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Dr. Chris Palmer: Diet & Nutrition for Mental Health | Huberman Lab Podcast #99

Andrew Huberman・127 minutes read

Dr. Chris Palmer, a psychiatrist at Harvard Medical School, specializes in the relationship between metabolic and psychiatric disorders, focusing on the impact of diets like ketogenic and modified ketogenic in treating conditions such as psychosis, schizophrenia, ADHD, OCD, anxiety, and depression. The ketogenic diet shows promise in improving cognitive function and quality of life, with studies supporting its effectiveness in treating conditions like epilepsy, Alzheimer's disease, and various mental health disorders, rooted in its impact on brain chemistry, mitochondrial function, and overall health.

Insights

  • Dr. Chris Palmer specializes in metabolic and psychiatric disorder relationships, treating conditions like psychosis, schizophrenia, ADHD, OCD, anxiety, and depression.
  • Dr. Palmer emphasizes the impact of mitochondrial function on mental health, showcasing successful treatments with diets like ketogenic and modified ketogenic.
  • Various diet interventions, including the ketogenic diet, were initially developed for neurological conditions like epilepsy.
  • The ketogenic diet has a powerful antidepressant effect on patients with treatment-resistant mental illnesses, requiring careful medication adjustments under professional supervision.
  • Monitoring compliance with the ketogenic diet through blood ketone levels is crucial for treatment success.
  • Mitochondria play a significant role in mental health variables like neurotransmitters, hormones, and inflammation, providing insights into mental disorders.
  • The ketogenic diet's efficacy in treating mental disorders is rooted in its impact on brain chemistry, mitochondrial function, and overall health, making it an evidence-based treatment for psychiatric and neurological conditions.

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Recent questions

  • How does the ketogenic diet impact mental health?

    The ketogenic diet has a significant impact on mental health by influencing brain chemistry, mitochondrial function, and overall health. It stimulates mitophagy, the removal of old mitochondria, and mitochondrial biogenesis, the creation of new and healthier mitochondria, leading to improved health outcomes. The diet's historical use for epilepsy provides credibility for its application in treating mental health conditions, with studies supporting its efficacy in various disorders like chronic depression, PTSD, alcohol use disorder, Alzheimer's disease, bipolar disorder, and schizophrenia. By understanding mitochondrial science and the diet's effects on neurotransmitters, hormones, epigenetic expression, and inflammation, valuable insights into mental disorders are gained.

  • What are the benefits of intermittent fasting?

    Intermittent fasting can be combined with the ketogenic diet for improved results, with water fasting also showing positive effects on blood sugar levels. Fasting is considered a powerful tool by many, limiting carbohydrate intake and inducing ketosis. It can influence brain function and mental health by impacting cortisol levels, adrenaline, noradrenaline, inflammation, and gene expression. For individuals seeking improved energy and mental clarity, a period of carbohydrate restriction may be recommended as an initial intervention. However, it is crucial to monitor compliance and adjust medication or nutrition accordingly for treatment success.

  • How does the ketogenic diet affect weight loss?

    The ketogenic diet can lead to rapid weight loss by limiting carbohydrate intake, resulting in water excretion and making individuals feel lighter and more energetic. By restricting starch intake and inducing ketosis, overweight and obese patients can experience high levels of ketosis, aiding in weight loss. Some patients follow a fat fast or consume primarily fats to achieve ketosis, especially those with ample fat stores. The diet's impact on glucose levels and mitochondrial function plays a crucial role in weight loss and overall health improvements.

  • What role do mitochondria play in mental health?

    Mitochondria are crucial regulators within cells, directing resource allocation and influencing neurotransmitter production, release, and regulation. They are involved in neurotransmitter release, epigenetics, stress response, hormone synthesis, inflammation, and wound healing. Mitochondrial dysfunction is linked to various mental disorders, impacting glucose dysregulation and overall health outcomes. Understanding mitochondrial science provides insights into mental health variables like neurotransmitters, hormones, epigenetic expression, and inflammation, offering valuable information on mental disorders.

  • How can the ketogenic diet benefit patients with treatment-resistant mental illnesses?

