Paul Saladino, MD interviews Chris Palmer, MD for his podcast, Fundamental Health
Can a Medical Ketogenic Diet Bring Relief to People Suffering from Depression, Bipolar Disorder and Schizophrenia?
Paul Saladino skillfully guides this interview about:
- The urgent need to find more effective psychiatric treatments, especially for treatment-resistant cases. Current mainstream treatments have poor outcomes.
- Traditional psychiatric treatments versus the medical ketogenic diet, which has been used in epilepsy for over 100 years.
- The significant interconnection between metabolic disorders and mental disorders. And how the ketogenic diet can treat them both.
Both audio-only and video versions available.
Podcast show notes
- 00:00 Chris. Opening excerpt about a recent and significant study. This study shows that ketone production in people with Alzheimer’s is correlated with improvements in cognition, mood and energy.
- 01:00 Paul. Introduces Chris Palmer MD, his education, professional history and current focus.
- 08:10 Paul. Excitedly welcomes Chris. Brings useful perspective about psychiatry.
- 10:46 Chris. Talks about three different levels of depression. In conventional psychiatry, we are told that more serious cases of depression are caused by a chemical imbalance. Medication only works for some of these people. Thirteen percent of the population take an antidepressant medication.
Similarities between bipolar and schizophrenia
- 15:19 Chris. Explains similarities between bipolar disorder and schizophrenia. Despite extensive studies, no biological marker has found to show difference between bipolar disorder and schizophrenia. This suggests they may be the same disorder, on different points of a spectrum. People with bipolar disorder sometimes end up having schizophrenia later in life.
- 20:22 Chris. Talks about our current medication-focused treatments for mental disorders. One study followed 6,000 people treated for schizophrenia at high-end medical centers. Over a 3 year period only 4% had a recovery when measuring three important metrics:
- relief from symptoms
- ability to function in work or school, and
- “quality of life” (e.g. relationship success, ability to experience joy)
Current paradigm – neurotransmitters, genetic mutations, family history from Paul Saladino
- 24:50 Paul. Explains that the paradigm we are using to treat mental disorders is 40 or 50 years old. This paradigm is based on the idea that mental disorders primarily result from neurotransmitter derangements. These derangements are said to be caused by genetic mutations and a bad family history.
Why are neurotransmitters disordered?
- 27:14 Paul. Talks about how focusing on medications that address neurotransmitter issues is not getting us where we want to be. When we look at the data for antidepressant treatment it is not that positive. Instead, we need to focus more on understanding why neurotransmitters are disordered.
Depression is the leading cause of disability
- 29:45 Chris. “One of the most staggering statistics right now is that major depression is now the leading cause of disability in the United States. In the last 3 years it has taken the lead role in disability throughout the world.”
- 31:30 Chris. Talks about the emotional struggles of patients. Some of them are wanting help so much that they are willing to do anything to get better.
Using the ketogenic diet as an alternative to medications
“I can’t tell you how delighted I am to be able to look people in the eye and say I’ve got a treatment for you… It’s a medical ketogenic diet”Chris Palmer, MD on Fundamental Health podcast
What might be driving psychiatric illnesses?
Could it be different types of metabolic dysfunction?
[For more see our post How many mechanisms of ketogenic diet action can you name?]
35:00 Paul. Recent discoveries that might help readers understand why a ketogenic diet might be working. So much more happening than just neurotransmitters being disordered.
1. Relationship between mental and metabolic disorders is Bi-directional
36:04 Chris “My main focus right now is understanding the connection between metabolic and mental disorders.”
- The three main metabolic disorders are obesity, diabetes and cardiovascular disease.
- These three disorders have bi-directional relationships (relationship goes both ways) with mental disorders.
- For example, people with depression are at least twice as likely to have diabetes and about 25% of people with diabetes have clinical depression.
- 43:00 Chris Palmer, MD.
“Depression is a physical illness. It is affecting the brain but it is also affecting the entire body.”
- 43:56 Chris. Talks about how inflammation causes mental disorders to become worse. Interestingly, inflammation also worsens obesity, diabetes, heart disease.
Lactate is made when your body does not have enough oxygen to break down glucose for energy. This often happens during exercise. Lactate is produced when we have a metabolic problem. E.g., when a body builders or marathon runner pushes themselves to their limits.
