Why Mental Health Care Is Failing & What We Can Do About It with Dr. Chris Palmer

Chris: 
Forty percent who are getting treatment, 40% of people with a mental health condition in any given year on average in the United States are getting mental health treatment. Of them, only 40% are getting what is considered minimally adequate treatment. What that means is 60% of the time, 60% of the people in the United States getting mental health care from a clinician, are not getting evidence-based care at all.

Bret: 
Welcome to the Metabolic Mind Podcast. I’m your host, Dr. Bret Scherr. 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.

Dr. Chris Palmer from McLean Hospital and Harvard Medical School is on the forefront of metabolic psychiatry, of using metabolic therapies and ketogenic therapies as treatment for mental illness, but he’s also just a tremendous advocate for better psychiatric care. And in this interview, we really dig deep into the state of research and research funding and how that maybe has led us astray. He brings up some sobering statistics about how psychiatry, psychiatric care is not improving despite the billions of dollars in research.

Why is this, and what can we do differently to make the impact that we all want to ease the suffering from mental illness, to ease the burden of mental illness? Here we get into quite a lot of details and in a very passionate discussion with Dr. Chris Palmer.

All right, Dr. Chris Palmer, welcome back to Metabolic Mind. 

Chris: 
Thank you, Bret, for having me back on. 

Bret: 
Yeah, it’s always a pleasure to get to talk to you, and I like to start my interviews with you with just checking in because so much happens between our interviews. You’re doing so many things, but now brain energy, which was just such a, I guess you could say, a revolution in terms of the concept when it was published or certainly seemed that way. The way it was received has now been out for what, a couple years now? How long has it been? 

Chris: 
Yeah, a little more than two years now. 

Bret: 
Yeah. And so what have you seen in the focus on metabolic health on brain energy metabolism, how all these things are interrelated? What have you seen in the world of psychiatry since that book has come out? 

Chris: 
it’s really, it’s really been pretty phenomenal, I think, in terms of what’s happened because everybody who publishes a book, you got to be prepared for nobody to read it and to go nowhere.

And I think some of the big things, certainly all of the work that you and the Baszucki family are doing, is really spearheading research on ketogenic therapies and the broader concept of the role of metabolism in metabolic health and mental health. And that is nothing short of just incredible and somewhat miraculous on its own.

We’ve got about 20 clinical trials underway of ketogenic therapies for a wide range of mental health conditions. Eight of those are randomized controlled trials. So just again, kudos to you and the Metabolic Mind team and the Baszucki family for everything that, all of you are doing to spearhead that research, to give hope.

And I’ve heard some of the preliminary results of some of the studies that are about to be published coming soon, and it’s nothing short of spectacular. Some of the researchers that I’m talking to who are doing this research are saying like, I’ve never seen anything like this in my career.

I’ve done lots of medication trials, psychotherapy trials, nothing has ever worked like this. And that is nothing short of incredible. I had one researcher who was almost in tears just like, Chris, a few years ago when you were talking about this, I didn’t really know what to think. I know you and I know that you’re not completely crazy or, but I just, it seemed too incredible to believe.

And she said, now that I’m seeing it with my own eyes. I just feel so blessed to be part of this. Like I’m seeing patients’ lives transformed right in front of my eyes in a way that medications have never been able to do. And so I’ll start there. And then I think the next phase is just tremendous public support.

Hearing literally from thousands and thousands of people, their success stories, how maybe they read Brain Energy and implemented some of the strategies. And not all of them are doing ketogenic diets, but some of them just changed their diet, got rid of ultra-processed foods, started exercising, maybe prioritized sleep, maybe deprescribed in a safe way, and that made all the difference in the world.

We did a newsletter story a few weeks ago of a woman who had reached out. She wanted to share her story about how, I think ,the bigger intervention for her was getting off of psychiatric meds and then changing her diet and adding exercise, and also doing psychotherapy.

So, it’s not throwing traditional mental health out completely. She was using psychotherapy to recover from some traumatic events, but she has a new life. She has a new life, and she wanted to share her story because she felt so trapped and stuck and alone and felt so hopeless for years. And the word that she used was broken.

She felt like she was just broken. And there are countless people like that who feel that way. And so having those people come out of the woodwork, having Lauren Kennedy share her story and her like just amazing, heartwarming documentary. And so that has been nothing short of incredible. And then, I’ve given, I think, over 27 professional lectures just in the last year alone. Not even since Brain Energy was published, but just in the last year alone, 27 professional lectures. I’ve had the honor privilege of being invited to do keynotes, lots of different conferences and the amazing thing.

