Essentials: Diet & Nutrition for Mental Health | Dr. Chris Palmer

Key Takeaway

Start with the lowest-risk nutrition change: remove highly processed, high-sugar foods for two weeks and track your mood, energy, concentration, sleep and cravings each day. Dr. Palmer argues that some people experience meaningful mental-health benefits simply by lowering carbohydrate intake and improving metabolic health. If you have bipolar disorder, schizophrenia, severe depression, diabetes, or take psychiatric medication, make dietary changes with a qualified clinician rather than changing medication on your own.

Episode Overview

Dr. Chris Palmer discusses the relationship between metabolism, nutrition and mental health, drawing on his clinical work with treatment-resistant psychiatric illness and the long history of ketogenic diets in epilepsy. He explains why highly processed foods may harm metabolic and mental health, why ketosis may be useful for some severe conditions, and how mitochondrial function could connect energy, neurotransmitters, inflammation and stress responses.

Full Transcript

Transcript of Essentials: Diet & Nutrition for Mental Health | Dr. Chris Palmer from Huberman Lab. Auto-generated from episode audio; may contain minor errors.

Welcome to Huberman Lab Essentials, where we revisit past episodes to find the most powerful and practical science-based tools for mental health, physical health, and performance. I'm Andrew Huberman, a professor of neurobiology and ophthalmology at Stanford School of Medicine. And now my conversation with Dr. Chris Palmer. Chris, Dr. Palmer , thank you for being here. Thank you, Andrew, for inviting me. I have a lot of questions for you , and I'm really excited about this topic because I think most people know what mental illness is, or have some idea of ​​what it is.

Most people have some idea of ​​what nutrition is. Of course, fewer people know how closely these things can interact. I think everyone is familiar with the feeling that eating or consuming food makes them feel good in the short term. But I think very few people understand or are familiar with the fact that nutrition and our mental health interact in such a very close, perhaps even causal, way. And this happens over long periods of time, meaning what I ate yesterday, the day before yesterday, maybe even 10 years ago, can influence how my brain and body make me feel now.

So , if you would allow me, I would really appreciate it if you could tell us a little bit about your history, specifically your history of researching the relationship between nutrition and mental health. And then we can get into some, um, more detailed details of ketogenic diets compared to other diets and some of the really amazing discoveries that you and others have come to based on real patients and real experiences of people who are suffering and then finding relief by changing their diet. Of course. This story actually begins with my personal story.

I don't need to go into detail, but to set the stage, when I was a child, I definitely had mental illness. It started with obsessive- compulsive disorder. Eventually, I developed depression, suicidal thoughts, all sorts of things. But somehow I pulled myself together and graduated from medical school, actually did pretty well in medical school, and then did my internship and residency at Harvard. And at that moment I was diagnosed with metabolic syndrome . So, I had high blood pressure, terrible lipid levels, and prediabetes. And I supposedly did everything right.

I followed a low-fat diet and exercised regularly. And year after year, my doctor constantly advised me to follow a diet and exercise. I did everything he told me. Everything was getting worse. My blood pressure continued to rise. And at some point he said, “You’re going to have to take medication for prediabetes, something for cholesterol, and something for blood pressure. So, three pills. Essentially, you are lost. It's your genes. You'll just have to grit your teeth and take your medicine ." As a doctor, I knew what that meant.

I knew that in my 20s, if I was already taking three medications for metabolic syndrome, I would be in trouble until I was 40 or 50 , and I would probably have heart attacks. I've heard rumors that the Atkins diet can somehow help people improve their cholesterol levels and prediabetes. I was very skeptical, and I, you know, I believed everything I was taught in medical school. Why did my professors lie to me? They knew what they were talking about. A low-fat diet was exactly what needed to be done, and the Atkins diet was clearly dangerous and reckless, and I had tried medical dogma for years, and it ...didn't work for a long time.

And so, for some reason, I decided that this would be my last attempt at something different. And then I'll just grit my teeth and move on to medication. So I tried the Atkins diet. Within 3 months, my metabolic syndrome completely disappeared. I probably lost about 10 pounds through this process. But everything normalized. And when we went back to my doctor, he was shocked. What surprised me most after 3 months of dieting wasn't that my metabolic syndrome had disappeared. That was my goal , and it was, you know, an amazing achievement , because I got rid of everything with just one change in my diet.

