Pod Insights The Diary Of A CEO with Steven Bartlett Keto Diet Specialist: What The Keto Diet Is Really Doing To Your Body! Can It Cure 43% Of Mental Illnesses? The Truth About The Keto Diet! About this episode Could the secret to better mental health be on your plate? Dr Georgia Ede explains how the right diet can profoundly impact your mental well-being
Dr Georgia Ede is a Harvard trained psychiatrist specialising in nutritional and metabolic psychiatry. She is the author of the book, ‘Change Your Diet, Change Your Mind: A powerful plan to improve mood, overcome anxiety and protect memory for a lifetime of optimal mental health’.
In this conversation, Dr Georgia and Steven discuss topics such as, how the keto diet impacts mental health, the importance of balanced insulin levels, the link between keto and weight loss, and the secret to staying on the keto diet.
00:00 Intro
02:12 What Do You Do?
02:31 Is Metabolic Psychiatry a New Term?
03:48 Why Is the Ketogenic Diet at the Heart of Your Work?
04:51 What's Your Academic Experience?
05:48 What Does Practicing Psychiatry Involve?
06:18 When Did Nutrition Become Part of Your Career?
07:49 Social Component of Mental Illnesses
09:57 The Eureka Moment
17:00 Adapting Diet to Personal Needs
19:05 Fundamental Principles of a Healthy Diet: Nourish, Protect, Energize
21:56 Diet Personalization: Trial and Error
25:22 What Is the Ketogenic Diet?
27:15 What Does the Ketogenic Diet Do to the Brain?
29:53 Impact of the Ketogenic Diet on Refractory Mental Illnesses
34:17 Calorie Restriction
35:31 Alternative Ways of Lowering Insulin Levels
37:37 Why Is the Ketogenic Diet Difficult to Sustain?
41:26 Keto-Adaptation or Keto-Flu
45:37 Misconceptions About the Foods Included in the Ketogenic Diet
47:05 Is Ketosis a State?
50:57 Getting Into Ketosis
53:44 Connection Between Food and Neurodivergent Disorders
56:06 Why Are Dietary Modifications Not Commonly Prescribed to Alleviate Symptoms of ADHD?
57:56 Are ADHD Medications Helpful in Some Cases?
1:02:52 Research on the Link Between Ketogenic Diet and ADHD
1:04:04 Could ADHD Lead to Diabetes?
1:09:33 Benefits of Ketogenic Diet for People With Food Addiction
1:13:50 Depression, Anxiety, and ADHD - Case Study
1:21:08 Carnivore Diet
1:22:19 Do We Need Fiber?
1:25:50 Is the Carnivore Diet Sustainable Without Supplementation?
1:29:33 Why Does the Ketogenic Diet Help With Losing Weight?
1:35:09 What Part of Your Work Overlays With Psychology?
1:37:12 How Do You Approach Challenges With Adopting the Ketogenic Diet?
1:40:23 Ketogenic Diet's Role in Reducing Anxiety
1:43:23 Question From the Previous Guest
1:45:29 What Would You Say Someone On Their Death Bed?
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Transcript 17,576 words · 3 speakers
Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.
0:00 Speaker 00 Most people will experience tremendous reductions in anxiety within three days to three weeks of starting a ketogenic diet. In fact, we did a study where patients with bipolar disorder, major depression, or schizophrenia tried the ketogenic diet, and 43% achieved clinical remission from their chronic mental illness. And 64% of them left on less psychiatric medication because it improves the balance of chemicals in the brain. But the question is, what's causing those chemical imbalances in the first place? And so let's start there.
0:28 Speaker 01 Dr. Georgia Ead is a Harvard-trained psychiatrist who specializes in nutritional science and mental health.
0:33 Steven Bartlett? She was one of the first psychiatrists to offer nutrition-based approaches as an alternative to psychiatric medications to optimize brain function and enhance performance.
0:40 Speaker 00 People need to know how powerful nutrition strategies can be for the brain because if you're feeding it the wrong way, things will go wrong. And that's exactly what happened to me. My health was declining in my early 40s in ways that is true for a lot of my patients: chronic fatigue and IBS, being really anxious and depressed. And so I did all kinds of tests. And they said, "There's nothing wrong." Of course, there was something wrong. So I instinctively started experimenting with my diet. And the diet that I ended up on was backwards from what we're told is healthy for us. It should theoretically kill me, but it resulted in every single one of my symptoms. And so I studied for years, learning things about food that most people don't know, and which foods contain the nutrients the brain needs or the ingredients that damage the brain, and found three principles of nutrition. They can help you in ways no medicine can,
1:24 Speaker 00 as well as improve mood, memory, concentration, stamina, productivity. So let's unpack that.
1:30 Steven Bartlett? I find it incredibly fascinating that when we look at the back end of Spotify and Apple and our audio channels, the majority of people that watch this podcast haven't yet hit the follow button or the subscribe button, wherever you're listening to this. I would like to make a deal with you. If you could do me a huge favor and hit that subscribe button, I will work tirelessly from now until forever to make the show better and better and better and better. I can't tell you how much it helps when you hit that subscribe button. The show gets bigger, which means we can expand the production, bring in all the guests you want to see, and continue to do in this thing we love. If you could do me that small favor and hit the follow button, wherever you're listening to this, that would mean the world to me. That is the only favor I will ever ask you. Thank you so much for your time.
2:12 Steven Bartlett? Dr Georgia Ead. How do you define what it is you do?
2:18 Speaker 00 I'm a psychiatrist specializing in nutritional and metabolic psychiatry. So how food affects the brain and how food affects brain metabolism and how brain metabolism affects our mental health.
2:31 Steven Bartlett? This is a fairly new phrase, metabolic psychiatry. Am I right in thinking that?
2:36 Speaker 00 Yes, it's a really, it's a very new field and really exciting field. The term itself was coined by Dr Shabani Sethi, who's a metabolic psychiatrist at Stanford University, maybe five years ago or so, maybe a little longer than that. So it's a very, very new field. It's even newer than the other exciting new field in psychiatry, which is nutritional psychiatry. And so, and this is a really exciting time to be a psychiatrist.
3:04 Speaker 00 And it's also a really exciting time or a hopeful time and empowering time for people with mental health conditions because we're finally able to explore root causes, the real root causes, the deeper root causes of mental health conditions that go beyond things like what we're told all the time, which are these mysterious chemical imbalances, you know, that need to be addressed with medication. We now understand that the real drivers, the primary drivers of mental health conditions are inflammation of the brain, something called oxidative stress, which is why we're always told to eat more antioxidants, and insulin resistance or pre-diabetes, which is now affects more than 90% of Americans.
3:48 Steven Bartlett? In your work, you talk a lot about the ketogenic diet. Why is that so prevalent in your work?
3:54 Speaker 00 Because the ketogenic diet energizes the brain differently. So it really fundamentally changes the brain's operating system. So when you switch from a high carbohydrate, high insulin diet to a low insulin, which is usually a low carbohydrate diet, ketogenic diet.
4:14 Speaker 00 The way that cells receive energy, the mixture of fuels that they're using changes, and that has profound influences on just about every pathway, just about every chemical pathway inside of that cell. So it is as though you are fundamentally changing the brain's operating system in very healthy ways that allow not brain cells not only to work better, but for, but for brain cells to heal. So the longer you stay on a ketogenic diet, the more healing, the more brain healing can take place.
4:51 Steven Bartlett? And what is your sort of academic and career experience? What's that? Can you run me through that sort of timeline?
4:56 Speaker 00 Yeah, so I got a degree, an undergraduate degree at Carleton College in Minnesota in biology. So I always have loved science and biology, understanding how things work. And then for years I worked as a laboratory research assistant, different types of research labs around the world, Boston, Munich, including in diabetes research, until I had figured out what I wanted to do and I decided that I wanted to go to medical school. So then four years of medical school at the University of Vermont in Burlington, Vermont, which is a great place to go to medical school. And then four years of psychiatry residency training at a Harvard program called Cambridge Hospital in Cambridge, Massachusetts.
5:40 Speaker 00 And then, so it was 25 years ago that I finished my psychiatry residency training and I've been practicing psychiatry ever since.
5:48 Steven Bartlett? And what does practicing psychiatry involve?
5:52 Speaker 00 What it usually involves for most psychiatrists is psychotherapy and medications. And for some psychiatrists, only medications. Some psychiatrists prefer to focus exclusively on psychopharmacology or medication management. There are some psychiatrists who choose to focus only on psychotherapy and don't prescribe medications. But the vast majority of psychiatrists offer a combination of both medications and psychotherapy.
6:18 Steven Bartlett? And when did nutrition become part of your career?
6:21 Speaker 00 Well, I never thought about the relationship between food and the brain once. During medical school, we had maybe two or three hours worth of nutrition lectures in four years, and in four years of psychiatry residency, we didn't talk about food and the brain once. So I honestly had no idea how important it was to the to brain health. So I practiced conventionally, as I was saying, you know, medications and psychotherapy for the first 10 years of my practice. And as much as I love my work, I it was becoming painfully obvious that most people in my practice were just not getting that much
7:02 Speaker 00 better, no matter how hard I tried. And and it wasn't just true for me. You know, it wasn't as though I was thinking, well, you know, I don't have maybe I don't have enough experience, or maybe I'm not reading enough, or maybe I need more supervision. When am I going to be able to really be able to help people? Because when I looked around, even very senior psychiatrists who had been in practice for decades, the same was true for them. I mean, we had we'd been taught to think of mental illnesses as chronic, mysterious, and incurable, and that the best way you can help people is to support them with medications and psychotherapy. And but that these are lifelong illnesses that we really don't
7:46 Speaker 00 understand very well, and that we can do very little about.
7:49 Steven Bartlett? Presumably, there's like a significant social component to mental illnesses as well, right?
7:54 Speaker 00 Absolutely. I mean, the brain, the brain is a very responsive organ, and it's listening to it's not just paying attention to the food you eat, it's paying attention to every aspect of your life, how much light the brain receives, how much love you have in your life, how how much you love your work, what kinds of people are around you, how you use your body, exercise, stress, everything, everything matters to the brain. But most people are led to believe that food doesn't matter that much to the brain. And that's partly because we've only recently started to think about it. But the other piece is that The information that we're given about how to feed the brain and the body properly
8:39 Speaker 00 is incorrect. And so when people are trying their best to improve their mental health using nutritional strategies, those strategies fail most people because those strategies are grounded in the wrong information. And so a lot of people just think, oh, you know, I tried eating more whole foods, or I tried, you know, I tried putting blueberries on my oatmeal, or making my flaxseed smoothie every morning, or eating more plants than animals. I tried all of those things and they just didn't help very much. So I'm just going to go back to eating everything in moderation because it doesn't seem to matter. But what's really great about you inviting me here to talk with you today is that people
9:19 Speaker 00 need to know how powerful an intervention, these nutrition strategies can be. They can help you in ways no medicine can. In days to weeks, in many cases, people can experience meaningful improvement to their mood, their memory, their concentration, their stamina, their productivity, and their mental stability, their effectiveness in their lives, if they have the right information about how to change their diet. So you have to know which changes are the ones that are worth making, and they're not the ones we're used to hearing about.
