Pod Insights The Diary Of A CEO with Steven Bartlett Harvard Psychiatrist: THIS Food Is Causing The Mental Health Crisis! - Chris Palmer About this episode If you want to hear more about ways to tackle mental health problems, I recommend you check out my conversation with Dr. Aditi Nerurkar, which you can find here: https://www.youtube.com/watch?v=FN0_ow76hU8
Too often we think that physical health has nothing to do with mental health and vice versa, but could it be that we have the equation completely upside down?
Chris Palmer is an Assistant Professor of Psychiatry at Harvard Medical School. He is also the author of the book, ‘Brain Energy: A Revolutionary Breakthrough in Understanding Mental Health’, which outlines a combined theory of what causes mental illnesses, and that mental disorders are metabolic disorders of the brain
In this conversation Chris and Steven discuss topics, such as how depression and anxiety are caused by diet, the impact of gut health on mental illness, and why mental health problems and rates of suicide are increasing.
You can purchase Chris’s book, ‘Brain Energy: A Revolutionary Breakthrough in Understanding Mental Health’, here: https://amzn.to/4b6O8Fg
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Transcript 13,907 words · 2 speakers
Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.
0:00 Speaker 00 If a woman has obesity and diabetes, she has quadruple the risk of having an autistic child. But I want to go deeper. And most people don't know this. Something horrible has happened. Dr. Chris Palmer.
0:16 Steven Bartlett? The Harvard psychiatrist.
0:17 Speaker 00 Whose groundbreaking new research could be the missing piece to cure the mental health epidemic. Mental disorders are the leading cause of disease and disability worldwide. Governments are actually labeling them as terminal illnesses and to allow people to die by assisted suicide. And they're going to allow them to die because they know what I'm saying is true. They know that our treatments fail people year after year after year. And what I'm here to say is, you can, in fact, get better.
0:47 Steven Bartlett? How?
0:48 Speaker 00 I struggled with mental illness myself for 20 years. I tried to kill myself several times. There was no hope for me whatsoever.
0:58 Speaker 00 And I was furious with the mental health field for being so incompetent. And I wanted to try to help. And the thing that people have not opened their eyes to is the science of metabolic health. And there's tiny things in our cells that can heal and recover people who have had chronic, horrible mental illnesses.
1:18 Steven Bartlett? Really?
1:19 Speaker 00 Yes. And if autism is genetic, it shouldn't quadruple in 20 years. These are facts. And we can do something about it today. But the easiest way to understand it is that...
1:38 Steven Bartlett? Chris, when you speak, before we started recording, you speak with a deep, authentic sense of mission. And that underneath there is a personal driver that is unimitatable. And that is getting you out of bed every day. Because I could see it in your eyes. I could see it in the way that you said the words that you said to me. Where does that drive begin for you? What was the catalyst moment in your life that inspired you and gave you that fire that seems to be unquenchable to pursue the path that you've pursued?
2:14 Speaker 00 You know, I struggled with mental illness myself, starting in childhood.
2:21 Speaker 00 Nobody recognized it, nobody diagnosed it. I didn't know what it was, nobody knew what it was. I just knew I was different and somehow ostracized for who I was. And it just felt like part of who I am. And then a series of horrible tragic events happened in my extended family when I was about 12 years old. And my mother ended up having a nervous breakdown. She called it a nervous breakdown. It started with what we would call major depression, quickly escalated to depression with suicidality. And then she developed psychotic symptoms.
3:06 Speaker 00 She became very delusional. She got mental health treatment, but the treatment didn't work. They basically were just kind of, in my 12-year-old mind, the psychiatrists were just drugging her. And those drugs weren't making her symptoms better. They weren't restoring her health. She went on to live the rest of her life with a chronic psychotic disorder. And that disorder completely ruined and devastated her life in so many ways. She lost everything. She lost custody of her eight kids.
3:50 Speaker 00 She lost all of her money, everything. The courts didn't give her any support or any money. I had my own struggles, even worse with mental illness after all of that. I ended up leaving home before I finished high school. I had chronic depression and suicidality and OCD and other things. And the mental health field was worthless for me and probably caused a lot of harm for me. And so, at the end of the day, the reason I'm a psychiatrist is because I recognize how horrible and devastating mental illness can be.
4:34 Speaker 00 And I came to the field really angry with the mental health field for being so incompetent. And I wanted to try to help. I wanted to try to maybe contribute to better solutions for people.
4:50 Steven Bartlett? My futile attempts to save you from the ravages of mental illness lit a fire in me that burns to this day. I'm sorry I didn't figure this out in time to help you. May you rest in peace.
5:05 Speaker 00 That's my mom. And that's the dedication of the book. Her story and the devastation to her life is the thing that drives me to this day.
5:21 Speaker 00 And I just know that there are hundreds of millions of people just like her, with different diagnoses, with different symptoms.
5:32 Speaker 00 But the devastation to their lives is the same. And those people deserve better. And I want to help them. I want to get them better treatment.
5:45 Steven Bartlett? Those people, those people exist on some kind of, I guess, multiple different spectrums of disorder. What are those spectrums of disorders? And what are, what are those disorders that you're referring to? And you say those people are the people that I want to help?
6:00 Speaker 00 People who are diagnosed with a mental illness. And so,
6:08 Speaker 00 you know, the diagnoses are all over the map. We have all of these different diagnoses and the DSM-5 TR, the Diagnostic and Statistical Manual of Psychiatry, which is kind of considered the bible of psychiatry. And it has all of these labels in it. Schizophrenia, bipolar disorder, major depressive disorder, alcohol use disorder, which most people know as alcoholism.
6:42 Speaker 00 Other addictions, anorexia nervosa, but also autism, autism spectrum disorder, or dementia that most people know as Alzheimer's disease. But those are all of the labels in our, in our kind of bible of psychiatry. And the reality is that when you look at the treatment outcomes for people who are getting treatment for those diagnostic labels, there is no doubt that our treatments do work for a lot of people,
7:27 Speaker 00 millions of people. And so millions of people are helped. Their lives can be saved by the current treatments that we have. And I'm not here to take that away from anyone. So for people who are getting treatment and those treatments are working, keep getting that treatment. I don't want to interfere with anyone's access to those medications or psychotherapies or electroconvulsive therapy or whatever treatment they're getting. I don't want to stand in the way. But there are far too many people just like my mother who did everything they were asked to do, who took all of the pills, who showed up for their therapy appointments, who did everything they were asked to do,
8:12 Speaker 00 and they're not getting better. You know, mental disorders as a whole are now the leading cause of disease burden and disability worldwide. And it's not because those people aren't getting treatment. Many of them are getting treatment. Yes, there are people who can't afford treatment or can't get access to care. But a lot of people are getting treatment. I work at one of the best psychiatric hospitals in the world. I have the privilege of doing that. And we see patients that aren't getting better. We see them all the time, day in and day out.
8:54 Speaker 00 And the crisis, the tragedy is that some governments are actually now moving to labeling mental illnesses as terminal illnesses. The Canadian government in March of 2024 is going to allow people to die by assisted suicide because of a treatment-resistant mental illness.
9:20 Steven Bartlett? Really?
9:21 Speaker 00 Yes. They're going to allow them to die, and they're going to allow them to die because they know what I'm saying is true. They know that our treatments fail people year after year after year. And those people become desperate and hopeless, and they give up on treatment for good reason because they've participated in treatment for decades, and it hasn't helped them. And the Canadian government has now made the decision that they should be allowed to die with the help of a physician who can prescribe deadly medications and make it easy for them to die by suicide.
10:03 Speaker 00 The UK is now labeling some people with eating disorders as terminal eating disorders. And that maybe, you know, if they've exhausted treatment, if they've had treatment for several years or more than a decade, well, treatment's just not going to work for them. So let's call them terminally ill with an eating disorder. People are frustrated and hopeless. Again, I'm not talking about the people for whom treatment's working. If treatment is working for someone, if they're taking a pill and it's working, fantastic. You're lucky. Keep doing it. And I don't want to interfere with anyone's access to that treatment.
10:48 Speaker 00 But we can't hide from the tragic realities of the world.
10:55 Steven Bartlett? For all of those people that are, they might have extreme anxiety, depression, schizophrenia, these extreme sort of mental health disorders. What is it that you want to put into their hearts and minds with your work, with the message that you're spreading? What is it that those people need to know? And I say that not as all of the details which we're going to go into, but the very top line message that, you know, maybe in a sentence, you want those people to have.
11:21 Speaker 00 If you have been trying treatment and those treatments aren't working for you, please don't give up. There is hope. You can, in fact, get better. If you understand the science, you can get better.
11:36 Steven Bartlett? The mental health conversation, the prevalence of mental health.
