Podcast: Dr. Chris Palmer on the Keto Diet’s Potential to Treat Mental Illness

When it comes to our bodies, there are many seemingly unrelated things that can actually affect our mental health and our general feeling of well being. From the foods we put into our body to the amount of exercise we get each day, there is a clear link between our physical health and our mental well-being.

In this episode, Trevor discusses how depression can sneak up on us at any time and the false sense of security that we create in our minds when we’ve had a series of consecutive good days.

Then we talk to Christopher M. Palmer, MD, (5:40) director of the Department of Postgraduate and Continuing Education at McLean, who has spent the last 20 years working on cases of treatment-resistant mental illness and the idea that diet can put psychiatric conditions into remission.

Dr. Palmer goes pretty deep and shares lots of interesting information in this one, so check it out!

More Exciting Content From Dr. Palmer

Episode Transcript

Trevor: For me, this is always the most awkward part, the first word that’s said in the podcast episode. I mean, obviously it should be “hello,” or a few words, like “welcome back.” I’ve been recording for maybe about 40 seconds just sitting here in silence, just standing at the edge of the cliff. When are you going to start talking?

Believe it or not, folks, there are some days where I don’t want to do this podcast. I don’t know, have you sensed that in my voice? I don’t know. Since the last time I checked in, or you checked in, or we all checked in, I was on the descent into depression, and I’m there. However, I got tricked. I had such a good week, well, up until Friday, I had a great week. I felt solid, I felt consistent, I felt focused, I was mindful, I was using my wise mind. The combination of my objective mind and my emotion mind. And since this rarely happens for me, I mean, I have good days, okay, but it’s rare that I have a series of days where I’m really proud of my behavior.

That happened this week, and I was feeling really good. And over those four days, I was actually able to build up so much confidence that, and other people who suffer from depression, you guys know where this is going, I actually said to myself, “Well, I think we might actually have this thing beat.” Yeah, four days, that’s all it took. Four days. So if I can build up that much confidence, if I can build up enough confidence that I think that I can, that, “Oh, I’m past this depression thing.” In just four days. Imagine if I had a month of freedom from depression? I’d be unstoppable building that much confidence over a month.

But yesterday, and I didn’t even see it coming, normally when a wave of depression is coming, I’ve been doing this long enough where I can recognize it, okay, I can see it coming from pretty far away, and I know it’s coming, and I can do some preparation. But every once in a while it just comes out of no ... I mean, prompted by absolutely nothing. I mean, I’ve been kind of obsessing over what happened yesterday. And really not much, okay. I’m bummed that I didn’t get tickets to the Aphex Twin show in New York City. It’s only one of my favorite musicians.

And, you know, I had an opportunity to see him 23 years ago, and I didn’t take it. So, yeah, I’m bummed that I didn’t get those tickets, but that stuff doesn’t wreck my day anymore. But, suddenly, coming back from a meeting, I was just suddenly there back into the pit of it. And it was almost funny. Because I was like, “How did I get here? How did that happen? How did that happen? One minute I was, and now I’m over here.” So confusing, so frustrating, and sometimes it’s kind of funny. I get it, some of you might not find it funny. It’s gotten to the point where when that happens every once in a while, I just got to laugh about it. It’s such a switch. You’re just there. I don’t know. I try and laugh about it because the only other thing is I’m going to beat myself up about it. And I beat myself up about way too much crap already.

So, it’s nice to have finally let that one go. So if laughing at it, you know, kind of weird, I don’t know. I’ll take weird. Weird, I’ll take weird. Anyway, on today’s podcast, I am interviewing Dr. Christopher M. Palmer. He is currently the director of Department of Postgraduate and Continuing Education at McLean Hospital, and an assistant professor of psychiatry at Harvard Medical School.

For over 20 years, Dr. Palmer’s clinical work has focused on treatment-resistant cases. And recently, he has been pioneering the use of the ketogenic diet in psychiatry, especially treatment-resistant cases of mood and psychotic disorders. So that’s kind of at the heart of what Dr. Palmer and I talk about is the ketogenic diet, because the idea that a diet could put mental illness and psychiatric conditions into remission blows my mind. Enough setup. Let’s go to my conversation with Dr. Christopher Palmer. I hope you enjoy.

Chris: We have the most data for epilepsy—

Trevor: Okay, can you go into more detail on that?

Chris: I can.

Trevor: Yeah.

Chris: So, the ketogenic diet for epilepsy, the roots of it go back about 100 years. But it’s all based on this observation that goes all the way back to Hippocrates, that fasting can stop seizures. So this is something that people have known for a long, long time.

Trevor: That fasting—

Chris: Fasting—

Trevor: ... can stop seizures.

Chris: ... going without food for a period of time can stop people from seizing. You know, up until about the early 1900s, I think a lot of physicians thought that that was folklore, an old wives’ tale, craziness, whatever, they didn’t really believe it. And in the 1920s, two different physicians, one from the Mayo Clinic, and one from Johns Hopkins. The one from the Mayo Clinic independently showed that fasting, in fact, does stop seizures. It was medically accurate and true.