Like I hear from patients, I hear from colleagues, I hear from philanthropists, I hear from scientists that people like at other meetings are saying, what do you think of this brain energy? What do you think of this metabolism? What do you think of this ketogenic diet stuff? What do you think of it?

And people are talking about it, and that’s where it starts. The great news is that a lot of people are getting it. A lot of the scientists, a lot of the very hardcore scientists understand it. And they, some of them I think, are coming out on the side of, we already knew this. That’s a good thing.

That’s pro, that’s called progress. When they start saying, we already knew this, of course, it’s true. Great. We’re all in agreement that metabolism plays a foundational role in brain health and that means mental health. And so however people came to this information, whenever, because again, this research has actually existed well over a century in the 1930s, researchers were measuring lactate levels in people with schizophrenia and bipolar disorder.

Lactate is a metabolic biomarker. I wasn’t alive in the 1930s. I don’t get to take any credit for any of that stuff. And so it’s like this has been, this is about the culmination of literally over a century of science that in my mind, at least for me, that the mitochondrial science has caught up. Even 30 years ago, if you ask anybody what do mitochondria do? They would say, powerhouse of the cell. What does that mean? It means they make ATP. Do they do anything else?

No, of course not. They, all they do is make ATP. And that’s really important, but that’s all they do. And if you ask people what controls cells or how do cells function or what makes them function or dysfunction, the mitochondria have anything to do with that? They would say absolutely no. Mitochondria are just stupid little organelles that just churn out ATP.

And now we know thanks to researchers, like Martin Picard and Douglas Wallace and so many others, we now know that is not at all true. Mitochondria are doing so much more. And so I think that the science is finally coming together. Scientists are recognizing this. I’m hearing from clinicians, like every now and then, I like just, I just get flabbergasted and honored that I hear from these like world-renowned clinicians who are like, Chris Palmer, can I talk to you about your work?

And I’m like, oh my God, do you know who you are? You are, you’re really famous and important. How do you know who I am? That’s so shocking. And so it’s been nothing short of incredible. And then, to top it all off, I’ve been involved in government advocacy. And I spoke at the round table discussion, and that has led to at least an opportunity to talk to people who are involved in national politics and at least plant some of these seeds in their minds that metabolic health does impact the brain.

Metabolic health and mental health go together. And that they are part of the chronic disease epidemic that so many people are rising up shouting from the rooftops, we must do something about this chronic disease epidemic.

And sometimes I think people get more focused on obesity and diabetes and fatty liver. And yes, I’m all for that, but I’m always right behind them shouting, don’t forget the brain’s part of it, too. And that means mental health. And people sometimes are looking at me like I have two heads.

What are you talking about? That has nothing to do with calories? And I’m like, yeah, no. Metabolism is so much more than calories. This isn’t a calorie issue; it’s a metabolism issue. So that has been nothing short of spectacular as well. 

Bret: 
Oof. I got to take a breath after that answer.

That is impressive. You need to take a breath. Yeah, your passion and your energy is so clear on this. But the way you can connect the impact from the individuals living with mental disorders, their families, the clinicians, the researchers, the policymakers, like all along the line, your book has had an impact on them. And not just your book.

So, you’ve also published papers, beyond comorbidities, metabolic dysfunction as a root cause of neuropsychiatric disorders, and the ketogenic diet as a transdiagnostic treatment for neuropsychiatric disorders, mechanisms, and clinical outcomes. So, it’s not just a book, which by the way, was very well researched and referenced, but also publications in peer review journals.

So, where I’m going with this is, this question of what is evidence-based medicine? What is science? What is anti-science? Because anytime you come out with something that’s perceived as new in clinical care, and as you said, this is not new, this has been around forever, but it’s like a new perspective on it in terms of his application more broadly in psychiatry, the impact of metabolism.

So, whenever you do something new like that, the question is yeah, but is it evidence-based? So, let me start with just asking you, what is, what does that mean to you when you hear, is this evidence-based? Is it science-backed? How do you respond to that? 

Chris: 
It’s a really important question.

I think most of, I think many medical professionals, because we’re the ones who use that term most often. Some psychologists do, and certainly lots of other fields do, but the medical field in particular is about evidence-based practice or evidence-based medicine. And there is zero doubt in my mind, it is an extraordinarily important concept and if we completely ignore it, the alternative is that random clinicians are just going to do whatever they want. They’re going to make up snake oil. They’re going to make up cocktails. They’re going to recklessly prescribe pills, or do therapies on people, or do hypnosis on people with schizophrenia to try to make them stop hallucinating.

