Diet & Nutrition for Mental Health | Dr. Chris Palmer

1. 0:00 – 3:25

   Dr. Chris Palmer, Mental Health & Metabolic Disorders

   1. AHAndrew Huberman0:00

      (instrumental music) Welcome to the Huberman Lab Podcast, where we discuss science, and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. Today my guest is Dr. Chris Palmer. Dr. Chris Palmer is a medical doctor specializing in psychiatry at Harvard Medical School. He is the world expert in the relationship between metabolic disorders and psychiatric disorders. He treats a variety of different conditions, including psychosis, including schizophrenia, as well as attention deficit hyperactivity disorder, obsessive compulsive disorder, anxiety disorders, and depression, among others. He is best known for understanding the relationship between how metabolism and these various disorders of the mind interact. And indeed today, he describes not only his own fascinating journey into the field of psychiatry, but also his clinical and research experience using diet, that is, different forms of nutrition, in order to treat various psychiatric disorders. He describes some remarkable case studies of individuals and groups of people who have achieved tremendous relief from the types of psychiatric disorders that I just mentioned a few moments ago, as well as new and emerging themes as to how metabolism and the mind interact to control things like obesity. Indeed, he raises the hypothesis that perhaps obesity, in many cases, is the consequence of a brain dysfunction as opposed to a, the consequence of a metabolic dysfunction that then impacts the brain. During today's episode, he shares with us his overriding hypotheses about the critical roles that mitochondrial function and dysfunction play in mental health and mental illness, and how various particular types of diets, ranging from the ketogenic diet to modified ketogenic diet, and even just slight adjustments in carbohydrate intake, can be used in order to change mitochondrial function and bring relief for various psychiatric illnesses. He also highlights the essential and important theme that various diet interventions, including the ketogenic diet, were not first developed for sake of weight loss, but rather were developed as treatments for neurologic conditions such as epilepsy. Today, he shares with us how the foods that we eat, alone and in combination, and how fasting, both intermittent fasting and more lengthy fasts, can interact with the way that our brain functions to strongly control the way that we think, feel, and behave. What's wonderful is that Dr. Palmer not only explains the science and his clinical expertise, but also points to various actionable measures that people can take in order to improve their mental health. I'd like to mention that Dr. Palmer is also the author of a terrific new book. The title is Brain Energy: A Revolutionary Breakthrough in Understanding Mental Health and Improving Treatment for Anxiety, Depression, OCD, PTSD and More. I've read the book, and it is a terrific read. I came away from this book with a much evolved understanding of how the various psychiatric disorders that I just described, as well as ADHD, emerge in people, and it has completely revised my understanding about the possible origins of various psychiatric disorders and the best ways to treat them, including both with medications, but also with nutritional approaches. If you'd like to learn more about Dr. Palmer's work and the book, please go to chrispalmermd.com. We also provide links to the book and to his website

2. 3:25 – 7:18

   Thesis, Eight Sleep, ROKA

   1. AHAndrew Huberman3:25

      in our show note captions. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools for the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast. Our first sponsor is Thesis. Thesis makes custom nootropics, and as I've said many times before on this podcast, I am not a fan of the word "nootropics" because it means smart drugs, and frankly, there are no specific neural circuits in the brain or body for being, quote-unquote, "smart." Thesis understands this, and they've developed custom nootropics that are designed to bring your brain and body into the state that's ideal for what you need to accomplish. They use the highest quality ingredients, things like phosphatidylserine, Alpha-GPC, many ingredients that I've talked about before on this podcast and that I happen to use myself. I've been using Thesis for over a year now, and I can confidently say that their nootropics have been a game-changer. For me, I like their nootropic for clarity, I use that before cognitive work often, and I like their nootropic for energy, and I often use that before workouts, in particular, workouts that are especially intense. To get your own personalized nootropic starter kit, go online to takethesis.com/huberman, take their three-minute quiz, and Thesis will send you four different formulas to try in your first month. Again, that's takethesis.com/huberman and use the code "Huberman" at checkout to get 10% off your first box. Today's episode is also brought to us by Eight Sleep. Eight Sleep makes smart mattress covers with cooling, heating, and sleep tracking capacity. I've talked many times on this podcast about the critical relationship between sleep and body temperature. That is, in order to fall asleep and stay deeply asleep throughout the night, our body temperature needs to drop by about one to three degrees. And conversely, when we wake up in the morning, that is in large part because of our body heating up by one to three degrees. Now, people have different core body temperatures, and they tend to run colder or hotter throughout the night. Eight Sleep allows you to adjust the temperature of your sleeping environment so that you have the optimal temperature that gets you the best night's sleep. I started sleeping on an Eight Sleep mattress cover about eight months ago, and it has completely transformed my sleep. I sleep so much deeper, I wake up far less during the middle of the night, if at all, and I wake up feeling far better than I ever have, even after the same amount of sleep. If you wanna try Eight Sleep, you can go to eightsleep.com/huberman to save up to $400 off their Sleep Fit Holiday Bundle, which includes their new Pod 3 cover. Eight Sleep currently ships in the USA, Canada, United Kingdom, select countries in the EU, and Australia. Again, that's eightsleep.com/huberman. Today's episode is also brought to us by ROKA. ROKA makes eyeglasses and sunglasses that are of the absolute highest quality. The company was founded by two all-American swimmers from Stanford, and everything about ROKA eyeglasses and sunglasses were designed with performance in mind. I've spent a lifetime working on the biology of the visual system, and I can tell you that your visual system has to contend with an enormous number of challenges in order for you to see clearly, for instance when you move from a sunny area to a shady area and back again, whether or not you're looking at something up close or off into the distance. ROKA understands the biology of the visual system and has designed their eyeglasses and sunglasses accordingly so that you always see with perfect clarity. ROKA eyeglasses and sunglasses were initially designed for activities such as running and cycling, and indeed they are very lightweight. Most of the time I can't even remember that they're on my face they're so lightweight. But the important thing to know about ROKA eyeglasses and sunglasses is that while they can be used during sports activities, they also have a terrific aesthetic and they can be used just as well for wearing to work or out to dinner, et cetera. If you'd like to try ROKA eyeglasses and sunglasses, you can go to ROKA, that's roka.com, and enter the code "Huberman" to save 20% off on your first order. Again, that's ROKA, roka.com, and enter the code "Huberman" at checkout. And now for my discussion with Dr.

3. 7:18 – 20:43

   Nutrition & Mental Health

   1. AHAndrew Huberman7:18

      Chris Palmer.Chris, Dr. Palmer, thank you for being here.

   2. CPChris Palmer7:21

      Thank you, Andrew, for having me.

   3. AHAndrew Huberman7:23

      I have a lot of questions for you. And I'm really excited about this topic because I think most people know what mental illness is, or they have some idea what that is. Most people have some idea what nutrition is. Fewer people certainly know how closely those things can interact. And I think everybody is familiar with the feeling of a food, or the ingestion of a food making them feel good in the short term. You know, we eat a food that tastes delicious to us or that we associate with something nice and we feel good, mentally and physically. Whereas when we eat something that gives us food poisoning, or maybe even something that just doesn't taste that great or that we associate with a bad experience, we feel less good in the short term. But I believe that very few people understand or are familiar with the fact that nutrition and our mental health interact in this very intimate, maybe even causal way, and that is something that occurs over long periods of time. Meaning what I ate yesterday, the day before, maybe even 10 years ago could be impacting the way that my brain and body are making me feel now. So if you would, I'd love for you to just tell us about a little bit of the, the history, in particular your history, with exploring the relationship between nutrition and mental health. And then we can dive into some of the, um, more particulars of ketogenic diets versus other diets, and some of the truly miraculous findings that you and others are, are coming up with, um, based on real patients and real experiences of people who suffer and then find relief by altering their nutrition.

   4. CPChris Palmer9:05

      Sure. I, you know, I ... This story really starts with my own personal story. And, uh, uh, I don't need to go into great detail, but, uh, to set the stage, when I was a kid, I definitely had mental illness. Started with OCD. Um, a series of events happened in my family. My mother had a horrible kind of psychotic break, um, and all sorts of adverse childhood events for me. She and I were actually homeless together for a while. Um, I went on to have subsequent depression, suicidality, all sorts of things. But somehow or another, I pulled myself together, um, and got through medical school, actually did quite well in medical school. Got an award for being one of the top students. Uh, and then was doing my internship and residency at Harvard. And, uh, and at that point in time, I was diagnosed with metabolic syndrome. So, uh, I had high blood pressure, horrible lipids, uh, and pre-diabetes. And I was doing everything right, supposedly. I was on a low fat diet and I was exercising regularly. And year after year, my doctor kept telling me, "Diet and exercise." I kept asking him, "What diet? What exercise?" I was doing everything he kept telling me to do. Everything was getting worse. My blood pressure kept going higher. And, uh, and at some point he kind of said, "You're gonna have to go on medication. I need to put you on something for your pre-diabetes, something for your cholesterol, and something for your blood pressure." So three pills out, out of the gate. And I'm like, "I'm only in my 20s."

   5. AHAndrew Huberman10:53

      Were you overweight?

