliant upon prescribing medication, that’s the way it is.
When you come out with this and you’re watching this and understanding it for yourself and seeing the story for yourself over and over, how do you have the courage? I’m sure that’s not overly popular. Also, some of it we’ve been doing for 25 or 30 years let’s say with your peers. It’s not right. Nobody wants to hear that. Do you come in like a freight train? Do you come in gentle? How do you proceed forward? A lot of times, I would imagine that can be a lonely journey at times.
A lot of people in the low-carb keto space do have lonelier journeys, there’s no question about it. The shocking thing for me is that I’ve gotten to meet many important people. I have received a tremendous and overwhelming amount of support for the work that I’m doing. I’m collaborating with researchers around the world. I have philanthropists and rich famous people who have reached out to me and want to support this work. I would never have met these rich and famous people if I wasn’t doing the work I’m doing.
When I give presentations to colleagues, I build credibility and excitement. People are excited about this. One of the reasons that I’ve been successful at doing that is that I’ve always remained a scientist. I’ve never said something like sugar causes schizophrenia because I knew that would not fly with anyone. I don’t say junk food causes mental illness because that won’t fly with anyone, at least not in the mental health field.
Instead, I had to do a much deeper dive to understand what exactly is junk food or excessive sugar intake doing to metabolism or to brain cells that might result in the symptoms of mental illness. The great news is that I had decades of neuroscience research from the epilepsy literature to fall back on. I could legitimately use hardcore neuroscience to defend exactly how and why the ketogenic diet is helping the patients that I’m seeing in front of me. To get back to your point, I’m about to publish this book and the book is going to be a freight train and I may not get a warm reception.
What I appreciate about Brain Energy is that you said that it’s a science book for the general public. You didn’t get kitschy, “Here are ten ways. Say no to sugar,” all the stuff that sometimes is a tendency because it sells and people can digest it easily. You went for it in this book. When you say that the group that likes support of pharmaceuticals is going to be unhappy, it’s a freight train, and it’s coming, is that who’s going to be unhappy?
Most mental health professionals and the world at large, people who are suffering from mental disorders, or people who know somebody that they care about or love with a mental disorder, my hope is that people will be excited about this book and about this theory. This theory, somebody called it provocative. It’s highly disruptive to the mental health field. I take on the diagnostic criteria and I’m arguing that the diagnostic labels that we have are not valid constructs. I’m not alone in saying that.
Break that down for me a little more so that we can understand a little more what you mean by that.
Let me start by saying I’m not alone in what I’m about to say. The National Institute of Health abandoned DSM diagnostic labels over a decade ago recognizing that they are not valid disease entities. On the surface, what that means is that schizophrenia, bipolar disorder, depression, alcoholism, and anorexia nervosa are not as distinct disorders as everyone thinks they are. On the surface, they make sense.
As I say those labels and as I say those words, everybody has a sense for, “That’s somebody drinking too much. That’s someone starving herself. That’s somebody hallucinating or having delusions.” On the surface, the labels are helpful and they make a lot of sense because they describe some symptoms that are important that can be disabling symptoms but they also help us understand how to better treat these people.
There are three problems with our diagnoses and our diagnostic criteria. One is something called heterogeneity and another is something called comorbidity and then another is the validity of these diagnoses. Heterogeneity means that if I look at two people with autism, for instance, they can look wildly different from each other. One person with autism can be living in a group home, can also have seizures, can have mental retardation, and can be unable to care for himself.
Another person diagnosed with the exact same disorder, autism, can be a billionaire who we all know, love, see on the news every day, and this person is one of the most successful human beings on the planet. It doesn’t make sense that we give that same label to those two human beings. Clearly, both of them have differences in the way they act, respond, behave, or whatever compared to “neurotypical” or “normal people.”
Those differences are useful to acknowledge because sometimes they can be helpful for that person to understand, “I am a little different or other people are different from me.” To suggest that those two human beings have the same disorder is silly. The same goes for two people with schizophrenia. The same goes for two people with depression. For two people with depression, one of them can be oversleeping and overeating and the other can be undersleeping, only getting a few hours of sleep a night, and can be losing massive amounts of weight. Yet, we could still say they have major depression. The symptoms can start to get wildly different. That’s heterogeneity.
