Speaker 1: People who suffer from adverse childhood experiences are more vulnerable
Speaker 1: to develop all of those brain disorders.
Speaker 2: Welcome to the one you feed throughout time. Great thinkers
Speaker 2: have recognized the importance of the thoughts we have. Quotes
Speaker 2: like garbage in, garbage out, or you are what you
Speaker 2: think ring true, and yet for many of us, our
Speaker 2: thoughts don't strengthen or empower us. We tend toward negativity,
Speaker 2: self pity, jealousy, or fear. We see what we don't
Speaker 2: have instead of what we do. We think things that
Speaker 2: hold us back and dampen our spirit. But it's not
Speaker 2: just about thinking. Our actions matter. It takes conscious, consistent,
Speaker 2: and creative effort to make a life worth living. This
Speaker 2: podcast is about how other people keep themselves moving in
Speaker 2: the right direction, how they feed their good wolf. Thanks
Speaker 2: for joining us. Our guest on this episode is doctor
Speaker 2: Christopher Palmer, an Assistant Professor of Psychiatry at Harvard Medical
Speaker 2: School and the director of the Department of Postgraduate and
Speaker 2: Continuing Education at McLean Hospital. For the past twenty five years,
Speaker 2: he's been an academic physician with administrative, research, educational, and
Speaker 2: clinical roles. Today, Chris and Eric discuss his book brain Energy,
Speaker 2: a Revolutionary Breakthrough in understanding mental health and Improving treatment
Speaker 2: for anxiety depression OCD, PTSD and more.
Speaker 3: Hi Chris, welcome to the show.
Speaker 1: Thank you Eric for having me on.
Speaker 3: I'm excited to talk with you. You wrote a book called
Speaker 3: Brain Energy, A Revolutionary breakthrough and Understanding Mental health and
Speaker 3: Improving treatment for anxiety depression, OCDPSD and more. And there
Speaker 3: is so much in this book and we're going to
Speaker 3: get to as much of it as we can cover,
Speaker 3: but will start like we always do, with a parable.
Speaker 3: In the parable, there's a grandparent who's talking with their
Speaker 3: grandchild and they say, in life, there are two wolves
Speaker 3: inside of us that are always a battle. One is
Speaker 3: a good wolf, which represents things like kindness and bravery
Speaker 3: and love, and the other's a bad wolf, which represents
Speaker 3: things like greed and hatred and fear. And the grandchild
Speaker 3: stops and thinks about it for a second, looks up
Speaker 3: at their grandparents, says, well, which one wins, and the
Speaker 3: grandparent says, the one you feed. So I'd like to
Speaker 3: start off by asking you what that parable means to
Speaker 3: you in your life and in the work that you do.
Speaker 1: You know, it's interesting because I've been giving some thought
Speaker 1: to this, knowing that you were going to ask me
Speaker 1: that question, because you ask everyone that question. And as
Speaker 1: a psychiatrist, I work with a lot of people who
Speaker 1: are filled with fear. I work with a lot of
Speaker 1: people who have some hatred. I work with people who
Speaker 1: others might not call greedy, but they might call them
Speaker 1: self centered, which kind of starts to go along with
Speaker 1: something that people might call greed. And so as a clinician,
Speaker 1: I'm always trying to understand the gray. I'm trying to
Speaker 1: understand instead of seeing it as black or white, good
Speaker 1: or bad wolf, I'm trying to understand, well, what purposes
Speaker 1: do those different wolves serve? And because if we can
Speaker 1: understand what purposes they serve, maybe we can help people
Speaker 1: make better choices and not give in to their instincts.
Speaker 1: And so, to me, the bad wolf represents at the
Speaker 1: end of the day's survival, but it represents solitary survival.
Speaker 1: I imagine a wolf that has been traumatized, beaten, abandoned
Speaker 1: by the tribe, by the pack, by whatever, and it
Speaker 1: has made the decision to look out for itself and
Speaker 1: only itself. It is filled with fear, it is filled
Speaker 1: with hatred of others who've hurt it and greed to
Speaker 1: just whatevermulate to survive, just accumulate it. And the good
Speaker 1: wolf is a wolf that's connected to the others, that's
Speaker 1: connected to the pack, that's connected to the world, and
Speaker 1: that is actually in a position to be able to
Speaker 1: look out for other wolves or other people. And so
Speaker 1: when I think about that, I often do come across
Speaker 1: people and I share kind of that perspective with them
Speaker 1: that you're in survival mode right now, and so of
Speaker 1: course you're fearful. Of course you might not trust other
Speaker 1: people and you might even hate them, and that survival
Speaker 1: mode is serving a useful purpose that's helping you survive,
Speaker 1: but you're not going to really fully thrive. You're not
Speaker 1: going to flourish until we can get you beyond survival
Speaker 1: mode and into you know, a mode of reaching out
Speaker 1: to others, sharing yourself, sharing your talent, sharing your strength
Speaker 1: with others, building people up, being useful to them, because
Speaker 1: at the end of the day, that's actually the most
Speaker 1: adaptive survival strategy is to not say solitary, to not
Speaker 1: only look out for yourself, but to look out for others,
Speaker 1: because when you love others, you get often oftentimes not always,
Speaker 1: but oftentimes you get love and return and those other
Speaker 1: people are then going to be available to look out
Speaker 1: for you when you're down and out and you need it.
Speaker 1: And so I like to think about the nuance and
Speaker 1: all of that, but I'll stop there.
Speaker 3: Yeah, yeah, well, nuance is really critical to understanding I
Speaker 3: think anything. Which it's funny that I have a parable
Speaker 3: on one hand that sounds so black and white, and
Speaker 3: I am absolutely a middle way, nuanced kind of thinker.
Speaker 3: So it is interesting. As you were talking, it made
Speaker 3: me think about something I hadn't thought about in a while.
Speaker 3: But it's the idea. We use that phrase lone wolf, right,
Speaker 3: and we say it oftentimes in a good way, But
Speaker 3: a lone wolf is a wolf that there's something really
Speaker 3: wrong with. Because wolves are supposed to be im pacts.
Speaker 3: If you come across one, it's all by itself. Something
Speaker 3: has gone wrong. Yes, you know something has gone wrong
Speaker 3: in that wolve's life. You know it might be sick,
Speaker 3: it might be any number of different things. Before we
Speaker 3: get into your core theory about what is underlying really
Speaker 3: all mental illness. I was wondering if you could just
Speaker 3: spend a couple minutes. The relatively short version of your
Speaker 3: story primarily around your mother, because the book is dedicated
Speaker 3: to her. It's, you know, basically saying, I wish that
Speaker 3: we had been better able to help you, you know,
Speaker 3: when you were struggling, and so I think that drives
Speaker 3: a lot of the energy that goes into your work.
Speaker 3: Can you share a little bit about that.
Speaker 1: Yeah, you know a lot of people have asked me
Speaker 1: over the years, why are you a psychiatrist? And I
Speaker 1: have my own deeply personal experience with mental illness. You know,
Speaker 1: I've had my own depression, suicidality. I had OCD when
Speaker 1: I was a kid. I was in years of therapy
Speaker 1: and took medications and all sorts of other stuff, and
Speaker 1: all of that has helped me be a better psychiatrist.
Speaker 1: But in fact, the real reason I'm a psychiatrist is
Speaker 1: because of my mother, And not in a blame way,
Speaker 1: not in a she was a bad mother and messed
Speaker 1: me up aschiatrist. But it's because due to circumstances that
Speaker 1: were largely beyond her control, but horrible things that happened
Speaker 1: in her family, some horrible things that possibly happened to
Speaker 1: her by a priest that she trusted and went to
Speaker 1: for counseling. She developed a psychotic episode. And she had
Speaker 1: been relatively quote unquote normal prior to that. She was
Speaker 1: living a normal, middle class life, but became severely depressed
Speaker 1: in response to all this stress, and then developed psychosis,
Speaker 1: and she began to believe that she was Mary Magdalene reincarnated,
Speaker 1: that the world was ending, that my father was the devil,
Speaker 1: all sorts of delusional thinking, and that ended up persistent
Speaker 1: for the rest of her life, and I desperately wanted
Speaker 1: to save her. I was young at that point in time.
Speaker 1: I was twelve thirteen years old, and I went to
Speaker 1: live with her for a short period of time. We
Speaker 1: were actually homeless together, and her life, for all intents
Speaker 1: and purposes, was decimated by it. And I was actually
Speaker 1: furious with the mental health field. I was furious at
Speaker 1: their incompetence. She went to the mental health professionals, she
Speaker 1: was hospitalized, she took their pills, she did their therapy,
Speaker 1: and it didn't do anything for her. And I was
Speaker 1: initially just actually in disbelief, like, how can these people
Speaker 1: be so incompetent. There's something wrong with my mom. Why
Speaker 1: aren't they helping her?
Speaker 3: Right?