9:55 Steven Bartlett? Is there a particular case study that comes to mind when you think about this? Is there a most prominent case study or a first case study that was a eureka moment for you?
10:04 Speaker 00 I wouldn't say there was a eureka moment case in my life because I came to it in a different way. My eureka moment really came through my own personal experience. I think a lot of physicians who practice nutritional and metabolic strategies, most of us stumble into this work accidentally because we're not taught it. And most of us stumble into it either because a patient comes to us and says, hey, you know, I've tried this new way of eating and that's why I'm so much healthier than when you saw me a year ago. Or the physician themselves encounters their own health challenges, you know, uses the conventional nutrition approaches, they don't help, and they find that they're kind of
10:49 Speaker 00 left to their own devices to solve their own health problems. And that's exactly what happened to me. So when I was experiencing all kinds of...
10:59 Speaker 00 Health issues in my early 40s, despite doing everything correctly, you know, eating a low-fat, low-cholesterol, calorie-restricted diet,
11:13 Speaker 00 that was high in fiber, mostly whole foods, and exercising religiously. Despite doing all of those things, my health was declining in my early 40s in ways that was true for a lot of my patients as well. And I had no idea how to help my patients with these issues. These were things like chronic fatigue, and IBS, and fibromyalgia, and migraine headaches. Very common in middle-aged people and older, and even younger people nowadays. So when I encountered those issues, and I was working at Harvard at the time, I had access to all kinds of specialists, caring, intelligent, thorough. They did all kinds of tests, all kinds of tests. And they said, everything is normal. There's nothing wrong. Of course, there was something wrong.
11:58 Speaker 00 But I... So I instinctively started experimenting with my diet. And, long story short, six months later, trial and error changes, food and symptom journal. At the end of six months, and this was back in 2007, the diet that I ended up on, purely by trial and error, was almost upside down and backwards from what we're told is healthy for us. And that was the diet that resolved every single one of my physical health symptoms. But as a psychiatrist, what really got my attention was that it improved my mental health significantly. And I wasn't even trying. I wasn't even aware that my mental health
12:43 Speaker 00 needed that much attention. I think, like most people, I was walking around with suboptimal mental health. You know, more anxiety than was necessary, than was... You know, I... Slumping in the middle of the day, brain energy faltering a couple of hours after lunch, coming home at the end of the day and being completely spent and not being able to get anything else done after five o'clock, being really anxious on a Sunday night before Monday morning work, you know, being depressed in the wintertime. I mean, all of these things we think of as really normal. We've come to expect so little of our mental health.
13:23 Speaker 00 We've come to expect poor mental health as normal, and it isn't. If you feed the brain properly, it works better, and you can expect so much more of yourself. So when that happened to me, I thought, well, that's interesting. This diet seems to be good for the brain.
13:41 Steven Bartlett? Which diet was that?
13:42 Speaker 00 This was a mostly meat, low carbohydrate, low fiber, low cholesterol, high fat diet. No whole grains, no legumes, very few plant foods, mostly seafood, meat, poultry, non-starchy vegetables, and fats from whole foods. It really was as simple as that. And a diet similar to that is one of the starting places in the books. I have a variety of different dietary strategies people can explore in the book, not just one. So it's different places for people to grab on, depending on what they feel comfortable doing. But that
14:22 Speaker 00 way of eating resolved all of my physical issues and mental health issues I wasn't even aware needed attention. And that really was what inspired me to begin studying nutrition. I certainly did not go out and start recommending this dietary pattern to my patients. That would have been reckless. I didn't know the first thing about nutrition, and based on the little that I did know, the diet that I had ended up on should theoretically kill me. So.
14:55 Speaker 00 It could be dangerous for people. And so I studied for years independently, took a graduate course at the Harvard School of Public Health and studied independently, read everything I could get my hands on, studied the the primary literature, the actual scientific studies, to try to understand, okay, why? Why is red meat bad for us? What's the difference between red meat and white meat? Why are whole grains good for us? Why are whole grains good for us, but refined grains are bad for us? Why do we need a rainbow of fruits and vegetables? Are some of them more important than others? Are they all equally beneficial? I mean, all I just became so curious about food. I really wanted to get to the bottom of it. So for years, I studied nutrition and fell in love with nutrition science.
15:38 Speaker 00 And it's a lot of what I share in the book is all these fascinating things about food that most people don't know. And that can really, it's not just that it's interesting, it's useful. It's empowering because if you understand which foods contain the nutrients the brain needs, which foods contain the ingredients that damage the brain, which foods are going to damage brain metabolism and cause inflammation and cause oxidative stress, cause all these things that we're told we need to fight with supplements and superfoods. That's the real power. The real power in dietary change is not adding special things to the diet.
16:21 Speaker 00 It's actually subtracting the things that are harming the brain and working against your best efforts. It's it's it's just like anything, you know? You don't make money by spending money. You make money by by not spending money, right? So it's the power of subtraction. What are you not doing? And that's really step one is first do no harm. Understand where the harm is coming from the diet, because it's not where you think it's coming from. It's not coming from the red meat. It's not coming from the cholesterol. It's not coming from the saturated fat. So if you understand where the damage is coming from, then you can turn things around very quickly.
16:59 Steven Bartlett? You used a word there, you used the word explore, as it relates to different diets that you've written about in your book and that, you know, that are available online.
17:10 Steven Bartlett? From what I understood there, you're not saying that one diet is the right diet for everybody. You're saying that it's almost, the word explore suggests sort of experimentation, personal experimentation. And what worked for you in that case might not necessarily work for someone else in a different situation. Is that accurate?
17:27 Speaker 00 That's exactly right. And you're bringing up a really important point, Stephen, which is that there are two levels of dietary knowledge. So one is that there are fundamental nutrition principles that apply to all human beings. These are the rules, the cells require these nutrients, and you must consume foods that provide those nutrients to those cells, and you must exclude these certain ingredients that can damage those cells, and you must keep your glucose and insulin levels in the right range for your personal metabolism. You have to nourish, protect, and energize your cells. You must do that. But then beyond that, so those rules, and the rules that you have to follow to get there are not commonly known.
18:10 Speaker 00 But then beyond that, there's the personalization, right? Because we are all different. We're not different in what our cells need, but we're different in what we can tolerate, we're different in our metabolic health, we're different in how old we are, how active we are, what conditions we already have, what conditions we're most at risk for, what our goals are, what our preferences are, and whether we have food sensitivities, for example. And so all of those pieces, you know, food intolerances and different goals and different aspects of our lives, that's where the personalization comes in. And I teach people in the book how to take these fundamental principles, so I teach them what the fundamental principles are, which are very simple.
18:55 Speaker 00 Nutrition is not rocket science. And then show them how to personalize it to their metabolism, to their preferences, to their goals.
19:05 Steven Bartlett? What are the fundamental principles? Let's start there.
19:07 Speaker 00 So the fundamental principles are nourish, protect, energize. So nourish. What does a brain healthy diet look like? And by brain healthy, we are talking about what's healthy for all cells because it wouldn't make any sense to for the human body to require a different diet for every organ you possess. So a brain healthy diet is a diet that's healthy for every organ in the body. So it's good for the brain, it's good for the heart, it's good for the liver, et cetera. So what is a brain healthy diet? It needs to nourish, protect and energize. Nourish. It must contain and be able to safely deliver all essential nutrients to your cells. So you have to know where those nutrients are.
19:50 Speaker 00 You cannot, and using whole food principles and not including supplements or specially fortified processed foods, you cannot meet that goal without including some animal foods in your diet. That's just the truth of our biology. Protect. Protect the brain from damaging ingredients. So what damages the brain? Inflammation, which you can't see or feel. It's not so the brain is red or swollen or sore. The brain doesn't have nerve endings, but many, many people have brain inflammation without being aware of it. That's a main driver of depression and all kinds of other brain conditions. So you need to exclude. Protection is not about addition, it's about subtraction.
20:34 Speaker 00 You need to subtract the foods from your diet that cause inflammation, that cause something called oxidative stress, which is why we're always told to eat more antioxidants. What we really need to be told is what's causing all that oxidative stress in the first place and remove those things because the antioxidant strategy really doesn't work. And energize. Nourish, protect, energize. The third principle is energize, which means the brain, which is a very high energy electrical organ, it needs a constant supply of high quality, clean burning energy. And if you're eating the wrong way, your brain will not, will gradually lose its ability over time to generate energy.
21:19 Speaker 00 That's primarily about getting your glucose and insulin levels into a healthy range, not just your glucose, although getting your glucose levels in a healthy range is extremely important.
21:32 Speaker 00 You have to go one step further because underneath that glucose, you need to know what's happening with insulin. And that's, that's a really empowering strategy. It's sort of next level, right? So getting your glucose and insulin levels down will allow your brain to, uh, to energize itself in the most clean, efficient and reliable way possible.
21:56 Steven Bartlett? Nourish, protect and energize. And then beyond there, you said there's a level above that. So that's the sort of fundamental level. Beyond there, you go into sort of personalization, what's best for you? And is that where the sort of trial and error comes into play?
22:10 Speaker 00 Exactly. So these principles, nourish, protect, energize. The nourish, you need to include some animal foods. The protect, you need to exclude things like refined carbohydrates and vegetable oils, uh, which are the signature ingredients of the standard American diet or standard Western diet. Um, and the, the energize is, is the, the glucose and insulin levels, which for some people, this is some, a level of personalization begins here at the energize piece because if you have excellent metabolic health, and we can talk about what that means, then you may not need to eat a ketogenic diet to, to properly nourish, to, to really get those glucose and insulin levels under control and thoroughly energize your brain cells.
22:52 Speaker 00 But if you have significant metabolic damage, if you're sedentary, if you're older, if you have pre-diabetes or type two diabetes, um, then you may need to reduce the amount of carbohydrate in your diet, even from whole foods. You may even need to go to a ketogenic level. And, and that's where, that's where assessing your metabolic health, understanding where you stand on the insulin resistance spectrum, the spectrum of metabolic health, that's the empowering piece. Because if you know where you stand on the insulin resistance spectrum and you can get your glucose and insulin levels into healthy range.
23:33 Speaker 00 Then you have tremendous power over your emotional, intellectual, and your physical health future. It's really the number one risk factor for almost all chronic diseases, mental and physical. So personalization starts with a metabolic personalization. So how much carbohydrate can you safely tolerate? That's one example. But then there's another level of personalization that has to do with how well does your immune system work? How robust is your gut function? Your gut barrier? Many of us have lost our ability to safely and comfortably tolerate a wide variety of foods that we should be able to tolerate.