11:44 Steven Bartlett? Lots of these things seem to have changed in the last 28 years. What is the state of mental health as we sit here today? And how has that changed in the 28 years that you've been at Harvard and working in this field?
11:59 Speaker 00 I think I have a slightly different perspective. Yours sounded more hopeful than mine. You kind of said things have changed in 28 years. And tragically, I actually feel like they haven't changed a whole lot. If you look at, if you look globally at the problem, the problem of mental illness is increasing. It is not stagnant and is not decreasing. It is increasing in prevalence throughout the world. Prior to the pandemic, about 1 billion people had a mental or substance use disorder, representing about 13% of the world's population. And that was just in one given year, 2017.
12:45 Speaker 00 The pandemic added insult to injury and rates are much higher now. And the rates of mental illness have been increasing across a wide range of diagnostic categories. Rates of autism in the United States over the last 20 years have quadrupled, a fourfold increase. Rates of ADHD are up and through the roof. Rates of bipolar disorder in adults. A lot of people think bipolar disorder, that's genetic. Well, in adults in the United States, over the last 20 years, rates have doubled. In children and adolescents, rates are through the roof, up exponentially, thousandfold percent.
13:30 Speaker 00 Rates of plain old bread and butter depression, major depressive disorder. The Gallup poll does an annual survey in the United States of current and lifetime prevalence of depression. And just this year in 2023, rates of both, both current prevalence and lifetime prevalence, reached all time ever recorded highs. So we have a catastrophe. We have an epidemic. Mental illness is a growing, escalating problem. And I wish that I could say our treatments were dramatically better.
14:12 Speaker 00 There is no doubt, we do have new treatment options. We have ketamine and psychedelics. We've got transcranial magnetic stimulation, which wasn't around when I first started. We have some new medications, but the real answer is the medications that we have are no better than the old medications because they're all based on the same mechanisms. So companies are simply repeating what we already know kind of, sort of works. And they're just making new molecules that kind of, sort of do the same thing. And so they still just kind of, sort of work.
14:53 Speaker 00 They don't work for everyone and they even fail to work for most people.
15:00 Speaker 00 In the largest study ever done of depression, when people come in, the very first antidepressant treatment they get, over 4,000 people treated at the best academic centers that we have in the United States, the first antidepressant treatment, only about 30% get a remission. That means 70% still have major depressive disorder. They have enough symptoms to still be labeled clinically depressed. Even if the pill helped them a little bit, it didn't help them enough to make their symptoms, enough of their symptoms go away.
15:40 Speaker 00 Now, even those 30% who got a remission, many of them are still having low-grade symptoms, like all of their symptoms didn't go away. And after four levels of treatment, the original published report said that 67% got a remission after four different types of treatment for major depressive disorder. If we take that at face value, that means 1/3 of patients are still clinically depressed after four levels of treatment. Other researchers have challenged that 67% figure because the reality is half of the
16:23 Speaker 00 people in that study dropped out because it just wasn't working out for them. So, we got a problem there. Like, this protocol clearly isn't working out well for people when half of the people are dropping out of your study. And the second problem is that there are some researchers who point out that they changed the criteria for remission during the study. They prospectively said they were going to define remission in a very certain way using certain metrics.
17:00 Speaker 00 Those researchers said if they stuck to their protocol, only about 35% got a remission after four treatment levels. That would mean two thirds of people after getting four levels of treatment are still clinically depressed. And that is the current state of affairs for depression, something that we all know, something that we've got so many treatments for. If we look at more quote unquote, "serious" mental disorders, like bipolar disorder and schizophrenia, the results are abysmal.
17:41 Speaker 00 The one large study of 6,000 patients with schizophrenia, only 4% of the patients got a recovery, meaning that their symptoms were in full and complete remission. They were, they had a decent quality of life and that they were able to function in the world. They were able to have a job or go to school. Only 4% of people with schizophrenia got that using our best treatments available today. Those statistics aren't a lot better than they were 50 years ago, tragically.
18:24 Steven Bartlett? Chris, when people say to you, or when people say there were quite common rebuttal that the reason we're seeing this rise in mental health disorders is just because there's more of a conversation about it. So more people are stepping forward. We now have a word for it. So there's just more labeling and these mental health disorders, like the ones you've named, and even things like ADHD and autism, it's just because there's more conversation going on. And these things aren't in fact increasing.
18:49 Speaker 00 That is a common argument. And I would argue that it's like just putting your head in the sand. The easiest place to get an accurate read on the true prevalence of mental illness.
19:12 Speaker 00 And not just the recognition of it, but the true prevalence of it is to talk to school teachers who've been teaching for more than 30 years. If you ask them, "Were you just not recognizing the children 30 years ago who are screaming and tantruming in your classroom? Were you just not recognizing the children who were melting down when they got bad grades and injuring themselves in class? Were you just not recognizing the level of despair and anxiety that you see in children? Did you just have your head in the sand back then? And now, since everybody's talking about it,
19:56 Speaker 00 you see those behaviors, you see those symptoms. The schoolteachers and the guidance counselors will laugh at you and say, "No, no, no. Something has happened. Something horrible has happened." I wasn't ignoring mental health 30 years ago. I wasn't ignoring despair 30 years ago. I wasn't ignoring extreme anxiety and panic. I wasn't ignoring tantrums in my classroom 30 years ago. They are skyrocketing in prevalence. If we look at emergency rooms, so, emergency rooms in the United States,
20:41 Speaker 00 that's, I can speak best about statistics here in the United States. But I think in most Western countries, these statistics are similar. We have a crisis in mental health in emergency rooms, in particular, youth mental health, but it's across the board. We have all of these children and adolescents showing up to emergency rooms having attempted suicide, or they're becoming psychotic and they're diagnosed with bipolar disorder at skyrocketing rates.
21:22 Speaker 00 And we don't have enough services to treat these people, these kids, these adolescents, our children. We don't have places to put them. So they sit in emergency rooms, not getting optimal care, simply getting medicated, sometimes restrained to a hospital gurney so that they don't try to run away or hurt themselves. Talk to anybody in an emergency room. We're seeing that. Those people weren't hiding in their homes 30 years ago. Something's happening. They are actively acting on mental health symptoms.
22:07 Speaker 00 They are acting out of despair. The suicide rate has gone up. If you, in the United States, over the last 20 years, total suicide rate has gone up by about 30%. But if you look at a different statistic called deaths of despair, it has doubled in 20 years. Deaths of despair includes not only suicides, but also deaths from alcohol use, drug overdoses, and others. Those are mental health problems. Those are addictions. They are mental health disorders. They are in DSM.
22:50 Speaker 00 Rates have doubled in 20 years. People weren't dying 30 years ago and we just didn't recognize it. And now we're recognizing death. Now we're recognizing suicide. We didn't really recognize it 30 years ago, but now we recognize. No, no, no. We know what death is. Morticians know how to recognize it and diagnose it. And the rates are skyrocketing, a doubling in 20 years. That is nothing to ignore.
23:26 Steven Bartlett? That begs the question. What do you believe is causing it?
23:31 Steven Bartlett? Because clearly, you know, when I've heard people, when I say people, I mean, just the, you know, the things you see in culture and media, or maybe on Instagram, that say, you know, there's a chemical imbalance in people's brains. I've always struggled with that. I understand there might be sometimes, but I've struggled with that as a broad answer to a very complicated nuanced set of issues, because I just have a bias to believing that humans aren't born broken. You know, I believe that, you know, my ancestors go back very, I've got a lot of ancestors that I understand how natural, you know, natural selection and evolution works. I don't think that I was born broken. So I think maybe there's an environmental factor, maybe something I'm, I'm doing or something we're doing as a society is increasing these rates of suicidality that you talk about. What do you believe is the answer that we're missing?
24:17 Steven Bartlett? Or not talking about enough?
24:20 Speaker 00 The root causes, which we can get to, and, and I have lots of ideas and thoughts on it, if you want to get into the weeds of like, what are the exact causes? We can talk about that. But the thing that people have not opened their eyes to is the science of what we call metabolism or metabolic health. And what I ultimately am arguing, the easiest way for me to put it, is that what I'm arguing is that mental health conditions, the chronic, serious ones in which the brain isn't functioning properly, brain disorders that are causing mental health symptoms, those are the things I'm talking about now.
25:04 Steven Bartlett? That we're all susceptible to, you believe?
25:06 Speaker 00 I think we're all susceptible to it. Those, in fact, are metabolic disorders affecting the brain. And so the easiest way to understand why do we see skyrocketing rates of mental illness?