The comorbidity part is that when you look at any real people with these disorders, most of the people who get treatment for mental health conditions have more than one diagnosis. On average, they have about 3 to 4 diagnoses. That means the person with anorexia nervosa also has major depression and she also has a touch of OCD and maybe she’s got alcoholism as well. We say that she’s got four different disorders but, in fact, she’s only got one brain.
When you look at people who have anorexia, almost all of them have more than one disorder. She’s not alone. She’s not just an unlucky individual who developed four completely different disorders all at the same time. She and all of the other people are developing all of these disorders. You can mix and match them however you like.
The third major problem with our diagnostic criteria is that if you look at root causes such as specific genes that confer risk for mental disorders, one specific gene does not confer risk for any one disorder. There’s no gene for schizophrenia and another gene for bipolar disorder. In fact, there are some high-risk genes but one gene can confer risk for schizophrenia, bipolar, depression, alcoholism, epilepsy, and autism. One gene confers risk for 5 or 6 different disorders.
Even if you look at the psychological and social causes of mental illness like trauma in childhood, somebody who has a horrible and abusive childhood, that person is at risk for developing all mental disorders, not just PTSD but also depression, alcoholism, bipolar, and even schizophrenia. When we look at real people with these disorders, we look at root causes, our diagnostic labels start to fall apart, and we start to realize they’re not valid constructs.
When you talk about this, it is a lot to take in. If you’re trying to diagnose someone and treat them, you’re trying to narrow in on what’s going on. By saying this, are you suggesting that maybe we can talk about the way it’s expressing itself but it’s more about trying to focus on which part has disrupted this person, which system, or which part of the brain versus slapping this one label on and saying, “This is the medicine we give for this.” Does that make more work for you by taking away these general diagnoses for the therapist?
No. It makes it so much easier. In a nutshell, what I’m arguing is that all of the mental disorders that I’ve been talking about so far are metabolic brain disorders. Once you understand that, you can understand why you can mix and match them and you can understand why people develop more than one of them. Much more importantly, we can develop treatments that start to address all of the disorders at the same time.
[bctt tweet=”What I’ve done is painted a broad overview, an outline of a rigorous scientific theory that I am convinced holds weight. I’m not alone.”]
If that’s hard for some people to wrap their brains around, let me give you one clear example that a lot of people understand. Diabetes is one illness, one diagnosis, and one disorder. People who have diabetes are more likely to have liver problems, kidney problems, nerve problems, brain problems, and problems with infections.
You could say they’ve got five different disorders, they’ve got a liver disorder, a kidney disorder, a nerve disorder, a brain disorder, and a diabetes disorder. Those are all different and they probably all need different pills. We need different treatment strategies for all five of those different disorders or you can understand that they are all interconnected through metabolism.
Once you understand that they’re all interconnected through metabolism, we use diet, exercise, good sleep, stress reduction, and other techniques to help that person reclaim their metabolic health. If you can do that, guess what you’re going to do? At the same time, you’re going to treat that liver problem, kidney problem, nerve problem, brain problem, and diabetes problem. You’re going to treat all of them at the same time because you’re getting at the root cause. It’s a metabolic problem.
What I’m arguing is that people with mental disorders have different areas of their brains impacted by metabolic abnormalities. Yes, people have different symptoms and we do need to take those seriously because different symptoms sometimes require different treatment strategies. They certainly impact people in different ways. Some can make people a danger to themselves or others, whereas others don’t. We need to acknowledge that and take it seriously.
When we take a more overarching broad approach, it ends up being like treating diabetes, the liver, the kidney, and all the other things. We can treat it all at the same time with comprehensive strategies that are not that difficult to understand. They can be difficult for people to implement but they’re not that difficult to understand.
I have to say that I’ve had a lot of conversations around self-care, health, fitness, ad wellness, you name it. I talked to a gentleman that you probably know, Dr. Benjamin Bikman. It’s great that everyone’s monitoring their glucose but staying insulin sensitive or the fact that many people who become insulin resistant wreaks havoc on people. For some people, it could be overweight. For some people, it turns into diabetes. For other people, maybe it turns into cancer. The root cause might be similar and express itself in multiple or many different ways. You also believe that becoming insulin resistant, and this is oftentimes connected to what we’re eating, can mess around with your mental wellness.