   6. CPChris Palmer10:54

      No. Technically no. I had a l- I had a gut, so, you know, that's a sign of insulin resistance, I know now. I didn't know it then. But, um, uh ... And he actually kind of leaned in at one point and said, you know, "Do you, do your parents have diabetes?" "Yeah." "Do your parents have high blood pressure?" "Yeah." "Do your ... Are your parents overweight?" "Yeah." "Oh, I'm really sorry, it's genetic. Um, basically you're screwed. It's your genes. You're just gonna have to bite the bullet and take meds." And as a physician, I knew what that meant. I knew that I'm in my 20s, if I'm already on three meds for metabolic syndrome, I'm gonna be screwed by the time I'm 40 or 50, and I'm probably gonna be having heart attacks. And, uh, and I'd heard through the rumor mill that the Atkins diet could somehow help people improve their cholesterol and pre-diabetes. I actually didn't really believe it. I was highly skeptical. And I, I, you know, I believed everything I was taught in medical school. Why would, why would my professors lie to me? Th- they knew what they were talking about. Low fat diet was the thing to do, um, and the Atkins diet was clearly dangerous and reckless and, uh ... But I had been trying the medical dogma for years and it wasn't working for me. And so for whatever reason, I decided this is gonna be my last attempt at, at something different, and then I'll just bite the bullet and go on meds. So I tried the Atkins diet. I did my own special version of it. I still avoided red meat, 'cause I was terrified of red meat and, you know, I, I ... I, I tried to do a healthy version, which is probably more like the South Beach diet af- you know, this was before the South Beach diet was invented. But, um, within three months, my metabolic syndrome was completely gone.

   7. AHAndrew Huberman12:55

      So blood pressure normalized, lipids normalized. Did your weight change? Or that ... You mentioned that you were of healthy weight, but that you had a bit of, um, abdominal-

   8. CPChris Palmer13:05

      Yes.

   9. AHAndrew Huberman13:05

      ... fat. Yeah.

   10. CPChris Palmer13:05

       So I, I lost the abdominal fat.

   11. AHAndrew Huberman13:07

       Mm-hmm.

   12. CPChris Palmer13:07

       I probably lost about, you know, 10 pounds-

   13. AHAndrew Huberman13:10

       Mm-hmm.

   14. CPChris Palmer13:10

       ... through this process, and, but everything got normal. And when I went back to my doctor, he was shocked. He actually said, "What the hell are you doing?"

   15. AHAndrew Huberman13:19

       During the time before you switched to this new diet, w- uh, how was your mental health, if you don't mind me asking? Because it sounded like ...You, you're very clear that there was metabolic syndrome, or you were headed towards more severe metabolic syndrome. You mentioned OCD. Um, I actually am familiar with this. As a kid, I had a, a low level kind of Tourette's grunt (clears throat) , and, uh, probably maybe obsessive still, uh, to some extent, although not full-blown, clinically diagnosed OCD. So I can relate somewhat. Um, if you're willing, um, what was the context of, of all that before and after this, uh, nutritional switch?

   16. CPChris Palmer13:55

       (smacks lips) So before the nutritional switch, I was still struggling with low-grade depression and OCD. Uh, I, um ... (smacks lips) Again, it wasn't necessarily interfering with my ability to function, 'cause I was functioning at a high level. I mean, anybody looking from the outside, you're a top student, you just got into one of the most competitive, actually at that point, it was the most competitive residency program in the country for psychiatry. So they would have looked at me and said, "You're fine," but I wasn't. I was actually on medications. I was trying different medications, trying to figure out how, how to feel better, how to stop obsessing so much, how to not be so depressed. Um, and I found that those medications, they, they actually came with more side effects for me than benefits. I was on Prozac for a long time. It totally messed up my sleep. And then the psychiatrist was like, "You need pills to help you sleep now." And I'm, I just, I'm like, "That doesn't ... That- that's not really resonating very well with me." And I'm now a psychiatrist. I'm in my psychiatry residency. And I'm thinking, "You know what? That's just not sitting well with me, that you're gonna prescribe more and more meds for all the side effects that you're causing." And yet at the same time, I wanted to feel better. And I was learning chemical imbalances, this is what we do to get rid of depression and OCD. You're supposed to take your pills. And so I was taking my pills. I was in psychotherapy. I had been in psychotherapy on and off for years. Um, I had received much more intensive treatment when I was younger, and that was essentially worthless for me. Uh, it actually probably just caused harm at the end of the day.

   17. AHAndrew Huberman15:48

       Psychoanalysis?

   18. CPChris Palmer15:49

       Um, n- various psychotherapies. Not psychoanalysis per se, but some of them were psychoanalytically oriented psychotherapies. Was actually hospitalized at one point.

   19. AHAndrew Huberman16:00

       Mm-hmm.

   20. CPChris Palmer16:01

       Um, uh, had been put on lithium and, uh, imipramine, which is a tricyclic antidepressant, and other things. And they, uh, they were actually horrible. They were horrible. They did nothing beneficial for me. Um, I gave them a decent amount of time to work. I, I really wanted to feel better. Um, so at the time that I tried this diet, I, I certainly wasn't impaired in the same way. I wasn't struggling that much. But I was, still had these low-grade symptoms, was trying to feel better. And the thing that was the most striking to me after doing the diet for three months was not the fact that my metabolic syndrome was gone. That was my goal, and it was a, you know, seemingly miraculous, uh, achievement, because I got rid of everything with one dietary change. But the thing that I noticed was dramatic improvement in my mood, energy, concentration, and sleep. I, for the first time in my life, I started waking up before my alarm went off and feeling rested. That never happened to me before. I, I was meticulous about planning when my alarm went off and how many times I could push the snooze button in order to be on time for wherever I needed to be, whether it was school or the hospital or whatever. Um, I had a, I had a good system. I was never late for anything. But, uh, that was shocking to me, that I felt so good. And, you know, one of the things that I've often said to people, prior to the diet, I always felt like there are two types of people in the world. There are haves and have-nots. There are these happy, peppy people who just are so positive and they've got energy, and they have these, this saying, they like to work hard and play hard. And I always understood working hard. I totally got that, 'cause I was a hard worker, and I understood the value of hard work and that, you know, you gotta do something useful with yourself. But I never understood who the hell wants to play hard. Like, who's got energy for that? Like, aren't you tired from working so hard? How on Earth do these people have energy to go and play hard? And I assumed that they were just part of the haves in the world, and they were just lucky and privileged. They either had good genetics or maybe they had good, good childhoods or good parents or something, something that I didn't have.

   21. AHAndrew Huberman18:50

       The kids with genuine smiles in the yearbooks. (laughs)

   22. CPChris Palmer18:53

       Yes. Exactly. Yes.

   23. AHAndrew Huberman18:55

       Whereas the rest, the rest, uh ... And by the way, I really appreciate you sharing some of your personal story, because I think it is very important for people to hear and understand that people like yourself who are extremely high functioning and accomplished, that the road was, from everything I'm hearing and understanding, very choppy, um, internally at times, and that you've overcome a lot in order to get there, and also have, um, been going through what sounds like a very long iterative process of trying to figure out what works and what doesn't work to finally arrive at a solution, and then ma- make that the basis of much of the work-...that you're doing today for other people. I think it's very important, because I think many people share with you this notion that there a- are indeed two groups, a happy group and a fated to be unhappy group. Um, and it speaks to the fact that... Your story, rather, speaks to the fact that what we see is not always what's going on internally with people, and that this notion of there just being two groups, the, the happy or the haves and the have-nots, um, can't be the way that it works. And there are probably many more people suffering than we realize, and that there is an important need for tools to overcome that suffering. So I really just, uh, here, even early in our discussion, I just want to extend a genuine thanks, because, um, so much of what I hear from people is, you know, questions about health and mental health and physical health, but that clearly point to the fact that many people are struggling to varying degrees. And even the people who are in this category of great childhood and, and happiness could do far better for themselves and then also for other people. So thank you for that. I,

4. 20:43 – 27:52

   Low-Carb Diets & Anti-Depression, Fasting, Ketosis

   1. AHAndrew Huberman20:43

      I want to know, at the point where you realized that nutrition can play a profound role in how you feel and operate in a large number of domains, you were still a student or a resident at that point?

   2. CPChris Palmer20:57

      I was a resident.

   3. AHAndrew Huberman20:59

      At that point, did you decide that you were going to explore this in a professional context?

   4. CPChris Palmer21:04

      Uh, not yet.

   5. AHAndrew Huberman21:04

      Okay.

   6. CPChris Palmer21:05

      Um-

   7. AHAndrew Huberman21:05

      So what was the, what was the journey forward into the, the work that you're doing now?

   8. CPChris Palmer21:10

      So th- so the next step was that... I just had friends and family who saw me, saw that I had improved my health, saw that I lost some weight pretty easily. Um, in particular, I remember, like, my sister and sister-in-law, they were, got really pissed at me one Thanksgiving, because I could resist all the pumpkin pie and apple pie and everything else. They were like, "How the hell are you doing that? How are you resisting all of this food?" and I said, "I don't crave it anymore. I don't want it. I'm fine. I'm just... I'm having turkey and green beans, and, and that's good enough for me." So I got them to do the diet, and they too noticed dramatic improvement in their moods and energy and sleep and everything else. So within a few years, I, I, I, I... The, the primary thing I noticed is this powerful antidepressant effect. And now, I'm, you know, an attending physician. I've got all these patients in my clinical practice with treatment-resistant mental illness. I'm in a tertiary care hospital, so I almost never get somebody off the street with their first episode of depression. Out of the gate, as part of my career, I get treatment-resistant mental disorders. So I get people who've already been to six-plus psychiatrists, therapists. They've usually tried dozens of different medications. They've been in decades of psychotherapy. They've often had ECT and other things, and nothing's working. And I'm thinking, "You know, well, we're kind of out of options for these other people, and this diet is having this really powerful antidepressant effect. I think I'm gonna try it and just see if any of my patients are game to try it, to see if it might help them." Sure enough, it did. Didn't help everyone, and not everybody was interested and/or able to do it. But the... But some of the ones who were able to do it ended up having a remarkable and powerful antidepressant effect. One woman actually became hypomanic within a month, and she had been depressed pretty much nonstop for over five years, chronically depressed, suicidal, in and out of hospitals. And I saw her become hypomanic, and I'm thinking, "Wow, this really is a powerful (laughs) antidepressant effect." Like, this is amazing. This is like a medication, but better, because it actually is working for her. And, um... But I laid low at that point, because at that point, we didn't have many clinical trials of the safety or efficacy of the Atkins diet for even weight loss or diabetes, let alone any mental disorders. And so, I really actually felt like, "I'm on the fringe here, and this is not going to be met with, (laughs) with praise by anyone, so I'm just gonna lay low. I'm gonna offer it to patients." And, uh, and I, I went along that way up until 2016.

