Ep. 239 Brain Energy: A New Way to Look at Mental and Metabolic Health with Dr. Chris Palmer

I am honored to connect with Dr. Chris Palmer today! He is a psychiatrist and researcher working at the interface of metabolism and mental health. 

Mental illness can devastate lives! Some members of Dr. Palmer’s family struggled with serious mental health issues, and his mother’s experience with the mental health system impacted him deeply. He found the system incompetent and ineffective, and many mental health clinicians were distant, aloof, and snobbish. 

In this episode, he shares his background and explains how a patient changed his career trajectory in 2016. We dive into the connection between mental disorders and metabolic disease, the traditional focus of psychiatry, the value of low-carb and ketogenic diets, the role of mitochondria, and mitochondrial dysfunction. We also get into intergenerational transmission of trauma and the importance of sleep, and Dr. Palmer discusses his new definition of mental health.

Looking at mental health through a metabolic health lens makes so much sense! I believe that Dr. Palmer’s new book will be an incredible resource for clinicians, their patients, and their patient’s families. Tune in to hear what he says about the link between metabolic disorders and mental health issues.

“Mental disorders are now the leading cause of disability on the planet because our treatments fail to work for far too many people.”

– Dr. Chris Palmer

IN THIS EPISODE YOU WILL LEARN:

• The traditional methodology used to address and treat psychiatric illnesses when Dr. Palmer started in the mental health field.
• The serendipitous way in which medications for mental problems got developed.
• Why are most psycho-therapies and treatments ineffective for treating chronic PTSD and depression, and personality disorders?
• Why mental disorders are currently the leading cause of disability on the planet.
• How an experience with a patient-led Dr. Palmer to understand the connection between metabolic health and mental health.
• The connections that contributed to the miraculous changes Dr. Palmer’s patient experienced.
• How does the ketogenic diet affect the body and brain?
• The role of the mitochondria in the body and how they contribute to mental health. 
• The impact of intergenerational trauma.
•  How intergenerational trauma could show up as mental health issues in future generations.
• The interplay between sleep and mental health.
• Dr. Palmer gives an overview of his new definition of mental health.

Bio: Dr. Chris Palmer

Dr. Chris Palmer is a psychiatrist and researcher working at the interface of metabolism and mental health. He is the Director of the Department of Postgraduate and Continuing Education at McLean Hospital and an Assistant Professor of Psychiatry at Harvard Medical School. For over 25 years, he has held leadership roles in psychiatric education, conducted research, and worked with people who have treatment-resistant mental illnesses. He has been pioneering the use of the medical ketogenic diet in the treatment of psychiatric disorders – conducting research in this area, treating patients, writing, and speaking around the world on this topic. More broadly, he is interested in the roles of metabolism and metabolic interventions on brain health.

Connect with Cynthia Thurlow

• Follow on Twitter, Instagram & LinkedIn
• Check out Cynthia’s website

Connect with Dr. Chris Palmer

• On his website
• Go to www.brainenergy.com to get involved with Dr. Palmer’s new approach to mental health and learn more about his book.
• On Facebook, Instagram, and Twitter

Transcript:

Cynthia Thurlow: Welcome to Everyday Wellness Podcast. I’m your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent are to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.

Today, I had the honor of connecting with Dr. Chris Palmer, who is a psychiatrist and a researcher working at the interface of metabolism and mental health. We dove deep into mental disorders and the connection with metabolic disease. We spoke about his background and the traditional focus of psychiatry, how he had a patient in 2016 that changed the trajectory of his career and the value of low-carb ketogenic diets, the role of mitochondria, mitochondrial dysfunction, intergenerational transmission of trauma, the role of sleep, and other lifestyle modalities, as well as Dr. Palmer’s new definition of mental illness. I do believe this book is profoundly impactful not just for clinicians, but also for patients and their families and allowing them to have a hopeful look toward the future. I hope you will enjoy this podcast as much as I did recording it.

Well, Dr. Palmer, I’ve been so excited to have our conversation, I really think that your book is going to be an incredible resource, not just for providers, but also for patients as well.

