Brain Energy, Mitochondria, and Mental Health with Dr. Chris Palmer

Bret: 
Welcome to the Metabolic Mind Podcast. I’m your host, Dr. Bret Scher. Metabolic Mind is a nonprofit initiative of Baszucki Group where we’re providing information about the intersection of metabolic health and mental health and metabolic therapies, such as nutritional ketosis as therapies for mental illness.

Thank you for joining us. Although our podcast is for informational purposes only and we aren’t giving medical advice, we hope you will learn from our content and it will help facilitate discussions with your healthcare providers to see if you could benefit from exploring the connection between metabolic and mental health. 

Chris: 
The Brain Energy Theory suggests that mental disorders are metabolic disorders affecting the brain.

What I am arguing is that when people’s brains are malfunctioning and resulting in symptoms of chronic depression or anxiety or bipolar symptoms or psychotic symptoms, that the reason for that, the foundational reason for the brain to malfunction in those ways is metabolic in nature. And in fact, understanding this opens up entirely new ways to think about and to treat mental illness.

Bret: 
Welcome back to Metabolic Mind. I’m your host, Dr. Bret Scher. Metabolic Mind is a nonprofit initiative of Baszucki Group where we’re exploring this connection between metabolic health and mental health and metabolic therapies, like ketogenic therapies as treatment for mental illness.

And today, we’re joined by Dr. Chris Palmer, once again, to dig deeper into this concept of mitochondria and how mitochondria play a role in mental health and mental illness, and also, about just brain energy and how the connection between brain energy and mitochondria. Now, if you’re interested at all in mitochondria and mental health, you’ve probably heard of Dr. Chris Palmer.

But he’s the Director of the Department of Postgraduate in Continuing Education at McLean Hospital and Assistant Professor of Psychiatry at Harvard Medical School. And he’s a Harvard psychiatrist and researcher working at the interface of metabolism and mental health, and he published his book, Brain Energy.

And since then, as you’ll hear us discuss, has been just a whirlwind of speaking engagements and podcasts because of the interest in this. You could call it a new theory or really a compilation of evidence and research, that’s been out there, into this theory of brain energy with mitochondria being at the core of that.

And you can find more about Dr. Palmer at brainenergy.com. You can sign up for his newsletter, which is really educational. And on Twitter, he’s at ChrisPalmerMD on Twitter. But before we get into the interview, please remember this channel is for informational purposes only. We’re not providing a group or individual medical or healthcare advice or establishing a provider patient relationship.

A lot of the things we talk about, whether it refers to medications or nutritional ketosis or their lifestyle interventions, can be potentially harmful and dangerous if not done without clinical supervision. So please, do not take any of this as advice to do on your own, and please use this as information to bring to your clinical team to discuss, if it’s appropriate for you.

Now, with that, let’s get on with this really insightful and enjoyable interview with Dr. Chris Palmer. So Chris, thank you so much for joining me again here at Metabolic Mind. And wow, what a year it’s been, not even a year. In November of ’22, you published Brain Energy and it seems every week I see you somewhere else, whether it’s the Huberman podcast or whether it’s Tim Ferriss podcast or giving talks at different conferences. There’s been such a whirlwind seeming like surrounding this book.

So first, how are you doing? How are you doing with all this? 

Chris: 
Honestly, it’s a little overwhelming at times. it’s flattering and humbling. It’s inspiring. I’m actually really thrilled and delighted that so many people are understanding what I was hoping to convey. And I think people who had no idea that metabolic health and mental health could be related are now opening their eyes.

And and I think the most heartwarming thing is that I am literally hearing from thousands of people around the world who are transforming their mental health using metabolic treatment strategies. I’ll also say that the heartbreaking thing for me as a clinician is that I’m also hearing from thousands of people begging for help.

They’ve read the book, they’ve seen me on a podcast. They understand the theory, but they don’t know exactly what to do for their loved ones or for themselves. Or they’re running into problems with medications or adjusting medications or how to do the diet or how to get their ketones higher or other complications. How to get better sleep?