   9. AHAndrew Huberman24:12

      S- Um, I may just ask about the diet. Um, when you say Atkins diet, so this is low to zero starch, so low-carbohydrate diet, certainly low sugar?

   10. CPChris Palmer24:23

       Yeah.

   11. AHAndrew Huberman24:24

       Um, and was it traditional Atkins? Uh, were you tailoring it to the individual patient, depending on their psychiatric symptoms, whether or not they were overweight or not overweight? Um, I'm assuming you're not a nutritionist, so how did you prescribe a nutrition plan for your patients, um, and what was involved in making sure that they adhered to that, um, maybe even some of the things you observed in terms of who was more willing to try this or not try this? Um, a- any observations or maybe even data?

   12. CPChris Palmer24:56

       So early on, I was winging it, and (laughs) -

   13. AHAndrew Huberman24:58

       (laughs)

   14. CPChris Palmer24:58

       ... I was... You know, the, the, the, the first few patients, it was, "Try this Atkins diet. I want to see ketosis." So I was going for ketones.

   15. AHAndrew Huberman25:08

       So they were pricking their finger, and they were doing a blood, uh, ketone test?

   16. CPChris Palmer25:11

       W- I, I, I didn't know about blood ketone mea- monitors, if they existed back then, so I was... We were using urine strips.

   17. AHAndrew Huberman25:18

       Which are not quite as accurate, but still useful as a general guide, from what I understand.

   18. CPChris Palmer25:22

       True.

   19. AHAndrew Huberman25:23

       Is that right?

   20. CPChris Palmer25:23

       Absolutely.

   21. AHAndrew Huberman25:24

       Okay.

   22. CPChris Palmer25:25

       And, uh, so, so I was strongly recommending that patients achieve urinary ketosis. And the interesting thing is, I noticed a pattern, that when they were trying the diet and not getting ketones, they often did not get a clinical benefit.It was once they got into ketosis that I began to notice the clinical benefit and, uh, the- the powerful antidepressant effect.

   23. AHAndrew Huberman25:52

       So probably any nutrition plan, aka diet, that elevated ketones in the urine to the point where you would say, "This person is in ketosis," or they would say, "I'm in ketosis," that was a step in the right direction, independent of, like, exactly what they were eating or not eating to get there. Um, including fasting? Uh, at that time probably fasting wasn't as popular. Now, thanks to the incredible work, I think it's incredible, and he is a former colleague, and I know there's a lot of controversy about fasting, but I think for many people fasting is a powerful tool. For others, it's a less useful tool. But of, uh, Satchun Panda and others. Um, but fasting certainly will limit your carbohydrate intake and get you into ketosis, correct?

   24. CPChris Palmer26:38

       It will.

   25. AHAndrew Huberman26:39

       Did you have any patients fast or do intermittent fasting?

   26. CPChris Palmer26:42

       I did. Um, so, and- and we had some pa- I had some patients who did what- what Atkins had called a fat fast, where they eat primarily fat. Um, so they either fast and/or they eat primarily fats to try to get into a state of ketosis. So for some patients it was actually quite easy to get into ketosis, especially overweight and obese patients. They have a lot of fat stores on their body, and actually limiting carbohydrates usually results in high levels of ketosis for them.

   27. AHAndrew Huberman27:14

       And they probably feel better too, I imagine, because when we limit our starch intake, we start to excrete a lot of water. People can, um, get some pretty quick weight loss that even though it may not be fat loss, makes them feel literally a little lighter and maybe a little more energetic. Is that- is that right?

   28. CPChris Palmer27:30

       Ab- absolutely. And, uh, and as the years went on, you know, the field was advancing, more research was coming out, people were getting a little more sophisticated with blood ketone monitoring, with different versions of ketogenic diets, and I was evolving my practice.

5. 27:52 – 34:32

   Schizophrenia, Depression & Ketogenic Diet

   1. CPChris Palmer27:52

      Um, the thing that completely upended everything that I knew as a psychiatrist, though, was when I helped a patient in 2016 lose weight. So this was a patient, 33-year-old man with schizoaffective disorder. He had been my patient for eight years now.

   2. AHAndrew Huberman28:12

      Could you clarify for people what schizoaffective disorder is? I- I'm not a clinician, but as I recall, it's- it's like a low-level of schizophrenia, so there might be some auditory hallucinations. If I met this person, I might think they're kind of different, quote/unquote weird, but they would not seem necessarily a the, um, scary to me, uh, and to typ- typically to other people. Um, and I mean that with- with respect of course, but oftentimes people with schizophrenia can seem just like you- you don't even know how to interact with them because their world seems so altered, um, because they have all these bo- so-called positive symptoms, hallucinations, and they're talking to people that no one else can see, et cetera. Is that sch- schizoaffective?

   3. CPChris Palmer28:52

      So no, actually. So schizoaffective is the same as schizophrenia essentially. The only difference is it's schizophrenia with superimposed mood episodes.

   4. AHAndrew Huberman29:01

      Oh, so it's actually more severe than ...

   5. CPChris Palmer29:03

      It can be.

   6. AHAndrew Huberman29:04

      Okay. So I have it backwards.

   7. CPChris Palmer29:06

      So it's, so schizoaffective disorder is essentially schizophrenia and plus some mood episodes. So-

   8. AHAndrew Huberman29:11

      Ah. Maybe I'm thinking of schizotypal? Is it-

   9. CPChris Palmer29:14

      Schizotypal is-

   10. AHAndrew Huberman29:15

       I see.

   11. CPChris Palmer29:15

       ... is the low-grade-

   12. AHAndrew Huberman29:16

       Got it. Okay.

   13. CPChris Palmer29:16

       ... kind of mild paranoia or, eh, you know, kind of eccentric beliefs and other things.

   14. AHAndrew Huberman29:21

       Okay. So I- I, uh, folks out there, I have my nomenclature backwards. Schizotypal is the quote/unquote lower, low-level schizophrenia or schizoid-like. Um, schizoaffective is as or more severe-

   15. CPChris Palmer29:33

       Full-blown schizophrenia-

   16. AHAndrew Huberman29:35

       Okay. Great.

   17. CPChris Palmer29:35

       ... plus full-blown-

   18. AHAndrew Huberman29:36

       Right.

   19. CPChris Palmer29:36

       ... usually bipolar symptoms.

   20. AHAndrew Huberman29:37

       Right. And now it's absolutely clear who the clinician in- in the room is.

   21. CPChris Palmer29:41

       (laughs)

   22. AHAndrew Huberman29:41

       Thank you for that reminder.

   23. CPChris Palmer29:42

       No-

   24. AHAndrew Huberman29:43

       Uh, thanks.

   25. CPChris Palmer29:43

       No worries. So, so this man had schizoaffective disorder. He had, he had daily auditory hallucinations. He had paranoid delusions. He could not go out in public without being terrified.

   26. AHAndrew Huberman29:56

       Mm-hmm.

   27. CPChris Palmer29:57

       He, uh, he was convinced that there were these powerful families, that they had technologies that could control his thoughts, they could broadcast his thoughts to other people. They were trying to hurt him. They had targeted him for some reason. He wasn't quite sure why. He had some bel- suspicions and beliefs about maybe when he did this bad thing when he was 11 years old, that's why they decided to target him. This man was tormented by his illness, tormented. It ruined his life. He had already tried 17 different medications, and none of them stopped his symptoms. But they did cause him to gain a lot of weight.

   28. AHAndrew Huberman30:35

       These are g- are the medications, as I recall, for schizophrenia, the classical ones are dopamine receptor blockers, cause people the huge increases in prolactin.

   29. CPChris Palmer30:45

       Yes.