Chris Palmer: Thank you so much. And thanks for taking the time to read the book and thanks for having me on your podcast.

Cynthia Thurlow: Absolutely. We serendipitously literally ran into one another at an event we both spoke at in Austin. And I know when you started talking about your book, the first thing I said was, “Oh, I have to bring you on the podcast because this is so relevant,” looking at the lens of mental health through metabolic health, which makes so much sense. I’d love to really start the conversation from a perspective of, did when you went to medical school that you were going to specialize in psychiatry? Was that the direction you were headed in or was there something that was serendipitous for you?

Chris Palmer: It’s a really good question. And the real answer is, it’s a very long story. I’ll try to give you the very short version. I struggled with my own mental health issues when I was young. My mother had very serious mental health issues, as well as some other people in my family, but my mother’s experience with mental illness and with the mental health system had a profound influence on me. And I was actually quite angry with the mental health system, I saw the mental health system as incompetent and highly ineffective and so many mental health clinicians, I just saw them as aloof snobs, and they just put their nose up at you and just ask you how does that make you feel, and they tried to distance themselves from you and not show their true emotions or their true selves. And I actually never liked that approach. And that’s where I came out from. When I was in college, I actually thought about specializing in psychology. Many people actually talked me out of it, saying that there are too many psychologists, you’ll never get a good job, so don’t do that. And for a variety of reasons, I ended up deciding to go to medical school. And when I went to medical school, I actually had no desire to go into psychiatry initially. Although, I was still deeply passionate about mental illness and how it can devastate people’s lives and how we need better treatments and better solutions.

But I was thinking I’ll do internal medicine or pediatrics or something else. And when I did my psychiatry rotation, actually, in medical school, I was equally disappointed. I thought “Oh, my God, what are they doing? They’re not really helping these people at all.” And I ended up winning some prizes for being one of the top medical students and I had so many professors, tell me in no uncertain terms, don’t go into psychiatry, it would be a waste of your career. And that actually ended up having the opposite reaction on me that they wanted. I actually thought to myself, is this why the outcomes are so poor in mental health because none of the good medical students go into psychiatry? I get all the not-such-good students and maybe that field needs some smart people and maybe I could actually do something and make a difference. And that’s how I ended up in psychiatry [chuckles].

Cynthia Thurlow: No, but I’m so grateful because of my experience, I was an ER nurse before I became an NP. And the first hospital I worked at was right across from Sheppard Pratt, and for anyone that’s listening, it’s one of the mental health centers for the part of the Northeast that I was in, and we did a lot of their intake and I was able to see as a new clueless nurse sitting at triage and taking intake for the psychiatric hospital, I was completely astonished at the way patients were treated, the way that most of the psychiatrists interacted with them. And I used to pray, I worked at this Catholic hospital, so it’d be very appropriate for me to say I used to pray that there were certain psychiatrists that were on call because several of them were incredibly compassionate and kind, and really took care of these ER patients, and some of them were not. And I remember saying to a colleague of mine, it’s just unbelievable that we don’t have more options, at that time, this was in the late 1990s, and I just recalled that there were so few options for patients and their families. And I would have family members that would express concern– just because my family member isn’t saying that they want to hurt themselves or hurt someone else. They’re being sent home with us, but clearly they need better care. And they felt even at that time that they were given the runaround. So, I’m so very grateful to know that there are clinicians out there that are as kind, compassionate, and are really paving the way to change what has been a very traditional trajectory for psychiatry and medicine. And perhaps paint the picture of when you enter psychiatry, what was the traditional methodology that was utilized to treating and addressing psychiatric illnesses because I would imagine most listeners may not be familiar with this, that they haven’t worked in the medical system or had a family member that’s been utilizing those services.