Yes, and we have good evidence for that. We’ve known since the 1800s that people with serious mental illness are much more likely to have diabetes and people with diabetes are much more likely to develop serious mental illness. Those two disorders run in the exact same families. That’s been known for a long time. Recent research over the years has shown insulin problems in the brains of people with serious mental disorders.
To give you one clear example that highlights the power and the hope of this understanding, this new understanding, is there was one study that followed 5,000 kids for over 24 years and they were measuring levels of insulin in the kids. Beginning at age 9, the kids with the highest levels of insulin were five times more likely to have a psychosis-at-risk mental state.
That means they’re at risk of developing schizophrenia or bipolar disorder by the time they turned 24. They were three times more likely to already be diagnosed with schizophrenia or bipolar disorder by the time they turned 24. We can measure insulin resistance in kids today. This means that if we could reverse that insulin resistance in these kids, we might be able to prevent that kid from having a psychotic break and from developing schizophrenia or bipolar disorder.
Even though the risk for schizophrenia and bipolar disorder is not huge, it’s not like 100% of that group of kids were developing these psychotic disorders, we know that high levels of insulin resistance confer risk for obesity, diabetes, cancer, and everything else. It’s a one-size-fits-all treatment. We treat the kids with diet, exercise, and other lifestyle strategies. We get their insulin resistance down and we are probably going to address a whole host of health problems by doing so. Mental health problems, even severe and serious ones, are included in that list.
Sometimes when I hear this, it’s like, when you cross the street, look left and look right. The messages are out there. I could be wrong but food seems to be showing up, at least in the conversations I’m having, as the number one. If someone came into you and you’d say, “This is what we’re going to do.” You encourage movement or some form of exercise.
Maybe because the drug is the food. The stuff that tastes the best, the most accessible, and costs the least is the one that crushes us the most. You have to put effort into getting the good stuff and you have to learn. Also, there’s stuff that is snuck into everything. I always joke that organic salad dressing could have vegetable oil and you think you’re doing yourself a favor because you’re having a salad but you’re eating the wrong oil and now you’re in inflammation and whatever.
You’re optimistic and you’re like an upper. You must see it so many times and it’s obvious to you and there’s so much common sense. I always say, all hands on deck. We all have to participate in this and we all need to try to be better so that we can all help each other. How do you keep that levity, that lightness? Is it because you’ve seen people get better? You must see people and go, “Are you serious? You don’t understand how Diet Coke and Doritos are not helping you.” More importantly, how do you get through to people finely?
You’re hitting the nail on the head. It is a challenging issue. The reason I am hopeful and light is because, up until now, our field still tells people with schizophrenia and bipolar disorder, “You have a chronic lifelong disorder. There’s nothing we can do for you. Sorry. Sucks to be you. You’re going to be disabled.” I’m hopeful that at least the people who want to do the work, the people who want to open their minds to a new treatment approach, the people who want to open their minds to the detailed science and understanding that science because it can lead to a very much better life, I can at least help them. They’re the first wave that I’m trying to help, the people who will do anything to get better.
What they’re being told right now is highly ineffective and sometimes, sadly, detrimental to their mental health. They’re being told, “Take more pills. If ten pills aren’t doing it, let’s add 2 more pills and see if 12 pills will do it for you.” That does not work. Sorry, folks, recovery is not as simple as taking twelve pills. I wish it was but it’s not. That is pretty much across the board. I would challenge anybody to find me somebody who is happy, healthy, and thriving on twelve pills. I honestly and legitimately have never seen it in over my 27-year career.
You’re right, there are other people who are going to struggle with this. The mental health field may resist this message. I’m trying to upend the diagnostic criteria. I’m also upending pharmaceutical approaches, at least in some cases, to the treatment of these disorders. Pharmaceutical companies are multi-billion dollar companies. Even with the best of intentions, they’re not going to give up their multibillion-dollar industry for Chris Palmer. They’re not going to go down without a fight.
They’re not going to give that up even for maybe a better way. Shareholders are fascinating to watch.