Speaker 1: And then it just went to anger. And at the
Speaker 1: end of the day, that's why I'm a psychiatrist, because
Speaker 1: I know how much mental health problems and challenges can
Speaker 1: cause suffering. I know how they can ruin people's lives,
Speaker 1: and I know they're real. And I not one of
Speaker 1: those people who's in denial about it. Even though I
Speaker 1: was angry at the mental health field, I wasn't silly
Speaker 1: enough to start denying that mental health problems are even real, right,
Speaker 1: But I wanted to do something. I wanted to make
Speaker 1: a difference.
Speaker 3: Well, thank you for sharing that. And I think we're
Speaker 3: going to come back, perhaps to your mother and look
Speaker 3: at her story through the lens of the theory that
Speaker 3: we're about to unpack. But before we get into this
Speaker 3: idea that mental illnesses all share a common pathway, we
Speaker 3: probably need to start by talking about what is a
Speaker 3: mental illness. So you know, even this is very difficult
Speaker 3: for anybody to come up with definitions, but you've got
Speaker 3: a couple fairly concise definitions that you use in the
Speaker 3: book to kind of sum up what we're talking about
Speaker 3: when we talk about mental illness.
Speaker 1: I do you know, I didn't use this analogy in
Speaker 1: the book. But one way, just in terms of talking
Speaker 1: broadly I think that can be really helpful for people
Speaker 1: is to talk about three different categories of things that
Speaker 1: often get called mental illness or mental health challenges or
Speaker 1: mental symptoms that often get confused with each other, but
Speaker 1: they are very different things in my mind. So one
Speaker 1: is normal depression, anxiety, and other thoughts and behaviors. So
Speaker 1: everybody has those. Everybody gets depressed, everybody gets anxious, and actually,
Speaker 1: if you don't, there's probably something really wrong with you.
Speaker 1: So when people have stressful exams, or when you get
Speaker 1: dumped by your boyfriend or girlfriend that you were really
Speaker 1: in love with, you're going to get depressed, you're going
Speaker 1: to get anxious, you're going to have other symptoms. In
Speaker 1: my mind, those are not a mental illness. Those are
Speaker 1: reflections of normal human suffering, normal human adaptations. It doesn't
Speaker 1: mean that people don't need help, doesn't mean that people
Speaker 1: don't deserve help, or they don't deserve therapy, or insurance
Speaker 1: shouldn't pay for therapy. I'm not saying that at all. Yes,
Speaker 1: psychotherapy can help those people. If you get dumped by
Speaker 1: the love of your life and you're really depressed, you
Speaker 1: deserve help. You deserve compassion, but I don't think you
Speaker 1: have a brain disorder. The second category are people who
Speaker 1: are exposed to extreme forms of threat, trauma, or stress.
Speaker 1: So soldiers on a battlefield, a woman being beaten up
Speaker 1: and beaten up repetitively by her abusive husband. Those people's
Speaker 1: lives are being threatened, and so they will have extreme symptoms.
Speaker 1: They will have extreme versions of post traumatic stress symptoms,
Speaker 1: or they will have extreme depression, extreme anxiety. They won't
Speaker 1: be sleeping well at night, all of those things. And
Speaker 1: I again would say those, at least at the outset,
Speaker 1: are not necessarily brain disorders. Those are normal reactions to
Speaker 1: horrific circumstances. People are going into survival mode for good reason.
Speaker 1: Their body's trying to protect them. They shouldn't be sleeping
Speaker 1: through the night. Again, those people need help, But I
Speaker 1: don't want to call those brain disorders. And yet I
Speaker 1: think there's a third category of brain disorders that I
Speaker 1: would call mental illness, in which people's brains are malfunctioning.
Speaker 1: People are having anxiety symptoms for no good reason at all.
Speaker 1: They can be sitting in the comfort of their home
Speaker 1: and out of the blue get an anxiety attack. Or
Speaker 1: they can just be preoccupied with anxious thoughts and ruminations
Speaker 1: and not be able to stop them. Or they can
Speaker 1: be overwhelmed with unrelenting depression for no good reason. When
Speaker 1: they look objectively at their life, they think to themselves,
Speaker 1: I have a good life, I should be happy, but
Speaker 1: I'm not. What's wrong with me? And it can be
Speaker 1: more extreme, like with my mother. People can start having
Speaker 1: hallucinations or delusions or other things that are clearly not
Speaker 1: quote unquote normal, and I believe all of those represent
Speaker 1: the brain malfunctioning. You know. In the book Brain Energy,
Speaker 1: I'm primarily focused on brain disorders or what I would
Speaker 1: call mental illnesses, which is that third category, people who
Speaker 1: are having experiences that are not normal, that their brains
Speaker 1: are doing things that they should not be doing. They're
Speaker 1: not serving a useful purpose anymore, They're just causing suffering.
Speaker 3: You make a really great an analogy in the book
Speaker 3: to these sort of three categories. You talk about three
Speaker 3: types of cars. I think that'll put this in a
Speaker 3: really good context if you could just maybe share that real.
Speaker 1: Quick absolutely so, to make it really simple, I describe
Speaker 1: three cars. Car A is a car that lives in
Speaker 1: Los Angeles, let's say Sunny Skies. It's housed in a garage,
Speaker 1: only gets driven a couple times a week, gets regular maintenance,
Speaker 1: living a pampered car life, and that car is basically
Speaker 1: living a good life. Car B is a car that
Speaker 1: lives in the mountains in New Hampshire and is not
Speaker 1: housed in a garage, gets driven all the time, gets
Speaker 1: driven through blizzards, all sorts of things, and it has
Speaker 1: to use its windshield wipers and blinkers and mountain gear
Speaker 1: and all sorts of adaptations to deal with the adverse
Speaker 1: weather it is facing. And what I'm arguing is that
Speaker 1: in this simplistic way, things like windshield wipers and headlights
Speaker 1: and mountain gear represent things like depression or anxiety, and
Speaker 1: if there's a good reason for them to be occurring,
Speaker 1: there going to take a toll on that car. They
Speaker 1: are absolutely going to affect the lifespan of that car.
Speaker 1: But they are not disorders. That car is not dysfunctional
Speaker 1: for using its headlights and windshield wipers and everything else
Speaker 1: in a blizzard. It's doing exactly what it should be doing.
Speaker 1: And the analogy for a quote unquote mentally ill car
Speaker 1: would be a car that's driving down the highway in
Speaker 1: sunny weather with its windshield wipers on, and it's going
Speaker 1: really slow, and it's putting on the brakes all the time,
Speaker 1: maybe honking his horn for no reason at all. It's
Speaker 1: doing those things for no reason at all, and most
Speaker 1: people would look at the driver of that car and
Speaker 1: think there's something wrong with his driver, like what is
Speaker 1: he or she doing? Like why are they doing that?
Speaker 1: There's something wrong with them. That represents a car using
Speaker 1: adaptations that all serve a useful purpose, but they're being
Speaker 1: used at the wrong time or under the wrong circumstances,
Speaker 1: so they don't make sense anymore. And I think that
Speaker 1: analogy for a lot of people really helps people kind
Speaker 1: of understand, like windshield wipers have a time and a place,
Speaker 1: just like depression has a time and a place, and
Speaker 1: if it's occurring for a good reason, we all get it.
Speaker 1: If it's occurring for no reason at all, it's probably
Speaker 1: a problem.
Speaker 3: Yeah. I think that's a great analogy, And I think
Speaker 3: your three categories are really helpful. I think what gets
Speaker 3: tricky and the nuance starts to be that these cars
Speaker 3: can move from one category the next.
Speaker 2: Right.
Speaker 3: You could be in California, for a while and everything's
Speaker 3: going really sunny, and then all of a sudden, you
Speaker 3: could have the sort of weather they've had in California lately,
Speaker 3: and all of a sudden start to develop some symptoms
Speaker 3: that may or may not go away once the weather passes. Right,
Speaker 3: And that car that's being really run down in New Hampshire,
Speaker 3: maybe it moves now to California, but it's still been
Speaker 3: worn down by its previous conditions. And so I think
Speaker 3: what gets challenging, and you talk about this in the
Speaker 3: book is starting to talk about frequency durability, like how
Speaker 3: long is something lasting? You know, because we could look
Speaker 3: at somebody their depression makes total sense for a period
Speaker 3: of time. I know a lot of people that this
Speaker 3: seems to be the case, where there's an acute event,
Speaker 3: the depression makes sense, but then it never leaves, you know,
Speaker 3: it never really really goes away. And I know we
Speaker 3: haven't gotten to the idea underneath your theory, and your
Speaker 3: theory basically is that these mental illnesses are metabolic issues.
Speaker 3: And we're going to talk about what all that means.
Speaker 3: But I have a quick question, which is in those
Speaker 3: three categories that you're talking about, do you think that
Speaker 3: only number three is a metabolic issue.
