Dr. Chris Palmer: Diet & Nutrition for Mental Health

Metabolic Syndrome and the Atkins Diet

• Traditional treatments for metabolic syndrome not working
• Skeptical about the Atkins diet, but decided to try it
• Within three months, metabolic syndrome was gone 
  • Blood pressure normalized, lipids normalized
  • Lost abdominal fat, about 10 pounds

Mental Health and the Atkins Diet

• Struggled with low-​​grade depression and OCD
• On medications with more side effects than benefits
• After trying the Atkins diet, noticed dramatic improvement in mood, energy, concentration, and sleep 
  • Waking up before the alarm feeling rested

Sharing the Atkins Diet with Others

• Friends and family noticed improvements in health and weight loss
• Helped others improve their moods and energy levels
• Powerful antidepressant effect observed

Atkins Diet in Clinical Practice

• Working with patients with treatment-​​resistant mental illness
• Offered the Atkins diet as an option for some patients 
  • Some experienced remarkable and powerful antidepressant effects
• Laid low due to lack of clinical trials on the safety or efficacy of the Atkins diet for mental disorders

The Atkins Diet

• Low to zero starch, low carbohydrate, low sugar

• Avoided red meat, tried a healthier version similar to the South Beach diet
  Tailoring Ketogenic Diet for Psychiatric Patients

• Individualized approach based on patient’s symptoms and needs

• Initially used Atkins diet to achieve ketosis 
  • Measured using urine strips for ketones
• Clinical benefits observed once patients achieved ketosis

Case Study: Schizoaffective Disorder Patient

• 33-​​year-​​old male with schizoaffective disorder 
  • Daily auditory hallucinations, paranoid delusions, and difficulty in public
  • Tried 17 different medications with no success
• Decided to try ketogenic diet for weight loss (340 pounds) 
  • Within two weeks, experienced dramatic antidepressant effect
  • 6–8 weeks in, hallucinations and delusions began to fade
• Lost 160 pounds and regained control of his life 
  • Completed a certificate program, performed improv, and lived independently

Medication and Adherence

• Patient continued taking antipsychotic medication 
  • Dosages may have been adjusted during the transition

• Adherence to the ketogenic diet can be challenging

  • Patient’s motivation and determination played a significant role in success
  • Support from healthcare providers and personal commitment are crucial factors
    Adherence to Diet and Medication in Mental Health

• Importance of supervised medication tapering

  • Stopping medications cold turkey can lead to severe symptoms
  • Adjustments should be made safely, cautiously, and gradually
• Frequent contact with mental health professionals for adjustments 
  • Applies to both medication and nutrition
• Compliance with prescription medications 
  • Majority of patients are somewhat non-compliant
  • Often unintentional, due to forgetfulness or changes in routine

Measuring Ketones and Ketosis in Mental Health

• Ketone levels depend on the patient and the condition being treated 
  • Not every patient needs a ketogenic diet
  • For some, eliminating junk food can improve mood disorders
• Ketogenic diet may be more beneficial for chronic conditions like schizoaffective disorder, schizophrenia, or bipolar disorder 
  • Aim for blood ketone levels greater than 0.8 millimole for depression
  • Aim for blood ketone levels greater than 1.5 millimole for psychotic disorders and bipolar disorder

Epilepsy and the Ketogenic Diet

• Long-​​standing use of ketogenic diet and fasting to treat epilepsy
• Using nutrition as a treatment tool for mental illness still considered unconventional by some 
  • Dr. Chris Palmer emphasizes that nutrition should be considered one of the major tools in the landscape of effective treatments
• Ketogenic diet’s history in treating epilepsy provided credibility for Dr. Palmer’s work in using diet to influence mental health conditions

The Role of Insulin Resistance and Metabolic Syndrome in Mental Health

• Emerging data suggests that insulin resistance and impaired glucose metabolism are linked to chronic mental disorders 
  • Applies to anxiety, depression, bipolar disorder, schizophrenia, and Alzheimer’s disease

• Targeting insulin resistance and metabolic syndrome through dietary changes can improve mental health