   30. AHAndrew Huberman30:45

       That's why sometimes men will get breast development, and they'll put on a lot of weight, and they'll be catatonic or movement disorders.
6. 34:32 – 35:38

   AG1 (Athletic Greens)

   1. AHAndrew Huberman34:32

      that covers all of your foundational nutritional needs. I've been taking Athletic Greens since 2012, so I'm delighted that they're sponsoring the podcast. The reason I started taking Athletic Greens and the reason I still take Athletic Greens once or usually twice a day is that it gets me the probiotics that I need for gut health. Our gut is very important. It's populated by, uh, gut microbiota that communicate with the brain, the immune system, and basically all the biological systems of our body to strongly impact our immediate and long-term health. And those probiotics in Athletic Greens are optimal and vital for microbiotic health. In addition, Athletic Greens contains a number of adaptogens, vitamins, and minerals that make sure that all of my foundational nutritional needs are met, and it tastes great. If you'd like to try Athletic Greens, you can go to athleticgreens.com/huberman, and they'll give you five free travel packs that make it really easy to mix up Athletic Greens while you're on the road, in the car, on the plane, et cetera, and they'll give you a year supply of vitamin D3 K2. Again, that's athleticgreens.com/huberman to get the five free travel packs and the year supply of vitamin D3 K2. I have a couple

7. 35:38 – 42:35

   Psychiatric Mediations, Diet Adherence

   1. AHAndrew Huberman35:38

      of questions. Um, first of all, did he stay on any kind of antipsychotic or other medication? If so, were the dosages ado- adjusted, excuse me, while, um, undergoing this remarkable transition? Um, because, as we know, it's not an either/or, medication or nutrition changes. It can be both. And then the other question is one of adherence. You know, I think about a, someone with schizoaffective disorder who's suffering from all the sorts of things that you described. How does somebody like that organize themselves in order to stay on a ketogenic diet? And I say this with all the seriousness in the world. I think there are a lot of people who do not have schizotypal or schizoaffective disorder who have trouble, they claim, um, adhering to a ketogenic diet. It's not the easiest diet in its... uh, certainly in its extreme form. At first, it's not the easiest diet to s- to stick to. So, how did he do it? This sounds like a remarkable individual. Um, and I'd also like to just know your general thoughts about, um, adherence to things when people are back on their heels mentally, you know. How do they, how do they get motivated and stick to something? Um, so the questions were medication, yes or no? If yes, dosage adjusted, yes or no? And if people are suffering from depression or full-blown psychotic episodes, how does one ensure that they continue to adhere to a diet?

   2. CPChris Palmer37:10

      So in terms of medications, he has remained on medication. So e- early on, I wasn't adjusting anything. I was just in disbelief and shock that this was happening. Uh, I didn't know what was going on. Over the years, we have slowly but surely tried to taper him off his meds. He has been on meds for decades. He started medications when he was a young child. His brain is, uh, has developed in response to all sorts of psychiatric medications, and it has not been easy to try to get him off. So we are... We continue to try to get him off medication, and it's-... challenging and difficult. And I just want to say for any listeners, it is- getting off your meds is very difficult and dangerous, and you need to do it with supervision, with a, um, a mental health professional or a prescriber, um, because it is dangerous. When people reduce their meds too much, they can get wildly symptomatic.

   3. AHAndrew Huberman38:17

      This, is that true for depression as well?

   4. CPChris Palmer38:19

      It's true for any psychiatric medication. The, the brain makes adaptations in response to psychiatric medications, and when you w- when you stop them cold turkey, uh, some people are fine. But I wouldn't, I, I wouldn't recommend finding out, because I- I've seen patients, when they stop antidepressants, I've seen patients get floridly depressed and suicidal within three months. I had one patient almost quit her job, because she keep- she became convinced that, you know, "Well, my life sucks, and it's all because of my boss, and I know that she's just, you know, a horrible human being, and she's abusing me." And I was like, "Whoa, whoa, whoa. I think this is related to your medication change." We got her back on her meds. Within three days, she said, "Oh my god, I can't believe that happened. Like, I almost quit my job, and that would have been the most illogical and irrational decision I've ever made in my entire life. But somehow, it seemed so real just several days ago, and now that I'm back on this medication..." And it doesn't mean that she needs the meds. But, it doesn't mean that he needs the meds. It means that meds need to be adjusted very safely and cautiously and gradually. So that's the medication piece. The adherence piece was not easy for him and for other patients. It is very rare that I have a patient who I can say, "Do the ketogenic diet, come see me in three months, and let me know how it's going."

   5. AHAndrew Huberman39:53

      (laughs)

   6. CPChris Palmer39:54

      Tha- that, tha- almost never happens. It has happened, I think, on two occasions.

   7. AHAndrew Huberman39:59

      But that is, if I understand correctly, what, perhaps not you, but many psychiatrists do with medication. It's, "Here's your prescription. Let's talk in thr- in-"

   8. CPChris Palmer40:09

      Yes.

   9. AHAndrew Huberman40:10

      ... a month or three months.

   10. CPChris Palmer40:11

       Yes.

   11. AHAndrew Huberman40:12

       Um, so that's a variable that is probably worth us exploring a little bit here as the conversation continues.

   12. CPChris Palmer40:17

       Absolutely.

   13. AHAndrew Huberman40:18

       You know, that frequent contact and making micro-adjustments or macro-adjustments to medication or nutrition could be meaningful.

   14. CPChris Palmer40:26

       Absolutely. So with that, with this particular patient, um, you know, early on, he was actually pretty adherent. I was seeing him once a week, uh, and so I could do a lot of education. I was weighing him. I was checking his ketones. I was checking his glucose levels. You know, at that point, I had a blood ketone monitor in my office. So, I knew whether he was compliant or not, which is so beneficial in doing clinical work and research on this diet. It's the only diet where, within seconds, I can have an objective biomarker of compliance or non-compliance.

   15. AHAndrew Huberman41:03

       Uh, uh, such a key point, and again, brings to mind for me the parallel with medication. I mean, a patient can say they're taking their medication and, unless they're in a hospital setting where somebody's checking under their tongue and, you know, all of this, they, they very well could not be taking it, or, or taking more. And, um, you and I both know that, um, blood draws for neurotransmitter levels are complicated, because you want to know what's in the brain and what's functional in the brain. So, and now you have to imagine that most people that are prescribed drugs for any number of different psychiatric conditions are not giving blood every time they talk to their psychiatrist or psychologist.

   16. CPChris Palmer41:39

       No. No, and when you, and when we've looked at, you know, on that front, when we've looked at studies, um, of compliance, the, the majority of patients are at least somewhat non-compliant with prescription medications. It's not on purpose. It's, it's forget, they forgot. They take it at night. They were out late. They were off their routine. They forgot to brush their teeth because that's when they take their meds, and so because they, you know, it was so late, they just crashed when they got home. They forgot to take their meds. Happens all the time. If it's a medication that people take more than once a day, the non-compliance rates are much higher, um, because it's just easy to forget. So it's not that people are willfully, you know, disobeying their doctors or anything else. It's just hard to remember to take meds consistently every day.

   17. AHAndrew Huberman42:34

       When you say,

8. 42:35 – 46:51

   Highly Processed Foods, Ketones & Mental Health Benefits

   1. AHAndrew Huberman42:35

      um, measuring ketones, I, um, want to drill into this a little bit, uh, because it does seem that the presence of ketones and somebody being, quote-unquote, "in ketosis," turns out to be the key variable. Certainly in your book, that's what I, one of the major takeaways, um, although there were many important takeaways, um, that people get into ketosis. Do they have to stay in ketosis? So for instance, I've followed the, uh, I don't any longer, but I've tried in the past, the so-called cyclic ketogenic diet, where every third or fourth day, you get some pasta or rice, et cetera. Um, and that, uh, it's not, that was interesting, um, as an experiment. Um, but to stay in ketosis, uh, what sort of blood levels of ketones do you like to see in your patients? Uh, what is the range that you think most people could, uh, aspire to?

   2. CPChris Palmer43:26

      So it really depends on the patient and what I'm treating, quite honestly. So, a- and I don't think every patient needs the ketogenic diet. For some patients, simply getting rid of junk food can make a huge difference in a mood disorder, for instance.

   3. AHAndrew Huberman43:41

      So, uh, uh, junk food meaning highly processed food, food that could last on the shelf a very long time.

   4. CPChris Palmer43:46

      Highly processed foods that are usually high in both sugar, carbohydrate, and, uh, uh, carbs, and fat.... those seem to be the worst foods. That combination, sh- high sugar, high fat, um, seems to be the worst combination for metabolic health. And lo and behold, we've got emerging data that suggests, that strongly suggests, it's also bad for mental health. Depression and anxiety are the most common mental disorders, and so we have the best of data for those disorders. But we actually have a lot of data with even bipolar disorder and schizophrenia that insulin resistance in particular, and insulin signaling in the brain, is impaired in people with chronic mental disorders kind of across the board, all the way from chronic anxiety, depression, to bipolar, to schizophrenia, and even Alzheimer's disease. We know that patients with all of those disorders have impaired h- glucose metabolism and that the insulin signaling system in the brain, which is different than insulin signaling in the periphery, um, seems to somehow possibly be playing a role. So, so to step back from that, so for some patients, I might just want to decrease glucose and insulin levels, and I can do that by getting rid of sweets. For other patients, like patients with schizoaffective disorder, or schizophrenia, or bipolar disorder, especially if it's chronic, if I'm using it as a brain treatment, um, then I do want a ketogenic diet. And I usually want reasonably high levels of blood ketones. Usually, for, for depression, I want to see at least greater than probably 0.8 millimole. For, for psychotic disorders and bipolar disorder, I usually want to see levels greater than 1.5. That's what I'm shooting for, if at all possible. Um, and, uh, so yeah, I, that, I, I think that's what I'd go for.