“We have known since the 1960’s that mental disorders correlate with disturbances in metabolism. We have also known that lactate plays a role in at least some mental disorders.”Chris Palmer, speaking on Fundamental Health podcast
- 46:23 Paul. Talks about how higher levels of lactate-signal mitochondrial dysfunction which is in some ways synonymous with metabolic dysfunction. Lactate plays a role in at least some mental disorders. E.g., panic-disorders.
- 47:17 Chris. We have double blind studies from the 1980’s and 1990’s showing that people with panic disorder will have a panic attack within seconds of being infused with lactate.
4. Other types of metabolic dysfunction
Mitochondria, ATP, NAD & NADH, reactive oxygen species, gut microbiome
- 48:27 Chris. Accumulating evidence for other types of metabolic dysfunction that might be contributing to mental illness.
- Impairment in Mitochondria, the power house of the cells.
- Levels of ATP are reduced.
- Ratios of NAD & NADH. They are markers of metabolism.
- 51:52 Chris. Part of metabolism has to do with reactive oxygen species. (They play a vital role in our cells and are a signaling molecule). Researchers think of them as waste products. They stimulate inflammation. People with mental disorders have both higher levels of reactive oxygen species and higher levels of inflammatory markers.
5. Gut microbiome
52:14 Chris. Talks about the issue of the gut microbiome.
- The bacteria, fungi and everything else in our gut are eating the food we eat. They are then excreting many things such as neurotransmitters and hormones. There is a lot of research going on with this currently.
- We have some evidence that the gut microbiome plays a role in mental disorders. We have even stronger evidence that the gut microbiome plays a role in obesity, diabetes and cardiovascular disease.
- 53:30. 55:00. Mental and metabolic disorders are clearly connected.
- “Figuring out how all these things are connected is an important question that many are trying to answer right now, including me.”
Traditional medical psychiatric treatments and metabolism
- 56:00 Chris. Sometimes our traditional psychiatric treatments affect metabolism in a negative way. They do this by causing people to become overweight, diabetic and have heart attacks. The medical ketogenic diet helps with symptom relief. It can also lessen the side effects of medications.
- 1:03:45 Chris. We have evidence that antipsychotics increase levels of insulin and glucose within hours of the first dose.
Metabolic disorders and insulin resistance
- 1:04:35 Chris. Gives an example of the connection between metabolic disorders and mental disorders. He explains how they relate to insulin resistance.
Ketogenic diet in psychiatry – a metabolic intervention and treatment
The medical ketogenic diet in psychiatry is something I’ve taken on and it has become a big passion of mine. It’s become a passion of mine because I’ve seen it work firsthandChris Palmer, speaking on Fundamental Health podcast
- 1:16:48 Chris. “I’ve seen a number of patients now that have dramatically improved from using the ketogenic diet. Some of them have gotten off all medications and have gone into complete remission, even after decades of serious, disabling mental illness. As psychiatrists we don’t get to see recoveries like this with the standard treatments available today.”
Ketogenic diet for bipolar and schizophrenia
- 1:17:00 Chris. “Generally, when someone gets diagnosed with bipolar disorder or schizophrenia, they are told they have a lifelong disorder and they will need to be on medication for the rest of their life. I was following this paradigm because it is what I was taught.”
Studies on the ketogenic diet for schizophrenia
- 1:22:15 Chris. I’ve written four case studies in the journal, Schizophrenia Research. (1, 2, 3) Also, we have three animal studies published. (3) More are on the way from a group in Australia. These studies tested the ketogenic diet in mice. They used control groups and the evaluators were blinded. They show that the ketogenic diet works for animal models of mental illness.
- 1:23:39 Chris. We have a case series of 10 patients (dating back to 1965(4)) that used the ketogenic diet successfully to treat schizophrenia.
A case study: Doris has full remission from schizophrenia using a ketogenic diet
- 1:23:55 Chris. Shares a case story of Doris, a woman treated by Eric Westman at Duke University, who has since agreed to share her story. (5, 2) I spoke with her personally not too long ago. She had been diagnosed with schizophrenia as a teenager and was on countless medications over the course of her illness. She had tried to kill herself at least 4 times. Doris needed a court-appointed conservator as well as a team of caretakers. She was 70 years old when Eric put her on a ketogenic diet in order to help her lose weight it ended up putting her schizophrenia into remission. She got herself off all her medications and within about two months of starting the diet she was symptom free.