  • For some, eliminating highly processed foods is enough
  • For others, a full ketogenic diet may be more beneficial
    Ketogenic Diet and Epilepsy

• Developed in 1921 by a physician to treat epilepsy

  • Based on the observation that fasting can stop seizures
  • Fasting causes shifts in metabolism, beneficial to human health
• Dr. Russell Wilder at the Mayo Clinic developed the ketogenic diet 
  • Mimics the fasting state to stop seizures long term
  • Early results: 50% of patients became seizure-​​free, 35% had a 50% or greater reduction in seizure frequency
• Used for both pediatric and adult epilepsy 
  • Fell out of favor in the 1950s due to pharmaceutical treatments
  • Resurrected in the 1970s at Johns Hopkins for treatment-​​resistant cases 
    • 1/​​3 became seizure-​​free, 1/​​3 had a clinical benefit, 1/​​3 did not respond

Ketogenic Diet and Mental Disorders

• Nutritional psychiatry is a broad field in its infancy 
  • Case studies and mechanistic science papers available
  • Randomized controlled trials are underway
• Disorders that may benefit from the ketogenic diet: 
  • Chronic depression
  • PTSD
  • Alcohol use disorder
  • Alzheimer’s disease
  • Bipolar disorder
  • Schizophrenia
• Pilot study of 31 patients with treatment-​​resistant mental disorders 
  • 100% had at least some improvement in symptoms
  • 46% had remission of illness
  • 64% were discharged on less medication

Ketogenic Diet’s Effects on the Brain

• Influences neurotransmitter levels (glutamate, GABA, adenosine)
• Changes calcium channel regulation and calcium levels
• Alters gene expression and reduces brain inflammation
• Changes the gut microbiome
• Improves insulin resistance, lowers glucose and insulin levels
• Stimulates mitophagy (removal of old/​​defective mitochondria) and mitochondrial biogenesis (creation of new mitochondria)

Connection Between Epilepsy and Mental Health

• Epilepsy treatments are used in psychiatric patients every day 
  • Depicote, Tegratol, Lamictyl, Topamax, Neurontin, Valium, Clonapin, Xanax
  • Many were initially developed for seizures but are now used for mental disorders

• Using the ketogenic diet as a treatment for serious mental disorders is an extension of this established practice
  Psychiatry and Neuroscience

• Psychiatry tools: language and observing behavior

• Neuroscience tools: neurotransmitters, neuromodulators, and altering brain chemistry 
  • Antidepressants, antipsychotics, adjusting dopamine, serotonin, epinephrine, adenosine, etc.
• Psychiatry and neuroscience still in infancy 
  • 100 years ago, phrenology was used for diagnosis
• Adjusting nutrition, ketogenic state, eliminating processed foods, and sugars can help with psychiatric disorders 
  • Diet, exercise, social connection, and limiting stress are essential

Mitochondria and Mental Health

• Mitochondria: energy factories of cells, present everywhere in neurons
• Mitochondria have functions beyond energy production 
  • Direct role in production, release, and regulation of neurotransmitters (serotonin, dopamine, glutamate, acetylcholine)
  • Provide building blocks and energy for neurotransmitter production
  • Directly related to release of neurotransmitters
• Mitochondria are primary regulators of epigenetics 
  • Responsible for expression of about 60% of genes in a cell
  • Manage calcium regulation and reactive oxygen species levels
• Mitochondria play a role in human stress response 
  • Increased cortisol, adrenaline, noradrenaline, inflammation, and gene expression
  • Involved in synthesis of steroid hormones (cortisol, estrogen, testosterone, progesterone)
  • Direct role in inflammation and immune response
• Understanding mitochondria can help connect the dots in mental illness puzzle

Mitochondria and Their Importance

Mitophagy and Autophagy

• Mitophagy is a subset of autophagy, specifically targeting mitochondria
• Autophagy is the process of recycling dead or injured cells, stimulated by fasting states or fasting mimicking states
• Mitophagy helps remove old or defective mitochondria and replace them with new ones