But what I noticed was a dramatic improvement in mood, energy, concentration, and sleep. For the first time in my life, I started waking up before my alarm went off and felt more rested. This has never happened to me before. I carefully planned when my alarm would go off and how many times I could hit the snooze button to get to where I needed to be on time, whether it was school, or the hospital, or... Whatever . Before this diet, I always felt like there were two types of people in the world.

There are happy, cheerful people who are just so positive, full of energy, and they have this saying: they like to work hard and rest hard. But I never understood who the hell wants to rest so hard. Who has the energy for that? Are n't you tired from all this hard work? I thought they were just lucky and privileged. They either have good genetics, or maybe they had a good childhood, or good parents, or something. Something I didn't have. What was the path to the work you do now?

So, over the course of a few years, I, you know, became a doctor. In my clinical practice, there are all these patients with treatment-resistant mental illnesses. I work in a tertiary hospital . That's why I almost never pick up someone off the street with a first episode of depression. From the very beginning, as part of my career, I have developed mental disorders that are resistant to treatment. So I have people who have already been to more than six psychiatrists and therapists. They usually tried dozens of...different medications.

They had been undergoing psychotherapy for decades. They have often undergone electroconvulsive therapy and other methods, but nothing helps. And I think, you know, well, we don't have any more options for these other people, and this diet has a really powerful antidepressant effect. I think I'll try it and see if any of my patients are willing to try it and see if it can help them. Of course, it helped. It did n't help everyone, and not everyone was interested and/or able to do it, but some of those who were able to do it eventually experienced a striking and powerful antidepressant effect.

One woman actually began to develop a hypomanic state within a month. And she was depressed almost continuously for over 5 years, chronically depressed, with suicidal intentions, constantly ending up in hospitals. And I saw her go into a hypomanic state, and I think, "Wow, this is a really powerful antidepressant effect. It's just incredible. It's like medication, but better, because it really works for her." “At that point, we didn’t have many clinical trials of the safety or effectiveness of the Atkins diet, even for weight loss or diabetes, let alone any mental disorders.

So I really felt marginalized, and no one would welcome that. So I'll just stay in the shadows, I suggest it to patients. And I followed this path until 2016. So, a low-carb diet is, of course, low in sugar. Yes. I assume you are not a nutritionist, so how did you prescribe a meal plan for your patients? The first few patients needed to try this Atkins diet. I want to see ketosis . So I strongly recommended that patients achieve urinary ketosis. And what's interesting is that I noticed a pattern that when they tried the diet and didn't get ketones, they often didn't get clinical benefit.

It was once they reached ketosis that I started to see clinical benefit. However, what completely turned everything I knew as a psychiatrist upside down was when I helped a patient...In 2016. A 33- year-old man with schizoaffective disorder. He has been treating my patient for 8 years. He had daily auditory hallucinations. He had paranoid delusions. He couldn't go out in public without feeling terrified. This man was tormented by his illness. She ruined his life. He had already tried 17 different medications, and none of them stopped his symptoms.

He weighed 340 pounds, and for some reason he gets it into his head, "I'll never get a girlfriend if I don't lose weight." He also admits that I will never get a girlfriend because I am a loser. I am schizophrenic . I live with my father. You know, I can't do anything . For various reasons, we decided to try the ketogenic diet. He decides to try. Within 2 weeks, he not only started losing weight, but he also started to notice this striking antidepressant effect. He started looking me in the eyes better.

He smiled more. He talked more. I wonder what's gotten into you ? You come alive. You ...I've never heard you talk so much . I've never seen you so excited, present, or alive. I did n't change his medication at all. What turned everything I knew as a psychiatrist upside down was that after 6-8 weeks he spontaneously started reporting, “ You know these voices I hear all the time? "They disappear." And he says, "You know, you know, I always thought there were all these families that were controlling my thoughts and trying to get me, and they targeted me." And I think, "Oh, yeah." We've been talking about this for years.

