Doctor Matt Bernstein, Welcome to the podcast.
Thanks for having me, glad to be here.
So, Matt, you have been a practicing psychiatrist for over twenty years and you're the CEO of A Chord, and a Chord has really caught my eye because you provide metabolic based mental health programs and like, when I saw that, I'm like, hallelujah, hallelujah, somebody actually approaching mental health from
a different and probably more effective angle. Before we dive into this, do you just walk through the training required to be a psychiatrist and maybe give us a couple of career highlights or career lows or what sort of drove you to this spiece?
Absolutely, so it's like being a psychiatrist is a medical doctor. So first we do four years of undergraduate education. I was actually an English literature major at Columbia University. Then I had a little time in between that and medical school, which is four years. And then beyond those four years, we do four years of psychiatry training, one year in internal medicine, and then three years of straight psychiatry.
So you're twelve years in all.
In all, post high school, twelve years of training, that's right, yeah.
This is crazy, so kind of thirty years old by the time if you don't take any breaks by the time you pop out of the training sass. Right, okay, and then let's so you organized the first metabolic psychiatry conference in twenty twenty three. We had a very very brief chat before you came on. I've had a metabolic neurologist on who you're familiar with, doctor Matthew Phillips. And now we've got a metabolic psychiatrist, which is really cool.
Now I've got a little insight into this area, mainly through reading doctor Chris Palmer's book, which I'm sure you'll be familiar with Brian Energy. But tell our listeners what is metabolic psychiatry overall?
Sure, So it's really approaching mental health through the lens of metabolic health, with the recognition that the brain is the most energy intensive organ in the body by far, weighing about two percent of our overall body weight, but using usually more than twenty percent of our overall energy.
So the brain requires lots of energy. When the body isn't producing energy efficiently and effectively, it affects brain health first, and we can intervene on brain health through that metabolic these metabolic interventions, and we've known this for I mean really actually millennia. In the time of Hippocrates, they used fasting to treat seizures fifth century BC, and then this
was picked up again in the nineteenth century. There were fasting clinics all over the place, and a very clever doctor at the Mayo Clinic in nineteen twenty one used the ketogenic diet to treat pediatric epilepsy.
I remember that, yeah, and it was very effective. Yeah, and then we just sort of forgot about it for a quite.
A wele well, the neurologists never fully forgot about it. They were studying this all along and using it in treatment refractory kids. So for the first thirty forty years after that, it was used extensively in epilepsy. But then the medications came along, and everyone's enamored with the drugs. Right there, we can pop a pill, you know, you take of medication. It's much easier, you don't have to completely change your diet, and so that's what neurologists gravitated
towards to treat epilepsy. But there was always a recognition that with certain kids, the diet worked much better than the drugs. And there were kids who would be on two or three anti seizure medications at a time, still having seizures all throughout the week, and they would switch them to a ketogenic diet. They would see control over the seizures. They could taper them off of all of those medications and still get control over the seizures with
the diet. And then what was even more amazing is many of those kids could come off of the diet after two or three four years and still retain control over the seizures.
So that period of because they kind of fixed in inverted commas, the dysfunctional metabolism in certain parts of the breed.
I think we don't really know scientifically exactly why some of those kids can come off the diet and some of them can't, but that was certainly an intriguing thing. You know, there's very few brain disorders where there's any treatment that fixes the problems such that you don't need the treatment anymore. Yeah, so that's really fascinating and intriguing and led to lots of neuroscience research about how are
thesees doing what they're doing in the brain. And so now we've had decades of neuroscientists delving into, you know, what is going on with ketogenic diets and brain health, and there's now lots of studies about that, and lots of theories and many mechanisms now that have been identified about how these ketogenic diets improve brain health.
Yeah. I remember going through my nutrition master's degree and you know, the whole talk about the brain was the brion needs glucose, and it just runs off glucose. But but then we have seen that the brion actually functions really well in the absence of glucose and actually in some cases seems to prefer ketones.
Yes, well, just to clarify, actually it never stops using glucose.
Yeah, correct.
So, no matter how deep of a ketosis someone's in and how helpful that is for their brain, there are certain parts of the brain that always going to be using some glucose. And so what we do is we're really providing this additional source of fuel, not not a complete alternative source of fuel. But in addition, we're getting a signaling from the keytones to tell these neurons and
other brain cells to change in certain ways. And we think that maybe you know, in it, you know, we don't know which is more important, but that's also very important, that signaling that the ketones are giving to the brain.
And I think it's important to know when people are on a ketogenic diet that the body still makes enough glucose that's right right through gluconeogenesis, So it has this whole process that's evolutionarily conserved that it can make as much glucose as it needs in the absence of a dietary source of glucose, like, for instance, if our ancestors were were not deliberately practicing fasting, but if they went for periods with our food and I see, I want to just take a couple of steps back and your
description about the brilling. You know, two to three percent of our wee about twenty plus percent, and particularly in times of chronic stress, you know, or high cognitive demands, you know, up to thirty percent of our energy. But and then when you look at it like that and then realize that that compromised energy supply can really affect it. But like, like when you thought of that, was it like a duh moment For years as a psychiatrist where you going, oh my god, this is so bloody obvious.
Not that I've seen it. I can't unsee.
Yes, absolutely, yeah, I mean, of course this was not part of my training at all. We didn't learn nutrition in all of those twelve years, you know, college, medical school, residency training. I got almost no training in nutrition, which is very common in the States, It's.
Very it's very common over here in Australia, it's very common around the world. I mean, most medical degrees would have a maximum of two weeks of nutritional training. But for me that they in psychiatry in particular, has got no nutritional training. I mean that's kind of dark a just stuff, really, isn't it. When we know what we know today, it's true.