24:14 Speaker 00 And that's because our environment, multiple toxins in the environment have broken down a lot of our defenses, our gut barrier, our blood-brain barrier. And our immune system has become overwhelmed by trying to process lots of toxic ingredients in our environment. So these are things like plastics and pesticides and antibiotics and food additives and all kinds of ultra-processed foods that we were never designed to handle. These are really stressful on the human body, and they do break down our defenses over time. So this level of personalization is very much about trial and error.
24:58 Speaker 00 But to save people some of that frustration of trial and error approaches, I give them very specific lists of foods that are more likely to be culprits than others. And so that helps cut back on some of the trial and error elimination.
25:22 Steven Bartlett? This keto diet, you did a study on the ketogenic diet. Got the study here. The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of Thirty-One Inpatients.
25:35 Steven Bartlett? What is the ketogenic diet for someone that might not know?
25:38 Speaker 00 So, a lot of people think, or they've heard about a ketogenic diet as a weight loss diet. They think of it, maybe it's a fad weight loss diet. They think of it as a very, very low carbohydrate diet. They might think of it as a diet that's very high in meat and dairy products.
25:54 Speaker 00 And, but actually, the ketogenic diet was originally created in 1921, more than 100 years ago, to stabilize brain chemistry in children with severe seizures. And this was long before the availability of useful seizure medications. So, these were children who were having multiple seizures per day in many cases. And so, the ketogenic diet was designed back then, created back then, a very strict version of the ketogenic diet, to get as close as possible to fasting without starving children to death. Because for millennia,
26:36 Speaker 00 people had noticed that those with epilepsy would often improve if they were fasting. But you can't fast forever. So, how do you get close to fasting? This is the original fasting mimicking diet. How do you get as close to fasting as you can while still providing some nutrition? So, that was the original goal of the ketogenic diet. It was very successful for seizures. More than 50% of children had more than a 50%, and adults as well. It's since been shown. More than 50% response rate in children and adults, and 10 to 20% completely free of seizures following a ketogenic diet.
27:15 Steven Bartlett? How's it acting on the brain? What's it doing to the brain?
27:18 Speaker 00 The ketogenic diet does many, many things. It's like a multi-purpose tool for brain health. So, one thing it does, because we talked about how
27:28 Speaker 00 some of the root causes of mental illnesses, which are only relatively recently a focus of research, are Inflammation and oxidative stress and insulin resistance. The ketogenic diet reduces inflammation. It reduces oxidative stress and it reduces insulin resistance. It also improves the balance of chemicals in the brain. So, a lot of people think of mental illnesses as problems with chemical imbalances in the brain. And these are the chemicals that they're talking about. You might have heard of serotonin, or dopamine, or norepinephrine. There are others, glutamate, GABA. Many different chemicals in the brain are associated with,
28:12 Speaker 00 or in some cases even very much, causing mental health symptoms. But, the question is, what's causing those chemical imbalances in the first place? And, one of the things that's causing those chemical imbalances is that inflammation and oxidative stress. But another thing is that the brain is, if you're feeding it the wrong way, it will not be able to, in many cases, produce energy reliably. And if it can't produce energy reliably, all kinds of things will go wrong, and in quite spectacular fashion. What actually goes wrong is going to depend on who you are. And that's where our individual differences come in.
28:53 Speaker 00 So, if I eat the, if you and I eat exactly the same bad diet, depending what runs in your family and how you've lived your life to this point, you might develop Alzheimer's disease, you might develop bipolar disorder, you might develop type 2 diabetes, you might develop fatty liver disease. I might develop completely different conditions. I might, I might develop cardiovascular disease. I might develop depression. I might develop ADHD. It's, and that's where the individual differences are. But, all of these conditions are just metabolic malfunction. Really, at the heart of it, that's what's going on. If cells aren't functioning properly, you will develop the disease, physical and mental diseases.
29:38 Speaker 00 And which ones you get, it's really kind of luck of the draw. But you have tremendous control over what you are at risk for if you understand how to help your cells operate at their personal best.
29:53 Steven Bartlett? Can you tell me about what you learnt in this study? And what this study concluded?
29:57 Speaker 00 Yes, so this was the work of my friend and colleague, Dr Albert Denon. He's a psychiatrist who's been practising in Toulouse, France for more than 35 years. So after witnessing a young family member, someone in his extended family, with autism and seizures improve within weeks of adopting a ketogenic diet, he thought, well, I wonder if this diet could help my patients, especially my patients who are not responding to anything else that I have tried to help them. Psychotherapy, medications, hospitalisation.
30:39 Speaker 00 And so he invited 31 of his most treatment-resistant patients with bipolar disorder, major depression, or schizophrenia to come into the hospital and voluntarily try a very mildly ketogenic whole foods diet in the hospital under his supervision to see whether or not they would respond. And this was, these were folks who, these are all adults. These were people who had been ill for an average of 10 years, some for as long as 30 years. These were people who were taking, when they came into the hospital at the beginning of the study, an average of five psychiatric medications.
31:22 Speaker 00 Not at all unusual for people with chronic mental illness. And all of them had one or more markers of poor metabolic health. Obesity, high blood pressure, high blood sugar, things like that. So these were people with poor metabolic health and poor mental health. And they eagerly came into the hospital to try this intervention because nothing else had helped them. And what was remarkable about what he observed was that of the 31 people, 28 were able to stay on the ketogenic diet for more than two weeks, which is what you need to do to start to see benefit. Every single one of them improved to the point that forty three percent of them
32:05 Speaker 00 achieved clinical remission from their primary psychiatric treatment-resistant chronic mental illness. And sixty four percent of them left the hospital unless psychiatric medication. And all of them improved metabolically as well. And you do not see results like this in conventional psychiatric care.
32:26 Steven Bartlett? So there's a few things that spring to mind when you talk about this study. The first is that they were inside a hospital.
32:32 Speaker 00 Yes.
32:33 Steven Bartlett? So I guess that's a confounding factor potentially.
32:34 Speaker 00 Oh, yeah, well, a blessing and a curse.
32:37 Steven Bartlett? Yeah.
32:37 Speaker 00 So a blessing is that the diet was very carefully supervised. Six days out of seven, they were allowed to go home on Sundays.
32:45 Steven Bartlett? Okay.
32:46 Speaker 00 And which still, I'm just mentioning, but that, but they had tremendous amount of support and supervision. And that's, that's really, really helpful when you're switching from a standard high carbohydrate diet to a low carbohydrate diet. They also had very careful medical and psychiatric supervision, which is also really important because when you, when you change to a ketogenic diet, brain chemistry fundamentally changes in ways that can, at first, when you're transitioning from one operating mode to another operating mode, it's, it's stressful and sometimes you can feel worse before you feel better. And medications can be affected. So medications need to be monitored.
33:29 Speaker 00 And everything, everything changes. These are all really healthy. Your blood sugar can drop, your blood pressure can drop, especially if you're taking blood sugar lowering medications or blood pressure lowering medications. If you switch to a ketogenic diet, it's so effective at lowering blood sugar, many physicians who prescribe blood sugar lowering medications for diabetes need to cut the diabetes medication in half on day one in order to prevent dangerously low blood sugar. Because you've got a medication that's lowering blood sugar, now you've added a diet that lowers blood sugar, and this could be potentially dangerous. The diet on its own is not dangerous. It's the diet in combination with medications.
34:14 Speaker 00 So you need to know what you're doing. And so, yes.
34:17 Steven Bartlett? In the case of these thirty one adults, so a certain proportion of them, was it twenty eight that managed to see it through?
34:23 Speaker 00 Twenty eight of thirty one.
34:24 Steven Bartlett? Twenty eight saw it through. Had I just restricted their calories, for example, but kept them on whatever diet they were on, would I have seen an improvement as well?
34:33 Speaker 00 That study has not been done, to the best of my knowledge. However, you're bringing up a really interesting point. So what a ketogenic diet is, is really not about carbohydrate. The definition of a ketogenic diet is any diet that lowers insulin levels to the fat burning point. So that if you're insulin, you can't burn fat if your insulin levels are too high. And most people are walking around with insulin levels that are high twenty four hours a day. They don't even come down overnight because people are just eating too much, too frequently, and the wrong foods.
35:06 Speaker 00 To get into ketosis or generate ketones, you need to lower your insulin levels to the fat burning point. And when you, and if, and if you're burning fat vigorously, the liver will turn some of that fat, chop that fat into ketones, which are very small fragments of ready to burn fat. And these cross easily into the, into the brain and can be burned for energy. And they can bridge any energy gaps that may be there, which many of us have.
35:31 Steven Bartlett? If these people had done the Mediterranean diet, would they have seen the same consequences?
35:37 Speaker 00 The Mediterranean, oh, sorry, please.
35:38 Steven Bartlett? I imagine they were probably on the Western diet, like the American diet, which is ultra-processed, high sugar. So bringing them into a controlled environment and just depriving them of that would have surely caused just, that on its own would have been beneficial.
35:54 Speaker 00 Yes, so I wrote in the paper, and I, I mentioned this, you're making a really excellent point. And I addressed this in the paper, is that because when you, when you change from a standard junky, modern diet to a ketogenic diet that's whole foods, you're changing a lot of variables, right? So how do we know that it had anything to do with the ketones, right? And, and this is a good question and a fair question, and we don't know the answer, but new studies are helping us to understand that. But before we get to that, I just wanted to say the point you're making is so important because there are lots of ways to lower your insulin levels. So you can lower your insulin levels through fasting, intermittent fasting. You can lower your insulin levels through exercise.
36:38 Speaker 00 You can lower your insulin levels through calorie restriction. If you restrict your calories below 750 grams per day, many people will go into ketosis. That's another version of a fasting mimicking diet made popular by Dr. Walter Longo. So there are many ways to lower your insulin levels. The ketogenic diet is just one way to do that. But the ketogenic diet is the only way to safely, sustainably maintain a state of ketosis long term. So you can initiate, you can get into ketosis using these other strategies, but it's, you can't fast forever. You can't exercise all day long. You can't restrict calories below 750 for the rest of your life.
37:21 Speaker 00 But you can safely and comfortably eat a well-formulated ketogenic diet, which is very low in carbohydrate, moderate in protein, not excessive in protein, and relatively higher in fat, depending on your energy needs indefinitely.
37:37 Steven Bartlett? Sustainably, use the word sustainably there. That's kind of always been my challenge with the keto diet is being able to stay on it. I mean, you saw in this particular study that even trying to get people to do it for two weeks resulted in some portion of them dropping out.
37:51 Speaker 00 Yes.
