Introduction: How did you get into low-carb keto for mental health?
Dr. Eric Westman: Today is going to be a little different. It is my great pleasure to talk to a mover and shaker in the mental health world, Dr. Christopher Palmer. Thank you for being with me.
Dr. Christopher Palmer: It is a long story. The quick version is that I had mental illness when I was a child – OCD, chronic depression, and suicidality due to a lot of different reasons. My mother had a chronic psychotic disorder that she developed when she was in her 40s. That is highly relevant. I had a “normal” mom up until about 12 or 13 years old. Through a constellation of horrible tragic life events in her family, she ended up having what started as what she called a nervous breakdown but progressed into depression with psychotic features. Unfortunately, the psychosis never went away. She got a lot of mental health treatment. It was worthless for her. I was furious with the mental health field for not being able to help her. I thought mental health professionals were a bunch of incompetent, arrogant snobs.
On becoming a psychiatrist
Dr. Eric Westman: Is this before you became one?
Dr. Christopher Palmer: This is before I became one. That is why I became a psychiatrist. I went into the field because I recognized how devastating mental illness can be to people and families, how it can ruin lives and families, and what an utter disaster the mental health field was. I went into it not out of a love of the mental health field, but out of a strong dislike and disapproval of the mental health field and wanting to change it from within. Wanting to help patients, wanting to do better than what I saw being done for people like myself and my mom. I went through a lot of adversity and flunked courses in high school. They did not look at my high school transcript. They only looked at college and medical school. By then I was doing better. When I was doing my residency in psychiatry at Harvard, I developed metabolic syndrome, the whole thing. I was developing high blood pressure and pre-diabetes, my lipids were awful, my triglycerides were through the roof, my HDL was really low, my LDL was high, everything was bad. The doctor kept telling me to diet and exercise. I kept doing a super low-fat diet and exercising regularly, and everything just kept getting worse year after year. The doctor was starting to push medicines on me, telling me it is not your fault, it is genetic, you’ve got a family history, do not worry about it, just take your medicines. I am only in my 20s and I am thinking, “Be a good patient.” It made me think I was not doing the diet and exercise right. I thought to myself that I am on a super strict low-fat diet, I am not lying and it is just not working. I had heard through various friends that they had heard about this crazy diet called the Atkins diet, where you eat a lot of eggs and bacon in the morning, and it was somehow lowering cholesterol and improving diabetes.
Dr. Eric Westman: What year was this?
Dr. Christopher Palmer: This was in the mid to late 90s.
Dr. Eric Westman: At the same time this was getting national attention.
Going on the Atkins Diet
Dr. Christopher Palmer: Yes. Initially, I was highly skeptical. I was part of the regular medical establishment. I was angry at people for suggesting such absurd, dangerous, outlandish things like eating eggs in the morning and lowering your cholesterol, which is an oxymoron and makes no sense. I was trying everything the doctors were telling me and finally, the doctor said, “You are going on meds, you have no choice, we are done with this diet and exercise.” I had one or two friends who were passionate enough about it who were saying, “No Christopher, it works, try it.” I decided I am going to give it a shot, I am going to do this Atkins diet. I did not think it would work. I thought I would give it a shot for a few months and see what happens and then I will bite the bullet and take meds. Within 3 months my metabolic syndrome was completely reversed, everything was better, my blood pressure was normal, actually a low healthy normal, my triglycerides were down, my HDL was, and my LDL cholesterol, the one that everybody worries about, it went down for me. My pre-diabetes was gone but the thing that I noticed was I had mental health benefits that I had never experienced in my life. For the first time in my life, I was waking up before my alarm went off and feeling rested. I had more clarity of thought, I had more motivation, more energy and it was striking. I had never felt that good in my entire life. Even when I was a child I had never felt that good. I was shocked because I thought this was impossible, this is not who Christopher Palmer is, Christopher Palmer is that loser, the pathetic loser, and somehow I am feeling really good now and so I made a mental note of that. I was not telling people about it, especially not at the hospital, because I am doing this crazy Atkins diet and nobody is going to approve of that.
Dr. Eric Westman: Were you still in training then?
Dr. Christopher Palmer: I was doing my residency.
What you eat could affect your brain
Dr. Eric Westman: Had you any notion that what you could eat could affect your health let alone your brain and your nutritional background?