Yeah, I mean I think and there's a lot of resistance in the psychiatric world about this alternative way of seeing brain health and mental health.
As you might imagine.
Yeah, this message that we can have such a profound effect on the brain through non pharmacologic, non psychotherapeutic options, and it's not to throw those away. They can be incredibly powerful and life saving. I've seen medications and other biological standard psychiatric treatments save lives many times. I used to work on an inpatient unit with people who were
acutely ill. The medications literally would save lives. We used ect It would save lives, I have no doubt, but those treatments are not very good at continuing to make people well after the acute crisis is over.
Yeah, yeah, you know that's it's an interesting observation, Matt. I'm just today five weeks out from open heartshot. Wow, because I'm very very lucky. Boy. I am discovered because I'd play soccer with a cardiologist and asked them, if you do some checks. I was born with a bicusp of diotic vale, right, So I'm very lucky because it probably would have killed me if I hadn't picked it up,
or certainly caused heart failure. But what I observed going through that whole hospital system is that we have a very very effective sick curse system, but not a very effective health slash willness system. Right. It's really all about just treating the disease or the condition and really not very much, if anything, about then returning to optimal health and wellness and quality of life and all those sorts of things.
That's exactly right.
Yeah, that's exactly how I see things. And as you said before, once you sort of see this this way, you can't unsee it. Once you see the importance of the underlying metabolic health to the function of all the cells in the body, not just the cells in the brain, but all over, you can unsee how important that is. And once you also feel it and experience it, when you achieve some better metabolic health. Wow, I mean, you know, the sky's part for most people when that happens, And
it does take a lot of work. I mean, of course you know, and I know that this isn't something you do by you know, hanging out on the couch and getting up and you know, doing a few laps on a treadmill once or twice a week like this is serious work.
And coming back to your point earlier, lots of people will in a human nature, we default to the easier option. It's easier to pop uphill, and that's what people tend tend to go towards. And it's harder to change your lifestyle. And it's really freaking hard to change that, yes, particularly if you've been eating a certain way, and certainly ultra
processed foods, which we're now seeing are quite addictive. I'm not sure if you saw the recent umbrella review on ultra processed foods so a review of reviews of meta analysis and find convincing class one evidence that increasing ultra processed foods in the de it increased risk of anxiety by I think it was forty eight percent off the top of my head, and common mental health disorder by
fifty three percent. Like class one evidence. Yeah, you don't say that shit in nutrition, right, I mean, this should just be alarm bailed for psychiatrists on people all around the bloody country.
Shit it shit, absolutely, Yeah.
The more we actually study it, the more we see how powerful food is. It's really the most powerful thing to control our epigenetics. You know, we're all born with certain genes, but that's really only ten to twenty percent of the story of health. The other eighty to ninety percent is what's going to turn the genes on and off, which is epigenetics. And of course many things control epigenetics, but food is the one that we have the most
powerful control over. You know, it's so powerful and we can control it, and here we are instead, you know, eating diets that really you know, do the worst to us.
And absolutely absolutely, and I think Hippocrates let food be thy medicine and medicine be thy food, right, absolutely, the intur Greeksikia. So now I know there was a bit of a pivotal moment for you in your journey, and it was around your son's mental health journey. Could you tell us a little bit about that?
Sure? So you know, here we are, we have three boys, and we're talking about eight years ago now almost. We have twins at the time who were fourteen and another one who was twelve. They were very happy, well adjusted kids, going to school and playing sports and music and friends and all these things. And you know, I'm a psychiatrist, my wife's a psychologist. You know, some people might say, our poor kids, they've got double shrink parents, you know,
of course, but but they were doing great. And then all of a sudden, two of my boys, one of the ones the twins, who was fourteen and the other one who was twelve, got very very sick, all both at the same time, which was very unusual, and it looked very psychiatric mental health. In the beginning, they got a cute depression, severe anxiety, but when we started really looking closer, they had a lot of physical symptoms and really severe cognitive symptoms. Which one would not expect from
just you know, depression and anxiety and kids. They could not even go to school. I mean they really just had to drop out of life. It was that severe, and it really almost happened overnight, and so two at the same time, you know, we were wondering, you know, what happened?
What, you know, did we do something?
But it really pointed to you know, potentially something environmental or infectious that you know, would cluster together like that. Well it took quite a while to figure out, but eventually we learned that they had a form of autoimmune encephalitis, which is essentially the immune system attacking parts of the brain that were causing these mental health symptoms. We got no help from traditional medicine. I mean literally none. And here I am, we have great resources, I know a
lot of people, I'm a doctor myself in Boston. We could get no help from traditional medical care at all, and eventually sort of went into this medical odyssey working with functional medicine providers and environmental medicine providers and eventually got them well through very intensive treatments of infections and
their immune systems that traditional medicine didn't provide. One of my sons is still unfortunately sort of had a relapse during COVID and so he's not all the way well yet, but at one point he was almost all the way well from those treatments. And really what it taught me was that we don't know everything, and in fact, we don't know a lot about the body and biology and the brain. And you know, it really made me rethink how many of my own patients have something physical going on.
I mean, as you probably know, you know, psychiatric diagnosis, mental health diagnosis is.
Not based on valid biology. We sort of gave it.
We sort of gave up validity and psychiatric diagnosis with ds M three.
Yeah, I have talked about this quite a few times that there's I think DSM five and you correct me if I'm wrong. Maybe is one hundred and six identified conditions and not one of them has a consistent biological signal. Correct.
Correct.