   5. AHAndrew Huberman45:59

      Mm-hmm. Yeah, so, um, and sorry, I didn't mean to imply that you, people need to be in ketosis in order to see some mental health benefits from changing their diet. Um, you make very clear in your book, and we'll go into this in more detail, that avoiding insulin resistance, reversing insulin resistance, and essentially trying to reverse what earlier you described as, you know, this metabolic syndrome, which is a bunch of different things, um, is the target. And for some people, getting rid of highly processed foods and focusing mainly on non-processed or minimally processed foods will really help. For others, going straight to the full-blown ketogenic diet will be of most benefit. I'd like to back up a little bit in history and get to something which I find incredibly interesting, which is epilepsy and

9. 46:51 – 56:10

   Ketogenic Diet & Epilepsy Treatment

   1. AHAndrew Huberman46:51

      the longstanding use of ketogenic diet and fasting to treat epilepsy. And the reason I want to kind of rewind to that point in history is that I think that for a lot of listeners and people out there who are familiar with how changing your diet or changing your exercise can positively impact sleep, and weight, and all these things, and it cascades into feeling better, that makes perfect sense. But for a lot of the world still, the idea that changing or using nutrition as a dissection tool or as a treatment tool to understand and treat mental illness is still a kind of heretical idea, that to them, it kind of falls in the, "Okay, well, that's like a woo science or something like that." Now obviously, you're a board-certified physician and psychiatrist at arguably one of the finest medical schools in the world, Harvard Medical School, you know, even though I'm on the Stanford side.

   2. CPChris Palmer47:50

      (laughs)

   3. AHAndrew Huberman47:51

      We acknowledge, we acknowledge our East Coast, uh, friends.

   4. CPChris Palmer47:53

      You're the Harvard of the West Coast. (laughs)

   5. AHAndrew Huberman47:55

      We're not going to talk count, we're not going to talk count-

   6. CPChris Palmer47:57

      Or we're the Stanford-

   7. AHAndrew Huberman47:58

      Right, right.

   8. CPChris Palmer47:58

      ... of the East Coast.

   9. AHAndrew Huberman47:59

      That argument could go back and forth a number of times.

   10. CPChris Palmer48:01

       (laughs)

   11. AHAndrew Huberman48:01

       But you know, this is, you're a, you're a serious clinician and a serious scientist, and, uh, you're a, you're a serious thinker. Uh, but for a lot of people out there, the notion of using diet, they immediately think, "Ah, um, well, that makes perfect sense." Or I think there's a category of people who think, "Well, yeah, didn't Atkins die of a heart attack?" You know, I hear that a lot, you know? (laughs)

   12. CPChris Palmer48:23

       Yeah.

   13. AHAndrew Huberman48:23

       "So, uh," like, "that was crazy," you know? Like, people will think, they immediately discard the, the Atkins diet, um, for that reason, um, which I do think is throwing the baby out with the bath water, but it's an interesting thing nonetheless. And then I think that the majority of people sit in the middle and just want to see science and medicine come up with treatments that work. And I have to say, I'm very, uh, relieved to hear what you said earlier, which was you never said that people should come off their medication and just become, go on a ketogenic diet and everything will be cured. You're certainly not saying that.

   14. CPChris Palmer48:54

       No.

   15. AHAndrew Huberman48:55

       And rather you're saying, if I understand correctly, that nutrition needs to be considered one of the major tools in the landscape of effective tools, and that it can be very effective, evidenced by the, the story that you shared. And, and there are many other stories in there as well, um, of r- tru- truly miraculous transformations. So let's talk about epilepsy and how the ketogenic diet is not just used for epil- epilepsy, but is one of the oldest, if not the oldest, examples of the use of nutrition to treat a condition of the nervous system that can be incredibly debilitating, even deadly.

   16. CPChris Palmer49:33

       Yeah, and the reality is that this literature and this clinical history and all of the research we have was the godsend that I needed to do the work that I'm doing. Otherwise, I would have been discredited on day one. "Chris Palmer's claiming that a dietary change can influence schizophrenia or schizoaffective disorder? That's impossible, and he's a quack." Um, but-The thing that immediately got me credibility was I didn't focus on it as a diet. I did a deep dive into the epilepsy literature. So, the ketogenic diet, unbeknownst to most people, was actually developed a hundred years ago, ni- 1921, by a physician for one and only one purpose, to treat epilepsy. It wasn't developed as a weight loss diet. It wasn't developed as the, the diet that all human beings should follow. And the reason it was developed is because of this longstanding observation since the time of Hippocrates that fasting can stop seizures. Now, fasting is not a healthy diet. Fasting is the process of no diet. But under- so we now understand a tremendous amount of science. Most people think going without food is bad and they equate it, uh, with starvation. But in fact, when we go without food, it causes tremendous shifts in metabolism, both brain and body metabolism, and it puts the body into a mode of autophagy and conservation of resources and all sorts of things that, uh, that are beneficial to human health. And this is why fasting has been used as a therapeutic intervention in almost every culture and almost every religion for millennia. But, but for the most part, that was all thought to be religious folklore. That wa- that was just crazy talk and those, those stupid people way back then, you know, thought God cured everything and so they fasted and they just assumed that they were getting better. Well, in 1921, one physician used intermittent fasting on a child with seizures and found that, oh, lo and behold, this religious folklore stuff (laughs) has something to it. It actually worked. The problem with fasting is that you can only fast for so long before you starve to death, and that's not a very effective treatment.

   17. AHAndrew Huberman52:10

       And, uh, this child was ingesting water, correct?

   18. CPChris Palmer52:14

       Yes.

   19. AHAndrew Huberman52:14

       It was just a l- food elimination fasting.

   20. CPChris Palmer52:16

       Food elimination.

   21. AHAndrew Huberman52:18

       Okay.

   22. CPChris Palmer52:18

       So no special diet. So it was, uh, but the problem with fasting for epilepsy is that as soon as people start eating a normal diet again, their seizures usually come right back, oftentimes with a vengeance. And so it can be a good short term intervention, uh, you know, the fa- if the fasting can take a few days 'cause it can take a few days to get ketosis, um, and then you can get some relief from chronic seizures. But it's not a good long-term treatment because, again, people will starve to death. As soon as they start eating, seizures come back. So it was actually Dr. Russell Wilder at the Mayo Clinic who developed the ketogenic diet with one and only one purpose. He wanted to see, can we mimic the fasting state using this special diet to see if it might stop seizures long term? And lo and behold, it worked. It, uh, you know, early results were extraordinarily positive. 50% of patients who used the ketogenic diet became seizure-free, and another 35% had a 50% or greater reduction in their seizure frequency, so about 85% efficacy rate.

   23. AHAndrew Huberman53:31

       Sorry to interrupt. I, I didn't mean to do that. There the, um, w- was it just for pediatric epilepsy or for adult epilepsy as well?

   24. CPChris Palmer53:37

       So back in the 1920s, we didn't have many anti-epilepsy treatments and a lot of adults were struggling as well, so they were using it on anybody who would do the diet. Um, by the 1950s, pharmaceuticals were coming out and we had many more anticonvulsant treatments and there's no question they work for a lot of people. That's great. And taking a pill is so much easier than doing this diet. So the diet pretty much fell out of favor and nobody was using it from the 1950s to about the '70s. But lo and behold, even to this day, people with epilepsy, about 30% don't respond to the current treatments that we have available. 30% will have treatment-resistant epilepsy, which means they continue to have seizures no matter how many anticonvulsants they're taking, even if they've had brain surgery. It just doesn't stop their seizures. And so in the 1970s, the ketogenic diet was resurrected at Johns Hopkins for these treatment-resistant cases. And lo and behold, it works. Not for all of them, but it works and about, uh, about one third become seizure-free, and these are people who've tried everything and nothing's working. So one third becomes seizure-free. Another third get a clinical benefit, meaning a 50% or greater reduction in their seizure frequency, and the other third, it doesn't seem to work. It's not always clear if that's because of non-compliance or if that's because it, the, the diet's just not working. But about a third, a third, a third seizure freedom, reduction in seizures, or it just doesn't work. Um, and so the reality, the s- the godsend for me is that we have decades of neuroscience research on the ketogenic diet and what it is doing to the brain. We know that the ketogenic diet is influencing neurotransmitter levels, in particular glutamate, GABA, adenosine. It changes calcium channel regulation, uh, and calcium levels, which is really important in the function of cells. Uh, it changes gene expression. It, it reduces brain inflammation. It changes the gut microbiome. And there are, you know, gut microbiome's a huge topic right now and there are some researchers who argue that is the primary benefit of the ketogenic diet. It's changing the gut microbiome in beneficial ways. Um, so it's doing a lot of things. It obviously improves insulin resistance, uh, lowers glucose levels, lowers insulin levels, which improves insulin signaling.The

10. 56:10 – 57:05

    Ketogenic Diet & Mitochondria Health

    1. CPChris Palmer56:10

       key for my research that I've outlined, the real magic, is that this diet stimulates two processes that relate to mitochondria. It stimulates a process called mitophagy, which is getting rid of old and defective mitochondria and replacing them with new ones, and it also stimulates a process called mitochondrial biogenesis, which means that after people have done the ketogenic diet for a while, months or years, many of their cells in their bodies and brains will have more mitochondria and those mitochondria will be healthier. And I believe that is the reason the ketogenic diet is such a powerful treatment, not only for epilepsy, but also for people with chronic mental disorders.

11. 57:05 – 1:05:44

    Nutrition & Benefits for Neurologic/Psychiatric Disorders

    1. CPChris Palmer57:05

    2. AHAndrew Huberman57:05

       Would you mind listing off a few of the mental disorders? Um, and I know, uh, this is not meant to be inside ball, but we should distinguish between psychiatric disorders and neurological, uh, symptoms and diseases, you know, uh, that the fields of psychiatry and neurology hopefully someday will just merge. But for instance, typically if somebody is presenting with something that looks like Alzheimer's dementia, they'll talk to a neurologist, whereas if somebody is presenting with symptoms like schizophrenia, bipolar, they'll talk to a psychiatrist. But if you wouldn't mind, um, wearing a dual hat, could you just quickly list off some of the neurologic and psychiatric disorders for which ketogenic, or let's just say nutrition changes, have been shown to improve symptoms significantly? And then maybe we can dive into a couple of these as well as get more deeply into these two very interesting aspects of mitochondrial function and repair and turnover.