37:52 Steven Bartlett? Why is it so hard to stay on the ketogenic diet? I've managed to do it for, I was saying to you before we start recording, once a year, around this time of year, I do it for about eight weeks and it has a really profound impact on a lot of my life. It helps me feel more focused. My body composition radically changes faster than any other diet or thing that I've ever tried faster than just exercise alone. I sleep a little bit better as well, I noticed. But you've been doing it for a long time. You've been doing it for roughly, what, almost ten years?
38:24 Speaker 00 For the better part of twelve, I mean, more often I'll say. I've been following a ketogenic diet for twelve years. And I agree with you, it's not always easy. I'm not perfect about it myself, but I have been on the ketogenic diet the lion's share of the last twelve years.
38:40 Steven Bartlett? It being hard is an important factor.
38:42 Speaker 00 Yes.
38:43 Steven Bartlett? Because when you're trying to prescribe it to somebody who has got, you know, treatment-resistant depression or is really suffering in some way, I imagine they'll find it even harder than I do.
38:51 Speaker 00 Yes and no.
38:52 Steven Bartlett? Okay.
38:53 Speaker 00 So it's hard, well, it's definitely, there's no question about it. It's hard to eat a low carbohydrate diet in a high carbohydrate world.
39:01 Steven Bartlett? Yeah.
39:02 Speaker 00 So there's that. There's the environmental temptations and the social temptations and the habits and the addiction. Sugar addiction is a very real biochemical phenomenon, so there's that. But, but it, I mean, I've been, I, I had a weight issue growing up. Everyone in my family did. And I've been on lots of different diets in my life. This is the easiest one to stay on. I can't say about any other diet that I've followed for twelve years. And the reason why is this diet really stabilizes appetite hormones. So your cells are getting energized in between meals. You're not getting those spikes and crashes in glucose,
39:44 Speaker 00 which cause spikes and crashes in appetite hormones, satiety hormones, stress hormones, reproductive hormones, brain chemistry. You're not getting, you're not on that roller coaster anymore. So your cells are, are being satisfied. They're getting the energy needs satisfied in between meals. And everything is quiet and calm on the inside. It doesn't mean you're a hundred percent protected against temptation. So I describe it to my patients with food addiction. I describe being in ketosis as a suit of armor. You know, the sword can still get you, but you, but you know, you're not a hundred percent protected, but you've got a real fighting chance. And for, for anybody who's never tried a ketogenic diet
40:27 Speaker 00 and been on it for at least, I would say, six to twelve weeks. It, most people have no idea how much easier it is um to follow, to follow a healthy eating plan when their appetite is in good control. A lot of people know they've shifted into ketosis without even checking their ketone meter because they can go for so long without eating, without even thinking about food. They can work through lunch and not even realize that they've missed a meal. Most people, the way we eat, most of us now, are thinking about food all the time. You haven't even finished breakfast and you're already thinking, what am I gonna have for lunch? You're carrying food around with you everywhere you go. You're eating at least six times a day in many cases.
41:12 Speaker 00 This is not, I mean, we would never have survived as a species if we needed to eat six times a day. So we're not eating in a way that is, that is nourishing us and satisfying us. We're eating in a way that's making us hungry.
41:26 Steven Bartlett? I find what you've said there to be sort of true in my experience, especially in the context of the roller coaster analogy. So when I'm not on ketosis, I do feel like sometimes I'm in a bit of a roller coaster of like temptation, craving, et cetera. And then when I do ketosis and I get past the first week or two, the roller coaster seems to stop.
41:51 Speaker 00 Right.
41:51 Steven Bartlett? I'm off the roller coaster. It's then maybe six, eight weeks later, you're busy, life happens, you're traveling, you're tired. That temptation creeps in and it just takes that one moment of weakness in my head to then fling me off ketosis and all my effort is gone. And in my head, the way I've always thought about it, and I'm sure this is wrong, but I've thought about it like, it takes a couple of days to get into a state of ketosis. And then, once you're in, and I usually get a headache
42:19 Speaker 00 Yeah.
42:19 Steven Bartlett? on my way into ketosis, I feel a little bit bad on the way in. And then, once I'm in there, it's fine. So when I have something that breaks my keto, this is what I refer to, me and my girlfriend talk about it, when I have broken my keto, whatever, I think, oh my god, I've got to go through another headache and another five days of, you know, getting back into it. What, is that correct?
42:40 Speaker 00 It's a very common experience because there are these adjustments that happen inside with your physiology as you're shifting from one operating system to another. When you're shifting from a carbohydrate burning system to a more, you're shifting your ratio of your fuels, so the body and the brain are a hybrid engine, so we're never burning 100% fat, we're burning a mixture of fat and carbohydrate. When you're shifting from a, from a system that's fueled almost entirely by carbohydrate almost all the time, to a system where you're burning more fat than carbohydrate, that's uncomfortable for some people, shifting back and forth, especially if what they have,
43:22 Speaker 00 if, if the reason why you've quote "broken your keto" is because you've had something that has a lot of refined carbohydrate in it, a lot of sugar or flour in it, for example. So it depends on what you've eaten, and how much, and for how long. But, but many people do experience this so-called keto flu, when they are shifting from a carbohydrate-based system to a fat-based metabolism. And some of this can be, much of this can be prevented in a couple of different ways. One is with electrolyte supplementation, supplementing electrolytes to keep your, your salt balance even as you're transitioning. And another is by transitioning slowly onto the ketogenic diet, rather than all at once.
44:07 Speaker 00 And so, and there are many, there are other tips in the book about how to do this more comfortably, but those are the two big ones. And going slowly, so in the book, I don't recommend that people start on a ketogenic diet just straight away, like learn about it on a Monday, start it on a Tuesday, but ease into ketosis over a week or two. And there's a, there's a, kind of a moderate carbohydrate plan in the book that allows people to do this, so you, you follow that plan for a couple of weeks to gradually lower those glucose and insulin levels. It's gonna be a lot more comfortable, it's gonna be a lot less of a shock. To the brain and body. And if you're supplementing electrolytes and going slowly,
44:48 Speaker 00 most of these quote keto flu symptoms will not occur, or they'll be very brief and mild. So again, it's a positive change to have these electrolyte changes. And it's all of these things are good, but there is this transition period which can sometimes be uncomfortable. And this is not to say that it's dangerous. Again, it's a very, we're designed. Our biology is designed for us to be able to shift back and forth between fat and carbohydrate as fuel sources. But many of us have lost some of our metabolic flexibility because we've done some damage to our metabolic engines by eating the wrong way for too long.
45:32 Speaker 00 So we don't shift as comfortably back and forth as we used to be able to.
45:36 Steven Bartlett? I guess most people don't even know what foods are included in a keto diet because most diets are restrictive to the point that, you know, people think they just make your life miserable. But what are the sort of big misconceptions you've seen with the foods you're able to eat on a ketogenic diet?
45:50 Speaker 00 Yeah, so because a ketogenic diet, because the definition of a ketogenic diet is any way of eating that lowers insulin levels enough to turn on fat burning and generate ketones in the blood. Because it's about insulin, it's really not a food list. So you can, it's not about plants and animals. It's not even about fat or carbohydrate. It's about understanding how to lower your insulin levels, which you can do with a vegan dietary pattern, with a vegetarian dietary pattern, with an omnivore dietary pattern, or even with a carnivore dietary pattern. So whatever your dietary preferences are,
46:32 Speaker 00 you can get the benefits, the brain healing benefits of ketosis. So it's not about the foods you're eating. It's more about understanding what raises and lowers insulin. The things that raise and lower insulin are refined carbohydrates, whole foods carbohydrates, refined proteins like protein powders, whole food sources of protein. And guess what barely touches insulin at all? Fat. Fat is metabolically the quietest and safest macronutrient you can eat because it barely stimulates insulin.
47:05 Steven Bartlett? Is ketosis a state? Like, do I, is it like a binary state? Like, now I'm in ketosis and now I'm not?
47:13 Speaker 00 So, yes, but there's, there's, yes.
47:17 Speaker 00 Let me put it this way. That most experts will agree that
47:24 Speaker 00 in order to be, quote, "in ketosis", your level of beta-hydroxybutyrate on a blood ketone meter, a blood ketone meter is prick your finger and, and put a drop of blood on this little test strip, and it will read the amount of a particular ketone in the blood called beta-hydroxybutyrate, and it will give you a reading. If that reading is point, is 0.5 millimole or higher, you are in ketosis, in ketosis. So what does that mean? Why, why is the cutoff 0.5? Because three things have to happen for you to get to at least 0.5. One is your glucose levels have to come down. The second thing is your insulin levels have to come down.
48:09 Speaker 00 The third thing is you have to burn off a certain amount of the stored starch in your liver. We have a, a storage tank for carbohydrate in our liver. It's not very big. It holds less than a day's worth of carbohydrate. Because really, as animals, we're designed to store energy as fat. Carbohydrates there for quick energy emergencies, short term. The fat, we, for better or for worse, we have almost an unlimited capability to store fat. We can store months and months and months worth of fat. And so, but we can only store a very small amount of carbohydrate. So if your storage tank in the liver is full, your body will not switch to fat burning because it says, "Oh, we've got plenty of starch to burn. Let's start there."
48:55 Speaker 00 Once it comes down to a certain point, the body goes, oh, we're running out of energy. Let's go to fat now. And that's when the liver will start breaking fat down, whether it's fat on your body or fat from your plate, and start chopping it up into these ketones. And but so those three things have to happen. And once that happens, you'll see the ketone levels rise on the meter. So most people who are not eating a ketogenic diet are walking around with ketone levels either undetectable, or they're point two, or they're point three. They might they might float up into above point five every once in a while if they're not eating for a long time, or if they've just exercised. But for the most part, most people eating a typical diet are not in ketosis.
49:39 Speaker 00 And when you get above point five, a lot of metabolic magic starts to happen because there are lots of pathways in the body and brain that are not very active unless you're in ketosis, and those are the healing pathways, the recycling and maintenance and cleanup pathways, the recovery pathways. All of us, this is something that I came to appreciate a number of years ago as I've been studying this, is that there are many people, unfortunately or fortunately, there are many people who discover with mental health issues that they need to be in ketosis long term in order to be well.
50:20 Speaker 00 But I've become convinced by the science that all of us need to be in ketosis, at least intermittently. All of us need to spend some time in ketosis on a regular basis, or else we can't heal. We'll only be, it's like a, it's like a manufacturing plant where the plant is just running 24/7, 12 months a year, and and they never take time to replace the parts or clean up the floor, or, you know, they never do any maintenance work or repair work, and so eventually, everything breaks down.
50:56 Steven Bartlett? And when you say ketosis, again, you're not saying the keto diet, you're saying the low levels of glucose and insulin?
51:05 Speaker 00 Exactly.