And they’re asking for help. And right now, we don’t have enough clinicians to treat these people. And for me as a clinician, knowing that help is available, that there are solutions for these people, it’s frustrating and heartbreaking. 

Bret: 
Yeah, I can see that. You’ve inspired so many people to dig deeper and take charge of their own health, but you’re one person. So, you know, how many of those people can you actually help?

So, we need more people. So, let me ask you about the clinician response. it’s clear what your message and the brain energy proposal hypothesis description, that it’s really resonated with people. But what about with clinicians? How have you seen their response or their pushback or their acceptance?

Chris: 
it’s been a mixed bag. So many clinicians have not read the book. They don’t really understand the theory. They just hear the soundbite, mental disorders or metabolic disorders, and they dismiss it out of hand. There’s no way that could be true. If that was true, I would’ve been taught that in medical school. It would be front page news in the New York Times and the Wall Street Journal.

And given that it’s not, it must not be true. The really inspiring thing is that leading scientists, psychiatrists, neuroscientists, and others have been hot on this trail for decades. So, some of them are feeling like, it’s about time. Why? It’s about time people are talking about this. We’ve been trying for years to get people to take this seriously.

What’s taken so long? So, and then you know what’s really inspiring for me is when I hear from clinicians who say, I was really skeptical. I didn’t think this could possibly be true, but one of my patients read your book or watched you on a podcast or heard about the ketogenic diet for mental illness, and they did it themselves.

And before my eyes, I’m seeing this patient that I have known for years transform into a new person. They’re coming back to life. Their symptoms are diminishing or completely going away. They’re able to function in ways that I’ve never seen before. And so now, I’m sold, Chris Palmer. I’m sold. What can I do to help?

Or what can we do? And there’s the old saying, seeing is believing. And this can be really hard to believe that a diet or that the other strategies outlined in Brain Energy could actually restore the health of somebody with schizophrenia or bipolar disorder. It can be really hard to believe. But when people see it and see the transformations in front of their own eyes, it becomes real.

Bret: 
Yeah, that is powerful as a clinician to see your patient transform. And then to dig deeper and figure out why and understand that, oh, it was because of this brain energy concept. It was because of this metabolic intervention. But you can understand sort of the skepticism, right? You know how difficult it is to treat someone with treatment-resistant bipolar disorder or schizophrenia or major depression.

It is really challenging. And I think that sort of whole, in terms of how psychiatry treats people is, what is on the one hand ready for a revolution, if you want to use that word, with a metabolic treatment, but also resistant to it because it’s nothing works.

If you were going to give advice to the skeptical psychiatrist, who said, we weren’t taught this. These patients are just too difficult to treat. What is the one thing you can tell them to say, this is worth trying? 

Chris: 
The one thing that I would say that usually gets the most traction, is that although you may have your own ideas about what the ketogenic diet is and whether it’s a dangerous diet or a fad diet or just a weight loss craze. In fact, the ketogenic diet is a 100-year-old evidence-based treatment for epilepsy.

It can stop seizures even when medications fail to stop seizures. And it turns out as a mental health clinician, we use epilepsy treatments in tens of millions of people every day who have mental health disorders. And some of them are on-label, meaning the FDA has approved their use for the specific condition. But the overwhelming majority of them are off-label treatments, meaning that we use epilepsy treatments for a wide range of diagnoses even though we don’t have randomized controlled trials.

Because we know that if something stops seizures, it may, in fact be able to help people with mental disorders, whether it’s a mood disorder, a psychotic disorder, anxiety, a substance use disorder, an eating disorder, dementia. We use them for almost everything. And so, in that respect, the ketogenic diet is nothing new.

It is an evidence-based treatment for epilepsy. We are using it off-label right now, quote unquote, in people with serious mental disorders. And lo and behold, it’s working. 

Bret: 
That is powerful. A hundred years of clinical experience and decades of research in one brain disorder that is closely linked to another.