Dr. Christopher Palmer: I was told that what we eat would affect our health. I was told that it was fat. Eating too much fat is what makes us both fat and what also causes metabolic syndrome and high cholesterol. Eating fat and cholesterol is the evil thing and if you just eat less of that everything will be fine. That is what I was taught and I believed it
Dr. Eric Westman: Two things were a bit suspicious because if cholesterol is so bad for us why does our liver make more of it when we eat less of it? If saturated fat is so bad for us, why does our liver make saturated fat and store it as energy? Was there anything in your training that primed you for something that did not make sense?
Dr. Christopher Palmer: My experience did not make sense and I did not give it that much thought. There are so many things in the medical field that we should be questioning. I was focused more on psychiatry. For instance, is it really a serotonin imbalance? Why are these medicines not working? Then what is lithium doing and, how long do people need to take these medicines? My mom took these medicines and they did not work for her and they are not working for these patients. I was more focused on those things and those kinds of challenges and things that were not adding up. I was less interested in cholesterol and the liver. I am a psychiatrist. I am interested in the brain. I was thinking the experts know what they are talking about and they are telling me to eat less fat and cholesterol and that will make you healthy and it just was not working.
Within a year friends and family noticed these changes in me, noticing that I had lost a little bit of weight. I was not technically overweight, but I had abdominal obesity, which is a sign of insulin resistance. I was a “skinny-fat” person who was relatively skinny and unathletic and had a little bit of a stomach. I did not need to lose a lot of weight but I lost abdominal fat. Friends and family had noticed that and more importantly, they noticed me being able to resist candy and sugar and pies at Thanksgiving and other events. They would get upset, I think more with themselves, but they would direct it at me. How are you not eating the pie? We are eating the pie and the cookies, we can’t resist and we want to lose weight … how are you doing this? You do not need to lose any more weight. I convinced a few of them to try this out because your cravings will go away. Get through a couple of months of it and you will not crave these things anymore.
Dr. Eric Westman: I say after a couple of days the craving will go away just so I do not scare people as most will not wait a month.
Dr. Christopher Palmer: I am the opposite. I prepare people for the worst. I say it is going to be awful in the first week or two. It is just going to be tormenting and that we will get you through it. Invariably they come back and say it was not nearly as bad as you made it out to be.
Dr. Eric Westman: For those watching or reading this, this is the psychology used by a trained psychiatrist. I usually barter and say, “Try it for a day.”
Dr. Christopher Palmer: I like to set the expectations low and then have them be pleasantly surprised.
Using psychology to stay on the diet
Dr. Eric Westman: That should be a randomized trial – the psychology of starting the keto diet.
Dr. Christopher Palmer: It should, and in my experience, the reason I do that is I have had people say it was hard. I started out telling people it is easy and then I would have them come back to me three or four days later saying, “I got so famished and I felt a little weak or dizzy.” “It was not easy and something was going wrong and so I knew I needed to break the diet.” I tell them, number one, you probably were not eating enough. If you are cutting out all of the carbs and if you are going to McDonald’s and cutting out the bun and the french fries and everything else and the shake, you might need more than one hamburger patty. You might want to add a salad or something with it. That is one of the big mistakes. Sometimes people are not eating enough.
I get some friends and family to do the diet and they too notice not just the weight loss but significant mental health Improvement. They feel better, they are more positive, they have more energy, they are sleeping better and they feel great. I am thinking this Atkins diet is an antidepressant
Dr. Eric Westman: Was your mom able to try it?
Dr. Christopher Palmer: Interestingly she did try it and she had periods when she was on the diet that she was starting to do better. My mom had obesity, she had low thyroid hormone, and she was on thyroid hormone supplements. She also had type two diabetes and was on medication for it so she came in with a lot of hits against her and her metabolism and everything else. She never completely got off diabetes meds. She never did it long enough to completely get off everything but she did it intermittently and I would notice that she was a little bit better but her psychotic symptoms would wax and wane. She would have good months where she was not talking about it too much and then she would have bad months. When she was doing the diet, my recollection is she was talking a lot less about it and seemed happier but I did not make too much of it then because I had no conception that a ketogenic diet could do anything for psychotic disorders. I was thinking maybe it was an antidepressant.