    The ketogenic diet has shown powerful antidepressant effects on patients with treatment-resistant mental illnesses, leading to significant improvements in mood, energy, concentration, and sleep. By inducing ketosis and impacting brain chemistry, mitochondrial function, and overall health, the diet offers evidence-based treatment for a wide range of psychiatric and neurological conditions. Clinical observations and case studies support the diet's efficacy, emphasizing the importance of professional medical guidance, adherence to treatment, and ongoing support for successful outcomes in patients with severe mental disorders.

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Summary

00:00

"Metabolic Psychiatry: Treating Mental Disorders with Diets"

  • Dr. Chris Palmer is a psychiatrist at Harvard Medical School, specializing in the relationship between metabolic and psychiatric disorders.
  • He treats various conditions like psychosis, schizophrenia, ADHD, OCD, anxiety, and depression.
  • Dr. Palmer focuses on how metabolism and mental disorders interact, sharing case studies of successful treatments using different diets.
  • He highlights the impact of mitochondrial function on mental health and the role of diets like ketogenic and modified ketogenic in treating psychiatric illnesses.
  • Various diet interventions, including the ketogenic diet, were initially developed for neurological conditions like epilepsy.
  • Dr. Palmer discusses how food choices and fasting can influence brain function and mental health.
  • He authored the book "Brain Energy," offering insights into mental health and treatment approaches.
  • The podcast aims to provide science-based tools for the public, separate from Dr. Huberman's roles at Stanford.
  • Thesis offers custom nootropics designed to enhance brain function based on individual needs.
  • Eight Sleep provides smart mattress covers for optimal sleep by adjusting body temperature, improving sleep quality.

12:50

Diet-induced Ketosis Resolves Metabolic Syndrome & Depression

  • Within three months, metabolic syndrome disappeared after a dietary change.
  • Blood pressure and lipids normalized, with a 10-pound weight loss.
  • Prior to the diet, the individual struggled with low-grade depression and OCD, despite high functionality.
  • Medications for depression and OCD caused more side effects than benefits.
  • Psychotherapy and hospitalization with various medications were ineffective.
  • After three months on the diet, significant improvements in mood, energy, concentration, and sleep were noted.
  • The diet led to a newfound sense of well-being, improved sleep quality, and increased energy levels.
  • The individual previously felt like there were "haves" and "have-nots" in terms of energy and positivity.
  • The diet had a powerful antidepressant effect on patients with treatment-resistant mental illness.
  • Ketosis was a key factor in observing clinical benefits and the antidepressant effect of the diet.

26:18

Ketogenic Diet Improves Mental Health Symptoms

  • Fasting was less popular in the past, but it is considered a powerful tool by many, limiting carbohydrate intake and inducing ketosis.
  • Some patients followed a fat fast or consumed primarily fats to achieve ketosis, especially overweight individuals with ample fat stores.
  • Limiting carbohydrates often leads to high levels of ketosis for overweight and obese patients.
  • Restricting starch intake can result in rapid weight loss due to water excretion, making individuals feel lighter and more energetic.
  • A patient with schizoaffective disorder, plagued by auditory hallucinations and paranoid delusions, struggled with his illness despite trying 17 medications that caused weight gain.
  • The patient decided to try the ketogenic diet to lose weight, not expecting any impact on his psychiatric symptoms.
  • Within two weeks of starting the diet, the patient experienced weight loss and a significant improvement in mood and behavior.
  • After six to eight weeks, the patient reported a reduction in auditory hallucinations and delusions, leading to a profound transformation in his life.
  • Despite remaining on medication, efforts have been made to gradually reduce the patient's dosage over time, although it has been challenging.
  • It is crucial for individuals to taper off psychiatric medications under professional supervision to avoid dangerous consequences like severe symptoms or suicidal thoughts.