I can see how that’s so powerful. But now if we talk about brain energy, it almost depends on how deep you want to go to understand it. Because at its core, it’s about the way the brain produces energy and a disfunction in that energy production. But going even deeper, you get to these little bits, called the mitochondria, and that’s where the energy is coming from.

And we recently had an interview with Dr. Martin Picard, who is a pre-eminent mitochondrial researcher. But I think one place that some people get lost is going from brain energy to mitochondria because you can’t see mitochondria. You can’t feel mitochondria. You can’t, people don’t necessarily have a good grasp of what mitochondria are or how to impact them.

So, how do you like to connect the dots? And that could be for physicians too, right? Because how many, like everyday physicians, unless you deal with inborn genetic mitochondrial disorders, how many physicians think about mitochondria every day? So, how do you help people connect the dots between psychiatric symptoms, brain energy production, and mitochondria at the core? 

Chris: 
Most people have heard that, or we’re taught that, mitochondria are the powerhouse of the cell. And so, they create energy. And that is really the play on words for brain energy.

And there is no doubt they serve that role, and they perform that function. They take food and oxygen and turn it into or transform it into ATP, the energy molecule of the cell. But in fact, research over the last 20 years has completely shattered that simplistic definition of mitochondria and that is critically important to the brain energy theory.

It’s not simply energy. Mitochondria play a role in directing and allocating resources for cells, and that means that they are taking food and some of it, most of it, is getting turned into ATP. But some of it is getting turned into serotonin. Some of it’s getting turned into dopamine. Some of it’s getting turned into cortisol. And in fact, mitochondria play a critical role in regulating all of those molecules that I just mentioned. And anybody familiar with the mental health field will know, wait, neurotransmitters and hormones.

We know that those can become dysregulated or imbalanced in people with mental illness. Mitochondria are a way to understand that dysregulation or those imbalances. Mitochondria play a role in inflammation, turning it both on and off. Mitochondria play a role in sending signals to the cell nucleus.

Meaning they play a role in epigenetics or the expression of different genes at different times. Mitochondria are sensing our environment, and that means sensing levels of stress, sensing the food we eat, sensing the levels of oxygen. But they’re also sensing blood glucose levels and other things, and responding appropriately.

And here’s the shocking thing, and Dr. Martin Picard is one of the pioneers in this field, mitochondria play a role in our response to trauma, psychological and social stressors. And that is powerful because we know that trauma and psychological and social stressors play a role in mental illness. We have known that for millennia, but we’ve never understood exactly how it works at a biological level. And In many ways, mitochondria are a way to begin to connect the dots of the mental health puzzle, neurotransmitters, trauma, stress, drugs, and alcohol, sleep. All of these things are either impacting mitochondria and metabolic health or being impacted by mitochondria or metabolic health. And in some cases they are bi-directional relationships.

And once and for all, it’s a way to connect so many dots that we’ve long been trying to connect. So, it’s a way to connect physical health with mental health. We have long known that people with mental disorders have numerous physical disorders, such as heart attacks and strokes and obesity and diabetes. We’ve long known that. We have also long known that they die early deaths.

This is a way once and for all to connect those dots, and more importantly, for us to be able to help people heal and recover. 

Bret: 
Yeah, you brought up so many important issues in that answer right there because people will say no mental illness is genetic, or they will say, no, it’s because of a neurotransmitter imbalance, or they’ll say it’s because of prior trauma.

And all of those three things are true to a degree. They are all related. But the question is, how are they related and what impact do they have? So, would you argue the underlying theme to all of those is mitochondrial function? 

Chris: 
For some people, this seems too hard to believe, and I just want to share at least one kind of perspective of why it shouldn’t be so hard to believe. Mitochondria are performing the task of metabolism, which means they’re performing the task of taking food and oxygen and turning it into energy and building blocks for cells.

Metabolism is essential to life. Without metabolism, we die. That means a heart attack, a stroke, anything that stops metabolism, stops life. If you look up any poisons, a poison that can kill a human being in a matter of minutes or hours almost always without exception, works at the level of mitochondria because mitochondria are essential to life.