They’re going to do whatever the hell they want, and people are not going to get better. Some people will be harmed by some of those treatments, and it will cause tremendous pain and suffering, that if we just allow clinicians to do whatever the hell they want. So we, by no means, do we want that.

So, the alternative is what we call evidence-based medicine. And evidence-based medicine means that everything we do should be based on randomized controlled trial data. And we should have, they should all be replicated multiple times, and we should have very large sample sizes, and they should be follow rigorous scientific design.

And we should know beyond a shadow of a doubt that when somebody comes in with this health condition, whether it’s a physical health condition or a mental health condition, when somebody comes in with this problem, illness, disease, if we prescribe this treatment, whether it’s a pill or a psychotherapy or even a cast or something or recommending that people rest or whatever, all of those are treatments or prescriptions.

When people with those diseases or illnesses, if they get this intervention in very clear ways, on average, it will improve outcomes. And evidence today-based medicine doesn’t mean that people can’t have side effects. It doesn’t mean that some people may not benefit from treatment, but it just means that on average, hopefully better than just 51%, but on average, people are benefiting from this treatment.

And then importantly, evidence-based medicine is looking at what are the potential harms and risks of this intervention and can we mitigate those harms and risks and all of that? And in an ideal world, all of the treatment we would be offering would be getting people better and it would be safer and just much more effective.

The reality is that when you look at the mental health field, the tragic reality is that much of what we are doing is not actually even based on evidence. It’s not based on randomized controlled trials. Much of what we in the mental health field are doing is actually that Wild West category that I just described, and what I mean by that is that even when psychopharmacologists prescribe a pill for your condition, we almost only have trials of single pills for single diagnoses.

But when you look at the real world, a lot of patients with mental health conditions are on more than one pill. A lot of them are on multiple pills. They might be on an antidepressant or two antidepressants and a mood stabilizer, or an antipsychotic or a benzodiazepine for sleep or whatever. And the reality is we have no idea based on evidence what those cocktails of medications are doing to the human brain. When we look at studies of outcomes of those patients, on average, those patients are doing much worse than the patients who are prescribed no pills or only one pill. And then, of course, the circular argument is that, of course, they’re doing worse because they’re really sick and that’s why we have to prescribe so many pills.

If somebody’s really sick, we wouldn’t be prescribing so many pills, and then they would be fine. But, of course, that ignores the possibility that maybe sometimes those pills are doing harm. It just ignores that possibility and really we’re not even allowed to have those conversations publicly.

It’s considered anti-psychiatry or anti-medicine or anti evidence-based medicine. And again, I , to be clear, I am not at all anti evidence-based medicine and I’m definitely not anti-psychiatry. And I have suffered from mental health conditions myself, and I’ve had family members whose lives have been decimated from mental illness.

So, I fully understand respect that mental illness is real, and it can be life threatening. And it can ruin lives, and at a minimum, it can just cause suffering. And that if we can help people fight mental illness, if we can improve mental illness, if we can help people achieve remission, if we can help them recover, their lives can be so much better.

So, I’m not at all anti any of that. And yet, we as a field are often reluctant to look at that or have those conversations. So, let me at least just give you some quick, sad statistics. And these come from Tom Insel, the former director of the National Institute of Mental Health. He wrote a book on healing. And in that book, he quotes some commonly used kind of off-the-cuff statistics that generally the mental health field, and at least the researchers in the mental health field widely acknowledge, only about 40% of people with a mental health condition get any treatment at all. So 60% are not getting any treatment.

And oftentimes, sometimes it’s because they don’t know they have a problem, sometimes it’s they don’t want help. Who wants to go to a psychiatrist? That’s for crazy people. Sometimes it’s access to care. Their insurance doesn’t cover mental health treatment very well, and so they can’t find a provider who will take their insurance.

Or they have to pay out of pocket and they just can’t afford that. So, there are lots of reasons for that 60%. But let’s just stick with the 40% who are getting treatment. Forty percent of people with a mental health condition in any given year, on average about in the United States, are getting mental health treatment. Of them, only 40% are getting what is considered minimally adequate treatment. What that means is 60% of the time, 60% of the people in the United States getting mental health care from a clinician, are not getting evidence-based care at all. Only 40% are even getting evidence-based care. And then of those 40% who are getting evidence-based care, the real answer is that only about 33% have remission or recovery or a really good outcome from that treatment.

