Your Brain on Ketones: The New Science Linking Metabolic Health, Mental Health, and the Power of Ketosis with Dr. Georgia Ede

People with pre-diabetes are 2.7 times more likely to develop major depression. People with new bipolar disorder are 3.5 times more likely to have metabolic syndrome. If that stopped you in your tracks, good – it stopped me too. I brought Dr. Georgia Ede back to The Resetter Podcast to dig into her new expert consensus on ketogenic diets and mental health, and this conversation is one every woman needs to hear. Dr. Ede is a Harvard-trained psychiatrist and one of the world's leading experts in nutritional and metabolic psychiatry. What she laid out in this episode completely reframed how I think about brain health, brain energy, and what it actually means to feed your mind. We get into why the brain is a hybrid engine that runs best on a mixture of glucose and ketones and what happens when it runs on glucose alone. If you've ever wondered whether what you eat is affecting how you think, feel, and function – this one will give you the science and tools to find out. For more resources related to today's episode, visit the podcast episode page: https://www.drmindypelz.com/ep334 CONNECT WITH DR. GEORGIA EDE: Change Your Diet, Change Your Mind https://www.diagnosisdiet.com/change-your-diet-change-your-mind Instagram: @GeorgiaEdeMD https://www.instagram.com/georgiaedemd/?hl=en Facebook: @GeorgiaEdeMD https://www.facebook.com/GeorgiaEdeMd/ LinkedIn: @GeorgiaEdeMD https://www.linkedin.com/in/georgiaedemd/ X: @GeorgiaEdeMD https://x.com/GeorgiaEdeMD CONNECT WITH DR. MINDY: Join Reset Academy https://resetacademy.drmindypelz.com/reset-academy?utm_source=libsyn&utm_medium=podcast&utm_term=&utm_content=loc-description&utm_campaign=reset-academy Watch the episodes on YouTube https://www.youtube.com/@DrMindyPelz?sub_confirmation=1 Follow Dr. Mindy on Instagram https://www.instagram.com/dr.mindypelz/ Subscribe to Dr. Mindy's newsletter for tools and research on fasting, hormones, and metabolic health https://www.drmindypelz.com/ Disclaimer: This podcast is intended for educational and informational purposes only and is not a substitute for professional medical advice. Always consult a qualified healthcare professional before making changes to your diet, fasting routine, or lifestyle.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:01Mindy Pelz?

  Okay, let me ask you a personal question. And this one is a really important one, which is when was the last time you had your vitamin D checked? And I'm saying this because in all my years of working with women, low vitamin D is one of the most consistent findings I see, and one of the most consistently missed. And vitamin D matters for so many aspects of your health. We're talking about a deficiency that can show up as hormonal imbalance, mood struggles, poor sleep, immune issues, even stubborn weight that won't budge no matter what you do. But here's the part that most people don't know.

• 0:43Mindy Pelz?

  Taking an isolated D3 supplement isn't enough. This isn't like just running down to the local store and grabbing some D3. Your body actually needs D3 to be combined with very specific cofactors to actually absorb and utilize vitamin D the way nature intended it. And most supplements on the market don't include these cofactors. That's why I personally love Cataplex D from Standard Process. It's a whole food supplement. It's vitamin D complex, not just an isolated nutrient. There's an incredible difference between checking a box and actually moving the needle on your health, and this one really moves the needle.

• 1:27Mindy Pelz?

  In fact, in my clinic, we used to test vitamin D, and we could see with a product like Cataplex D, we could see on lab work, the vitamin D levels in people go up. So you can learn more and you can get yourself some vitamin D. You can test out Cataplex D at drmindypels.standarprocess.com. Enjoy.

• 1:58Mindy Pelz?

  On this episode of the Resetter Podcast, I bring you back Dr. Georgia Eadie. So if you didn't hear her the first time, you're definitely going to want to hear her this time because Georgia is a globally recognized expert in nutritional and metabolic psychiatry. Her 25-plus years of clinical experience include seven years at Harvard University, where she was the first psychiatrist to offer nutrition-based approaches to mental health conditions. She has also co-authored, and you're going to hear about this in this episode, the first inpatient study of the ketogenic diet for serious mental illness.

• 2:43Mindy Pelz?

  And why I brought her back to you is twofold. One, so many of you are seeing a positive result when you go into ketosis with your mental health, not just brain clarity, but depression, anxiety, focus. It's like a miracle. Just overnight, when you get into ketosis, you start to experience your brain in a different way. And so much of what we chat about here, in my books, on my YouTube channel, is we think of fasting and ketosis as a tool for weight loss. And yes, it's phenomenal for that.

• 3:24Mindy Pelz?

  But what I wanted to bring Georgia back for is to talk about how it's a tool for mental health. There is a new expert consensus that she has published with some colleagues, which, as you will hear, are the protocols. I know how much you all love protocols. The protocols for ketosis to help mental health. And you'll hear in this episode, there was a reason they wanted to do this, is they were finding the ketogenic diet. And when she says ketogenic diet, by the way, you'll hear us flip in between fasting as a tool to get into the ketogenic diet and low carb as a Tool to get into the ketogenic state.

• 4:07Mindy Pelz?

  And you'll hear at the end, she lists all the different ways that you can get into ketosis. But from a, from a mental health perspective, she is the champion right now showing the mental health world that along with whatever therapy they're using, whether it's drugs or it's something like EMDR or CBT, some of the other clinical styles of addressing mental health, there needs to be a pairing of ketones. And it's really profound. So, so many of you I know are fasting, you're working with carb cycling.

• 4:49Mindy Pelz?

  And what Georgia offers us is an incredible way to look at ketones as a brain hero. I definitely went into menopause, had to talk about it, had to talk about the brain rewirement. And I think that many of you are not only going to see yourself in this conversation, but you're going to see your loved ones, especially those with cognitive decline. I think if anybody's experienced depression right now, you need to listen to this. She gives numbers, she gives protocols. It's, it's a really powerful episode. So excited to bring it to you, Dr. Georgia Eadie.

• 5:33Mindy Pelz?

  What, what do we, what would you give pre-diabetes? The, is, are you considering that like a 5.8 hemoglobin A1C level? Like, do we have a measurement of what pre-diabetes is according to your?

• 5:47Speaker 01

  It's about, it's about the fasting glucose level. So the fasting glucose level pre-diabetes has to be above 110 milligrams per day.

• 5:56Mindy Pelz?

  Oh, wow. Okay.

• 5:58Speaker 01

  So if you, if, if, if your morning fasting glucose level is above 110, you're, you're, you're edging into the risk, higher risk category. Whereas if you have full-blown type 2 diabetes, you're going to be 180 or higher. So it's, it's very, it's very much based on the fasting glucose level, which is unfortunate because the fasting glucose level is not a very good test for metabolic problems.

• 6:23Mindy Pelz?

  Right.

• 6:24Speaker 01

  As you, as you.

• 6:26Mindy Pelz?

  Yeah, we probably just, we probably just freaked a few people, a few of my fasters out with that, that statistic. So explain what, why it's not such a great measurement of metabolic health.

• 6:36Speaker 01

  Yeah, because fasting glucose is one of the last dominos to fall.

• 6:40Mindy Pelz?

  Right.

• 6:41Speaker 01

  By the time your fasting glucose is high, you're already in trouble.

• 6:44Mindy Pelz?

  Right.

• 6:45Speaker 01

  Because what's, what's going on for years before that happens in the background silently, without anybody testing for it, unfortunately, is your body is producing more and more insulin to keep your fasting glucose in a healthy range. So, and it will do that for as long as it can, until it can't do it anymore. So it can be, so fasting glucose can be totally normal for years, while in the background, your insulin's going higher and higher and higher to, to keep that fasting glucose normal. So a better test, a much better test for insulin resistance and metabolic health problems is a fasting insulin level.

• 7:29Mindy Pelz?

  Right.

• 7:30Speaker 01

  That's a much more sensitive and an earlier test to see, you know, what's going on underneath.

• 7:35Mindy Pelz?

  And what would you want those levels to be at? Just, we have, we have a lot of number watchers in this crew that listens. So what would you want your fasting insulin to be at?

• 7:45Speaker 01

  You, I mean, you really want it to be below 10. Ideally, even six or less is better, but in the single digits, you want your fasting insulin to be in the single digits. And it's not, it doesn't have to be there every single minute of every single day, but the fasting insulin, if you say that above 10, that means that you are, that you're, you're producing too much insulin. Your body's having to work pretty hard to try to keep your glucose levels in check. It means you're eating too much carbohydrate for your personal metabolism.

• 8:16Mindy Pelz?

  For what your body can break down and actually do.

• 8:19Speaker 01

  Right.

• 8:20Mindy Pelz?

  What, what's the mechanism behind high glucose, high insulin and depression?