They are essential to living organisms and the other parts of the machine, the other parts of cells, yes, they can get damaged too. But when they get damaged, they don’t result in immediate death. Damaging mitochondria does result in immediate death. So, in a way, mitochondria are the most sensitive, necessary parts of cells to keep the cell functioning.

And so, when there are problems with mitochondrial function, there will be problems in the way that cell functions. It can become overactive. It can become underactive. And that’s one of the critical paradoxes of the theory, is that it can be either one.

But that helps us understand what would make the brain malfunction, and why would different parts of the brain become overactive? And why would other parts of the brain become underactive? And why does that abnormal activity wax and wane throughout the day? Why does stress make it worse? Why does sleep deprivation make it worse?

And this is a way for us to finally, in a coherent and cohesive way, put the dots together and understand the biology. Now, I do want to say this. If you actually do a deep dive into the science of mitochondria, and how exactly do they send all of these signals to the DNA and how exactly do they regulate the release of serotonin and what exactly are they doing to turn inflammation on and off?

There is a tremendous amount we do not know. This is an emerging field. It’s like opening a door into an entirely new universe, and there’s so much we have to learn. There’s so much we need to know. But regardless of that, regardless of all the unknowns and all of the uncertainty, this information, this insight allows transformation in the mental health field. 

Bret: 
As you said, there’s so much still unknown, which in a way is what can be frustrating for clinicians, you know, say, I don’t have time for that. Wake me up when we know more, kind of answer that. 

Chris: 
Yeah. 

Bret: 
Because clinicians are busy, let’s face it. But so, let’s transition to a second then about what we can do to help our mitochondria.

And there, if you research that, there’s a laundry list of things that you find on the internet from omega-3 fatty acids to methylene blue to infrared light therapy to glutathione, and to ozone therapy, right? You can find something that says this one thing is beneficial for your mitochondria. Now, we’ll talk about the more comprehensive lifestyle measures in a second.

But how do you respond or what are your recommendations when it comes to some of those sort of specific interventions that are recommended and have been studied to a degree? 

Chris: 
They have. So, at the end of the day, all of the things that you just mentioned, yes, there is some research to suggest they may improve mitochondrial health. But at the end of the day, unfortunately, solving metabolic or mitochondrial problems is usually not as simple as taking a supplement or applying red light to your scalp or getting sunlight in the morning.

Those can be a part of a comprehensive treatment plan. And I think for some people, they can be a game changer even. But I would venture to guess for the majority of people, they will not change the game without the common sense lifestyle strategies.

And the reason is because if, so one clear mitochondrial toxin is alcohol. And if somebody is a heavy alcoholic, they are drinking a gallon of vodka every day throughout the day, they are poisoning their mitochondria. If that person then takes methylene blue to save his mitochondria, it doesn’t stand a chance against a gallon of vodka a day.

The gallon of vodka a day is a much more potent toxin to mitochondrial health than anything methylene blue will be able to reverse or ameliorate. And so, we need to think about comprehensive lifestyle strategies. The good news is, they’re not rocket science. They’re things that most people already know.

A healthy diet, good sleep, some exercise or movement and other things. 

Bret: 
Yeah, and and that’s an extreme example about the vodka, that certainly happens. But you could say the same thing for someone who’s sleeping five hours a night and who’s eating packaged ultra-processed, nutrient poor foods, and not exercising and the same thing.

And then, they get the infrared light therapy and the, glutathione and the methylene blue. And it may help a little bit, but it’s not going to undo the damage or correct it. Yeah so, when it comes to the specific lifestyle changes that can be beneficial, obviously a big discussion from you, from us, from others is ketogenic therapy.

And not that’s the only way to do it. But what is unique about nutritional ketosis, ketogenic therapies, that is can uniquely impact mitochondrial health. 

Chris: 
So, in my mind, we have decades of neuroscience research looking at the effects of the ketogenic diet on brain function.