So we don't use biological markers in psychiatric diagnosis at all. We try to rule out a few things. You know, if someone goes to an er, they'll get a chemistry panel and a complete blood count, and you know they may get an EKG or if in very rare circumstances. They might get a CT scan of their head if they're a first episode of psychosis, but that's kind of the end of the medical workup most of the time. And I just start thinking to myself, you know, my
kids had a condition. If I, if we didn't dig deeper, my wife and I, they would have been lost to their a mental health condition that no one can treat,
no one can help. And how many of my own patients have we sort of done the same thing to have we abandoned they have a you know, this is a there's a physical basis to what's going on in their brains, and yet we just put them in this diagnostic category, give them some medications that were essentially fiddling with neurotransmitters, which may be somewhat effective, as I said, sometimes life saving in the acute setting, but very or almost never does a psychiatric medication get someone all the
way back to wellness, true true wellness, where they're back to their functioning, they're back to their normal social roles.
The medications just don't do that almost ever. And the sometimes with psychotherapy we can get almost all the way there, but we're missing something in my field clearly, and So then I was sitting in a Grand Rounds lecture at McLean Hospital part of Harvard, and my colleague who I knew from way back when I was a resident during my training, doctor Christopher Palmer, who you mentioned his book, is giving a lecture on ketogenic diets and psychosis and
showing data about how ketogenic diets can help the brain, and then showing some case reports of some people with chronic psychotic disorders who were on the strongest medication and still having psychotic symptoms and having those symptoms completely reversed by a ketogenic diet.
Wow.
And I'm sitting there and my jaw hits the floor, and literally, I think most of the people in the room didn't quite believe him, but I knew him, and I knew he was telling the truth. And I had already had my own experience with my kids at that point, and I knew that, you know, there's more to the story, And here he is, you know, telling me what more
of the story there was. And I was sort of off to the races learning more about that at that point, and then trying to figure out how am I going to apply this to my patience, which is a big challenge, which we can get into.
Yes, just before we move on, I just wanted to say that that as a fellow dad, I really think for you, you with your your your your kid's journey and having had a my little guy went through cushions, which is pretty horrible and has pretty horrible mental health
effects that nobody even bloody looked at. And yes, when like medicine was fabulous to the point of getting the tumor rut, but then absolutely useless in terms of his recovery, and we had to go and work with a functional medicine doctor and do all sorts of different things slightly alternative to get him back to wellness. So yeah, look, I just want to say I feel your pain, and I know how motivated can it can also be, and to go and try and find something that's actually going
to work. Now, now that's getting back to this whole idea of metabolism and mental illness. How much of mental illness do you think has a strong metabolic component.
It's a great question, and I don't pretend to know the answer to that. We're still so early in the science of really understanding how powerful these metabolical treatments may or may not be in mental health disorders. But what I can say is that for the people who respond it can be really incredible. And then the people who even have a lesser than incredible response, there's still profound and powerful, important changes that are going on that we see.
So at the minimum, I tell people, if you're going to do this, it's a lot of work, but I can guarantee you that you're going to feel more energy, You're going to have better sleep, you're going to have a better concentration and focus. Those things are almost universal for anyone who's done a program of improving their metabolism
and really improves their metabolism. We may also get, you know, bonus things like, you know, stabilizing your mood if you have bipolar disorder, or reducing your psychosis if you have a schizophrenia or schizoeffective disorder, or reducing your obsessions if you've got OCD. I've seen all of those things happen in people. And at this point, again the science is so early, it's hard to predict how much of a symptomatic benefit people are going to get, or maybe how
long it might take. I mean, that's the other part is that for some of these people, it may be that this is a treatment that could give them some immediate benefit. As soon as they're into keytosis, some people start feeling the benefits, and for other people it may take quite a few months or even many months for
them to get all of those benefits. But the benefits accrue over time as the metabolism continues to improve, as the mitochondrial health continues to improve from that ketone signal, the benefits keep accruing.
Now, and look, we'll dive into the role of the mitochondria in a minute, and really into the kedogenic diet, but just really if we take a step back and look at first principles here kind of like you know, the observation earlier on that the bring you know, it's only two to three percent of the way but uses twenty percent plus of energy. I like to think of
these things from the perspective of the human genome. And I remember as a legendary exercise physiologist Professor Frank Booth, who in a research paper in twenty twelve said the human genome hasn't changed in over forty five thousand years. They said the current human genome requires and expects us to be highly physically active for normal functioning. But then
you add on a couple of things to that. And if you just look at our species, the evolution of our species, we've always moved as shitload, shitload more.
Than we had to just survive, right, we had.
To absolutely, And now the research around the role of milo kinds, these signaling molecules from contracting muscle and how they impact every friggin organ including the brain. You know this is in your face, right, But then you know nutrition, we have always as a species eaten natural foods, and the enzymes in some of those foods they work as cofactors for our metabolism. And it just for me is pretty friggin obvious that with then you take this genome
and you stop it moving or reduce its movement. You then do two things in nutrition. You reduce the amount of good nutrition that it's it's it's really depended on and depends on metabolically, and you replace that with a whole heap of ultra processed ship which we know is doing damage. And then if you throw in lack of sleep as well, which you know was a psychiatrist can cause mood disorders in and of a tone and a whole heap of overstimulation, like good luck with your mental health.
It's so true. It's so true.
The modern world is an absolute setup for poor mental health. It's not individual people's fault. I mean, I think that's really important to say, is that the system is set up for people to have poor mental health.
Everything you described is one hundred percent true.
