Why Mental Illness Is a Metabolic Problem—and What That Means for Your Health with Dr. Chris Palmer - Transcript

Dr. Chris Palmer
In any given year, approximately one billion people are diagnosed with a mental illness. That represents about thirteen percent of the world's population. In Western countries, the rates are higher. One in two people will meet criteria for a mental illness at some point during their life. Mental disorders are one of the leading causes of disease burden and disability worldwide.

At the same time that the rates of obesity and diabetes are skyrocketing, chronic diseases are skyrocketing, the rates of mental disorders are also skyrocketing. I point that out as it should not be considered a coincidence and yet most people in our field don't think about it that way. I think that at the same time that people's physical health is getting worse, their brains are impacted too.

Dr. Mark Hyman
Doctor. Christopher Palmer is a Harvard psychiatrist and a researcher working at the interface of metabolism and mental health. He's the founder and director of the metabolic and mental health program at McLean Hospital and assistant professor of psychiatry at Harvard Medical School.

Dr. Chris Palmer
The reason this is so important is because if you make the assumption that these disorders are genetic and permanent and fixed, it immediately instills hopelessness. I'm saying it is time for the mental health field to have a transformation.

Dr. Mark Hyman
A revolution. You are a pioneer in this. I would love you to just close out by saying, what do you think is next? Welcome to a special episode of the Doctor. Hyman Show, recorded live at the Eudaimonia Summit.

Eudaimonia is a three day gathering designed to elevate human health and potential. Here, over a 100 leading scientists, clinicians, and wellness innovators come together to share the most advanced evidence based strategies for longevity and well-being. And I'm thrilled to bring you a conversation from the heart of this transformative event. Okay. Chris, welcome back to the show.

Dr. Chris Palmer
Thank you so much for having me back on.

Dr. Mark Hyman
It's so great to be here with you at Eudaimonia, which is an amazing conference that talks about health and wellness. And we're gonna dive deep into the psychiatric revolution that's happening now in medicine. And you're the tip of the spear in that revolution. We had a funny encounter because you emailed me and said, Mark, would you give me a quote for my book, Brain Energy? And I was like, sure.

And sent me the book. So I had a look at the book and I was like, wait, I wrote this book fifteen years ago. It's called The Ultramind Solution. And I and you read it and you're like, sent me a very contrite email. Says, Mark, I really promise I did not read your book.

I promise I didn't plagiarize it. I'm like, don't worry. It's like the science is finally catching up. I think both of us had the experiences both personally and also with our patients of seeing what happened when we changed the diet and also change the biology of people's body. And what really became clear to me was that psychiatric problems are basically framed by traditional medicine based on symptoms.

So the DSM five or whatever it is now, ten, eleven, 12, is basically a catalog of symptoms defining people based on x y or z symptom, and you have anxiety, you have PTSD, you have depression, you have bipolar, you have schizophrenia, you have schizoaffective disorder, you have whatever, but it talks nothing about the cause or the mechanism. And what became really clear to me was that and I spent I remember one of my favorite times in medical school and residency was spending a month in a psychiatric hospital. I mean, not not personally, but I was was a resident. I just was fascinated and sat there and listened and listened, and I realized it's something's off. And I I remember writing a little piece, I'll see if I can send it to you, about this because I was like, this is just off.

How we're thinking about this is off. But I didn't really quite get it. And what I realized later as I was beginning to to practice functional medicine and treat people's biology, that their psychiatric problems would get better. And I realized that mental health was not a brain problem. It was a body problem that affected the brain.

It wasn't a brain disorder, it was a systemic disorder that affected the brain. And that includes Alzheimer's, schizophrenia, autism, depression. The whole spectrum of things that affect the brain are are driven by underlying biological mechanisms that we're just beginning to understand. I'd love you to start by kind of framing the problem of the scope of mental illness, how big a issue it is for us, and really how you came to understand the root causes of it from your patients and through the science, which is actually amazingly there. It's just mostly ignored.

Know, think there's so much literature out there and and most doctors don't have time to read it all. And they focus on what they were trained in, and they if there's something that contradicts or challenges their paradigm, very hard to change it. RD Lang says, scientists can't see the way they see what they were seeing. It's very hard to change things. The structure of scientific revolutions, Thomas Kuhn said, it's hard to shift people from an from what he called normal science and have a paradigm shift, but we're in a paradigm shift.

So can you talk about how you came to understand this, and what's happening with the scope of mental health, and and where metabolic psychiatry kinda plays a role in this.

Dr. Chris Palmer
Thanks again for the opportunity. Those are massive questions. You don't have to go

Dr. Mark Hyman
the whole hour on those, but you know, just give me give me the reader's digest version for the the scope and

Dr. Chris Palmer
I'll take the quick. So the scope is that, you know, in any given year, approximately one billion people on the planet are diagnosed with a mental illness. That represents about thirteen percent of the world's population. In Western countries, the rates are higher. About twenty percent, one in five, will be diagnosed with a mental illness in any given year.

In Western countries, such as The United States, about fifty percent, one in two people, will meet criteria for a mental illness at some point or another during their life. Mental disorders are one of the leading causes of disease burden and disability worldwide, and the reality is that the rates of mental disorders have been skyrocketing for decades now. At the same time that the rates of obesity and diabetes are skyrocketing, chronic diseases are skyrocketing, the rates of mental disorders are also skyrocketing.

Dr. Mark Hyman
Not a coincidence.

Dr. Chris Palmer
I I point that out as it should not be considered a coincidence, and yet most people in our field don't even talk about it that way, don't think about it that way. Many of the academic psychiatrists will say, well, the reasons the rates are increasing is because we're recognizing it more. We're talking about mental illness. We're destigmatizing mental illness. More celebrities are sharing their stories.