And the problem with fasting for seizures is that you can only fast for so long. And after several weeks of fasting, now you are starving to death. And you’re putting somebody in starvation mode, which is obviously quite dangerous, and people die from starvation. So you can only fast for a certain period of time. The difference between fasting and starvation in my mind is that fasting is a process where you go without food, but your body actually, believe it or not, goes into a metabolic mode of healing.

As soon as your body starts degrading healthy tissue, like your muscle, and other healthy tissues, that is called starvation. And that is obviously very dangerous. I think we, in the United States, are terrified of people going without food for even eight hours. “Oh, you got to eat, eat, eat.”

Trevor: So my mother grew up, she had food, but she had 18 brothers and sisters. Yeah. And there was food, but there wasn’t a lot of food. And yeah, hearing somebody going hungry, that is, I don’t know necessarily if I’d say it’s a trigger, but anybody saying the words, “I’m hungry.” Especially a child. Like I ... it makes me kind of crazy.

Chris: We, in the United States, have a phobia of being hungry.

Trevor: It doesn’t make me mad. It’s just like, I need to take care of this situation now. Somebody is hungry, I will stop anything.

Chris: We have what I would controversially say, we have an irrational fear of being hungry. So the dietary advice over the last few decades has been, “Eat, eat frequently, eat lots of small meals, eat snacks, make sure you don’t get hungry. Make sure you keep eating.” Well, for better or worse, the American population has followed that advice, and look around, look at the statistics, and see what that advice has gotten us. We have epidemic levels of overweight and obesity. We have epidemic levels of diabetes. For better or worse, rates of mental illness are increasing. Right along the same trajectory, at the same time that rates of overweight and diabetes are increasing.

Trevor: So, you think that that has, not just on obesity, but it has an effect on mental illness. That it’s, in fact, maybe not causing mental illness, but it is a factor in it.

Chris: I think it’s definitely a factor. There’s a clear correlation between mental illness and the big metabolic disorders. And the big metabolic disorders are being overweight, or obese, having diabetes, having cardiovascular disease. Those are like the big three metabolic disorders.

Trevor: But being overweight, I mean, I’ve heard, I don’t know if I’d use the word common, but I’ve heard many stories about people developing depression because they’re overweight. But I always assumed, again, possibly incorrectly, that it was because they’re overweight. Now you’re saying there might be a metabolic, because of the image of being overweight.

Chris: Yeah, I know. You’re spot on, Trevor, that is the most common perception. Is that, well of course people who are overweight are going to be somewhat depressed or anxious because they’re probably getting bullied and teased, people are looking at them with judgmental looks.

Trevor: All of pop culture does not look like them —

Chris: They don’t look like the supermodels in the magazines, they have a poor self-image. They look at themselves in the mirror, and they hate themselves, they don’t like the way they look. Maybe they have a harder time dating.

Trevor: But you’re saying that there’s a metabolic factor to this as well.

Chris: What I would say is everything that I just said is absolutely true. And clearly does not help a person’s mental health.

Trevor: Sure.

Chris: When people feel ostracized, when people feel ridiculed, when people feel not included in terms of all of the things that we value in our society, and that people inherently need, friends, dating relationships, getting a job, there’s a lot of discrimination against obese people in terms of even hiring. There’s no question that all of those societal and psychological factors can contribute to or even cause depression and anxiety. However, there’s a tremendous amount of evidence that it’s more than just that. That there are metabolic things that happen in the body when people become overweight or obese.

And those same metabolic abnormalities have been identified in almost every psychiatric disorder that we know. The big one that everybody talks about today is inflammation. People who are obese have higher levels of inflammation than normal control people. People with every mental illness that we talk about, pretty much every single one, have higher levels of inflammation. Now—

Trevor: What does inflammation have to do with it.

Chris: That’s one of the points, is that inflammation seems to be related to metabolic disorders. So there’s a lot of speculation right now in terms of the mental health field about what does inflammation have to do with it. What we know as a fact is that almost every mental disorder has been associated with higher levels of inflammation. What we don’t know is what does that mean. What we know is that people with obesity have high levels of inflammation. What we don’t know is what does that mean.

What we also know is people with diabetes and cardiovascular disease also have high levels of inflammation, but we don’t know what it means. So we’ve got four groups of disorders, all chronic disorders that can go on for years or decades, that are associated with higher levels of inflammation, and we also know that all of those disorders, they go back and forth with each other. People who have mental illness are much more likely to have diabetes. People who are diabetic are much more likely to have a mental illness.