Chris Palmer: When I first started, I was being sold a message that “Oh, we’re making so much progress. We’re having rapid advances in the mental health field. We’re discovering genetics, neurotransmitter imbalances, and levels of inflammation, and these things are going to make a huge difference for mental health patients.” Within a couple of years of that, I quickly began to realize any patient or family member asking me just basic common-sense questions, well, “If it’s a chemical imbalance, why don’t the meds work right away?” What causes that chemical imbalance? Because it hasn’t been there along like this person was fine a month ago and now they’re not fine. So, what caused the imbalance? It can’t be a genetic imbalance because if it was genetics, this person would have had it all along, right? And I’m sitting there thinking, “Yeah” [chuckles] and our field didn’t have any answers. And very quickly, I got to a place that I felt comfortable and told people the simple truth, no one knows what causes mental illness.

And that has been really huge part of the problem in the mental health field, is that statement. No one knows what causes mental illness. All we know are some of the factors involved like genetics, neurotransmitters, hormones, stress, trauma, sleep, drug use, all of these things we know play a role in different ways in different patients, but without knowing the exact cause, we have developed a lot of treatments that were usually discovered serendipitously. So, for instance, the first antipsychotic medication called promethazine, was actually developed as an anesthetic for surgery. And the researchers and clinicians using this noticed that it really significantly sedated people. They were called major tranquilizers. And it really tranquilized people and they thought, “Oh, you know all of those psychotic patients, this might be really useful to tranquilize them in this way.” And that’s how we began developing and using those treatments.

The researchers quickly studied these molecules of these medications and tried to figure out what exactly are they doing. And then they developed more and more medications based on that model without any understanding of what these medications are doing, and without any appreciation that for the majority of patients that these medications were being used, and it was not changing their lives, and restoring health completely. It was reducing symptoms, and make no mistake, I am not apologetic about this. It was keeping people alive. It was keeping people out of prisons and jails and homeless shelters. It was keeping people from assaulting other people and those are really good things. I don’t think anybody in the mental health field had bad intentions in using these. They were the only tools that we had available. Antidepressants also were discovered serendipitously, believe it or not, the first real antidepressant on the market was actually a tuberculosis treatment. And as they were using it in tuberculosis patients, the ones who were depressed were all of a sudden getting less depressed, and the clinicians treating them noticed that. And so, so many of the medications that we have, we don’t even know how or why they work. We just know they work for some people and so we use them. And sadly, our field has not progressed much since the 1950s.

We are shooting in the dark, we are using these treatments. Now, in addition to medications, treating chemical imbalances, we’ve also got lots of psychotherapies, psychodynamic psychotherapy or analysis, we’ve got behavioral therapies and lots of others. And we use those and those work for some people as well. But again, if you look at the outcome, statistics, they’re not that great. For people with chronic PTSD for people with chronic depression, for people with personality disorders, we’re not curing mental illness with any of these treatments. We’ve got more aggressive things like electroconvulsive therapy or shock therapy, we’ve got transcranial magnetic stimulation these days, they can implant an electrode and stimulate your vagus nerve and that is a treatment that we’ve got.

So, we’ve got all of these treatments, but the real answer and I don’t say this to be pessimistic on purpose, the honest real assessment is that our treatments failed to work for far too many people. And if you don’t believe me, please answer the question, “Why are mental disorders now the leading cause of disability on the planet?” It’s not because people aren’t getting treatment, it’s because our treatments fail to work for far too many people.

Cynthia Thurlow: I think it’s really a sobering statistic and when I was reading your book, I had to read it and absorb because I’m looking at it as a clinician and understanding the way that we have conventionally looked at mental health is really missing the mark. You mentioned in the book that you had this patient that really changed everything for you. I think this is a really powerful example of how metabolic health is intertwined with mental health. I’d love for you to share your experience with that patient.

Chris Palmer: Absolutely. So, that really is where I was until 2016, I had actually been using low-carb and ketogenic diets due to my own experience, and I’ve been using it with patients with depression for almost 20 years now. But depression is depression, that’s I don’t know, a milder illness than this patient that I’ll tell you about in 2016, who had schizoaffective disorder. For your listeners who don’t know that term, it’s a cross between schizophrenia and bipolar disorder, it’s kind of a mix. The bottom line is this man was tormented by his illness, he had hallucinations and delusions, he was convinced that everybody was out to get him, there were these powerful families in the world that had all this technology, and they could control his thoughts, they could broadcast his thoughts. When he went out in public, he was convinced everybody was part of the conspiracy and they were all looking at him, mocking him, or getting ready to harm him, and life was terrifying for this man.