25:23 Speaker 00 It's not a coincidence that we're seeing those skyrocketing rates at the same time that we see skyrocketing rates of obesity, overweight, diabetes and prediabetes, which are also metabolic conditions, that all of those things are rising simultaneously. And that the brain is an organ. And so some people can have metabolic problems and some people can be thin and still have a metabolic problem. So I'm not at all saying that obesity is the only driver, because a lot of times people think about it in that way. So are
26:05 Speaker 00 you saying obesity comes first and then everybody gets a mental illness? No, I'm not saying it that way. Sometimes the mental illness starts first because it's a manifestation of metabolic dysfunction in the brain. And it basically means the brain isn't working right. And so somebody might have unrelenting depression, or unexplainable anxiety, or psychotic symptoms, or bipolar symptoms, or eating disorder symptoms, or substance use disorder symptoms, that they may have symptoms, but all of those things are a manifestation of metabolic dysfunction in the brain.
26:48 Speaker 00 Can you explain metabolic dysfunction to me like I'm a 10-year-old? The easiest way to explain it is that our bodies and our brains are made up of cells. And all of our cells need two essential things to function properly. They need food, oxygen. Those are the big ones that most people know. It gets much more complicated fast because food contains all sorts of nutrients, so we need certain vitamins and nutrients, and hormones are playing a role, all sorts of things are playing a role. But at the end of the day, that's what metabolism is. Metabolism is taking food and oxygen and
27:28 Speaker 00 keeping us alive. They are fundamental to our health, but also the function of our cells. And when something goes wrong in that process, and there are lots of things that can go wrong, when something goes wrong with taking food and oxygen and turning it into energy,
27:52 Speaker 00 The cell can malfunction. And when it happens in your brain, it means that your brain can malfunction. And the way that we know the brain is malfunctioning are all of the symptoms of mental illness. When somebody has depression for no good reason, when somebody has anxiety for no good reason, when somebody just has experiences like hallucinations or delusions for no good reason, that all of those things represent the brain malfunctioning.
28:33 Steven Bartlett? If you could take me one step deeper into this idea of food and oxygen being converted into energy in the cell, something goes wrong there. What goes wrong? Why does it go wrong?
28:48 Speaker 00 So the real answer is it's extraordinarily complicated. There are many pathways in metabolism. There are many things that play a role. But the easiest way to understand it and the way to unify it, the helpful insight, the immensely helpful insight. And this is new, cutting-edge information. Most people don't know this.
29:16 Speaker 00 But there are these tiny things in our cells called mitochondria. And they are actually the primary sites in our cells that food and oxygen are getting converted into energy or building blocks for our cells. When you do a deep dive into the science of mitochondria, you can actually begin to understand what's happening in the brains and bodies of people with mental illness. And you can begin to understand all of these very complicated things, like why would neurotransmitters become imbalanced?
30:00 Speaker 00 What's causing a neurotransmitter imbalance? If there even is one? What's causing a hormone imbalance? What's causing higher levels of inflammation in the brains and bodies of people with metabolic and mental disorders? What about the gut microbiome? How does that play a role? But what about stress and trauma? Psychological stress, trauma? How do those things fit in? Mitochondria are actually the scientific way to begin to connect all of those dots and help us understand why the brains of some people
30:45 Speaker 00 quote unquote malfunction or why they are dysregulated, might be a better way to put it, or why some people can't seem to quote unquote get over it, get over a trauma or get over a breakup with someone. What's going on? Why aren't they more resilient? Why can't they pull it together? Mitochondrial dysfunction, as nerdy and sciency as that is, can help us connect the dots.
31:16 Steven Bartlett? What do I need to know about the mitochondria? What it is? I know it's in every cell in my body. Is there anything else I need to know about it before we explore these through lines and how all of these other things come back and connect to the mitochondria?
31:29 Speaker 00 So mitochondria are present in most cells in the body.
31:34 Steven Bartlett? Almost.
31:34 Speaker 00 Not every single human. The glaring example are red blood cells, which actually lose their mitochondria. They have them when they are first forming, but then they lose their mitochondria. So red blood cells, interestingly, don't live all that long. We're constantly creating new ones and turning them over. So most people know mitochondria as the powerhouse of the cell, which means they take food and oxygen and turn it into ATP. And that's what most people learn in school. They're the powerhouse of the cell. But I'm here to tell you they are so, so much more than that. There are hundreds or thousands of them in most cells. They are highly dynamic.
32:14 Speaker 00 At one point, you know, the the theory of multicellular life on planet Earth is that mitochondria were once independent living bacteria and that another single cell organism engulfed that very first bacterium. And the two of those organisms lived, they stayed alive. Usually, when you get engulfed by another organism, that means getting eaten and you die. For whatever reason, these two stayed alive and they became symbiotic with each other.
32:58 Speaker 00 And actually, that event is thought to maybe have only happened once on Earth. And that single organism evolved into all multicellular life that we know today. So all living organisms that we can see with our eyes, plants, all animals are evolved from that same organism. So mitochondria divide and replicate. They actually move around cells. They fuse with each other. They bud off from each other. They they form patterns around the nucleus, cell nucleus,
33:41 Speaker 00 which plays a role in which genes get expressed or don't get expressed. They do all sorts of things.
33:48 Steven Bartlett? When people say that we have a predisposition, a genetic predisposition to mental health disorders and that, you know, you'll have depression if depression runs in your family, etc., is there merit in that, in your view? Is there evidence to support that?
34:01 Speaker 00 Absolutely. So we know that we know that mental illness runs in families. Genes explain some of that, but not all of that. The environment actually can
34:14 Speaker 00 Influence things called epigenetic factors, which are factors that control the expression of genes. They turn genes on or off. And those epigenetic factors are actually inheritable. You can inherit them from your parents. And so it's not all strictly genetics. Some of it is epigenetic. So first and foremost, there are no genes that are specific to specific disorders. Most people think, well, you know, bipolar disorder runs in my family. There must be a bipolar disorder gene. And in fact, there isn't a bipolar disorder gene.
34:59 Speaker 00 There are genes that increase risk for bipolar disorder. But at the same time, they also increase risk for schizophrenia and epilepsy and autism and depression and other types of mental and neurological disorders. And if you look at the unifying theme, like, is there a theme for these genes? Is there a common pathway that can help us better understand mental illness? The common pathway is that most of the genes are affecting metabolism and mitochondria. One research study that came out a couple of years ago, researchers have been looking
35:38 Speaker 00 for years at a high risk gene for schizophrenia. And we know that people who have this very, very rare gene, so almost nobody has it. But if you do have it, you're at high risk for developing schizophrenia, along with lots of other mental illnesses. But schizophrenia is the big one. And the researchers did this deep dive into trying to understand what exactly is this gene doing? And at the end of the day, they said, it's affecting mitochondria. And that is probably how it is causing schizophrenia.
36:12 Steven Bartlett? Metabolism, that happens as a result of the work of the mitochondria, is accurate. So we make sure I've been clear on them before we proceed.
36:19 Speaker 00 90% of metabolism, at least, is occurring in mitochondria. So it's That definition as a scientist, I have to say, isn't 100% accurate. Because there is a thing called glycolysis that can happen in cells where you can actually produce ATP without using mitochondria.
36:40 Steven Bartlett? What's that?
36:41 Speaker 00 So ATP is usually known as the energy currency of living organisms, of cells. And so, and that ATP ends up making cells work. It is the energy that's flowing around cells, or the molecule that's flowing around cells, to make receptors work, to make all of the machinery of cells work. And that becomes relevant, maybe some of your listeners will know this, if you exercise really hard, like you're running a marathon, or you're running as far as you can get with a marathon before you absolutely are exhausted and you just have to stop. Your mitochondria will actually become maxed out.
37:24 Speaker 00 That is what's preventing you from running, is your mitochondria max out. And it's like, you don't have enough of them, or they're not healthy enough. And so they just, they can't keep you going. They can't keep your muscles going. And so you peter out. And when you peter out, you start, you turn to this process called glycolysis, which actually ends up producing lactic acid or lactate. And so runners will get higher levels of lactate, and then that can create soreness and all sorts of things. But, yeah. That's, so metabolism is really the process of taking food and energy, food and oxygen, I'm sorry, and turning it into energy or building blocks.
38:07 Speaker 00 And that can occur on a small scale, outside of mitochondria. But as soon as the mitochondria in most of your cells are dysfunctional or dead, you die. There's no way around it.
38:21 Steven Bartlett? So let's use some of those examples that you gave earlier. You talked about stress and trauma and these kinds of things. I'm really keen to know how a traumatic event can have an impact on your metabolism, your mitochondria, which then manifests as a mental illness. So if we take trauma, for example, people go through early trauma in their life. I don't know, there's a, I mean, you had a very traumatic upbringing. How do you think that, maybe even in your case, if you were able to see inside of your body and what was happening, that external traumatic event came into your body in some way, caused a physiological reaction, had an impact on your metabolism, which results in a mental health disorder of sorts?