• 8:27Speaker 01

  So this is a topic of intense research. So we have some theories that are being tested. So for example, um, uh, one of the theories that that is, uh, very common in our field is to think about, uh, mental health disorders as disorders of brain metabolism, meaning that the brain is having trouble turning glucose, blood sugar, into energy. So, and if the brain can't turn glucose into energy smoothly and reliably, um, uh, whenever it needs to, because the brain's a very high energy organ, it's an electrical organ. So, and, and if it doesn't have access to smooth, clean, reliable flow of energy at all times,

• 9:12Speaker 01

  then something's going to go wrong. So one of the theories is that depression, um, is a reflection of an energy shortage in the brain, that there isn't enough energy, and so the brain is powering down. You know, you, your energy goes down, you know, you don't feel like doing anything, you have no motivation, you want to sleep all the time, uh, you're, and, and so, uh, uh, things like that. So, so the brain doesn't have enough energy, that's one of the theories. Another theory is that there's a lot of inflammation going on in the brain. And inflammation is, uh, very damaging to the brain and causes the brain to, causes the brain to enter kind of a sickness mode, where it wants to put you into bed and have you rest until you feel better.

• 9:55Mindy Pelz?

  Right. So. Smart, it knows it's intuitively trying to get you to recover. That's, that's super smart. What, so if the brain's energy powers down, does that mean, I know some neurotransmitters are actually produced in the gut and some are produced in the brain, does that mean then it's also can't be a factory for neurotransmitters that keep us focused and happy and well-balanced?

• 10:18Speaker 01

  Yeah, so that's a great question. So, yeah, uh, the, the, the gut has its own nervous system and it produces a lot of neurotransmitters, but those neurotransmitters don't cross into the brain, the brain makes its own neurotransmitters.

• 10:31Mindy Pelz?

  Great.

• 10:31Speaker 01

  And so, but that, the, the balance of those neurotransmitters, we're talking about things like. Serotonin and dopamine and norepinephrine and glutamate, lots of different neurotransmitters. Uh, it, the, the, the balance of the production of those neurotransmitters and how, how well they work is strongly influenced, not just by how much energy is coming into the brain, but also by how much sugar is coming into the brain.

• 10:57Mindy Pelz?

  Right.

• 10:58Speaker 01

  So if you're eating too much, if, if your glucose is running too high too often, your blood sugar is running too high too often, your brain sugar will also be running too high too often. And that extra glucose inside the brain will, it has nowhere else to go. It sticks. It starts sticking to things inside the brain. And, and, and, and that will set off waves of inflammation inside the brain. And, and depression is very strongly associated with inflammation of the brain.

• 11:26Mindy Pelz?

  Yeah, fascinating. And how many fuel sources does the brain have?

• 11:31Speaker 01

  It has multiple fuel sources, but its favorite fuel sources are very small molecules. Primarily glucose, ketones, and to a lesser extent, lactag acid or lactate. Which we, we don't need to talk about today, it'll get too complicated, but glucose is one of the brain's favorite fuels. But it, uh, it really, um, the brain is, has been described as a hybrid engine. It works best on a mixture of glucose and ketones. Because glucose is a fast fuel, so there's certain, certain operations in the brain that need that fast energy. Ketones are a slower fuel, slower burning fuel, but they're cleaner.

• 12:15Speaker 01

  And they're smoother and they're more efficient and they cause less inflammation and oxidative stress when you're burning them. So it's really a combination of the two that, that works best.

• 12:25Mindy Pelz?

  And what, like, if I have a hybrid car and the, I'm not doing anything to facilitate the electrical, the, you know, the electric part of it, I'm only working on the gas. It seems like I wouldn't be using the car to its full capability. So as I'm hearing you talk, I'm thinking about the millions of people that never have really experienced the power of a ketone. What, what would happen to the brain if it never got exposed to ketones and it was only exposed to glucose? Does that cause any inflammation because it doesn't have that second fuel source or any challenges to the brain?

• 13:05Speaker 01

  One hundred percent. So if your, if your brain tries to run entirely on glucose, first of all, it'd be very, very difficult for that to, for that to occur. Because um you would have to be, glucose doesn't last very long. You have to keep, you have to keep uh putting it in. You have to keep it. So, so like, for example, overnight, uh when you're not eating carbohydrate. Um if, unless you're fat adapted and on a ketogenic diet, overnight, your body will say, we're running out of glucose, we're running out of glucose. Um and your body, your body and your brain will try to then switch over to ketones. Um to uh to bridge that energy gap, but that takes a little bit of time. And so what's happening is that there's a stressful transition period overnight.

• 13:48Speaker 01

  Where cortisol levels can go up and um and people can actually wake up or they can, their, their sleep can be disrupted. Because they've got this surge of stress hormones that are trying to, they're looking for energy. Where's the, where's the energy for the brain? As the glucose is dropping overnight. So um so having a smooth, having your body be metabolically healthy. Means that you can switch easily and efficiently between the two. And most of us are not metabolically flexible anymore. And it's hard to regain that. You can regain it, but it's hard to do and, and it takes some time to, to rebuild that flexibility. But most people are trying to um for, to fuel their brains almost entirely with glucose.

• 14:31Mindy Pelz?

  Right.

• 14:32Speaker 01

  And that's, so a couple of problems with that. One is that your energy level is going to be unstable.

• 14:37Mindy Pelz?

  Right.

• 14:37Speaker 01

  And, and the other is that um a glucose, it does burn faster, but it burns, it doesn't burn as cleanly. And or efficiently. And so what you get is you can get more inflammation and more of something called oxidative stress. And these are, these are damaging forces in the brain. So if you're running on glucose all the time. It's like you've got your foot on the gas pedal and, and you're really damaging the engine. What you wanna do is you wanna occasionally take your foot off that gas pedal. And, and, and give your brain some, some downtime, some healing time, some, some time in a lower glucose state, not a zero glucose state. You always need some. Glucose.

• 15:15Mindy Pelz?

  Of course.

• 15:16Speaker 01

  But you want to, but if you're trying to run a hundred percent on glucose, you're really going to have to keep that foot on the gas pedal to get enough energy. Whereas you can let up and let, let ketones do some of that work for you. And that way, when you're in ketosis, the brain can enter a, a healing mode where you can recycle, you can regenerate, you can, you can, you can build and repair and clean up. If you're running on glucose all the time, your cells are too busy processing that glucose for them to actually do maintenance and repair and healing work.

• 15:51Mindy Pelz?

  And so I'm thinking in, in application of, of what you just said, would it be to my brain's benefit to maybe eat an earlier dinner? Maybe even a dinner that's more stable for my blood sugar, knowing that I'm hoping to go into a mild state of what we, what I refer to as nutritional ketosis.

• 16:13Speaker 01

  Yes.

• 16:14Mindy Pelz?

  When, when I'm sleeping, like, would that be the goal of brain repair? Is to have everybody be in a metabolic state where they can flip into ketosis when they're asleep?

• 16:25Speaker 01

  That is the way I think about it. I believe that everybody, whether they have a mental health condition right now or not, or whether they have metabolic problems right now or not, even people who are robustly mentally and physically healthy, which are very few of us, unfortunately.

• 16:40Mindy Pelz?

  Few, I know.

• 16:41Speaker 01

  You know, but, but even, even if you are in, in the, you, if, if you're right now, the picture of health, it's still, this is my opinion, based on, you know, what I've studied. I think it's still ideal for humans who want to maintain their good health to get into ketosis on a regular basis, especially overnight. It doesn't mean you have to be in ketosis all the time. It doesn't mean you have to even eat a ketogenic diet. It's just about making sure you're using those pathways and keeping the, keeping those pathways well-oiled and well-used so that you can flip back and forth easily. And, and so that, so that everything stays in working order. So that you enter this healing mode every night, overnight is the perfect time. To do it.

• 17:26Mindy Pelz?

  Right.

• 17:27Speaker 01

  And so overnight, go into that healing mode and then the next day, eating in a way that doesn't spike your glucose into unhealthy ranges. And again, that doesn't necessarily mean a ketogenic diet. It depends on who you are. So I agree with you that getting into ketosis overnight, even just mild ketosis overnight, is really beneficial for everyone.

• 17:50Mindy Pelz?

  Mm hmm. Can I be honest with you for just a second? So many of the women who have come to me have literally already tried everything. They've done the diets. They've worked themselves out to death. They've done the programs. They've diligently followed the advice of their doctors. And yet they are still exhausted. They are still hormonally lost. They are still wondering why nothing seems to work for them. And here's what I've learned after two and a half decades of working with women. It's not a willpower problem. I promise you, it's an education problem.

• 18:34Mindy Pelz?