We can talk about this again." He says, " Now that I think about it, I don't think that's true." And now that I say it, it sounds kind of crazy. Apparently, she never was. I must have had schizophrenia all along, as everyone tried to tell me. And I think it's disappearing." “He has now lost 72 kg and has managed to maintain this weight to this day. Wow. He was able to do things he had n't been able to do since his diagnosis. He was able to complete the certification program.

He can go out in public and not be paranoid. He improvised in front of a live audience. At some point, he was able to move out of his father's house and live on his own. Did he continue to take any antipsychotic or other medications? We slowly but surely tried to gradually wean him off his medication. He has been taking medication for decades. He started taking medication when he was a young child. His brain is developing in response to all sorts of psychiatric drugs. And trying to give them up wasn't easy.

And I just want to tell everyone in the audience that coming off medication is very difficult and dangerous, and it should be done under the supervision of a mental health professional or the doctor who wrote the prescription. To stay in ketosis, what blood ketone level would you like to see in your patients? What range do you think most people have?”...can aspire to? So, honestly, it really depends on the patient and what I'm treating. And I don't think every patient needs a ketogenic diet. For some patients, simply avoiding unhealthy foods can have a significant impact on mood disorders, for example.

So, junk food means highly processed food, food that can last on the shelves for a long time. Highly processed foods, which are usually high in sugar, carbohydrates, fats, and carbohydrates. These seem to be the worst products. This combination, high sugar, high fat, hmm, seems to be the worst combination for metabolic health. And now, we have new data that suggests it's also bad for mental health. So, to give up on this. So, for some patients, I might just want to lower my glucose and insulin levels, and I can do that by cutting out sweets .

For other patients, like patients with schizoaffective disorder, schizophrenia, or bipolar disorder, or especially if it's a chronic condition, if I'm using it as a brain treatment, then I want a ketogenic diet, and I usually want fairly high... ketone levels in the blood . For depression, I want to see at least more than probably 0.8 mmol. For psychotic disorders and bipolar disorder, I usually want to see levels above 1.5. That's what I'm aiming for, if at all possible. I think for many listeners and people who are familiar with how changing your diet or exercise can positively impact sleep, weight, and everything else, and that leads to improved well-being, this makes sense.

But for many in the world, the idea that changing or using nutrition as a tool to analyze or treat mental illness is still heretical. That for them it kind of comes down to normal, well, it's like pseudoscience or something . They immediately think, "Did n't Atkins die of a heart attack?" " You know, I hear that a lot , you know, which I think is like throwing the baby out with the bathwater, but it's still interesting. And then, I think most people sit in the middle and just want to see science and medicine invent treatments that work.

And I have to say, I'm very relieved to hear what you said earlier, which is that you never said that people should stop taking their medication and just go on a ketogenic diet and everything will be cured. You're definitely not saying that. No. Or rather, you're saying, if I understand correctly, that nutrition should be considered one of the main tools in the landscape of effective tools, and that it can be very effective. Let's talk about epilepsy and how the ketogenic diet is not only used to treat epilepsy, but is also one of the oldest, if not the oldest, examples of using nutrition to treat a nervous system condition that can be incredibly debilitating, even fatal.

Yes. The reality is that this literature, this clinical history, and all the research that we have, has been the lifeline that I needed for the work that I..." do . Otherwise, I would have been discredited from day one. The ketogenic diet, which most people don't know about, was actually developed 100 years ago, in 1921, by a doctor with one sole purpose – to treat epilepsy. It was not designed as a weight loss diet. It was not designed as a diet that all people should follow. And the reason for its development is this ancient observation, dating back to the time of Hippocrates, that fasting can stop seizures.

Most people think that fasting is bad, and they equate it with starvation. But in reality, when we starve, it causes huge changes in metabolism, both in the brain and the body. And this puts the body into autophagy mode and resource conservation, and all sorts of things that are beneficial to human health. And that's why fasting has been used as a therapeutic intervention in almost every culture and almost every religion for millennia. But for the most part, all of this was considered religious folklore. In 1921, a doctor used intermittent fasting on a child with seizures and discovered that, oh my, this religious folklore ...there was something to it.