People are comfortable talking about their mental health struggles. But these things are largely genetic, and that means they are fixed. They are fixed, permanent genetic disorders in the population, and they must have been there all along. We just didn't recognize them. That is, in fact, the predominant narrative right now, and I very much disagree with that narrative.

I think that at the same time that people's physical health is getting worse, their brains are impacted too. And that sounds so obvious, but it is not obvious. Again, this is the predominant paradigm and narrative is mental disorders are genetic. They are permanent fixed brain disorders, and and then there's once you get this label, there's no hope. There's no hope for recovery because now you are schizophrenic the rest of your life.

Once you have your first manic episode, you're bipolar the rest of your life. And what do you need? You need a mood stabilizer or an antipsychotic for the rest of your life. Don't you dare ever stop it because if you stop it, you're gonna get sick, and you're gonna end up in the hospital or end up dead. And so the reality is that mental disorders ruin lives.

They ruin families. They cause tremendous suffering. And there still to this day is this tremendous stigma that comes with having a mental illness.

Dr. Mark Hyman
So like it's it's like God made a, or nature made a massive mistake and a design flaw in creating human beings, so that we have this massive amount of mental health issues. That just doesn't make sense to me. If you think you think about our evolutionary drives, if we all were suffering from mental illness and depressed in our cave and not hunting, we'd be all dead. Right? And you're right.

We we think of these as fixed genetic disorders that we can't do anything about. We can manage them, we can treat them, we can suppress the symptoms, but we can't reverse them, and we can't really do anything about them, maybe except medicate or do thirty years of psychoanalysis. And and that's really a flaw. And when you when you started to kind of uncover the science around metabolic dysfunction in the brain, it kinda the light bulb went off for you. And tell us about that that experience, and tell us about, you know, what what metabolic psychiatry is, and how it shifts the paradigm from this fixed genetic disorders that don't change to something that's actually immensely treatable.

Dr. Chris Palmer
Obviously, as you said, you've been talking about this for a long time, shouting from the rooftops about this.

Dr. Mark Hyman
Nobody was listening.

Dr. Chris Palmer
And in well, and in many ways, it's it's catching up to what you've been saying. And I think some of the foundational differences are things that we've just said, that we need to think about mental disorders as systemic disorders that happen to be affecting the brain. But they are almost never limited to the brain. At the same time that people have these mental disorders, they also have body disorders. They have liver problems, metabolic problems.

They have immune system problems, gastrointestinal problems. Antibodymyome. Yeah. They have other problems. But then they're written off.

Oh, you're mentally ill and you're complaining about stomach pains. It must be psychosomatic.

Dr. Mark Hyman
Yeah. We call it suprachinclurals. Anxiety.

Dr. Chris Palmer
You're yeah.

Dr. Mark Hyman
Suprachinclurals. For those laypeople, it means it's in your head. You're can term is the part of your brain that fixes your kind of lower brain from your upper brain. And it's like it's kind of like a pejoratives thing that doctors say. Oh, it's suprachentorial, and it's kind of a very derisive joke, I think.

Dr. Chris Palmer
I mean, the reason I think the reason I stress this is because it comes with, again, so much stigma and shame and humiliation for the patient, for the family. And it it really comes down to you are broken or you are weak. You're just anxious. Take a deep breath. Why don't you take a deep breath and make your stomach pain go away?

Well, maybe their stomach is inflamed. Yeah. Maybe their gastrointestinal tract is inflamed, and taking a deep breath isn't gonna do a damn thing for their stomach inflammation. But yet we we we like, we still say this. This is told to millions and millions of people every day.

Another really important part of this revolution is this concept that instead of telling people you have a permanent fixed brain disorder due to your genetics and even when I talk to people about metabolic psychiatry and stuff, they are still really focused on this. But but wait, Chris. My my dad does have bipolar disorder, so mine is genetic. Right? So mine is genetic.

It must be. I'm like, no. You're not getting it. You're not understanding it. And the reason this is so important is because if you make the assumption that these disorders are genetic and permanent and fixed, it immediately instills hopelessness.

Dr. Mark Hyman
Right.

Dr. Chris Palmer
That you are defective. You are a defective human being. And it's not your fault. Your your parents gave you these genes. It's not your fault that you are defective.

And you're gonna have to take pills for the rest of your life in order to to to manage your brain defect. And so even the most compassionate psychiatrists have that mindset. It's not their fault, but they are damaged. Mhmm. They are defective.

Yeah. And they do have to take their pills. And I'm doing a good job. And I wanna get rid of that narrative. That narrative needs to go away and be buried.

That the narrative needs to be there is something wrong with this person's brain or body or combination of the two that is causing dysfunction or dysregulation that can be fixed. If we can ask the question, what might be causing the problem? And we can systematically look for causes.

Dr. Mark Hyman
So what do we know now about those causes? And what are the mechanisms that are going on that are causing this brain dysfunction? Because it's things like insulin resistance, inflammation, oxidative stress, mitochondrial dysfunction, all these fundamental concepts that are root rooted in functional medicine thinking that we've been talking about for decades, it's happening in the brain. And we know what's causing it, and and yet we're not treating it. So can you talk about what are those causes in in a little bit more depth, and and how do we start to begin to think about fixing those, and even diagnosing them?

Dr. Chris Palmer
So the the part of the field that I really want to embrace, which has been around for, you know, fifty, sixty years, is this concept of biopsychosocial. Biological, psychological, and social. Those are the root causes, and we know it. So adverse childhood experiences, if they occur early enough in life, they increase risk for all of the mental disorders, and even autism spectrum. Mhmm.

If if you if if a if an infant is severely neglected or abused, that infant is at much higher risk of developing autism because they that infant will never learn appropriate social skills. But every label in DSM five TR is increased. You're at increased risk from adverse childhood experience. What else do adverse childhood experiences increase risk for? Obesity, type two diabetes, cardiovascular disease, autoimmune disorders, all sorts of other physical metabolic health conditions.