Within a couple of years, I was working at McLean Hospital, which is the flagship psychiatric hospital of Harvard Medical School. We are a tertiary care hospital. We get people with treatment resistance and severe mental illness. That is what I have always treated most of my career. It is very rare for me to get somebody off the street with their first episode of anxiety or depression or something else. Usually, people coming to me have tried lots of medicines, years of psychotherapy, possibly even electroconvulsive therapy and other treatments and nothing has worked for them, they are still sick. Within a few years, I am thinking, I have got these patients and they have tried just about everything. One woman had tried over 30 different medications. She had been in therapy for decades, was in and out of hospitals, had ECT and nothing worked. I am thinking, you want to think about maybe trying a diet now. Initially, she was skeptical, and pushed back a lot and I was not trying to force it on her at all. If you do not want to try it that is no problem, but we have tried everything and if you want to try medicine number 31, here is one that you haven’t tried.
Dr. Eric Westman: To unpack the acronym of ECT, electroconvulsive therapy, it is the classic, stereotype shock therapy. This is very serious. Although old, it is being used for less serious diseases now. Not only medicine but also electroconvulsive therapy was tried.
Success story
Dr. Christopher Palmer: Yes, the change in diet. She was the first success story I had. It took us months for her to even contemplate doing it. She got the Atkins book, read it and we talked it over, we talked about what foods she would enjoy eating, what foods she did not want to eat, and what was going to be hard for her to give up. I was not telling her to wing it. I said, “You have got a really serious crippling mental health condition and I as a clinician want to see if this is possibly going to help you”. It took her over a month to get into ketosis. She was trying different things and they were not working. We ended up trying what Atkins had described as a “fat fast.” Basically, increase her fat significantly and lower and restrict her carbohydrates. That was the trick that did it for her. As soon as she got into ketosis, within a week she got a little bit hypomanic. For people who do not understand, that is the opposite of depression. Not only did she get an antidepressant effect, but she was giddy, she was giggling, laughing and smiling in a way I had never seen and in a way that she said she could not believe and that it was the best she had felt. She started dating. She had not dated in years and it was working beautifully.
I had been trying to convince her to exercise as a treatment for her crippling depression for over two years. She scolded me at one point and said, “I get that exercise is important for me, but stop talking to me about it. I am never going to do it. I am depressed, I am lazy, I am not going to do it, I do not want to hear the words exercise out of your mouth anymore.” I was okay, loudly heard and I am not going to ever bring up exercise again. We get within a month of starting ketosis, she came in smiling, grinning one day, and says “Dr. Palmer, guess what I did? I joined a gym!”
Dr. Eric Westman: Were you worried she was in full-blown mania? For those who do not understand psychiatric illness, especially with bipolar, this is a mood being tranquil, people accuse me of that all the time, and if you are depressed, the mood is down; if you are elated, the mood is up, and it is normal to have these cycles. Not so normal to be down there all the time. She had come up to this. Were you still skeptical?
Dr. Christopher Palmer: At that point, I already knew it worked for “non-patients” like myself because I was not doing it as a patient. My friends and family did not even have a mental health diagnosis. They just felt dramatically better. This was a legitimate treatment-resistant patient with a very severe mental illness.
Therapy for mental illness that is not a drug
Dr. Eric Westman: The importance of that is the spectrum of disease that you would typically see in the clinic. We call people “patients,” they are people but they come to us, to the clinical world, typically worse off, seeking care for whatever the problem is. Now you are introducing a therapy that is not a drug. They do this on their own.
Dr. Christopher Palmer: I am starting to use it in other patients, especially patients who have type 2 diabetes. Again, I am only working with people who have treatment-resistant mental illness. it is not like I am offering this as a first-line treatment off the street. I feel very secure in my decision and my licensing credentials because they have tried everything and we are totally off-label now anyway. Like any other medicines that I am using that are not indicated by the FDA for the treatment of their condition. I am now in fringe territory anyway, so let’s use a diet.