- 1:30:21 Chris. It is now twelve years later. Doris is still off all psychiatric medications, lost 150 lbs, and no longer needs the court appointed conservators. She lives completely independently. She feels genuinely happy. I don’t see this kind of transformation with medication treatments.
Chris’s use of the medical ketogenic diet in his own practice
- 1:35:02 Chris. There are several variations of the ketogenic diet. I am using the medical version of the diet which is the same version used for epilepsy.
- 1:39:21 Chris. The ketogenic diet causes an intense, metabolic, disruptive change to the human body. It is a powerful treatment. Read more about the dangers here.
[Read more about how the initial weeks can be especially dangerous for people with serious mental illness. ]
Chris’ experience using the ketogenic diet for his own health issues
- 1:43:42 Chris. Personally I follow a low-carb/ketogenic diet. I have also experimented with a 4:1 (fat:protein) medical ketogenic diet in order to understand what my patients are experiencing when doing this diet.
- 1:45:17 Chris. The mood benefits of low carb and ketogenic diets are clear to me. I began the diet 20 years ago because I was developing metabolic health problems. After starting the diet, my health, mood, energy, sleep and motivation improved. Life became much easier. Consequently, I began to wonder if this could help people with depression.
Chris’ main focus now: studying the use of the ketogenic diet in psychiatry
1:49:35 Chris. “Three and a half years ago one of my patients with schizophrenia went on the medical ketogenic diet and he had a dramatic improvement. This was a turning point for me. I can’t stay quiet about this anymore. Too many human beings are suffering. Lives are ruined. Too many lives are lost. Psychiatrists are doing their best and I know they care about their patients. But what’s happening to these people’s lives is unconscionable.”
Volunteer effort for Chris [and his team]
- 1:54:49 Chris. I’m not getting paid for any of my current research. I am actually turning patients away in order to volunteer my time to research.
- 1:55:33 Paul. I think that understanding the way food creates disease and health is the greatest paradigm shift that will happen in medicine in the next 20 years.
- 1:57:33 Chris. As psychiatrists, we face two challenges at this point. First, showing that our dietary interventions really do work. And second, getting people to actually do the dietary interventions. [Both Dr. Palmer and Dr. Saladino are psychiatrists.]
- 2:01:08 Chris. Doing dietary research is challenging because it is difficult to get people to stay on a diet for an extended period of time.
- 2:02:55 Chris. As psychiatrists we can bring our skills to the table to help motivate people to do the ketogenic diet. We can also make it as easy as possible for people to do.
- 2:02:55 Why is it important to write medical case reports about unique cases?
My goal is to help the hundreds of millions of people around the world that need help. I want to convince medical providers that the medical ketogenic diet can help their patients.
How to find out more about Chris’ work
- 2:09:20 Chris. The easiest way for people to find me is to come to my website. There are resources and providers listed on my website that use the medical ketogenic diet. www.chrispalmermd.com
Talking with your own Psychiatrist about the Ketogenic Diet
- 2:12:13 Chris. If you have a skeptical psychiatrist I encourage you to print the articles that I’ve published in Schizophrenia Research and Psychology Today. Take them to their psychiatrist. This is likely to convince them that the ketogenic diet is worth trying.
- 2:15:11 Paul. Closing
- Palmer CM. Ketogenic diet in the treatment of schizoaffective disorder: Two case studies. Schizophrenia Research 2017 Nov;189:208-209. doi: 10.1016/j.schres.2017.01.053. Epub 2017 Feb 3.
- Palmer CM, Gilbert-Jaramillo J, Westman EC. The ketogenic diet and remission of psychotic symptoms in schizophrenia: Two case studies. Schizophrenia Research. 2019 Jun; 208:439-440. doi: 10.1016/j.schres.2019.03.019. Epub 2019 Apr 6.
- Sarnyai Z, Kraeuter AK, Palmer CM. Ketogenic diet for schizophrenia: clinical implication. Current Opinions in Psychiatry. 2019 Sep;32(5):394-401. doi: 10.1097/YCO.0000000000000535.
- Pacheco et al. A pilot study of the ketogenic diet in schizophrenia. Am J Psychiatry 1965, 121:1110-1111. [Article] [PubMed] [Google Scholar]
- Kraft, B. D., & Westman, E. C. (2009). Schizophrenia, gluten, and low-carbohydrate, ketogenic diets: A case report and review of the literature. Nutrition & Metabolism, 6(1), 10. https://doi.org/10.1186/1743-7075-6-10