Dr. Mark Hyman
Yeah. Anybody listening, you should go online and look up the ACE questionnaire, ACE, adverse childhood events, and get your score. And it'll tell you what your score is, and the higher your score, the more likely you are to have your health issues driven by what happened to you. Because it's what happens to you is not just a emotional thing. It actually gets written in your epigenome and written in your biology in a way that changes everything and drives inflammation.

So when you have adverse events happening to you, it literally turns on different genes that drive different metabolic pathways that drive inflammation and oxidative stress and even things like insulin resistance. We we know the biology of this.

Dr. Chris Palmer
And interestingly, can change your gut microbiome. So we just had a paper out, research study out in last year showing that amygdala activation, So this is your threat system in the brain. The amygdala actually activates a certain specific pathway in the vagus nerve, which then lands on something called Brunner's glands in your digestive tract that secrete an enzyme that changes the acidity of your gastrointestinal tract that within an hour changes your gut microbiome. And so stress and trauma impact your gut microbiome, which can then impact whole body health, mental health, all of it. But as you might know, what you eat also impacts your gut microbiome, and so we need to put it together.

So even if stress or trauma is causing changes in your gut microbiome that then increase your risk for a disorder, we can use diet and nutrition to treat those changes in your gut microbiome to restore a healthier gut microbiome, which will then reduce your risk for disease or improve your health.

Dr. Mark Hyman
Just one one note on that because it's really important. It seems to me a final common pathway is anything that triggers inflammation. Whether it's toxins, your diet, psychological stress, changes in your microbiome, allergens, infections, anything can drive changes that drive inflammation that ends up in your brain that causes mitochondrial dysfunction. And that becomes part of the root dysfunction in the brain that you fix with the changes that you do with diet and other therapies, right?

Dr. Chris Palmer
Yes. That's the way I think about it. So I I think There

Dr. Mark Hyman
are many roads to roam and there's many things that can drive it, but the brain only has so many ways of saying, ouch. And so when it when it's inflamed, you don't feel it. But when you look at the science, people who are depressed have inflamed brains. Autism has inflamed brains. Alzheimer's has inflamed brain.

All the psychiatric illnesses, their brains are literally inflamed on fire, but we we don't feel it except as as psychiatric symptoms, and we think of it as something that is, like you said, genetic or because of it's in our head, as opposed to it's in our body, and there's something we can do to find the root cause and fix it.

Dr. Chris Palmer
I think about inflammation I mean, the way that I think about it really is that there are a series of pathways that are all connected, like a series of dominoes that are connected. And so inflammation is one of those dominoes. It is not the only domino because all of us get inflamed when we get a cold, And that includes brain inflammation. And yet, most people don't become psychiatrically ill from a cold. Some do, but not most don't.

And on and on. COVID infection caused severe neuroinflammation.

Dr. Mark Hyman
I mean, remember when I had COVID, I got severely depressed afterwards, and I could feel my brain, and I'm like, wow. I've never felt this before, and I felt suicidal. And I actually took exosomes and it was gone like literally in a day.

Dr. Chris Palmer
So the It was really interesting. The depression part is common. And a lot of people don't think about that, but researchers have been talking about this for decades. High levels of inflammation cause behavioral motivational changes in most animals. So if you get the flu, you have a decrease in energy.

You have a decrease in confidence. You are less likely to take risks. And what does that do? That drives you to wanna go to your bedroom, get under the covers, and hide from the world and stay away from the world. You are less interested in reproduction, less interested in sex.

Even if the opportunity's right there, you're like, get the hell away from me. Leave me alone. I'm sick. I don't feel well. Leave me alone.

Let me recover. And in in my mind, those are all adaptive responses. The that that your body is hardwired to have this response, and the response is conservation of energy because your body is expending tremendous amounts of energy on your immune system right now. It is waging war on this thing that is infecting you and trying to take your life. It is waging war, and it is spending every ounce of energy possible to create new immune cells, antibodies, cytokines, other things that are all trying to defend your life.

And it is telling you as an organism, do not spend an ounce of energy that is unnecessary. Get into bed. Go into that cave and hide from the world. Don't challenge anyone right now. Don't go out and get into a fight where you have to fight or flee.

Don't do anything. Stay away. Hide from the world. The suicide so that part is actually really common Yeah. With infections and high levels of inflammation.

The suicidality part is not. And that's where I think about the brain becoming dysregulated Yeah. From the neuroinflammation Yeah.

Dr. Mark Hyman
Yes.

Dr. Chris Palmer
And and people getting all of the constellation of symptoms.

Dr. Mark Hyman
Well, you talk about, you know, the genetic vulnerabilities, but then there's a lot of inputs that can drive the same final common pathway of energy dysregulation in your brain cells. Right? Diet, sugar, and refined carbs, which affects everybody. I mean, ninety three percent of Americans are metabolically healthy at some level. I I would say most of those have some degree of insulin resistance.

We've been gonna test for it. At Function Health, the company I started with with a bunch of folks, we actually can measure insulin resistance. And we can see the degree at it's probably over ninety percent of people who we test have some degree of insulin resistance. It's it's pretty striking. You know, chronic stress and trauma, so psychological traumas can be transmuted into biological signals, sleep deprivation, substance use, toxins.

We talk about microplastics in a minute. Not exercising and being sedentary drives inflammation, and anything like infections or allergens, microbiome changes. All those kind of lead to this final dysfunction, which you you kind of think is is at the root of it. And when you look at things like Alzheimer's or autism, which are not psychiatric particularly diseases, the same phenomena is going on. Suzanne Goh, who's been on the podcast, talks about mitochondrial dysfunction in autism, and treating kids by treating their mitochondria and helping them with autism.