  Your body has a very specific set of needs. And most health advice out there was never designed with those needs in mind. And so this is exactly why I built my Reset Academy. It's my monthly membership community where I teach you how to use fasting, food and lifestyle to genuinely work with your female biology. Every month you get new trainings, live Q and As with my team and I, and a community of incredible women who are all in it with you. They're doing the work. They're seeing the results. And the best part is they're cheering each other on. If you're ready to stop guessing and start actually understanding your body

• 19:19Mindy Pelz?

  and finally getting results, come join us over there. All you have to do is head over to resetacademy.drmindypelz.com. And I would love to see you inside the community and help you accomplish your health goals and fall in love with your body again. So that's resetacademy.drmindy.com.

• 19:46Mindy Pelz?

  Yeah, I've been really, you know, when I started to really understand melatonin, I saw that there's an inverse relationship between melatonin and insulin. And so, you know, from a weight loss standpoint, I really started teaching people that they shouldn't eat right before they go to sleep because especially if it's dark out, you've got, you know, you've got a lot of melatonin going in you, which makes you a little more insulin resistant.

• 20:10Speaker 01

  Yes.

• 20:11Mindy Pelz?

  It's really, and then I just recently saw another study that was showing improved heart rate variability if people didn't eat three hours before they went to bed. It was easier on the nervous system, the cardiovascular system. So I feel like we're just getting this arsenal of don't eat before you go to bed.

• 20:30Speaker 01

  Don't eat when it's dark out, you know, and so we have, we have a circadian rhythm, just like all creatures do. And, you know, we metabolize our food best during daylight hours.

• 20:44Mindy Pelz?

  Yeah.

• 20:45Speaker 01

  And so, and once it gets dark, that's, you're going to become more insulin resistant. And so that's, that's when you're going to tend to store more of your calories as fat. And, you know, it's just not going to be as, as healthy for you. And you're going to lose out on that precious overnight healing phase that

• 21:02Mindy Pelz?

  Right.

• 21:03Speaker 01

  I think one of the holy grails of good health.

• 21:04Mindy Pelz?

  So, so amazing. And, you know, we're over here telling people that sleep is so important, but we're forgetting the nuance of like, sleep is really important and here's some factors to get you the most out of your sleep, which food timing would be a big one. In your, in this new expert consensus, there was a couple of things that were really interesting to me. So one was that you all decided what the amount of ketones that was best for depression, schizophrenia and dementia. Is that correct? Those were the three conditions you looked at?

• 21:42Speaker 01

  So this paper, the, the expert consensus was eight of us who have many years of experience studying and using ketogenic diets in mental health. We, we were asked this question.

• 21:55Mindy Pelz?

  Yeah.

• 21:56Speaker 01

  And tried to come up with an answer. And, and we focused on what we called, what are often called serious mental illnesses, which are major depression, bipolar disorder, and schizophrenia. So those three major mental illnesses were the ones that we focused on in this expert consensus. And so now, we don't know for sure what is going to be the right range of or or level of ketosis for every person with with with one of these conditions. But what we said in this in this paper was that based on our clinical experience and the research that we have available so far, it appears there appears to be a trend

• 22:38Speaker 01

  where with these serious mental illnesses, most people seem to do better when their degree of ketosis, their range of ketosis is somewhere between 1.0 millimole per liter and 3.0 millimole per liter most of the time. Doesn't have to be all the time, ketones fluctuate, they naturally fluctuate quite a bit. But and you know, we've all seen, all of us on this panel had seen people respond to lower levels and seeds and seen some people in the higher levels. But most of most of what we tend to see, people tend to do better when they're in that range. And so we ask people to aim for that range at first.

• 23:18Speaker 01

  And then they can find out for themselves what their personal optimal range is after they've after they've gotten into good, consistent ketosis for a while. See whether they can loosen it up a little bit, or whether they have to actually tighten it up. But between one and three is a nice window to aim for.

• 23:36Mindy Pelz?

  Which is so beautiful, because I get asked all the time from fasters. You know, when people start fasting, they're like, oh, my God, my ketones were 4.0, 5.0. And I'm always like, look, I've sat with so many ketogenic experts. None of them are going for the more is better. In fact, I've sat in so many conferences where people say 1.5 is my sweet spot. It's where I feel my best. So I think it's really interesting that you gave that range. Because there is, what I've seen on my end is this desire to get more. But do we know if more is better?

• 24:13Speaker 01

  We don't know that. I can say that if ketones are too high for too long, you're kind of edging into starvation range and nutrient deficiencies and so forth. But most people are not using fasting in that way. Most people are not using a ketogenic diet in that way. So those are kind of more extreme situations. But with intermittent fasting and with a properly formulated ketogenic diet, getting into that range is considered ideal by a lot of people. But there are some people who do feel better when they're even higher. Some people feel better when they're 3.5 or 4. But I have many patients who feel quite uncomfortable when their ketones are running too high for too long.

• 24:58Speaker 01

  They just feel anxious, can't sleep, they're hungry all the time, can't concentrate. And usually that's because they're not getting enough of something they need. And so it depends on the devils in the details. But I've also seen people who respond to a low carbohydrate diet and maybe a little intermittent fasting, where they're never really in great ketosis, but they're just so much better anyway because they've gotten their glucose levels nice and low and stable, right? So sometimes that's all you have to do. And sometimes all you have to do is just give yourself a break from food processing.

• 25:42Mindy Pelz?

  Yes, well said.

• 25:44Speaker 01

  It's hard on the body and brain.

• 25:46Mindy Pelz?

  Yeah. And so the other interesting thing I found about this consensus was there are some recommendations. Now, I understand we're talking about severe depression and some severe mental health conditions. But the recommendation was four to six weeks consistently. Did I read that right? With these 1.0 to 3.0 ketones. My first question was, how did you get people to stay at that level for four to six weeks?

• 26:15Speaker 01

  Right, so most of us agreed that that you wanted to give it at least six weeks in relatively consistent ketosis. And in some cases, you're going to need a little bit longer than that. So what I, what I, what I see in my practice, and many of us have seen, is that there, when somebody with a mental health issue starts a ketogenic diet, I, what I like to say is, three days, three weeks, three months. Some people feel better in three days. Some people, it's going to take more like three weeks. And then there are a few outliers where they're going to have to go a whole three months to really see, to turn that corner. That's not very common. But, but, you know, for people who are really get, really have a sticky mental health problem,

• 26:59Speaker 01

  they might need to, you know, just to make sure it's not going to work, to give it a good three months before you decide it's not going to work for you.

• 27:06Mindy Pelz?

  Yeah.

• 27:06Speaker 01

  So, but most people within three weeks will respond. But we say, give it a good six. And, and so how do you get people to stay? This is, I love this question.

• 27:17Mindy Pelz?

  Yeah, exactly. That was like, compliance for that long has got to be really interesting.

• 27:22Speaker 01

  You know, it is. So, so it's a real issue. Adherence to these diets is a real issue, especially in the very beginning. So anybody who's tried a ketogenic diet for a few days are like, oh, it's so hard. How am I ever going to stay on this? But those who make it, who make it past the adaptation phase, especially if you can get to week three, it becomes so much easier because all of your pathways have shifted into a different, into a different mode of operation. So your appetite is under better control. You've got good energy flow to your brain. Your cells have, are adapting to using more fat for energy and less glucose. They're still using glucose, but they're using less glucose. And now they're using a mixture of fuels.

• 28:06Speaker 01

  So you're, everything's quieting down. You've found a kind of a new equilibrium. Your cortisol levels have come down. Your acid-base balance has corrected itself. And your electrolyte imbalances, which can happen in the beginning, have sorted themselves out. So your body's adapted to this new mixture of fuels and, and becomes happy and content.

• 28:27Mindy Pelz?

  Yeah, and it wants that now.

• 28:29Speaker 01

  It wants that now. It's just like, you know, I have had some patients try extended fasting, and they have all said to me, without exception, get to day three. You get to day three, suddenly it's like, oh, I could do this for another week.

• 28:46Mindy Pelz?

  We do, every, every January, we lead a worldwide fast and we get 100,000 people to do a three-day water fast.

• 28:53Speaker 01

  Wow.

• 28:53Mindy Pelz?

  It's, and it's so fun, because people are like, you know, I always say on day one, tell me what you're feeling, just get it out. And then by day three, I'm like, now tell me what you're feeling. There's so much apprehension. And then the, on the other side, people are like, I couldn't believe I did that. I can't believe how easy it was. Can I keep going? Like, it's, there is something about priming the metabolic switch that does not get enough credit. And, and outside of like, other diets, it gets easier with time.