Mitochondrial Dysfunction and Aging

• Mitochondrial dysfunction is associated with aging and chronic mental disorders
• Reactive oxygen species (ROS) were once thought to be the cause of aging, but now they are known to have both positive and negative effects
• Mitochondrial dysfunction is now considered a possible unifying cause of aging and aging-​​related disorders

Diet and Mitochondrial Health

• Calorie restriction, fasting, and intermittent fasting can stimulate mitophagy and improve mitochondrial health
• These dietary changes can positively impact mental and physical health

Glucose and Neurons

• Neurons rely on glucose for energy, but too much glucose can be detrimental
• High glucose levels may be a symptom of metabolic dysfunction, possibly related to mitochondrial dysfunction

• The relationship between glucose levels and neuronal health is complex and not yet fully understood
  Effects of Diet on Mood and Mental Health

• Many people suffer from moodiness, subclinical depression, and burnout

• Ketogenic diet can be an effective treatment, but it doesn’t imply that carbohydrates are the cause
• Example: infants with epilepsy can benefit from a ketogenic diet, even though they consume breast milk, which is considered the optimal food source

Obesity and Mitochondria

• The cause of obesity is still unknown
• Mitochondria might be the key to the obesity epidemic
• Factors that impair mitochondrial function: environmental toxins, stress levels, poor sleep, lack of sunlight, and diet
• Mitochondrial dysfunction could be a primary driver of mental illness and metabolic illness

Inheritance of Mitochondrial DNA

• Mitochondria have 36 genes, 13 of which code for ATP production
• Majority of proteins that make up mitochondria come from over 1300 genes in nuclear DNA, inherited from both parents
• Mitochondrial dysfunction is not solely due to inheriting defective mitochondria from the mother

Effects of Sleep, Stress, and Substance Use on Mitochondria

• Sleep disruption, high levels of stress, and trauma impair mitochondrial function
• Alcohol, tobacco, and marijuana (THC) also impair mitochondrial function
• THC directly affects mitochondria by binding to CB1 receptors, which are involved in memory impairment and lack of motivation

Mitochondrial CB1 Receptors and Marijuana Use

• Mitochondria have CB1 receptors that are influenced by marijuana
• Studies show that adolescents who use marijuana have brain areas with high numbers of CB1 receptors that are atrophied or shrunk compared to healthy controls

• CB1 receptors on mitochondria play a role in memory impairment and amotivational state induced by THC
  Effects of Alcohol and THC on the Brain

• Alcohol and THC can harm mitochondria in brain cells

  • Chronic use can negatively impact mental and metabolic health
• Alcohol disrupts brain fuel usage, making alcohol more rewarding to drinkers 
  • Also alters glucose metabolism, negatively affecting brain health

Ketogenic Diet and Alcoholism

• Study led by Nora Volkow, director of the National Institute of Drug Abuse 
  • Examined the effects of a ketogenic diet on alcoholics during detox
  • Ketogenic diet group required fewer benzodiazepines and had fewer withdrawal symptoms
  • Reported fewer cravings for alcohol
  • Brain scans showed improved brain metabolism and reduced neuroinflammation
• Suggests that correcting brain metabolic defects from chronic alcohol use may help with sobriety

Caution: Ketogenic Diet and Alcohol Consumption

• Study on rats found that those on a ketogenic diet had a five-​​fold increase in blood alcohol levels when exposed to the same amount of alcohol as rats on a standard diet 
  • Indicates that alcohol metabolism is different on a ketogenic diet
• People on a ketogenic diet should be cautious about alcohol consumption, as it could lead to higher blood alcohol levels and increased impairment

Neuroimaging Studies on Diet and Brain Function

• PET scans can measure glucose metabolism in the brain 
  • Researcher Stephen Cunnane has conducted studies on Alzheimer’s disease patients and glucose hypometabolism 
    • Some researchers call Alzheimer’s “type 3 diabetes” due to insulin signaling impairment
  • Cunnane’s studies show that ketone supplements can correct brain metabolism deficits in Alzheimer’s patients, at least short-term 
    • Suggests a link between mitochondria and glucose metabolism in the brain
      Ketogenic Diet and Cognitive Health