They have a fiduciary responsibility to their shareholders and so they will argue Chris Palmer’s theory isn’t proven or Chris Palmer’s treatments don’t work or whatever and I’m ready for that. I’m ready to defend it. I’m not defending it for myself. I could care less about myself. I could have a pretty good life and go take vacations and stuff and not be in the spotlight or not be speaking on podcasts or publishing academic articles or anything else. The reality is I am passionate about helping the millions of people who are beaten down and tormented by their mental disorders.
I am full of hope that this theory can help them. I want to help them and I will fight for them. I will fight pharmaceutical companies if they want to fight me. I will fight the American Psychiatric Association if they want to fight me. I will know that I’m not alone. The National Institute of Health is on the side against the American Psychiatric Association. There are more than enough people who fully understand and appreciate that, at least for them, with their disorders, pharmaceuticals have failed to work for them.
I have met extraordinarily powerful, wealthy, and influential people who have family members disabled by mental disorders who are not getting better with all of the different pills that we have to offer. Those people are ready for new solutions and new ideas. I want this to lead to a national conversation. I want this to be a stimulating discussion and debate.
There might be parts of my theory that I’ve gotten wrong. In one chapter, I may have not recognized that there’s a whole other body of literature suggesting that the way I stated this one part of my theory is not quite right. That’s okay. I’m fully prepared for that. Nobody can be an expert in everything brain, everything metabolism, and everything human health. Nobody’s that smart and I’m certainly not. I’m prepared for that.
What I’ve done is painted a broad overview, an outline of a rigorous scientific theory that I am convinced holds weight. I’m not alone. I already have sixteen people publicly endorsing this book and many of them are leading neuroscientists and psychiatrists. I’m not a complete quack because they wouldn’t have done that.
You have to start. You have to put the book out. You have to start the conversation. An important point too is that when you’re seeing patterns showing up, the fact that you can share that and see if other people can now add to this conversation as you go. I am always curious if somebody would start a pharmaceutical company but you can’t get patents on micro-dosing, let’s see if they get interesting.
Who knows? You never know, maybe in twenty years, that’ll be the thing. It’s like, “They found in their science to whether repair, restore, or protect your brain a little bit.” Obviously, there is even science on that. Maybe these are all the little steps that add to a bigger conversation. The thing that I find interesting about health in all types of health is how we’ve gotten further away from nature and our natural selves.
It’s gotten complicated by the way that we live. I would imagine that for over 27 years, you’ve seen probably a serious uptick. People know it’s an option, “I’m depressed. I’m anxious.” Certainly, before my generation, you were talked to a little bit to suck it up, which isn’t always great. With the phone and with the lifestyle that goes along with the phone, you’re less social, you probably don’t move as much, and all these things. Now you have a comparison and all these things. It must be influencing a group of people. We’re not going to give up our phones. I’m going to be fascinated to see how we find our way with this.
You’re raising an important question and it’s a question that’s on a lot of people’s minds. We know that the rates of mental illness are increasing and they’re particularly increasing in youth. The younger the generation, the higher the rates. The mental disorders are across the board. Rates of autism are increasing. Rates of bipolar are increasing. Certainly, rates of depression and anxiety.
A lot of people are quick to find something to blame, it’s social media, the phones, the lack of exercise, or the lack of family time. Nobody’s eating dinner together, everybody’s eating dinner in front of the TV, they’re binge-watching Netflix, or whatever. There’s no doubt in my mind that those things do play a role.
The bigger picture that I want to highlight for people is that we have skyrocketing rates of metabolic disorders, skyrocketing rates of obesity, diabetes, and prediabetes. At the same time that those disorders are skyrocketing and prevalent, we have skyrocketing rates of mental illness across the board. I don’t think those things are disconnected. The good news is that I don’t think the phone is the primary cause.
One of the things that I found is that when people are metabolically compromised, it means that they are sluggish, they’re slightly depressed, they have brain fog, and they don’t want to move because they don’t have the energy to move. When they get better, when we get them better with diet, exercise, sleep regulation, and other things, they start getting restless sitting there watching TV.
They don’t want to just sit and watch TV anymore. They don’t want to sit on their phone. They want to go out for a run. They want to go out in nature. They want to see friends in real life. They want to go out to clubs if they’re that age. They want to live their lives. I’m hopeful that, for a lot of people, if we can restore their metabolic health, these other things will come back online.