• 29:23Speaker 01

  When you're well adapted to a properly formulated ketogenic diet, it feels so much easier than trying to walk this tightrope of how much carbohydrate can I have? And, you know, and what types and all that kind of thing, which can be so challenging, especially for people with carbohydrate addiction issues, which are fairly common. It can be hard to moderate. And so that kind of being completely on the other side, where you're in ketosis, it's, it's just, it's easier. There was a great study by Dr. Ian Campbell. He's a researcher at the University of Edinburgh in Scotland, who, years ago, eight years ago,

• 30:08Speaker 01

  he was a musician in Scotland, a very good one, and talented. And he had bipolar disorder, and he, you know, hadn't found anything that helped him. And so he, and he was overweight, and he's like, well, you know, I can't fix my mental health. Why don't I, why don't I try to lose some weight? I can at least try to lose some weight. So he went on the Atkins diet, and he, within three days, his bipolar depression started to let go. And he was like, oh, that's interesting. So, and he tested this over and over and over again, and then started learning about ketogenic diets. And then he went back to school, got a PhD. And now he's one of the world's leading researchers in the field studying ketogenic diets for bipolar disorder.

• 30:50Speaker 01

  And I tell you this story because you asked, um, you know, isn't it hard to stick on, stick to the diet? So he published a study where 20 people with bipolar disorder, um, uh, tried a ketogenic diet because people said, oh, you know, it's, you know, uh, people with mental health disorders, they're not going to be able to do this. It's going to be too hard. And he's, well, let's find out. So the 20 people with bipolar disorder, not, they were able to get into great ketosis. They were able to measure their ketones every day. Their levels were about 1.3 on average, which is nice, above three, above 1.0. And, um, and then so, and, and they did wonderful and, and their mood and their energy and their, and, and, and anxiety and so forth improved.

• 31:32Speaker 01

  Um, the higher their ketones were, they seemed to do better, the higher their ketones were. But the thing that was really great about this, and one of the many things that was great about this study was that after the, the, uh, study was over, um, there was supposed to be a washout period where the researchers were supposed to help people, uh, wean off the diet. That was part of the protocol. Seven of them refused to come off.

• 31:56Mindy Pelz?

  I bet. I, I, I wondered if you were going there. Yep.

• 32:00Speaker 01

  Yeah, they were like, well, we feel too good. We're not, we're not, we're not doing it.

• 32:03Mindy Pelz?

  Yeah. I, you know, I, I always tell the story that, that when I did the last, uh, two times ago, I do a three day water fast, usually once or twice a year. And, uh, the last time, a couple of times ago, one of my closest friends knows me enough and was like, are you on a fast? You're really, you're, you're so happy today and you're so, uh, you know, you're so clear headed. I'm like, oh yeah, third day. She goes, I could tell it was almost like you were on cocaine or something. I'm like, yeah, that's how it feels when you've really tapped into that. So it, it's quite remarkable.

• 32:41Speaker 01

  It really is. And there's a strong connection between how we eat and how we feel and, and other people can feel it too. So in terms of ju- just your outlook on life, your tone, um, your facial expressions, your energy. The kind of the energy you put onto the world, how you roll with things. And so, and I can tell when I'm working with patients, I can tell as soon as we get on screen, because I do, I work almost entirely virtually now, I can tell within 10 seconds if they're on plan or off plan. Because

• 33:11Mindy Pelz?

  Yeah.

• 33:12Speaker 01

  by how they're holding themselves, their look on their face, their tone of voice. And so it, it, it really is a lot more powerful than, than people realize.

• 33:24Mindy Pelz?

  You, you bring up a really interesting point because when I had my clinic and I started teaching fasting, I could literally tell when the person walked in the door and was sitting in my waiting room, if they were in a state of ketosis. Like, and, and I would look at them and I'd be like, you're doing it, aren't you? You're fasting, because I, I taught it through fasting and then I taught carb cycling and all kinds of changes to it. But you, you could see it in them. It's like you, it's like on one hand, they can't lie to you because you can see if they're not doing it. But then on the other hand, just to look across the room, you could see the vibrancy and, and the, and the alertness, the, and the happiness.

• 34:08Mindy Pelz?

  And this is where when people start to break the ketogenic diet down or even fasting down, I'm like, you gotta try it and then you come back and tell me how it feels. Because there's no drug on the planet that can give you that lift like ketones do.

• 34:23Speaker 01

  Thank you for saying that. That is a great point. And we talked a lot about this last time I was on, on with you is how many, how the, the many, many, many of the same or similar benefits from fasting and ketogenic diets is that you're in ketosis in both, in both of those cases.

• 34:40Mindy Pelz?

  Right.

• 34:41Speaker 01

  And so the ketones are, being in ketosis is a different state of mind. It's a different state of mind. It's a superior state of mind.

• 34:48Mindy Pelz?

  Yeah, thank you. You said it. I think so too. I think so too.

• 34:52Speaker 01

  It really is. People feel better, they sound better, they, they get more done, they are better able to deal with stress, better able to recover from, from. From difficult events in their lives. And so, I mean, person after person after person that I've worked with has told me, you know, it's not like my life changed. I mean, it's, you know, I'm still in, I'm still have a difficult relationship, or I'm still having trouble at work, or well, my kid is still sick, whatever it is. But I, but I don't feel the same way about it. I can step back from it. And I can get, get, I have like a buffer and I can think through, okay, how am I going to, how am I going to work with this today?

• 35:32Speaker 01

  And you start to imagine more options, you feel more flexible, flexible in your thinking. And you feel more capable, you feel more confident and you're less likely to let things really get you down.

• 35:44Mindy Pelz?

  Agreed, agreed. Did your group look at ketones compared to medications at all? Have we done those kind of analysis?

• 35:53Speaker 01

  Not really, no. But so, I mean, you can look at them separately, but they haven't been compared head to head. So we don't yet have any studies where you take a group of people with a mental health condition. Let's say you take a group of people with major depression and you put half of them on a medication and you put half of them on a ketogenic. We haven't done that yet. So, but what we can, what we, what has been done, for example, is in fact, in just about every study that's been published in the field of metabolic psychiatry, that's this field that we're in, is in almost every case, whether it's been a clinical study or whether it's been case reports or case series that have been published,

• 36:36Speaker 01

  the ketogenic diet has been added to existing treatments. So the person is already in counseling, they're already taking one, two, three, four, five medications. And then you add, and, and, and they're not really responding. They're, you know, they're not getting much relief from those conventional treatments. You add the ketogenic diet and they improve.

• 36:59Mindy Pelz?

  Off they're going, yeah.

• 37:01Speaker 01

  And so this, it, it, it's, in fact, there was just a study published, there were actually several different studies, but the study was just published out of Oxford University a few weeks ago, first ever. Um, what's called a randomized controlled trial, which is a more rigorous kind of clinical trial. Where they took people with so-called treatment-resistant depression, which just means they have not responded to two, at least two different antidepressants. So they took this group of people with treatment-resistant depression, they divided them into two groups. And they put one group on a ketogenic diet, well, they, thirty grams of carbohydrate per day.

• 37:41Speaker 01

  And they put the other group on this diet that they made up called the Fido diet. And the Fido diet is just, uh, supposed to be like a placebo, like a sham diet that wasn't supposed to do anything. But that people who were in the study would believe it would do something. They said, oh, you, you have to eat one extra colorful fruit or vegetable every day. And you have to, you know, replace your cooking fats with olive oil. And that's gonna be really good for your depression. So, um, the interesting thing about this study, um, not too surprising, but interesting is that both groups got a lot better. It's got a lot better. The keto group got even better.

• 38:22Speaker 01

  But both groups got better. And, and if you had very serious, um, severe depression, the keto group got especially, got much better than the other group. So you saw some separation there, but what this really tells us is that, you know, and this happens a lot, when you enter a study and people are, people are, um, paying attention to what you're eating and you're trying to, of course, you're gonna make a lot of changes and you're gonna feel supported and you're gonna, you're, you're gonna, you're going to get better if you pay attention to your diet and if other people are supporting you. So, I think it's really hopeful, hopeful.

• 39:00Mindy Pelz?

  Yeah.

• 39:02Mindy Pelz?

  Let's talk about cod liver oil for a second. And I, I know what you're thinking, cod liver oil, really? Dr. Mindy, that sounds like something my grandmother took. But hang with me here for a moment, because this is one of those old school remedies that modern science keeps proving right. Cod liver oil is one of nature's most concentrated sources of omega-three fatty acids.

• 39:27Mindy Pelz?

  Also, it's high in vitamin A and vitamin D, all in a form your body can actually recognize and use. This is such a powerful combination that is profoundly anti-inflammatory. It's protective to your brain, it supports your hormones, and it does something I care really deeply about, which is it starts to repair and nourish your gut lining at a deep cellular level. This is something I personally take every single day, and one of the things that I have noticed the most is what it's done for my skin. I recommend it to women who are navigating hormonal shifts, dealing with chronic inflammation,

• 40:10Mindy Pelz?

  or simply trusting to protect their long-term health. So Standard Process is the company I deeply align with and trust. It's a whole-food-based, clean company, and it has held the standard of quality for decades, and I expect only the best from Standard Process. They are definitely one of the top supplement companies in the world. So if you want to try it, check it out. You can learn more and get some for yourself at drmindypels.standarprocess.com. That's drmindypels.standarprocess.com. Enjoy.