He had tried 17 different medications, but they did not stop his symptoms. Instead, they made him gain a tremendous amount of weight. Weighing 340 pounds, he asked for my help to lose weight. I’m very familiar with ketogenic diet, so we decided to try the ketogenic diet. And at that time, I really was only trying to help the guy lose weight. Even though I was using this for the treatment of depression, in my mind, depression is very different than schizoaffective, they have nothing to do with each other. And I just wanted to help the guy lose weight. I’m hoping it might help his self-esteem or something, and losing weight is a good thing, anyway maybe decreases risk for all sorts of other metabolic disorders. And within two weeks, not only did he begin losing weight, but I started to notice a very powerful antidepressant effect, he was making better eye contact, he was smiling more, he was talking a lot more. And I thought, “Wow, there’s that antidepressant effect I’ve seen in other patients, it’s happening for you, that’s nice.” But he was still having hallucinations and delusions.

About six to eight weeks into the treatment, he spontaneously reported to me “You know those voices that I hear all the time, they’re actually going away. I’m barely hearing them and sometimes when I hear them, I can ignore them now. I don’t even let them bother me anymore.” And it took a little bit longer, so the voices were the first thing to go away. And then he said, “You know, I always thought there were those powerful families that were controlling everybody and everything and had these technologies and they targeted me.” Like yeah, I remember. And I’m thinking, yeah, I remember. Are we going to talk about that again, and he says, “I don’t think that’s true anymore and now that I think about it, maybe it never was, it sounds crazy now that I say it out loud.” And you and others have been trying to tell me for years that I have schizophrenia and that that’s why I have these thoughts. And I never believed you. I always knew they were real. And now I’m starting to question that maybe they weren’t real, maybe they weren’t real are all along, and maybe I’ve had schizophrenia all along. And it’s actually starting to go away. That man went on to lose 160 pounds and keep it off to this day, he was able to do things he had never been able to do since the time of his diagnosis, he was able to go out in public and not be afraid. He was able to complete a college program, he was able to perform improv in front of a live audience. These things would have been impossible for him and when that happened, I was initially just dumbstruck, but I went on a scientific journey to understand what just happened.

Cynthia Thurlow: It’s such an incredibly powerful story and when you share it in the book. We’re not taught in traditional allopathic medicine that nutrition is all that important. And I have come to find that is the most important thing, which is one of the reasons why I left cardiology. What were some of the connections you started putting together that contributed to this miraculous change in your patient’s behavior, views in themselves, weight loss, etc.?

Chris Palmer: It’s really interesting, initially, it was a little overwhelming for me because the ketogenic diet is used as a weight loss intervention, I already knew that. It’s also used for type 2 diabetes, and we have good randomized controlled trials for all of this stuff that I mentioned. It’s not speculation, it’s not anecdotes. These are evidence-based treatments based on randomized controlled trials. It’s good for type 2 diabetes. But of course, obesity and type 2 diabetes are totally different than mental illness and certainly different than schizophrenia. But it’s also used as an evidence-based treatment for epilepsy. And that was a really powerful clue to me initially, I hadn’t realized it at that time. I knew about its use in weight loss and diabetes, had not realized it was an epilepsy treatment. And the reason that was so important to me as a psychiatrist is that we use epilepsy treatments every day in 10s of millions of people. For any of your listeners who have heard of the medications like Depakote, Tegretol, Lamictal, Topamax, Neurontin or gabapentin, Valium, Klonopin, and Xanax, all of those are antiseizure medicines. And the ketogenic diet can stop seizures even when those pills fail to work for people. I immediately started realizing “Wait, if the ketogenic diet can stop seizures even when all of those pills that we use all the time in psychiatry aren’t working, maybe that’s why it’s working for my patient.” And in fact, we’ve got decades of neuroscience research telling us how this diet works on the brain, it changes, and it’s doing all the things we want it to do, it’s changing neurotransmitter systems, changing hormones, certainly improving insulin resistance, it’s decreasing inflammation, and even decreasing brain inflammation, we have direct evidence of that.