Likewise for being overweight, or obese, likewise for cardiovascular disease. They go back and forth, they’re bidirectional relationships. And on top of it, they’re all associated with this biological thing that we can measure called inflammation. So there’s a lot of confusion about what that means. Some people think the inflammation is due to a poor diet, and that if you eat a lot of sugar, and junk food, for instance, those are more inflammatory. And they can cause inflammation and maybe that’s somehow is contributing to the development of these disorders.

Trevor: Sugar in particular, or processed sugar, or garbage sugar? What is it? The corn syrup stuff. Or is it just—

Chris: High fructose, yeah —

Trevor: High fructose corn syrup. Is it just sugar?

Chris: So, it depends on what disorder you’re talking about, well, and it depends on what study you’re talking about. So, there’s a lot of bias in dietary research and these studies. A lot of studies will pair sugar with fat. Because a lot of the really kind of dangerous junk foods have high levels of both. So things like potato chips, donuts, cake, chocolate chip cookies, all the things that we know, like these things are kind of dangerous, these things are not healthy for us. People who eat a lot of them tend to gain weight and tend to not be so healthy. All of those foods have high levels of both sugar and fat.

So, there’s a lot of confusion and controversy in the dietary field about what’s the real culprit. Some groups believe, still believe, that it’s fat. So in the 1990s, in the early 2000s, fat was public enemy number one. And it was fat across the board. Saturated fat, polyunsaturated fat, monounsaturated fat, olive oil, eggs, doesn’t matter where the fat is coming from, it’s all bad, it’s all evil, everybody should be on a low-fat diet.

There’s pretty compelling evidence that has come along since then that that is actually not correct. And the current consensus right now is that there are good fats, healthy fats, and then there are bad fats. The bad fats, we really don’t—

Trevor: I want to go back. Compelling evidence? Are you talking hard evidence or evidence that’s kind of pointing us in this direction?

Chris: No, I’m talking hard evidence, probably the best evidence for the safety or the dangerousness of fat in our diet comes from this one study that was just published last year. It was called the PURE Study, Prospective Urban Rural Epidemiology Study. And they looked at people from 18 different countries, they looked at over 135,000 people, it was the largest prospective dietary study looking at health outcomes ever done. And they followed people for over 7 years. And when they started this study they basically asked these 135,000 people from all these different countries, they asked them for several days, “Record in detail everything you eat.”

Trevor: For how many days again?

Chris: For several days.

Trevor: Several days.

Chris: And then, the researchers took those kind of recordings and calculated how much protein are they eating? How much carbohydrate are they eating? How much fat are they eating? And then they even subdivided all the fats into saturated fats, monounsaturated fat, polyunsaturated fat. And then they followed these people for seven years and looked at their health outcomes. The biggest things they were looking at were how many people had heart attacks, how many people had strokes, and how many people died from anything.

And the findings of that study completely contradict current recommendations. The findings in that study say that people who eat the most fat in their diet have the lowest rates of mortality, and people who eat the least amount of fat in their diet, so low-fat diet, super low-fat diets, they have the highest rates of mortality.

Trevor: So, if I ate a chicken breast wrapped in bacon with a fried egg on top, I’m going to live forever, aren’t I?

Chris: I’m not willing to go there quite yet. That is definitely a ketogenic meal, so you’re talking about a ketogenic meal.

Trevor: So, I am not trying to sound like a jerk, but you got to understand, from my point of view, and lot of other people’s, you realize how ridiculous that sounds right?

Chris: I totally realize. Because I was right with you. So in the 1990s, when I was in medical school, I was taking the dietary advice. I was on a super low-fat diet, I was exercising like crazy, but I was on a ridiculously low-fat diet. Because I was hearing from all the really intelligent, smart, medical people, fat is evil, fat is public enemy number one. Go on a low-fat diet. And that’s what I did. And you know what happened to me by the time I was 30?

Trevor: What happened?

Chris: My cholesterol was already going up. My bad cholesterol was going up, my good cholesterol was going down, my blood pressure was going up, and I got told over several years, “You need to go on medication. Because—”

Trevor: What kind of medication?

Chris: “You need to go on both blood pressure medicine and cholesterol medicine. Because you are going to have a heart attack or a stroke by the time you’re 50 if we don’t do something about this.” And I would ask the doctors, “What am I supposed to be doing?” They say, “Diet and exercise.” And I say to them, “What kind of a diet, and what kind of exercise?” And they say, “Low-fat diet.” I’m like, “I’m eating like no more than four grams of fat a day. What kind of exercise?” “Well, you know, whatever, a few times at the gym, or go for runs.” “I’m working out four times a week at the gym, two hours per day that I go to the gym.”

The last straw for me was when my primary care doctor looked at me, and I told him that, and he says, “Oh, it must be genetic. Tell me, does your mom have diabetes?” “Yes, she does.” “Does your mom have high blood pressure?” “Yes, she does.” “How about your dad? Does he have any of that?” “Oh yeah, he’s got both, both my parents are overweight.” “Oh, sucks to be you, it’s genetic. You’re screwed, you need to go on medicine.”