And when you take all of those statistics and put them together, it means that about 5 to 7% of people in the United States who are getting mental health, who have a mental health condition, only about five to 7% of the people who have a mental health condition are getting highly-effective treatment for their condition. 

Bret: 
That’s depressing. 

Chris: 
It is unacceptable. It is depressing. It should be infuriating. People should be enraged by this. People should want to do something about this because it is 2024. We can do so much better or 2025.

Actually I forgot. Sorry, I’m off. It’s 2025. We can do better, and I actually really firmly believe that we can do better. We can do better with the evidence-based treatments that have been around for a while. We can do better with access to care. And certainly you and I both know we can do better with novel new metabolic strategies like ketogenic therapies and other strategies.

Bret: 
Yeah. So a lot of people would respond to your comment about the statistics and say, we need a better structure to get more of the patient’s seen. And we need better medications to treat these individuals. And it seems the research has focused on medications and what are the genetic predisposition so that we can maybe focus our treatment with medications towards genetics. And what are the specific mechanisms that can lead to mental illness so we can design medications to address those?

So, would you agree that’s been the focus of research? And then the follow-up question, how’s that working for you based on the statistics you gave? So what are your thoughts on that? 

Chris: 
I think it really depends on what researcher you talk to, but if we look at what the National Institute of Mental Health has been doing over the last 25 years now, the model that they have been pursuing is based on the observation that one of the most significant risk factors for mental illness is having a parent or family member with a mental illness. So if you have somebody in your family who’s got a mental illness, it automatically puts you at much higher risk.

And that has led to this belief, for very good reason, I’m not at all faulting this logic, but I’m going to walk you through the logic. Because mental illnesses run in families, it must mean that they’re genetic, that these are genetic disorders.

Things like bipolar disorder, ADHD, autism, schizophrenia, chronic unrelenting depression, even PTSD has genetic vulnerabilities, genetic roots, even though people have to have a trauma, traumatic event in order to get diagnosed with PTSD. Maybe it’s more about the genetic predispositions that allow one person to have a traumatic event and still go on and be resilient and be okay and another person who develops crippling incapacitating post-traumatic stress disorder?

So researchers are, and clinicians both are always trying to understand, why did this one person do okay with that trauma and the other person is not okay at all? And what makes them different and how can we help them? Ultimately, it’s all about how can we help them. In order to help them and better help them and come up with better treatments, they want to understand what happened.

And so a lot of people in the field are actually thinking it’s genetic. So, the overarching theme of the National Institute of Mental Health is that mental disorders are genetic disorders that run in families, and that these genetic abnormalities or differences must result in differences in brain function.

And that these differences in brain function lead to the symptoms of mental illness. Now, the confusing part is that the brain is so complicated. It is so complicated and there is so much, so much that we do not know about how the brain functions. It is not at all an easy organ to understand. We are literally, we have to be at least decades, if not centuries away from truly understanding all of the complexities of how the brain works.

There are so many things that we don’t know and that we just don’t understand. And so the model of the National Institute of Mental Health for the last 25 years has really been based primarily on that, everything that I just said. Bad genes result in dysregulated or dysfunctional brains, and that is what mental illness is.

And if we could just understand which genes are doing this, and then what are those genes doing, and then what are the brain changes, maybe we can come up with new targets? That is the ultimate goal, new targets. If we could just develop new targets, that means new pills, and then we could have a cure for mental illness or at least a better treatment because wouldn’t a good pill just save the day? If we just had better pills, that would save the day.

I say that and I already know there will be people listening to this, including some neuroscientists, who will say, yeah, everything you just said is absolutely correct. And there will be other people listening to this who will probably be outraged screaming in their cars or their homes, no, how dare you. Don’t say that. That’s not true. I do want to point out that mental illnesses do run in families. I also want to point out that doesn’t necessarily at all mean that they are genetic. There are, and what I mean by that, is that parents can transmit epigenetic signals to their children when you are developing. Even your father’s age, your father’s sperm quality, your father’s metabolic status, all of that impacts his sperm quality, which impacts your ultimate health.

So that if you, if a father is much older when he has a child, that child is an increased risk of a neurodevelopmental disorder, such as autism or ADHD simply because the father is older. Now, that’s not a genetic disorder. That is, I would argue, a metabolic disorder. As people get older, their metabolic health declines.