It’s changing the gut microbiome. It’s doing all sorts of things that again line up perfectly to be potentially a really important treatment for people with serious mental disorders. Because we know people with serious mental disorders have hormonal imbalances. They have neurotransmitter problems at least or at least they have problems with the function of different brain regions. We know they have higher levels of brain inflammation on average, we know that the gut microbiome might be playing a role somehow or another in brain health. We know that all these things are connected. When I started realizing, “Wait, the ketogenic diet is doing all this stuff and this is highly relevant to the mental health field, this is a no-brainer.” It was extraordinarily exciting for me.

Cynthia Thurlow: I can just imagine a lot of inflammation, insulin resistance, weight loss resistance, mental health, nearly any chronic disease state is really a byproduct of dysfunctional mitochondria and certainly my listeners are familiarized with this concept, the powerhouse of the cells. But I’d love for us to talk a little bit about the mitochondria as well as how this interplays vis-a-vis with mental health because this will really bring this concept home for everyone that’s listening. Everyone is impacted by this, there is no one listening that is not impacted by dysfunctional mitochondria to some degree or another, some more significant than others.

Chris Palmer: Yeah, it’s a great question. And this is something that I dive more deeply into the book. The science of mitochondria and all of the different roles they play up until 20– One of the reasons that this is such an exciting advance is because I’m integrating a tremendous amount of clinical and neuroscience research from the mental health field. But I’m also looking at tremendous amounts of science from the metabolic health field, and from even just the aging field like anti-aging researchers, and interestingly all of these fields are converging on these things that we call mitochondria. All of them are converging on mitochondria in one way or another. And one of the reasons that this is such a revolutionary breakthrough is because 20 years ago, we really just thought mitochondria were stationary powerhouses, we just thought that they were in cells, and they cranked out, they took your food and used oxygen appropriately, and cranked out ATP. And some people even called them little batteries. And there are some researchers still to this day that use that term. And they’ve used it right in front of me and I almost want to smack them [laughs]. Because I’m like, you do not know mitochondria, how dare you say such a horrible insulting thing about mitochondria, they are not little batteries.

But 20 years ago, we didn’t know. Over the last 20 years, there has been an explosion of research looking at all of the roles that mitochondria play. And the more that I learned about these various roles, the more excited I became because they are roles that play a direct role in mental health. And we’ve known it for decades. For example, mitochondria play actually a direct role in both the production and the release of neurotransmitters, at least eight of them. And if mitochondria become dysfunctional, there’s a good chance that neurotransmitter production and/or release is going to become altered or dysfunctional. Mitochondria play a central role in hormone production and release. And there are a few really critically important hormones that mitochondria are actually instrumental in producing. And the reason is because they have the enzyme that controls the synthesis, the first step in the synthesis of these hormones and that means that mitochondria are instrumental in controlling how much of this hormone gets produced and how much of it gets released. And these names are names you’re going to know, cortisol, estrogen, testosterone, progesterone, those are all hormones that begin in mitochondria.

And in other cells that receive or the targets of these hormones, mitochondria are often the endpoint. Cortisol, for instance, can begin in mitochondria in one type of cell and end in mitochondria in another type of cell. And one way to think about hormones is actually a way for the mitochondria and different cells to communicate with each other. There are many other forms of communication, neuropeptides, and other molecules. Mitochondria also play an instrumental role in, for instance, inflammation and some very prominent research articles, especially over the last 5 to 10 years have actually determined that mitochondria are instrumental in turning inflammation on but they’re also instrumental in turning inflammation off in the human body. And what that means is that if your mitochondria are dysfunctional, you may have problems turning on an appropriate inflammatory response, but you may also have problems turning it off. And everybody has heard of COVID and how some people are dying of COVID, and one of the primary reasons or hypotheses for why some people die and other people don’t is because they get this exaggerated inflammatory response, they get a hyper inflammation that doesn’t turn off and it actually is extraordinarily aggressive, out of control, and people die more from the inflammatory response than the infection itself, and mitochondria turn inflammation off.