Speaker 1: No, So I think that the adaptations that we use
Speaker 1: are also directly related to metabolism. So why easy way
Speaker 1: to think about metabolism in the car analogy is to
Speaker 1: think about gas mileage. How fast can a cargo and
Speaker 1: how many miles per gallon is it getting? And that's
Speaker 1: one of the reasons I love that analogy is that
Speaker 1: the second car that I described, the one that's going
Speaker 1: through blizzards all the time, is actually getting really awful
Speaker 1: gas mileage right right because it's having to use so
Speaker 1: much energy and resources to navigate its difficult environment. It
Speaker 1: takes extra gas. It's less fuel efficient to go really
Speaker 1: slow in a blizzard, to put on the brakes all
Speaker 1: the time, to make sure you're not getting out of control,
Speaker 1: to use the windshield wipers and the heat on max setting,
Speaker 1: and to use mountain gear, all of those things, all
Speaker 1: of those things are actually taking a metabolic toll. And likewise,
Speaker 1: in human beings who are stressed, so soldiers on a
Speaker 1: battlefield or people who have a lot of childhood adversity
Speaker 1: and trauma, all of those people are you know, again
Speaker 1: having extreme stress reactions that are not disorders. They are
Speaker 1: occurring to try to help those people survive, but in
Speaker 1: fact they cost something. They require metabolic resources in order
Speaker 1: to be activated and maintained. And the use of those
Speaker 1: metabolic resources, just like the use of all of those
Speaker 1: you know, windshield wipers and brakes and everything else on
Speaker 1: a car and a blizzard, you have to pay a
Speaker 1: price for that, And those people are paying a price,
Speaker 1: and the price that they pay makes it more likely
Speaker 1: that their brain might malfunction in the future if the
Speaker 1: adversity is extreme enough, if it occurs over a prolonged
Speaker 1: period of time, it will wear down the human body
Speaker 1: and brain, and the human body and brain can begin
Speaker 1: to malfunction. And once it begins to malfunction, then I
Speaker 1: would call it a disorder, and I would say that
Speaker 1: we need to understand, well, what is causing this disorder,
Speaker 1: what is causing these cells or these parts of the
Speaker 1: body or brain to malfunction, and how can we help
Speaker 1: people heal. You know, So some people might think, well,
Speaker 1: what does it matter? Why are you talking about this? Like,
Speaker 1: what does it matter whether somebody's having trauma symptoms in
Speaker 1: response to horrific trauma or whether they're having trauma symptoms
Speaker 1: ten years later, for no reason if the symptom is
Speaker 1: the same, and the reason I think it's so critically
Speaker 1: important because the treatments absolutely matter. The treatment for the
Speaker 1: soldier on a battlefield is to actually ideally get that
Speaker 1: soldier off that battlefield. That soldier's life is in danger.
Speaker 1: And obviously we can't end all wars. I wish we
Speaker 1: were at a point where we could say where I
Speaker 1: could be that utopian, but that soldier is going to
Speaker 1: be having stress reactions, in survival reactions, and there's no
Speaker 1: way around it. The solution is to not have that
Speaker 1: soldier's life be in danger and threatened.
Speaker 3: And it's not to give them drugs that might make
Speaker 3: him not so anxious, because he needs to be anxious
Speaker 3: in that situation because he's in danger.
Speaker 1: Yes, he does not have a chemical imbalance that we
Speaker 1: need to be prescribing pills for. That is unequivocally clear
Speaker 1: in my mind. And yet right now the mental health
Speaker 1: field actually doesn't distinguish that. The mental health field says, well,
Speaker 1: let's check off the box for PTSD and if he's
Speaker 1: got enough PTSD symptoms and he's got a brain disorder
Speaker 1: called PTSD, and we should be prescribing zoloft to him,
Speaker 1: or we should be prescribing sleeping pills because he's not sleeping, right,
Speaker 1: And I think that is very shortsighted and actually quite
Speaker 1: silly and naive if you really think about it. And yet,
Speaker 1: if that soldier ends up developing a brain disorder twenty
Speaker 1: years down the line, I think understanding the physiology of
Speaker 1: why is he still having trauma symptoms twenty years later
Speaker 1: when they should be gone by now in the majority
Speaker 1: of people they go away. Why are they persisting in him?
Speaker 1: And how can we get them to turn off? I
Speaker 1: think if we understand the physiology of what's causing those symptoms,
Speaker 1: it gives us entirely new ways to not only understand
Speaker 1: his symptoms, but also treat his symptoms. And so with
Speaker 1: that person, I'll give you a shocking possibility. We might
Speaker 1: change his diet to try to control his brain symptoms,
Speaker 1: or we might use other treatment strategies to try to
Speaker 1: control his brain symptoms. And we might use medications or
Speaker 1: psychotherapy and all of the standard treatments as well, but
Speaker 1: all of those could conceivably play a role and helping
Speaker 1: him reduce his symptoms and live a better life.
Speaker 3: Right, And I think this is the right point to
Speaker 3: put in what anybody talking about this disclaimers would put in,
Speaker 3: which is like, we are not saying all psychiatric medicine
Speaker 3: is bad. We are not saying that you know, mental
Speaker 3: health treatment is all bad. We're not saying stop what
Speaker 3: you're doing. None of this is indicating that that is
Speaker 3: the recommendation. What we're pointing to is that there may
Speaker 3: be more here going on, or other ways to treat
Speaker 3: beyond what we currently do.
Speaker 1: Absolutely so, for people who are using psychotherapy or medications,
Speaker 1: or even electroconvulsive therapy or transcranial magnetic stimulation or ketamine
Speaker 1: or psychedelics. If you got yourself into a psychedelic study,
Speaker 1: if those things are working for you and you are
Speaker 1: all the way better, that's phenomenal. Congratulations, Hats off to
Speaker 1: you and your treaters for figuring it out and you've
Speaker 1: got a solution. The tragic reality is that for the
Speaker 1: majority of people getting mental health treatment, those solutions aren't
Speaker 1: working all the way. They're not helping people fully heal
Speaker 1: and recover. And so, like you said, I want to
Speaker 1: offer additional options. It's not that I'm trying to take
Speaker 1: away those options. I want to augment those options. In
Speaker 1: some cases replace those options with ones that might be
Speaker 1: more effective for individual people. If people can understand the
Speaker 1: science of what's happening in the brain and what's causing
Speaker 1: the brain to malfunction, we can come up with entirely
Speaker 1: new ways to treat these disorders. And I really believe
Speaker 1: we can help a lot of people heal and recover.
Speaker 3: So up till now, you're putting forth a theory that
Speaker 3: I promise we're going to talk about. It keeps saying
Speaker 3: that we actually are, We're almost there. That says that
Speaker 3: here's an idea about what a common pathway underline mental
Speaker 3: illness is. And we really don't know, right, I mean,
Speaker 3: you're proposing your answer, but outside of that, we don't
Speaker 3: know what is causing mental illness. There's different theories. There's
Speaker 3: the whole like, well, it's a chemical imbalance, and that's
Speaker 3: been you know, sort of debunked in a number of places. Right,
Speaker 3: we're doing the well, if we give them something that
Speaker 3: affects serotonin and it helps, then we must assume that
Speaker 3: serotonin is the problem and they have a serotonin deficiency,
Speaker 3: which we know not to be the case. So we
Speaker 3: don't have good answers till now, and I want to
Speaker 3: talk a little bit about what lots of people have
Speaker 3: started to notice, and you lay out very clearly, which
Speaker 3: is two things that seem to be very common among
Speaker 3: people who have mental illness, and that is the idea
Speaker 3: of heterody. Say that word for me, heterogeneity, thank you.
Speaker 3: I don't know why I stumble over that word, and comorbidity.
Speaker 3: Describe what those are, because I think it's an important
Speaker 3: piece of understanding what's going on here.
Speaker 1: It is so on the surface, you know, our DSM
Speaker 1: diagnoses make sense. So you know, in the mental health field,
Speaker 1: we have all these diagnostic labels schizophrenia, bipolar, depression, OCD, anorexia,
Speaker 1: alcohol use disorder, which is really what most people would
Speaker 1: call alcoholism. So we've got those different labels yep, And
Speaker 1: on the surface they all make sense. Everybody kind of
Speaker 1: probably has a good idea of what I mean by
Speaker 1: those things when I just say those words depression and alcoholism,
Speaker 1: those are totally different. OCD and anorexia, those are totally different.
Speaker 1: Schizophrenia is different from bipolar. But when you actually start
Speaker 1: to look at real people, the distinctions actually become quite
Speaker 1: blur rapidly. So for people getting mental health treatment. One
Speaker 1: study found that on average, people getting mental health treatment
Speaker 1: have three and a half diagnoses. So the alcoholic who's
Speaker 1: trying to deal with their alcoholism, oh gosh, also has depression,
Speaker 1: also has an anxiety disorder and every now and then
Speaker 1: thinks he might hear voices and they're not really even
Speaker 1: sure what to label that. Does that make them bipolar?
Speaker 1: Does that make them schizophrenic?
Speaker 3: And probably has ADHD to boot, Oh, he's got ADHD,
Speaker 3: of course, yep.
Speaker 1: So now we're talking about, Wow, he's got four or
Speaker 1: five independent brain disorders. What a really unlucky, unfortunate individual
Speaker 1: to have developed four completely separate, totally different brain disorders
Speaker 1: all at the same time. Are around the same time. Huh.