It changes neurotransmitters and inflammation and the gut microbiome, and all of those things are known to play a role in mental health and metabolic health. But in fact, I think the money really is on mitochondrial health. And so, anything that mimics the fasting state. So, that could be fasting itself or a fasting mimicking diet, such as the ketogenic diet, will stimulate two processes.

One is something called mitophagy, which is getting rid of old and defective mitochondria and replacing them with new ones. And the second is something called mitochondrial biogenesis, which is the production of more healthy mitochondria, or hopefully healthy, for people who have rare mitochondrial diseases, where they have genetic abnormalities, coding for proteins that make up their mitochondria.

Mitochondrial biogenesis would not produce healthy mitochondria in those people. They would probably replicate more unhealthy mitochondria. But for the overwhelming majority of human beings on the planet, stimulating mitochondrial biogenesis will stimulate the production of healthy mitochondria. And it’s those two things, it’s the process of getting rid of the old and defective mitochondria and replacing them with new ones and increasing the supply of mitochondria in cells, that I believe it’s the healing potential of the ketogenic diet.

And that if people do that over years, a few years, they may actually experience long-term healing so that if they go off the diet, they may not have a relapse of symptoms. At least, not right away. 

Bret: 
So, you said years. Now, we hear reports of people starting a ketogenic diet and symptoms improving within days or within weeks, within months, but you said years. Now, I know this is outside of research and what you think in your clinical experience and what you know of triangulating all the data.

Why’d you pick years for long-lasting improvement? 

Chris: 
So, I chose years because of the evidence that we have in neurology with epilepsy, is that when there’s no doubt patients, people can get relief of symptoms, dramatic improvement in symptoms, and even full remission of symptoms within days or months, and that’s usually the goal.

And that’s usually the expectation is within days or months, people will be experiencing dramatic improvement in symptoms. So, for symptoms of severe mental disorders, like schizophrenia, I usually tell people to give the diet at least three months. They usually do not. I have not typically seen reduction in psychotic symptoms in days.

It usually takes many weeks or two or three months, and sometimes even four months for some people. So, I encourage people to be patient longer. But the reason I chose years for the long-term healing is because epilepsy patients, if they have a complete remission of epilepsy, meaning seizures completely stop and they are seizure-free on the ketogenic diet, the standard recommendation right now is that those patients should remain on the ketogenic diet for anywhere from two to five years.

And it’s usually clinician discretion based on a lot of information about the patient’s presentation and medications and longstanding history response to the diet and other factors. So, you’re having a medical professional who’s a specialist in epilepsy and ketogenic therapies make an informed decision about how long you should stay on the diet.

But for most centers and most neurologists and epilepsy specialists and dieticians working in that space, it’s two to five years. And after two to five years, they ask the patients to transition away from the ketogenic diet, and they jointly decide what kind of a diet is the person going to go back to.

Hopefully, not a junk food diet, but they try to figure out what type of a diet will the patient transition to. The majority of patients, more than 50% of those patients, will remain seizure-free when they transition off the ketogenic diet.

Now, it’s not a hundred percent. There are patients with epilepsy who’ve been on ketogenic therapy for over 40 years because every time they stop the diet, their seizures come back. And there are some rare genetic disorders that, GLUT1 deficiency syndrome, in particular, that is a genetic disorder.

It is permanent and fixed, and the primary therapy for that disorder is, in fact, the ketogenic diet. And the ketogenic diet is a lifelong treatment for those people. There’s no going back. But for most people, like the famous Charlie of the Charlie Foundation, he’s no longer on a ketogenic diet, and yet, remains seizure-free.

Bret: 
Yeah, that’s a very interesting parallel. That if it’s that way for epilepsy, as best we know, maybe it’ll be that way for mental illness as well? But I also want to go back to what you said that you tell people to be patient and stay on it for at least four months. And I think that’s important because the things that grab the attention in social media is the person who has decades of psychosis, resolve within two days of a ketogenic diet.

So, everybody thinks it’s going to be two days, and I’m going to be completely healed. But I think it’s really important for you to, for all of us, to emphasize that yes, that does happen, but that’s on one end of the bell curve.