And you're doing the same thing with mental illness. So can you talk about this kind of final common pathway of energy dysregulation and how it ties everything together? Because there's lot of ways to grow on this, but it There's final dysfunction is very similar, and the the therapies can be cross diseases very effective. So whether you have fibromyalgia, whether you have, you know, alcohol use disorder or eating disorder, whether you have Alzheimer's, autism, depression, bipolar, schizophrenia, anxiety, PTSD, these can be impacted by changing your diet.

Dr. Chris Palmer
The way that I think about it because some people think, oh, know, Chris Palmer, you're being too reductionistic. You're saying everything's mitochondrial dysfunction. And so I really like, I'm struggling. How can I explain this so people understand what I'm really trying to say? Yeah.

So what I'm really trying to say

Dr. Mark Hyman
We're on the edge of our seat.

Dr. Chris Palmer
Is that bio biological like, wide range of biological.

Dr. Mark Hyman
All those

Dr. Chris Palmer
things. Whether it's infections or, you know, hormones, like, all sorts of things. Gut microbiome, diet, biological, psychological, social, and environmental, in particular environmental toxins. All of those four buckets are the root causes of chronic disease. Those four buckets.

So there are lots of things that go into those four buckets, but they all converge at this central pathway called metabolism mitochondria. Mitochondria are regulating and controlling metabolism because they are they are really Mitochondria

Dr. Mark Hyman
Give us a sixty second, like, when you say metabolism, people, I have a slow metabolism. You're not talking about that. I'm not talking about What you mean by metabolism? Because it's important for people to understand this.

Dr. Chris Palmer
So most people think of metabolism as burning calories, and yes, it is burning calories. Most people think of it as well, it's metabolic syndrome. It's high blood pressure, high glucose, insulin resistance. That's metabolism. Yes.

Those things are tiny parts of metabolism, but metabolism, in fact, is a fundamental definition of a living organism. The ability to take food and turn it into energy or building blocks is a fundamental definition of a living organism. Viruses cannot do that independently, and so many biological authorities will say viruses are not independent living organisms. They are not a life form under themselves. They so life, a living organism, whether it's a bacterium to a human being and everything in between, has to be able to take food, oxygen, nutrients, and turn that into energy or building blocks to maintain life.

And in fact, the absence of metabolism, the cessation of metabolism is the definition of death. There are zero exceptions. There is no cause of death that does not involve the cessation of metabolism. Suffocate somebody, you're depriving them of oxygen, which stops metabolism. Starvation, toxins, you will not find any toxin that can kill a human being that does not disrupt metabolism.

Dr. Mark Hyman
Cyanide. That's what it does. Boom. You're dead in seconds because it interrupts.

Dr. Chris Palmer
It is a mitochondrial toxin. Arsenic, a mitochondrial toxin. Tylenol overdose, mitochondrial toxin. Alcohol poisoning, mitochondrial toxin. You can go on and on.

And the reason is not it's not you know, when I first started doing this work, I was initially, like, shocked by what I'm saying, and I was a little bit in disbelief. I'm like, it can't be that simple. It is that simple. And why is it that simple? Because metabolism is a fundamental law.

Like, we don't really have laws like they do in physics. They have laws, and this is a law of biology. Metabolism is fundamental to life. The absence of metabolism is the definition of death. Disregulation of metabolism this is what I am proposing.

Disregulation of metabolism leads to chronic disease. Yeah. Dysfunction of mitochondria broadly leads to chronic disease. That like, metabolism is so foundational

Dr. Mark Hyman
Yeah.

Dr. Chris Palmer
To life that it shouldn't I get that some people are really skeptical of that because they're focused on but it's neurotransmitters. And I'm like, neurotransmitters are part of metabolism. Yeah. It's hormones. They're part of metabolism.

Inflammation, part of metabolism. You know, viruses, a viral infection, that is an assault on your energy systems. It's an assault on your metabolism. It's threatening your life. And again, anything that threatens your life is threatening your metabolism ultimately.

If your metabolism is going, you're still alive by definition. You're still alive.

Dr. Mark Hyman
So, Chris, you know, people are listening and they're like, okay. Great. This is this is a different paradigm. Like we got it wrong around traditional psychiatry. We have a new paradigm that's emerging around metabolic nutritional psychiatry.

But I'm depressed or I'm bipolar or I'm struggling with x y or z. What do I do about it? How do I fix this? How do these insights and what are the science that's emerging that kinda points to what to do about all this?

Dr. Chris Palmer
So the the one the one point I wanna make before I before I directly answer that, like an indirect answer or really a direct answer is also what do I not want you to do? And and I just wanna like, I am a psychiatrist. I've been at Harvard Medical School for thirty years. I still have my job. I wanna keep it.

I don't hate psychiatrists. I don't hate mental health professionals. I actually have the utmost respect and admiration for most of them because I know that they, like me, are treating people who otherwise society just wants to get rid of. That society and families wanna give up on. And yet, we in the mental health field prescribe pills that harm mitochondrial function, that harm metabolism.

Prescribe pills that cause obesity, that cause type two diabetes, that cause cardiovascular disease, that cause premature mortality. And I want to point out, we didn't I didn't say this yet.

Dr. Mark Hyman
Accuracy, but the patient died.

Dr. Chris Palmer
People with mental illness are dying early deaths across the board. It is transdiagnostic. It applies to every label in DSM. In a recent meta analysis, over a 100 studies, over a 100 studies, 14,000,000 people represented in the studies, on average, people with mental illness are dying fifteen years early deaths. Wow.

Fifteen years. They are losing fifteen years of life. Everybody goes to suicide. Yes. The suicide rates are higher, and yes, that is one of the factors.

And if a 20 year old commits suicide, that does skew the statistics, so I'm not gonna deny that. But the primary cause of death in the mentally ill is cardiovascular disease. It's just happening fifteen years earlier in life. And

Dr. Mark Hyman
Which is primarily driven by metabolic dysfunction and insulin resistance.

Dr. Chris Palmer
Metabolic dysfunction. They are dying of metabolic diseases fifteen years earlier.