51:05 Steven Bartlett? In the blood, and that can be achieved by calorie restriction, potentially fasting, I guess you could achieve it, and other diets like the Mediterranean diet, if administered in the right sort of doses, right?
51:15 Speaker 00 Well, we should come back to the Mediterranean diet a minute. But first, the first part of your question is important because ketosis is, you can, as you said, you can get into ketosis a variety of different ways. If you're eating properly, and this would have been our evolutionary heritage, our ancestors, especially our prehistoric ancestors, they didn't have access to these lots and lots of refined carbohydrates a long time ago. They were eating carbohydrates from whole foods, fruits and starchy root vegetables, right? And so even grains and beans are very, very relatively, relatively much newer sources of carbohydrate. So let's think about fruits and vegetables.
51:59 Speaker 00 But they would have been, we can only guess, looking at their diets. We don't have proof of this, but think about it. If you're eating in a way where your insulin levels are allowed to come down overnight, if you're eating, if you're eating a balanced diet, so to speak, but it's got everything it needs in it, and it's not giving you exaggerated spikes in your glucose and exaggerated spikes in your insulin, and you're not eating six times a day or all day long, your insulin levels will naturally come down overnight, and that will, that will allow you to go into a healing mode. So I believe that if people have the right information about what a healthy diet is supposed to look like, they may not even need to, in many cases, especially if you're younger
52:41 Speaker 00 or athletic or don't have a lot of metabolic damage already. You may not need to, you may not need to lower your carbohydrate intake during the day. You might just need to be careful about what kinds of carbohydrate you eat and how often. So, for example, it's known that in children who are eating a regular diet, many of them wake up the next morning in ketosis. They're metabolically much healthier than we are as we get older. So they're much more metabolically flexible. And so, now, they didn't go on a ketogenic diet. They were eating a regular diet. They slept overnight, didn't eat anything. The next morning, they were in ketosis.
53:24 Speaker 00 That's not true for all children, but it's true for enough children that we know it's possible. Most adults, it takes them several days at least to get into ketosis, even if they're not eating anything at all. So fasting can take two to three days at a minimum for most people to get into ketosis, but some people it can take a whole week.
53:43 Steven Bartlett? And you talked about children there. One of the big conversations at the moment around children is the the rise in ADHD diagnosis. And there's a lot of different sort of thoughts on the causal factors of this. And what is it that's making children be diagnosed at higher and higher rates with these sort of neurodivergent disorders? Is there any evidence to suggest that what we're eating is playing a role in these neurodivergent disorders?
54:09 Speaker 00 Yes. The first thing I would like to tell you about is that there were studies, quite a few studies back in eighties, nineties and early two thousands in Europe by a variety of different research teams that explored exactly the question you're asking. And what they did was they placed children with ADHD, some quite severe ADHD, even hospital level ADHD, and put them on something called a few foods diet. This is, the scientists called it an oligoantigenic diet, which just means it's kind of a low allergen diet. So they removed all of the common culprits and they focused mostly on just a few whole
54:53 Speaker 00 foods and and and a few extras. So very specifically describing this diet, most of these diets were chicken, lamb, fruits, vegetables, and sometimes they'd throw in some apple juice and margarine because they couldn't use butter because dairy is a common allergen. So, but these were mostly whole foods diets, you know, poultry, red meat, fruits, vegetables. And there were sixty-two to eighty-two percent response rate to these diets, no matter which study you looked at. And in some of these studies, there was a seventy percent cure rate within weeks of changing the diet to a few foods diet. So what does this tell us?
55:37 Speaker 00 It doesn't tell us which foods were the problem. It tells us that food can be the problem. That if you make the right dietary changes, it's possible for children, even with very severe ADHD, to improve within weeks to the point that they no longer qualify for having ADHD anymore.
55:56 Steven Bartlett? Because there's a change in the symptoms.
55:58 Speaker 00 Oh, yes. The children's behavior as rated by parents and teachers and the researchers themselves.
56:06 Steven Bartlett? So I've just did some research to find some stats on this.
56:10 Speaker 00 Sure.
56:11 Steven Bartlett? Diet modification isn't widely prescribed as a way to alleviate ADHD symptoms, is it? It says, "As of 2019, major health organizations, including the American Academy of Pediatrics and the National Institute of Health and Care Excellence, do not recommend dietary modifications as standard treatment for ADHD due to insufficient evidence." A 2014 review found elimination diets might offer minor benefits in a subset of children, particularly those with food sensitivities or allergies. However, these benefits are not substantial enough to advocate for widespread dietary changes in ADHD management.
56:44 Speaker 00 So what I would say to that is there are multiple studies, all pointing in the same direction, that I think give parents and families and children tremendous hope with really no risk. What are we doing instead? We're medicating children. We're giving children stimulants, which can stump their growth, make them anxious, and cost money. And is the... I mean, I'm... One of the reasons I do this work is because I really don't think that for most people, the right thing to do is to medicate our way out of this situation.
57:28 Speaker 00 I mean, just about every mental and physical health issue we have, we think about, we've just kind of been conditioned to think about medications as the solution. But medications don't solve problems. They cover them up. And what we really want to do is want to get to the root of these problems and not just treat them, which nutrition interventions can do in many cases.
57:52 Speaker 00 But perhaps even prevent them from happening in the first place.
57:56 Steven Bartlett? Can they all be treated by, because you know, I, I was, I guess technically diagnosed with ADHD, but I don't take any medication for it. I'm, it's a personal choice. I personally just don't think that the net impact has on my life is worth taking any medication. I also have friends with ADHD who have significantly worse symptoms. When I say worse, I mean more pronounced symptoms than I do. So my personal decision was just not to take medication. However, I sat here with a guy called Dr. Ayman, who has a daughter who had ADHD. She got the medication and it turned her life around. Like she went on to become super successful, but was like struggling in school. So it's really difficult, isn't
58:38 Steven Bartlett? it? Because it's such a personalized sort of personal decision. And some people have it more extreme and in a way that makes their life more dysfunctional than others. You know, and my friends, some of my friends do really say, they say, I took this medication for my ADHD or my, my attention issues, whatever. And it's been revolutionary for me. They just like, they, they just offload on me how profound it's been for them. So
59:09 Steven Bartlett? I guess it goes back to being a personal.
59:11 Speaker 00 It does, but you know.
59:15 Speaker 00 So I have a lot of experience treating ADHD because I worked for two years at an ADHD specialty clinic called the Halliwell Center outside of Boston. I also worked for 13 years in college mental health at Harvard and at Smith College and saw lots and lots and lots of students with ADHD. Most of who actually had it, some of who didn't, some who were just looking for stimulants. But I, I can tell you as a psychiatrist who's prescribed medications for 25 years, the stimulants are some of the most effective medicines we have in our toolbox.
59:49 Speaker 00 For the people it works for, it works very, very well. So, and it can be life-changing. A lot of people think of ADHD as, oh, a minor issue. Oh, you can't concentrate, or maybe you daydream, or maybe you're fidgety, or, you know, maybe you get distracted. ADHD can be a really serious condition, just like all mental health conditions. It exists on a spectrum of mild to very severe. And so, people with ADHD are at much higher risk for suicidal ideation. They're at much higher risk for substance abuse. They're at much higher risk for accidents. They're at much higher risk for depression, for anxiety. These, and twice the, twice the rate of divorce in people with, with adults with ADHD.
1:00:33 Speaker 00 These are serious, can be, for some people, really disabling conditions. People cannot function in their lives. They can't function in their relationships. They can't hold a job. You know, they, they feel so frustrated and powerless. I mean, I was telling you that I worked with students in, in, you know, these elite universities, right? These are very intelligent people who were struggling 10 times harder than their peers in, in classes. They had to work so much harder. They had to stay up four or five hours later than everybody else. And, and, and they did because they were hardworking, but they're really suffering.
1:01:13 Speaker 00 And this discrepancy between how smart I am and how much I think I should be able to do, and how much I'm actually able to do, makes me feel bad about myself, right? They feel bad about themselves. And because they know they're capable of more, but they can't get there. And it's a real biological condition. Now, the great thing about, this is a perfect example that you could, we could have this conversation about any mental health condition, but ADHD is a great example because...
1:01:43 Speaker 00 There's always a risk benefit analysis when you're thinking about how we're going to treat this condition. So do you want to take medication? What are the pros and cons of that? Does the medication work for you? Does it give you side effects? Can you access the medication? Can you afford the medication? How hard is lifestyle change for you? One of the most powerful interventions for ADHD, and I think you're probably just maybe one of the most stellar examples I can think of is this. Change your lifestyle to suit your strengths. Play to your strengths and don't try to swim upstream against your weaknesses. People with ADHD often have tremendous talents in certain areas and are tremendously gifted
1:02:27 Speaker 00 in certain ways because they can make connections, because they don't always think in a straight line, because they often have very diverse interests and they can pull different kinds of information together. And, you know, given the right path, they can be hugely successful, right? But that's not possible for everybody. And for more severe cases of ADHD, it's not possible at all.
1:02:51 Steven Bartlett? Has there been any studies on the link between the ketogenic diet and ADHD?
1:02:56 Speaker 00 So not yet, but I'm very excited to be involved in two brand new studies of the ketogenic diet for ADHD. So one is a ketogenic diet for adults with ADHD and depression that's getting started at Oxford University in 2025. And the other is a study of ketogenic diets for ADHD and adults at the University of Michigan. It's also going to be starting in 2025. We have no data on ketogenic diets in ADHD, but we have good reason to believe, the reason we were able to get funding for these studies is because there's reason to believe that it could be useful. Because when you look at ADHD, you see clues to poor metabolic health.
1:03:41 Speaker 00 So for example, children with obesity are twice as likely to have ADHD. Obesity is a marker for insulin resistance. Adults with type 2 diabetes are twice as likely to have ADHD. Type 2 diabetes is severe end-stage insulin resistance. And the ketogenic diet is the most effective way to address insulin resistance that we have at our disposal.
1:04:04 Steven Bartlett? Is it hard to establish cause and effect there? I was thinking about the diabetes one where if you've had ADHD, maybe your life has been harder. Again, I don't know what I'm talking about here, but maybe your life has been harder. And if your life has been harder, you're more likely to be obese potentially. If you've been gone, had more stress and you've, you know, you've had a worse, a worse, more challenging job. And so is it, you know, and will, will a test be able to exclude these sort of confounding factors to the point that we'll know for sure?
1:04:33 Speaker 00 I think that would be a very difficult study to, to design. But I think what I can tell you from my clinical work, because I work, I'm a general psychiatrist. So I see adults of all ages and with all psychiatric conditions from major to minor. And I've worked, as I said, with people with ADHD, hundreds and hundreds of patients with ADHD. What I can tell you is that it's the same with medication. If someone comes in and says to me, I can't tell if this medication is working.