Speaker 1: But when we look at all patients that wait for
Speaker 1: all of them, the anorexic patients are also struggling with
Speaker 1: depression and OCD and other symptoms. The schizophrenic patients are
Speaker 1: also struggling with anxiety and depression and substance use disorders
Speaker 1: and other problems. And so you can end up mixing
Speaker 1: and matching any way you want. And then the heterogeneity
Speaker 1: issue is that although those labels sound good, you can
Speaker 1: take two people with any one of those labels. You
Speaker 1: can take two people with depression and they can have
Speaker 1: wildly different symptoms from each other. One person may not
Speaker 1: be able to sleep at all or very little, and
Speaker 1: might have lost their appetite and they're losing a tremendous
Speaker 1: amount of weight and they're thinking about suicide a lot.
Speaker 1: And the other person can be very different. They can
Speaker 1: actually be sleeping all the time, eating way too much,
Speaker 1: not at all considering suicide. And you know, so the
Speaker 1: symptoms can be wildly different from each other, and yet
Speaker 1: we call it the same disorder. We label it the
Speaker 1: same disorder, and so that gets confusing. Here's the big shocker,
Speaker 1: the big shocking news that researchers have been working on
Speaker 1: for decades, because trust me, researchers have been trying to
Speaker 1: figure this out for a long long time. How do
Speaker 1: all these different labels and diagnoses differ from each other?
Speaker 1: Where are the similarities? Where are the differences? How can
Speaker 1: we better understand these? The shocking news is that there
Speaker 1: appears to be one common pathway to all mental disorders.
Speaker 1: And this is not my independent research. I am simply
Speaker 1: citing other researchers who've worked on this, and so We've
Speaker 1: got decades of research sequentially clustering more and more diagnostic
Speaker 1: categories together and finding that when they looked at even
Speaker 1: the risk factors for mental disorders down to specific genes,
Speaker 1: even you know a lot of people here, Well, these
Speaker 1: things are genetic. They run in the family. Bipolar disorder,
Speaker 1: it runs in your family. So if your parent has
Speaker 1: bipolar disorder and you get bipolar disorder, you must have
Speaker 1: inherited their bipolar gene. Well, it turns out there is
Speaker 1: not a bipolar gene. There are genes that increase your
Speaker 1: risk for bipolar disorder, but at the same time they
Speaker 1: also increase your risk for OCD and depression and epilepsy
Speaker 1: and ADHD and learning disorders and lots of other disorders.
Speaker 1: And so they're even one specific concrete gene does not
Speaker 1: confer risk for any one disorder. Instead, they all confer
Speaker 1: risk for a wide variety of disorders, and so you
Speaker 1: can mix and match even specific genes that run in families.
Speaker 1: And these researchers have concluded that there appears to be
Speaker 1: one common pathway that some people have called the P factor,
Speaker 1: that is involved in all mental illness. And at the
Speaker 1: end of the day, what I'm arguing is that that
Speaker 1: P factor, finally, I believe, can be known and it's
Speaker 1: something that we would call metabolism, or more specifically mitochondria.
Speaker 3: You talk about the P factor, which is sort of
Speaker 3: what you said, this is not a cutting edge idea, right,
Speaker 3: that there may be a common pathway here, right, And
Speaker 3: what the researchers found is looking at this lots of
Speaker 3: different ways, it does appear there's a common pathway. It's
Speaker 3: just that that common pathway is not apparent from the
Speaker 3: research that was done. What we can see is all
Speaker 3: the overlaps that you're talking about, all the different types
Speaker 3: of things here. And I think that point of you know,
Speaker 3: wouldn't it be wild if you really had gotten all
Speaker 3: five of these different disorders like that, that would be
Speaker 3: very unlucky and very unfortunate and very unlikely that that
Speaker 3: would be the distribution if there wasn't some relation. So
Speaker 3: your theory is that this is metabolic. So I think
Speaker 3: we're going to need to now define what metabolic means
Speaker 3: in the context that you're using it. And I know
Speaker 3: that we could talk for nine hours about what metabolism is,
Speaker 3: so choose your level of depth accordingly.
Speaker 1: But so the first thing I want to say is
Speaker 1: that you know, the medical field right now accepts this
Speaker 1: is well established and fairly well accepted, that there are
Speaker 1: three metabolic disorders, and those disorders are obesity, diabetes in
Speaker 1: particular type two diabetes. But type one diabetes is definitely
Speaker 1: related to metabolism, and it's a metabolic disorder and cardiovascular disease.
Speaker 1: So obesity, diabetes, and cardiovascular disease, they are all metabolic disorders.
Speaker 1: One of the reasons it's important to call them metabolic
Speaker 1: disorders is because we know that they are all interrelated,
Speaker 1: meaning that if one person has obesity, they are more
Speaker 1: likely to go on to develop type two diabetes and
Speaker 1: heart disease. But even a thin person can have diabetes,
Speaker 1: and that thin person with diabetes is actually more likely
Speaker 1: to subsequently develop obesity, but is also more likely to
Speaker 1: have a heart attack even if they never develop obesity.
Speaker 1: So first and foremost, I want to say, this is
Speaker 1: not about obesity alone. A lot of people hear that,
Speaker 1: and it's not at all about obesity alone. Obesity is
Speaker 1: a symptom of metabolic problems in the brain or body,
Speaker 1: and the easiest example of that is smokers. People who
Speaker 1: smoke cigarettes are often thin, but are much more likely
Speaker 1: to have heart attacks, and they actually have double the
Speaker 1: risk of developing type two diabetes even though they're thin.
Speaker 1: So that's a clear example of smoking, which is a
Speaker 1: metabolic toxin that can cause metabolic problems. It's not about weight,
Speaker 1: it's not about fat shaming. This is about human metabolism.
Speaker 1: And at the end of the day, what I'm really
Speaker 1: arguing is that mental disorders deserve to be the fourth
Speaker 1: group in all of that obesity, diabetes, cardiovascular disease, and
Speaker 1: mental disorders, because it turns out if you have any
Speaker 1: one of those things, you're more likely to have the other.
Speaker 1: And people with mental disorders are more likely to die
Speaker 1: early deaths, heart attacks, they're more likely to develop obesity
Speaker 1: and diabetes, and so you can mix and match those
Speaker 1: four categories a lot. So to answer your question, and so,
Speaker 1: what is metabolism At the end of the day, it
Speaker 1: is much much more than burning calories. A lot of
Speaker 1: people think of it as burning calories and therefore it
Speaker 1: affects your weight. Yes, it is related to burning calories,
Speaker 1: and yes it does affect your weight, but it is
Speaker 1: so so much more than that. So an easy definition
Speaker 1: is Metabolism is a fundamental part of living organisms. All
Speaker 1: living organisms require this to be called living. And in fact,
Speaker 1: when our metabolism stops, that is the definition of death.
Speaker 1: We die when our metabolism stops. So metabolism is taking
Speaker 1: food and oxygen, turning it into energy or building blocks
Speaker 1: that get used to make our cells, make our bodies.
Speaker 1: And it also involves the management of waste products of
Speaker 1: that process, so energy, building blocks, and waste.
Speaker 3: Yeah, I think it's important that we say, you know,
Speaker 3: metabolism isn't just a weight thing, because that's what we
Speaker 3: think of. You know, what's my resting metabolism? You know
Speaker 3: how many calories do I burn at rest? Oh he
Speaker 3: has a high metabolism, that's why he's thin. Oh I
Speaker 3: have a slow metabolism, that's why I'm heavy. And so yeah,
Speaker 3: that's one element, but there's a lot more to it.
Speaker 3: And then you go a level deeper and you say, okay,
Speaker 3: I believe that mental disorders are metabolic issues more specifically
Speaker 3: within that mitochondria.
Speaker 1: Yes, So if you start asking some really basic common
Speaker 1: sense questions, So just sticking even with the metabolic disorders,
Speaker 1: the already accepted metabolic disorders, obesity, diabetes and cardiovascular disease.
Speaker 1: How do those fit together? Like how exactly does obesity
Speaker 1: contribute to type two diabetes? How exactly does obesity end
Speaker 1: up resulting in a heart attack? Like what exactly is
Speaker 1: happening in the human body with human physiology to cause
Speaker 1: all of that? And then I'm going to throw in
Speaker 1: the conundrum that I offered before. How does smoking play
Speaker 1: into that? Smoking can cause type two diabetes or at
Speaker 1: least elevate your risk, double your risk for it, smoking
Speaker 1: can cause heart attacks? How does that work. That's not weight,
Speaker 1: that's not what you're eating, that's not cholesterol. So what
Speaker 1: does that have to do with metabolic dysfunction the end
Speaker 1: of the day, if you ask those kind of basic
Speaker 1: common sense questions, but then you parent with the mental
Speaker 1: health field and everything we have known, everything we've been
Speaker 1: figuring out in the mental health field, like what's happening
Speaker 1: in the brains of people with OCD, what's happening in
Speaker 1: the brains of people with addiction, what's happening in the
Speaker 1: brains of people with bipolar disorder and schizophrenia. We've long
Speaker 1: known that they also have metabolic problems in their brain.