Dr. Mark Hyman
It should be called cardiometabolic disease.

Dr. Chris Palmer
I would love that. I would welcome that. And well, and again, because cardiovascular disease cardiologists are focused on the heart. It's a is an organ that somehow lives in isolation of the rest of the body and brain, that it's all interconnected. A cardiovascular disease is also a systemic disorder.

Obesity is a systemic disorder. Type two diabetes is a systemic disorder, and we need to think about that. Network medicine. We need to think about the network of the human body. The human body is a network of interconnected cells, tissues, and organs.

And so back to your question, I don't want you to reflexively just go out and trust the mental health professional who wants to put you on an antipsychotic and mood stabilizer that's gonna cause you to gain massive amounts of weight. That's gonna that's gonna cause you to develop other metabolic disorders, that's going to cause you to die an early death, please don't just go out and reflexively do that. At the same time, those treatments, I do wanna say, I still use some of those treatments to this day. And in life threatening situations, they can be lifesaving. And I but I think about those treatments like I think about chemotherapy.

Chemotherapy is literally poison. They're trying to poison your cancer before they poison you. But oncologists admit it. Oncologists admit I'm delivering poison. I'm not happy about it.

I wish I had a better treatment. I wish I had something that would just kill their tumor and not harm the individual, but I don't, and I'm doing my best to save this person's life. In psychiatry, we deliver poisons, but we don't admit they're poisons, and we tell people to take them for life. Yeah. We say, you've got this label, bipolar disorder.

You need this poison. Go on it. We're really sorry it makes you feel like shit. We're really sorry it's causing you to become obese. This is really depressing.

We're really sorry it's causing you to become type two diabetic. But just take your pills. Take them. And I know you're probably on average gonna die an early death. I'm really sorry about that, but we don't know what else to do.

I'm saying it is time for the mental health field to have a transformation, a revolution.

Dr. Mark Hyman
Tell it. Help us understand this revolution. What's happening, and what's the hope and promise in this?

Dr. Chris Palmer
The revolution is that if we understand the complex biology so I'm not here to give you, here is the one, two, three recipe to cure all mental illness, because it's not that simple. You know that as a functional medicine practitioner. I wish it was. It's not. Open your eyes to the possibility that there is something wrong with you.

We can figure this out. It might take a while. We're not going to lose patience. We're not going to be deterred. We're not gonna become overly frustrated.

We are going to systematically figure out what is causing this metabolic dysregulation, this dysregulation in your biology. We are gonna figure it out, and we're gonna treat it. That's right. And the good news is that we have a lot of things we can do to test for those things now. Yeah.

Insulin resistance, we can test for. Blood pressure, we can test for. Gut pathology, we can test for. There are lots of things we can test for. Toxins.

Toxins. We can test for a lot of these things and then potentially treat them directly. We can test for infections that that nobody has diagnosed, Lyme disease, whatever.

Dr. Mark Hyman
Yeah.

Dr. Chris Palmer
There are lots of things we can do. And even when we can't, even when our testing capabilities are not yet where we want them to be, even when our medical knowledge is not yet where we want it to be, we can use what I call empirical metabolic treatments.

Dr. Mark Hyman
Yeah.

Dr. Chris Palmer
And the one that I'm probably most known for is the ketogenic diet. Yeah. And the ketogenic diet, unbeknownst to most people, a lot of people know it as a weight loss diet. It's a dangerous diet. They think that it's all bacon.

You can actually be a vegan on a ketogenic diet. You can be a vegan ketogenic diet. So you can do a vegetarian version, an omnivore version. Yes. You can do a carnivore version.

There are lots of versions of ketogenic therapies. But ketogenic therapy can change the lives of people with schizophrenia, with bipolar disorder, with chronic unrelenting depression. And and in my mind, it's not that I I wanna promote the ketogenic diet as the be all, end all, fix all, because it's not. I wish it was.

Dr. Mark Hyman
There's many other things. Yeah.

Dr. Chris Palmer
But there are a lot of other things we can do, and it really is about this mindset shift Yeah. That you have a treatable condition. Yeah. And it's on us to figure out how to treat it. But for the ketogenic diet, I will say that I have seen you know, we talked about this, I think, last time I was on the podcast.

There are patients with schizophrenia twenty years. The longest example I know of fifty three years of chronic unrelenting schizophrenia. Put it into remission, off antipsychotics for fifteen years before she passed away at the age Unbelievable. Of 80 So it was an enduring effect. The greatest hope, obviously, I'm using this treatment in a lot of people.

I'm promoting this treatment. We've got 20 research trials underway. Two randomized controlled trials of ketogenic diet for schizophrenia just wrapped up

Dr. Mark Hyman
Wow.

Dr. Chris Palmer
This week. So within the next year, we're gonna get those publications. We've got a $10,000,000 grant from the Wellcome Trust, a very conservative health care kind of funding organization. $10,000,000 to fund the largest trial of the ketogenic diet versus The UK healthy diet for the treatment of bipolar depression. Wow.

And it will be the largest research trial ever done of a dietary intervention for the treatment of a mental illness ever. So we're making tremendous progress in this field, and I think a lot of leading, world leading neuroscientists, psychiatrists are really excited about this. JAMA Psychiatry, the leading psychiatric journal in the world right now, just published a meta analysis of the ketogenic diet as a treatment for depression and anxiety. Just published it. The fact that it made it into one of the leading medical psychiatric journals Yeah.

Is nothing short of miraculous. I

Dr. Mark Hyman
wanna double click on a few things you said, because it's so important, I won't be able to get it. You said network medicine. The body is a system. It's an integrated, connected network. And there are many biological systems within that.

There's your immune system, your microbiome, your mitochondria, your detoxification system, your communication systems. All these things we map out in functional medicine. And we have a very clear model of how to think about network medicine, which is there's stuff that disturbs the system that you need to get rid of, toxins, allergens, infections, poor diet, stress, trauma, whatever. And there's things you need to add to actually help the body thrive, whether it's the right nutrients, whether it's the right food, whether it's light, air, water, sleep, movement, connection Relationships. Yes.