1:05:06 Speaker 00 So should I keep taking it? And I'll say, well, you know, if you can't feel it working, then it's not working. So when the diet works, it works regardless of what's going on around the person. So, and this is true for all conditions that I've worked with. So people with bipolar disorder, people with depression, people with ADHD, people with PTSD, people with anxiety. As you have said, we talked about the ketogenic diet, it's not easy to stick to, right? People fall off the ketogenic diet all the time, sometimes accidentally, sometimes intentionally, right? And you can see their symptoms come back within often 24 hours, even though their external factors have not changed. Your life hasn't changed, it's the diet.
1:05:51 Speaker 00 And when you follow the actual ketone levels daily, you can make that correlation. So what's really exciting about both of these studies is it's not just getting somebody into ketosis. It's, it's tracking on a day to day basis.
1:06:07 Speaker 00 Their ketone level and their attention signals, and seeing if we can see them go up and down together. And we've always got a little bit of data already from a pilot study by Ally Houston at Oxford University. We're starting to see some signals there. But it's too early, really. We need to actually launch the official study. So in my patients, it's a phenomenon I've seen over and over and over again. A great example is I have a patient that I worked with for a couple of years who had a condition called bipolar disorder type 2. So it's a form of bipolar disorder.
1:06:52 Speaker 00 Bipolar disorder, people used to call manic depression. You've got periods of mania, often followed by periods of deep depression. Bipolar type 2 is a milder form where you don't get quite as manic, but you still can get very depressed. So he had bipolar 2. And whenever... So he came to me because he wanted to try a ketogenic diet for bipolar disorder because he had heard it might help. So the other issue he was dealing with was that he and his wife were having some difficulties, some difficulty in their relationship that had started up a few years before. And every time they got into an argument, he would want to die. And he would start to think about ways of killing himself.
1:07:37 Speaker 00 Every single time he went on the ketogenic diet, the suicidal ideation went away, even though his wife had not. So he used to associate the depression with the marriage. But he learned over time to associate it with his metabolic state, that when he was in ketosis, he could then imagine other ways of coping with the stress in his marriage other than just killing himself. So a lot of people say to me that the ketogenic diet gives them this space. It allows them to pull back and see things from a different perspective. It buys them time. Perspective is like a buffer so that people aren't reacting as reflexively to difficult situations.
1:08:22 Speaker 00 Situation hasn't changed, but people are able to deal with the situation in a more effective way. They feel they have more control, not just over their emotions, but also over their behaviors and how they react to situations.
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1:09:33 Steven Bartlett? And for people that have food addictions and binge eating problems, the ketogenic diet, I guess it's knocking you off that roller coaster. Well, being in a state of ketosis is knocking you off that roller coaster of craving eating, craving eating, craving eating. Is that accurate? Is that what it's doing?
1:09:52 Speaker 00 Yes, so the ketogenic diet, by lowering and stabilizing glucose and insulin levels, the thing about insulin is that a lot of people think about insulin as a blood sugar regulator. They think of it as, oh, you know, when your glucose goes up, the insulin brings it down. And that's true, but that's, it's just one of many important roles that insulin has. It's the one it's most famous for. But the thing that, what is not well known is that insulin is so much more than a blood sugar regulator. It's actually a master metabolic hormone. And it's regulating the activity of every cell in the body. Every cell has an insulin receptor on its surface,
1:10:36 Speaker 00 multiple insulin receptors, to pay attention to the insulin level in the blood. And so when you're on a glucose and insulin roller coaster,
1:10:48 Speaker 00 That's just where the trouble begins. Insulin is talking to and controlling the behavior and levels and activity of many other hormones in the blood, including stress hormones like adrenaline and cortisol, reproductive hormones like estrogen and testosterone, your blood pressure regulating hormones, your satiety hormones, the hormones that make you feel full after you eat, your hunger hormones. So many other hormones are on this roller coaster that you're unstable from within. And people often will think, "Well, I'm stressed and that's why I'm eating. I feel really anxious. I get irritable, I get stressed, I'm hungry, I need to eat and then I feel better."
1:11:32 Speaker 00 And that's true, they will. They will feel better for a few hours. But what happens four to five hours later, if they've eaten something that's spiked their glucose and insulin again, is they're gonna get... There was this great study with healthy teenage boys. It's just healthy teenage boys, and they gave them either a sugar-free cola, caffeine-free, or a caffeine-free cola sweetened with sugar. And the boys who had the sugar-sweetened cola, their adrenaline levels, their stress hormones, their adrenaline, quadrupled four to five hours after drinking the soda. And the boys who drank the other soda stayed flat.
1:12:14 Speaker 00 It's the food that's causing the stress that's causing the food eating. So there's this vicious cycle. If people understood that most of what's happening there, it's not your fault that you want to overeat those foods. They are designed to be overeaten by chemical engineers. This is very intelligent engineering that's going on, very clever. And you will sell more of a product if you make it irresistible and if you make it unsatisfying. How many people feel that they can't control their consumption of certain foods? That's by design. If you want to keep eating it, you'll buy more of it. If you eat real food...
1:12:58 Speaker 00 You have to stop after a little while. They're so satisfying. Things like meat, seafood, poultry, eggs, fruit, vegetables, even fruits. Fruit, some people will overeat fruit. But, but fruit has fiber, it has water. It's really hard to eat, you know, 10 pieces of fruit. Very easy to drink, you know, a bottle of, several bottles of fruit juice. Very easy to eat multiple packages of candy. Because those, what happens with ultra-processed carbohydrates, these refined carbohydrates, they blow past your hormonal stop signs. And that's not your fault. But if you understand that that's what's happening, then you can, it takes a few days.
1:13:43 Speaker 00 You've got to step away from them. But, but on the other side is tremendous freedom and control.
1:13:50 Steven Bartlett? The gentleman you mentioned in that case study a second ago, you referred to as Carl, which I guess is a cloaked name. He's the one that had the bipolar disorder?
1:13:59 Speaker 00 Uh, no, Carl is a different case.
1:14:00 Steven Bartlett? Ah, okay. Tell me about Carl.
1:14:03 Speaker 00 Yeah, so I opened the book with a story of Carl, who has generously allowed me to share his story. A gentleman, great guy, in his mid-60s, who had had lifelong depression and anxiety. And for years, he, he didn't seek any treatment. And then, maybe about 15 years or so before he consulted with me, he went to a psychiatry specialty clinic for some specialized brain imaging and extensive evaluation and lots and lots of specialized tests. And he left the clinic with, you know, thousands of dollars later, with three diagnoses,
1:14:47 Speaker 00 depression, anxiety, and ADHD, and three prescriptions. One for depression, one for anxiety, one for ADHD. So he started those medications, and his depression got a lot better. But he then had a brand-new problem on his hands, which was he was becoming manic. And he had never had mania before. So he was uncharacteristically energetic and irritable and unpleasant. And so it was changing, it was changing his character, his personality, his behavior in a certain way that was becoming very unpleasant at work and at home. So he then turned to marijuana to try to take the edge off, develop to marijuana addiction. Now he's got another problem.
1:15:33 Speaker 00 And so he thought to himself, you know, this isn't, this isn't what I signed up for. I was trying to solve a problem and now I've got two new problems on my hands. So he took himself off the medications and said, you know, I, I, I can't use medication. Medication's not for me. I'm going to try to manage my mood issues, my depression, anxiety with rigorous exercise. I'm going to let exercise be my medicine. And he started cycling bikes over a hundred miles a week. And it actually helped a lot. It didn't completely resolve all of the symptoms, but it brought them down to a very manageable level for years.
1:16:18 Speaker 00 So exercise was his medicine. Exercise improves metabolic health. And so he was still eating a standard American diet. He'd never tried any dietary changes before. And then what happened is as he entered his sixties, the depression and anxiety started to rise in the background. Exercise wasn't working quite as well as it had. And then just before he met with me, something stressful had happened at work. And it was essentially a shift in his job description, which was making him anxious. And he started experiencing very suddenly these bouts of agitation and anxiety and restlessness.
1:16:58 Speaker 00 And exercise being his medicine, he would, he would cycle on the weekends. And at night, if it was, if it was, if it was happening on a weeknight, a worknight, he would be walking because he couldn't bike at night when it was dark. He would walk, sometimes eight, even 25 miles to try to get rid of this excess energy. And he said, I don't have time for this. I can't exercise enough to keep my symptoms under control. He didn't know what else to do. Starts searching online for solutions. Came across information about carnivore diets and mental health contacted me for a consult and said, I want to try the carnivore diet for my, for my anxiety.
1:17:40 Speaker 00 And I mean, there were lots of other things we could have done to improve the quality of his diet. But this is what he wanted to do because he was hoping that would bring him the most, the fastest relief. So switched to a carnivore diet, three to four pounds of fatty meat per day, mostly pork and beef. This was dairy free, no plants. And he checked his ketones using urine testing, which is less expensive than blood testing. He's in mild ketosis every day using urine strips. And he started to improve by week three. By week six, his score was zero on all his depression and anxiety scales.
1:18:19 Speaker 00 He had no symptoms at all of depression, anxiety, not just of those recent extreme symptoms that he was experiencing, but the symptoms that went back his entire life that had never completely resolved before. So he said, you know, I've, this is the, I've never felt this well in my entire life. And so this is the power of these strategies is they don't just reduce symptoms a little bit. They actually have the power to heal the underlying problem in ways that, I mean, this is a phrase I've heard so many times, I feel better than I've ever felt in my entire life. You don't hear that when you prescribe medications for people generally.
1:19:00 Steven Bartlett? That was in 2019, was it?
1:19:03 Speaker 00 I couldn't tell you what year, but that sounds right.
1:19:06 Steven Bartlett? How is he doing now?
1:19:07 Speaker 00 Yeah, I mean, we, we are still, we still talk with each other several times a year. He's doing very well. In fact, so he's, one of the interesting things about what happened with this diet is that during that long period of intermittent agitation, you know, he's a very physically fit guy because of all the exercise and he, and he was lean. He lost 10 pounds during that period of agitation that he could not afford to lose. When he first started working with him, he was underweight. And despite eating four pounds of fatty meat per day, he couldn't regain that 10 pounds unless we added back some carbohydrate into the diet. This is really, this is a subtle point, but for athletes, sometimes, especially in the early
1:19:52 Speaker 00 phase of the transition, there needs to be a certain amount of carbohydrate in the diet to support high performance.
1:19:59 Steven Bartlett? He didn't stay on the carnivore diet?