Speaker 1: And when you ask this question, well, what does that mean?
Speaker 1: You are led to these tiny things in ourselves called mitochondria,
Speaker 1: and most people know mitochondria as the powerhouse of the cell.
Speaker 1: But actually, if you do a deep dive into the
Speaker 1: science of mitochondria, and this science is fairly new and
Speaker 1: very cutting edge, we are learning new functions every day.
Speaker 1: This really is a rapidly exploding field. And that is
Speaker 1: why you've probably never heard this, and that is why
Speaker 1: your physician may not even know this. But the reality is,
Speaker 1: if you do a deep dive into mitochondria, you can
Speaker 1: actually once and for all, start to make sense of
Speaker 1: the mental health field. We can start to understand what
Speaker 1: would cause a neurotransmitter imbalance, what would cause a hormonal imbalance,
Speaker 1: How would a hormonal imbalance result in symptoms of depression
Speaker 1: or psychosis or OCD or pre menstrual dysphoric disorder in women,
Speaker 1: Like how exactly does all of this work act? Mitochondria
Speaker 1: can explain all of the different factors in the bio
Speaker 1: psychosocial model. So some people get upset with me and
Speaker 1: they think I'm only a biologist and that I lack
Speaker 1: all common sense and I don't understand the psychological or
Speaker 1: social aspects of mental health. But in fact, I'm well
Speaker 1: aware of the psychological and social impacts of mental health
Speaker 1: from my own personal experience, from the decades of patients
Speaker 1: that I've worked with. I am well aware of it.
Speaker 1: And that's the beauty of metabolism in mitochondria is that
Speaker 1: they help us understand the human stress response and how
Speaker 1: that plays into it.
Speaker 3: So let's go a little bit deeper here into how
Speaker 3: mitochondrial dysfunction, if that's the term that we can use.
Speaker 3: And I know that sometimes it's not the mitochondria that
Speaker 3: are dysfunctional. Sometimes it's their environment that is dysfunctional. And
Speaker 3: I don't think we're gonna have time to go that deep,
Speaker 3: so we'll just shorthand it right now with something's wrong mitochondrily.
Speaker 3: How is that leading to what appeared to be very
Speaker 3: different symptoms? Right, Depression, I am way too tired, Oh, schizophrenia,
Speaker 3: I am hearing things. These are very different things. And
Speaker 3: you talk about sort of three mechanisms that can be
Speaker 3: going on with the brain cells that would explain these
Speaker 3: radically different symptoms.
Speaker 1: Yeah, So at the end of the day, what I'm
Speaker 1: arguing is that if somebody is having symptoms of mental illness.
Speaker 1: So they're having symptoms that are occurring for no good reason.
Speaker 1: So they're not having normal depression and anxiety for a reason.
Speaker 1: They're having abnormal depression, anxiety, or psychosis. What I'm arguing
Speaker 1: is that at the end of the day, those are
Speaker 1: all metabolic problems in the cells. So what I'm saying
Speaker 1: is that somewhere in their brain cells are malfunctioning. That
Speaker 1: is the simplest way to put it. Somewhere in the
Speaker 1: brain cells are malfunctioning. There are several different ways cells
Speaker 1: can malfunction, but the two primary ones are they can
Speaker 1: actually become underactive or they can become overactive, and those
Speaker 1: are polar opposites, and so on the surface, it can
Speaker 1: be really confusing right there. It's like, well, wait, is
Speaker 1: it overactive or is it underactive? And what I'm saying
Speaker 1: is it's both. We know this from decades of neuroscience literature,
Speaker 1: all those brain scans that we've been doing. We have
Speaker 1: figured out some brain regions are overactive, others are underactive.
Speaker 1: We're not really sure why. What I'm arguing is that
Speaker 1: metabolic dysfunction and brain cells can explain both of those problems.
Speaker 1: More importantly, metabolic dysfunction can help us understand why do
Speaker 1: the symptoms come and go? Why do they wax and
Speaker 1: wane throughout the day or weeks or months on end.
Speaker 1: And then if you ask, well, why does one person
Speaker 1: have and another person has depression and another has schizphrenia,
Speaker 1: different parts of the brain are going to result in
Speaker 1: different symptoms. If the front left part of your brain
Speaker 1: is malfunctioning, you might have a specific set of symptoms,
Speaker 1: maybe related to depression. Whereas if another part of a
Speaker 1: person's brain is metabolically compromised, they might have symptoms of
Speaker 1: OCD instead. And why would one brain region be impacted
Speaker 1: more than another. Because brain regions are all responding, they
Speaker 1: have different receptors on the cells. Some of them respond
Speaker 1: to serotonin, some respond to dopamine. Some of them respond
Speaker 1: to light from our environment. The light goes from our eyes,
Speaker 1: gets into the brain and causes changes in brain cells
Speaker 1: and brain circuits. Some of them respond to the foods
Speaker 1: we eat. Some of them respond to how much sleep
Speaker 1: we get or don't get. So different brain cells are
Speaker 1: kind of respond to all of these different cues, and
Speaker 1: depending on the mix of cues that you have, you're
Speaker 1: going to end up developing different symptoms. So what I
Speaker 1: just said sounds like, oh my gosh, that sounds so
Speaker 1: complicated then, and it's going to be an impossible puzzle
Speaker 1: to figure out. Right, here's the great news. If you
Speaker 1: understand that it's metabolic in nature, some really common sense
Speaker 1: interventions can help all of those people, regardless of where
Speaker 1: the problem is located. That may sound complicated to a
Speaker 1: lot of people. A lot of people go, wait, you've
Speaker 1: lost me. That doesn't make sense. So let me come
Speaker 1: back to the well established three metabolic disorders. Let's say
Speaker 1: somebody is a little bit overweight. They've already got high
Speaker 1: blood pressure, they've already got type two diabetes, and they're
Speaker 1: having symptoms of a mild heart attack. They're having chest
Speaker 1: pain already. So they've got a lot of problems and
Speaker 1: a lot of different parts of their brain and body.
Speaker 1: They might even have some kidney problems and some liver
Speaker 1: problems related to their type two diabetes and obesity. They
Speaker 1: might have non alcoholic fatty liver disease, so fatty and
Speaker 1: maybe their kidneys aren't doing that great either. So now
Speaker 1: they've got a kidney problem, a liver problem, they've got
Speaker 1: a heart problem, they've got a weight problem, they've got
Speaker 1: a pancreas or diabetes problem. WHOA, that's so complicated, right, Well, no,
Speaker 1: not really, Like, if you want to help that person
Speaker 1: treat all of those complicated, different symptoms involving all of
Speaker 1: those different organs, what are you going to do. You're
Speaker 1: going to talk about changes in diet and exercise and
Speaker 1: stress reduction and sleep and if there's smoking cigarettes, maybe
Speaker 1: where you you off the substances that are harming you.
Speaker 1: Common sense lifestyle strategies can address all of those different
Speaker 1: complicated organs, all of those different complicated manifestations of metabolic dysfunction.
Speaker 1: What I'm arguing at the end of the day is
Speaker 1: that mental disorders are metabolic disorders of the brain, and
Speaker 1: in the same way, we can use common sense lifestyle
Speaker 1: strategies to help people heal and recover their brains.
Speaker 3: So, on one hand, that is simpler, on the other hand,
Speaker 3: it's more complicated. Then I have a serotonin problem. Give
Speaker 3: me a pill.
Speaker 1: Yes, yes it is. And that's why I say, if
Speaker 1: somebody's giving you a serotonin pill and it's working beautifully
Speaker 1: for you, that is the simplest answer. Just go ahead
Speaker 1: and keep taking your serotonin pill. But the reality again,
Speaker 1: I don't mean to be so pessimistic on the mental
Speaker 1: health field, but the reality is that depression right now
Speaker 1: is the leading cause of disability on our planet. Yeah,
Speaker 1: people are taking lots of pills and they're not getting better,
Speaker 1: so they want better solutions.
Speaker 3: That's right, that's right. I mean, you know, the fascinating
Speaker 3: thing is that most people who are taking psychiatric medication
Speaker 3: are getting them from their primary care doctor to a
Speaker 3: large extent, which in some ways I can see the
Speaker 3: ways in which that is a step forward for us,
Speaker 3: in that at least mental health is being talked about
Speaker 3: at the primary care level, and there are ways that
Speaker 3: I think that is a real step backwards for us,
Speaker 3: or maybe not a step backwards, but a step in
Speaker 3: the wrong direction for us. So taking this idea that
Speaker 3: these are all metabolic disorders and then saying okay, well,
Speaker 3: in order to treat this, we need to treat your
Speaker 3: metabolic disorder, that then does open up a number of
Speaker 3: different doors beyond just a pill.
Speaker 2: Right.
Speaker 3: We know that for some people taking prozac helps, right,
Speaker 3: I have had great help from antidepressants in my life.