• 40:53Mindy Pelz?

  Where do you think the GLP-1s fit into this? You know, they've become so popular, and my take is that I can see the benefits, but I also see all the fasting lifestyle I've taught people has given a very similar result that GLP-1s can accomplish. We're seeing hemoglobin A1C come down, and yet we're seeing some statistics like depression actually goes up because people don't have been using food to help their depressive symptoms. So how do we fit the GLP-1 conversation into this conversation we're having?

• 41:33Speaker 01

  Well, yeah, you know, GLP-1s are popular because they work, right? So, and how do they work? They help people eat a lot less.

• 41:43Mindy Pelz?

  Yep.

• 41:43Speaker 01

  That's the problem. So why are we eating so much more than we need?

• 41:48Mindy Pelz?

  Yeah.

• 41:49Speaker 01

  Right? So if we need a drug to turn down our appetite, w- w- why is that? W- yeah, and and and are you gonna do that for the rest of your life? Are you gonna put kids who are overweight and obese on on on? I mean, this, th- we can't medicate our way out of this overeating pandemic.

• 42:06Mindy Pelz?

  Well said.

• 42:07Speaker 01

  Why are we overeating? And so something is wrong, and it's not because we don't have willpower, or i- it's because the foods we're eating make us hungrier.

• 42:18Mindy Pelz?

  Hmm.

• 42:19Speaker 01

  They they're they make you hungrier. And so you you wanna eat foods that that are satisfying, that are real whole foods. We've been doing that for two million years. And suddenly, in the past fifty, seventy-five years, we're we're not eating food anymore. We're eating factory-processed ingredients that start out as whole foods, but they don't behave like foods in the human body because they've been concentrated and extracted, um, powdered and liquefied and crystallized and

• 42:51Mindy Pelz?

  Yep.

• 42:51Speaker 01

  that's not what we're supposed to be doing. And they, they really throw off your appetite-regulating mechanisms.

• 43:00Mindy Pelz?

  Yes. So they make you more, I think they make you more hungry is really important. I just did a video on YouTube about that, and I think it was six hundred calories more a day. Somebody will eat if they are eating an ultra-processed di- uh, diet compared to a whole foods diet. So, and a lot of people who who eat ultra-processed foods diet diets think they're saving money because it's cheaper food, but you actually become more hungry and you're eating more food than if you spent it eating a whole foods diet.

• 43:32Speaker 01

  Thank you. That's exactly right. And people always say, oh, I can't afford to eat real food. Well, you can't afford not to eat real food.

• 43:38Mindy Pelz?

  Right, right. Well, we weren't not even talking about the medical bills you'll have to pay for.

• 43:42Speaker 01

  Exactly. The the copays and the doctors' visits and the surgeries and the hospitalizations and injuries and everything else. So, but yes, actually, there was a study on people with with Alzheimer's disease, where they put half the group on a ketogenic diet and they put the other half in a regular, I think it was a low-fat diet. I can't remember what the diet was would be compared to. It was kind of more of a a standard diet. And and they said, you know, you can eat as much as you want. We're not going to limit how many calories you eat. But just, you know, this group on the ketogenic diet, and they were just going to look at memory testing, right? And so the group on the ketogenic diet did a little bit better on the memory testing, not a lot. We could talk for a long time about that, a little bit better. But what was remarkable was, the group on the ketogenic

• 44:27Speaker 01

  diet, without anybody telling them to and without them trying, they naturally ate 550 fewer calories per day.

• 44:35Mindy Pelz?

  Yeah, yeah. The hunger goes away. The first time the GLPs came out, I was like, I went to my to people that I knew were on them. I'm like, tell me what you noticed. And they're like, I'm not hungry. I'm like, yeah, that's what happened to me when I started fasting. I was my hunger went away. Like, we used to have a joke in my clinic when somebody would come in and they'd lost 30 pounds in a short period of time. And they're like, and I'm not even hungry. I was like, shh, don't say that too loud. You might upset some people in here. So, so, you know, for me, I think we don't give the body enough credit, what it's capable of doing when you give it the right fuel source. And we've given GLP-1s are all the heroes. And yes, they have helped some and save a lot of lives.

• 45:19Mindy Pelz?

  But to your point, what's the exit ramp? And how can you do this on your own to take your own power back and save your own money? So?

• 45:27Speaker 01

  Right, the exit ramp. So there was another study. So I'm saying was a study.

• 45:31Mindy Pelz?

  Yeah, yeah, no, I love your studies.

• 45:32Speaker 01

  I'm a study nerd. But the but the another study by Verta Health, and that's a virtual type 2 diabetes clinic that uses low low carbohydrate diets to to help people get off diabetes medications and manage their glucose levels and lose weight. Verta Health published a study two years ago, I believe it was, where they took people who had responded nicely to a GLP-1, they'd lost weight, they'd gotten their glucose levels under better control, and, and then they switched them to a low carbohydrate diet. And they, and, and took them off the GLP-1, and they were able to maintain all of those benefits even a year later. So that's, that's a great exit room. And it's not the only one.

• 46:11Speaker 01

  I mean, a- as you and I have talked about before, there are a lot of similar benefits to intermittent fasting compared to ketogenic diets. So whatever works best for you.

• 46:21Mindy Pelz?

  That's right.

• 46:22Speaker 01

  But make sure that you are finding a way to keep your glucose and insulin levels in a healthy range, and to keep your metabolic health where it needs to be. And so that, and, and you're eating in a way that, that doesn't make you hungry.

• 46:37Mindy Pelz?

  Right. Yeah. So, I mean, that's such a, let's just think about that con- that statement. Eat in a way that doesn't make you hungry. People eat because they're hungry.

• 46:48Speaker 01

  Right.

• 46:49Mindy Pelz?

  But, but I always think, and the way, this is literally the way my brain thinks. When I eat a meal, I ask myself, how do I want to feel two hours from now?

• 47:01Mindy Pelz?

  Right? Like, I'm like, I'm not just eating for my taste buds, I'm eating for performance. Like, how do I want to feel two hours from now? And sometimes I'll dip in, I, I'm gluten free, but sometimes I'll dip into a bowl of gluten free pasta, knowing two hours from now I'll be sitting on the couch watching a movie. I don't really care how I feel. But if it's during a workday, I'm very methodical about what I eat so that I don't get that glucose too high.

• 47:26Speaker 01

  Right. Then you have control. If you understand, if you understand your body and how it works and how different foods affect you, it doesn't mean you can never have that food again. That's up to you, right? It just gives you more control. So now you understand, okay, I, I want to have this food, but I know, I know what it's going to do to me, but that's okay. It's a conscious choice I'm making. Rather than saying to yourself, I know this is, I'm supposed to be eating whole wheat muffins every day because, you know, for fiber.

• 47:51Mindy Pelz?

  Yeah, because my doctor said so.

• 47:53Speaker 01

  Right. And which doesn't make any biological sense whatsoever. So don't fool yourself into thinking that certain things are good for you. It's okay to to eat things that you enjoy from time to time that might not be, it's not about being perfect. It's about understanding, working with your biology and may and and and having more control.

• 48:13Mindy Pelz?

  Yeah.

• 48:13Speaker 01

  So I love that. I think that's really important.

• 48:17Mindy Pelz?

  Well, are there certain groups of people that do better with ketones? Their brains do better with ketones than other groups? I mean, we talked about chronic depression and schizophrenia and dementia, but do we have other groups that we know? Like, yeah, you should be doing ketones.

• 48:34Speaker 01

  You know, the thing is that ketones, at least being intermittently in ketosis, we know that that's good for the brain. Full stop, right?

• 48:42Mindy Pelz?

  Yeah.

• 48:42Speaker 01

  So the the brain needs needs to, my reading of the science is the brain needs to go in and out of ketosis. It needs to spend at least some time in ketosis on a regular basis. So I think it's good for, no matter what the condition is. But the question you're asking is really interesting because there are, like we were saying before, some people just need to clean up their diets. Some people just need to get their glucose levels under control. Some people just need to eat less, whatever it is. All of those things can be, can help support better brain health. But who are the people who need those ketones?

• 49:16Mindy Pelz?

  Right.

• 49:16Speaker 01

  And especially who need them in a really good range. And we're starting to get a better feel for this, but the the the short answer is we don't know. But the but I think a better answer is the the people who are going to do best with those ketones are the people whose brains have lost some of their ability to use glucose for energy to full capacity.

• 49:38Mindy Pelz?

  Yes.