And that can be transmitted to children even through sperm and eggs. The mother, unfortunately, gets much more recognition or blame. I’m not, I don’t mean to be the psychiatrist who blames mothers. But I’m sorry, mothers are growing babies in their bodies for nine months. They contribute so much more to that baby than the father does.

Not that fathers don’t count, but mothers metabolic health absolutely, positively influences babies overall health, including brain health, including neurodevelopment, including long-term metabolic health. And so that means that if your, both of your parents have obesity, for example, you as a child are more likely to have obesity.

That doesn’t mean it’s genetic. It means that they did transmit something to you that puts you at increased risk, but it doesn’t mean it’s in the genes. The reason I actually focus on that, and a little bit harp on that is because to me, that is extraordinarily hopeful. You don’t, people aren’t, don’t have defective genes.

There are things that we can do to change epigenetics. There are things that we can do to improve metabolism. And that means these are not hopeless diagnoses that we just are victims of bad genes, and that there’s nothing we can do about it. So, I just talked about obesity, but all of this applies to the brain and brain health, and that means mental disorders do run in families.

And so despite that, I think the primary cause of mental illness, it is something that we often talk about, it’s called the biopsychosocial model, which says there are biological, psychological and social factors that all come together to cause mental illnesses, all of the mental illnesses, in different ways in different people. And they result in different diagnostic labels, and the symptoms can be wildly different from each other.

That is the general theme. Now, even though that sounds so familiar, and it sounds so obvious, when we look at the research funding from the National Institute of Mental Health, that’s not the kind of research they’re really supporting. They’re really hyperfocused on genetics and the brain. And what I would argue is that instead of seeing mental disorders as purely brain disorders, that instead we see mental disorders as systemic disorders that result in brain symptoms.

And so that could be dysregulated glucose metabolism. It could be dysregulated mitochondrial function. It could be high levels of inflammation. It could be an infection that is spreading throughout the body but also affecting the brain. And we focus on the brain symptoms of that infection. But in fact, it’s not, that’s not really a brain disorder.

It’s an infection affecting the entire organism. And it, and so I think about mental disorders as systemic disorders. And another way to say that is physical health and mental health go together. Like we can’t separate them, and we need to stop arbitrarily separating them. But I want to come back to one of the questions you asked or implied was like, how’s this working out?

So, this model of the NIMH, bad genes cause bad brains. Those are my words. I know those are inflammatory to a lot of people and offensive, and I don’t mean to be offensive. But sometimes saying it plain and simple is the way to fight the stigma and is the way to fight entrenched dogma. I don’t think that model is correct, and I’m not alone.

I’m not alone. Tom Insel, himself, the former director of the National Institute of Mental Health, he was there for 13 years. Under his leadership, he oversaw a $20 billion budget. $20 billion was spent on mental health research. And he is very public in saying, I was at the NIMH for 13 years. We had lots of really cool scientists publishing really cool papers in top journals on genetics and neuroscience. And at the end of the day, we didn’t do really much of anything to move the needle for people with mental illness. We didn’t reduce suicides. We didn’t reduce hospitalizations. We didn’t improve treatment outcomes. We didn’t come up with any new blockbuster treatments.

We have essentially nothing to show for it. Yet, I think there are still people who feel like, maybe if we just understand the brain a little better, then we’ll know. But there are many other researchers, who all along were actually shouting from their own rooftops, tom Insel, you’re wrong.

Don’t, it’s not just genetics, it’s not just brain neuroscience. What about biological, psychological and social factors? What about trauma? What about all of these other things? Why aren’t you guys researching that? Why aren’t you paying attention to that? And so I think there are a lot of people, a lot of researchers who have been frustrated, disheartened at the lack of progress in the mental health field, I think nobody deserves to be more disheartened and angry and enraged about our lack of progress than people with mental illness.

We have failed them. We have failed the millions of people whose lives are influenced by mental illness because not everybody’s life is decimated. So, I hate to be so extreme. I see very severely ill people. So most of the people I work with, their lives are ruined or greatly impacted by mental illness. But again, people can have mild or moderate disorders, and they can just suffer. And they can just live less than optimal lives, and we have failed all of them.

And we can do better. 

Bret: 
Yeah, we have to do better, for sure. And so you’ve already mentioned seeing a mental illness as a systemic metabolic illness and focusing on the biopsychosocial model. Do you think if we started focusing on the research in that area that things would dramatically change? Or do you think you could say, look, we already know enough about this.

