A very interesting podcast from Tim Ferris with Dr Christopher M. Palmer, on how a ketogenic diet could help positively with depression, anxiety and other mental disorders.
Also a similar conversation with Dr Andrew Huberman.
As a disclaimer, I am not a strong advocate of ketogenic diets but strongly believe in eating less processed foods which does generally mean less processed carbs and less carbs in general, as there is only so much fruit, vegetables and salad one can eat 😊.
The podcast connects mental disorders with mitochondrial function. Here is a good summary of how to improve mitochondrial function, no big surprises here:
- Get at least 30 minutes of exercise daily.
- Eat fewer calories.
- Eat 2-3 meals, within an 8-10 hour window, stopping 3 hours before bedtime.
- Reduce refined carbs such as bread, pasta, pastries, alcoholic drinks and sugary drinks including juices. Replace these with fresh vegetables, fruit and salad.
- Eat quality protein like grass-fed beef and pasture-raised eggs.
- Eat sources of omega-3s and alpha-lipoic acid. Eat antioxidant-rich foods with resveratrol like dark chocolate.
- Prioritize getting 8 hours of sleep every night.
- Reduce stress with relaxation techniques like meditation or massage.
- Try heat therapy like sauna.
Learning Points
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Metabolic Psychiatry and the Brain Energy Theory
- Dr. Christopher Palmer, a Harvard psychiatrist and researcher, is pioneering the use of the medical ketogenic diet for psychiatric disorders.
- He has developed the Brain Energy Theory of Mental Illness, which is the first comprehensive theory integrating existing research and theories into one unifying explanation: that mental illnesses are fundamentally metabolic disorders of the brain, rooted in mitochondrial dysfunction.
- This theory suggests that mitochondria are much more than just the "powerhouses of the cell"; they connect all known factors in mental illness, including neurotransmitters, stress, trauma, and hormones.
- Studies across various methods (blood work, neuroimaging, genetic research) consistently show mitochondrial impairment or metabolic compromise in specific brain regions of individuals with mental disorders.
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Limitations of DSM-5 Diagnostic Categories
- The DSM-5, psychiatry's "bible," provides diagnostic labels useful for symptom identification and treatment but doesn't explain causes.
- Major problems with the DSM-5 are heterogeneity (people with the same diagnosis can have vastly different symptoms) and comorbidity (people often have multiple psychiatric diagnoses).
- There is no single root cause for any singular psychiatric diagnosis, and individual genes can confer risk for numerous different disorders (e.g., schizophrenia, bipolar, autism, epilepsy).
- The National Institute of Health abandoned DSM-5 diagnoses about a decade ago, recognising they are not valid constructs.
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The Ketogenic Diet's Impact on Mental Health
- Dr. Palmer's interest began with his own experience: a low-carb (Atkins) diet resolved his metabolic syndrome and led to dramatic improvements in his mood, energy, sleep, and confidence.
- Case Study (Doris): A 70-year-old woman with 53 years of chronic paranoid schizophrenia, who had tried numerous medications without success, experienced full and complete remission of all symptoms after starting a ketogenic diet for weight loss. She remained off medications, symptom-free, lost 150 pounds, and lived another 15 happy years.
- Another patient with schizoaffective disorder also saw spontaneous remission of hallucinations and delusions on the diet while losing 160 pounds.
- The ketogenic diet is a 100-year-old evidence-based treatment for epilepsy, and many psychiatric medications are anti-seizure treatments, suggesting a common neurological link.
- Mechanism of Action: Ketones serve as "rocket fuel" for metabolically compromised brain cells, enabling them to function normally again. The diet leads to at least 40 different mechanisms of action, including changes in neurotransmitters, calcium channel regulation, gene expression, gut microbiome, and inflammation.
- Effects on Sleep: While many report improved sleep quality and reduced need for sleep in ketosis, this can, in some cases, lead to hypomania or mania, especially in individuals with a history of psychosis or bipolar disorder. An evolutionary speculation is that the body interprets ketosis as a state of famine, triggering heightened energy and reduced sleep to seek food.