39:19

Optimizing Treatment: Medication and Diet Considerations

  • Medication adjustments need to be done cautiously and gradually for patients.
  • Adherence to treatment, like the ketogenic diet, is challenging for most patients.
  • Regular contact and adjustments to medication or nutrition can be crucial for treatment success.
  • Monitoring compliance with the ketogenic diet through blood ketone levels is beneficial.
  • Noncompliance with prescription medications is common due to forgetfulness or disruptions in routine.
  • Blood ketone levels are essential for determining the effectiveness of the ketogenic diet.
  • Eliminating highly processed foods can significantly impact mood disorders.
  • Insulin resistance and impaired glucose metabolism are linked to various mental disorders.
  • Ketosis levels for different mental disorders vary, with higher levels needed for psychotic disorders.
  • The ketogenic diet's historical use for epilepsy provides credibility for its application in mental health treatment.

52:59

Ketogenic Diet: Effective Treatment for Seizures & Mental Disorders

  • The ketogenic diet was developed to mimic the fasting state to potentially stop seizures long-term.
  • Early results showed that 50% of patients on the ketogenic diet became seizure-free, with an additional 35% experiencing a 50% or greater reduction in seizure frequency, resulting in an 85% efficacy rate.
  • Initially used for pediatric epilepsy, the ketogenic diet was later utilized for adults with epilepsy due to limited anti-epilepsy treatments in the 1920s.
  • Despite the emergence of pharmaceutical anticonvulsant treatments in the 1950s, about 30% of people with epilepsy do not respond to current treatments, leading to the resurgence of the ketogenic diet in the 1970s for treatment-resistant cases.
  • The ketogenic diet works for about 1/3 of treatment-resistant epilepsy cases, with 1/3 becoming seizure-free, another 1/3 experiencing a 50% or greater reduction in seizures, and the remaining 1/3 showing no improvement.
  • The ketogenic diet influences neurotransmitter levels, gene expression, brain inflammation, gut microbiome, insulin resistance, and mitochondrial function, leading to improved health outcomes.
  • The diet stimulates mitophagy, the removal of old mitochondria, and mitochondrial biogenesis, the creation of new and healthier mitochondria, which contributes to its effectiveness in treating epilepsy and chronic mental disorders.
  • Nutritional psychiatry is an emerging field with ongoing randomized controlled trials, case studies, and mechanistic science papers supporting the use of the ketogenic diet for various mental disorders like chronic depression, PTSD, alcohol use disorder, Alzheimer's disease, bipolar disorder, and schizophrenia.
  • A pilot study involving 31 patients with treatment-resistant mental disorders showed that 100% experienced some improvement in symptoms, with 46% achieving remission of illness and 64% requiring less medication upon discharge.
  • The ketogenic diet's efficacy in treating mental disorders is rooted in its impact on brain chemistry, mitochondrial function, and overall health, making it a valuable evidence-based treatment for a wide range of psychiatric and neurological conditions.

01:06:59

Mitochondria: Crucial Regulators in Mental Health

  • Mitochondria were previously viewed as simple batteries that convert food and oxygen into ATP, but they are now recognized as crucial regulators within cells.
  • Mitochondria are compared to the motherboard of a computer, directing resource allocation within cells.
  • They play a significant role in the production, release, and regulation of key neurotransmitters like serotonin, dopamine, glutamate, and acetylcholine.
  • Mitochondria provide energy for neurotransmitter production and are directly involved in neurotransmitter release.
  • Mitochondria are primary regulators of epigenetics, influencing gene expression in cells.
  • They are linked to the human stress response, impacting cortisol levels, adrenaline, noradrenaline, inflammation, and gene expression.
  • Mitochondria have enzymes necessary for synthesizing steroid hormones like cortisol, estrogen, testosterone, and progesterone.
  • They play a role in inflammation, both activating and deactivating the inflammatory system.
  • Mitochondria are essential in wound healing, influencing the phases of macrophage activity during the healing process.
  • Understanding mitochondrial science can help connect various mental health variables like neurotransmitters, hormones, epigenetic expression, and inflammation, providing insights into mental disorders.