Meaning purpose, relationships. All those things are medicine. So you take out the bad stuff, you put in the good stuff, but the key is to be able to dive in and diagnose what those things are, and they're different for everybody. Because depression you know, I I in my first book, I wrote that because you know the name of the disease, doesn't mean you know what's wrong with you. If someone says you have depression, it doesn't mean you have a Prozac deficiency.

It it right? It's it's often caused by many things. So it could be caused by eating gluten that creates brain inflammation. It could be caused by an autoimmune thyroid condition that gives you hypothyroidism. It could be because you've been taking an acid blocker because you have a crappy diet and have b twelve deficiency that's accumulated over years.

It because you live inside and you go outside and work inside and have vitamin d deficiency. It could be because you have some resistance. It could be because you eat a lot of mercury and have mercury poisoning, or you hate fish and have omega three deficiency, or it could be because you

Dr. Chris Palmer
You got COVID.

Dr. Mark Hyman
You got COVID. You got

Dr. Chris Palmer
And could also be the obvious psychological or social reasons. It could be because your spouse is beating the shit

Dr. Mark Hyman
out of you It every

Dr. Chris Palmer
could be because your parents

Dr. Mark Hyman
Yeah.

Dr. Chris Palmer
Told you you were worthless every day of It your could be because your friends are alienating you for something that just happened, and you feel shunned. Like, can be any of those things. It can be psychological, social, environmental. That's right. It can be any of those.

Dr. Mark Hyman
Agreed. And that's why you have to learn how to be a detective and figure out what's going on with that individual. It's really personalized psychiatry. It is. And and

Dr. Chris Palmer
And at the same time, I wanna say because I'm worried that sometimes when I say that exact same thing, people hear, again, a hopelessness. You're saying it's overwhelmingly complicated and nobody can figure it out. I wanna say more often than not, the clues are relatively obvious. Yeah. And we can do some basic blood work to get some really powerful signals and clues leading us in the right direction.

Or you can just talk to the person. Talk to the person. You're you get an upset stomach every night. What are you eating? Have you ever tried an elimination diet?

Have you ever tried to figure out what's causing your stomach to be upset?

Dr. Mark Hyman
It's true.

Dr. Chris Palmer
Mean We can figure it out.

Dr. Mark Hyman
Chris, at Functional Health, we've now tested over 300,000 people. We have probably over 50,000,000 data points And we see these patterns. We see over ninety percent have some degree of insulin resistance. We see thirty percent of autoantibodies to their thyroid. Many of them not diagnosed, which causes depression.

We see massive nutritional deficiencies, not at the level that I would think would be optimal, like vitamin d over 50, but like the reference range, which is 30. Iron deficiency, vitamin d deficiency, omega three deficiency, folate deficiency through homocysteine, methylmalonic acid. We see so many things on the function panel that are biomarkers of mental illness, which nobody talks about. So let's take a minute to kind of dive into a little bit about what are the biomarkers that you've been exploring around mental illness? Because you've been looking at some of these things like folate, b twelve, microplastics.

Kinda tell us about your work in that area.

Dr. Chris Palmer
It's really exciting. So I'm I run the metabolic mental health program at McLean Hospital, Harvard Medical School. So we have the privilege of doing a lot of different researchers, research studies, and I'm really interested, again, in root causes. And so there are two antibodies that we're exploring that one of them prevents folate from crossing the blood brain barrier, and the other is a brand new newly discovered antibody that attacks a protein called c d three twenty, which transports vitamin b twelve across the blood brain barrier. Prior to about three years ago, nobody was aware that humans could spontaneously develop this autoantibody.

Mhmm. The the there is not a commercially available test. I know that's a logical question when I'm talking about this.

Dr. Mark Hyman
People are gonna

Dr. Chris Palmer
be like, where can I get this test? It is not yet commercially available because it is so brand new. There people are working on it. But the reason both of those antibodies are really important because folate and vitamin b twelve are required for numerous reactions in the body, but most of them center on mitochondria and metabolism. Right.

They are primary so if you have folate deficiency, you have a metabolic problem. If you have vitamin B12 deficiency and or a deficiency in the methylated versions because you're having trouble methylating them, you have a metabolic problem.

Dr. Mark Hyman
That's the active form. Right?

Dr. Chris Palmer
And so the reason these antibodies are particularly intriguing to me as a psychiatrist is because if you measure their levels of folate and b twelve from their arm, they will be normal. Yeah. If you look for homocysteine in the periphery, it's normal. They show no signs from the biomarkers that we would normally measure from your blood. They show no signs of being abnormal.

Yeah. The person can be eating the healthiest possible diet, can have no gastrointestinal problems, but can be profoundly deficient in folate or b twelve Because

Dr. Mark Hyman
the

Dr. Chris Palmer
their antibodies block central nervous system. So antibodies block Because the antibodies are preventing the transport of these vitamins across the blood brain barrier into the brain and spinal cord. The the reason that's really important to me, again, is because on the surface, if I look at the person externally, they can look otherwise healthy and actually be otherwise healthy. Their heart can be relatively healthy because it's getting all the nutrients it needs. Yes.

If the person's eating a healthy diet and exercising regularly, their heart probably is healthy. But their brain can be grossly impaired in terms of its ability to function. And when we see brain impairment in a relatively young person, guess what that gets called? Ninety nine out of a hundred times, it gets called a mental illness. Yeah.

We call that a mental illness. Your brain isn't working right, that's a mental illness. And then we get we slap a label on you. We say it's genetic. We we treat you with relatively toxic medications for life, and then we just write you off.

