November 21, 2022 • 3hr 0min
Dr. Chris Palmer: Diet & Nutrition for Mental Health
Huberman Lab
Key Takeaways
- Ketogenic diets can have powerful effects on mental health, including improving symptoms of depression, anxiety, bipolar disorder, and even schizophrenia in some cases
- Mitochondrial health and function play a crucial role in mental health. Ketogenic diets and fasting can improve mitochondrial function through processes like mitophagy and mitochondrial biogenesis.
- Reducing carbohydrate intake, even without full ketosis, can provide mental health benefits for some people by improving metabolic health and insulin signaling in the brain
- Ketogenic diets were originally developed to treat epilepsy, not for weight loss. They have a long history of use in neurology before being applied to psychiatric conditions.
- Measuring ketones provides an objective biomarker of dietary compliance, which is very useful clinically compared to other diets
- Ketogenic diets need to be tailored to the individual based on their symptoms, current diet, weight status, and willingness to make changes
- Potential side effects like hypomania need to be monitored, especially in psychiatric patients. Sleep disruption may need to be addressed.
- More research is still needed on the long-term effects and optimal implementation of ketogenic diets for mental health conditions
Introduction
In this episode, Dr. Andrew Huberman interviews Dr. Chris Palmer, a psychiatrist and researcher at Harvard Medical School who specializes in using ketogenic diets and metabolic interventions to treat psychiatric disorders. Dr. Palmer shares his journey of discovering the powerful effects of ketogenic diets on mental health through his own experience and clinical work with patients. He explains the science behind why ketogenic diets can improve brain function and discusses both the benefits and potential risks of this approach for treating conditions like depression, anxiety, bipolar disorder, and schizophrenia.
Topics Discussed
Dr. Palmer's Background and Discovery of Ketogenic Diets (6:31)
Dr. Palmer shares his personal history of struggling with mental health issues like OCD and depression as a child and young adult. As a psychiatry resident, he was diagnosed with metabolic syndrome despite following conventional diet advice. He tried a low-carb diet similar to Atkins and experienced dramatic improvements in both his physical and mental health.
- Within 3 months, his metabolic syndrome resolved completely
- He noticed significant improvements in mood, energy, concentration, and sleep
- This sparked his interest in exploring dietary interventions for mental health
Case Study: Ketogenic Diet for Schizoaffective Disorder (27:21)
Dr. Palmer describes a remarkable case of a 33-year-old man with treatment-resistant schizoaffective disorder who experienced dramatic improvements on a ketogenic diet:
- The patient had daily auditory hallucinations and paranoid delusions for years despite trying 17 different medications
- Within 2 weeks on the diet, he showed an antidepressant effect
- After 6-8 weeks, his hallucinations and delusions began resolving
- He lost 160 pounds and was able to live independently and perform activities he hadn't done in years
"That man went on, he's now lost 160 pounds and kept it off to this day. He was able to do things he had not been able to do since the time of his diagnosis. He was able to complete a certificate program. He was able to go out in public and not be paranoid. He performed improv in front of a live audience." - Dr. Chris Palmer
Mitochondrial Function and Mental Health (1:06:12)
Dr. Palmer explains how mitochondrial health and function play a crucial role in mental health:
- Mitochondria are involved in neurotransmitter production and release
- They regulate gene expression and epigenetics
- Mitochondria are key players in the stress response and inflammation
- Mitochondrial dysfunction is associated with many mental health conditions
"I believe once you understand the science of mitochondria, you can actually connect all of the dots of the mental illness puzzle." - Dr. Chris Palmer
Ketogenic Diets and Mitochondrial Health (1:19:04)
Dr. Palmer discusses how ketogenic diets can improve mitochondrial function:
- Ketogenic diets stimulate mitophagy - removal of old/dysfunctional mitochondria
- They also stimulate mitochondrial biogenesis - creation of new mitochondria
- This leads to healthier, more abundant mitochondria in brain cells
- Improved mitochondrial function may explain the mental health benefits
Ketogenic Diet vs. Exogenous Ketones (1:59:26)
Dr. Palmer explains why exogenous ketone supplements likely don't provide the same benefits as a ketogenic diet:
- Ketogenic diets have multiple effects beyond just raising ketone levels
- They lower glucose, improve insulin signaling, change the gut microbiome, etc.
- Exogenous ketones alone don't address underlying metabolic issues
- No evidence that ketone supplements alone can control epilepsy or psychiatric symptoms
Implementing Ketogenic Diets Clinically (2:24:11)
Dr. Palmer describes his approach to prescribing ketogenic diets:
- Assess the patient's symptoms, current diet, and willingness to change
- Tailor the approach based on whether the patient is overweight or thin
- For overweight patients, focus on carb restriction initially
- For thin patients, emphasize high fat intake to achieve ketosis
- Use ketone measurements to guide and adjust the intervention
- Work closely with patients to ensure proper implementation and monitor for side effects
Potential Risks and Side Effects (2:36:22)
Dr. Palmer discusses some potential risks to be aware of:
- Hypomania in some patients, especially those with bipolar disorder
- Sleep disruption that may require intervention
- Possible impacts on menstrual cycles and fertility (mixed evidence)
- Need for electrolyte and nutrient monitoring
- Importance of medical supervision, especially for psychiatric patients
Future Research Directions (2:10:10)
Dr. Palmer highlights areas where more research is needed:
- Larger, long-term randomized controlled trials for psychiatric conditions
- Studies on optimal implementation strategies
- Research on impacts on hormones and fertility
- Comparisons to other interventions like medications
- Need for more funding and interest from mainstream psychiatry
Conclusion
Dr. Chris Palmer's work represents a pioneering approach to treating psychiatric disorders through metabolic interventions, particularly ketogenic diets. While more research is still needed, the clinical results and scientific rationale are promising. Ketogenic diets appear to improve mental health symptoms in some patients by enhancing mitochondrial function and brain metabolism. However, proper medical supervision and individualized implementation are crucial. As this field continues to develop, it may lead to new treatment options for patients struggling with mental health conditions.