It actually worked . The problem with fasting is that you can only fast for a certain amount of time before you starve to death, and it's not a very effective treatment. Once people start eating normal foods again, their attacks usually return, often with a vengeance. Therefore, this may be a good short-term intervention. Fasting can last for a few days, because it can take a few days to reach ketosis, and then you can get some relief from chronic attacks, but it's not a good long-term treatment because, again, people will starve to death.

As soon as they start eating, the attacks return. So it was Dr. Russell Wilder of the Mayo Clinic who developed the ketogenic diet with one goal in mind. He wanted to see if we could simulate a state of starvation with this special diet to see if it could stop the attacks in the long term. And, miracle of the matter, it worked. Early results have been extremely positive. 50% of patients who used the ketogenic diet became seizure-free, and another 35% had a 50% or greater reduction in seizure frequency.

Therefore, the efficiency level is about 85%. By the 1950s, pharmaceuticals began to appear, and we had many more anticonvulsant treatments. And there is no doubt that they work for many people. This is great. And taking a pill is much easier than following this diet. But, surprisingly, even to this day, about 30% of people with epilepsy do not respond to available treatments. 30% will have treatment-resistant epilepsy, meaning they continue to have seizures no matter how many anticonvulsant medications they take, even if they have had brain surgery.

It just doesn't stop their attacks. And so in the 1970s, the ketogenic diet was revived at Johns Hopkins University for these treatment-resistant cases, and lo and behold , it works. Not for everyone, but it works, and about 1/3 lose their seizures. And these are people who have tried everything, and nothing helps. So, 1/3 loses attacks. Another third experience clinical benefit, meaning a reduction in seizure frequency of 50% or more. And the other third doesn't seem to work. So the reality, the real gift to me, is that we have decades of neuroscience research on the ketogenic diet and its effects on the brain.

We know that the ketogenic diet affects the levels of neurotransmitters, including glutamate, GABA, and adenosine. It changes the regulation of calcium channels and calcium levels, which is very important for cell functioning. It changes gene expression. It reduces brain inflammation. It changes the gut microbiome, and , you know, the gut microbiome is a huge topic right now, and there are some researchers who are saying that this is the main benefit of the ketogenic diet. It changes the gut microbiome in a beneficial way. Um, she does a lot of things.

It apparently improves insulin resistance, lowers glucose levels, lowers insulin levels, which improves insulin signaling. The key to my research that I outlined, the real magic, is that this diet stimulates two processes related to mitochondria. It stimulates a process called mitophagy, which gets rid of old and...defective mitochondria and replaces them with new ones. And it also stimulates a process called mitochondrial biogenesis, which means that after people follow a ketogenic diet for a period of time, months or years, many of their cells in the body and brain will have more mitochondria, and those mitochondria will be healthier.

And I believe that's why the ketogenic diet is such a powerful treatment for not only epilepsy, but also people with chronic mental disorders . But if you're looking for randomized controlled trials documenting efficacy in large numbers of patients with these disorders, we don't have them . They are ongoing now, but we do n't have them yet. Maybe we could just talk about mitochondria for a moment and then talk about these two main effects. What other things are important for mitochondria in neurons and perhaps in other brain cells?

If you imagine a cell as a computer, many people think of mitochondria as the power cord to that computer because they provide the power. And they are actually the power cord to this computer. But in reality, their real function is the motherboard of this computer. So, mitochondria direct and distribute resources throughout...the cell. This is their main function, and they are also powerful neurotransmitters. To give a few clear examples, mitochondria play a direct role in the production, release, and regulation of some really key neurotransmitters, including serotonin, dopamine, glutamate, acetylcholine.

These are quite powerful neurotransmitters. I would call them the ones you listed more than three, but they are kind of the primary colors of neurotransmission. Yes, you know, any of these in excess or deficiency will have a profound negative effect on the nervous system. Mitochondria provide some of the building blocks, if you will, for some of these molecules . They are part of the Krebs citric acid cycle. Some of the intermediates are actually used to create these neurotransmitters. Much more importantly, mitochondria provide the energy for the production of these neurotransmitters.