We don’t need more research. We need to start putting this into practice, and it could be, Yes. And so where do you fall on that spectrum? 

Chris: 
I think it’s a yes. And I think that in order to get insurance companies to pay for some things, that they are, the way the system is designed right now in medical care, that they are going to demand some level of evidence base that these treatments work.

So, I think we do have to continue doing the research to demonstrate that treatments can improve outcomes for people. And that because that is one of the necessary paths to get insurance companies to start paying for these treatments, it’s also a necessary path to get all of the professional societies like the American Psychiatric Association, the American Psychological Association, and others to issue treatment guidelines where they start incorporating these practices into treatment guidelines.

And some clinicians will hold out for the evidence base. One of the things that I didn’t mention is that, again, another tragedy with what’s happening at the NIMH is that 10% or less of their total research budget is funding clinical trials, 10% or less. So clinical trials are the way we develop new treatments, plain and simple. There is no other path to develop new treatments that are evidence-based. You have to do clinical trials. So. The NIMH has really become a basic science research institute.

They are focused on neuroscience and how the brain works with very little regard for the real lives of people with mental illness who are suffering and dying today. And, so I think we need to prioritize clinical trials, whether they’re ketogenic diet trials, whether they’re just common sense comprehensive biopsychosocial treatment programs that give people housing or that help them at least with housing or the homeless people with schizophrenia. Let’s come up with just a reasonable way to try to get them off the street and help them have a better life. But that might mean housing. It might mean food. It might good food, even better.

It might mean getting, helping them recover and detox. It might mean psychological therapies and other things. Lots of strategies, and Tom Insel made this point that we don’t even necessarily need a breakthrough drug, a new breakthrough drug to improve the lives of people with mental illness.

There are a lot of common sense treatments and psychosocial strategies that we can use today to improve people’s lives. And we’re not typically using them because the model is prescribe a pill, and we can do so much better. And then, of course, I am ever hopeful. By better understanding metabolism and mitochondrial biology, we may in fact be able to refine protocols for ketogenic therapies.

Or do ketones, add benefit, like drinking, ketones, exogenous ketones? Are those helpful or not helpful? Are there other molecules? Are there other supplements, vitamins, medications? How can we safely get people off medicines when indicated? How will we know, like how many people should we be trying to take off of medicines instead of just prescribing more and more medicines?

Those are all questions that we can answer with research. And I think all of those questions, if we can do a better job of trying to answer them, hold great potential to improve the lives of people with mental illness. 

Bret: 
Yeah, and if you’re talking about nIMH public funding, only 10% going to clinical trials.

You got to say, okay, where’s the rest of the funding for clinical trials coming from? And it’s the pharmaceutical companies. So that you know, it’s got to be that’s where most of it’s coming from now. We’re trying to break that trend with philanthropy, and hopefully other philanthropists will see what Baszucki Group is doing and realize that they can move the needle with clinical trial funding.

But it’s not the same as how the millions and millions of dollars coming from NIMH that could be funding larger studies. And you know what’s interesting, the way you were speaking is like so obvious that, okay, exercise can be beneficial. Providing housing can be beneficial.

Providing the right food can be beneficial. But then the next statement I think is frequently, yeah, but that’s like really hard to do, and they don’t stick with it. And it seems It’s not very vogue or sexy to say, okay, let’s study how to make it work. Then, let’s study how to do that as opposed to studying genetics and mechanisms and drugs.

And so it seems like there’s a real lack of that. Do you think that’s a direction that we should go in terms of the next phase of research? 

Chris: 
One hundred percent, and so even for people who say, even for some of your listeners I know are passionate advocates for keto, ketogenic diet, and just do keto. Actually no, research can really be helpful because research can tell us what kind of keto, and what should the ketone levels be and can that inform practice?

How can we get more people to do it and stick with it? What do we need? Do we need communities? Do people do better if they have groups over time? Do people do better with individual one-on-one clinicians? Do people do better if they work with a dietician or not with a dietician? Like what do people do better with keto adaptation if we slowly, gradually get them there?

Or should we just go all in? All of these things can be answered. All of those questions are real world questions that clinicians, like me, are constantly struggling with because I don’t know the definitive answers to those. I don’t think anybody knows the definitive answers to those. And anybody who says they do, they maybe take it with a grain of salt because they probably don’t.