    3. CPChris Palmer58:02

       Yeah. The, so the field, you know, in terms of nutritional psychiatry, it's a broad field and it's in its infancy is the real answer. If you're looking for randomized controlled trials documenting efficacy in large numbers of patients with these disorders, we don't have them. They're underway now, but we don't have them yet. What we do have are, um, case studies. We have a lot of mechanistic, um, science papers by some of the leading neuroscientists and psychiatrists in the world and neurologists in the world, um, kind of outlining, "This is everything we know that the ketogenic diet's doing. These are the problems in the brains of people with these chronic mental or neurological disorders, so we know that they should work." But, but the disorders range from chronic depression to, we've got, we've got a trial underway for PTSD. We've got one actually decent pilot trial from the National Institutes of Health for the ketogenic diet for alcohol use disorder of all things, and we can go into that a little more. We've got a couple of pilot trials of the ketogenic diet for Alzheimer's disease. We've got... And those are randomized controlled trials. We've got case studies of the ketogenic diet for chronic depression, bipolar disorder, and schizophrenia. The largest study that we've got in that mental health sphere is a pilot study of 31 patients admitted to a French hospital. Um, the, 28 of those patients were able to do the diet and stay on the diet. Uh, so 10% off the bat, non-compliant, couldn't do the diet. So, we need to include that. But of the 28 patients who were able to do, and these were 28 patients with treatment-resistant mental disorders, chronic depression, bipolar, and schizophrenia, um, of the patients who were able to do the ketogenic diet, 100% had at least some improvement in symptoms, 46% had remission of illness. Remission of illness. That does not happen with current treatments. And 64% I think were discharged on less medicine than they went into the hospital on. So, it wasn't that the, the people were prescribing more medicine and that's why. It was they were being discharged on less medication. We've got at least... Again, a lot of the, the hardcore scientists are gonna say, "Show us the randomized controlled trials-"

    4. AHAndrew Huberman1:00:47

       Sure.

    5. CPChris Palmer1:00:47

       "... with hundreds of patients." And we've got five randomized controlled trials underway now, uh, funded primarily through philanthropy. Um, I can tell you that, you know, we've talked about that one index patient, but at this point I have now treated dozens of patients and I've heard from hundreds of patients who've been treated by other clinicians, researchers, or I've just heard from patients from around the world who have shared stories of complete remission of long chronic mental disorders like bipolar disorder and schizophrenia off of psychiatric meds some of them. Not all of them, but some of them are able to get off all psychiatric meds and remain in remission. Again, I think... I didn't say this before, but it's really important to mention. For people who might be unfamiliar with the mental health field and its connection with epilepsy, the reason that's, it's such an important connection is that we use epilepsy treatments in psychiatric patients every day in tens of millions of people. So, a lot of people don't know this, but I'm, I'll list off some names that a lot of your listeners may have heard of and they probably know them as psychiatric drugs, but in fact these are epilepsy drugs. Depakote, Tegretol, Lamictal, Topamax, Neurontin or gabapentin, Valium, Klonopin, Xanax.Those are all medications that stop seizures. And many of them were developed initially for seizures, but we in the mental health field quickly steal them and start using them in tens of millions of people, even if they're off label. So that means we don't have research studies documenting that they're effective, but we go ahead and use them anyway, because the reality is far too many patients aren't getting better with the FDA approved treatments that we do have to offer, so psychiatrists are just winging it in some cases, and we're just throwing whatever we can at them, and we absolutely include epilepsy treatments. So in many ways, using the ketogenic diet as a treatment for serious mental disorders is nothing new at all. It's an established evidence-based treatment for epilepsy. We use evidence-based treatments for epilepsy across the board for a wide range of mental disorders, and so in many ways, that's all I'm doing with the ketogenic diet. It just happens to be a diet. (laughs)

    6. AHAndrew Huberman1:03:26

       I love it. I love it, and I should say I love it because we had a guest on here early days of the podcast. He's a colleague of mine at Stanford. He's a bioengineer and a psychiatrist, phenomenal s- scientist and psychiatrist, um, Karl Deisseroth, who won the Lasker Prize and so f- so on and so forth, and he made a, a really important point which should have been obvious to me but wasn't, um, until he said it, which was, you know, the, the psychiatrist has tools just like the surgeon has tools but the tools are language and observing behavior. Um, you know, those are the dissection tools for what's going on in someone's brain. And then as a neuroscientist, I, you know, I'm familiar with the neurotransmitters and neuromodulators, and you mentioned that, you know, and there are these tools of, of, you know, altering brain chemistry which are of the sorts of drugs you just listed off were antidepressants or antipsychotics that fall under these major bins of adjusting dopamine, or adjusting serotonin, or some combination of dopamine, serotonin, epinephrine, adenosine, and on and on and on. And it seems to me it's, um, it's an incredible field but that the field is still very much in its infancy, that it wasn't but 100 years ago that, um, people were measuring bumps on the head as a way to diagnose, you know, phrenology, and, um, that there's still so much to learn, and so when I hear you say, you know, adjusting nutrition or putting people into a ketogenic state or even just eliminating highly processed foods, sugars, et cetera, taking care of metabolic syndrome and then observing tremendous relief in, uh, clinical syndromes of, uh, or symptoms rather of psychiatric disorders, it makes perfect sense to me. It's yet another dissection tool and a, uh, tool for altering brain chemistry. I think that if I think about the landscape, the sort of sociology out there of, uh, again, it, there seem to be these bins, like a third of people saying, "Of course, you know, diet and exercise and social connection and limiting stress, like that's the good stuff. That's the stuff that we know really works." And then about a third of people are sort of unclear and then a third of people think, "Well, if it's not a prescription drug, then it just has no place in medicine," and hopefully that's changing, um, and certainly the work that you're doing is, is going to be important in, in that, that transition that I think we will see. I'd like to talk

12. 1:05:44 – 1:15:12

    Mitochondrial Function & Mental Health

    1. AHAndrew Huberman1:05:44

       about, uh, mitophagy and mitochondrial biogenesis. I think, uh, most people learn that the mitochondria are the energy, um, factories of cells and that indeed they are. Um, as a neuroscientist, what I know about them is that they are present everywhere in neurons, not just in the so-called cell body but you can find mitochondria in, in the furthest little bits of neurons and neurons can be quite big. Uh, very large, in fact, meters long or more in some cases in some species, including us, depending how tall somebody is. Could be many meters, or several meters rather. Um, and that mitochondria do a l- a lot of stuff besides just produce energy, 'cause I think people hear mitochondria, energy, and they think, "Oh, so these patients felt better, they lost weight, they have more energy, and then they're doing better." But here we're talking about remission of auditory hallucinations, people feeling, uh, suici- you know, suicidal and, and then changing their diet and feeling like life is something they can deal with and maybe even function extremely well and et cetera. So maybe we could just talk about mitochondria for a moment and then talk about these two major effects. What are some of the other things that mitochondria are important for, uh, in neurons and, um, and maybe other cells of the brain? Because as a access point for all this, I think it would be great if people could learn a little, uh, mitochondria biology.

    2. CPChris Palmer1:07:03

       Yeah. No, it's... So I guess the first thing that I'll say is that, you know, this field is one of the most cutting edge fields in medicine right now. Um, 20 years ago or so, I think the majority of research scientists thought of mitochondria as nothing more than little batteries. They, they take food and oxygen and turn it into ATP and that's really important. Yeah, we get that, but they're, they're just little batteries. That's all they are. Um, and so one of the reasons that this work is so important is it, it, is because it combines cutting edge research in the metabolic field and the aging field, and we can start to pair it with the mental health and neurological health field. So mitochondria, you know, one, one scientist gave me this analogy. He said, "If you think of the cell as a computer, a lot of people think of mitochondria as the power cord to that computer 'cause they're providing the power. And they are in fact the power cord to that computer. But actually their real function is the motherboard of that computer." So mitochondria are directing and allocating resources throughout a cell. That is their primary function, and then they happen to be powerhouses as well.And so, to, to give some clear examples, mitochondria play a direct role in the production and release and regulation of some really key neurotransmitters, including serotonin, dopamine, glutamate, acetylcholine. Um, those are pretty powerful neurotransmitters.

    3. AHAndrew Huberman1:08:54

       Yeah. I would call those, I would consider those the, I know you listed more than three, but, uh, the sort of primary colors of neurotransmission.

    4. CPChris Palmer1:09:01

       Yes.

    5. AHAndrew Huberman1:09:02

       You know, any one of those in excess or deficiency is going to have profound negative effects on a nervous system. Or it's gonna alter the way that people and animals feel, think, move-

    6. CPChris Palmer1:09:14

       Yes.

    7. AHAndrew Huberman1:09:14

       ... remember, et cetera.