And the other end of the bell curve is that it could take months for symptoms to resolve, which would go to the point of mitochondrial healing. Mitochondria aren’t going to just heal overnight. And that they’ll take time, which brings me to another question of though digging into what does it take for mitochondria, to help mitochondrial health and to help with this connection of metabolic and mental health?

Because it’s clear, look, if you’re on a standard American junk food diet and you improve your diet in any way, some things are going to improve. So, we hear, omega-3 fatty acids and fatty fish are good for brain health. Blueberries and dark leafy greens and phytonutrients are good for brain health. But the question always becomes, is that enough?

You will, you’ll likely get some benefit, but is that going, in your opinion, will that impact mitochondria? Will that start the healing process or does it truly have to be this metabolic switch of ketosis to see the mitochondrial involvement and improvement? 

Chris: 
I think it really depends on the person and the severity of their symptoms or the severity of their metabolic health.

So, if a person is relatively healthy but has very mild anxiety, and there’s no clear psychological or social reason for that anxiety. So, both the patient and clinician, family members all think no, there’s a problem here. This isn’t normal. The person’s normally not this anxious. We don’t know what’s going on.

This doesn’t even make sense. There’s nothing really in his life to bother him, not much. That person may benefit, if that person is eating a lot of junk food, a lot of highly processed foods loaded with sugars and other substances, lots of man-made chemicals, and ingredients that we probably don’t even know the effect of.

If that person cleans up his diet and goes with a more whole food type of a diet, maybe something like a paleo-ish diet that includes some fatty fish and blueberries and other things, that may be enough for that person, and that person may have resolution of his anxiety symptoms. For the patients with severe symptoms, like bipolar disorder, schizophrenia, severe chronic unrelenting depression that’s maybe been present for years, I think those people, their brains, are telling us that there is significant metabolic impairment occurring.

And I think those people do need a more powerful intervention. And again, I just want to draw on this simple analogy that is a really powerful analogy. We use epilepsy treatments in psychiatry all the time. Eating fatty fish does not stop seizures. It doesn’t. I am not saying it’s not good for you. Sure, it might be helpful. Sure, it might improve some things, but eating fatty fish does not stop seizures.

Yet, ketogenic therapy does. And so, when we’re talking about people with equally serious brain disorders, like severe mental disorders, we need to think along the same lines that ketogenic therapy is a unique and powerful intervention. And so, I think for some people, yeah, cleaning up the diet’s just not enough. 

Bret: 
Yeah, I think that’s well said. and at the same time, a ketogenic diet may not be enough by itself either. Just like the analogy of the person drinking a gallon of vodka and the glutathione’s not going to help.

The same thing, the ketogenic diet isn’t going to do everything. So, we’ve mentioned toxins, you’ve mentioned sleep as two very important parts of the whole metabolic treatment. Now what about exercise? Because we hear a lot about exercise and the benefits of exercise, and what does it take get your 150 minutes per week. And it’s just the very generic recommendation.

Or do we need high intensity interval training? Do we need resistance training? If someone really wants to dial in their exercise, it can be confusing. What do I need to do? For mental health, for mitochondrial health, and I know the research is spotty, but how do you answer that question of what exercise recommendations to give where you’re getting, so to speak, the best bang for your buck?

Chris: 
So, as part of a comprehensive treatment plan, I think exercise is very powerful. And and if you really want to optimize your metabolic and mental health ,exercise should be part of your treatment plan. I think the two types of exercise that we have the most evidence for are exercise that builds muscle, and so that’s usually called strength training or weightlifting or whatever.

And it doesn’t have to be a lot. You can use bands if you’re not strong. You can use a band. You can just press against a table or a door. You can do a wall pushup. Lots of things that you can do to build muscle.