Because the way to know that is not through our own bias. It’s not through my own clinical judgment and the patients that I personally have seen. It is by rigorously testing these hypotheses and taking a group of patients and having half of them do it one way and half of them do it a different way, and then really seeing which group does better.

is that a variable that matters? And if it’s a variable that matters, we’ll see that one group did better than the other. And that’ll be really empowering, useful information for patients, for families, for clinicians, and all of that research could be getting done today. The only thing standing in the way is funding and really just a lack of an agenda that we do not have national agenda right now to address these questions.

The national agenda, right now in January of 2025, is still focused on, we need to understand the broken genes and how they break the brain, and we need to understand how the brain works and just give us more time. We know it hasn’t paid off at all, but just give us more time, give us more money, give us billions more dollars, and leave us alone and we’ll figure it out.

And then we’ll get back to you when we’re ready. And I am stomping up and down as a clinician. No, the world is on fire now. We have to do something now. 

Bret: 
Yeah, and the other sort of almost heretical topic that people don’t want to talk about is, what about interventions to help people get off their medications because it’s such a medication-focused practice treatment.

Medications make you better. Why would we want to study how to get off medications? And that really ties into ketogenic therapies and metabolic therapies because, unfortunately, we’ve seen a number of cases where people try to simplify things and maybe oversimplify and say, oh, I’m starting keto.

I can come off all my medications, and that can lead to disastrous consequences. Now, some people do that and do well and talk about their experience. Then everybody thinks it translates across the board, and that’s exactly where we need research. Why can some people do it? Why? Why can most people not? And how does that help?

But when it seems like when it comes to getting off medications, people don’t want to touch it, don’t want to fund it, don’t want to research it. Is that a role that government public funding, NIMH, do you think they should be addressing that as well? 

Chris: 
They must. They, I believe, they, the government has an obligation to address those questions, and pharmaceutical companies will never address them.

And perhaps we could, again, we could think about if you’re going to prescribe a pill and make billions of dollars from it. You must also then outline a reasonable plan to for people to get off this pill eventually. Every psychotropic medication should not be prescribed for life. Let me just say that every pill that your psychiatrist prescribes should not be taken for life. And therefore, there must be evidence-based ways to safely get off the pills, and yet we don’t have them.

Right now, that research doesn’t get done. We don’t have really good information. The information that we do have is that when people abruptly stop medications, it’s more often than not much, much more often than not, it is an unmitigated disaster.

People get wildly ill and sick, and we know that. And when I say wildly ill and sick, manic, psychotic, depressed, suicidal, homicidal, all sorts of things. And we do have research that strongly suggests, like some researchers at McLean Hospital where I’ve been working for a few decades, have actually been doing this work for decades.

Like the slower you taper off lithium, if you’re going to discontinue lithium, the slower you taper off, the better. Because if you take people off too fast, they almost always relapse, meaning they have a manic or depressive episode. But if you very slowly, gingerly taper them off over a year, some people will do fine.

Some people won’t have any relapses so you increase the probability that people will do well. So, we do have some evidence, but we don’t have large randomized controlled trials, and that is really what we need are large, randomized controlled trials of how to effectively discontinue medications. And why would we do that, those studies?

The easy answer is because every psychiatric pill should not be prescribed for life. And therefore, if you’re going to prescribe it, if anybody’s going to prescribe it, we need to know how do, how are we going to get you off this? And does that mean that everybody comes off in three weeks so that they never really developed too much tolerance so that it was easy to get off?

That’s not realistic. What if they’re on it for a year? How do we get them off? What if they’ve been on it for 10 years? How do we get those people off? And my strong guess is a clinician is that the answers are different. If you’ve only been on a pill for two weeks, it’s pretty easy to get off of.

If you’ve been on it for a year, it’s much more difficult to get off of. And if you’ve been on it for 10 years, it’s a lot more difficult to get off of. Now, that doesn’t mean it’s impossible to get off of, but it just means that maybe we need to taper it more slowly. Maybe we could think about augmenting the process with other metabolic strategies like a ketogenic diet or supplements or exercise or sleep or light therapy or lots of other things?

Lots of options and it, but again, we won’t know the answers to those things unless we do the, that research. 

Bret: 
Are you optimistic that we can see a change? The train’s been going down this track for so long and gathering so much momentum. The longer that’s been going on, the harder it is to stop and put on another track.

Do you, are you optimistic that we can see a change? 