    8. CPChris Palmer1:09:15

       Yeah. And so as part, so mitochondria are providing both some of the building blocks, if you will, for some of those molecules. They're part of the Krebs citric acid cycle. Some of the, some of the intermediate products actually go into making those neurotransmitters. Much more importantly, mitochondria provide the energy for the production of those neurotransmitters. And fascinatingly, mitochondria are directly related to the release of neurotransmitters. ATP alone is not enough. There have been some research studies that have actually found that mitochondria move along the membrane of the synapse to release batches of vesicles of neurotransmitters. And that if the mitochondria are removed from the synapse and researchers flood that cell with ATP, neurotransmitters usually are not getting released. Mitochondria are doing other things. We don't entirely even understand what all they're doing or how they're doing it. But they're doing other things than just providing the power. Another really important example is that mitochondria are actually the primary regulators of epigenetics. If you look at any one factor, so one study actually found that they're responsible for the expression of about 60% of the genes in a cell. And so, and mitochondria do this through a lot of ways that have been known for years and sometimes decades. So mitochondria are directly related to the levels of reactive oxygen species in a cell. They are managing calcium regulation in cells. Um, and we know that those things play a role in epigenetic expression. We know the levels of ATP to ADP or AMP also play a role. Um, and mitochondria are doing those things, but it turns out mitochondria are actually doing much more sophisticated things than even those, in terms of gene expression. Mitochondria at least play a role in all of the aspects of the human stress response. So, um, when humans are stressed, either physically or psychologically, uh, you know, there are several things that happen. Um, increased cortisol, increased adrenaline, noradrenaline, uh, inflammation, and gene expression, in particular in the hippocampus, occur with the stress response. And one group of researchers actually genetically modified mitochondria in four different ways and found that all of the stress response, all those four buckets of the stress response were impacted in one way or another, implying that mitochondria are somehow playing a role in those. In terms of it, their role in cortisol, we know that mitochondria actually have the enzyme required for the synthesis of steroid hormones. So that includes cortisol, estrogen, testosterone, and progesterone, some names that maybe everybody's heard of. And, uh, so that means that if mitochondria are in short supply or dysfunctional, the production of those hormones may become dysregulated. Um, mitochondria play a direct role in inflammation, and they turn the inflammatory system both o- or they, they at least play a role in turning the inflammatory system both on and off. I think, I'm not gonna be able to quote the exact study and author, but one paper in Cell actually identified mitochondria as the key regulator in turning certain inflammatory cells off. And that when you inhibit mitochondrial function, those cells don't turn off, that mitochondrial levels of reactive oxygen species are a key signaling process to turn the inflammatory cell process off. Another study found that macrophages, so macrophages are an important immune cell that play a role in healing. So if you cut yourself, your, your body will get, you know, send inflammation that way and, uh, and send immune cells that way to try to heal your skin. And macrophages play an important role in that healing. One group of researchers tried to figure out, how do macrophages know to switch between the different phases of wound healing? 'Cause the macrophages do different things in the different phases of wound healing. And the conclusion of all of their research was that it's mitochondria. Mitochondria are sending the essential signals that change the state of the macrophages to induce these different phases of wound healing. So, so I've just talked about neurotransmitters, hormones, epigenetic expression, inflammation. For anybody familiar with the mental health field, they know these are like-... some of the key variables that researchers have been struggling with for decades, trying to figure out how do these fit together. We know that all of the, those buckets can be disrupted in people with mental disorders. And our field has struggled to understand that how do they fit together. How can we make sense of this disruption? And I believe, once you understand the science of mitochondria, you can actually connect all of the dots of the mental illness puzzle.

    9. AHAndrew Huberman1:15:11

       I'd like to take

13. 1:15:12 – 1:16:23

    InsideTracker

    1. AHAndrew Huberman1:15:12

       a brief break and thank our sponsor, InsideTracker. InsideTracker is a personalized nutrition platform that analyzes data from your blood and DNA to help you better understand your body and help you reach your health goals. I've long been a believer in getting regular blood work done for the simple reason that many of the factors that impact your immediate and long-term health can only be analyzed from a quality blood test. The problem with a lot of blood and DNA tests out there, however, is that you get data back about metabolic factors, lipids and hormones and so forth, but you don't know what to do with those data. InsideTracker solves that problem and makes it very easy for you to understand what sorts of nutritional, behavioral, maybe even supplementation-based interventions you might want to take on in order to adjust the numbers of those metabolic factors, hormones, lipids, and other things that impact your immediate and long-term health, to bring those numbers into the ranges that are appropriate and indeed optimal for you. If you'd like to try InsideTracker, you can visit insidetracker.com/huberman to get $200 off an Ultimate Plan or 34% off the entire site as a special Black Friday deal now through the end of November. Again, that's insidetracker.com/huberman and use the code huberman at checkout.

14. 1:16:23 – 1:25:09

    Mitophagy, Mitochondrial Dysfunction, Aging & Diet

    1. AHAndrew Huberman1:16:23

       Super interesting little subcellular, uh, goodies these mitochondria are. I, I, um, I come from a field where people are often divided into lumpers and splitters. And, um, I'm somewhere in between. Um, for those of you who don't know, lumpers are people that like to make things really simple, l- lists of no more than three functions or dividing brain areas into no more than three. Splitters are people that like to subdivide into a ton of detail. Um, there's a history of scientists being splitters in order to be able to name things after themselves because, you know-

    2. CPChris Palmer1:16:56

       (laughs)

    3. AHAndrew Huberman1:16:57

       ... uh, there's more territory to go around if you're splitting than if you're lumping. Um, but we are doing neither here. What, what I'm he- hearing is that mitochondria, in addition to being important sources of energy production and output in cells, which of course they are, um, probably have other roles and that maybe s- maybe someday what we call mitochondria will actually be two or three different little subcellular organelles. Like, there may be little bits in there that are controlling gene expression and little bits in there that are controlling neurotransmitter production. At least for now, the, the name is mitochondria. And thank you, by the way, for, um, illustrating some of the other things that they do. Because, um, in the landscape of science education, uh, oftentimes people think, okay, energy production, there'll be a picture or a cartoon of mitochondria, like, flexing its muscles. People go, "Okay, energy, mitochondria, mighty mitochondria." And then they'll think, "Oh, you know, they're just sort of like a dumb jock portion of the cell," right? "They're not doing anything sophisticated." And everything you listed off is that they are doing many sophisticated, intricate things within cells. So, I think how things are cartooned and discussed actually has an impact and not just on the general public, but on (laughs) the medical field and on the science fields. Anyway, that's more science sociology. But now that, um, everyone is well aware that mitochondria are doing a large number of very important things in a very regulated way, let's talk about mitophagy. You know, a few years ago, because, uh, a Nobel Prize was given for autophagy, sometimes called autophagy ... Look, people, you can say it either way. People will know. Hopefully what it means is more important, which is the gobbling up of one's own cells that are dead or injured or, um ... And this idea of autophagy, of cells, uh, uh, being eaten up or, uh, within a system, nervous system or other system, um, has come up again and again. Uh, I actually wasn't aware that mitophagy could be such an important lever. So tell us about mitophagy, which I have to presume is the, um, intentional, or not, gobbling up of mitochondria presumably to replace them with newer, healthier mitochondria. Is that right?

    4. CPChris Palmer1:19:06

       It is. So, in, in, in many ways, mitophagy is a subset of autophagy. Um, but it is, it's got its own name because it is specific to mitochondria. There do appear to be s- some unique regulators of mitophagy compared to autophagy more broadly. Mitochondria actually are playing a r- a role in autophagy itself. Um, and this makes sense because one of ... So, the global picture of autophagy is stimulated by fasting states or fasting mimicking states. So when your body senses that you don't have enough food, it actually hunkers down and starts to recycle dead, old parts, um, in this kind of carefully orchestrated way, and it takes them to lysosomes, they get degraded, and then those degradation products get used for either energy or to build new things. Autophagy is always occurring, um, at a low level. But you can really hyper-stimulate the process through fasting, calorie restriction, fasting-mimicking diets, other things. And this is why fasting and fast, you know, calorie restriction is so, kind of such hot topics in the medical field now is because we, it, they've been shown to induce longevity. And we think it's probably through that process, that you're, you're stimulating the body to-... um, kind of become lean and conservative in terms of its allocation of resources. And the body doesn't just destroy the healthiest tissue along with the old dead stuff. It has these processes that identify the old and defective parts first, and they go first. And that's what's beautiful about the whole thing, and that's why fasting is so important. So mitophagy, um, we know plays a really important role because, uh ... So there's this term called mitochondrial dysfunction, which some researchers are actually wanting to get rid of and move away from because, as you just said, mitochondria do so many different things. And different mitochondria, even within the same cell, may very well be specializing in different tasks. And mitochondria from one cell to another are sometimes doing very different things. Like, not all mitochondria can produce cortisol. That's specific to specific cells, um, where those genes are getting turned on. So it's not like all mitochondria are producing cortisol, just the ones in your adrenal gland, for instance, are producing cortisol. Um, but there is this term mitochondrial dysfunction, and it has long been known for decades that mitochondrial dysfunction is associated with everything that ails us, essentially. So, um, in the 1950s we had a theory of aging that was based on reactive oxygen species, and that essentially, and that's where all the "inflammation is bad for you" comes from.

    5. AHAndrew Huberman1:22:29

       And where all the, um, noise about antioxidants-

    6. CPChris Palmer1:22:35

       Yes.

    7. AHAndrew Huberman1:22:35

       ... came, ca- like, in the '90s it was like, "It contains antioxidants." Not to say antioxidants are bad, but they are certainly not the be all, end all of health.

