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