And interestingly, mitochondria are directly linked to the release of neurotransmitters. ATP alone is not enough. Some studies have been conducted that have actually found that mitochondria move along the synapse membrane, releasing batches of neurotransmitter vesicles. And that if mitochondria are removed from the synapse, and researchers fill that cell with ATP, neurotransmitters are not normally released. Mitochondria do other things. We don't even fully understand what they do or how they do it, but they do other things than just provide energy . Mitochondria play at least a role in all aspects of the human stress response.

So when people are under physical or psychological stress, several things happen: increased cortisol levels, increased adrenaline, noradrenaline, inflammation, and gene expression, particularly in the hippocampus, that goes along with the stress response. And one group of researchers actually genetically modified mitochondria in four different ways and found that all four of these categories of stress response were impaired in one way or another , which means that mitochondria somehow play a role in them . Regarding their role in cortisol, we know that mitochondria actually have an enzyme needed to synthesize steroid hormones.

So, this includes cortisol, estrogen, testosterone, and progesterone, some names that everyone may have heard of. So, this means that if mitochondria... If they are deficient or dysfunctional, the production of these hormones can be disrupted. Mitochondria play a direct role in inflammation, and they both turn the inflammatory system on and off. One article in the journal Cell identified mitochondria as a key regulator in turning off certain inflammatory cells. And when you inhibit mitochondrial function, these cells don't shut down, which is that mitochondrial levels of reactive oxygen species are a key signaling process for turning off the inflammatory process of cells.

Another study showed that macrophages, or macrophages, are important immune cells that play a role in healing. So if you cut yourself, your body will, you know, direct inflammation in that direction, and, uh, direct immune cells in that direction to try to heal your skin. And macrophages play an important role in this healing. One group of researchers tried to figure out how macrophages know to switch between different phases of wound healing? Because macrophages do different things in different phases of wound healing. And the conclusion of all their research was that it's the mitochondria that send the important signals that change the state of the macrophages to trigger...these different phases of wound healing.

So, I just talked about neurotransmitters, hormones, epigenetic expression, inflammation. Anyone familiar with the mental health field knows that these are some of the key variables that researchers have been trying to figure out for decades to figure out how they fit together. We know that all of these “ buckets” can be disrupted in people with mental disorders , and our field is trying to understand, but how do they fit together? How can we understand this violation? I believe that once you understand the science of mitochondria, you can connect all the dots of the mental illness puzzle.

What I'm hearing is that mitochondria, in addition to being important sources of energy production and generation in cells, which of course they are, um, probably have other roles, and that maybe someday what we call mitochondria will actually be two or three different little subcellular organelles. In the field of science education, people often think, " Okay, energy production." “There will be a picture or cartoon about mitochondria straining their muscles . People say, "Okay , energy, mitochondria, mighty mitochondria." “And then they’ll think, ‘Oh, you know, they’re just kind of a dumb sports camera part, right?

They don't do anything fancy." " And all you've listed is that they perform a lot of complex, intricate actions in cells." So now that, um, everyone knows very well that mitochondria perform a lot of very important actions in a very regulated way. Let's talk about mitophagy, which I have to assume is, ahem, the intentional or not ingestion of mitochondria, presumably to replace them with new, healthier mitochondria. Is that so ? Yes. So, and, and in many ways, mitophagy is a subset of autophagy, but it has its own name because it's specific to mitochondria.

There appear to be some unique regulators of mitophagy compared to autophagy in the broader sense. Mitochondria actually play a role in autophagy itself. Hmm, and that makes sense because one of the... So the global picture of autophagy is stimulated by starvation or starvation- mimicking conditions . So when your body senses that you're not getting enough food, it actually goes into hiding and starts recycling the dead old parts in this carefully orchestrated way and takes them to the lysosomes, they degrade, and then these breakdown products... are used either for energy or to build new things.

Autophagy always happens, ahem, at a low level, but you can really stimulate this process through fasting, calorie restriction, fasting-mimicking diets, and other things. And that's why fasting and fasting, you know, calorie restriction, are such hot topics in the medical field right now, because they've been shown to promote longevity, and we think that through this process, you're encouraging the body to become lean and conservative in its allocation of resources. And the body doesn't just destroy the healthiest tissues along with old dead material. It has these processes that identify old and defective parts first, and they disappear first.