38:59 Speaker 00 It gets a little complicated because it goes through a couple of stages. So I'll try to walk you through it in the simplest way I can.
39:09 Speaker 00 When somebody is first traumatized, everybody, if they are normal, will have symptoms. If you get traumatized, you will experience fear, you will experience hypervigilance, you will want to fight or flee, or you might freeze, or you might surrender, you might beg for forgiveness, or mercy, or whatever.
39:34 Speaker 00 Everybody is going to have those reactions. In my mind, those reactions are not disorders. They are not malfunctioning brains or malfunctioning anything.
39:48 Speaker 00 So everybody will have that. However, when that happens, it immediately changes your metabolism. Your metabolism, the easiest way to understand it is the sympathetic nervous system gets turned on fiercely if the trauma is really bad, because you have to defend yourself. Your life is threatened, your safety is threatened. Traumas can even be less extreme than that. You can have highly stressful events in which maybe, even though your physical life isn't threatened, maybe all your money is threatened.
40:32 Speaker 00 The stock market crashes and you lose everything.
40:37 Speaker 00 And you now think, I'm worthless, I'm penniless.
40:45 Speaker 00 I'm losing my status in society. I'm gonna have to live a very different life. I've just disappointed everybody who depends on me. That could be a trauma, even though by definition, because it doesn't threaten your life, it's not technically considered a trauma.
41:03 Steven Bartlett? So for those people that are, you know, they've been through a traumatic event, what then is going on in their body as it relates to metabolism, based on that traumatic event?
41:14 Speaker 00 Trauma immediately changes metabolism. So, trauma puts us into this, you know, most people know it as fight or flight mode. And again, there are other responses that one can have. You can surrender, you can freeze, you can do other things. But when people feel threatened, either physically, or their reputation is threatened, or their identity is threatened, immediately their nervous system and hormones are changing.
41:54 Speaker 00 And the reason they're changing is because your, our bodies are hardwired to protect us. And in order to protect us, it means that we need more energy, and we need it now. We need more energy in order to be able to run, or to fight, or whatever we need to do. And that means that our heart rate goes up, our blood glucose goes up, cortisol is flowing, adrenaline is flowing through the body, inflammation is actually occurring, and epigenetic changes are occurring.
42:33 Speaker 00 Memory formation is occurring in a powerful way during a trauma. Memory, our brains are hardwiring this event so that we remember it. We remember this threatened us, and you cannot forget this. This is not a trivial moment. You must remember this for the rest of your life, because it's threatening your survival.
43:01 Steven Bartlett? And you must remember how to respond to this again?
43:03 Speaker 00 Not necessarily, because our responses can be all over the map. Sometimes our responses can be quite effective, and other times, people...
43:14 Speaker 00 Can die. They don't respond effectively and they are killed. I mean, that would be the worst case scenario. And then there's everything in between where you you get a suboptimal outcome. You end up homeless with your psychotic mother. That's not a very effective response.
43:29 Steven Bartlett? When I asked that question, I was asking, we see patterns in trauma, like a trauma pattern. There's a trigger, there's a response. And then, you know, I even think about some of the low, small t traumas that I had in my life. That meant that I would run from romantic commitment for the rest of my life, for example. And it was like a pattern. I was going through the same loop over and over again. Trigger, Steve's responses like this causes this outcome. Trigger.
43:53 Steven Bartlett? So I was wondering if I learnt at that very young age, that cycle somewhere in my like neurons in my brain. So that's why I said, do we then learn the response to that trauma at that point as well?
44:05 Speaker 00 We we learn the response. We remember the response that we did.
44:11 Speaker 00 And as long as we've survived, that is the ingrained memory. The ingrained memory is when this happens, do this, because this is what I did and I survived it. And so that becomes the default. And then that becomes a default pattern for many people. At some point in life,
44:36 Speaker 00 it can be actually be quite useful to look at that response. Okay, so when I was five years old or 20 years old or whatever, and that thing happened, I responded this way and I survived it. Great. But how's this working out for me now? Is that the optimal response? It's not about beating yourself up for I should have done something different back then. It's simply about recognizing and honoring. I did what I thought was the right thing to do. I did my best back then. But I'm smarter now. I'm older now. I'm wiser now.
45:21 Speaker 00 If I could do it again, if I could go back in time as my smarter, wiser self, would I do it differently? And what would the outcome be if I did it differently? And then that becomes highly relevant to today. So when I'm in this romantic relationship now, I keep having this urge to break up because this person is disappointing me in this way. And I feel like she or he is going to threaten me or betray me or whatever. And is that the right approach?
46:05 Speaker 00 Is it true that this person is going to betray me like the person in the past did? Or am I hypersensitive to that? Am I, again, we're wired to look for any clue that a trauma might happen again. So we're, we're going to over interpret things sometimes in an erroneous way.
46:31 Steven Bartlett? So that early trauma or that trauma I experienced made my body go into that survival mode, fired all kinds of ways and my glucose levels went out. My, all of these things, all metabolism related stuff happened. How does that then cause a mental health disorder at some point down the line?
46:48 Speaker 00 If that trauma is not resolved. So for some people, they can experience a trauma. They can be quite effective at mitigating it and move on with their life. Somebody could get into a fight. Somebody could get mugged on the street. They're just walking down the street. Somebody pulls a knife on them or a gun on them and wants to rob them. If somebody manages that trauma highly effectively, let's say you happen to have a black belt in karate and you disarm your assailant very quickly and rapidly.
47:30 Speaker 00 You may not think twice about the trauma. You may actually be emboldened after that traumatic event and think, "I'm quite effective and skilled. Wow, those karate classes really came in handy. And I'm quite powerful and maybe even feel a little more confident than you normally would."
47:47 Steven Bartlett? And that's the interpretation element, right, of the situation? So two people could be in the same situation, but have-
47:52 Speaker 00 So that person still had the same physiological reactions, a gun in your face or wherever. That person's glucose was going up, their heart rate was going up. All of those metabolic changes were occurring. But so that's a success story. And that's probably a resilient person who moves on and never thinks twice about that trauma or rarely thinks about it and thinks about it with pride if they do think about it. In the case where it doesn't go well at all, let's leave the extreme out where the person is murdered. Let's leave something less severe than that.
48:36 Speaker 00 But the person is beaten.
48:41 Speaker 00 They are injured severely.
48:47 Speaker 00 They are terrified to go out in public for fear that there could be another one just like that. That person, their fight or flight system is not turning off. Their fight or flight system is now on,
49:06 Speaker 00 at least at a low level, possibly a very high level, for a very prolonged period of time. They are now afraid of the world immediately after that type of horrific assault. They are now afraid of the world. They probably aren't sleeping as well. And what's happening physiologically, and we know this, is that those higher cortisol levels are actually causing something called hypermetabolism. Their mitochondria are actually working on overtime because the body is still primed for the world is unsafe. Everything is unsafe.
49:49 Speaker 00 Maybe that person who assaulted me is gonna somehow figure out where I live and come through that door any minute. So you're sleeping at night and you hear a sound or you hear a creak. And you panic and you wake up and you're startled and you're terrified. Or you sleep at night and you have a nightmare and you wake up and you're reliving that experience and just you're horrified and overwhelmed again.
50:13 Steven Bartlett? Is it, is this conscious? Because you know, often you speak to people with severe anxiety and they have panic attacks and they don't know what, why they're having panic attacks. They can't name something that they're scared of or a fear they have.
50:25 Speaker 00 No, this is not at all conscious. So at this point, in the week or two after a horrific trauma like I've described, I would argue this is not a disorder. This is not the brain malfunctioning. This isn't the body malfunctioning. The brain and body are doing precisely what they are programmed to do. Protect you. Your life is in danger. Why? Because somebody just tried to take it and they were close. They came close to taking your life. They could have killed you. And so your body and brain are trying to protect you. Unfortunately, that comes at a cost.
51:08 Speaker 00 All of this energy going toward the defense system means that energy that should be going toward maintaining your cells is actually being bypassed sometimes. So we know this. So for example, there are these things called stress granules, where cells that are trying to just do basic ho-hum everyday repair work, create some new proteins or new receptors or, you know, do some cleanup work. The code for those, which are called messenger RNAs,
51:49 Speaker 00 actually get sequestered in these little bubbles called stress granules. And what that means is that they're not getting done. The messages are starting from your DNA because the cell is saying, hey, I need some repair work over here. Send some new proteins over here to do some repair work. When your body is in fight or flight mode, those messages actually get interrupted. And that means, bottom line, it means that when you feel threatened, your body is diverting metabolic resources toward your self-defense system.
