Show notes for Episode 49
- 00:00 Welcome to the Low Carb MD podcast with Dr. Chris Palmer. He is a Harvard psychiatrist who has case reports and case studies on mental health and the ketogenic diet.
- 01:23 Nutritional approaches to psychiatric disorders.
Dr. Chris Palmer’s personal health history and metabolic recovery
- 02:19 Dr. Palmer’s story, 20-25 years ago, “I was one of those skinny, metabolically-disordered people.”
- 03:19 Chris’s low fat diet
- 03:33 Dr. Palmer’s health: “I was pre-diabetic. I definitely had hypertension and I had horrible cholesterol.”
- 05:36 The effect of low-carb diet intervention, “Everything was better. My LDL plummeted. My HDL doubled. And my triglycerides plummeted into a normal healthy range. I was no longer pre-diabetic. My blood pressure was down to a really good, healthy level.”
- 06:02 Twenty+ years on a low-carb ketogenic diet.
- 09:01 “When I speak to other physicians I often ask how lifestyle interventions are going for their patients? Almost all of them roll their eyes and give a deep sigh of hopelessness futility. ‘There’s no point. It never works.’ Their perception is that the patients are lazy slackers.”
Change is hard
- 10:01 “Bad advice doesn’t work. Low-carb, high-fat eating goes against everything that we have believed for decades. Everything that we’ve been taught. Change is hard.”
Global metabolic and mental disorder epidemic
- 11:44 “In the United States, and around the world, there is something profoundly wrong… Obesity rates are skyrocketing. Diabetes rates are skyrocketing, and my passion, mental disorders, are skyrocketing.”
- 12:30 Other mental disorders are also skyrocketing at the exact same time that we’re seeing these exploding rates of metabolic disorders.
Ketogenic diet as intervention for treatment-resistant depression and weight loss
- 13:40 “ I’ve been using it with patients for treatment-resistant depression. And, I’ve been using with a lot of people for weight loss and just for general health improvement.”
- 14:04 Also, I knew I was going against the medical establishment.
- 14:54 “I can’t stay quiet anymore”
- 15:21 “A schizophrenic patient was on every medication. He suffered every day every day.”
- 16:19 “On psychiatric medication, he gained 150 – 200 lb, he was sedated. He couldn’t function. He couldn’t live alone.”
- 17:03 “I had worked with him for 10 years. We had tried numerous medications.”
Sometimes medication is not enough when treating schizophrenia
- 17:22 “And we couldn’t help him. We’re doing our best. The medications are required. They’re essential.”
- 18:12 “But these medications also made him morbidly obese. These medications are sedating him so that he sleeps 16 hours a day. And these medications are not working for him.”
- 18:45 “Unfortunately, there are literally tens of millions of people just like him all around the world, and this is what the medical field has to offer them.”
Weight loss and psychosis
- 19:02 The patient wants to lose some weight.
- 19:09 “Getting a person with schizophrenia to do a diet though. Everybody thinks that’s impossible.”
- 20:34 But, at the 3-week mark of doing a ketogenic diet, I noticed something distinctly different about him. He’s losing weight. But he is now starting to be more alert. I haven’t changed his meds at all.”
- 21:26 At about 6 weeks, “He spontaneously reports to me: ‘Dr. Palmer, you know those voices that I tell you I hear all the time? I think they’re kind of getting quieter and I’m not hearing them as much, they’re not talking as much anymore…’”
Ketogenic dietary intervention takes time to work
- 22:01 Another 4 weeks go by, this treatment takes time, he says “Dr. Palmer, you know, I had these delusions? I think maybe that’s not really happening, I think maybe I have schizophrenia and it’s getting better.”
100 pound weight loss and psychiatric symptoms improve
- 23:48 He loses over a hundred pounds at the one-year mark. He is improved psychiatrically, functionally, and socially.