If you have dysfunctional mitochondria, in particular, in your immune cells, they’re not going to turn the inflammatory reaction off at an appropriate time, and you are going to suffer, you’re going to have symptoms or a disease process or something going on. I’ll stop there. So, I could probably keep going on forever. But essentially, the big picture that I took away of these years of research, is that mitochondria are actually instrumental players in controlling the function of cells. But they are, in fact, one term that gets used by others, and myself, and in the book is they’re workforce of the cell. They’re the workers in a factory and if the workers in a factory aren’t performing properly that factory is going to suffer in some way and the products that that factory is trying to turn out are going to suffer in some way. And that’s the way I think about it.

Cynthia Thurlow: I think that’s such a beautiful analogy to make the point really clear that we want to have our mitochondria optimized, if at all possible, not only just for metabolic health but vis-a-vis for also mental health. And one of the things I found really interesting and I can completely nerd out and I very appropriately told, Dr. Palmer before we started recording that, I always have a good amount of podcast prep, but I had twice the amount I normally do because there was so much information in the book that really was very interesting. As an example, when we’re talking about depression and we’re talking about dysfunctional mitochondria, we have decreased ATP production. So, this is this energy within our cells, we know that we have changes in the hippocampus, which is part of the brain that can impact the– well you explain this better than I do, but my understanding of hippocampus, if that’s impacted that can impact energy levels, perception of reality. There was a rat study that was showing that there were a fewer mitochondria and anxious rats, which makes sense and the differences in the way their mitochondria used oxygen to turn energy into ATP. And so again, it’s really reaffirming that our mitochondrial health is critically important for mental health.

Chris Palmer: Absolutely, there are so many ways to nerd out about this. And one of the tricky things is that mitochondria in different cells are different from each other. What that means is that you can have healthy mitochondria in one part of your body or in certain types of cells. And you can have dying or struggling mitochondria in other types of cells. And what that means is that the rest of your body can be reasonably okay and functioning relatively well. But the cells that have increasingly defective mitochondria, or suboptimally functioning mitochondria, whatever term we want to use, those are the cells that are going to start to show symptoms of dysregulation or dysfunction. And at the end of the day that’s really what illness is dysfunction of cells. Although this all sounds brand new or cutting edge, or maybe even Chris Palmer’s making stuff up, this mitochondrial theory of bipolar disorder, depression, and schizophrenia have been around for about 20 years. I’m standing on the shoulders of a tremendous number of brilliant researchers who have all done this pioneering work. I don’t deserve credit, certainly not fully for this theory.

Science is a team effort and teamwork, a lot of people coming together, and in many ways it’s nothing new. And the mitochondrial theory of mental illness was actually developed because of all those brain scans that we’ve been doing for decades, like SPECT scans and PET scans and functional MRI. Everybody’s heard of those and they know that, oh, they do that research all the time in the mental health field. And they can identify abnormalities in this part of the brain or that part of the brain. And all of those brain scans are actually measuring brain metabolism. And when they’ve gotten down to specific molecules or differences that’s where they’ve started to identify, “Wait, these cells have less ATP than they should.” Healthy people have higher levels of ATP than these people or glucose metabolism. Glucose metabolism is impaired in these brain regions in these people with mental or neurological disorders. And this goes for disorders like Alzheimer’s disease, but surprisingly also depression, bipolar, schizophrenia, but also surprisingly alcoholism.

People with alcoholism over the years, once they have the full-fledged illness of alcoholism or alcohol use disorder, as we call it in DSM-V, they actually have brain regions that aren’t getting enough energy from glucose. All of those brain scans have shown metabolic abnormalities and some really brilliant researchers looked at all of these different metabolic abnormalities and came to the conclusion, the only way that these can fit together is through mitochondria. And we have to understand mitochondria and what’s happening in mitochondria. In order to make sense of all of these abnormalities that we’re seeing on all of these brain scans.