Speaker 3: At points. We know that some people are seeing great
Speaker 3: breakthroughs with ketamine. I've got a friend who's got a
Speaker 3: you know, internal thing that stimulates. I believe it's his
Speaker 3: vagus nerve right that has caused him great deals of
Speaker 3: help ECT, you know, elect So there are different things
Speaker 3: that work some of the time for some of the people,
Speaker 3: and those are not well. I was going to say,
Speaker 3: those are not metabolic treatments. You may show me the
Speaker 3: pathway that I'm not seen. So talk to me about
Speaker 3: why some of these things that do not appear to
Speaker 3: be metabolic treatments are working for some people some of
Speaker 3: the time.
Speaker 1: The fascinating thing is all of those are metabolic treatments.
Speaker 1: That's the beautiful thing about this theory is that it
Speaker 1: helps us understand why does ECT work for some people,
Speaker 1: But it also helps us understand why doesn't it work
Speaker 1: for others? Maybe, like at least it can start to
Speaker 1: open up the door for us to better understand those questions. So,
Speaker 1: electroconvulsive therapy and transcranial magnetic stimulation ECT and TMS are
Speaker 1: actually delivering energy directly to the brain. That's what they're doing,
Speaker 1: and so in many ways they are absolutely a metabolic
Speaker 1: treatment because they are stimulating brain cells that are underactive.
Speaker 1: They can also be used to suppress overactive brain cells.
Speaker 1: If you hyper stimulate, that can actually cause suppression of
Speaker 1: brain regions. So in many ways the researchers are used
Speaker 1: or the clinicians are using electricity or magnetic stimulation to
Speaker 1: try to alleviate these overactive and underactive brain cells. That
Speaker 1: is the simplest way to understand them. They directly relate
Speaker 1: to mitochondrial function and mitochondrial biogenesis almost certainly as well.
Speaker 1: There was a group of researchers that looked at the
Speaker 1: effects of ketamine and they concluded that actually, ketamine appears
Speaker 1: to have its effects primarily through mitochondria or brain metabolism,
Speaker 1: because when they gave people a substance that stopped or
Speaker 1: I think this was in lab animals, because you can't
Speaker 1: do this with humans. When they gave the lab animals
Speaker 1: substances that blocked mitochondrial adaptations, the ketamine didn't work anymore.
Speaker 1: Ketamine was useless. It was like a placebo. So those researchers,
Speaker 1: at least in that study concluded that ketamine appears to
Speaker 1: be having its effects through energy metabolism and mitochondria. Now,
Speaker 1: some of your listeners hearing this might think that, Chris Palmer,
Speaker 1: are you saying neurotransmitters don't matter at all now? And
Speaker 1: that's not at all what I'm saying. Neurotransmitters so serotonin,
Speaker 1: for instance, has been shown to increase mitochondrial biogenesis or
Speaker 1: the production of new mitochondria, So serotonin can target a
Speaker 1: cell and can go to a receptor on a cell.
Speaker 1: But what I'm arguing is that the effects of those neurotransmitters,
Speaker 1: whether they are neurotransmitters that stimulate a cell or suppress
Speaker 1: a cell, the effects of those neurotransmitters ultimately at least
Speaker 1: pass through mitochondria. They have to, because mitochondria, in a way,
Speaker 1: are kind of like the engine on a car. So
Speaker 1: you might think of neurotransmitters as like the accelerator on
Speaker 1: the car or the brake on that car. And yes,
Speaker 1: the accelerator and the brake matter, but at the end
Speaker 1: of the day, the action is all going through that
Speaker 1: engine still, and mitochondria are the engines of cells.
Speaker 3: I think you're saying, as I understood you there, that
Speaker 3: the neurotransmitters are acting on mitochondria. But from reading your book,
Speaker 3: I also got the sense that mitochondria is controlling oftentimes
Speaker 3: the release of or the production of neurotransmitters and hormones.
Speaker 3: So so much of this seems to be sort of bidirectional.
Speaker 1: It is. You know, a lot of times people are
Speaker 1: looking for linear relationships. You know, A causes B causes C,
Speaker 1: and when we talk about metabolism, unfortunately or fortunately, things
Speaker 1: are not set out in linear relationships in that way.
Speaker 1: It's not A goes to B, goes to C. It's
Speaker 1: actually A goes to B, goes to C, which then.
Speaker 3: Feeds back back to AA.
Speaker 1: And you get a circle. And so one useful thing
Speaker 1: I think is so A to B, two C and
Speaker 1: ends at C is a line segment and the other
Speaker 1: one is a circle. Just like the universe is based
Speaker 1: on circles. All the planets are circular and they travel
Speaker 1: around in circles. Metabolism is also circular. And so when
Speaker 1: you think about metabolism, you need to think about, well,
Speaker 1: if serotonin's doing something, there's no stopping point. You need
Speaker 1: to look for the circle, Like serotonin does something to
Speaker 1: this sell and then that feeds back and then that
Speaker 1: affects serotonin levels in one way or another.
Speaker 3: So mental disorders are metabolic disorders, and our metabolism and
Speaker 3: our mitochondria can affect how we are feeling what's going
Speaker 3: on in our brain. Let's talk about the other direction,
Speaker 3: because the question that would come up would be, well, okay,
Speaker 3: let's just say that I have a breakup and I
Speaker 3: stay depressed, or I am under stress at work and
Speaker 3: I start to become depressed, or I'm lonely. Right, all
Speaker 3: these sort of what I would call environmental risk factors
Speaker 3: that at first glance, don't appear to have anything to
Speaker 3: do with mitochondria.
Speaker 1: Right.
Speaker 3: I don't think the mitochondria is sitting around going, well,
Speaker 3: you know, we did break up with our girlfriend. We
Speaker 3: don't feel like showing up on the job today, Right,
Speaker 3: So what's the mechanism by which these sort of external
Speaker 3: events that are happening to us the psychological aspect, How
Speaker 3: is that feeding down to a mitochondrial level.
Speaker 1: So let's take the one example and maybe I can
Speaker 1: hone in on a little bit. So the example of
Speaker 1: girlfriend breaks up with a boyfriend, boyfriend is decimated and
Speaker 1: gets depressed. Yeah, and let's take two different men. One
Speaker 1: man I am going to say is quote unquote metabolically healthy.
Speaker 1: The other man is going to be a little bit
Speaker 1: overweight and a type two diabetic girlfriends break up with
Speaker 1: both of them at the same time. Both of them
Speaker 1: are going to get depressed. That is normal. That is
Speaker 1: what the human brain is programmed to do. Get depressed.
Speaker 1: You just lost the love of your life. You're gonna
Speaker 1: feel bad about yourself. You need to make some corrective action.
Speaker 1: You need to lose your confidence a little. You need
Speaker 1: to rethink your strategies in life and how you were
Speaker 1: treating her, and could you have done something different. All
Speaker 1: of those things are actually trying to help that person
Speaker 1: either get her back or be a better boyfriend next
Speaker 1: time around so that you don't get dumped. So they're
Speaker 1: all serving useful purposes. The theory goes that the metabolically
Speaker 1: healthy person is more likely to recover in a normal,
Speaker 1: resilient way. So maybe that depression that long. Severe depression
Speaker 1: lasts one or two weeks and then mild lingering depression
Speaker 1: for another month, and then the person starts dating someone
Speaker 1: else and gets over it and moves on. The other
Speaker 1: person is just decimated by the breakup and doesn't recover
Speaker 1: a year later. A year later, they're severely depressed. They
Speaker 1: became suicidal. They can't function, they can't get over her,
Speaker 1: They're obsessing about her, they can't imagine life without her.
Speaker 1: Life is ruined. They can't really focus or concentrate anymore.
Speaker 1: And I would say certainly after a year, probably even
Speaker 1: after six months, I would say that that person would
Speaker 1: depend a little bit on how long they were together
Speaker 1: and other circumstances, So I don't want to generalize too much.
Speaker 1: Maybe six months would be appropriate if.
Speaker 3: You've got three weeks to get over your breakups people,
Speaker 3: otherwise Chris is going to diagnose you.
Speaker 1: I don't want to get into that, you know, because
Speaker 1: it depends on how long were you together and what
Speaker 1: that person mean to you and everything else. But after
Speaker 1: some appropriate amount of time, the person should have gotten
Speaker 1: over it. And if they haven't, then I'm going to
Speaker 1: say that person has a brain disorder. And what I'm
Speaker 1: arguing is that because that person already had some metabolic
Speaker 1: vulnerability in their brain, maybe because of what outwardly people
Speaker 1: would identify as a physical metabolic problem like obesity or diabetes,
Speaker 1: but this also includes psychological and social factors, so they
Speaker 1: may have more internal brain metabolic vulnerabilities because they were
Speaker 1: abused and traumatized as children. And if they were abused
Speaker 1: and traumatized as children, their brain is going to be
Speaker 1: more sensitive to rejection. Their brain is going to be
Speaker 1: more likely to fail when it is stressed. And even
Speaker 1: if they are on the surface, thin and healthy, what
Speaker 1: I'm arguing is that their brain probably is not one
Speaker 1: hundred percent as resilient as someone else's. It's not their fault.