• 49:39Speaker 01

  So if if you've lost some of that metabolic flexibility and you've burnt out some of your glucose pathways by overusing them, and you've made your brain insulin resistant by bombarding the your brain with too much insulin too many times over too many years. The brain becomes insulin resistant, becomes harder and harder for insulin to get into the brain. Glucose can still waltz in, no questions asked, but now you don't have enough insulin because you're insulin resistant. You know, your brain can be swimming in a sea of glucose and still starving.

• 50:11Mindy Pelz?

  Yeah.

• 50:11Speaker 01

  Because of lack of insulin. So, people who have lost some of their glucose processing capacity, they really need ketones because there is no other molecule that's going to be able to bridge that energy gap. But you, if your brain is having trouble burning glucose, more glucose is just gonna make the problem worse.

• 50:31Mindy Pelz?

  Right.

• 50:31Speaker 01

  You need ketones are your only hope.

• 50:35Mindy Pelz?

  Yeah.

• 50:35Speaker 01

  Obi-Wan Kenobi.

• 50:38Mindy Pelz?

  I love that. I am like, amen, sister. I, you, you know, so I just, since we last talked, I published another book called Age Like a Girl. And it's all about-

• 50:48Speaker 01

  When do you have time to do this?

• 50:49Mindy Pelz?

  I know, well, I'm, I'm on a hiatus from work, book writing for a while. I'll send you a copy of this one. And I have a whole chapter on fueling the menopausal brain. And in all the research I've seen, that you, we see this as estrogen goes down, I would put menopausal women in the category that you just said. The menopausal brain cannot use glucose as efficiently as it used to. And then I paired that, I paired that thought with, I was actually on a podcast back in January with a neurosurgeon. And she says to me, "Did you know that when a woman's brain goes through menopause and those neurons start to prune away,

• 51:31Mindy Pelz?

  the old neurons, because there is a pruning process, these neurons get pruned away, making room for new neurons to form, the degeneration of the neuron in the menopausal brain, the byproduct of that is a ketone." The brain, and I, I've been dying to ask you this because basically she's saying that the brain knows it's rewiring itself. It knows it's getting rid of these neurons it no longer needs. Many of them are those, are in, inside the hippocampus. Some of them are in the amygdala, areas that were, that kept us addicted to people pleasing and performative mode.

• 52:15Mindy Pelz?

  We get this pruning away and the brain is so intelligent that it knows that there's a shift happening that is going to require the fuel source of a ketone.

• 52:27Speaker 01

  Well, I haven't looked at that. So I've written it down because I'm Yeah, I'll send you the study. Thank you. So but but what I can tell you, which lines up perfectly with what you were just saying, is that when you're in ketosis, remember, we were talking before about how the brain enters a healing mode, where you're recycling and regenerating and cleaning up and maintaining and that sort of thing. One of the things that happens in ketosis is levels of a growth factor in the brain called BDNF, or brain-derived neurotrophic factor. It's kind of like fertilizer for the brain, and it helps you sprout those new connections and create those new circuits. And so that's what's responsible for something called neuroplasticity, with the brain is rewiring

• 53:11Speaker 01

  itself and remodeling itself. If you're not in ketosis on a regular basis, your BDNF levels will be lower. And so if you want your brain to be able to remodel itself and rewire itself and heal from injury and create new connections, which is essential for learning and memory, the way you learn or memorize something is you have to create a new circuit that understands what that new word was or that new skill was. So that requires building a new little circuit, and you can't do that unless you've got, A, some insulin coming into the brain, so you can't be too insulin resistant. Right, right. B, you've got to have, you've got to spend some time in ketosis to get the brain-derived

• 53:52Speaker 01

  neurotrophic factor up, because that, those, those new, starting those new connections requires BDNF. So lots of reasons why it's good for everybody to be in ketosis from time to time. But especially, you know, the perimenopause and postmenopause, one of the major things that happens for women, and I'm sure this is a major focus of your book, is that, you know, we become more insulin resistant. Yeah. And, you know, the shape of our bodies change, our metabolism changes, and we catch up to men. Men are men who tend to gain weight around their midsection, even when they're

• 54:34Speaker 01

  younger. Women tend to gain it in their hips and thighs, but then when they go through menopause, everything changes. So women become more insulin resistant as estrogen falls away. And so that is a major challenge for a lot of women to maintain their metabolic health.

• 54:52Mindy Pelz?

  I was just curious, do we have any research showing waist circumference? Because that seems to be for both men and women. As they age, that seems to be where fat accumulates more easily. Do we have waist circumference and cognition or dementia? Do we have, have we seen any studies that are showing the bigger your waist, the more cognitive decline is happening?

• 55:18Speaker 01

  What a great question. I'm going to say I don't know, but I bet, I bet we do, but I don't have my fingertips. I'm gonna, I'm gonna look it up, but that's a great question because I bet there is. I know there is for glucose levels, but I don't know if there is for waist circumference in particular, but I wouldn't be surprised.

• 55:36Mindy Pelz?

  Because I'm thinking it's visceral fat and it's the out expression of metabolic dysfunction. So if you want to know if your brain is suffering from metabolic dysfunction, my intuitive sense would be look at your waist circumference. You know, what are we seeing there?

• 55:55Speaker 01

  Yeah, I mean, waist circumference is a really good marker of insulin resistance. It's not perfect, but it's very, very good. I mean, there's no one perfect marker for insulin resistance. But, but waist, waist to height ratio. So if your waist is more than half your height, then that, then you're very likely to have insulin resistance. And, and, and often that has to do with visceral fat, the fat around the organs and fat in the liver. And, you know, and I think what a lot of people don't realize again is if you, if you're eating too much carbohydrate for more than you need, more than your personal metabolism can handle, and that's going to be a different level for every person, then every single

• 56:38Speaker 01

  extra molecule of carbohydrate that you eat that you can't burn or store right away, your body turns into, your liver turns it into saturated fat.

• 56:48Mindy Pelz?

  Right.

• 56:48Speaker 01

  Right there on the spot because

• 56:50Mindy Pelz?

  Right.

• 56:50Speaker 01

  There's nowhere else to put it.

• 56:51Mindy Pelz?

  Right.

• 56:52Speaker 01

  There's nowhere else to put it. So it's just doing the best it can with a difficult situation. So really wanna make sure that you're not eating more than you need. And again, it doesn't mean that everybody needs to be on a ketogenic diet. It just means that, what it means, most people are eating so much more than they can handle and process that of course, where else is it gonna go? Has to go somewhere.

• 57:18Mindy Pelz?

  Right. Well, how do we support the communities that either are, like, a lot of women that follow this podcast have aging parents with Alzheimer's and also may have grandchildren who have, you know, ADHD. And I look at those two groups of people and sometimes it can look impossible to keep, put them on a low carb diet or to even have them intermittent fast. Did your group look at all at the possibility of exogenous ketones? Or how we help those two populations that might really struggle to get on to a ketogenic diet?

• 57:59Speaker 01

  Yes, so there have been a number of studies in Alzheimer's disease and mild cognitive impairment. So mild cognitive impairment for people out there who, who don't know that's, you can think of it as kind of predementia, the way prediabetes and diabetes, you know. So mild cognitive impairment, about 10% of those people every year will go on to develop an Alzheimer's disease diagnosis, dementia diagnosis. And so they've done studies of ketogenic diets in both of those types of, types of situations. And they've also done studies of exogenous ketones and MCT oil in those situations. And so, and we still don't have a large randomized controlled trial. And I believe one is in the works for the ketogenic diet.

• 58:44Speaker 01

  But, but we still don't have a, a, a well-conducted, large randomized controlled trial, which would be wonderful in this, in this population. But the studies we do have, they show promise, meaning that You know, there are lots of people in that situation, as you said, who, let's say they're in assisted living, or they're in a nursing facility and they can't change their diet, or, or they have enough memory challenges that they can't learn a new diet, or can't stick to a new diet. Um, uh, so, and I've had, I've had patients in these situations. In those cases where the person either can't, or chooses not to, follow a ketogenic diet,

• 59:25Speaker 01

  exogenous ketones and MCT oil are gonna be your best bet. Because they can raise ketone levels, even if you're eating a, a high carbohydrate diet. So, it's better than, you know, it's, it's not, it's not perfect, but it's better, because those ketones, the brain is still gonna appreciate those ketones. Even though your glucose levels are still too high, and your insulin levels are still too high, because you're eating the wrong foods, you'll, your brain will be getting some ketones, and those ketones can energize, help support better brain energy, and can, uh, you can see this in the studies, can support, um, some degree of improvement in, in cognition and mental clarity.

• 1:00:07Mindy Pelz?

  Yeah, and I, I, that's what we used to do in my practice, a lot of people would ask about, well, what about my mom, you know, she's in first stage of Alzheimer's, and we would, we would try exogenous ketones, and, you know, this was like, ten years ago. So it was like, there wasn't a lot out there about it. And, um, you would see some brightness come back, and I think it's, it's an interesting approach. Even, I was even thinking as you were talking about like TBIs, people who have had concussions.