- Lyme Disease and Mitochondria: Inflammation from infections like Lyme disease can directly impair mitochondrial function, potentially triggering or worsening mental health symptoms in vulnerable individuals.
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Psychiatric Medications and Metabolism
- Many psychiatric medications (antipsychotics, mood stabilizers, some antidepressants) impair metabolism, leading to common side effects such as massive weight gain, type 2 diabetes, and cardiovascular disease risk factors. These effects are stated on FDA package inserts.
- Dr. Palmer theorises that these medications work by "putting a straitjacket" on hyperexcitable brain cells, suppressing their function to reduce symptoms in the short term.
- However, long-term suppression of cell function by these medications may weaken the cells over time, potentially worsening the underlying illness.
- Nonetheless, these medications have a vital role in acute, severe situations like panic attacks, seizures, or violent psychosis.
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Exercise and Mitochondrial Health
- Exercise is a powerful tool for improving mitochondrial health. Zone 2 training is particularly beneficial for increasing mitochondrial quantity and quality, which translates to brain benefits and neuroplasticity.
- Group sports, cycling, and gym activities that combine cardio with social contact are also highly recommended due to the added benefits of social connection.
- It's important to note that the benefits of exercise on mitochondrial function can be impaired by certain medications, including psychiatric drugs and some diabetes medications like metformin.
Action Points
- Do Not Discontinue Medications Abruptly: If you are on psychiatric medications, do not stop or taper them on your own. Abrupt cessation can be dangerous, leading to hospitalisation, suicidal ideation, or death. Always work closely with a healthcare professional for any medication changes.
- Integrate Dietary and Lifestyle Interventions: Consider introducing dietary changes, such as a ketogenic diet, alongside your current medications. This can be a parallel track, gradually restoring metabolic health to cells. Other beneficial changes include removing junk food and sugar, increasing exercise, and improving sleep.
- Monitor Ketone Levels: If pursuing a ketogenic diet, use a blood ketone meter (e.g., Abbott Labs Precision Xtra) for objective feedback on your state of ketosis. This helps in "detective work" to understand what impacts your levels.
- Tailor Your Ketogenic Approach:
- For those with significant obesity, carb restriction (under 20g/day) might be sufficient, as the body can tap into existing fat stores.
- For leaner individuals, it's crucial to moderate protein intake and increase fat consumption (e.g., using "fat bombs," heavy whipping cream, liberal use of healthy oils) to sustain ketosis.
- Avoid "keto-labeled junk food" as these often contain ingredients that prevent effective ketosis and hinder benefits.
- Be Your Own Health Advocate: In a complex healthcare system, it is essential to take radical ownership of your health. Educate yourself on metabolic interventions and be prepared to discuss them with your doctor.
- Utilise Resources: Dr. Palmer's book, Brain Energy: A Revolutionary Breakthrough in Understanding Mental Health and Improving Treatment for Anxiety, Depression, OCD, PTSD, and More, and his websites (chrispalmermd.com or brainenergy.com) offer free resources, lay articles, and links to peer-reviewed medical literature. Print out scientific articles to lend credibility when discussing these approaches with your healthcare provider. Mention "Harvard" when discussing Dr. Palmer's work to enhance credibility.
- Consider Zone 2 Training: Incorporate Zone 2 cardio training into your exercise routine to improve mitochondrial health, which benefits both muscles and brain function.
- Understand Medication Risks: Be aware that powerful drugs, even those with benefits, are not without risk. For example, metformin, while excellent for type 2 diabetes, can impair mitochondrial function and may not be advisable for metabolically healthy individuals seeking life extension.
- Explore Lifestyle Levers: Beyond diet, consider other lifestyle interventions like exercise, improving relationships, and removing metabolic toxins as part of a broader "metabolic reboot or rejuvenation" strategy.