It’s well-described anecdotally and we even have some preliminary evidence from even randomized controlled trials that when you restore metabolic health, addictions can go away, or addictions can get a lot better. This includes addiction to things like alcohol. We have a good study from the National Institute of Health documenting that. It can also include addiction to being on your phone, addiction to pornography, or addiction to other things that are not good for you that are way overconsuming too much of your time and energy and preventing you from living your best life.
As people feel better, they get more energized, their brain comes back online, and they want to do things. I noticed that myself. One thing that I always say is before I went on a low-carb diet, I could never understand why the hell anybody would want to work hard and play hard. It never made sense to me because I knew what hard work was like. I was getting through medical school, which was hard work. I always wondered, “How the hell do they have the energy to play hard? Aren’t you tired after working hard? Don’t you just want to lay on the couch and watch TV and eat like I do? That’s all I have the energy to do anymore.”
As soon as I changed my diet, I became one of those people who was a work-hard and play-hard person. I didn’t want to just lay on the couch and watch TV anymore, I didn’t want to do that. I wanted to go out and play. I wanted to explore the world. I wanted to exercise. I wanted to socialize. I wanted to produce more. I wanted to be somebody in the world. That has never changed for me. I haven’t gone back.
You talk about the importance though also. You said something important about purpose and about contributing. With your patients, one of the other things that are important is that there’s a purpose. That’s not always easy to find. Sometimes, being engaged in rich relationships and friendships as a starting point can be a pretty great purpose.
People think, “You have to have a title in this thing that you do that you’re known for.” I want to remind people that sometimes purpose is going out and enjoying your life and maybe helping someone out when you have the opportunity. These don’t have to be fanciful things. Purpose comes in so many ways and that feels important. You have low-carb. Maybe from your point of view, if someone was reading and they say, “I’m going to try this out.”
[bctt tweet=”The reality is I am passionate about helping the millions of people who are beaten down and tormented by their mental disorders.”]
Do you encourage people, if they’re not taking any, to take any supplements? It could be complicated if they are on medication. There’s a place for maybe B12. Maybe that’s under a doctor’s care. Maybe you could give your baseline. You’ve read this and you think, “I’m going to start.” Even if it’s like, “I could feel better. I could have more energy.” It’s not just about, “I’m in the doldrums and I’m trying not to.” This would help us across the board. What would the invitation be to go, “These are some of the rules of engagement.”
I want to break people into two categories and you said this or hinted at this. For people with chronic serious mental disorders that have been dangerous to themselves or other people, they’ve been suicidal, they’ve been aggressive with others, they’re hallucinating, they’re injuring themselves, and their substance use gets way out of control in a dangerous way. Also, for people who are on prescription medications, I want you to work with your healthcare professional.
I want you to find a health care professional to do this safely. Why am I saying that? It’s because your illness has been unsafe. That’s how I defined it. Your illness has been unsafe at times in the past and that means, as you’re making changes, it could possibly become unsafe again. If you’re on prescription medications, I want those to be managed in a safe and responsible way. If your goal is to get off medications, I want you to taper off safely.
There’s another bucket of people. People who have more mild and moderate disorders and that could be mild and moderate depression, anxiety, and other disorders, or it could be, “I’m burned out. I’m stressed. I don’t have energy at the end of the day.” I’m the person who wants to lay on the sofa, eat, watch TV, and fall asleep. I don’t have the energy to be playing hard. Most of you can try some of these strategies on your own.
The strategies are widely variable. It’s not that there is a one size fits all solution for everyone. I hinted at a few solutions. Please understand that there are lots to choose from. Certainly, in terms of dietary recommendations, there are lots of diets to choose from. If you want to be an omnivore, that’s great. If you want to be vegetarian, I can respect that. If you want to be vegan, I can respect that. If you want to be a carnivore, I can respect that. I am open-minded in terms of dietary strategies.
I would start with looking at your diet because that is probably one of the more powerful levers that we’ve got in terms of changing metabolism. I want to eliminate junk food. I want to eliminate added sugars. Nothing with added sugars. There’s no reason to have added sugars. If you’re going to have them, know that you’re having them as a treat.