• 1:00:36Speaker 01

  Yep.

• 1:00:37Mindy Pelz?

  If, the brain is, is definitely searching for energy, and it feels like a ketone would be really helpful.

• 1:00:43Speaker 01

  Yeah, there's some, there's some early research on that, too, that the ketogenic diet has tremendous potential for, uh, traumatic brain injury. Again, because when you're in ketosis, you enter healing mode, and that's what you need. If you've had an injury, you want your brain to heal. Um, and so, uh, yeah, and I'm actually working right now with a patient who, um, had a concussion from a car accident, um, in August, and so I'm excited to see. What may possible for him. The it always makes sense. It always makes sense to consider a ketogenic diet, no matter what the brain condition is. It doesn't mean it's always going to be the right thing to do or the safe thing to do, or even the feasible thing to do, but it's always the right thing to consider.

• 1:01:28Speaker 01

  And that's where our consensus, expert consensus comes in because there are situations where you don't necessarily want to just jump right to a ketogenic diet. And and and there are many situations where you're going to need some extra knowledge and skill in order to be able to do that safely.

• 1:01:44Mindy Pelz?

  Yeah. Why do you think the ketogenic diet was dismissed is what I'm going to say. I've been teaching ketogenic diet to my patients for fifteen, twenty years. It's got its roots in epilepsy. I mean, there's so much good research, but it seemed seems to me as it became more of a fad, just like every nutritional strategy is everybody's all excited about it. And then people start criticizing it. Why do you think people went after the ketogenic diet?

• 1:02:14Speaker 01

  Oh, my gosh, well, lots of reasons. I mean, first of all, there's a lot of confusion and misunderstanding about what a ketogenic diet is. I mean, and and and like any diet, there are there are healthy ways to do it and unhealthy ways to do it. Same same thing with fasting. I mean, any any nutritional approach can be done well or less well. And so so, you know, you can eat a ketogenic diet where all you're eating is keto junk foods all day long. No, and you're and you're overeating all day long and you're never giving your body a break. And you're eating all the wrong foods and you're eating too many calories and you're eating all the. So there's that's not the right way to do it.

• 1:02:56Speaker 01

  There are other versions of ketogenic diet, especially the the original version, which nineteen twenty one. The we think of the ketogenic diet as a weight loss diet, but as you were saying, it's originally designed over a hundred years ago to stabilize brain chemistry in children with severe epilepsy. And which it actually is extremely helpful in those cases. So what better, you know, what what better evidence do you need that the ketogenic diet can stabilize brain chemistry than stopping seizures? And so, yeah, it's a the ketogenic diet.

• 1:03:33Speaker 01

  The original version of it was very strict and extreme.

• 1:03:37Mindy Pelz?

  Yeah, it was like, it was like ten, ten grams of net carbs. It was, it was almost Atkins. It was like, just, just eat meat.

• 1:03:45Speaker 01

  It was, well, unfortunately, no, the original version of it.

• 1:03:49Mindy Pelz?

  Oh, the original, original.

• 1:03:51Speaker 01

  The original, we're talking way back nineteen twenty one. The original version was designed to get as close to fasting as possible, while still providing some nutrition for these children, because all they knew at that time was that fasting helped with seizures. But you can't fast forever. And so what do you do? So what do you feed the child? And so they, what this was, was a, a diet that was designed to get ketones into a very high range, five to eight millimole per liter, very high, and keep them there for a year or two.

• 1:04:21Mindy Pelz?

  Oh, wow.

• 1:04:22Speaker 01

  And I know. And so it, it required not just bringing carbohydrates down to about five, uh, four, five percent of calories. It required minimizing protein, bringing protein down to about, um, I want to say, I think it was about six percent of calories, far too low.

• 1:04:40Mindy Pelz?

  Too low, for sure.

• 1:04:42Speaker 01

  So it just wasn't nutritious enough. It wasn't enough protein to support growth and reproductive pathways. So you saw side effects. And so, again, that, so there's criticism of the ketogenic diet is often rooted in some of those older studies where the diet was very extreme and not nutritionally complete. And, uh, so, so part of this has to do with misunderstandings of the definition and how best to do it and what, what the right way is to do a ketogenic diet. But another, I think another source of criticism about the ketogenic diet is that it's often misunderstood. Well, you, you have to eat red meat and you have to eat dairy. No, you don't.

• 1:05:21Mindy Pelz?

  Nope, nope.

• 1:05:22Speaker 01

  This is not about plants and animals. You can have a vegan ketogenic diet. You can have a carnivore ketogenic diet.

• 1:05:28Mindy Pelz?

  Yep.

• 1:05:29Speaker 01

  It's not about the plants and animals. So, and, and a lot of people, you know, are, are, have strong reactions to diets that include animal foods and, and that's, and so there's that backlash. The third backlash is people love carbohydrates and so

• 1:05:44Mindy Pelz?

  They're like, let's make that bad.

• 1:05:46Speaker 01

  Right? Like, oh, that can't be good for you. I'm, you know, so there's an emotional reaction to it's like, oh, really? I can't imagine living without these things. Really? I can't ever have these things again. And so

• 1:05:58Mindy Pelz?

  Yeah.

• 1:05:59Speaker 01

  I think there's a lot going on there.

• 1:06:01Mindy Pelz?

  Yeah. And that's why I actually switched over the years of talking about ketosis more from a fasting lens. Because I look at a 24 hour cycle and I'm like, you have a fasting window and you have an eating window. When you switch into that eating window, you get to decide what you're going to eat. If you want to stay in ketosis, then you're going to need to look at keeping that carb count down. So, but for that exact reason is that the confusion, the blame. And I was like, okay, let's just stop talking about the diet and let's talk about how you can use fasting to get into ketosis. And I found that people were more receptive once I did that.

• 1:06:38Speaker 01

  Oh, yeah. I mean, they're, so you have to know who you are, right? So some people are all or nothing people. And, and they, it really helps to have those, those black and white lines. Okay, I'm going to not eat during this window and then I'm going to eat what I, what, what I enjoy during this window. And that's how I'm going to manage my metabolic health. That's how I'm going to get healthier. There are other people who, um, and, and I would count myself in this group. I can't go back and forth because it just

• 1:07:05Mindy Pelz?

  Yeah, there you go.

• 1:07:06Speaker 01

  Triggering for me to be able to include some carbohydrates. I, I, I'm, I'm too addicted to them and I, it becomes difficult for me to, to stay in that lane. And so, um, for me, I know myself because I've tried it many, many times. It's just too hard for me. So, and I feel better when I just kind of stick, stay in ketosis. But the, um, uh, I think that, you know, you, there are different ways to get into ketosis. Fasting gets you into ketosis. Intense exercise get you into ketosis.

• 1:07:36Mindy Pelz?

  Well said.

• 1:07:37Speaker 01

  Calorie restriction get you into ketosis. And a ketogenic diet can get you into ketosis. And so, um, you know, choose the methods that work best for you. But however you can get there. Make sure you spend some time there because that's I really think is going to be the key for most people, as you say, to kind of unlock unlocking their own good health. Like we all have access to this. We just need to find the best way that works for us to

• 1:08:08Mindy Pelz?

  Our rhythm, yeah. How is the mental health community taking this good news of the ketogenic diet and ketosis? I am assuming this consensus, expert consensus was important, probably in a large way to your own community to say, this is what we are finding as protocols. But do you think we're still years away from the mental health world psychologists, behaviorists, psychiatrists, really accepting this diet as treatment?

• 1:08:41Speaker 01

  I think we're probably two to five years away from that. And the reason I say that is because it's already changing. Every time a study comes out, more and more people hear about it. And you know, there are studies being done around the world at some of the most prestigious institutions. You know, Harvard, Stanford, the University of Edinburgh in Scotland, James Cook University in Australia, Leiden University in the Netherlands. I mean, I could go on and on and on. Oxford. I mean, they're just, this is a reputable field of academic exploration where we're seeing really promising results in conditions which where a lot of people have lost hope.

• 1:09:19Mindy Pelz?

  Right, right.

• 1:09:20Speaker 01

  The treatments we currently have, it's not that they don't help anybody. It's that they they do unfortunately, they're extremely limited in what they can do for people and they they come with tremendous side effects and and and they they unfortunately fall short for most people.

• 1:09:39Mindy Pelz?

  Yeah.

• 1:09:40Speaker 01

  So we need another way forward. And so I think there is, every time a study comes out, it kind of chips away at that either lack of awareness or that resistance or the worry about these diets for mental health. And so I think, and as the the next study that's going to come out is going to come from James Cook University in Australia is going to be 100 patient, very, very carefully conducted randomized controlled trial of ketogenic diets in bipolar disorder and schizophrenia.