    8. CPChris Palmer1:22:42

       They are not, but that's exactly where that research came from is that researchers were narrowing in on these reactive oxygen species are highly, highly correlated with all of the diseases of aging and poor health outcomes. Turns out, they're also highly, highly correlated with all chronic mental disorders, interestingly. And so researchers used antioxidants to see if we'll maybe if we can stop, somehow tame these reactive oxygen species will improve health outcomes. Doesn't seem to work. By the 1970s, our understanding of mitochondria and their role in the production of reactive oxygen species expanded, and that led to the mitochondrial theory of aging. So in the 1970s, we had this mitochondrial theory of aging based primarily and exclusively on reactive oxygen species. Fast-forward a couple of decades, that was disproven because we now know reactive oxygen species aren't all bad. They actually serve a signaling process, they're a normal part of human functioning and cellular function, so they're not all bad. But we still know high levels of reactive oxygen species are bad for you. Fast-forward to just, I think, maybe last year, with this expanded role of all of the different things mitochondria are doing, so David Sinclair, uh, published a pa- paper in one of the Cell journals, I think, uh, saying that, "Oh, mitochondria are actually the unifying link of everything that we know about aging." Mitochondria are the cause, or defective mitochondria or defective mitochondrial function, mitochondrial dysfunction is possibly the unifying cause of aging and all of the aging-related disorders. Um, so mitophagy is trying to address all that, is trying to say, "Okay, this is bad. We don't want defective mitochondria, and how can we get rid of old ones or defective ones and s- and replace them with new ones?" And I think the most powerful signal and tool that we have right now is, in fact, related to diet. It's calorie restriction. That is the oldest, truest, kind of best

15. 1:25:09 – 1:31:54

    Neurons, Mitochondria & Blood Glucose

    1. CPChris Palmer1:25:09

       proven way to prevent aging in a wide variety of animal species. Fasting and intermittent fasting, and again, you can only do those things for so long, and then fasting-mimicking diets, um, can also stimulate this process of mitophagy.

    2. AHAndrew Huberman1:25:29

       Before we talk about mitochondrial biogenesis, um, if ... And I certainly accept the idea that mitochondria are extremely important in physical health and mental health. That's a, for me is, is a straightforward, uh, conclusion at this point based on what you've said, what I've read elsewhere, et cetera. And if various diets, including ketogenic diet, including fasting, reducing sugar intake, et cetera, can assist in mitochondrial function and mitophagy, and that's at least one of the levers by which diet can positively impact mental health and physical health, can we conclude that there's something special about low blood glucose in the brain, right? I mean, that they, the sort of common pathway of all of those things, fasting, ketogenesis, re- for some people maybe they, for m- maybe some people manage, have great insulin management, so just removing sweets, you know, refined sugars, you know, brings down their blood glucose level substantially. They don't need to go on a ketogenic diet in order to relieve a low-level depression or something like that. Seems like the, the common theme here is that glucose levels in the brain need to be reduced, which for me-... is surprising because neurons love glucose. I mean, there are some really nice studies. One that I can think of, um, recently that was published in Neuron, J- if you just look at the tuning of a neuron, how well a neuron in the brain represents some visual image in the environment, in terms of... Here we can just generalize in saying more action potentials, more electrical signals from the neuron generally correlates with better high fidelity representation. It's like sort of, you know, for every one time someone says, "Shout," and then someone shouts, the neuron is like the one responding to the, the order. And these neurons just, when there's high glucose, they are faithful representatives of what's out there in the world. But then when you fast an animal, they become less faithful representatives of what's out there. And yet, when I've done intermittent fasting, and I do a kind of modified version of it, my mental clarity is far better than when I've had a big bowl of pasta, probably for other reasons related to serotonin and tryptophan and... So I think, um, for the typical listener out there, I have to imagine it's got to be a little confusing, right? We hear, "Neurons love glucose. They live on glucose." And here we're saying, "Let's deprive them of some glucose," or, "Let's just bring glucose levels down," or, "Let's switch the fuel source of the brain from glucose to ketones, and now the brain really works the way it's supposed to." So this raises a little bit of a just so story question. Like, why would it be the case that neurons love glucose, and yet if there's too much glucose around, they become sick? Um, and of course with any, uh, why would it be story, as I always say, you know, I wasn't consulted at the design phase, and I'm going to presume that you weren't consulted at the design phase either.

    3. CPChris Palmer1:28:25

       I was not. (laughs)

    4. AHAndrew Huberman1:28:25

       And that if any of us say that we are, then we are probably the patients that need evaluation.

    5. CPChris Palmer1:28:29

       (laughs)

    6. AHAndrew Huberman1:28:29

       So, um, I think there's a name for that, right? There's delusion, right?

    7. CPChris Palmer1:28:32

       Yeah.

    8. AHAndrew Huberman1:28:32

       Okay. My first, uh, correct clinical assessment of myself. So, um, how do I get my head around this, right? You've got me sold on mitochondria. Not that I needed to be sold, but that's an easy, like, yes, yes, absolutely yes. The idea that diet can impact mental health and physical health. Yes, absolutely, by way of mitochondria, at least in part. Great. But then neurons love glucose. So what's going on or what do you think is going on?

    9. CPChris Palmer1:29:00

       I am not convinced that glucose is the real story. Glucose may in fact be a symptom. So we know that, we know that parts of the brain... You know, there was a, there have been a couple of studies that just came out in the last couple of weeks, I think, um, documenting that actually astrocytes (laughs) in the hypothalamus play a key role in glucose regulation throughout the body. And, uh, and it appears to be a metabolic role, which, in my mind, implies that the mitochondria in those astrocytes are probably playing a key role because we know mitochondria play a key role in sensing glucose levels, they play a key role in the release of insulin from the pancreas, but mitochondria in the brain is also playing a role in kind of balancing how much glucose is around. And so it's, it's a difficult question, because I think in some cases high glucose levels are actually a symptom of metabolic dysfunction somewhere in the body or brain. And when I think about, well, what does that mean? In my mind, most of the evidence currently is pointing to mitochondrial dysfunction somewhere in the body or brain that is the most likely cause of that dysregulation of glucose levels.

    10. AHAndrew Huberman1:30:53

        Got it. Mm-hmm.

    11. CPChris Palmer1:30:56

        Um, but we know that if you consume massive amounts of junk food, sugar, and other things, that you can get dysregulation of glucose levels. The, the conundrum though is that that's not a universal response.

    12. AHAndrew Huberman1:31:17

        And what about the typical person? Like, I've never really liked junk food that much. Maybe as a kid I can recall liking candy. But I was a sandwich for lunch person for a long time, and as I've changed that out for salad and, uh, maybe a small piece of meat with my salad or something like that, I feel far better during the day, far more alert. But I do eat carbohydrates. I eat starches typically at night, but I tend to do some very hard training at some point during the day, so I imagine I have some glycogen to repack. Okay, that's me. I only mention that because I am not in ketosis as far as I know, having... Unless you brought the, the strips, I haven't-

    13. CPChris Palmer1:31:53

        (laughs)

    14. AHAndrew Huberman1:31:53

        ... done the blood glucose

16. 1:31:54 – 1:40:00

    Obesity, Ketogenic Diet & Mitochondria

    1. AHAndrew Huberman1:31:54

       test today. Um, so what about the, the typical person who's an omnivore eating, um, you know, some rice, some pasta, pasta salads, you know, people that are, that are eating not junk food, massive amounts of sugar, but have blood glucose that's in kind of moderate range? Do you think, and here feel free to speculate, do you think that those people might feel far better or even a little bit better if they were in a lower glucose state? And I ask this because of, I think there are a lot of people out there who suffer from full-blown depression, but there are also a lot of people who suffer from, like, moodiness and feeling not so great, subclinical depression.

    2. CPChris Palmer1:32:38

       Yes, burnout is what I would call it.

    3. AHAndrew Huberman1:32:40

       Yeah, and just feeling like some days are great and then other days they feel lousy for reasons they don't understand.

    4. CPChris Palmer1:32:46

       Yeah.

    5. AHAndrew Huberman1:32:47

       Um, and those make for less dramatic case studies, and yet I have to assume that that description will net a large fraction of the general public.

    6. CPChris Palmer1:32:57

       So, the, the way that I kind of break this field, and I'm probably getting too nerdy right now, but I kind of break this field into cause, what's the actual root cause, and what are effective treatments? And I really see them as two separate things. Simple- just because the ketogenic diet is an effective treatment does not imply that the cause of the problem was eating carbohydrates. And I think that's a really important distinction. There are many people who disagree with me on that. There's no doubt about it. And everybody's heard people say, "Sugar is the cause of everything that ails you." Or, "Carbs are the cause of everything that ails you. If everybody does a low carb diet or a ketogenic diet..." And then they go to, "So it must be sugar that was the cause." I don't see it as clearly black and white as that. The calorie restriction, ketogenic diet, carbohydrate restriction are inducing metabolic changes in the brain and body. And regardless of what the person was eating, they are inducing metabolic changes that can be really beneficial to brain health. So let me, let me just give a clear black and white example of this, and then I, and then I can speak to the broader topic that you brought up about just the general population. The easy example of the ketogenic diet being an effective intervention for somebody who was not following a bad diet is an infant with epilepsy. There are lots of infants who have uncontrollable seizures. They are drinking breast milk. To the best of our knowledge, that is the primary most beneficial food source an infant could be consuming. Now some might say, "Well, maybe the mother's..." you know, whatever. I don't buy that. The mother's breast milk is, in fact, the, the optimal food source for that infant. And yet that infant is still seizing. If we put that infant on a ketogenic diet, a lot of those infants' seizures will stop. It doesn't mean that the cause of the infant's seizures was a bad diet. But it means a dietary intervention can change brain metabolism and improve symptoms in that person. So going to your broader question about adults modern day, the real answer, you know, there was just this conference in London, the Royal College of Obesity Medicine or something like that. That's not the name, but it's something along those lines. The conclusion of that conference, it invited the greatest minds in obesity medicine. The overarching conclusion of that conference was, "We don't know what causes obesity." I- it's really important that we sit with that. We don't know what causes obesity.

Episode duration: 3:03:41