Dr. Eric Westman: Let us go back to thinking about research because you are getting into that area and we will get to that in a minute. It is so important that you know that the disease is relapsing and goes up and down. You need to understand that in any research that is done, and the idea that there may be other factors that need to be controlled. That is the main thing. Having someone have a benefit, you do not know what percentage of folks will have that benefit. Just because you saw one person climb Mount Everest does not mean we can all do it. My other point was that an area to be in research is a place where no one else wants to be – the sickest of the sick. I will ask other doctors to send me people that they can’t stand because they are on 20 different medicines, literally, and diabetes and all these different things. Then I just do my thing. Having the sickest of the sick is a great research place because no one else has any other option. It is brilliant.
Dr. Christopher Palmer: It is more compelling to those other clinicians because if I took somebody with mild depression and got them better with a change in diet, most clinicians just brush that off as it was probably going to go away anyway. They probably weren’t sick anyway. You were probably just overestimating their level of depression. Or, maybe they were just whining and complaining and they did not have real depression. When you see these patients who have tried 30-plus medicines, have had electroconvulsive therapy, and have been in therapy for decades, there is zero ambiguity. They had a real mental illness.
Dr. Eric Westman: That doesn’t mean those arrogant mental health vultures won’t blow it off with “They just grew out of it.” That is the response I got. You have brought one of your patients to the Metabolic Health Summit, at Low Carb Denver. It was an unbelievable story of someone down and out, homeless, now organized and dressed up. Is that the same patient you are talking about or is it someone else?
Dr. Christopher Palmer: That is a different one. I have got a lot of stories now. I was just going along, minding my own business for about 10 – 15 years. I am just doing this on the down-low because I do not want to get into trouble. I do not want to have anybody come after my license.
Dr. Eric Westman: Being the low-blade of grass. I have lived this.
Dr. Christopher Palmer: I was not looking for trouble. I was just looking to help the patients in front of me. One of my patients with schizoaffective disorder had chronic hallucinations and delusions. He was tortured by his illness. He was essentially a hermit. He had become obese from all the medicines we prescribed to him. He was over-sedated from those medicines.
Schizophrenia
Dr. Eric Westman: Spend a minute or two about what it is like to have that disease. To be tortured. What about people who do not understand, never had a family member with this or not been in the medical world? What kind of things would he experience?
Dr. Christopher Palmer: This is not universal for all people with schizophrenia, but when you see homeless people who mumble to themselves and smell, they have schizophrenia or schizoaffective disorder and they may have substance use disorders, and other things too. For a lot of them, including him, his torture was that he would hear voices in his head that he assumed were from people who had targeted him. He assumed that there were powerful families in the world who had all of this technology, and they were evil families, and they randomly or non-randomly selected people to torture. They would put these voices into his head, and the voice would often denigrate him. “You are worthless, you are fat, you are a loser, you should kill yourself.” He was convinced that other people, everybody in society, was in on this. When he went out in public, if anybody glanced his way, even in his direction, did not even look at him, he was convinced, “They are part of it, they are monitoring me, I know it.” Sometimes he would be terrified. “They are going to pull out a knife and stab me in the eye at any minute, I know they have got a knife, look, he is putting his hand in his pocket, he has got a knife, he has got something, and he is going to come after me any second.” Or they were mocking. If he was out in public and two women, far away at the other end of the park, started giggling because one of them told a joke, he would think, “They are laughing at me, they are mocking me, look, they are making fun of me, I feel humiliated, I am not taking this, they can’t do this to me, I am sick of it.” That was his life, day in and day out. He couldn’t go to a movie theater because he was convinced that somebody would be lurking in the dark, ready to kill him. He couldn’t go on a bus because he was convinced everybody there was talking about him, thinking about him, laughing at him, mocking him, monitoring him. Even when he hides in his home for safety, the voices are there. The voices are tormenting him, telling him, “You are a loser, you are fat, you are ugly, nobody wants you, just kill yourself.” So it is a living hell. Even the descriptions of hell that we hear usually are not that bad. It is a living hell.
Dr. Eric Westman: I have to let you know, I am a son of a child psychiatrist. I am not a psychiatrist, but my father always used to say that physical pain rarely leads to suicide. There are pain clinics. It is mental pain and anguish that leads to suicide. I remember, in training, sitting one night with a fellow who came in for psychosis. It was not just the voices for him, it was as though his whole body felt anxiety and his pulse was rapid. It is remarkable to see, and you can’t fix this.