And that's what's beautiful about this whole thing, and that's why fasting is so important. So mitophagy, as we know, plays a very important role, because there's a term called " mitochondrial dysfunction," which some researchers actually want to get rid of and move away from, because, as you just said, mitochondria do so many different things, and different mitochondria even in the same cell may well be... specialized for different tasks. And mitochondria from one cell to another sometimes perform very different actions. For example, not all mitochondria can produce cortisol.

This is specific to the particular cells where these genes are activated. So not all mitochondria produce cortisol. For example, only those in your adrenal glands produce cortisol. And it's been known for a long time, for decades, that mitochondrial dysfunction is linked to everything that bothers us, essentially. So David Sinclair published an article in one of the cell journals, I think, where he said, "Oh, mitochondria are actually the unifying link of everything we know about aging. Defective mitochondria or defective mitochondrial function, mitochondrial dysfunction, is perhaps the unifying cause of aging and all disorders associated with aging.

So mitophagy tries to solve all of this. Trying to say, “Okay, that’s bad. We don't want defective mitochondria. And how can we get rid of the old or defective ones and replace them with new ones? »“And I think the most powerful signal and tool that we have right now is actually related to diet. This is calorie restriction. This is the oldest, most proven, best-tested way to prevent aging in a wide range of animal species. Fasting and intermittent fasting. And again , you can only do this for a certain amount of time, and then fasting-mimicking diets , um, can also stimulate this process of mitophagy.

So, what about the typical person who is an omnivore, who eats, um , some rice, some pasta. Do you think these people would feel much better, or even a little better, if they had lower glucose levels? I ask this because I think there are a lot of people who suffer from full-blown depression, but there are also a lot of people who suffer from moodiness and not-so- good feelings, subclinical depression. Yes, I would call it burnout. Yeah, and just the feeling that some days are great and then other days they feel terrible for reasons they don't understand.

I'm kind of expanding on this field, and I'm probably too boring right now , but..." I kind of divide this field into the cause, what is the real root cause, and what treatments are effective. And I really view them as two separate things. Calorie restriction, ketogenic diet, carbohydrate restriction cause metabolic changes in the brain and body. And regardless of what a person ate, they cause metabolic changes that can be very beneficial for brain health. So, moving on to your broader question about modern adults, if this is the average person who is not currently under psychiatric care, not taking prescription medication, but says, “I’m exhausted.

I am exhausted. I want some of that brain power that Andrew Huberman talks about.” "I...he talks about feeling good." I want some of this. I would probably actually recommend..." Let's see if we can just limit carbs for a while. “Hmm, and let’s see if it has clinical benefit. I have one ... He's not even a patient, just someone who read my book. I had chronic anxiety, tried meditation, tried all sorts of things. He was ready to switch to prescription medication. He read an early copy of the book.

He himself, without consulting me, took it upon himself to limit only carbohydrates. He did not switch to a ketogenic diet. He is a vegetarian. He restricted carbohydrates. Within 3 weeks he said, “I don’t need prescription drugs . I can't believe how much better I feel." And all I did was eliminate some high-carb foods from my diet. So, I think for some people it might be that simple. For people with serious mental health conditions , if they're chronically depressed, if they're on a lot of prescription medications, if they're disabled because of their symptoms, and certainly if you have bipolar disorder or schizophrenia or something like that , those are the people I really want to work with a healthcare professional because the medications may need to be adjusted; they really need…They need a real try at this diet.

"It's not the same as losing weight." Losing weight is something everyone does. Either you are successful or you are not. You search the internet or read a book and see if it works or not. But if you're using this to treat a serious disorder, I think you need serious help. On behalf of myself and on behalf of the listeners, and of course on behalf of everyone, because everyone should be concerned about mental health issues, whether they are in their family or not, because they affect everyone.

So I really want to thank you for your work. You've given us a lot of hints about the underlying mechanisms that indicate why this should work , and you've given us examples of how it's worked in patients you've worked with. So thank you for your courage, for taking on this, for doing it in such a structured way, and for bringing it here today and to the wider public through your book and your online presence. We will be sure to point people in the direction of these valuable resources.

Thank you very much. We really appreciate it. Thank you, Andriy, for your courage and inviting me to your show, as well as for the wonderful conversation.

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