1:20:01 Speaker 00 No, he did not. So he was on the carnivore diet for many months and then, but because he couldn't regain that weight, I asked him, I said, well, you know, I think we need to put some carbohydrate in to help you regain this weight. And so I asked him which foods he missed the most, gave him a list of whole foods to choose from. And the things he missed most were potatoes and yogurt. So some starchy root vegetables, some plain unsweetened yogurt, up to about 100 grams of carbohydrate per day seemed to be about right for the days when he was, excuse me, exercising. On the days when he wasn't exercising, he would cut it back. So he was tailoring it to his personal energy needs. And so, so this is
1:20:43 Speaker 00 another interesting thing about what happened for him is that, I mean, his, his scales are still at zero, but he has been, as we've talked to each other on and off over the years, he has been able to make adjustments to his diet, understanding the principles. If you understand the principles, then you know which changes you can get away with and which changes you can't. And he has stayed well.
1:21:08 Steven Bartlett? There's a couple of key things people always talk about when they hear the carnivore diet. The first is they say there's nutritional deficiencies to the diet that aren't like sustainable. So if you eliminate certain food groups like fibers, vitamin C's, vitamin E, magnesiums, et cetera, then, which are essential nutrients.
1:21:26 Steven Bartlett? Then you're gonna have problems.
1:21:27 Speaker 00 So a carnivore diet theoretically does provide all essential nutrients. So if you look at what is inside animal foods, you will find all essential nutrients. You can't say that of any plant food. There's not a plant food on earth that can, that provides all essential nutrients. Animal foods can, I would say meat, seafood, poultry. Eggs are missing a couple of nutrients and dairy is missing even more. But meat, seafood and poultry contain every nutrient we need. The question is, how much do you need?
1:22:00 Steven Bartlett? Like fibre?
1:22:01 Speaker 00 Oh, well fibre's not a nutrient.
1:22:03 Steven Bartlett? Oh, okay, but do you get fibre in a carnivore diet?
1:22:06 Speaker 00 There are different definitions of carnivore, but the strictest sort of purest definition of carnivore is animal foods only. And fibre comes from plants, so it's fibre free. A true carnivore diet is fibre free.
1:22:19 Steven Bartlett? So could you last on a true carnivore diet without getting some kind of like gut microbiome issue or some kind of, because you need fibre, right?
1:22:29 Speaker 00 Why?
1:22:30 Steven Bartlett? I thought it was good for like digestion and your gut microbiome and stuff like that.
1:22:35 Speaker 00 What does it do?
1:22:36 Steven Bartlett? A lot of people tell me that it prevents glucose going into the blood or something.
1:22:40 Speaker 00 Where's the glucose coming from?
1:22:42 Steven Bartlett? So you don't need it?
1:22:44 Speaker 00 Fibre, fibre is very helpful and I spell this out in the book so, because there's we have a lot of half truths in our minds about food. Even people who are paying really close attention to the, to nutrition science have a lot of half truths in their minds about food. So yes, fibre, for example, you're exactly right, lowers glucose spikes. But the glucose is coming from a diet that's too high in sugar. And so you won't get glucose spikes if you regulate your glucose levels. So, so that's one interesting thing about fibre. So if you're eating a high carbohydrate diet. Fiber can soften your glucose spikes, and that's a plus.
1:23:28 Speaker 00 But there's a more effective way to lower your glucose spikes is to not get a glucose spike in the first place. And that may not require taking all the carbohydrate out of your diet. It might just mean lowering it to your personal tolerance. Another thing people often say about fiber is that it sweeps your colon clean of toxins and that might otherwise build up and cause problems. But fiber, there's no evidence that fiber is sweeping anything clean, or there's never been a study that demonstrates this. It's really just a belief about what we imagine fiber as being like the broom of the intestines. But that's just a belief. There's no science behind that whatsoever. The intestines clean themselves.
1:24:12 Speaker 00 The lining sheds regularly, actually very frequently, and the border of the intestines sweep themselves clean. So the intestine knows how to take care of itself that way. But the biggest myth about fiber is that it's good for digestion because fiber, by definition, is indigestible by humans. So there are two kinds of fiber. There's soluble and insoluble. And the soluble is the kind that holds water, like in an apple. And the insoluble is the kind of tough, stringy, woody stuff that you might find in broccoli, for example. So the soluble fiber, the bacteria in the lower parts of our intestine can ferment
1:24:56 Speaker 00 that to a certain extent, but then we can't make use of the sugars that it's releasing.
1:25:03 Steven Bartlett? I read here fiber traditionally considered essential for feeding beneficial gut bacteria and promoting regular bowel movements.
1:25:11 Speaker 00 Yes. Okay, so a couple of things to unpack there. So one is that a lot of people, there are quite a few papers on this, claiming that we need fiber because we need to feed our cells butyrate, which is a breakdown product of fiber. But butyrate, if you think about what a ketone is, it's beta-hydroxybutyrate, feeds the intestinal cells just as well. So you don't need to eat fiber to feed your cells butyrate. If you think that the cells need butyrate, then you can get it from a ketogenic diet. So I explain that in the book, too, is that there's more than one way to generate that molecule.
1:25:50 Steven Bartlett? Can someone exist on the carnivore diet, like the extreme version of the carnivore diet, for a long time without any supplementation?
1:26:00 Speaker 00 So we really don't know, and we really don't have any long-term data on any dietary pattern. I think this is really important for people to understand. There's this very common criticism of diets that we feel uncomfortable with or might be worried about, like ketogenic diets or carnivore diets. Because they're so different from what we're told we're supposed to eat, there's a lot of fear and worry about them. And so we'll often think, well, OK, it's normalized my blood sugar level. I used to have type 2 diabetes. I've lost 50 pounds. My depression went away. I normalized my coronary artery calcium score, so I'm at lower risk for cardiovascular disease. My triglycerides came down. You know, I feel better.
1:26:45 Speaker 00 In every way, like all of my health markers have improved. And so when you show people study after study after study of a ketogenic diet improving multiple aspects of metabolic health and physical health and mental health, it's cured my seizures, it's cured my bipolar, whatever it was. The only last, the sort of the last thing somebody could say is, well, yes, OK, it's made you extraordinarily healthy now, but I wonder what's going to happen 20 years from now. Nobody can tell you that because there's no way you could design a 20-year-long study of any diet. So you could say this about the Mediterranean diet, you could say this about a carnivore diet, you could say this about a vegan diet.
1:27:27 Speaker 00 Well, vegan diet, unsupplemented, is fatal. It has dangerous nutritional holes. So why aren't we saying this about vegan diets? When we can look at a vegan diet and see that it's incompatible with human life unless you eat fortified processed foods or supplement, which most people in the world cannot do. We look at a carnivore diet and you can actually find all of the nutrients in these animal foods and that's the diet that you're more worried about because theoretically, long term, something bad might happen. Now, I am not at all saying that a carnivore diet is the right diet for everybody, or that it's even the right approach for everybody
1:28:10 Speaker 00 to consider, but I think we have to keep an open mind and stay curious and look at the biology of food and allow people to make their own... I'm nutritionally pro-choice, which means I would... if you came to me with a mental health issue, I would support you in optimizing the diet of your choice and making it as brain-healthy as I possibly could because it's very important that you feel comfortable with the diet that you're eating. And so, there are lots of ways to do that. But I think it's really important, and one thing I encourage people to do in my work and in my book, is to open our minds
1:28:55 Speaker 00 and get curious about food, the biology of food, the biology of the brain, because most of what we hear about nutrition doesn't come from biology, it doesn't come from clinical experiments, or information about how cells work, or about what's actually inside food. It comes from this type of study called a nutrition epidemiology study, which is just questionnaire-based guesswork, untested theories about what we should eat. Most of what we believe about nutrition is untested theories, wild guesses, and wishful thinking.
1:29:33 Steven Bartlett? Many of the people that choose a keto diet do it for they sort of superficial reasons.
1:29:38 Speaker 00 Sure.
1:29:38 Steven Bartlett? You know, I think it's probably one of the reasons why I do it once a year for a couple of weeks. Why does it help you to lose weight? Is that, again, just because of calorie restriction?
1:29:50 Speaker 00 So it's insulin. So everybody out there who's trying to lose weight, they need to know one thing. And it works. You cannot burn fat if your insulin levels are too high. So if you know what raises insulin, you can turn that insulin knob down. If you know how to do that, you will lose weight. It's a biological fact. So when you turn down insulin, you will burn fat. So a ketogenic diet, you can't produce ketones unless your insulin is low enough. So the ketones on that meter are showing you that you are burning fat. You can't make ketones unless you're burning fat. So you really cannot burn fat unless you're in ketosis.
1:30:35 Speaker 00 You don't necessarily have to be in ketosis all the time. You don't necessarily have to have very high ketone levels. But if you're not in ketosis, you're not burning fat. So if you're not in ketosis, the brain can't even see that you've got energy, spare energy to burn. You might have 200, 300 pounds of stored energy as fat. The brain will still ask you to eat more carbohydrate because it's not in fat burning mode. So it's in carbohydrate burning mode. When it's hungry, it's going to look for more carbohydrate. You have to teach it. You have to bring your body into fat burning mode and train your body. Give your cells some time, a few weeks, to learn how to burn fat again and stay there.
1:31:20 Speaker 00 My mother is 91 years old. She has lost 50 pounds on a ketogenic diet. It is never too late. All she has to do is make sure there are ketones on her meter. When her glucose meter was nice and stable, she wasn't losing weight because the insulin was still too high. The ketones are essentially a mirror image of your insulin level. So we don't have a home insulin level test yet. We have fabulous continuous glucose monitors, which I recommend anybody out there with a mental health issue or physical, anybody out there who can afford $45 or $50 for
1:32:03 Speaker 00 a single two-week glucose sensor, which are now available in the United States over the counter, which they weren't before. I think you've had them in the UK for a lot longer.
1:32:13 Speaker 00 You can see what your glucose levels are doing in response to your lifestyle, your food choices, your exercise, et cetera. They can't, it can't tell you what's going on with your insulin level. So you can have a nice, beautiful, stable glucose level, nice in the healthy range. Your insulin can still be too high and you still might just be, you're burning all that glucose for energy. A ketone meter will tell you if you're burning fat.
1:32:37 Steven Bartlett? I'm on Amazon now, it says sort of fifty dollars or
1:32:39 Speaker 00 Yeah.
1:32:40 Steven Bartlett? There's ones for forty dollars as well.
1:32:41 Speaker 00 Yeah.
1:32:42 Steven Bartlett? One for thirty dollars as well.
1:32:44 Speaker 00 Yeah.
1:32:44 Steven Bartlett? Interesting, okay. I think I'm gonna try one. I've never actually done one before, so I guess I didn't really know if I was in ketosis or not, but I just.
1:32:52 Speaker 00 Oh, it's so useful because if you're, if you're following a ketogenic diet, the thing that makes it ketogenic is the ketones.
1:33:01 Steven Bartlett? Yeah.