And I would add in were we evolved to have light as a nutrient as well, the right amount of blue light in the morning and no blue light in the evening and throughout the night, and that was such a powerful way to control our circadian rhythms, and our whole biology is controlled by those rhythms. And we've also messed that all up by being indoors all the time and having blue light at the wrong times at night, which is the most powerful signal for us, Katie and clock.
But absolutely the exercise thing, you know, you make me think of this book I read by an anthropologist Dan Lieberman.
He's at Harvard.
Yeah, yeah, well he wrote Exercised also, which is an interesting one. It's all about how we are not. We did not evolve to choose to exercise ever. In fact, we evolved to conserve our energy because throughout our evolutionary history we were barely surviving. You know, food acquisition was the biggest challenge for survival and predators of course, but
food acquisition was really the main thing. So that means we were going through periods of time where there was no food or no carbohydrates, in and out of ketosis all the time. So we certainly evolved to have ketones. Keytones were part of our survival mechanism, which I want to go into as well. But you know, we had to move so much to survive. Whenever there was a chance to rest our, brains of course were evolved to
choose to rest. And here we are, we have no survival need to move anymore, correct, And so of course no one wants to go. It's not in our brains
to want to go and exercise. I mean, of course, those of us who do, we've taught ourselves that this is good for us and that will feel good, and that there's really good reasons to do it, and and then it becomes a habit, and of course you know, we feel all the benefits of it, but most people don't do it because we didn't evolve to, you know, wake up and decide I'm going to go run for
no reason. And in in you know, in persistence cultures, subsistence cultures, now, you know, in you know, traditional cultures, people look at the idea of exercises the craziest thing they've ever heard, you know, because he goes and talks to these people, and you know, in the remote parts of Africa, and yeah, the hads they don't exercise for exercise sake.
Ever.
They sit around if they can, and of course they still because their survival needs will get you know, a good ten twelve miles a day, but they will never choose to do it if they don't have to.
Yeah, absolutely, Like we are absolutely aligned on this. I wrote a book called death by Comfort while modern life is killing Us and what we need to do about it, And it was that whole idea that we am default towards comfort and relaxation because of exactly all the stuff
that you just said. Yeah, now, let's let's not then talk about the role of the ketogenic So you've mentioned a number of times the ketogenic diet, and let's use that as a segue into metabolic treatment versus medication treatment. So obviously you're an expert in both camps right now, So just give us the overview on that and as dive as deep as you want into high a ketogenic tyte and ketones in particular or play a role here.
Yeah. Well, yeah, there's so many ways I can go with this.
But the one thing I want to say at first is that, and I know you know this, is that we don't have a lot of deep knowledge about how psychiatric medications help with mental health disorders, and in fact, the prevailing theories, for example, the serotonergic hypothesis of depression has been challenged and I think very much.
I've had one of the authors of the seminal research paper on this podcast.
I know exactly what you're talking about, the umbrella research article from the group in London.
Yeah.
Yes, so you know, all we know is that we can fiddle with these neurotransmitters and we can get some percentage of people of reduction and symptoms, not a huge percent them and certainly not all the way to wellness
and with a lot of side effects. Meanwhile, on the other side of the ledger, with this metabolic approach, the ketogenic diet, as I alluded to, the neuroscientists have been studying this intensively because they've known the ketogenic diet works in epilepsy and they're trying to figure out, well, how does it work? Of course, I think the main motivation for a lot of them is how are we going to find a drug that mimics what this diet does, because it's hard to get people to do the diet.
But we now know that there's at least seven main mechanisms of how this diet works, and I can go through I can go through them. We've already alluded to some of them, but one is this alternative source of fuel, and that one's important. I'll go into a little detail about that. The brain becomes insulin resistant just like the rest of the body does. In mental health disorders. It may be that the brain is insulin resistant well before
the rest of the body. Different organs get insulin resistant at different rates, and so when the brain is insulin resistant, it can literally be bathed in glucose but not be able to get that glucose into the cell to burn for energy.
And the keytones type three diabetes type three.
Exactly, So that same mechanism may be at play with mental health disorders, or at least some of them. Or some of the people that have them, and we bypass that blockade essentially by getting ketones into those neurons, and it doesn't need insulin to get in. And so in that case, some people will get that immediate effect from keytones. Even exogenous keytones will give them a huge mental health boost, or even something like MCT oil which makes has deliver make keytones out of it.
That's a really important point that I just want to double click on mot that that and again those first principles. If your neurons are not getting the energy, they don't work, they stop working, and then you are going to have compromise Brian function, which can manifest in a range of different psychiatric conditions. Absolutely, and you restore the energy, then neurone start working again, that Brian starts working again. I
think that's really important for people to understand. I just wanted to really emphasize that.
Thank you.
Yeah, I agree, that's important to double click on for sure. So that's the first mechanism. Second one I would say is this improvement in mitochondrial health. So the keytones are a signal for mitochondria biogenesis, but also for mitophagy, essentially the recycling of the old damage, non working mitochondria, you know, breaking them down for parts and making new, good, well
functioning mitochondria. And people might remember from their high school biology that mitochondria are the energy factories in the cell, which they certainly are, but they do many many other things, right.
Shit, look right, more than just producing energy. We've actually had a whole podcast on the mitochondria with doctor Cristo bill Yow. So anybody who wants to dive into that can can go and look at that. But yeah, uh, I mean, I'm all over this like a spider monkey,
that that that mitochondry. But isn't it amazing just as a little aside high the sale and even in the mitochondria high it recycles and these these but this this mital autophogy that hi just high freaking clever and and and how there's no wasted resource within the sales r. It's constantly recycling stuff to to recreate. Ny.
Well, it's amazing. The whole process of autophagy is absolutely incredible. We recycle everything.
All of our.