If you’re stronger than those types of interventions, you want to push yourself, you want to try to build muscle, not looking for Arnold Schwartzenegger-level muscle. Arnold Schwartzenegger-level muscle might actually be contraindicated, if you’re really trying to improve mental and metabolic health because it’s hard to get to Arnold Schwarzenegger without some help. But, so resistance training. And then the second step of exercise that I think we have the most evidence for is zone two cardio.

And so, zone two cardio would be 30 to 60 minutes, maybe even a little longer if it’s a weekend. If you’re going to be a weekend warrior, go for a run, go for a bike, ride something else. But you’re not necessarily sprinting, you’re not necessarily doing high intensity intervals. You’re going at a pace where you can. talk, if you need to. You’re breathing a little bit heavier but not out of breath, and that type of exercise is really working your mitochondria.

Your mitochondria in your muscles are keeping your muscles going, they are keeping your legs moving, they are keeping your arms swinging. And and over time, you’re going to build up more mitochondrial health in those muscles. And shockingly, the mitochondria in your muscles are then sending signals, endocrine signals, neuropeptides, and other things that reach the brain and that impact brain health.

Now, the one thing that I do want to say about exercise is exercise on its own is likely not enough of an intervention. And there are some caveats to exercise that I just want people to know about that can actually interfere with the ability of exercise to help you improve your metabolic or mitochondrial health.

We have an abundance of data that exercise alone does not typically help people lose weight. So, if you don’t change their diet, just have them exercise, that in and of itself, typically does not result in any kind of meaningful weight loss, and let alone, sustained weight loss. Same is true for type II diabetes, that exercising on its own without any dietary intervention or sleep intervention or anything else, usually does not improve type II diabetes all that much on its own.

The caveat is that we have one really well done study of middle-aged adults, who were asked to exercise, and half of them were given metformin and the other half were given a placebo pill. The patients who got metformin actually did not experience the same benefits in mitochondrial adaptations and metabolic adaptations or metabolic health improvements.

They did not get the same benefits when they were taking metformin, and that implies that metformin is somehow interfering with mitochondrial biogenesis or autophagy, if taken consistently. And so there are many other medications that interfere with mitochondrial function. Some, many I would say, actually psychiatric medications.

Some of them can enhance mitochondrial function, but others impair mitochondrial function. And so, it’s important to think through what medications am I taking? We brought up alcohol, but I’m going to include smoking cigarettes and marijuana use. That if you’re trying to improve your mitochondrial health through exercise, all of those things, certain medications, alcohol, smoking, marijuana, they’re all going to prevent you from getting the benefits that you should be getting. 

Bret: 
That makes a lot of sense. And I don’t mean to put you on the spot, but now are you comfortable calling out one or two of the psychiatric medications that do impair mitochondrial health or mitochondrial biogenesis?

Not saying that anybody should stop the medication. Not saying that it can’t be effective for some psychiatric symptoms, but what are, one or two of the most glaring that affect mitochondrial health? 

Chris: 
So, the glaring ones are many of the antipsychotic medications. So, we have long known that antipsychotic medications come with side effects, and the side effects are typically lumped into the categories of metabolic side effects or neurological side effects.

And all of those can be understood through their toxicity on mitochondria. So the antipsychotics can cause weight gain. And in some people it can be massive amounts of weight gain. I have seen people gain a hundred pounds within six months of starting antipsychotic medicines. The antipsychotics can also cause type II diabetes or pre-diabetes.

They worsen everything known for cardiovascular risk. They can increase your blood pressure. They can in adversely increase lipids. Lower HDL, raise triglycerides, raise LDL. They in can increase inflammatory biomarkers. So, all of the things that we don’t want to do, they are known to do. This is not heresy. It’s right on the package in inserts issued by the FDA. So, for some people, those can impair progress or impair a metabolic treatment plan.

But as you said, and I just have to reiterate, stopping those medications can be very difficult and very dangerous, and it needs to be done safely. And obviously, you can probably tell by what I just said that I am a fan of helping people get off those medications in a safe manner. So, I’m not here to try to say, just keep taking those medicines for the rest of your life and be a good patient and don’t try to get better.