Ketone Esters and Carbohydrates

• Liquid ketone esters can increase energy levels, focus, and improve sleep
• Effects observed with or without a ketogenic diet
• Research on ketone esters and salts in metabolically compromised brain cells 
  • Noticed immediate changes in metabolism when given to patients on non-​​ketogenic diets

Reducing Carbohydrate Consumption

• Pilot trial in a nursing home 
  • Reduced carbohydrate consumption at breakfast and lunch
  • Resulted in cognitive improvement in some subjects
• Limiting carbohydrates during the day can help maintain alertness

Exogenous Ketones and Ketogenic Diet

• No clear evidence that exogenous ketones alone can control seizures or improve cognitive health
• Ketogenic diet has multiple benefits beyond ketones 
  • Lowering glucose levels, improving insulin signaling, and increasing mitochondrial biogenesis
• Exogenous ketones may be beneficial for metabolically healthy individuals
• Potential use of exogenous ketones for alcohol use disorder

Ketones as Brain Fuel

• Some brain cells require glucose and cannot use ketones
• Metabolically compromised cells may benefit from ketones 
  • Can help cells repair themselves when given enough energy

Alzheimer’s and Age-​​Related Cognitive Decline

• Ketogenic diet may help offset symptoms of Alzheimer’s and cognitive decline
• Lack of controlled clinical trials exploring the role of ketogenic diet in Alzheimer’s treatment

• Ongoing research needed to establish the effectiveness of ketogenic diet in cognitive health
  Ketogenic Diet and Alzheimer’s Research

• Small pilot clinical trials on ketogenic diet and Alzheimer’s

  • Randomized controlled trial with 26 subjects 
    • 12 weeks of low-​​fat diet, 10-​​week washout, 12 weeks of ketogenic diet
    • Statistically significant improvement in activities of daily living and quality of life
    • Improvement in cognitive function, but not statistically significant
• Animal models show ketogenic diet can improve biomarkers of Alzheimer’s 
  • Reduces plaques and tangles, improves cognitive impairment
• Other small pilot trials in humans show improvement in biomarkers compared to low-​​fat or American Heart Association diets

Challenges in Alzheimer’s Research and Ketogenic Diet

• Johns Hopkins researchers attempted a study with Alzheimer’s patients on ketogenic diet vs. control diet 
  • Over three years, screened 1300 people, only 27 enrolled, and 14 completed the study
  • Subjects who achieved ketosis had cognitive improvement
• Study section panels evaluate grants for research, but only a small percentage of studies are funded

No Conspiracy in Alzheimer’s Research

• No active suppression by pharmaceutical companies 
  • Pharma would likely capitalize on positive results from ketogenic diet studies

Importance of Support and Education for Dietary Interventions

• Intensive support and education needed for patients to adhere to the ketogenic diet 
  • Weekly sessions, health and wellness coaches, dietitians, family education, and meal provision
• Consequences of going off the diet can be a strong motivator for patients to stay on it 
  • Schizophrenic patients experience hallucinations within 24–48 hours of breaking the diet
  • Alzheimer’s patients may experience similar reinforcement if they notice cognitive decline after going off the diet

Different Forms of the Ketogenic Diet

• Ketogenic diet for weight loss is just one aspect 
  • Can be used to treat obesity and induce weight loss, but also has other medical benefits

• Different “dosage ranges” of a nutritional plan can be prescribed depending on the patient and their needs

  • Classic keto, Atkins, and other variations
  • Not necessarily zero carbohydrates or a specific number of grams, but tailored to the individual
    Ketogenic Diet and Mental Health

• No one-​​size-​​fits-​​all recommendation for dietary intervention

• Assess patient’s symptoms, current diet, and willingness to change
• Goal: induce a state of ketosis, mimicking fasting state
• Can be achieved through fasting, intermittent fasting, or ketogenic diet

Ketogenic Diet Variations

• Carnivore diet: all-​​meat version, controversial but some swear by it
• Vegetarian and vegan versions of the ketogenic diet also exist
• Not about specific foods, but inducing ketosis

Factors to Consider in Prescribing Ketogenic Diet

• Patient’s current weight 
  • Obese patients: focus on carbohydrate restriction, using body fat as a source
  • Thin patients: need to consume more fat to achieve ketosis
• Encourage a wide range of fats, depending on patient preferences 
  • Olive oil, avocados, nuts, coconut oil, coconut cream, meat, eggs, sardines, tempeh, etc.