52:30 Speaker 00 Hypervigilance, be ready to run at any minute, be ready to fight off the offender at any minute. You cannot feel safe, don't feel safe. When that goes on for a prolonged period of time, your cells can fall into a state of disrepair because metabolic resources are not going toward cell maintenance. If that occurs long enough or in a severe enough way, it means that some of your cells can now fall into a state of disrepair and they can begin to malfunction. When that happens, if it's happening in brain cells,
53:14 Speaker 00 that's when I would say the person has crossed the line from a normal survival reaction to trauma. If their cells in their brain begin to malfunction now because they are on a state of disrepair, that can turn into what we call a mental illness. And that means that maybe they can't remember like they used to. It means that maybe, and now they can't pay attention like they used to. Now, somebody might say, hey, maybe you've got some ADHD going on.
53:52 Speaker 00 Or their anxiety pathways become what's called hyperexcitable. And now their anxiety pathways are being triggered even when they shouldn't be triggered. And out of the blue, they're having panic attacks or anxiety symptoms. They can be sitting in the comfort of their own home, not thinking any scary thoughts, not watching anything on television or anything that's really disturbing. And out of the blue, they can just be overwhelmed with a panic attack. And that person...
54:32 Speaker 00 I would say if they have a panic attack for no reason, that person's brain is now malfunctioning. It is dysregulated. And I would say that that person has now crossed over into what I would call a mental disorder where their brain is in fact malfunctioning now. The great news, the hope, and we can get to more of it, is that that those cells can be repaired. We can fix that. We can do something about that. The person does not need to be like that forever. This notion that they now have a chemical imbalance that they were probably genetically predisposed to,
55:17 Speaker 00 and now we've got to just medicate them for the rest of their life. I don't agree with that. I'm not at all opposed to medication. If medications can be helpful to that person, 100%, let's use them. Let's help that person heal and recover. But I want to go deeper. I want to understand what is happening in that person's brain and body using this kind of information about metabolism and mitochondria? And how can we effectively help them heal and repair and recover?
55:58 Steven Bartlett? You know, we talk a lot about diet and food on this show as it relates to metabolism and mental health, diet.
56:07 Speaker 00 So diet is huge. And most people have no clue that diet plays any role in mental illness or mental health. 95% of mental health clinicians think it's laughable that anybody would suggest that diet can play a role in mental illness. They think it's laughable.
56:34 Steven Bartlett? What do you think?
56:35 Speaker 00 I think.
56:38 Speaker 00 If you do a deep dive into the science, all of the science that we have accumulated over the last 100 years, and longer sometimes. If you do a deep dive into all of those neuroimaging studies that we've been doing, all of the genetic studies we've been doing, all of the neurotransmitter and hormone studies, and trauma studies, and adverse childhood experiences studies. If you do a deep dive into the science, and you understand what is happening in the brains and bodies of people as a consequence of those things, or what could be causing those things. If you put it all together,
57:21 Speaker 00 you come to this soundbite that mental disorders are metabolic in nature. And there is no questioning whatsoever. It is incontrovertible that diet plays a massive, huge role in metabolism. And therefore, I believe very strongly that diet might be playing a role in the mental health epidemic that we are seeing. And it also might provide an avenue of hope and healing and recovery.
58:05 Speaker 00 And I use the word "might" as the scientist in me, as the clinician in me. I know without certainty it can heal and recover people who have had chronic, horrible, debilitating mental illnesses. And I know from my own personal story... When I was in medical school and residency, I'm still suffering from low-grade depression, OCD, other symptoms. But I also developed what's called metabolic syndrome. I developed high blood pressure, high cholesterol, prediabetes. And I wasn't really overweight. I was exercising.
58:49 Speaker 00 I was following a low-fat diet, mostly of processed foods because they're cheaper. But that was the diet that was touted as a healthy diet. It was low in fat. And as long as it was low in fat, that was supposed to be good for us. And my metabolic syndrome just kept getting worse and worse. And so at some point, in order to treat my metabolic syndrome, I changed my diet to essentially a low carbohydrate diet. And within three months, my metabolic syndrome was completely gone.
59:31 Speaker 00 But the thing that just dumbfounded me was that my mental health was better than it had ever been in my entire life. And I just couldn't believe what I was experiencing. I didn't know that I could be that kind of a person. I didn't know that I could be happy and positive and energetic and confident. I had no idea. I didn't think that was in me. And by changing my diet, all of those things happened.
1:00:05 Steven Bartlett? At the level of the mitochondria, are you saying, do you believe that because you changed your diet to more sort of natural, healthier foods, at the level of the mitochondria, the mitochondria were able to function more naturally themselves and in a more functional way, which meant that... They released the chemicals they released and the processes they go through were more consistent with positive mental health. Is that like the simpletons way of understanding it? And before then, you talked about manmade compounds in the foods, et cetera. I'm assuming you're saying that some of the modern foods that we eat, the ultra-processed
1:00:48 Steven Bartlett? foods that have all of these random named chemicals inside them that we see on the labels, the mitochondria don't know how to deal with that. So it's causing the same sort of dysregulation and dysfunction that they might see if we'd gone through like an extreme trauma or something else, or some other adverse environmental situation. It's just this dysfunction of the mitochondria, which is causing the knock-on effects we see. But there's many things that can cause dysfunction in the mitochondria. And we went through a bunch of them earlier. Is that like a simple way of understanding it?
1:01:16 Speaker 00 Hundred percent.
1:01:16 Steven Bartlett? Okay, great.
1:01:17 Speaker 00 Perfect.
1:01:18 Steven Bartlett? Super interesting. Okay, so on that point then, we have to zoom in on this thing of diet. If you wanted my mitochondria to be perfect, and maybe even give me a case study of, I don't know, patients you've worked with that you've prescribed a certain diet to, what diet, what food would you tell me to eat? And what would you tell me not to eat?
1:01:41 Speaker 00 So I actually don't have a one-size-fits-all prescription. And so I want to say that upfront. So I would want to know, who am I working with? And how is there mental and metabolic health now?
1:01:58 Steven Bartlett? Me.
1:01:59 Speaker 00 So you?
1:02:00 Steven Bartlett? Yeah.
1:02:01 Speaker 00 So I would want more details. Are you having symptoms of any mental health condition?
1:02:07 Steven Bartlett? I would say no. However, I can, I can have moments where I feel a little bit anxious. So, you know, I've been through a lot of, I'd say like stressful events in my life because I was running a big business, we had hundreds of employees, paydays all the time. So I had this, at one point, I had this constant subtle stress.
1:02:29 Speaker 00 And so I would want to know, do you feel like you have anxiety for no good reason?
1:02:35 Steven Bartlett? Sometimes. Sometimes it can feel a little bit like that. It's very infrequent, I'd say.
1:02:44 Steven Bartlett? But I can also have moments where I just think of something and then I get the same kind of like, it's almost like the fight or flight response has just kicked in.
1:02:51 Speaker 00 But you think of something adverse or stressful?
1:02:54 Steven Bartlett? Yeah, yeah, yeah.
1:02:55 Speaker 00 So, so the, so the one thing I would say about that, and we could get into a lot more details, which we probably don't want to do now.
1:03:05 Steven Bartlett? I don't mind.
1:03:05 Speaker 00 Podcast, but my, my strong guess, based on just what you've said, is that that level of stress and anxiety is quote unquote, "normal."
1:03:17 Steven Bartlett? Okay.
1:03:18 Speaker 00 Because you, you are sensing, "I have to go do something that's really scary right now," or "I have to go do something that's going to ruin someone's life," or "that, that might threaten my success." It is normal and actually healthy to have anxiety and stress in those situations. The anxiety and stress can sometimes be quite helpful and adaptive because it can make you pause and reflect on, "Is this really what I want to do?" As opposed to being overly confident and just proceeding.
1:03:59 Speaker 00 Your own personal history almost certainly informs your level of stress response. And again, so if you go back to your own traumas, you're going to remember, when I'm facing a situation like this, it's helpful to be on hyper alert. It's helpful to be hyper vigilant. And your body and brain will remember that helped you navigate this safely and effectively.
1:04:28 Steven Bartlett? But if I have that profile, if I have that sort of mental profile now as I sit here, and then for the next decade, I ate processed junk food.
1:04:41 Steven Bartlett? Am I going to send my mitochondria into disarray, which is going to increase the probability that I have a mental health disorder?
1:04:47 Speaker 00 Yes, I think yes. We've got, you know, we, there's no way we will ever be able to do a human randomized controlled trial to test that precise
1:04:58 Steven Bartlett? unethical.