Going off the diet and symptoms return
- 24:57 If he does not follow the diet, he can become acutely psychotic again within 24-48 hours. Just like stopping medication. When he resumes the diet, symptoms abate.
Keto diet is not a stand-alone treatment
- 25:57 Psychosocial and psychoeducational intervention, and sometimes medications, are still necessary. Keto is not a cure-all.
- 27:43 Medications interfere with metabolism, cause weight gain, diabetes, and increases in blood sugar and insulin.
70 year old woman with schizophrenia improves on keto
- 28:25 One of Dr. Eric Westman’s patients had chronic paranoid schizophrenic for 53 years. She couldn’t function in life.
Dr. Eric Westman at Duke University
- 29:24 She had debilitating, disabling schizophrenia and she gained weight up to 330 pounds. Eric Westman, MD treated her at the low-carb weight-loss clinic at Duke University
- 30:24 Within 2 months her psychotic symptoms were improved
- 30:32 “She has been off of medications now for 12 years, fast forward 12 years. That’s today. She’s lost 150 lb.
- 31:14 The patient is symptom-free.
- 31:16 She’s off all medications.”
- 31:36 “She is so excited to share her message of recovery using the ketogenic diet.”
- 32:21 Compliance is a huge issue.
Food as medicine?
- 35:00 Food can act as medicine?
- 36:11 It’s not a conclusion. It’s a question.
- 36:42 Quackery…skepticism
- 37:54 “We have more basic science research and knowledge and understanding of the effects of this [ketogenic] diet on the human brain than we do any other dietary intervention and than we do for most psychiatric medication.”
- 38:14 “Thousands and thousands of studies published in some of the best medical journals neurology journals.”
Keto for epilepsy
- 39:14 20 to 30% of treatment resistant people treated with the ketogenic diet are seizure-free. “These are the worst of the worst. They’ve tried everything they suffered for years or decades and nothing is working for them. And this diet can make 20 to 30% of them seizure-free.” But, some can’t stay on the diet.
- 39:50 “The Cochrane review on the ketogenic diet for pediatric epilepsy in particular, and it is unequivocal in its conclusion: The ketogenic diet is an effective treatment for epilepsy.”
- 40:59 A ketogenic diet is shown to work for epilepsy. Every anti-epileptic medication is used in psychiatry. “We use benzodiazepines, Depakote, Lamotrigine and Tegretol. We use all of it. Every anticonvulsant medication is used in psychiatry sometimes on label, sometimes off label.”
- 42:45 “When we combine two psychiatric medications, that’s off-label.”
- 43:41 “We use every epilepsy treatment in psychiatry. We often treat patients off-label in psychiatry…why should I even consider using the ketogenic diet today in a patient with a treatment-resistant mental illness? [It is] because it’s a proven treatment for treatment-resistant epilepsy and you’re going to use it off label. So the way I look at it is, I am using an off-label established treatment for epilepsy in psychiatric disorders.”
Time with patients
- 47:15 “…one of the great things about being a psychiatrist is that we are probably the last of the medical professionals who still get to have a relationship with our patients who still get to talk about whatever we think is important to their health.”
The mental-metabolic connection
- 51:24 “We have hardcore epidemiologic data… obesity affects diabetes and diabetes control affects cardiovascular disease.”
- 51:59 Sleep and metabolism
- 53:59 Bipolar disorder
- 54:43 Treatment-resistant depression. “…dramatic Improvement in mood disorders and anxiety symptoms…”
- 55:23 Caveats: Keto adaptation-keto flu is a serious medical risk. People may get worse initially, before they get better.
- 56:13 Transition from utilizing glucose for fuel to using fat for fuel takes time and the process initially deprives cells of energy.
- 57:48 Metabolic disorders and energy deprivation
- 58:56 Medical monitoring necessary for people with serious disorders
- 59:52 Medical risk, powerful intervention
- 1:02:47 “Mental health and metabolic disease are intimately related.”