Cells get recycled, not just the mitochondria, but our cells and our tissues recycle. In fact, you know, if you look at like one of your muscles. You know, your biceps. Let's say you know that bias is not going to be there's not going to be a single cell that's the same a year from now.
That's there.
Now, Yes, it's just incredible. We keep recycling ourselves. We're not the same cells now. There are some cells that stick around and don't recycle, neurons in particular, but muscle cells, they'll just recycle, turnover. We got a whole new set of them, whole new muscle, you.
Know, in a year. Absolutely incredible, that's right, and that most people have good no idea about that, right Like that, I talk about change and cellular change. The only reason we're still alive is that we're constantly recycling.
So we need to take care of our recycling.
And one of the ways we get ourselves to recycle is having some periods of time when we're not eating.
That helps with autophogy. Exercise for sure.
Ketogenic diets are very powerful signal for autophogy and especially mytophagy. So that's our second mechanism. The third one is less oxidative stress. So when we burn fat for fuel, it's much cleaner than burning glucose for fuel, and so we are producing less oxidative stress. People are so interested in taking antioxidants, which I'm all for as well, but even more powerful is just let's produce less oxidative stress in
the first place. And if we can reduce some of the simple carbohydrates, get our bodies to be burning more fats and ketones in the brain versus you know, glucose, we're going to create less oxidative stress in the first place, create less of that damage.
Less energy is.
Needed to squelch the oxidation oxidative stress.
Absolutely, and I think most people don't realize. I mean, most of the ultraprocessed foods are simple carbohydrate bias because it's very very cheap to produce it highly profitable, and most people don't realize about age GLYCATIONI antestors that we get from the die congestion of these simple carbohydrates, and that causes oxidative stress and inflammation at a cellular level, which just wreaks havoc on your metabolism.
Yes, it does, absolutely and and just you know how much resources need to be put into fixing all the damage.
That's a good point, actually, Yeah, the antioxy and defense systems and stuff like that expensive to runness stuff is.
So you already mentioned the fourth mechanism, which is inflammation. So the ketogenic diet reduces neuroinflammation. We now know that inflammation is a huge component for most of the mental health disorders. It's been most studied in depression. They're actually studies that show that people who are depressed, who have elevated C reactive protein, their depression responds to anti inflammatory drugs and so you know, and that's been replicated a number of times.
Actually, Yeah, and I've seen studies actually on tumoric and calcumen being pretty effective as an antidepressdent. And actually out of iran on looking at saffron, yes, which is anti inflammatory, good anxiety really effect.
Safron's good for anxiety actually, but of course those are not nearly as powerful as the reduction in inflammation we get from a ketogenic diet.
Yeah, So that's the fourth.
Fifth one I'll talk about is neurotransmitter based. So we ketogenic diet produces an increase in GABBA, which is our calming neurotransmitter, the one that people are looking for when they're taking a drink of alcohol or taking a medication like a benzodazepine like laraise a PAM or diazepam clinasea PAM. Yeah, the brand name would be Valuum or adavan xanax. Those
there's the brand names. And it reduces the kegenic diet also reduces glutamate, which is this excitatory neurotransmitter that we certainly need, but too much of it causes lots of problems. And in fact, a study just came out today I think in the British Journal of Psychiatry. A group in University of Edinburgh did a pilot study on ketogenic diet and bipolar disorder and they didn't have a control group. There are controlled studies going on now, but most of
the ones published so far don't have control groups. But they saw a really nice response to bipolar with the ketogenic diet dose response as well, so that the higher the keytones, better response. But what they also did is magnetic resonance spectroscopy of the brains and what they saw is it very significant reduction in glutamate in these people whose bipolar got better from a ketogenic diet. And this is really cool because the other things that reduce glutamate
are anti epileptic drugs. And also when people with bipolar recover from any mechanism, they get a reduction in glutamate. But this was the biggest reduction in glutamate that's been seen from any intervention was the ketogenic diet. So that's really exciting because we're now seeing some really good hard science associated with the clinical outcomes in that study, which is very cool.
That is that is very cool actually, and and the dose response that's a telling thing as well, isn't it when you see that dose response for people, I think we are a gluten baturgic society. We really because we're just always all right, and this is what a lot of people don't realize. And glue to me. It's been
highly implicated in depression as well. And then because glue to me, I think it's important for people to understand that that excital toxicity that can happen with too much glue to me, basically the nerve celle can fire itself
to death. And and actually my main professor, Grant Scofield, showed me research that when a a sale and neuron dies from excited toxicity, it actually spills out glue to me and inflammatory compounds that then infect and have a negative effect on surrounding neurons, and there can be like this negative domino effect.
It's very interesting.
Yeah, and that's so that's in the intro. I didn't realize that included. Sorry, A kindogenic diet increases GABA, which is the balance. I mean, everybody hears about serotonin and dopamine and all of these things, but there are dominant neurotransmitters, aren't it, glued to meine in gabba and if they're not in balance, good luck.
They're all over the brain.
So right, there are systems that use serotonin, there's some systems that use neuroper nephrins, some that use dopamine, but the whole brain is running on GABBA and glutamate. I mean, it's the brakes and the gas. It's like the basic fundamental neurotransmitter systems in our brain and they've got to be in balance. And as you're right, modern world, as we talked about, is very pro glutamine and very short on gabba.
Yes, yeah, absolutely, yeah.
So what we got two more more one The one is really an overlap with exercise, but the ketogenic diet on its own increases bdn F brain drive neurotropic factor.
Ah, that's interesting, okay, Because I knew that that a mega three fatty acids can increase BDNF, I did not know that that a ketogenic diet produces BDNF.