Speaker 1: It's not that they're doing anything wrong. It's that they
Speaker 1: had a really horrible, stressful life. So going back to
Speaker 1: those cars, you know, the car that goes through the
Speaker 1: blizzard all the time, you mentioned, well, what if we
Speaker 1: take that car and put it in California, it was
Speaker 1: still exposed to all that salt and all that wear
Speaker 1: and tear and everything else. It is a little more
Speaker 1: vulnerable than a car that was just living its good
Speaker 1: life in California, live in the high life all the time.
Speaker 1: It's not a fair comparison. Doesn't mean that that car
Speaker 1: that went through the blizzard is defective. It's gone through
Speaker 1: a lot, right, and it's a little more vulnerable to
Speaker 1: failure if it gets really stressed.
Speaker 3: Let's take your scenario here and say that the person
Speaker 3: doesn't appear to have any what we would diagnose as
Speaker 3: outward metabolic syndromes. Right, they're healthy, and if we were
Speaker 3: to look at their metabolism, we would say, well, it
Speaker 3: seems like you know, okay, at least at first glance,
Speaker 3: from the biomarkers that we use, I'm not diagnosing metabolic
Speaker 3: syndrome or anything even close to it. But that person
Speaker 3: had been abused as a child. What you're saying is
Speaker 3: that coping with that abuse ultimately takes energy, and that
Speaker 3: energy consistently output in that way is going to affect
Speaker 3: that person's mitochondrial health.
Speaker 1: Yes, okay, And that that person may have brain regions
Speaker 1: that are just a little more vulnerable or maybe a
Speaker 1: lot more vulnerable than other people's brain regions because when
Speaker 1: they were going through the trauma and stress, their sympathetic
Speaker 1: nervous system and other parts of their survival system, we're
Speaker 1: getting so much of the energy or metabolic resources, and
Speaker 1: that means that their brain may have not developed as
Speaker 1: robustly and resiliently as it could have, and that maybe
Speaker 1: leaves some brain regions or brain networks just a little
Speaker 1: more vulnerable, so that that person is more likely to
Speaker 1: be diagnosed with any brain disorder, any of them, whether
Speaker 1: it's a substance use disorder, whether it's ADHD, whether it's depression,
Speaker 1: whether it's post traumatic stress disorder, or even Alzheimer's disease.
Speaker 1: And although that may sound far fetched, the reality is
Speaker 1: that's all true. People who suffer from adverse childhood experiences
Speaker 1: are more vulnerable to develop all of those brain disorders.
Speaker 1: But guess what, they're also more likely to develop. They're
Speaker 1: also more likely to develop obesity, type two diabetes, cardiovascular disease,
Speaker 1: and they're much more likely to die early deaths from
Speaker 1: heart attacks. And that is the way we can put
Speaker 1: it all together.
Speaker 3: I'm going to pivot to a personal question here. Just
Speaker 3: laid out that the more adverse childhood effects you have had,
Speaker 3: the worse your overall outcomes for nearly anything. Are you
Speaker 3: had a number of those, How do you think about
Speaker 3: that with yourself, Because one way of hearing that is
Speaker 3: to hear it and go, oh, I understand why I'm
Speaker 3: suffering some of the things. I am right. The other
Speaker 3: way of hearing that is I'm screwed. So having been
Speaker 3: someone who has had a lot of those acees and
Speaker 3: does not strike me as somebody who spends a ton
Speaker 3: of time thinking that they're screwed. How do you think
Speaker 3: through that in a way that's empowering to you.
Speaker 1: Yeah. So I will say that there was a long
Speaker 1: period of time when I was younger that I really
Speaker 1: did think I was screwed. Yeah, I just thought I
Speaker 1: was a defective human being. And I didn't necessarily know
Speaker 1: everything that was wrong with me. I had lots of
Speaker 1: ideas about these things are bad and nobody likes this
Speaker 1: and me and I feel insecure about that, but there
Speaker 1: was just an inherent sense that I am a defective
Speaker 1: human being and I'm never going to be okay. And
Speaker 1: what I'm here to say, I think this is one
Speaker 1: of the reasons this is so important and powerful to
Speaker 1: me that I don't feel that way at all now,
Speaker 1: and I haven't felt that way in decades. I still
Speaker 1: remember it. I can't say that it never shows itself,
Speaker 1: at least hinting to try to come back. It does.
Speaker 1: It does? I still get it. But I use primarily
Speaker 1: metabolic strategies to improve and maintain my mental health and
Speaker 1: physical health. So I use diet and exercise and really
Speaker 1: good sleep practices and light in the morning and connection
Speaker 1: and purpose with people. I use all of those strategies
Speaker 1: to maintain my health. If I'm traveling, or if my
Speaker 1: schedule is really disrupted and you know, I'm really stressed
Speaker 1: with lots of extra demands or something, and I get
Speaker 1: off my routine, I'll notice, Yep, I'll notice myself slipping
Speaker 1: back into mild depression, or at least i'll notice hints
Speaker 1: of it coming. And as soon as I notice even
Speaker 1: the slightest hints of it coming back, I know what
Speaker 1: to do to correct it. I can look at myself.
Speaker 1: I can look at my diet, my exercise, my sleep,
Speaker 1: my stress, everything else, and I can figure out, oh,
Speaker 1: this is why I'm feeling this way. That's obvious and intuitive,
Speaker 1: and here's what I need to do to get back
Speaker 1: on track and to feel good again. Although I agree
Speaker 1: with you, some people might hear this I'm screwed and
Speaker 1: it's hopeless because I've had a really horrible life. I
Speaker 1: really don't at all want to send that message. Instead,
Speaker 1: I want to send a message of empowerment with knowledge,
Speaker 1: like nerdy scientific knowledge about what's happening in your mitochondria,
Speaker 1: in your cells. Even though I had to get really
Speaker 1: nerdy with all of this. The outcome is hope, you
Speaker 1: can do something. You don't have to suffer. You do
Speaker 1: not have to be disabled by a mental illness, And
Speaker 1: I really mean that across the board. Depression, anxiety, OCD,
Speaker 1: but schizophrenia and bipolar disorder and substance use disorders, all
Speaker 1: of them. You do not have to be disabled by
Speaker 1: those illnesses. You can get better and heal and recover.
Speaker 3: That would absolutely be the right place to end this.
Speaker 3: That was a very empowering and hopeful note. And yet
Speaker 3: I have a few more questions. I just have to ask.
Speaker 1: That's fine, I guess.
Speaker 3: Sorry, that was the moment to end it. I know,
Speaker 3: but I've got a few more questions. Do we have
Speaker 3: better outcomes in treating metabolic disorders then we do mental
Speaker 3: health disorders?
Speaker 1: No, probably even worse metabolic disorders. If you look at
Speaker 1: the treatment success of obesity, it's abysmal ninety five percent approximately,
Speaker 1: depends on what studies you're looking at and what population
Speaker 1: you're looking at. But an often cited statistic, I don't
Speaker 1: know how accurate this is, because again you can look
Speaker 1: at different population, but an often sided statistic is ninety
Speaker 1: five percent of people who try to lose weight, and
Speaker 1: they do lose weight, they actually lose it, they start losing,
Speaker 1: they gain it back, right, And what that tells us
Speaker 1: is that metabolic health is complicated and that it's more
Speaker 1: than just diet. And I actually think that's one of
Speaker 1: the things that I'm bringing to the table with this
Speaker 1: theory is what I'm saying is not that mental health
Speaker 1: is all the consequence of diet. That's not at all
Speaker 1: what I'm saying, right. What I'm saying is that people
Speaker 1: who have metabolic problems like obesity or diabetes, they might
Speaker 1: actually benefit from mental health treatment. They may have experienced
Speaker 1: trauma or adversity in life, and if they did, they
Speaker 1: might benefit from psychotherapy and that might help them lose
Speaker 1: weight and keep it off.
Speaker 3: Yeah. Yeah, I think that's a really important idea there
Speaker 3: is that if they're bi directional, they're bidirectional, right, meaning
Speaker 3: if you are having trouble sticking with a diet and
Speaker 3: exercise plan, there may be real reasons for that and
Speaker 3: you may really need help in doing that. I Mean,
Speaker 3: I think that's one of the biggest problems is that
Speaker 3: knowing that diet, exercise, getting good sleep and all that
Speaker 3: is important shouldn't be news to anybody at this point
Speaker 3: in life, Like, if you haven't heard that message, I
Speaker 3: don't know where.
Speaker 1: You've been, right exactly.
Speaker 3: That's not as easy as it sounds. Right. People struggle
Speaker 3: with these things, which is why getting help can be
Speaker 3: so important.
Speaker 1: For me.
Speaker 3: Seeing the connection has been really helpful. Now, I couldn't
Speaker 3: have told you why until looking at your theory sort
Speaker 3: of explains the pathway between them. But I've known very
Speaker 3: clearly that my physical health is related to my mental health.
Speaker 3: That has just been evident to me. Like, if you
Speaker 3: said you could only have one intervention the rest of
Speaker 3: your life for your mental health, what would it be?