Trevor: Yeah, but hold on, what about genetic markers that are passed down from generation to generation? Do you not take those into account?

Chris: Genetic markers for what?

Trevor: For diabetes, for heart disease, you know, stuff like that.

Chris: So that’s the really fascinating thing. We have finished the Human Genome Project. So we pretty much know all of the human genes, and we always talk about heart disease, diabetes, and even obesity, and certainly mental illness, being genetic diseases. But interestingly, with all four of those categories, we have not found any significant genes that confer risk to even more than 5% of the people who’ve had those disorders. None of those disorders are straightforward genetically inherited disorders. Instead, what we say is, “There are probably lots of genes involved.” And none of them confer a significant amount of risk, and by the way, in addition to the genes, you also have to have some environmental trigger. Nobody knows exactly what the environmental trigger is.

Trevor: I was just going to ask. What specifically? But nobody knows what it is.

Chris: Well, we can’t say with certainty right now, but what we do know is that diet and exercise influence which genes get expressed. We know that diet and exercise almost certainly part of the environmental triggers for diabetes, cardiovascular disease, and obesity. We have some emerging evidence that poor diet is also a risk factor for mental illness. So there was one study done in the United Kingdom, they talked to people about, “How much sugar are you eating?” And for sugar they included everything. They included table sugar, sugar in the foods that you’re eating, honey added to tea or coffee, they included all of it.

Trevor: Sugar in fruits and vegetables?

Chris: Yes. So, any sugar in your foods. And then, they followed these people for 10 years, and they looked at, it was over 10,000 people, and then they looked at how many of these people developed depression. And was there any relationship between the amount of sugar they consume and their probability of developing depression? And what they found was that people who ate the most sugar in their diet had the highest rates of depression, and people who ate the least amount of sugar in their diet, had lower rates of depression.

Now, one of the things that commonly gets questioned in that is that we all know that when people get depressed, a lot of people want to comfort eat to comfort themselves.

Trevor: Absolutely.

Chris: If you feel like shit, you want to come home at the end of your day, sit on the couch, watch TV and eat.

Trevor: Listen, I’m probably about to say the most mentally ill thing I’ve ever said in my life, but if you’re saying that cutting out, or breaking off my lifelong torrid love affair with chocolate chip cookies. Now, gluten-free chocolate chip cookies, unfortunately, but if you’re saying that I have to break that off in order for my borderline personality disorder, narcissistic personality disorder, and severe depression to go into remission, I don’t know if I can do it. But I was honestly having that reaction. And that is so stupid of me to say, but the truth of the matter is that must make you and your work absolutely controversial, because not only are you up against a business paradigm designed to profit and push out these foods, but it’s the exact thing that you brought up, there is a social thing. “Oh, I’m depressed, I’m going to go comfort myself with a slice of cake,” which is actually going to turn into three slices of cake.

Chris: Yes, and then, you’re going to wash ... And then you’re going to have something salty, maybe some chips or some nuts, or something else.

Trevor: Absolutely.

Chris: And then you’re going to alternate between sweet and salty.

Trevor: Right, and you’re going to be watching some ratchet-ass reality TV show while you’re doing it. It’s going to rot your brain.

Chris: You are. And a lot of people are going to accompany this comfort eating with either alcohol or marijuana.

Trevor: Right, exactly. Which, in my case, as somebody who smokes medical marijuana regularly, I’ll be honest, it just perpetuates the eating even more.

Chris: It does. So, the medical marijuana is going to increase your appetite. Alcohol, interestingly increases appetite, or at least decreases inhibitions in a lot of people, so a lot of people, when they start drinking, you can squeeze a little more food in. When you’ve had a few drinks, “Oh, that probably tastes good. Well, I’m actually really full, but it doesn’t matter. Even though I’m stuffed, and I’m like overstuffed, and I’m probably going to puke if I eat this, I can fit a little more in, because that tastes really good.” And then I’ll—

Trevor: The wheels have been greased. Let’s—

Chris: So, alcohol somehow settles your stomach, like, you know, sometimes in the old days, we talked about ice cream settling your stomach, even though you’re stuffed like a pig. And then you’re like, “Oh, have some ice cream, it’ll settle things. So I’m going to put even more food in there.” Yeah, no, so it can be a hard sell to people.

Trevor: Oh, stop it. It can be more than a hard sell. I mean, this sounds, for what I’ve been raised with, 42 years on this Earth, this flies completely in the face of that. And there has to be a lot of resistance from your peers, from other professionals, and from the common person, there has to be a lot of resistance to this.

Chris: There’s a tremendous amount of resistance. So the ketogenic diet in the medical community is really completely shunned. U.S. News & World Report, they have a lot of dietary experts get together and rank all of the popular trendy diets in terms of their order of preference. And the ketogenic diet, the last couple years, is ranked last in terms of a healthy reasonable diet to try.

Trevor: Why?