Monitor how this affects you. Is this slowing you down? Is it making you sluggish? Is it causing brain fog? Is it disrupting your sleep? If it is, I want you to do your best to make it a goal, “I’m going to try to get off of these. I’m going to try to get this stuff out of my life.” If you’re eating stuff with sweets every day, you’re addicted to it and you probably can’t imagine life without it. Trust me, I’ve been there myself. Trust me, you can get over it. If I can get over it, you can get over it.
I get to the point where I don’t crave it. I was at a dinner and they served me this delicious-looking chocolate cake right in front of me. They put it down and I didn’t even have a bite. I wasn’t tempted to have a bite because I’m like, “That’s going to taste way too sweet. It won’t sit well with me and it’ll mess up my sleep. I’m not going to have that. Why would I have that?” You can do it too. You might want to try a low-carbohydrate diet. You might want to try even a ketogenic diet. I am a big believer in those diets myself.
The ketogenic diet in particular can have profound effects on brain metabolism in particular. It isn’t about the keto diet being the one and only God-given diet for all human beings. This is a serious metabolic intervention that can impact brain function. It could be worth trying for a while. You don’t have to do it for the rest of your life. I don’t necessarily even recommend it for the rest of your life to be in ketosis forever and ever. It can be a good intervention if you’re trying to restore brain health.
You might transition to a paleo diet or something else once you’re feeling better. I would want you to take an inventory of harmful substances. Lots of alcohol, marijuana, and tobacco in any form are not going to be helpful for your metabolism. If you’re doing a lot of that stuff, know that you’re harming your metabolism every time you use them. That might be one of the reasons you’re not making the gains you want to make. You can’t be decisive.
Athletes have known this for decades. If an athlete is training for an important marathon and is drinking any alcohol, the first thing that coach is going to tell that person is to stop drinking. You cannot drink. If you want to be a good athlete, you got to stop drinking. Why? Alcohol impairs metabolism and impairs mitochondrial function. It’s not great for you. If you’re drinking and you can do it and it’s not affecting you in adverse ways, great. Good for you. Keep doing it. Have fun and party on.
That’s not what we’re talking about. We’re trying to support people who maybe are in a place. It’s like getting in front of the eight ball instead of being behind the eight ball. Once we can get in front of the eight ball, that’s a much easier place to function from, whether it’s making decisions, trying to get up in the morning, trying to have a good attitude, and trying to take, solve problems, and take on challenges. What you’re talking about is helping people and giving them tools to get in the upcycle.
If someone reads this and they are under the care of a physician and they are on medication and they think, “I’d like to experiment.” Can they ask their doctor? It’s like, “I’m going to do this experiment. Will you work with me on slowly getting me off these meds and helping me navigate this?” I want to remind people that it’s okay and important to communicate and ask for what you want even if it’s not the popular opinion.
I want to encourage people to do that. I am honestly hopeful that my book will get enough publicity that it will start a national conversation. I have armed people with tons of science, knowledge, and literature to back it up. This is not quackery. This should be taken seriously. If you go to your health care professional and they say, “Where the hell did you hear this? What podcast are you listening to? That sounds like baloney. You got to take your meds and stop complaining. Accept that you’ve got a chronic disorder and that’s your life.” I want you to at least say, “There’s this Harvard psychiatrist that I heard. I’m not saying that to be a snob, pretentious, or anything but it pulls weight for some reason.”
It has legs. What can you say?
“I heard this Harvard psychiatrist and he’s got this theory about mental disorders might be metabolic disorders of the brain. Have you heard anything about it? Have you read about it? I would like to give some of those treatment strategies a try. Would you please work with me? Would you please help me?” That will then motivate that healthcare professional, hopefully, to learn more about it, to learn more about this metabolic theory of mental illness. Hopefully, they start offering these treatments not just to you but to other people.
You’re not only doing yourself a favor by talking to your healthcare professional, but you’re also possibly helping hundreds of other people who the healthcare professional might then be able to help. If this treatment strategy works for you, that healthcare professional is going to see it and say, “I’ve got hundreds of other patients who could benefit from this same thing. You weren’t getting better with meds and now, all of a sudden, you seem a lot better. You’re getting off meds. Maybe I should start offering this to some other people who haven’t even heard about it.” Wouldn’t that be a nice world that we all live in?