01:22:14

"Mitochondria, Aging, and Diet: Key Insights"

  • In the 1950s, the theory of aging was linked to reactive oxygen species, leading to concerns about inflammation and antioxidants.
  • Research showed that high levels of reactive oxygen species were associated with aging, poor health outcomes, and chronic mental disorders.
  • By the 1970s, the focus shifted to mitochondria and their role in producing reactive oxygen species, leading to the mitochondrial theory of aging.
  • However, it was later discovered that reactive oxygen species are not entirely harmful and serve as a normal part of cellular function.
  • Mitochondria were then identified as a key factor in aging and related disorders, with mitophagy aiming to eliminate defective mitochondria and replace them with new ones.
  • Calorie restriction, fasting, and intermittent fasting are effective ways to stimulate mitophagy and prevent aging.
  • The impact of diet on mitochondrial function and mental health is significant, with glucose levels in the brain being a crucial factor.
  • Mitochondrial dysfunction is likely the root cause of glucose dysregulation, which can be influenced by diet and junk food consumption.
  • The ketogenic diet can be an effective treatment for conditions like epilepsy, showcasing how dietary interventions can improve brain metabolism and symptoms.
  • The cause of obesity remains unclear, with debates on whether it is solely due to energy balance or factors like junk food consumption.

01:36:48

"Mitochondria, Diet, and Obesity: Research Insights"

  • Research for a series involved detailed work on props, costumes, and diet.
  • The diet depicted in the series was poor, consisting of pre-packaged and frozen foods.
  • The speaker suggests that factors like diet, environmental toxins, stress, and poor sleep contribute to obesity.
  • Mitochondria are highlighted as crucial in the obesity epidemic due to environmental factors affecting their function.
  • A rare individual who can eat excessively and remain lean is mentioned.
  • Epigenetic factors in the womb environment may predispose children to obesity.
  • Mitochondrial DNA is inherited from the mother, impacting mitochondrial function.
  • Mitochondria have 36 genes, with 13 coding for ATP production and others affecting metabolism.
  • THC in marijuana affects mitochondrial function through CB1 receptors, leading to brain atrophy.
  • A study showed that a ketogenic diet reduced withdrawal symptoms and cravings in alcoholics, improving brain metabolism and reducing neuroinflammation.

01:51:27

Alcohol, Ketones, and Brain Metabolism: Insights

  • Researchers studied the effects of alcohol consumption on rats on a ketogenic diet, finding a five-fold increase in blood alcohol levels.
  • The rats on the ketogenic diet did not drink more alcohol but metabolized it differently.
  • Individuals on a ketogenic diet may experience increased blood alcohol levels, potentially affecting their ability to drive safely.
  • Mitochondria play a crucial role in producing energy from glucose, with some attributing Alzheimer's disease to glucose hypometabolism.
  • Ketone supplements have shown promise in correcting brain metabolism deficits in Alzheimer's patients.
  • Studies have shown cognitive improvement in subjects by reducing carbohydrate consumption at breakfast and lunch.
  • Limiting carbohydrates during the day can help maintain alertness and focus, potentially benefiting those with mood disorders.
  • Exogenous ketones alone may not provide the same benefits as a ketogenic diet due to the multifaceted effects of the diet on glucose levels, insulin signaling, and mitochondrial biogenesis.
  • Ketones are primarily produced in the liver mitochondria, which increase in number during fasting or a ketogenic diet to fuel the brain.
  • Simply consuming ketones without dietary changes may not be effective in reaping the full benefits of a ketogenic diet.

02:05:09

Benefits and Challenges of Ketogenic Diets

  • Ketones can be beneficial for metabolically healthy individuals, especially in clinical use for patients who struggle with strict ketogenic diets but can manage a low carb diet.
  • Exogenous ketones could potentially be used with alcoholics to replace alcohol during cravings, offering alertness without intoxication.
  • Ketones are considered the brain's preferred fuel source, with some brain areas requiring glucose over ketones, but compromised cells benefit significantly from ketones.
  • Ketogenic diets show promise in improving cognitive function and quality of life in Alzheimer's and age-related cognitive decline, with some animal models and small human trials supporting these findings.
  • Challenges in conducting clinical trials on ketogenic diets for Alzheimer's include low enrollment and completion rates, hindering research progress.
  • Intensive support and education are crucial for successful implementation of ketogenic diets, with options like health coaches, dieticians, family education, and meal provision to enhance compliance.
  • Long-term adherence to ketogenic diets is often driven by the negative consequences experienced upon discontinuation, particularly in patients with conditions like schizophrenia and bipolar disorder.
  • The lack of controlled clinical trials on ketogenic diets for Alzheimer's is a significant hurdle, with limited research funding and challenges in participant recruitment and retention.
  • Pharmaceutical companies are not actively suppressing trials on ketogenic diets for Alzheimer's, as positive results could lead to profitable treatment options.
  • The success of ketogenic diets in patients with severe conditions like schizophrenia highlights the importance of ongoing support and the significant consequences of diet non-compliance.