Chris: Because everybody is concerned about fat. Everybody is concerned about too much fat in your diet. And that if you eat too much fat, you’re going to drop dead of a heart attack. But I shared with you a little bit ago the results of the PURE study. So, do we have medical evidence that eating a lot of fat causes more people to die? The reality is we actually do have that medical evidence, but it actually says the exact opposite of what people want to believe, or what people believe, it’s the exact opposite of our current dogma. And so, people ignore it. When evidence comes out that—

Trevor: When you say exact opposite, tell me what that, tell me what it says.

Chris: So, the results from the PURE study say that people who eat the most amount of fat in their diet have the lowest rates of mortality, that even saturated fat, whether you eat a little bit of saturated fat or a lot of saturated fat, it does not have an impact on whether you have a heart attack. But, in fact it does have an impact on whether you have a stroke. And the impact that it has is exactly the opposite of whatever everybody thinks. People who eat the most saturated fat in their diet have the lowest rates of stroke, and people who eat the least amount of saturated fat have the highest rates of stroke. And it was a linear relationship all the way through the different groups that they kind of categorized people in.

So, according to the PURE study, the more saturated fat you eat, the lower your risk of stroke, and the lower your risk of death. But medical professionals don’t talk about that. So the medical professionals who published this study actually said, “Our dietary guidelines are clearly, probably wrong, and they need to be seriously revamped.” The United States medical professions have largely ignored that study and countless other studies like it. Because those studies don’t support this dogma that eating fat is bad for us.

Trevor: You know what? I’m going to get lunch after this in the cafeteria. They have these individually wrapped gluten-free chocolate chip cookies. Now, normally, I get a salad every day. Today I’m going to get 12 of those cookies.

Chris: I wouldn’t recommend it.

Trevor: Really? Really. Okay.

Chris: No, no, no. Because cookies, cookies are—

Trevor: Because of the sugar.

Chris: Yes.

Trevor: Yes.

Chris: So let me be clear with people. So when I talk about eating more fat, I’m not talking about eating more junk food, which is high in both fat and carbohydrates.

Trevor: Right. But go back to my earlier example of the fried chicken breast, or maybe just the chicken breast wrapped in bacon with the egg on it. A lot of fat, but not a lot of sugars or processed sugars like in that cookie.

Chris: That is actually part of a ketogenic meal, and there’s a lot of emerging evidence that people who eat that chicken breast wrapped in bacon with a fried egg on top, people who eat that way, without a lot of processed carbohydrates to supplement it, so you can’t have that along with a big heap of mashed potatoes, and then have like 10 of your cookies after that. But if you stick to a low-carbohydrate and/or a low-carbohydrate ketogenic diet, the evidence is overwhelmingly clear that those people will not only lose weight, which has a whole range of health benefits that come with it, including mental health benefits that we can go into, but those people’s risk for cardiovascular disease, or a heart attack or a stroke, their risk goes down when they eat that way.

We have abundant evidence for that now. Studies that have been published in the New England Journal of Medicine, studies that have been published in the Journal of the American Medical Association, two of the most prominent medical journals on the planet.

Trevor: Which issue of the New England Journal of Medicine? Do you remember? Just in case listeners want to read it.

Chris: I don’t have it off the top of my head.

Trevor: Okay, but it’s out there, people.

Chris: But they can contact me if they want.

Trevor: Okay. They can contact you. What about, okay, and I’m reaching far here. I’m reaching into a suspicion of mine that is not based in any science whatsoever, but we’re talking about diet, and I know this is probably outside your measurements, but I’m wondering if it’s something that’s been taken into account. Where does stress play in all of this? Does it play in all of this? Because I have met people with dog shit eating habits, rotten personal health, no exercise, no nothing, and probably some bad habits on top of that, and it seems like they’re never going to die, they just keep going. And if there’s one thing they all have in common is that they’re a stress-free person.

Whereas, people I know who eat healthy, well, that’s all been called into question today, you know, who ate healthy under the popular paradigm, but exercise and so forth, they’re a ball of stress, and they’re in and out of the hospital all the time.

Chris: No, you’re spot on, Trevor. And any—

Trevor: So, a stress-free life with a ketogenic diet, that’s what it sounds like is a key way to move forward with a healthy life, and maybe a possible way to dominate, or at least get control of your mental illness.

Chris: I know, when I talk with people about the ketogenic diet, everybody wants the quick fix.

Trevor: That is the problem, you’re absolutely right. That is the problem. People want the quick fix.

Chris: Everybody wants the quick fix, and everybody wants the one and only one answer to their problems.

Trevor: But isn’t that human? Come on.

Chris: It is human. And I don’t blame people. And I wish I could offer that. What I tell people when I talk about using the ketogenic diet as a medical intervention or a psychiatric intervention, what I tell people is that this is one piece of a comprehensive treatment plan. And I really authentically mean that. So let’s take an extreme example. You brought up stress. There’s no question stress, especially adverse events in people’s lives, things like abuse, trauma, neglect, poverty, crime, violence in your home, there is zero question that those things all contribute to mental illness. We have abundant evidence that all of those things make people more vulnerable to mental illness.