Chris: 
I am optimistic about the opportunity with Robert F. Kennedy, Jr., in particular. It’s not clear if he’ll be confirmed by the Senate, but if he becomes the Secretary of Health and Human Services, he really has spearheaded this Make America Healthy Again movement, which interestingly has some conflicting policy views from even the larger Trump administration.

The larger Trump administration, I think, is about deregulation. Make America Healthy Again is about more regulation, at least of foods and drugs, and the chemicals that are getting added to foods.

And, so again, I think that the Make America Healthy Again movement, regardless of what people think of RFK, Jr., regardless of whether they like him or don’t like him, what you’ve heard in the media, what the sound bites that you’ve heard. Regardless of where you’re at, I hope the thing that we can all agree on as Americans is that we have a chronic disease epidemic.

We have an unconscionable growing epidemic of obesity, diabetes, pre-diabetes, and mental health conditions, and somebody has to do something about it. And it is high time that we do something about it. And I think embedded in that movement is the recognition that pharmaceutical companies and food companies are not going to save us.

They are not going to save the day. It’s not that they are evil enterprises, they are for-profit companies. Their mission is not to optimize human health. Their mission is to maximize profits, and that’s fine. That’s what capitalism is. It’s not their job to optimize human health. It’s their job to make maximum profits.

We, as Americans, and certainly government entities need to recognize that and just accept that and then recognize they are not in a position to be calling the shots on what should Americans do to be healthy. It’s not eat more of their ultra-processed foods, and it’s certainly not take more and more of their pills.

Those are not the answers. Those are capitalist marketing messages to maximize profits. Again, that’s fine. Those companies can exist and do that, but we as individuals, we as the medical profession, in particular, the medical profession, our mission is to optimize human health. We need to separate ourselves from those messages. Completely separate ourselves and that involves so much.

I could go on and on. I’ll just use CME because that’s been a space. I’ve been a CME director for a few decades involved in the CME space. I think about 60% of the total CME national budget comes from pharmaceutical companies. The education that your physicians are getting, there’s a good chance it’s being influenced and funded by pharmaceutical companies.

And I’m not sure that is the right answer. I’m not sure that’s the right answer. I think that, I know some of my friends and colleagues in the CME space will hate me for saying that because nobody wants to lose 60% of their industry budget right away.

But it’s not a good way to optimize health when we’re letting, when we’re letting industries who stand to benefit financially call the shots and tell doctors how to take care of their patients. And I, so I think there are so many strategies, and certainly as we talked about funding research trials, we do need research trials that look at getting people off of medicines instead of putting them on more and more medicines.

Nobody’s going to fund that research other than the government or maybe some philanthropists. But again, as you mentioned, philanthropy can only do so much with these large, massive, entrenched organizations fields. There’s only so much that philanthropy can do. But I’m, I am hopeful. I’m hopeful because I think there are a lot of Americans who are fed up. They are the cliche. They’re sick and tired of being sick and tired. 

Bret: 
Every time I talk to you, it is clear your passion and your commitment for improving the mental health field and individuals, the mental health of individuals is unmatched. And that passion really comes through.

And the way you speak. And I have to take a moment to, since you brought up CME to plug your CME that you, a talk you gave at Ellenhorn is on myCME for free, and so not influenced by pharmaceutical companies at all. Hello. That’s an example of how it can be done, and hopefully, will continue to be done at scale.

But I can’t believe an hour has flown by, in this discussion with so many great points. And like I said, just so passionate, so I’m sure people are going to want to keep hearing more from you. And so where can they go to keep continue to follow you? 

Chris: 
They can. I’ve two websites, brainenergy.com.

We’ve got a newsletter, a weekly newsletter that we put out. We’ve got, we’re hoping to do some more videos and other informational things, and then people can find me also at chrispalmermd.com. So, if you’re looking for some of the research articles that we’re publishing out of our group and stuff, you can find them there. 

Bret: 
And then you’re active on Twitter or X, as well.

Chris: 
I am. Yeah, I’m very active on X Instagram, yeah. 

Bret: 
Okay, great. Thank you so much again for taking the time to join us here today at Metabolic Mind.

Thanks for listening to the Metabolic Mind Podcast. If you found this episode helpful, please leave a rating and comment as we’d love to hear from you. And please click the subscribe button so you won’t miss any of our future episodes. And you can see full video episodes on our YouTube page at Metabolic Mind. Lastly, if you know someone who may benefit from this information, please share it as our goal is to spread this information to help as many people as possible.

Thanks again for listening, and we’ll see you here next time at the Metabolic Mind Podcast.