• 1:10:12Speaker 01

  Conducted by very careful reputable researchers.

• 1:10:15Mindy Pelz?

  Amazing.

• 1:10:16Speaker 01

  I'm very curious to see what the response will be to, to, to that study when it comes out. Um, and so, uh, I mean, I, in ver- in a very short period of time, I think that any clinician in the mental health space who does not know about ketogenic diets and is not able to talk intelligently with their patients about them is going to be left behind.

• 1:10:39Mindy Pelz?

  Yeah, yeah. And I, and you know, there's, I've watched nutrition trends my whole life. I've been fascinated with nutrition since I was a young girl. I, I actually went to the Pritikin diet and did the whole Pritikin diet. Yeah, when I was sixteen years old, I've like, just because I wanted to understand, I just love how diet makes us feel. And you see diets come and go, and you see some stand this test of time, and this one's standing the test of time. And yes, it's had some arrows, ketogenic diet has had some arrows at it, but I think the way you described that is that we're gonna start to see more and more people come back to it and find their own rhythm with it, because this is not prescriptive of keep your carbs

• 1:11:25Mindy Pelz?

  at ten grams. This is, like you said, it could be fasting, it could be exercise, it could be plant-based, it could be carnivore, and I think that's so important, the flexibility of it.

• 1:11:36Speaker 01

  Oh, yeah. I mean, you know, I, I'd like to say I'm nutritionally pro-choice.

• 1:11:40Mindy Pelz?

  Yeah, right. That's good.

• 1:11:41Speaker 01

  So, you know, it's, it's, I, you know, uh, whatever diet you feel most com- whatever dietary pattern you feel most comfortable with, as long as it doesn't involve like Twinkies and Oreos and things like that.

• 1:11:50Mindy Pelz?

  That's right.

• 1:11:50Speaker 01

  There's a way, there's a way for the, you know, you, there's a way for you to design a ketogenic diet to, um, to suit your dietary preferences. And so, um, everyone can access the healing benefits of ketosis, regardless of their dietary preferences. Um, and the, the reason why we, why we published this expert consensus, what was, I mean, partly for clinicians who, uh, around the world who they have their pa- patients coming to them and saying, I've heard ketogenic diet might help me with. My depression or my ADHD or my bipolar disorder, or whatever it is. Can you, can you, can you work on this diet with me? And, and they may not have any experience or knowledge yet about it.

• 1:12:33Speaker 01

  So we said, okay, this, here is how you would approach that situation. Here are the lab tests you would get. Here are the things you're going to think about. Here are, these are the people who are going to be good candidates. Here's the people who are going to need extra monitoring. This is, this is what you're, this is what you're going to be looking for. And this is how long you should try it. And this is all kind of those, just practical information for clinicians. But also for patients. So patients who go to their psychiatrist, or their therapist, or their primary care and say, I want to do a ketogenic diet for mental health. And they look at you like they've never heard of this. And they can bring this paper, it's an open access paper. Bring this paper, it's free. And, you know, and, and hand it to them and say,

• 1:13:19Speaker 01

  would you be willing to learn more about this and help me with this? Because there are many situations where you, you're not going to want to start a ketogenic diet on your own without professional support. Especially if you are taking any kind of prescription medication, or if you have any kind of medical health issue. A high blood pressure, cardiac disease, type two diabetes. I mean, all kinds of situations where the medicines and your health condition is going to need to be carefully monitored. Because this is a powerful intervention, which is of course exactly what you want. But, but you want it to be safe and comfortable in the, the first couple of weeks.

• 1:14:04Speaker 01

  You kind of have to navigate the, the rocky shores of the diet first. Just you can get to that other side in that better state of mind that you're looking for.

• 1:14:15Mindy Pelz?

  It reminds me of the New England Journal of Medicine did something very similar with fasting about six years ago where it was a meta-analysis. They actually went in and looked at several different studies and just came out with a prescriptive plan that was like, these are the five conditions, neurodegeneration was one of them, that we, you should consider intermittent fasting for. And they even have, if you go and look at the study, they have protocols. They showed like, do this week one, week two. And it really was a breakthrough in the fasting community because now doctors were not looking at this as like a fad. They were looking at

• 1:14:57Mindy Pelz?

  it prescriptive, like you were talking about. And I'm thinking, wow, now we have two really powerful combination, that New England Journal of Medicine, which we'll leave the link to that, and your expert consensus, we'll leave links to both of those. And I love your suggestion of take that, take that to your doctor and say, can we talk about this? I just think what you did is going to accelerate doctors' willingness to take this in as therapy.

• 1:15:26Speaker 01

  I hope so, because you know, these are really, it's a really powerful tool that you can add to existing care. So you don't

• 1:15:34Mindy Pelz?

  That's right.

• 1:15:34Speaker 01

  You don't have to

• 1:15:35Mindy Pelz?

  It's an adjunct.

• 1:15:35Speaker 01

  pull the baby out with the bathwater.

• 1:15:37Mindy Pelz?

  Yeah.

• 1:15:37Speaker 01

  So if the therapy is working, if the medicines are partly helpful, it's not about either or, or you know, this is better than that. It's about another tool in the toolbox and a really powerful one. And so, you know, it, I think it's really, I think there are a lot of clinicians out there who are curious about it, but they just don't have the experience or the, or the information they need to be able to feel confident in supporting their patients. So that's why we published this, this document is to, to support clinicians and patients around the world who want to explore the potential of this really powerful metabolic intervention.

• 1:16:17Mindy Pelz?

  You're like, like I've got a kindred ketone sister here.

• 1:16:20Speaker 01

  Yeah.

• 1:16:21Mindy Pelz?

  I really, because I've watched from a different lens, I've watched millions of people heal themselves with fasting, and it's, hasn't been all weight loss. I mean, we, it's, it's a combination. And brain, brain health is a big piece of people's result.

• 1:16:38Speaker 01

  Well, you know, there's nothing wrong with wanting to lose weight, right?

• 1:16:41Mindy Pelz?

  Of course.

• 1:16:42Speaker 01

  Who is overweight that doesn't want to lose weight, right?

• 1:16:44Mindy Pelz?

  Right.

• 1:16:45Speaker 01

  But and the wonderful thing is that you get these wonderful side effects, side benefits. So yeah, you're gonna lose some weight, that's great. And guess what else? Your mental health is going to improve. The other, your other aspects of your physical health is going to improve. You're getting all these side benefits. And so all kinds of things are going to get better. And hey, you're gonna look better and feel better too. So you know, what's not to love?

• 1:17:08Mindy Pelz?

  It works so well. I always say, when I tell people, they're like, oh, I'm interested in fasting. I always say, yeah, if you want to come for the weight loss, that's great. But stay for the rest of the results. Don't leave after the weight loss because there's so many incredible results.

• 1:17:23Speaker 01

  So many things to look forward to. And that people have, can access, like you said, is if you trust your body and you give it what it needs, it will respond.

• 1:17:33Mindy Pelz?

  Yeah, yeah.

• 1:17:33Speaker 01

  You can, it will. It knows, it knows how to heal itself if you get out of its way.

• 1:17:37Mindy Pelz?

  Oh, it's so true. It's so true. Well, Georgia, I love talking to you. How do people find you? I know, I mean, you've got the book, Change Your Diet, Change Your Mind. What else are you up to? And if people want to dive into your work, where can they find you?

• 1:17:51Speaker 01

  Yeah, so I, I have a website, which is Diagnosis Diet. That's the name of my website. And you can find information about the book there, but you can also find all kinds of writing there. And I, I teach a course, a CME accredited course for clinicians and ketogenic diets for mental health. And so that's between the course and the book and writings and conferences. I'm going to be speaking at a couple of conferences coming up. I don't know when this episode airs. In Italy, in, in, at the end of April, and in London at the end of April, speaking at a couple of metabolic health conferences. Because the book is coming out in Italian.

• 1:18:28Speaker 01

  Which is really exciting.

• 1:18:29Mindy Pelz?

  Yeah, that's so fun.

• 1:18:30Speaker 01

  It's fun for me. But so, so there'll be a conference in Italy where, where the book will be coming out at that same time. And then an integrative health conference in London.

• 1:18:42Mindy Pelz?

  I'm just convinced on the power of ketones more than ever. And when I saw the new consensus come out, I was like, we got to bring this back to the surface.

• 1:18:51Speaker 01

  Great, I really appreciate it. Thank you. I hope it's helpful to people.

• 1:18:55Mindy Pelz?

  Yeah, thank you. Appreciate you.

• 1:18:57Speaker 01

  Thank you, you too. Bye, Mindy.

• 1:18:58Mindy Pelz?

  Bye. Thank you so much for joining me in today's episode. I love bringing thoughtful discussions about all things health to you. If you enjoyed it, we'd love to know about it. So please leave us a review, share it with your friends, and let me know what your biggest takeaway is.