The interesting thing is those exact same things also make people more vulnerable to be overweight or obese, they make people more likely to develop diabetes, and they make people more likely to die of heart attacks at younger ages than the rest of the population. Again, it all goes together. So if we start with children who are in really kind of adverse, hostile environments, and we follow them for decades, we actually know, not only are they more likely to develop mental illness, but they’re also more likely to develop all those metabolic disorders that I just described. Cardiovascular disease, obesity, diabetes. They’re also more likely to abuse substances, things like alcohol and recreational drugs. They’re also more likely to be smokers.

And those are all things that kind of everybody knows, like alcohol, drugs, smoking, cigarettes. Those also kind of are seen in much higher rates in people with mental illnesses. And so, with that one example, I could almost assert that the cause of all of those disorders, both physical disorders and mental disorders, is trauma and stress and adverse life events at an early age.

But, for better or worse, the medical profession separates out “mental disorders” from all the others. The others are somehow more legitimate. “Oh, you got diabetes. Hey, that’s a real problem. We’ll pay for whatever medical treatment you need, and we’ll pay for all your medicines and anything else.” As soon as it’s a mental disorder, whether it’s depression, bipolar disorder, schizophrenia, or borderline personality disorder, or anything else. “Oh, you know, insurance companies may or may not pay. Systems may or may not take your insurance.” It just gets so difficult to get treatment for it.

But, most importantly, it’s so difficult to get people to take it seriously. “Oh, you’re not trying hard enough. You’re not doing your therapy well. Oh, if you really wanted to get better, you should be doing this.” We never say to a diabetic, “If you really wanted to get better, you would be better about your diet and exercise, and not take that insulin and not take those pills.” For whatever reason, we’re much less judgmental about diabetes, we’re a lot less judgmental about heart attacks, “Oh, you poor thing, you’ve had a heart attack.” I can’t say we’re less judgmental about obesity. Obese people get a lot of shame and a lot of stigma, maybe on a similar level to some mental illnesses.

“You’re not trying hard enough. You need to.” But when I take you back in time to the people who are most likely to develop all four of those things, they were kids who had rough lives beyond their control, they did nothing wrong. They just had a lot of stress in their life. And that puts them at much higher risk to develop all of those things. So I think one way to kind of fight stigma of mental illness is to really talk about how much overlap there is with what we call medical, or physical, illnesses.

Because I actually think a lot of them are probably one and the same. But, in fact they’re different symptoms, or different manifestations in different people. So, one person who has a really rough life may not become overweight, but might still have a heart attack and might have chronic depression. Another person might become really overweight and develop diabetes. Maybe, there are some shared kind of pathways, or shared causes among those people, even though they have different illnesses, that we think about as different illnesses, maybe there’s something similar about them, more similar than most people recognize right now.

Trevor: With a ketogenic diet, does it make a difference if the foods are organic or have pesticides?

Chris: So, that’s a big controversy in dietary science as you probably know. And I would almost remove ketogenic diet from the initial part of your question, and just say with any diet, does it matter to have organic foods? Does it matter to avoid growth hormone, antibiotics in chickens or cows, all those things. It’s a controversial area, there’s no doubt. Certainly, some of the hormones, and some of the antibiotics that are given to livestock, the evidence seems to point to those may, in fact, have adverse effects on people. With pesticides, our government right now tells us no, there’s no adverse effect from it. But again, our government’s been giving us dietary recommendations for the last three, four decades, and all the while, even though people are, in fact, following those dietary recommendations, people are getting more and more overweight, our diabetes rates are going through the roof.

So, I’m not sure the government is always right, just because the government says it so, doesn’t necessarily make it so. So I honestly don’t, I don’t know, I don’t have clear and compelling evidence either way to say that pesticides are, in fact, really dangerous for us. I know that there are a lot of people very passionate on both sides of that argument. I guess, for right now, myself as a professional, as an individual, I have to say I don’t know. So, buying all organic, and free-range, all those foods, they’re very expensive.

Trevor: Yes, they are.

Chris: And for people with, especially for people with chronic mental illness, a lot of them don’t have a lot of money.

Trevor: No.

Chris: A lot of them are on disability. If they are employed, maybe they’re part-time employed. And so, it’s hard for me to recommend organic, free-range, all of that, for people when I know they can’t realistically afford it. What I have found is that people who do the ketogenic diet, I can say with certainty, a lot of them can definitely get benefit without doing organic. So using the cheaper produce, the cheaper cuts of meat that aren’t free-range. That can still have tremendous benefit for some people.

Trevor: So, before we wrap up, I want to bring up something. You yourself used to battle with a mental illness, and you have practiced, or continue to practice the ketogenic diet in the past, and it has shown benefits to yourself. Could you go into that a little bit more?