Another success story
Dr. Christopher Palmer: So this man asked for my help to lose weight. He had tried other weight loss methods that did not work for him. For a variety of reasons, we decided to try the ketogenic diet. At this point, I am far beyond. It has evolved from Atkins to ketogenic therapies. I am doing blood glucose monitoring, I am doing all sorts of things, but he wants help losing weight. I have not seen it work for psychosis or bipolar or anything else. I have seen it have a powerful antidepressant effect, but in my mind these are totally different disorders. I am thinking, “Okay, I’ll help the guy lose weight.” I had no expectations that it would do anything for his mental symptoms. Within two weeks, not only is he losing weight, but I start to notice this powerful antidepressant effect in him. I am not changing his meds, he is still on the same meds. He is smiling more, talking more, and much more animated. I am asking myself, “What is getting into you?” I did not even anticipate an antidepressant effect in him because he has a severe mental disorder. Schizophrenia is the sickest of the sick. I am like, “I am shocked that it is having an antidepressant effect on him, that is dumbfounding.”
At this point in my career, I have now concluded that people with his diagnosis have irreparable brain damage. That is the way I conceive of their illness, that they are beyond help. We keep trying medicines, and we are lucky if they reduce the symptoms enough, but they never restore lives. People are not getting better; they are usually just going on with chronic illnesses. If the medicines work, they stop working after six months and then the symptoms are back with a vengeance. At that point in my career, I have concluded that these people are beyond help. It is heartbreaking, because my mom was one of those people. It is like there is nothing we can really do, we do not know what to do, we do not have anything to offer these people, and nothing works. Electroconvulsive therapy does not help them and medications do not. Medications reduce their symptoms, get them out of trouble, and keep them out of jail, but they are not curing them.
At the two-week mark, it is having an antidepressant effect. It is not happening right away. At about the two-month mark, so six to eight-week mark, he says, “You know those voices that I hear all time, they are starting to go away. I am not hearing them that much, and when they do talk, I can ignore them. I am done with them. I am sick of listening to those voices; I am just going to ignore them now.” I am like, “Whoa.” The real shocker for me was a few weeks later, he says, “You know how I thought there were all those families who had targeted me and they were tormenting me on purpose?” He says, “Now that I think about it, I do not think that is true. I think I have had schizophrenia all along, like all you people have been trying to convince me, and it is going away.” At that point, I recognized I could not stay quiet about this. This is way too important; this is nothing short of a miracle.
The importance of keeping to a sensible low-carb keto diet
Dr. Eric Westman: Two months in, though it took a little patience, what was he eating? If someone is listening and they do not know what keto or low carb means,
Dr. Christopher Palmer: He was eating a traditional ketogenic diet. We were focused on higher fat and now I probably would do it differently, even for him, because he was obese to start. He would have bulletproof coffee in the morning, and then otherwise a very reasonable, sensible low-carb keto diet. So, chicken, poultry, fish, meat, low-carb vegetables, that might be asparagus, broccoli, salads, olives, cheese, those types of things. He would mix it up a little bit, but we were always going for ketones. One of the things that I noticed that I will share if this is helpful, is that he ended up falling off the wagon a few times and cheating on the diet, and his psychotic symptoms would almost always come back with a vengeance. Early on in the first six to 12 months, he was not better enough to be able to cheat, so when he did cheat, his psychotic symptoms would come back. One time he was convinced that he was still on the diet, and he came in saying, “I may need to go to the hospital. I can’t take it, the voices are so loud, they are tormenting, I cannot take it, I cannot stand it, I might need to go to the hospital.” It is important to point out he hated the hospital more than anything. The hospital to him was a torture chamber. When he is asking for the hospital, I think, “This must be really bad. This is not a good sign.”
I asked him to step on the scale. He steps on the scale and he weighs 10 pounds more than he did the prior week. I checked his blood ketones and they are essentially negative, which is 0.2 for beta-hydroxybutyrate. 0.2 is a negative reading for most people, that is kind of a baseline, non-ketogenic level. I say to him, “Something’s gone wrong, you’ve gone off the diet,” and he is yelling at me, “No, I have not, I am still on the diet,” and I am like, “Something changed – what is it?” He went out and bought these supposedly “ketogenic” chocolate bars. It says keto on it, so he thought he could have it, but it was not ketogenic and it threw him out of ketosis, it made him gain weight, and the weight gain that he gained was probably a lot of water weight because when you start replenishing glycogen, you start getting some water with that. The 10 pounds was not 10 pounds of fat weight gain, it was probably a lot of water and fluids. That was the clue and I let him know, “Whatever you ate, whatever was in that chocolate bar is not allowed. Let us get back on. I am not going to put you in the hospital right now if you think you can stay safe.” I had to check in with him every day. “I need to see you back here tomorrow, less than 24 hours. I am worried about you, but get back on the diet, no keto junk food, nothing new”. Within 24 to 36 hours, he was fine again.