So the reason I'm interested in these antibodies is because it helps us understand, like I said, that the pathways are dominoes. There are a lot of dominoes in play. But let me walk you through one clear example. Because the the leading theory about what would cause these antibodies to develop in the first place. The leading theory is inflammation of the blood brain barrier, and that could be caused by a virus.

Let's take a

Dr. Mark Hyman
Anything perfectly that causes inflammation.

Dr. Chris Palmer
Anything that causes inflammation, but let me walk down that example. So you could have a perfectly happy, healthy child who gets a viral infection. They have neuroinflammation, including inflammation of their blood brain barrier. Their immune system is primed for whatever reason to develop antibodies to c d three twenty, which now prevents vitamin b twelve from crossing the blood brain barrier. This child, unlike most with COVID, for example, who recover and do fine, this child falls off a cliff, develops new onset psychotic symptoms, new onset OCD, new onset panic disorder.

And sometimes we call it PANS PANDAS. Sometimes we call it something else. Sometimes we just call it a mental illness. And now this child has a mental illness due to a metabolic brain problem that we largely don't recognize. The reason I'm particular so we're gonna be doing the first ever study of these two antibodies in the largest cohort of people with schizophrenia.

Yeah. So we're gonna be looking for these antibodies in patients who have already been diagnosed with schizophrenia Yeah. To see how many of them might have these antibodies. And then we're gonna compare that to an equal cohort of healthy controls. By healthy, we don't mean completely healthy because no one is.

But we mean they've never been diagnosed with a mental illness. And we're gonna see if there's a difference. The reason I'm particularly passionate and driven to do this research is because if we see these antibodies, there are clear treatments. If you have this antibody against folate, there is an existing treatment called leucovorin that we can deliver today to get folate into your brain Yeah. And spinal cord even with with no FDA approval needed.

The FDA, in fact, just approved leucovorin as a treatment for autism for this exact reason.

Dr. Mark Hyman
I mean and Chris, when I I've been, you know, practicing with Amol for a long time, and I treat a lot of autistic kids. And one of the things we've been testing for decades is folate receptor antibodies. And they often are cross reacting to dairy, and you cut out the dairy, and you give them high doses of methylated folate, and the lights come on in these kids. It doesn't mean that all autism is caused by this, it means that in some subsets, this is a problem. And if you look for it, you'll find it.

And it's just remarkable that it's coming out with b 12 related antibodies as well as the other folate antibodies and and it's treatable. And again, everybody, this is not the full solution. This is just in some particular subset of people with mental illness or autism, this is a problem. But it just points to the fact that we actually are now beginning to kinda tease apart the biological mechanisms, be able to diagnose it. I mean, you know, the joke is that neurologists pay no attention to the mind, and psychiatrists pay no attention to the brain.

And that's changing

Dr. Chris Palmer
a lot. It is. It is. Well, and it to tie even that research in with my existing research on ketogenic therapy. So could ketogenic therapy help somebody who has one of these autoantibodies?

We have every reason to believe it might. Yeah. Because ketogenic therapy is broadly anti inflammatory and actually ramps down the immune system. Why does it do that? Because ketogenic therapy mimics the fasting state.

When your body thinks it is starving, it actually reduces immune system function Yeah. As a survival mechanism. Now long term

Dr. Mark Hyman
Anti inflammatory.

Dr. Chris Palmer
It's anti inflammatory. That is proven beyond a shadow of a doubt. Anti inflammatory in over, like, over 20 studies looking at inflammatory biomarkers and ketogenic therapy. But it also reduces immune system like autoimmune disorders. There's research on multiple sclerosis.

Terry Walls is doing one of the largest studies of ketogenic diet versus whole food Mediterranean diet versus controlled diet for multiple sclerosis. In my even in my world, when I deliver a ketogenic diet to somebody with schizophrenia and their symptoms get better, that's the way I'm thinking about it. Maybe this diet is actually reducing an autoimmune condition

Dr. Mark Hyman
Yeah.

Dr. Chris Palmer
That is impairing their brain body physiology. And so is that a root cause treatment? I don't think of it as a root cause treatment. I actually think I don't know what the actual root cause is, but ketogenic therapy might be correcting it. And interestingly, you know, fasting fasting mimicking that.

Fasting's been around for millennia in every culture for a reason, because it actually works. And there's a reason it works, and it's because our physiology is kinda designed that way.

Dr. Mark Hyman
It's amazing conversation Chris. And I think all this conversation points to, as you mentioned, a revolution in psychiatry. And the way I see psychiatry changing, know, I I read a book we chatted a little bit about it called Madness of Civilization when I was in college by Michel Foucault, talks about how we think about mental health through the ages. You know, visitation by gods or, you know, in Freud, it was all about the ego and super ego and id and your childhood. And then was this sort of neurochemical serotonin model.

And now, we're coming out, I think maybe with a closer representation of understanding human biology. Like the nature of nature. We're understanding what I call the laws of nature. If I asked, know, what are the laws of biology? Most people would have not have a clue.

They'd say, oh, maybe evolution. But laws of physics we've described. But there are laws of biology. We just have been shitty at figuring it out. And what you're pointing to are some of these fundamental laws.

And there's just It's so exciting to me to be in this moment in the world of psychiatry, and I I hope it scales up faster than, you know, it's doing right now because it's hard to change the paradigm. And I think there's another revolution that's happening at the same time, which is I think gonna be married together with this, which is psychedelic psychiatry. And you know, there's now been trial that is about to approve MDMA assisted therapy for PTSD and other things. I just was in Mexico at a place called Beyond, and I had the chance to do something called Ibogaine, which I'm gonna do a whole podcast on and talk about. But it's a powerful neurochemical reset, and it hits all the receptors in the brain, and it literally changes brain function, brain size, brain structure, heals brain trauma.

Met a a navy seal there who had, you know, had significant head trauma. He was a a blast expert, and he said before and after his MRI, his brain areas that were damaged healed. And so there are many ways to intercede. And I personally, you know, went through this last week, and I just had the most profound changes in my own sense of self, my well-being, my mental health symptoms, everything changed. And I I'm still like a newborn Ed.