Speaker 3: I would say, give me exercise, Like if you're just
Speaker 3: if you're going to strip me down to one, that's
Speaker 3: the one I'm going to take. I hope you don't
Speaker 3: take me to one, because I'm kind of a throw
Speaker 3: the kitchen sink at it kind of guy. But that
Speaker 3: would be the one. And when I realized that exercise
Speaker 3: and diet were going to help my mental health, they
Speaker 3: were going to help my physical health, they were going
Speaker 3: to help with my Alzheimer's prevention. Right, I've got a
Speaker 3: father who just passed of Alzheimer's. You know when I
Speaker 3: sort of saw the connection between all of these things,
Speaker 3: somehow for me it made it a little bit easier
Speaker 3: to really say, I'm really going to focus on these
Speaker 3: things because I'm not doing diet because I want to
Speaker 3: look good, not that there's anything wrong with that, Like
Speaker 3: it's a side benefit. Sure, it's great. You know, I'm
Speaker 3: not exercising only because of the size of my biceps, right.
Speaker 3: I also know that it's all these different things, and
Speaker 3: for me, seeing that whole picture has made it easier
Speaker 3: for me to remain focused on those things and to
Speaker 3: really see it like, oh, this is great because I'm
Speaker 3: getting a lot of bang from my buck here right
Speaker 3: Like I'm exercising and I'm getting a lot of benefits. Now,
Speaker 3: I couldn't have again told you why what appeared to
Speaker 3: be helping me metabolically was helping me mentally. I didn't
Speaker 3: see the pathway, but I knew it to be true experientially.
Speaker 1: Yes, and you and thousands of other people are The
Speaker 1: reason I at least have more confidence in my theory
Speaker 1: is because although it is a new theory, it tries
Speaker 1: to connect dots that have not yet been connected. There
Speaker 1: are so many examples, just like you said of lived
Speaker 1: experience of somebody who says, well, yeah, now that you
Speaker 1: say all of that, or now that I read this book,
Speaker 1: like yeah, that's what I do and it's really worked
Speaker 1: for me. And people didn't always believe me or trust me,
Speaker 1: or that the psychiatrist said that I needed pills still
Speaker 1: and I tried to I had to argue with them like, no,
Speaker 1: I don't I feel great? And I think you know,
Speaker 1: certainly my own personal experience has also emboldened this. I
Speaker 1: didn't know why diet or exercise or the other strategies
Speaker 1: that I use were so powerful for my mental health,
Speaker 1: but I knew they were. I didn't have mechanisms of
Speaker 1: action lined up, and I didn't really think I needed them.
Speaker 1: I didn't really care that much about them. But the
Speaker 1: thing that's been revolutionary to me is that this really
Speaker 1: genuinely does apply to all mental disorders. That was the
Speaker 1: thing that was mind blowing to me is that this
Speaker 1: even applies to people risks of frenia and by paular
Speaker 1: we can help them recover too, because right now they're
Speaker 1: kind of being told they can't. They're being told they've
Speaker 1: got a lifelong disorder and they just need to keep
Speaker 1: taking their pills even if those pills aren't working, and
Speaker 1: that that's the life they have to live.
Speaker 3: When we look at diagnosing metabolic syndrome, we typically can
Speaker 3: do a number of actual tests that are going to
Speaker 3: give us some information. Right, we can be looking at
Speaker 3: our insulin sensitivity. We can be looking at our blood sugar.
Speaker 3: We can be looking at our cholesterol, our lipids, we
Speaker 3: can be looking at our blood pressure. Right, there are
Speaker 3: diagnosable tests that tell us, Okay, we think we've got
Speaker 3: metabolic syndrome here, is there anything comparable mentally to see
Speaker 3: am I suffering metabolically mentally? So if we can assume,
Speaker 3: based on what you're saying, if the theory is true,
Speaker 3: if I have metabolic syndrome that's diagnosable by those other tests,
Speaker 3: there's a fair chance that those things are impacting my brain.
Speaker 3: So I think that at least for me, I feel
Speaker 3: comfortable saying like, Okay, I want to keep an eye
Speaker 3: on those markers. But is there anything that is for
Speaker 3: the more subtle case. You know, we talked about the
Speaker 3: person who appears to be healthy, they're not having the
Speaker 3: outward symptoms of metabolic syndrome. Any tests that might tell
Speaker 3: them that metabolically, brain wise, they're not healthy.
Speaker 1: You know, researchers have spent decades on all these brain scans,
Speaker 1: you know, PET scans, SPEC scans, functional MRI, and lots
Speaker 1: of others in the hopes that we would develop a
Speaker 1: diagnostic biomarker. All of those scans, by the way, are
Speaker 1: measuring brain metabolism, that is what they're measuring. All of
Speaker 1: the functional scans are measuring brain metabolism. And unfortunately, we
Speaker 1: don't have any useful diagnostic tests because of these problems
Speaker 1: of heterogeneity and comorbidity. If I take one person who
Speaker 1: who's got alcoholism and also depression and also OCD, they
Speaker 1: may have different brain scan showing underactive and overactive brain
Speaker 1: regions in different places than the person who has schizophrenia
Speaker 1: and anorexia and something else. So because of that, we
Speaker 1: don't have good brain scans. What I would argue right
Speaker 1: now is that we don't need them. I welcome the
Speaker 1: day when we will have them, and I think that
Speaker 1: day will come, but for right now, we don't need them.
Speaker 1: It is usually somewhat of a common sense identification, and
Speaker 1: that means the same way that I can look at
Speaker 1: a car driving down a sunny highway only going twenty
Speaker 1: five miles an hour and doing its windshield wipers with
Speaker 1: no rain. I can look at that car and say
Speaker 1: that car's got a problem. I don't need to know
Speaker 1: how the windshield wipers are working. I don't need to
Speaker 1: know how that car works. I don't need an objective
Speaker 1: biomarker test. I can look at it and see for
Speaker 1: myself it's got a problem. I believe, in most cases,
Speaker 1: not all. In most cases, we can look at human
Speaker 1: beings and simply ask them questions, how's your mood, how's
Speaker 1: your anxiety? What symptoms are you having? And is there
Speaker 1: any context for these symptoms? And is that context reasonable
Speaker 1: and appropriate? Sometimes there will be a gray area. There's
Speaker 1: no question my girlfriend just dumped me three months ago
Speaker 1: and I'm not over it yet. Is that person starting
Speaker 1: to border on what might be a mental disorder. Maybe
Speaker 1: maybe three months should have been enough time. But if
Speaker 1: that person says my girlfriend just dumped me a week
Speaker 1: ago and I'm still depressed, I am going to accross
Speaker 1: the board say yeah, well, welcome to human species. Let's
Speaker 1: support you, let's give you compassion, let's help you through
Speaker 1: this difficult time. I don't want to be heartless about it.
Speaker 1: But I'm not here to diagnose a brain disorder. I'm
Speaker 1: not here to say you've got a chemical imbalance. I'm
Speaker 1: not here to say you need pills. I'm here to
Speaker 1: say you're a human being suffering and we can help.
Speaker 1: If that same person comes to me two years later
Speaker 1: or one year later and says I can't get over her,
Speaker 1: I still can't get over her. What's wrong with me?
Speaker 1: I'm going to say, you do have a metabolic brain problem,
Speaker 1: and we can help you with a lot of strategies.
Speaker 1: So for now, unfortunately we don't have objective tests for this,
Speaker 1: but if I can actually just share one at least
Speaker 1: quick study, because some people may hear this is so
Speaker 1: you know, insulin resistance, for instance, may not have anything
Speaker 1: to do with it. In fact, although those things don't
Speaker 1: follow each other one to one. One of the largest
Speaker 1: studies that we have actually recently identified probably that one
Speaker 1: of the most significant risk factors for the development of
Speaker 1: bipolar disorder and schizophrenia in children. These researchers followed kids
Speaker 1: from birth to age twenty four, and what they found
Speaker 1: is that the kids beginning age nine who had the
Speaker 1: highest levels of insulin resistance had a fivefold increased risk wow,
Speaker 1: for developing schizophrenia or bipolar disorder by the time they
Speaker 1: turned twenty four. Fivefold increased risk. That's five hundred percent.
Speaker 1: That is not at all trivial. And what it means
Speaker 1: is that in that case, we could maybe be measuring
Speaker 1: insulin resistance in nine year olds and maybe preventing schizophrenia
Speaker 1: or preventing bipolar disorder by helping those kids change diet,
Speaker 1: use exercise, use stress reduction, look at sleep, make sure
Speaker 1: those kids aren't being traumatized or abused or something, and
Speaker 1: if they are, manage that in the most appropriate and
Speaker 1: safe way. But I think that we might be able
Speaker 1: to intervene based on some biomarkers that we've got available
Speaker 1: even today.
Speaker 3: Wonderful. Well, we really do have to end, even though
Speaker 3: I have nine to twenty more questions at a minimum,
Speaker 3: all right, but no, it's a testament to how fascinating
Speaker 3: this is. Chris, Thank you so much for coming on.
Speaker 3: Thank you for the work that you're doing, and this
Speaker 3: has been a pleasure.
Speaker 1: Thank you Eric for having me on.
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