Chris: So, I will just say publicly that I have a family that has a lot of mental illness. I have a big family, so when you have a lot of people, you get a larger sample size, and you get more of a probability that you’re going to see stuff.

Trevor: Science humor, I think that was.

Chris: So, I know mental illness from a very personal stance. And I know it for myself as well. So when I was a kid, I definitely had obsessive compulsive disorder that probably started probably around when I was in kindergarten, and then I developed pretty significant depression for lots of reasons, that I probably won’t go into, but a lot of stressors in the family, like ridiculous stressors, soap opera kind of stressors in the family. And probably by the time I was in seventh grade or so, I had pretty significant depression.

By the time I was in high school, it was pretty severe depression that interfered with my ability to participate in school, that interfered with my desire to live. And I got some treatment back then that realistically wasn’t all that helpful to me. Medications, therapy, and other treatments that at the end of the day didn’t really help me. And there’s no doubt in my mind that that’s part of what drives me in psychiatry is I realized how horrible and devastating these illnesses can be, not just from my own experience, but from watching family members and friends suffer from these.

So I realized how real and powerful these disorders are, how they can devastate people’s lives. And I’ve been really dissatisfied and unhappy with what the mental health field has to offer. And it’s not meant as a criticism of the mental health field, people are doing their best, we’re all trying our best, and I think the people who go into this field authentically want to help, and they’re doing everything they can. And some people are really lucky, some people respond really well to antidepressants, or even mood stabilizers, or antipsychotics, or psychotherapy without any medication.

And I don’t mean to detract from them getting appropriate treatment at all, I am all for getting treatment, getting appropriate treatment. And when it works, I’m the number one cheerleader, yay, this is great, it worked. But for way too many people, our treatments do not work, or do not work well enough. For people with chronic—

Trevor: And people don’t like you saying that. I would imagine people would not like you saying that. I agree with you. I refuse to believe that there is one approach to anything. I’m not talking about personality-wise, it’s just biologically, we’re all unique. How can there be one, two, even three answers for everybody? There’s got to be multiple answers.

Chris: Yeah. No, there are. That’s what I was alluding to before, I wish there was just a one, one and only one simple answer—

Trevor: Right, but it’ll never be that way.

Chris: It isn’t that way, because we’re human beings. And we have complex lives, and there are a lot of different factors that go into contributing to mental illness, or being a risk factor for mental illness. Stress is a big one. But at the end of the day stress is a perception. Stress is in the eye of the beholder, is in the eye of the person. So what stresses one person may not be at all stressful to another person. So somebody with a phobia of roller coasters, you try to force them onto a roller coaster, that’s really stressful. That’s like painfully stressful for them. They might even think they’re going to die. If you do that to them over and over again, that’s like torturing them.

Somebody else who loves roller coasters, you can’t drag them fast enough on. They like are, “Yeah, yeah, let’s go, this is awesome.” Two human beings having the exact same experience, but those experiences have profoundly different effects on those two people. So the person who experiences that as stress is actually going to be hurt by that in many ways, it’s going to be difficult for them. And if somebody does it to them over and over again, they might even develop depression, or anxiety, or other disorders as a result of that. And so, something like that, there’s not an easy recipe for just manage stress, it ends up being very individualized, it ends up being something that you have to talk to people and try to understand their perspective, and then try to help them reach a good healthy balance of developing a different perspective that makes that situation less stressful.

But to get back to your original question, so, I told you a little bit of the story about when that doctor kind of said to me, “Well, you’re screwed, you’ve got a family history of diabetes and high blood pressure. So you’re just screwed, it must be genetic.”

Trevor: I had family members tell me the exact same thing. This heart thing. “You’re screwed.”

Chris: Yeah, no. Doesn’t it suck?

Trevor: Yeah, I walked out.

Chris: Doesn’t it suck when people tell you that —

Trevor: Yeah, I was at the hospital, and yeah. They said that to me, and I was like, I stood up and walked out. Like, why would you say that?

Chris: I actually think genetics, saying it’s genetic is one of the biggest cop-out excuses used in American medicine today. Doctors tell people that. People tell themselves that.

Trevor: I tell myself that all the time.

Chris: “Well, I can’t lose weight because it’s genetic. Well, I can’t really be held accountable for my diabetes because it’s genetic.”

Trevor: “I’m mentally ill because it’s genetic.”

Chris: “I’m mentally ill because it’s genetic.” And I will let you know, I challenge that, at least with these major metabolic syndromes. There are clearly, unequivocally some things that are genetic. Hair color is genetic. You do have brown eyes because it’s genetic. There’s no changing that. You do have to accept it whether you like brown eyes or not.

Trevor: Right. Ketogenic diet is not going to change my eye color?

Chris: It’s not.

Trevor: No, I don’t know —

Chris: No changing that. So there are some things that are genetic that we do have to accept. I’m not at all convinced, and the research scientific data based on the human genome now is not at all compelling that those things are clearly simply genetic. They’re not simply genetic.