1:04:59 Speaker 00 hypothesis. But we have large epidemiological studies that strongly suggest that people who eat a lot of ultra-processed food have higher risk for developing depression, anxiety, and other mental disorders. And based on the science, the granular science, based on animal models. So we can do that to mice and rats. And in fact, that's exactly what we see in mice and rats. We feed them an obesogenic diet,
1:05:37 Speaker 00 which is usually high in fat, high in carbohydrates, ultra-processed foods. Some researchers have fed rats and mice cafeteria diets, where they feed them a lot of delicious junk food. And those mice develop higher rates of obesity, but also higher rates of diabetes and prediabetes. And oh, by the way, also higher rates of depression and anxiety. Because those are the two things that we can kind of measure in mice and rats. We can't necessarily measure ADHD symptoms. It's really hard to actually measure psychotic symptoms.
1:06:19 Speaker 00 But we can measure depression and anxiety symptoms pretty well in animals. And so in animal models, we know that that's unequivocally true.
1:06:27 Steven Bartlett? And we see the same in humans, though, because I was reading your book. And in chapter four, you say, people with ADHD are more likely to develop obesity. People who are obese are 50% more likely to develop bipolar and 25% more likely to develop anxiety or depression. And weight gain around the time of puberty leads to a 400% increase in the chance of depression by the age of 24.
1:06:48 Speaker 00 Yes, and insulin resistance at age nine.
1:06:54 Speaker 00 Makes increases your chances of developing a psychotic at-risk mental state, which is like, meaning you're at high risk for developing schizophrenia or bipolar disorder, 500%.
1:07:05 Steven Bartlett? And Alzheimer's?
1:07:07 Speaker 00 All mental disorders are associated with an increased risk of Alzheimer's disease, anywhere from the lowest is 50% increased risk and the highest is 2,000% increased risk.
1:07:22 Steven Bartlett? And the thread that unites all of these problems is metabolism.
1:07:27 Speaker 00 Metabolism. And at the end of the day, you have to talk about mitochondria in order to understand metabolism.
1:07:38 Speaker 00 Only 7% of US citizens have no signs of metabolic health problems. Meaning 93% or so of US residents will have at least one of the biomarkers of metabolic syndrome. Meaning they have prediabetes, or abnormal lipids, or high blood pressure, or abdominal obesity, or abdominal fat, excessive abdominal fat.
1:08:13 Steven Bartlett? So what do we offer those 93%?
1:08:16 Speaker 00 So those people, diet interventions would absolutely be a part of a healing strategy.
1:08:26 Speaker 00 A part of it, not the only strategy. I would want to know about their sleep. I would want to know about substance use. I would want to know about medications, lots of things. But for dietary interventions, I would want to meet them where they're at and just find out, well, where are you at? What are you eating? Do you have preferences or demands for what your diet should be?
1:08:49 Steven Bartlett? Could you give me a case study then? Maybe a more extreme case study from your practice that you've seen?
1:08:56 Speaker 00 I could, I can give you the simple cases where, which probably apply to the majority of human beings on the planet. But if it's okay, I'd rather give you the extreme case. Because a lot of people are skeptical. They probably hear me saying this and they think, well, you're just talking about general health and wellness.
1:09:22 Speaker 00 What about people with real mental illness? What about people like your mother, whose lives were decimated by mental illness? This doesn't have anything to do with them. And what I'm here to say is, no, actually, this has everything to do with them too. But yes, it applies to just common, everyday people. But, you know, probably, so one story that I will just share to just, because it's probably one of the most powerful stories I know. It was a woman whose real name was Doris. And in the book, I called her Mildred, because I changed everybody's names.
1:10:06 Speaker 00 But she actually gave me permission to use her real name. So in honor of her, I want to use her real name. So she was a woman who actually had a horrible abuse of childhood, lots of trauma. And by the time she turned 17, she started having daily hallucinations and delusions, and was diagnosed with schizophrenia. Over the ensuing decades, she tried numerous antipsychotic, mood stabilizers, antidepressants, and other medicines, but none of them stopped her symptoms. She remained with all of the symptoms of schizophrenia. She ended up gaining a massive amount of weight.
1:10:51 Speaker 00 She ended up weighing about 330 pounds by the time she was 70. Her life was devastated by this diagnosis. She had a court-appointed guardian to manage her financial affairs and other affairs. She had professionals coming into her home to help her with paying bills and grocery shopping and stuff like that, because she couldn't do it for herself, which is not at all unusual for people with schizophrenia. And between the ages of 68 and 70, she tried to kill herself at least six times and was hospitalized for those suicide attempts. She hated herself, and she hated her life.
1:11:34 Speaker 00 When she was 70 years old, her doctor told her, "You're overweight and you need to go lose some weight." And she was referred to a weight loss clinic at Duke University, where they just so happened to be using the ketogenic diet as a weight loss tool. And for whatever reason, she decided to give it a try. And so she tries the ketogenic diet. And within two weeks, not only does she start losing weight, but she notices dramatic reduction in her hallucinations and delusions. Within months, all of her symptoms of schizophrenia were in full and complete remission.
1:12:18 Speaker 00 She starts tapering off her psychiatric meds. And then about six months, she was off all of her psychiatric meds. And her symptoms of schizophrenia remained in remission. Doris went on to live for another 15 years, symptom-free, medication-free, out of psychiatric hospitals, no more suicide attempts. She stopped seeing mental health professionals pretty quickly because they were kind of worthless in her mind. They hadn't really helped all that much. She lost 150 pounds and kept it off until the day she died.
1:13:01 Speaker 00 She ended up dying at the age of 85 of COVID pneumonia. And but her story tells us, like, we could get, if you want, we don't have to. We could get into the science of the ketogenic diet and what it's doing to metabolism and mitochondria.
1:13:23 Steven Bartlett? I'd love to know.
1:13:24 Speaker 00 But there's an entire story that helps us understand what happened to her and how exactly that resulted in her really spectacular and almost miraculous recovery. So unbeknownst to most people, most people know the ketogenic diet is a fad diet. And a lot of people are really worried about it. They've heard that it's dangerous. It'll give you a heart attack. You'll die. Unbeknownst to most people, the ketogenic diet was developed over 100 years ago now by a physician for one and only one purpose. It was developed to stop seizures.
1:14:03 Speaker 00 And in fact, the ketogenic diet has been studied extensively for its effects on the brain over the past hundred years. And it is an evidence-based treatment for epilepsy. And the reason that is so important is because we use epilepsy treatments in psychiatry all the time. Lots of the medications that we prescribe to psychiatric patients are in fact epilepsy treatments. And so we know that there's a lot of overlap between epilepsy and mental illness, and that treatments that help with epilepsy can also help with mental illness.
1:14:45 Speaker 00 And so we actually know more about the biology of the ketogenic diet and its effects on the brain than we do any other dietary intervention. It changes neurotransmitter systems. It decreases brain inflammation. It changes the gut microbiome in beneficial ways. It actually changes gene expression or epigenetics. But most important and relevant to my theory is it improves mitochondria and mitochondrial function. And if you do it long enough, over a long enough period of time, you can actually repair mitochondrial dysfunction in cells, at least for some people.
1:15:30 Speaker 00 And then you can actually stop the diet. So in the epilepsy world, when neurologists use this diet to stop seizures, it's usually not a lifetime treatment. They usually only need to do the diet for anywhere from two to five years. Many people, about a third of people who have treatment-resistant seizures will become seizure-free. And another third, so two-thirds total, another third will have a dramatic reduction in seizure frequency. So that leaves a third for whom it's not really working. But these are people with treatment-resistant epilepsy. And there's no treatment that's going to work for everybody because we need to look at all of the other things involved.
1:16:13 Speaker 00 If, say, somebody has seizure cessation, they get rid of their seizures on a ketogenic diet, usually they have to do it for two to five years, somewhere in there. Their clinician will help them decide how long they should do it. And then they can stop the diet. And most often, the seizures don't come back. It seems to actually heal the brain.
1:16:37 Steven Bartlett? What is that diet adding or subtracting from the body that's causing that pretty phenomenal effect? Do people know?
1:16:44 Speaker 00 The real answer is we don't entirely understand. We don't know.
1:16:49 Steven Bartlett? I mean, the ketogenic diet removes sugar, for example.
1:16:53 Speaker 00 It does.
1:16:56 Steven Bartlett? Pretty much entirely. I mean, I've been on that diet for about, I was on the diet for about eight weeks or so, just to try. And I couldn't have anything with sugar in it, pretty much.
1:17:06 Speaker 00 No sugar, no carbohydrates, very few carbohydrates. The, so some people will argue, well, the diet is getting rid of gluten, and gluten is maybe the toxic thing. Other people will argue, oh, the diet is adding like some extra protein or meat, and maybe that's replacing a nutrient deficiency, like vitamin B12 deficiency or something like that, or iron deficiency. And all of those things might be true for some people. I don't think those are the primary explanation. I mean, obviously, if somebody has vitamin B12 deficiency, replacing vitamin B12 is essential. If somebody has iron deficiency, yes, recognizing that and replacing it.