I’m not saying that, but I am saying that if you take matters into your own hands and stop those medications on your own, I have seen people end up arrested. I have seen people hospitalized involuntarily and some people have died because they stop their medications on their own.

And so, please, don’t do that because I know that it can be life-threatening and dangerous. 

Bret: 
Yeah, and I think a perfect analogy is the the new GLP-1 receptor agonist medications for weight loss that you can take it and lose weight. And then, if you do nothing else with your lifestyle, as soon as you stop the medication, the weight comes back and more so. Same with the antipsychotics, if you just stop them without putting other lifestyle interventions or just other interventions, in general, in place to help you wean off it and do it under the guidance of clinical supervision, the symptoms can come back and even worse.

Similar analogy and have to be very careful with that, as you said. So, thank you for the way you phrased that. Now, to wrap things up here. I can’t remember if this is in one of our interviews or just one of the many discussions we had. It was clear your goal with Brain Energy was to educate the individual about this connection between metabolic and mental health, the brain energy concept, and what they can do about it.

And by all measures, you have absolutely succeeded. Whether it’s by the popularity of your book, the number of talks you’ve been asked to give, and the number of podcasts you’ve been on, the number of emails and lives you’ve touched. And that is going to keep going. I know that’s not going to stop, but what’s next? What do you think is the next step for you or the next step for this whole sort of metabolic mental health movement that you want to see happen? 

Chris: 
In my mind, I think the next step is, we need to keep spreading the word. I want to spread the word to clinicians and researchers. I want more clinicians and more researchers to open their eyes to this science to take it seriously. Even if they’re not going to begin implementing the treatments or doing research studies yet, that’s fine.

Change happens over time and. Just awareness of new information is the start of change. And so, I want more and more clinicians, more and more people, more families, more patients to become aware that there’s a different way out there. There’s a different way to think about mental illness, and to understand what might be happening in the brain and how to treat it.

Obviously, I’m really excited about the clinical trials that are already going on that you at Metabolic Mind and the Baszucki Brain Research Fund are supporting through philanthropic support. I’m very excited about all of that, and I think that really all of that research holds so much potential to transform our field and open even more eyes and get even more credibility for this work.

But the other thing that I’m really hopeful for right now, mental illness is high, still to this day, highly stigmatized. It is underfunded treatment for mental disorders, grossly underfunded. I can’t tell you how many people I know, just looking for a traditional psychotherapist or psychiatrist to prescribe medication.

It can be next to impossible to find somebody who’s taking new patients, let alone who’s good. And children in emergency rooms are being warehoused in emergency rooms even though they are suicidal or psychotic because they don’t have any beds in psychiatric adolescent treatment units. We have countless mentally ill people being warehoused prisons, homeless shelters, on the street, and so there is tremendous injustice in my mind in the way that we treat people with mental illness.

And I actually think that this new way of understanding mental illness, number one, let’s us know these are real physical disorders. And yes, psychological and social factors play a role in that, but that doesn’t make them any less physical. And that means that they deserve medically necessary treatment and that this new way of understanding it opens up so many pathways.

Many that we’ve talked about, dietary interventions, but even some of the supplements that you were talking about, methylene blue, could that play a role for some people in some situations? Red light therapy, could that play a role for some?

Yeah, they probably could, but we need clinicians and researchers exploring these options, coming up with treatment algorithms. How can we get the most people better the fastest? Because I actually believe we can start to manage the prison problem that we have and the homeless problem that we have by actually effectively treating these people. If we can fully restore their brain health, they won’t be in prison anymore.

They won’t be homeless anymore. They will be tax paying citizens, living good lives, and that’s what we all want. System benefits from that. 

Bret: 
Very well said. Thank you for those words. Thank you for all the work you’re doing and the advocacy, and you’re certainly racking up your frequent flyer miles with all the conferences you’re going to, and we appreciate it.

And we look forward to hearing more from you here at Metabolic Mind in the future. Thanks again. 

Chris: 
Thank you, Bret, for all you’re doing. 

Bret: 
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