Ketogenic Diet and Intermittent Fasting

• Can be prescribed together for some patients
• Example: patient with type 2 diabetes and chronic depression 
  • Ketogenic diet + intermittent fasting or water fast
  • Blood sugars normalize, patient feels better after initial discomfort

Neural Benefits of Intermittent Fasting

• Controversial: is it beneficial due to caloric restriction or additional benefits?

• Interest in the neural side of intermittent fasting
  Fasting and Rewarding Properties

• Fasting can have its own rewarding properties

  • Dopamine release from abstaining from food
  • Can be pathological in cases like anorexia nervosa
  • Non-​​anorexics can feel good from abstaining from eating

Hypomania and Ketogenic Diet

• Hypomania: feeling extraordinarily good, getting by on less sleep 
  • Can be a side effect of the ketogenic diet in some cases
  • Some famous people with bipolar disorder had productive periods during hypomanic episodes
• Strategies to address hypomania and sleep issues: 
  • Behavioral tools, exercise, sunlight exposure, avoiding late-​​night artificial light
  • Supplements like inositol, magnesium, and melatonin
  • Adjusting carbohydrate intake, especially in the evening

Ketogenic Diet and Hormones

• Interactions between ketosis diets and the endocrine system are not well understood 
  • Men generally have an easier time with the ketogenic diet than women
  • Female mice on a ketogenic diet had difficulty getting pregnant
• Evolutionary perspective: women’s bodies may change hormonal status to prevent pregnancy during fasting or starvation 
  • Ketogenic diet mimics fasting state
• Some women have benefited from the ketogenic diet, even experiencing increased fertility

Addressing Sleep Issues on Ketogenic Diet

• Education on the importance of at least 6 hours of sleep per night
• Behavioral measures, supplements, and adjusting carbohydrate intake
• Prescription sleeping medicines as a temporary solution for severe cases 
  • Avoiding trazodone due to its antidepressant effects
  • Using benzodiazepines or Z medicines for sleep (e.g., Ambien) for short-​​term use

Ketogenic Diet and Fertility

• Ketogenic diet may impact fertility in both men and women

  • Subcaloric diets can improve testosterone-​​estrogen ratios in obese men but may impair testosterone levels in non-​​obese men
  • Some women may experience hormonal changes that prevent pregnancy on a ketogenic diet
  • Other women have experienced increased fertility on a ketogenic diet
    Ketogenic Diet and Mental Health

• Ketogenic diet’s effects on male and female hormonal systems are not well understood

  • Anecdotal evidence suggests changes occur, but controlled studies are needed
• Obesity epidemic is a threat to human health and species 
  • Identifying the root cause of obesity is crucial for effective treatment
• Semaglutide drugs, developed for diabetes treatment, are now being evaluated for obesity treatment 
  • Tap into glucagon-​​related peptide‑1 (GLP‑1) pathways
  • Adjust glucose and insulin management in the body and brain
  • Can produce weight loss, but lifestyle changes can achieve similar results
• Concerns about using GLP‑1 medications for weight loss 
  • May not address the root cause of obesity or negative health consequences
  • Obesity is seen as a symptom of metabolic derangement in the body or brain
  • Previous weight loss drugs (e.g., fen-​​phen, dexedrine) had negative consequences
• Dr. Chris Palmer’s work focuses on the ketogenic diet as a treatment for psychiatric disorders 
  • Book: “Brain Energy” available on Amazon and other retailers
  • Website: chrispalmermd​.com