1:17:52 Speaker 00 But most people don't have those deficiencies, and they can still have mental symptoms or mental health problems. I believe what the diet is doing is it forces a transition in brain and body metabolism, essentially. And that transition is actually mediated through mitochondria. So the ketogenic diet forces your liver to start producing ketone bodies. So it forces your liver to break down fat. So you're losing fat from your fat stores, but that fat is being shuttled to the liver. And then the liver takes that fat and breaks it down. And I mean, I shouldn't say all of the fat is being shuttled to the liver.
1:18:37 Speaker 00 Some of the fat is going to muscles and other tissues and just being used directly. But a fair amount of the fat is actually being shuttled to the liver. And then that fat is being converted into ketone bodies. Some of it is being converted into glucose, so that you maintain normal glucose levels through this. Those ketone bodies are then going up to the brain and fueling brain cells. But those ketone bodies are actually doing so much more. They're changing mitochondrial function. They're changing epigenetics. They're changing neurotransmitters and inflammation and all sorts of things. But at the end of the day, I'm convinced that it's really the metabolic changes and the mitochondrial changes
1:19:22 Speaker 00 that are so important and that are so instrumental in these dramatic improvements in things like stopping seizures or stopping hallucinations and delusions.
1:19:34 Steven Bartlett? What about fasting? There's been a lot of talk, especially recently, about fasting and the impact that that can have on our mental health. Do you think fasting is a positive for our mental health?
1:19:47 Speaker 00 So it depends on the person.
1:19:48 Steven Bartlett? Okay.
1:19:49 Speaker 00 And so the ketogenic diet actually mimics the fasting state. That's why it was produced.
1:19:56 Steven Bartlett? Oh, right.
1:19:56 Speaker 00 The ketogenic diet was actually developed by a physician.
1:20:01 Speaker 00 Recognizing that fasting can have really powerful brain effects, including stopping seizures. If you're out on an island and your friends start seizing uncontrollably, the best thing to do is to fast them. Even if the seizures stop intermittently, you would think, oh, let's feed you to, you know, keep up your sustenance and, you know, take care of you. The best thing to do for your friend, if they are seizing repetitively over days or months, the best thing to do is to fast your friend and to tell them, let's have you go without food for a few days. And that can stop the seizures.
1:20:41 Speaker 00 The challenge with fasting is that you could starve to death if you do it long enough. And that's not a very good treatment for your friend on the island. And this physician who developed the ketogenic diet recognized that. And so that's why he developed the ketogenic diet, was really looking to see, can we mimic the fasting state with a diet? And get these longer term benefits. So back to your question, can fasting play a role? Hundred percent, yes, fasting can play a role. And fasting is doing pretty much the same thing that the ketogenic diet is doing. It's changing mitochondrial biology. It's improving mitochondrial function,
1:21:25 Speaker 00 changing neurotransmitters, changing the gut microbiome, improving insulin signaling and insulin resistance. It's doing all sorts of beneficial things. There are a couple of caveats with fasting, though. One is that people who are underweight should not fast. So that includes people with eating disorders who are emaciated or underweight. But it also includes people like who have had severe depression and lost weight as a result of their severe depression, or people with cancer who have lost a significant amount of weight. Fasting is not good for them. Fasting mimicking diets, like ketogenic diets,
1:22:08 Speaker 00 may in fact be very powerful for those people. But it needs to be done in a safe supervised medical way.
1:22:16 Steven Bartlett? Sugar. What impact does that have on the mitochondria? If I've got a super high sugar diet, is that impacting my mitochondria in some way and therefore my metabolism?
1:22:25 Speaker 00 It is. So low.
1:22:31 Speaker 00 Low intake of sugar in people who are otherwise healthy is perfectly fine and acceptable. So lots of people can consume treats every now and then, or desserts a few times a week, or special holiday, they can maybe even binge on sugar over the holidays. And they don't have any problems as a result of it. And that is fine. If that's the way it's working out. Again, only 7% of the population is metabolically healthy. So the majority of people, that's not the way it's working out.
1:23:14 Speaker 00 So high levels of sugar over time, we know can impair mitochondrial function. So there's this term called oxidative stress. And oxidative stress is primarily, it's directly related to mitochondria, because mitochondria are producing the energy, and then that energy production results in oxidative stress. And oxidative stress, we've known for decades, is bad for cells. And it is highly correlated with all of the metabolic disorders and all of the mental disorders. High levels of oxidative stress in different cells,
1:23:57 Speaker 00 in different people with different diagnoses, high levels of oxidative stress are a unifying theme. But that is a reflection of mitochondrial dysfunction. So we know that if you eat, if you eat a lot of sugar over time, it can dysregulate glucose levels. And then those high glucose levels can cause mitochondrial dysfunction, and you can end up kind of on the downward spiral.
1:24:26 Steven Bartlett? What about caffeine and these stimulants? There's like pre-workout stimulants. And, you know, before you do a workout, you have a big dose of this pre-workout, and it kind of makes you go, ah, like, you know.
1:24:37 Steven Bartlett? Do you have a view on caffeine and these sort of energy stimulants?
1:24:43 Speaker 00 I do. So caffeine gets complicated because we have to talk about whether it's in tea or coffee or not, because tea and coffee are different stories and they have other compounds that almost certainly are beneficial to human health. And whether it's the caffeine itself or not is still kind of a question, an open question. Caffeine stimulates metabolism in cells. We know that. So it blocks the adenosine receptor. And the adenosine receptor, the function of the adenosine receptor and adenosine on it is to slow a cell down. It's
1:25:25 Speaker 00 basically a feedback loop that slows cells down. It inhibits their function. So when we block adenosine, we basically stimulate the system and we stimulate our brains. And if you have low metabolic brain function, that can actually be really good. If you are feeling tired and sluggish, it can make you feel energized and clear thinking. The challenge is that you can overdo it. So when you stimulate it too fast, that in and of
1:26:05 Speaker 00 itself can end up causing oxidative stress or mitochondrial dysfunction. Maybe the easiest way to think about it is this. If you think about a car, you have an accelerator and a brake. If you're going to maximize the car's function, there's a right balance for all of that.
1:26:31 Speaker 00 You don't want to floor the accelerator and you don't want to underdo the accelerator. Likewise, you want to determine like you don't want to be pushing on the accelerator and the brake at the same time. So when we think about metabolism and mitochondria, when we think about caffeine or even glucose, caffeine and glucose are stimulating the system. They are through different mechanisms, but they are both stimulating energy production. But when you overdo it, it would be like flooring the accelerator. And then possibly putting on the brake at the same time because you don't want to be going that fast because you're going to crash.
1:27:16 Speaker 00 So either you're going to floor the accelerator, crash and burn, or you're going to floor the accelerator and slam on the brake at the same time. You're not serving your car well by doing that, by flooring the accelerator and pushing on the brake. And when we use substances like caffeine or alcohol or marijuana, which are all working at the level of metabolism and mitochondria, when we use those substances, in essence, we're using accelerators or brakes for cells. And we can overshoot or undershoot. So it's not that I'm against the use of those things.
1:27:56 Speaker 00 If you use reasonable, small to moderate amounts of those on a regular basis, I'm all for it. So I drink coffee every day, every morning.
1:28:08 Steven Bartlett? I was just going to hide this.
1:28:09 Speaker 00 To disclose my bias, to disclose my bias, I drink coffee every morning, about two cups of coffee every morning, but that's my routine. I don't go beyond that. I don't drink coffee in the afternoon. When I do drink coffee in the afternoon, I notice it starts to interfere with my sleep and then that throws me off.
1:28:30 Steven Bartlett? I have to ask you as well, I've had so many parents message me about autism and ADHD, so many. You know, I've had so many concerned parents message me specifically on Instagram saying, please, Steve, you know, I've had a child diagnosed with autism, they're trying to understand it, they're trying to get good information on it. You've used the word autism and ADHD as we've been speaking about metabolism. What is the link in your view?
1:28:56 Speaker 00 Everything. The link is everything. So the
1:29:00 Steven Bartlett? Really?
1:29:00 Speaker 00 The mitochondrial theory of autism actually was first proposed in 1985. And since then, we have had an explosion of research linking mitochondria and mitochondrial dysfunction to autism specifically. As I've mentioned to you, the rates of autism have gone through the roof. In the United States, it quadrupled in the last 20 years. And people think, well, what does that have to do with diet? Those kids haven't eaten a diet yet. Well, their parents have. And let me share a couple of statistics. So people are scratching their heads. Where's all this autism coming from? I thought autism was genetic.
1:29:43 Speaker 00 And if autism is genetic, it shouldn't quadruple in 20 years.