1:33:02 Speaker 00 And so, you were telling me before we started recording, that you're always looking up, which foods are keto, which foods aren't keto, and it's really not so much about that. You could eat almost anything on a ketogenic diet, if you, if you understand, you know, how much to have and when. But in any case, the ketone meter will tell you if you're in ketosis, and if you're not in ketosis, you can tweak your, your plan. So all of this is in the book, but, but you can, the really, the, the most important thing about a ketogenic diet is getting into good, consistent, daily ketosis for at least six weeks straight.
1:33:45 Speaker 00 That sends the daily signal to your cells, we're burning fat now, we're burning fat now, we need to learn how to burn fat. There are enzyme systems and pathways in cells that need to ramp up. And, and it takes time. So it takes a while for the body and brain to kind of learn how to burn fat again, and it doesn't happen overnight.
1:34:10 Steven Bartlett? In terms of energy, there are so many reasons why I'm a big matcha fan, if you don't already know by now. And so much so that I actually invested in the UK's leading matcha company called Perfect Ted. And one of my favourite Perfect Ted products is these delicious matcha pouches that come in every flavour, from salted caramel to peach flavour, to mint flavour, to berry flavour. One of my favourites is this vanilla flavour, which I'm going to make in just two seconds. You just take this mixer here, get a little bit of the powder, pop it on top of the shaker like that, put the lid on.
1:34:45 Steven Bartlett? Shake, shake, shake.
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1:35:09 Steven Bartlett? What part of your work sort of overlays with psychology? You know, when someone comes to you and they're experiencing some anxiety or depression or something, and they're describing their life and their life is full of trauma and hard things, and they got fired from their job, it seems a little bit peculiar to talk to them about diet in that moment. It seems peculiar.
1:35:35 Steven Bartlett? Do you ever think first about like some kind of psychological prescription?
1:35:41 Speaker 00 Oh, you know, I got some, my training at Cambridge Hospital in psychiatry residency is very psychotherapy focused. I got really excellent training in psychotherapy and I still use it every day in my work. We're not throwing the baby out with the bathwater here. In fact, the psychology of people's relationship with food is really important to address. I mean, most of what I do, I mean, I could, I could teach you in an hour, everything you needed to know about why you should switch to a ketogenic diet for mental health and, and I could give you a little sheet and you could go off and do it, right?
1:36:22 Speaker 00 I would be rapidly obsolete, which would be a good problem to have, right? But what actually is happening, most of the work I'm doing is not about, here's the science, here's why you need to do it, here's what's happening in your brain, here's the food list. It would be so easy if that's what it were. We are human beings, and we have really complicated relationships with food. We have history with food. We have spiritual attachments to food, cultural attachments to food, political beliefs about food. And a lot of us have addictions and attachments to food that go back a long way. So most of it is about helping people understand and sort of hold their hand through that process of making that behavior change.
1:37:06 Speaker 00 And whatever's going on in their life is also important.
1:37:12 Steven Bartlett? So how do you approach that with your patients?
1:37:14 Speaker 00 So in the first interview with somebody, I usually take 90 minutes to two hours when I'm first working with a patient. And I might do that two or three times before we actually begin discussing what to do with diet, because I really want to understand all of the different pieces of the puzzle, not just, oh, what are you eating? Here's what you should eat. That doesn't work for most people. And because there are going to be challenges that come up. And if the better I know that person, the better I can help them through those challenges. So it's not, it's definitely not, it's not like I hand them a prescription for a diet and send them out the door.
1:37:59 Speaker 00 I love understanding where people are coming from, their, you know, the challenges they're facing in their lives and how that all intersects with their metabolic health, their exercising, you know, why are they not exercising? How is their sleep? How are their relationships? Who in their life is supportive of them changing their diet? Is, who in their life is skeptical and worried? And because that could be a major factor for people. If one person in the family wants or needs to go on a ketogenic diet for mental health and nobody else in the family thinks it's a good idea, that's really tough for people. You've got to plan for all of that and talk it through. Say, okay, here are the roadblocks we might face. How are we going to, how are we going to deal with these when they come up?
1:38:43 Speaker 00 So I could give many, many examples, but... The psychotherapy, the psychology of it is why using ketogenic diets to treat mental health conditions is usually best done as a team. Ideally, if you can, a keto dietitian or nutrition therapist who's very skilled at using ketogenic diets, designing them and personalizing for whatever you like to eat, so that you'll have an enjoyable, diverse diet that meets your needs and your desires, so you won't get bored and you'll enjoy the food you're eating. And a prescriber, especially if you're taking medication or have any mental or physical
1:39:23 Speaker 00 health issues, you'll need a prescribing professional, primary care doctor, or psychiatrist or both, depending on what's going on for you, to manage the medications and help you through that transition period where there are so many different things changing in your physiology that it can sometimes be uncomfortable if you don't plan properly and set the person up for success. And a coach, a therapist, a psychologist, or a coach for motivation and support and be a cheerleader, but also to reflect back to you how things are going and keep you moving forward, because the first few weeks are the hardest. And once you get past about week three, week three is a real turning point for a lot of
1:40:06 Speaker 00 people, your cells just kind of settle in to a new way of operating, and it's this very noticeable shift that takes place in people's bodies and brains and that many people have never experienced before.
1:40:21 Steven Bartlett? As it relates to anxiety, what does the research say about the role that keto can play in reducing someone's anxiety?
1:40:32 Speaker 00 Yeah, so anxiety, if you talk to any practitioner who has been using ketogenic diets in their work, whether it's a psychiatric practitioner or a medical practitioner, there are a couple of things they'll tell you that are the most predictable benefits of a ketogenic diet. One is reduced anxiety, and the other is mental clarity. So most people will experience tremendous reductions in anxiety within, often within three days to three weeks of starting a ketogenic diet. And the mental clarity is, is one of those things that you hear almost from almost everybody. So the anxiety is, remember we're talking about this roller coaster.
1:41:17 Speaker 00 Those stress hormones are on a roller coaster. Life can cause stress and stress can unbalance your, your chemistry. There's no question about that. But your food can also do that. Your diet can also unbalance your stress hormones. So, and this is, comes back to your question about, you know, life stressors. You don't want to ignore those because they still count and they're still affecting your metabolic health. Stress raises your cortisol levels and cortisol levels are dangerous for long-term brain health. High cortisol levels. Most mental health conditions come along with dysregulated or poor regulation of cortisol levels in the brain. And too much cortisol can over time damage the brain, including the hippocampus, which is the brain's learning and memory center.
1:42:02 Speaker 00 So stress, whether it's coming from inside the body, from the foods you're eating or outside the body from your life, both of those need to be addressed, not just the dietary stress.
1:42:12 Steven Bartlett? There's some studies that I just found. A 2023 systemic review examined the efficacy of low carbohydrate ketogenic diets in treating mood and anxiety disorders. The review highlighted potential benefits, but emphasized the necessity for randomized controlled trials to establish definitive conclusions. That was the Cambridge University Press. And slightly separate to that, on serious mental illnesses, I think you talk about this in your work as well. A 2024 pilot study conducted by Stanford Medicine investigated the effects of a ketogenic diet on participants with schizophrenia and bipolar. And participants reported improvements in energy, sleep, mood and quality of life, suggesting that ketogenic diet may stabilize brain functions in serious mental illnesses as well.
1:42:53 Steven Bartlett? Really, really fascinating. Really fascinating. I never really thought about the ketogenic diets impact on my mental health. I used to think, I'll be honest, the reason I do it is helps me become more focused, it changes my body composition. And really, at the end of the year, for me, or at the start of the year, it's a nice way to kind of reset. That's the kind of how I see it. I want to come into the year feeling good and strong and focused. So I do it over sort of Christmas, New Year, January time, every year with my partner. But I never really considered the downstream consequences, things like mental health and those other things. But it makes sense. We have a closing tradition on this podcast where the last guest leaves a question for the next guest, not knowing who they're
1:43:32 Steven Bartlett? leaving it for. And the question that's been left for you is, what would you say to someone who wanted to have less regret and more contentment and peace on their deathbed?
1:43:53 Speaker 00 I'm trying to think about what, for myself personally, what I would have regretted. You know, you might want me to say that I would have regretted not having written this book, and that's true. But honestly, it's about finding a really good, healthy relationship in your life. I mean, if I hadn't accomplished that in my life, I would have more regrets than not writing this book.
1:44:20 Steven Bartlett? Thank you. Thank you for writing this book, because it's such a comprehensive analysis of this poorly understood link between the things we put in our mouth and the impact it has on our mind holistically. I don't think enough people, especially if we think back decades, even thought to really uncover this sort of link. I never, I think before even starting this podcast, never really understood the concept of metabolic psychiatry. And there was an association between the two. The great thing about your book is that you don't need to be a scientist to understand it. It's clearly written for people like me, who don't have a profound knowledge of science and medicine and psychiatry, but
1:45:00 Steven Bartlett? are able to learn and advance the decisions we make just by reading your book. It has been such a smash hit for so many people. I was looking at some of the reviews earlier on, and people really, really love it. You wrote it, you published it this year, January?
1:45:13 Speaker 00 January.
1:45:13 Steven Bartlett? January. And I highly recommend anyone that is intrigued by any of the subject matters that we spoke about today to go and get a copy. I'll link it below. It has some extraordinary people on the back, who, some of which I've interviewed, at least one of which I've interviewed, in Jason. Is there anything else you wanted to say about who this book is for?
1:45:33 Speaker 00 Yeah, I mean, I really want people with mental health conditions, even if they think they've tried everything. If, you know, if you're willing to try one more thing, hope is on the menu.
1:45:44 Steven Bartlett? A powerful plan to improve mood, overcome anxiety, protect memory for a lifetime of optimal mental health. Thank you so much for the work that you do.
1:45:53 Speaker 00 Thank you very much, Stephen, for your work.
1:45:58 Steven Bartlett? Do you know that 80% of New Year's resolutions fail by February? It's because we focus too much on the end goal and we forget the small daily actions that actually move us forward. Those actions that are easy to do are also easy not to do in life. It's easy to save a dollar, so it's also easy not to. Making one small improvement each day, one tiny step in the right direction, has a big difference over time. And that is the 1% mindset, which is why we created the 1% Diary, a 90-day journal designed to help you stay consistent and focus on the small wins and make real progress over time. It also gives you access to the 1% community, a space where you can stay accountable, motivated, inspired, along with many others on the same journey. We launched the 1% Diary in November and it sold out, so now we're doing a second drop.
1:46:43 Steven Bartlett? Join the waitlist at thediary.com and you'll be the first to know as soon as it's back in stock. I'll put the link below.
Previous Jordan B Peterson: You Need To Listen To Your Wife! We've Built A Lonely & Sexless Society! If You & Your Partner Do This, You'll Divorce! Next Best Moment: This Is The One Skill That Will Guarantee Your Success! (Even Against Smarter, Better & Richer People): Codie Sanchez Page updated October 5, 2026 · transcript and summary are machine-generated