Research and publishing papers
I will fast forward. I start using this with other patients with schizoaffective disorder and I start publishing research. I end up collaborating with researchers from around the world—Australia, the UK, and all sorts of places.
Dr. Eric Westman: Do you have a paper?
Dr. Christopher Palmer: We do have a paper. I started collaborating with famous people, like Dr. Westman, and we have a paper. Word starts spreading and at this point, we are way beyond anecdotes and stories like I have been sharing.
Effectiveness rate
Dr. Eric Westman: What percentage effect? The internet can show you what can happen, but it never gives you the denominator to be able to say 50% of people, for diabetes. The Virta study said that 70% of people can get off insulin with type 2 diabetes coming in. Any idea of what the effectiveness rate is at this point? I know you could say you got to give it a try and see, but I wonder if you have enough experience to gauge how effective this is?
Dr. Christopher Palmer: The interesting thing is that for people with mild to moderate disorders like mild depression or anxiety, in my experience overall, it can be less effective in terms of a percentage. The reason, I think, is because mild depression can be due to lots of different reasons. For some people, it is psychological or social reasons, so they may need psychological or social treatment to get better. However, the shocking thing and the paradox is that for people with really severe, crippling disorders, it is pretty close to, if I can get them to do the diet for three months and have ketones for three months, that is a big if, as not everybody can do that, but if they can do that, it is above 90% of people who have an improvement in symptoms. Usually not just a little bit of improvement, usually dramatic.
Dr. Eric Westman: With that sort of percentage effect, a study of 20 of the worst of the worst, put them in a step-down ward, it doesn’t have to be full-blown hospitalization but control what they are eating, with permission. You do not need randomized trials if it is that powerful. When there was meningitis, everyone died. When you introduced penicillin, there was no need for a randomized trial. One of the clinical epidemiologists I learned from said it is a good thing they did not have the power calculation requirement and statisticians that said you needed a randomized trial on penicillin because you did not. That kind of effect, even though people will say you need randomized trials. One of the best studies in the diabetes world was putting 20 people on a ward where they could study everything they were eating and watch the diabetes get better. They crossed them over, brought them in on their typical diet, and then changed them over, which might be another way to do research without a lot of money. I wanted to make sure that you were aware that while other people may want millions of dollars for research, a lot of this can be done if it is that effective with the right thought of the spectrum of the illness.
Dr. Christopher Palmer: That study has actually been done and you were a co-author.
Dr Eric Westman: That was with Dr. Albert Danan. It was his patients. It needs to be repeated.
Dr Christopher Palmer: I agree. We have now had two more studies published, one with 20 patients with bipolar disorder. That was an 8-week trial, but the patients were euthymic, meaning they were not in the middle of a severe depression or manic episode at the time. Many people with bipolar disorder are still having mood symptoms and cognitive symptoms in between episodes, so even when their mood is not officially depressed or manic, they still have symptoms. In their study, what they found in those 20 patients is, the higher the level of ketosis, the greater the improvement in mood, energy, cognition, decreased anxiety, and decreased impulsivity. They got high levels of compliance. 91% of the daily ketone readings were positive. They measured blood ketones every day in all the people for the eight weeks. 91% of those daily readings were positive, meaning a very high level of compliance with the diet.
They did brain imaging studies as part of that and they showed improvement in brain metabolism. That correlated with the clinical improvement. Dr. Shebani Sethi from Stanford Medicine published her study about a month ago, of patients with treatment-resistant schizophrenia and bipolar disorder and she got significant results. I think 79% of the patients had clinically meaningful psychiatric improvement. 100% of the patients who had metabolic syndrome reversed their metabolic syndrome, and a nice side effect, a lot of them lost some weight, too. That is the side effect of this treatment. We are treating brain conditions and that is the way I think about it. We are treating brain conditions and they are losing weight and getting rid of their diabetes and high blood pressure and everything else?