1:29:49 Speaker 00 Quadrupling in 20 years means something in the environment is causing it. And to provide just one piece of evidence to support what I'm saying. If a woman has obesity, she has double the risk of having an autistic child. If a woman has diabetes, she has double the risk of having an autistic child. If a woman has both obesity and diabetes, she has quadruple the risk of having an autistic child.
1:30:33 Speaker 00 If a man is obese, he has double the risk of having an autistic child. So people are scratching their heads, trying to figure out, where's all this autism coming from? Well, look around in the population. Are the rates of obesity going up? Are the rates of diabetes going up? The answer is unequivocally yes.
1:31:00 Speaker 00 And that is a reflection. It's not about fat shaming. I don't want anybody to hear that and wag their finger at fat people and say, "Oh, you're causing autism because you're overeating." It's not that simple. That's not the way it goes. People with obesity have a metabolic or mitochondrial problem. That is why they have obesity. Now, that might be caused by the foods they're eating, but they don't know any better usually. They think it's just about calories. And what I'm here to say is, no, there's more to food than just calories. It might be those chemicals in the food that you're eating or something else.
1:31:43 Speaker 00 Or it might be chemicals in our environment. It might be pesticides or microplastics, the forever chemicals that are becoming more and more ubiquitous. All of these things disrupt metabolism and mitochondrial function. And so when I talk about obesity and diabetes, increasing risk for autism, it's not about fat shaming. It's about understanding. It's about understanding that the parents have a metabolic problem already. That means that they have a problem in their cells with their mitochondria. And they then pass those on to their children.
1:32:26 Speaker 00 And in some cases, it may not show itself immediately as obesity or diabetes. It might show itself as a brain condition because lots of other things can play a role. And if an obese woman, for instance, also has an infection during pregnancy, that's going to increase her risk for having an autistic child even more. So she couldn't help whether she got an infection or not. Tragically, we just had an epidemic called COVID. And the early signs are telling us
1:33:07 Speaker 00 that in fact, neurodevelopmental disorders are going to increase as a result of that. We already had a quadrupling of the rates of autism. We are likely to see even worse statistics going forward.
1:33:26 Speaker 00 The hope is that if we understand that science, we can do something about it now, today. If you understand, if you see signs of autism in your child, if you see signs of metabolic or mental health conditions in your children, if we intervene early enough, we can probably do something about it.
1:33:53 Steven Bartlett? How?
1:33:56 Speaker 00 Number one, by recognizing the problem. And then two, for some people, it could be as simple as dietary interventions or just hyper focusing on good, clean living. So that means prioritizing sleep, little less screen time, little more human contact, purpose in life, you know, family connection.
1:34:22 Steven Bartlett? No alcohol.
1:34:23 Speaker 00 No alcohol, no marijuana, no CBD. Try to avoid pills. Try to avoid pills for everything that ails you. If your child's sleeping, please try methods other than pills, including melatonin and over the counter pills. Don't just whip out a pill for your child not being able to sleep. At least try some other interventions. Like, let's get you off the screen two hours before bed. Let's develop a routine in our household that we're all going to wind down. We're all going to turn off the electronics. Maybe I'm going to read you a bedtime story or we're going to play a game or we're going to do something really boring
1:35:06 Speaker 00 that everybody's going to say, this is so boring, I'm getting sleepy. And I'm going to say, great. It's so boring that you're getting sleepy. That means you're going to go to sleep because it's bedtime.
1:35:18 Steven Bartlett? I have to ask, you mentioned that you moved in with your mother to try and save her. When she was suffering with a multitude of sort of mental health disorders, what is that like as a child? I was trying to imagine if I moved in with my mother when she was, you used the word delusional, right? What is that like? I've heard people speak to me about a parent with dementia and that kind of that loss. But what is the loss like that you experienced? If I was a fly on the wall in those moments, what would I have seen? And if I was a fly inside of your heart, what would I have felt?
1:35:58 Speaker 00 It was actually really horrendously awful.
1:36:07 Speaker 00 When I first moved in with her, we had a little bit of money still. And so we were living in a rooming house. We were renting rooms. At some point, the money ran out and the support that we were getting wasn't enough. And that's when we became homeless.
1:36:29 Speaker 00 But almost from day one, living with someone who is severely depressed and suicidal and psychotic.
1:36:43 Speaker 00 It's hard to not feel that yourself. It's like you're living in this
1:36:53 Speaker 00 just oppressive cloud of despair.
1:36:59 Speaker 00 And it's everywhere. It's in the air. Like when you're in the home with that person, it's in the air that you're breathing. It's hard to describe it.
1:37:13 Speaker 00 But that hopelessness just overwhelms. I mean, you try to cheer the person up and it's just futile.
1:37:23 Speaker 00 And I remember, I think the first like three or four months I lived with her, I like cried myself to sleep every night, like just sobbing, crying, crying into my pillow so that she wouldn't hear me because I didn't want to burden her.
1:37:45 Speaker 00 But I didn't know what to do. I was just, I was, it was just overwhelming.
1:37:53 Speaker 00 And after about four months, I actually, I couldn't cry anymore. I just lost the ability to cry. I became numb. I just, I, I couldn't tolerate those emotions, that just despair. I couldn't, I couldn't manage it. That actually persisted with me for probably like 20 years. I wasn't able to cry for like 20 years. There was a part of me that just felt like, you know, crying is weakness and crying is futile. It doesn't do anything. It doesn't solve any problems.
1:38:40 Speaker 00 It's interesting because when I was with her, I hadn't gotten to the point of suicidality myself. I was desperately wanting to stay alive to see if I could help her and keep her alive. Within about a year of that, though, I started developing my own suicidality. And, um, and that persisted in me for years after. I tried to kill myself several times. I was injuring myself. I was doing all sorts of things.
1:39:22 Speaker 00 I was very, I was actually convinced. If you asked me at the time, I would have said I was 100% certain that I wouldn't be alive to the age of 20. I, I knew with certainty that I would be dead. And I knew that I just couldn't tolerate living and that there was no hope for me whatsoever.
1:39:45 Steven Bartlett? Chris, thank you. Your book is full of solutions and it's full of hope. And I think that's why it's such an incredibly important book. And it's a book that has the bravery to illuminate another set of answers and another path forward out of the despair and the epidemic of mental health illness that we're, unfortunately, I agree, we're heading, we are in and increasingly heading towards, if that makes sense. It's certainly increasing in prevalence. A revolutionary breakthrough in understanding mental health and improving treatment for anxiety, depression, OCD, PTSD and much more. Brain energy, really, really remarkable book. And once upon a, once in a while, books come along that challenge the status quo in the most
1:40:30 Steven Bartlett? necessary way. And your book is certainly one of them. We have a closing tradition on this podcast where the last guest leaves a question for the next guest, not knowing who they're leaving it for. And the question that's been left for you is, you are known for your work, Chris, but what would you like to be known for as the human that you are?
1:40:51 Speaker 00 I think I would like people to know, like I've shared with you today,
1:41:00 Speaker 00 that I was somebody who had given up on myself, who actually thought there's no possible way I could ever have a future, I could ever live a meaningful or even tolerable life.
1:41:19 Speaker 00 And that all has changed.
1:41:23 Speaker 00 And if it can change for me, and you happen to be one of those people in a similar state right now, it can change for you too.
1:41:34 Steven Bartlett? Chris, thank you. Thank you so much. You know, there's this...
1:41:39 Steven Bartlett? There's this wonderful quote that I read earlier from the start of your book, where you send that message to your mother. My futile attempts to save you from the ravages of mental illness, lit a fire in me that burns to this day. I'm sorry I didn't figure this out in time to help you. May you rest in peace. But I have to point out the fact that the work you're doing, the passion you're bringing to it, the wisdom and the 28 years of study and care you've put into all of the work that exists in your book and your wider work, is saving many people's mothers. Thousands of peoples of their mothers, their fathers, their daughters, their sons. And that, I think, is an absolutely incredible thing.
1:42:23 Steven Bartlett? So on behalf of all of those people that you'll absolutely never meet, you'll meet many of them. I'm sure many of them message you. But all of the ones that aren't able to or haven't yet, I just want to extend a big thank you for the work you've done in your life, for those mothers, for those fathers, for those daughters and for those sons.
1:42:41 Speaker 00 Thank you, Steve.
1:42:44 Steven Bartlett? Do you need a podcast to listen to next? We've discovered that people who liked this episode also tend to absolutely love another recent episode we've done. So I've linked that episode in the description below. I know you'll enjoy it.
Previous The Fasting Doctor: “Fasting Cures Obesity!”, This Controversial New Drug Melts Fat, Fasting Fixes Hormones! Skip Breakfast! Next Moment 146: 3 Simple Steps That Guarantees Ultimate Happiness (Jay Shetty's Happiness Model) Page updated October 6, 2026 · transcript and summary are machine-generated