Cynthia Thurlow: It’s really interesting when you get this convergence of technology with clinical medicine and you’re able to ascertain some of these connections. I want to pivot just a little bit because I think there’s been more and more research that I’ve been becoming more aware of in terms of trauma and talking about intergenerational transmission of trauma. And you do a really nice job within the book. And so, I’d like to at least look at the impact of intergenerational trauma, and how that could show up in mental health issues and concerns, not just with the existing generation, but future generations as well.

Chris Palmer: Yeah, I’m happy to dive into that. And it brings up a really important point that I just want to highlight the brain energy theory, a lot of people are like, “Well, you’re just a biological psychiatrist, Chris Palmer, you’re just interested in mitochondria and that’s biology and cell biology.” But this question speaks to the bigger issue of this theory, this theory looks at psychological and social factors, and ties them into human biology and brain health and brain biology, but also overall biology.

And there’s been a tremendous amount of research over many decades now, documenting that people who have horrible trauma histories are more likely to have children with psychiatric disorders. And interestingly, for the detailed studies that have followed generations, their children’s children, it goes at least three generations. And this started, actually, shortly after the Holocaust in about the 1950s, there was a psychiatrist who noticed “I have all of these patients whose parents were in the concentration camps.” It was the parents, the kids weren’t in the concentration camp and yet the parents aren’t in my office seeking psychiatric help, it’s their kids who are in my office seeking psychiatric help. And I’m sure she probably struggled with it, is it just because I’m Jewish, and a lot of Jewish people are sending their kids to like what is this? Why is this happening? I’m just noticing an awful lot of children of Holocaust survivors are now coming to my office with all sorts of serious mental disorders.

And that field ended up exploding and early on everybody assumed well the parents must be suffering from PTSD themselves and/or maybe they’re horribly depressed themselves. And that’s rubbing off on the kids. Maybe they weren’t good parents, maybe they weren’t nurturing parents. And maybe that’s why the kids are the way they are. These are traumatized numb parents for obvious good reasons, no judgment, please don’t at all read into that, that I’m blaming them. They survived horrific, horrific experiences and how could they not be numb and traumatized and depressed, but that that rubbed off on their kids and made their kids mentally ill. And that was the working hypothesis for decades, a lot of people didn’t even believe it. The ones who believed it thought, well, it must be the parent there are somehow being bad parents, or they’re teaching their kids to be afraid of the world. They’re teaching them “Don’t go out in public, don’t trust anyone, you can never trust any human beings, they’re all evil scum at the end of the day.” About the 1980s that began to change because we started to measure levels of cortisol in people with mental illness and began to recognize that people with mental illness have dysregulation in their cortisol system, which means that– normally, we all have peaks and valleys in our cortisol level throughout the day.

Cortisol goes up in the morning and then comes down. But in a lot of people with mental illness, cortisol is up and it stays up throughout the day. It doesn’t go through normal fluctuations. So, it’s almost like the stress response is fully on all the time, it’s never turning off, it’s not ebbing and flowing it should. And for a couple of decades, actually, biological psychiatrists were excited. They were thinking finally we have a test for mental illness and we are going to have an objective biomarker that we can draw blood and do some dexamethasone and suppression tests in people and objectively diagnose mental illness.

Unfortunately, that did not pan out not because people with mental illness don’t have this dysregulation of cortisol, but because it is highly nonspecific. And it turns out some people with mental illness actually have abnormally low levels of cortisol, it’s almost as though their cortisol system burns out for some reason. We actually now know with genetics and epigenetics that parents have epigenetic changes in their stress response system and cortisol system and they actually can transmit that to their kids. It’s not a change in genetics, but it’s a change in epigenetics and parents can transmit this to their kids, which means that if your parents had a trauma history or even your grandparents had a trauma history, you are more likely to have a sensitized heightened stress response, which in some ways biologically might be adaptive. For a family or a class of citizens that are chronically oppressed, and this has been around forever since society has existed, we had people who were put into slavery 1000 years ago. And we have continued that trend, unfortunately, even to this day in some countries, in some societies, there are horribly abused traumatized people who are enslaved essentially. But it’s interesting that biology is transmitting that from mother and father to child to grandchild. And I’m not trying to justify the oppression of people or races, I by no means, please do not interpret what I’m going to say in that way. But it may be that biology recognizes the world as a really unsafe place for you. Biology needs to protect your child and biology needs to make it so that they aren’t trusting of other people because people aren’t trustworthy.