Dr. Eric Westman: We would call the mental health effects a non-scale victory and you are calling the weight loss a non-brain victory.
Dr. Christopher Palmer: The reality is what we are doing is we are treating whole human beings as though they are all one, their body, their heart, their pancreas, their gut, and their brain are somehow all connected.
Start of the center and funded studies
Dr. Eric Westman: Where do we go from here? You put together an amazing book called “Brain Energy”. There is a Metabolic Health Psychiatry Unit, at Harvard and Stanford. How did your center start and tell me a little about the funded studies that are coming up?
Dr. Christopher Palmer: There is one philanthropic family, the Baszucki family, that is supporting over a dozen research trials of the ketogenic diet for mental health conditions around the world. A lot of them are focused on bipolar disorders and schizophrenia, but major depression, and anorexia nervosa are also being studied. The federal government is doing trials of the ketogenic diet for alcohol use disorder (a.k.a. alcoholism). A different philanthropist donated $3 million to McClean Hospital, which allowed me to set up the Metabolic and Mental Health Program. We will have the very first consultation service offering ketogenic therapy to people with mental health conditions. To the best of my knowledge, this will be the first psychiatric hospital in the world to offer this service to patients outside of clinical research. That is exciting. At McClean Hospital, with funding from the Baszucki family, we are doing a trial of a ketogenic diet for bipolar disorder and schizoaffective disorder in people who are between the ages of 18 and 44. I am in talks with other philanthropists who are also interested in supporting this work. We are looking at doing clinical trials.
Beyond ketogenic diet therapy, we are looking at more broad-based metabolic treatment strategies. We use metabolic treatment strategies to improve brain function and get people better. So we are looking at medications, vitamins, supplements, measuring hormones, and making sure people do not have thyroid hormone deficiency that has gone unnoticed or vitamin B12 deficiency that has gone unnoticed. I am going to be working with basic science researchers who are doing stem cell research, trying to further prove that metabolic dysfunction in cells can result in symptoms of mental illness and even the genes that increase the risk for mental illness. A lot of those risk genes have been tied directly to mitochondrial abnormalities or metabolic abnormalities. It appears that the risk genes for mental illness are metabolic in nature and if you pair that higher risk, because of your genes, with a really bad diet, or a toxic lifestyle like sitting all day looking at a screen and eating a lot of junk food, that can be a double whammy. It can result in being overweight or developing obesity, it can result in diabetes, but it can also result in the brain malfunctioning, what we call mental illness. It could be anything. It could be depression, anxiety, all the way to bipolar, or even schizophrenia.
Dr. Eric Westman: To editorialize a bit. This is a great start. A lot of money is always needed. At the end of every paper, they say more research is needed. This is the infancy of what I hope will grow. Harvard has a lot of different silos, including the Pediatric Endocrinology group, David Ludwig and Belinda Lennerz, hope you can work with them. There is a surgeon who has a cancer model, his name is Matthew Nehs. Someone came in with anaplastic thyroid carcinoma, something I had not seen in 30 years. I typed that into PubMed and keto and Dr. Nehs’ research came up. He has an animal model there and the feeling that all this is changing, which is wonderful. Are you set up that if I or someone else wanted to see you at the hospital, you come and make an appointment or are you still working things out?
Dr. Christopher Palmer: Two of the staff I am hiring are starting next week. They still need to be trained and we just have to set up our clinic and set up our systems. More than likely, that clinic is going to serve primarily McClean Hospital patients because it is going to be relatively small in scope to start. I unfortunately have a waiting list of over 4,000 people. I am working with lots of people to try to start the clinic that would likely be outside of McClean Hospital where we will be able to treat a lot of patients. I am not going to be the person treating all these people because I can’t treat 4,000 people by myself. I am hoping to hire clinicians, train them, and have team-based care. The great news is that I have a lot of clinicians who are actively reaching out to me. They too are desperate to help their patients better. They get it, they know that what we are doing is not always working and they want new tools and they love the concept of lifestyle. I am speaking at three Harvard Lifestyle and Obesity Medicine Conferences. A lot of people are interested in this work because it confirms what they kind of already know but have not been able to get others to take it seriously. When they help people lose weight using lifestyle interventions, they see their mood or anxiety or ADHD get better but nobody takes them seriously. What I am saying is it is a serious intervention, you are improving and at the same time you are helping them lose weight or improve their diabetes as well as helping improve their brain metabolism, and that makes their brain function better. Although some lifestyle medicine people lean more toward plant-based diets with lots of grains and other things, I am trying to insert that different people need different diets. If somebody is doing well with that diet, great, however, if they are not doing well with that diet let us get something different.