We all have to live together. How can we all help each other feel our best? You said something important that I want to circle back to, which is you saw that original patient in 2016 once a week. That’s a system of checking in or accountability. For anyone reading, I want to remind all of us that none of us can do this alone.
I don’t exercise and do all the things I’ve done for all these years by myself. I have built-in systems in place where I have to check in. It’s not about, “I love it. I can’t wait to do it.” It’s about knowing that I could fail. How do I avoid those pitfalls and build my life in such a way that I can try to be successful? I want to remind people that, of course, nobody feels like putting down the chocolate cake in the beginning or going for a walk rather than watching a movie.
If you can, do you have someone to check in with, someone to do it with, someone to call, and all these things? That point was important for success. Dr. Chris Palmer, the book is Brain Energy. What was the original title? Didn’t you have a different title? You were working on a different book that had a little bit more of a woo-woo name. What was it?
Brain Energy is the one that I wanted. When I first started the book, I was thinking about writing a book on the ketogenic diet for mental illness.
That was it.
I quickly realized that nobody was going to buy this. I have to go deeper. I have to go more scientific. It turned into something different.
People can preorder this already on Amazon.
Did I forget anything that you feel is an important reminder or support to people? We’re all impacted by this. We all are either dealing with it ourselves or connected to somebody who has some kind of mental illness so if there’s anything I have forgotten. Maybe it’s even where to find good help, maybe someone lives in a place and they don’t know who to venture into finding good help, maybe 2we could direct people if there’s a location that tells you doctors in your area or something.
The one thing that I’ll encourage people to do if they’re open to it is going to BrainEnergy.com. It’s a brand-new website. I am hoping to quickly start a mental health movement. I know that sounds grandiose and audacious. I want to start a mental health movement. I want to transform the mental health field. If people sign up for the newsletter, there will be opportunities for you to help out and help everyone, all of us working together to transform the mental health field. Part of those newsletters will hopefully be to develop clinician resources.
If you are somewhere looking for a clinician or if you want to connect with other people, maybe even over social media, Facebook, Twitter, or wherever, you might be able to connect with people on social media and get support in those ways. I want to make these treatments available and accessible. I want them to be free whenever possible. Obviously, not everything can be free. When you’re working with professionals, they’ve got to make a living. I do want support groups. I want self-help groups. I want a lot of information blasted over the Internet for free so that the millions of people who are looking for better solutions to their mental health problems can get some answers.
I appreciate that, Dr. Palmer. Lastly, in a loving way, I want to remind people that physical health, even though it’s all connected, you can’t phone it in, there’s no magic bullet, and you have to do the work. Somehow we’ve gotten to a place where we think things can happen without the work. It’s like a loving kick in the ass, you have to do the work. It’s not going to happen on its own. Also, it’s well worth it, the rewards are beyond. I appreciate it. If people want to learn more, they can go to Brain Energy or preorder the book. I’m excited to see where this goes. Thank you so much for your time.
Thank you so much, Gabby, for having me.
Thank you so much for reading this episode. Stay tuned for a bonus episode where I go deeper into one of the topics that resonated with me. If you have any questions for my guests or even myself, please send them to @GabbyReece on Instagram. If you feel inspired, please hit the follow button and leave a rating and a comment, it not only helps me, it helps the show grow and reach new readers.
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About Dr. Chris Palmer
Christopher Palmer, MD received his medical degree from Washington University School of Medicine. He did his internship and psychiatry residency at McLean Hospital, Massachusetts General Hospital, and Harvard Medical School. He is currently the Director of the Department of Postgraduate and Continuing Education at McLean Hospital and an Assistant Professor of Psychiatry at Harvard Medical School. For the past 25 years, he has been an academic physician with administrative, research, educational, and clinical roles. Dr. Palmer leads McLean Hospital’s Department of Postgraduate and Continuing Education. In this role, he has developed hundreds of educational conferences, workshops, Grand Rounds, and other professional educational activities, most of them under the aegis of Harvard Medical School. His leadership has transformed the department from a small, subsidized department of the hospital into a flourishing educational program that is now leading mental health education for professionals nationwide.