My listeners will be very familiar with BDNF. I'm buying on about it all the time. I think somebody once described it as miracle growth. I think you guys used to have miracle growing.
Yeah. Yeah, So the way I describe it is, all these neurons have these fine little branches and they connect to not just a few other neurons, to hundreds and sometimes even thousands of other neurons that process these They call them dendrites, and they call they almost look like the branches of a tree, so they call that arborization. And what B D and F tells these neurons to do is make more branches, you know, arborize more connect
to more neurons, and the more connections the better. So we really need this stuff for our brains to function optimally. It's one of the things that exercise is very good at producing more bdn F. But ketogenic diet also does that on its own, and so you're doing both.
You get that, you know, double effect essentially.
Yeah, I wanted to ask you about because I remember years ago, and I don't know where I saw the paper, but it was suggesting that some of the antidepressant medication and you know, it was like, well, if it was about serotonin, these antidepressants can impact on serotonin because they inhibit the reuptick pumps as as you will though, right, but that that happens instantly, but people generally don't see
an effect for weeks. And I remember reading a research paper that was suggesting that some of those drugs could increase b dn F, and they thought that it was the increase and the bdn F, not the change in serotonin that could have an impact on some people. I've read those any thoughts.
I've read those studies too, and I think there is something to that. But you know, again, like most of the research with antidifferent.
You know, there's just not that much there.
Maybe it's b D and F, but here we have much more science in with the ketogenic diet about raising BD and F.
It's a solid mechanism, you know, we know that it does it. Yeah, it's not and.
It doesn't come with a ridiculous list of side of correct.
Correct, And so the last one is the microbiome gut brain axis. So we know that the ketogenic diet yeah, changes the microbiome and there and we know how powerful the microbiome is as a mediator between this gut brain axis, which is a really powerful impact on brain health and gut health. It's this bi directional communication, incredibly powerful signals through neurons, through chemicals, through hormones that are going back
and forth all the time. I like to say, you know, if someone comes in to see me, if they've got a significant depression anxiety, I asked them about their gut health. Almost universally there's gut health issues. I almost never see someone with a healthy functioning gut. If I ask, most of the icientists don't ask. In fact, I didn't ask until I, you know, learned about this stuff because it
wasn't part of my training. But it's absolutely important, and ketogenic diet improves and changes microbiome composition in a way that improves brain health. We don't know all the details yet.
I mean, if if we know all the details about the microbiome gut brain access in general we've had, we'd have very powerful treatments at our hands, and we're you know, you know it's powerful, but we're at the infancy of really understanding how to manipulate it and what really makes a healthy microbiome, what really makes you know, what really works for brain health. We just we're just seeing little glimpses of magic so far. We don't have all the answers yet.
Yeah. Yeah, I think anybody who tells you they know exactly what a healthy microbiome looks like is full of my dog's cramp. That's my view on this. It's just as you say. It's it's in its infancy, but we know it plays a massive right.
That's right, That's exactly how I see it.
I mean, we can measure all the you know, all the bacteria species by you know, DNA analysis, and you can get this nice report and spend hundreds of dollars. But I think you're right in saying that if anyone tells you they know exactly what that means or exactly what you need to do to fix that, you know they're they're lying to you. You know, it's a nice
story to say. Okay, now we can do all these interventions, but we just don't have the science to know that those interventions really make the changes in the microbiome that we need to make. It's all, you know, it's associational at this point. But we do know that avoiding the chemicals that ruin our microbiome, eating things that nourish our microbiome, fiber, polyphenols, you know, probiotic foods like fermented foods, We know those
things are important for microbiotic health. We just don't know exactly how to manipulate it in a very specific scientific way yet.
Now that leads to an interesting question. So depending on the type of ketogenic diet that people go on, you know, they could have very low fiber in this and some researchers around the GOT will go, well, you have to have a lot of fiber for a healthy gut, right the you know the count because and particularly around the
short chain fally acids that are produced. But as my me professor Grantzcofil who's a big fan of the katogenic diet, says, you know, butter produces butta rate right and and and so there are things in a kidogenic diet that will actually supplant or or replace. Fiber is a substrate, but is the you know, and this might be just gaswork here. But when people have mood disorders and they go in a ketogenic diet, do we think the impact on the microbiome is more of they're now not eating all of
that shit that is disrupting it, or is it? And the stimulation of certain things from elements of the ketogenic diet and independently, you know.
I don't think we know the answer, but I agree with your first point that it's so powerful to remove the chemicals and the preservatives and all these things that we know are toxic to the microbiome. So at the very minimum, when we put someone on a ketogenic diet, they immediately are going to eat a lot less processed food.
You can't eat ult process on the hyogenics.
Right, You're going to be making much of your own food yourself, or you're going to be obtaining it from a place that's using whole foods because that's the only way to get the macronutrients right. And so most likely that's the biggest factor I personally, you know, And again I don't think the whole story is out here yet.
I like to hedge my bets.
I think there's some good evidence about fiber and polyphenols from plant foods being really good for our health in the long run. There's actually some interesting work on polyphenols giving signals to the mitochondria that are very similar to what ketones do to the mitochondria. The genetics overlap quite a bit. They're both hormetic things, hormetic stressors. You know, polyphenols are a hermetic stressor.
But I think can can you talk a little bit about that because Mark Mattson, I remember cheeses twenty thirteen reading a research paper by Mark Mattson about hormetic dietary polyphenoes. And I'm a huge fan of horrors. Me and Grant who are talked about their starting a lab called the Hormees love it. So just go down that pathway a little bit for people and have that understanding, because, like you,
I'm utterly convinced about polyphenols and the fiber story. We can see a healthy microbiome with less fiber and more fiber, and you know, I don't think we know all of it. But anyway, back to back to hormetic polyphenols.