Internet and other resources
Dr. Eric Westman: If ketosis is necessary, and that was one of my last questions, it is going to be hard to do that with all the carbs and plants. Angela Fitch is a good friend, she is the director of the Obesity Program there, although she is more of a medication obesity medicine doctor. Lifestyle medicine is usually plant-based, your alarm goes off. Is there any web presence if someone wants to learn about this as a patient? Do you have a website where people can learn?
Dr. Christopher Palmer: They can go to brainenergy.com. We have a free newsletter. I have a self-assessment that you can take to assess your mental health and metabolic health. I would encourage people to sign up for the newsletter. If you are interested in clinical services and being put on this wait list go to christopherpalmermd.com and you can find more of my academic research there. The wait list, we have ketogenic dietitians listed who want to work with mental health people so they are using ketogenic therapies for mental health conditions. I do not have any financial relationship with any of them. I should probably charge them something but I do not, I am doing it as a service to the community. They are dietitians who want to help people and, I want to help people. Most of them work remotely. Unfortunately, insurance doesn’t cover most of their services. There is another nonprofit organization, Metabolic Mind, that is run by the Baszucki group. People can go to Metabolic Mind and sign up for their newsletter and look at their videos. A lot is happening in this space which is taking off rapidly.
Dr. Eric Westman: I share your concern about people. You want to do it right. You want to do it in a way that has been tested and tried and true. It may not be the panacea for everything.
Dr. Christopher Palmer: There is an important example that I will give, and she is very public about it. There is a woman named Lauren Kennedy who has schizoaffective disorder and she has a YouTube channel called Living Well with Schizophrenia. She has been publicly speaking for years about how to live the best life possible with schizophrenia. She interviewed me over a year ago and had tried the keto diet on her own and said it did not work and gave up. For the past four months, she has been working with a ketogenic diet clinician and her psychiatrist doing a medical-grade, neurology-grade, ketogenic diet and for the first time in years, her symptoms are in full remission. She has a web presence with lots of videos. You can see her videos beforehand, her hospitalized and you can see her thriving now and glowing. The heartbreaking thing is, she put out a video a couple of weeks ago where she started crying about what would my life have been like if I had been offered this treatment 20 years ago.
Dr. Eric Westman: Hopefully, she can channel that into handing it forward to other people. This is not a panacea, we call it “Internet Keto,” where people say they have tried keto and it doesn’t work. Now we call it “prescription-strength keto” because we do 20 total carbs and I do not ask people to measure ketones but they are all in ketosis when you are under that 20 total per day. I want to catch up with you periodically, if that is okay, to see what the latest news is. It is awesome to see this transform over a relatively short period. We look back to that paper in 1950 where they put people on a ward to do a keto diet with schizophrenia and the paper is so short it is hard to know it happened. You know this is going to happen a lot faster than 70 years. Thank you for sharing your story. I did not know we had that connection. I walked my mom down the ward hallway to get her first ECT therapy for depression. My patient, Doris, who was one of the patients I had who came in after losing weight after 8 days and said, “My voices are gone,” and I was back in the chart that day and trying to figure out what she was talking about. This is now going to get some real formal attention
Dr. Christopher Palmer: It is, and you have been instrumental in all of it. For people who do not know, Dr. Westman has been instrumental not only in telling me about your patient Doris and sharing her story and letting me talk with her but all your support from day one back in the day when the Atkins diet was that fringe quack diet. I would never have gone anywhere if I did not have all that safety literature to fall back on and say, “This is serious. It is already published, researchers have already done this work.
Dr Eric Westman: You do not have to recreate the wheel. You are going to be amplifying this in a new direction that it has so much potential.
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