Trevor: So, what I’m hearing is that now that the Genome Project is done, is human biology in general, is it time for a reckoning?

Chris: It’s time for a reckoning with this concept of it’s genetic so people can’t do anything about it. Because we have the human genome. We have evidence now. And the evidence says it’s actually not a simple gene, or two, or even three, that the genes that code for diabetes, the genes that code for cardiovascular disease, the genes that code for being overweight or obese, and the genes that code for mental illness across the board, all four of those disorders, they’re common genes. There are many of them, numerous ones, and not one gene accounts for a significant proportion of any of those disorders.

And so what we kind of can say is what we thought was genetic maybe isn’t genetic after all. And genetic, at least genetic from the stance of the human genome, there’s no doubt that those disorders run in families. So I don’t want your listeners to interpret what I just said as I’m saying those disorders don’t run in families, because they unequivocally do run in families. And for over a century, we’ve assumed they run in families because it must be genetic. Because when things run in families, we usually think genetic.

But we now have that evidence, the evidence is in. And it looks like actually it’s not so simple. One of the really fascinating things, you brought up stress a little bit ago, is one of the really fascinating things is that parents can actually transmit their stress to their babies. And it’s not through a gene. It’s through these other mechanisms that a lot of people are just calling epigenetics.

But there’s pretty compelling evidence that if a parent really has a lot of adverse childhood events, for instance, even if it’s the man, definitely if it’s the woman, but even if it’s the man, his offspring are more likely to have a mental illness because of his stressful life. So, what we know is that stress can kind of be transmitted from generation to generation. And it’s transmitted in a way other than genes. The really good news about that is that the way it’s transmitted is changeable.

When we think about getting a bad gene, I got the schizophrenia gene, and so now I’ve got schizophrenia, so that means I’m screwed for the rest of my life. We think of genes as permanent and fixed. What we know about these mechanisms of transmission of stress, from parent to child, we know that almost all of them are reversible. And that to me gives me tremendous hope. Because it means that what we have thought was a genetic disorder, that’s kind of like you’re screwed, it probably isn’t true. And people might actually be able to change their fate and improve their symptoms.

Trevor: We need to wrap up, but before we go, I am going to go to the caf, I want you to go with me.

Chris: And get your cookies?

Trevor: No, no cookies. I’m going to get my salad. I’m going to get my salad.

Chris: Good.

Trevor: But I’m going to go, and I’m going to go up to the caf people, and I’m going to ask them to deep-fry my salad for me so—and then when they look at me weird, I want you to look at them—

Chris: No, no, no.

Trevor: ... and say, “Ketogenic diet. This is part of his therapy.”

Chris: Maybe I’ll have you pour some olive oil on your salad instead.

Trevor: Chris, is there anything you want to add before we wrap up?

Chris: No, thank you, it’s been a pleasure talking with you.

Trevor: No, this was really great. Thank you so much.

Chris: All right, thanks.

Trevor: Okay, take care. Okay, okay. What did you think? You can tell me. You can tell, send me an email. @email. You know, diets, they get people talking, they really do. The subject of diets, it gets people fired up. So let me hear it. You have to understand, I read up a bit on Dr. Palmer before he came in, but to hear him lay it all out, it’s a lot, you know, it’s a lot. And that is what he’s up against.

People with mental illness, we’re up against the stigma of being mentally ill, being labeled as crazy people, insane people. When we’re really people with problems, it’s true, we do have problems, and these problems sometimes affect others, but we’re good people, and those of us that are in therapy, we’re making the healthiest of choices by being in therapy. That’s the best place for us to be.

And you know, Dr. Palmer is kind of going through the same thing. There are a lot of people that give him a lot of pushback for what he’s suggesting. And whether you believe him or not, maybe we can all appreciate what he’s trying to do. I certainly appreciate it, and I really am going to learn more about it. A few nights after I recorded the interview with him, I did eat eight pieces of bacon for dinner, and I did not feel good about it. But I’m curious about it. And, with any diet, you need to do your own research, you need to do your own due diligence, and find out if it’s the right thing for you.

Am I really going to try it? I don’t know, I’m tempted, I’m tempted. Can we leave it at that? I’m tempted. Okay. There’s a snowstorm going on right now. The first big one of the year here in New England. And the forecast is somewhere, it’s going to snow somewhere between eight inches and 45 feet. If you go to the grocery store right now, that’s at least the feeling you get, that we’re going to be under 45 feet of snow by tomorrow morning. So, I’m going to wrap this up, because I want to get home safely. Anyways, are you guys going to come back? I want you to come back. I really do. I like all you guys. You’re all really cool. So keep coming back. Okay. Bye.

Thank you for listening to Mindful Things, the official podcast of McLean Hospital. If you have any suggestions for special topics or future guests, please email us at @email. And don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.

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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

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