02:20:12

Ketogenic Diet: Benefits and Variations

  • Patients who deviate from the diet may experience hallucinations within 24-48 hours, leading them to quickly return to the diet.
  • Alzheimer's patients may also benefit from the diet, potentially improving cognitive function and daily living activities.
  • The diet's effectiveness is supported by metabolic science, suggesting it as a viable treatment.
  • Clinical observations and case studies have historically contributed significantly to medical knowledge.
  • The ketogenic diet is not solely for weight loss but can also aid in treating conditions like epilepsy.
  • Different variations of the ketogenic diet exist, tailored to individual needs and preferences.
  • Obese individuals may benefit from carbohydrate restriction, while thin individuals may require higher fat intake to induce ketosis.
  • Healthy fats like olive oil, avocados, and nuts are encouraged, with personalized recommendations based on individual circumstances.
  • Objective biomarkers like ketone levels are used to adjust the diet and monitor progress.
  • For individuals seeking improved energy and mental clarity, a period of carbohydrate restriction may be recommended as an initial intervention.

02:33:30

"Ketogenic Diet for Mental Health Management"

  • Patient read an early copy of a book and decided to restrict carbohydrates without consulting a medical professional.
  • Patient, a vegetarian, restricted carbs and within three weeks, no longer needed prescription medicine.
  • For individuals with serious mental disorders, professional medical guidance is crucial due to potential need for medication adjustments.
  • The ketogenic diet should be approached seriously, especially for those with conditions like bipolar disorder or schizophrenia.
  • Dieticians can monitor ketosis levels, address nutrient deficiencies, and provide diet adjustments for those on the ketogenic diet.
  • Intermittent fasting can be combined with the ketogenic diet for improved results, with water fasting also showing positive effects on blood sugar levels.
  • Hypomania can be a risk with the ketogenic diet, leading to decreased sleep and heightened energy levels.
  • Behavioral measures like education on sleep requirements and supplements like melatonin and magnesium can help manage hypomania.
  • For patients with serious mental illnesses, maintaining ketosis long-term is recommended, with prescription sleep medications used as a temporary solution for sleep issues.
  • Benzodiazepines or Z medicines are preferred over trazodone for sleep aid in patients with hypomania.

02:46:20

Impacts of Ativan and Ketogenic Diets

  • Ativan is preferred for short-term use, aiming for 3 to 7 days of improved sleep before discontinuation.
  • Hormones, particularly related to the menstrual cycle, can be impacted by treatments like exercise, drugs, or dietary changes.
  • Low carbohydrate or ketogenic diets may affect hormonal balance, potentially leading to menstrual cycle disruptions.
  • Ketosis and diets can influence the endocrine system, affecting male fertility and hormonal ratios.
  • The ketogenic diet may have varying effects on individuals, with women sometimes experiencing negative impacts on hormones.
  • The ketogenic diet can mimic a fasting state, potentially affecting reproductive capabilities in women.
  • The ketogenic diet has shown positive effects on certain mental health conditions and fertility in some cases.
  • Semaglutide drugs are being explored for obesity treatment, altering glucose and insulin management to induce weight loss.
  • Concerns exist regarding the root cause of obesity and the potential long-term effects of medications like GLP-1 compounds.
  • Lifestyle interventions, such as diet and exercise, are emphasized over relying solely on medications for conditions like obesity and diabetes.

03:01:33

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