Yeah, so you know, polyphenols are compounds in plants.
There's about eight thousand of them. They're just a you know, a group.
Of chemicals, and there's eight thousand different types.
Some of them have been.
Studied to have, you know, some really interesting health effects. You mentioned curcuman before, for that's an example, Resvera trolls another example, Alison fore, you know, interesting you know, medicinal properties. But essentially, what they often are doing is they're causing
stress or hermetic stress to the cell. And of course, you know, you know, and your audience notes, the idea of a hermetic stress is that it's going to cause a stress that the cell will need to adapt to and get stronger by adapting to it.
Now, I think, you know.
For some people, you know, a very you know, you know, who don't have a healthy gut, this can be problematic because if they're there's holes in the gut wall. Let's say these polyphenales are getting into the bloodstream unchanged, unmetabolized, because really what often happens is the polyphenals are getting metabolized by the microbiota their food for our gut bugs, and they're metabolized and them turning them into a different chemical that maybe could.
Be useful for us.
And so it's this is synergy between eating plant foods, a healthy microbiota, and a healthy gut wall, that may be what's really working. And so for some people I think it is really important they need to actually reduce their plant material and some people can heal their gut by going to a low plant, low fiber diet, these carnivore diets for example, and there's one hundred really interesting you know idea of you know, healing the gut that way.
My hope is that for some of those people they can heal their gut and maybe get back to adding in some of these plant materials. Now a lot of them don't want to. They say, I've never felt better in my life. I am done with plants, you know, And they're never going to go back. And that's okay. I mean, they're doing great, you know, that's fine. But I do think there's potential benefits of these hormetic stress
or polyphenols. I do think there are potential benefits of different types of fiber if the gut is functioning well and the microbiomes functioning well. So I like to include that. But if someone's really having gutshoes will start eliminating some things and the carnivor is really almost like the ultimate elimination diet to heal the gut.
Right it is, Yeah, yeah, absolutely, And you will see a bucketload of people who say that they hate their gut on the carnivor. And I think you bring up a really good point, Matt, is that I think nutritional recommendations should be conditional, right, And so you talk to anybody who has a problem with fod maps and so so you know, you give them. So my wife has got a little bit of an issue with some of the fod maps. Things She eats garlic or onions, which
she loves, and her stomach just absolutely blows up. Right, So this is the thing, were its conditional right. It's anybody who says always are never and it just should listen to them.
That's right.
There's no one diet that fits all. We need to individualize it to that person and for that time in their life, and it might change over time for them what's needed. But there's no that's really human diet that doesn't exist.
Yeah, And there's no perfect human diet that that there's no one diet that is going to be optimal for you throughout your life course and you know, having certain conditions can then change it. Like you said, that's that's that's really important, and that that is a a a or force of the the impacts of of of the of the ketogenic diet and how they actually do it. So and then let's just talk a little bit about
the mitochondria in general. How big a role do you think the mitochondria play and what other support other than a kidogenic diet. So just before you answer that question, and you said earlier on about light and the importance of light, I don't know if you've seen some of the studies around photo biomodulation and the use particularly of
near infrared light for neurodegenerative diseases. Like I nearly fail off my chair when I've readen that, and I actually have a red and near infrared light panel that has actually been really useful for my recovery. But the shit that happens in your sales and with different wave lengths of light and how the mitochondria react to them, it's just mind boggling.
It is.
Yeah, the mitochondria are absolutely central to metabolic health, not just because they're the ones producing the energy in the cell, but they're involved in the whole process of energy accumulation, acquisition, and distribution, so many of the steps they're involved in the first steps of hormone synthesis, neurotransmitter release. They're turning genes on in the nucleus, turning them off. You know, they're they have an intelligence and they react to certain things.
They get energy from wavelengths of light. As you were mentioning photobiomodulation, they're reacting to the stress in our lives. They've been able to actually see under the microscope mitochondria change when people are doing a meditation. They react to medical they react to someone meditating, They huddle around the vesicles as the neurotransmitters are going to be released. They
have an intelligence. It seems that we're finding that I think we're again just scratching the surface, just like we're scratching the surface of the microbiota. And you know, I think all of the metabolic psychiatry program that that I want people to follow is focused on mitochondria. So ketogenic diet. Of course, we've talked about exercise, which is of course is huge for mitochondria and mind body practices which I
just talked about. These mitochondria reacting to the stress response and the relaxation response and circadian rhythms with light, getting that morning sunlight, getting the hormones and balance cortisol and melatonin imbalance at the right times, and then also getting that direct energy source from the best source of light of all, which is our sun. You know, we need people outside more and so that's the whole program. That's
what we do at a chord. It's all of those things and avoiding these metabolic disruptors like processed food and chemicals in the water and blue light at night and all these things that will disrupt our metabolism and our
mitochondrial health. So if someone does all of it at once, that's the idea is that you know, immerse ones, immerse someone in the whole program and teach them how to do it so that when they go home they can continue all of these lifestyle changes that they made and continue to accrue the benefits over the course of many months.
We need to take you and clone you and just have rapid reproduction. And so to tell me what sort of benefits are you seeing at a core like and what sort of people come to you guys, and what sort of results are you seeing because this is the most comprehensive mental health intervention that I've ever heard of.
Thank you, Thank you so much.
Yeah, we've had people with many different diagnoses, so we can take someone who has almost any mental health diagnosis. They have to be stable enough that they can do this program. They have to be motivated enough to want to do this program. So they have to have made a decision that they want to use diet and exercise and mindfulness and sleep rhythms to.