It's been like three days. But I I'm and we're gonna talk about it at length in the podcast. But I think these two revolutions really provide so much hope. And I think most people, like you said, are hopeless that have mental health issues. And I feel like we're in this incredibly potent time where where we're gonna see a real change in our approach and our thinking to mental health.

And you you are a pioneer in this. I I would love you to just close out by saying, what do you think is next? Like, where are we going with this, and how is this being readied by your colleagues? Is this something that's gonna become more part of psychiatric care?

Dr. Chris Palmer
You know, one of one of the most common questions I get is, like, are you getting a lot of pushback? And there are people who are pushing back, but more often than not, I'm pleasantly surprised, almost in disbelief of the positive reception I'm getting. I I just gave a grand rounds presentation to a lot of medical professionals at one of the Harvard affiliated hospitals. 150 people. Immediately after that, I had I got all of this praise.

All of this people want to come train.

Dr. Mark Hyman
Well, know what they're doing doesn't work. Like they're frustrated. They're depressed. They're psyched.

Dr. Chris Palmer
They no. They are. They are. And I think that so I think that you know, one of the one of the really positive things that I do wanna say about mental health professionals is, you know, that's kind of the negative spin, but the positive spin is their open mindedness. I think they they do recognize what we're doing isn't working, not fully, that our patients are dying.

Our patients are getting sick. Our patients aren't getting better. We we want more tools in our toolbox. We know what you're saying is true. And and I I think that they are desperate for better solution.

And that's how we've gotten some of the leading psychiatrists and neuroscientists to be doing studies of ketogenic therapy for mental illness. But again, I think the field of medicine needs to move in the area of functional medicine, network medicine, whatever we want to call it, and we just need to call it medicine. I

Dr. Mark Hyman
I like jumping up and down and going, hallelujah, hallelujah.

Dr. Chris Palmer
You need to call it medicine. And so I agree. One of the reasons, like, one of the terms that's

Dr. Mark Hyman
getting I get the chills. Mean, you are, Harvard psychiatrist at the world's top psychiatric hospital, and you're saying functional medicine's coming out of your mouth. And I'm like, really? You know, it's it's kinda mind blowing because it is it is so obvious when you see it. I mean, it the body is a network.

It's a system. We can't keep doing things the way we're doing them. They're not working. So many people are suffering. So many people are dying, and there is a pathway to get better.

Dr. Chris Palmer
And I think that there are sometimes fields forces that have maybe worked independently of each other, lifestyle medicine. Yeah. The field of lifestyle medicine, some of those people hate the ketogenic diet because they again, they're focused on plant sourced foods. Just gotta be plant sourced foods. They don't even realize that you can be vegan and on a ketogenic diet.

And so they they they fear that I'm promoting steak and bacon, and so I'm part of the evil, you know, adversaries. And it's like but increasingly, I think when they hear me speak about this, they increasingly get on board. And so I feel like, you know, I sometimes actually think that this may actually be one of the strategies of some powerful industries is to divide and conquer. Divide lifestyle medicine from low carb ketogenic people from functional medicine people. Get them all to call each other quacks.

Dr. Mark Hyman
A medical

Dr. Chris Palmer
Get them all to make fun of each other, and then, like, let them fight amongst them themselves so that we can keep remaining dominant in our narrative of medical education. And instead, I think that we, all of these people who are promoting exercise lifestyle nutrition and functional medicine, integrative medicine, whatever labels you wanna give them, we need to band together. We need to join forces. It doesn't mean we have to agree on everything. It doesn't mean, like but we need to come together and fight because we are fighting Goliath.

We are all little Davids, and they have the little Davids fighting amongst themselves so that Goliath doesn't even have to spend a penny of resources to fight us. We need to come together and use our little slingshots and aim aim and fire simultaneously, and I'm increasingly convinced that we are doing that. I mean, I think Eudaimonia is a great example. This conference that we're at is a great example of that, that we have a lot of different voices, a lot of different perspectives, but we can find the common connections and the commonalities and work together to improve health. And I am truly excited about it.

I think, you know, when you look at politics in The United States, I don't wanna go there too much, but chronic disease is now part of the national narrative.

Dr. Mark Hyman
Yeah. Thank God.

Dr. Chris Palmer
And and it needs to be part of the national narrative. And, the solutions people are gonna bicker about, but I think what increasingly almost everybody agrees on is what we're doing isn't working, and that we need a new strategy. We need new efforts. And so I'm really excited about it, because at the end of the day, I became a psychiatrist to help human beings who are struggling and suffering. Yeah.

And I simply want to alleviate their suffering Thank you. And improve their lives.

Dr. Mark Hyman
Thank you, Chris.

Dr. Chris Palmer
And I feel like we're getting there.

Dr. Mark Hyman
Thank you, Chris. I wanna close by a Machiavellian quote, which is, there's nothing more difficult to introduce than a new order of things, because the innovator has enemies in all those who have done well under the old conditions and lukewarm defenders in those who may do well under the new. So it's very hard to change things, but I think we're seeing it in again, you're the tip of the spear. Thank you for the work you're doing. I can't wait to see what comes next.

And everybody pay attention to Chris's work who's listening and check out what he's doing. Read his books, Brain Energy and where can they learn more about your work?

Dr. Chris Palmer
They can go to brainenergy.com. They can go to chrispalmermd.com.

Dr. Mark Hyman
Great. Wonderful. Well, thank Chris for being on the podcast. Thank you. I'll come be on the app.

Dr. Mark Hyman
If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Doctor Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to the doctor Hyman show wherever you get your podcast.

And don't forget to check out my YouTube channel at Doctor Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Doctor Hyman show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic, and Function Health where I am chief medical officer. This podcast represents my opinions and my guests' opinions.

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