Work on their problem. And we're going to help them do it.
We're going to give them a lot of support and a lot of teaching, and we have a chef there is making delicious foods, so it makes it very easy to do the ketogenic diet when when she's cooking the food and we have a dietician crafting the meals. So we've had people with bipolar disorder type one and type two, skizo effective disorder, major depressive disorder OCD. Many of these folks have had comorbid PTSD. Because almost everyone in the mental health world has traumatic experiences.
But we can take people who.
Have you know, some anxiety and ADHD and they'll get a tremendous response and we've just seen incredible outcomes for the people who do the program. We're monitoring their blood work, we're monitoring their key tone levels, continuous glucose monitor, body composition scans, and mental health rating scales. So we're seeing the results and they're just really, really mind boggling results that we're getting through these interventions in ways that traditional
psychiatrists just would not have expected. And you know, to be honest, I wouldn't have expected, you know, five six years ago, if someone told me that I was going to be running a program like this and getting these results, I would have left. Wow.
And are these are they all impatient that they have to come in and stay with you guys to get the sort of full immersive experience.
It is an immersive in person program we have. It's this very small program. We're just you know, we're just getting started here. But we have five beds and we can have people who live nearby can come for day treatment if they want, and just come and eat all their meals and get all the education and all the programming. They can then go back and sleep in their own bed at home if they want, if they live close enough by.
Yeah, Yeah, that is amazing and tell me last question, what are you excited about in the future of the mental health landscape and what are you concerned about as well?
Well.
What I'm excited about is that right now, as we speak, in early twenty twenty five, there are many randomized controlled trials of the ketogenic diet in mental health with basic science components along with it, meaning they're doing neuroimaging, metabolomics, genomics going on right now.
And so the.
Data and the papers that are going to come out in the next couple of years, I'm just over the moon about what we're going to see in these papers. We're going to learn so much about what works, how it works, what's going on in the brains, what's going on in the metabolism during all of these interventions. So that science that's going to come out I'm just so
excited about. I think what I'm worried about is I think what happened in the epilepsy world, which is that they knew that the ketogenic diets work, and they knew that they would work even when the medications wouldn't work, and even and there's you know, twelve randomized controlled trials showing that they work in kids and adults in epilepsy, and still it's not even in the first line treatment or the second line treatment or.
The third line treatment.
And so that's what I'm most worried about, is that we can show how effective this is and show how amazing it is, and the field of you know, my own colleagues are going to turn over and say, well, we can't get people to do it. It's too hard, So let's forget about it.
Yeah, and let's go down to drug right, right.
Or or some of the other exciting things. There are other exciting things happening in mental health with psychedelics and some brain stimulations. Some of the you know, mess studies that have come out are really exciting, and so you know,
those are more medical. They're not diets, they're not exercise, and so I just worry that everyone's going to gravitate towards these you know, medical things that are exciting too and miss what I think is the headline, which is that the metabolism is the underlying you know, basis the foundation of the brain's health. Those other things are great if someone gets into trouble, but let's work on the foundation for everybody first.
Yeah, Yeah, get your metabolism right, and your physical and mental health will thank you for it for your entire right.
That's right.
It just we just can't get away from the fact of what our genome requires. Going back to what we talked about earlier, exactly, Matt, this has been absolutely bloody awesome, eye opening and inspiring an equal degree. Where can people go to find more about you? Got you personally under core in general? And do you have any plans in the future to try to be able to scal this intervention? And I get the impatient requirement of the minute, but is there any plans on that.
Absolutely, we love the idea of scaling this up, and I think we need to demonstrate what we can do, how powerful it is, what are the ingredients that are most important. So that's sort of the phase where the field is now. But people are absolutely very interesting, including myself, and figuring out how do we provide this to way more people at way less of a cost, How do we make this easier for people and especially people with
a mental health condition. So again, you know, keygenic diet might be challenging for regular Joe out there, but add in this person has a pretty significant depression and it becomes even more challenging.
So that's hence the requirement for the price.
That's why it's not just online, you know, do it at home. You know, some people can do it that way, and I love it when people can do it that way, but many of the people that I work with, my clients, need more support than that to do it.
At this point.
In terms of where people can find me, I'm on LinkedIn. I'm not a big social media presence, so people aren't going to find me on you know, X and Instagram.
I'm just not out there. But they can find me on Instagram.
If anyone wants to message me on Instagram, I always connect with them there. And then people should look at the Accord web page. So Accord mh dot com is the web page for a Chord and that people can learn all about the program there and if someone has any interest in We've had people come from other countries already.
You know, if someone from your neck.
Of the woods or people listening all over the world, if they want to come to a Cord to get this treatment, we would love to have you. Unfortunately, at this point it is a private, pay you know, fairly pricey kind of program. Again, we'd love to make this, you know, easier and inexpensive for people. That is the goal for sure, But at this point this is sort of where we are. Was how we have to start.
Yeah, yeah, I get that, and hopefully at some stage governments will then, you know, as you guys grow and get your efficacy, have a look at this and think about the longest Absolutely, yes, these these intensive interventions can be expensive, but what's the cost of somebody being having a serious mental health disorder for twenty thirty years and even just the cost of the medication.
Costs of the medication is tremendous. But think about the lost productivity. Think about the costs of their families and the lost productivity there. Think about the pain and the anguish that they and their families have to go through. You know, we can avoid a lot of that, I think.
Yeah. Awesome, doctor Matt Bernston, you have been awesome. Thank you very much. Thank you so I'd love to have you on again.
It's I'd love to come back. It was a really fun conversation.
Thank you.