If they’re enslaving you, maybe they’re going to try to enslave your children and we need to make your children have higher levels of fear, have higher levels of stress responses in order to protect them from such an unsafe dangerous world. Those are just some of the ways. There are actually lots of other ways that parents can transmit trauma through messenger or micro-RNA molecules in the womb environment and all sorts of other things. But I’ll stop there.

Cynthia Thurlow: I’d never considered that biology was adapting to protect that next generation by heightening their stress response and reframing it to look at it as a protective mechanism as opposed to something that’s entirely negative. I also found it really interesting that you talk about how you can actually pass along these epigenetic changes via sperm. So, actually when there’s implantation of taking the ovum and the sperm itself, and so it can be imprinted again, can also be another way of imprinting this information, because I lived in a very multicultural area in Washington, DC. And I had the ability to work with 1000s of patients from many different cultures. And over time, you get to know your patients, and they would share things with you.

And although at the time, I was not making those connections, I can now retrospectively see how someone that was oppressed in another country come to the United States and they’re conditioned to make sure that their children don’t experience what they did. But then they’re seeing distressing symptoms and distressing things in their own children and wondering why this is happening. So, that can certainly make sense. I’d love to talk about sleep. Obviously, this is something that I think is truly foundational to our health in every way possible. But let’s tie in how sleep also interplays with mental health.

Chris Palmer: We have known for decades, probably centuries that sleep deprivation can trigger pretty much every mental illness. So, if somebody already has a mental illness, sleep deprivation can make it worse, and it’s across the board. So, somebody with a substance use disorder, somebody with depression, somebody with anxiety, somebody with psychosis. If you sleep deprive them, the symptoms of their illness whether it’s addiction or anxiety or psychotic symptoms or mood symptoms will get worse. But we also have a tremendous amount of evidence that sleep deprivation in and of itself can cause mental illness. Interestingly, sleep deprivation also plays a profound role in metabolic health, obesity, diabetes, and cardiovascular disease. Those are the three disorders that most people accept as metabolic disorders and sleep deprivation makes all of them worse as well.

In order to understand that we have to again, at least for me, I wanted to try to understand that at the cellular level, what on earth is happening? How can we make sense of this? Because we give these disorders different labels. And certainly, they’re very different symptoms. I mean drinking alcohol is not anywhere the same thing as having a heart attack. They’re totally different things. And most people would think those aren’t at all related to each other whatsoever. And yet, when you go to the level of the cell and the level of mitochondria, you can actually begin to connect all of these dots and you even can begin to understand why does sleep deprivation make both of those disorders worse? Why does stress make both of those disorders worse and the intersection point is mitochondria? And so, sleep deprivation– mitochondria are regulated by lots of things but they are regulated in part through our circadian rhythms and sleep is a big part of that. I’ll speak just broadly because I could nerd out and go into all these molecular things and that’s not really probably of too much interest to people.

The big picture is that sleep is a time when our cells are repairing themselves. They actually go into a metabolic state and one of the primary purposes is repair. So, your cells as the day goes on actually accumulate waste products, your cells are busy just trying to keep up doing what they’re supposed to be doing whenever you call on them to do something, whether that’s your muscle cells, whether it’s your brain cells, your heart cells, any of them, they are busy doing on demand, ready to go, working their butts off doing what they need to do, but things can back up and waste products can start to back up. And that’s one of the reasons it appears that humans need sleep. It’s the time when we go off into a lower metabolic state overall. But that’s when a lot of the housekeeping functions of cells take place. And so that’s when some of your brain cells are actually getting rid of, if they’ve accumulated any beta-amyloid plaque for a little while, they’re actually starting to get rid of it and process it and degrade it. And that’s actually getting drained out of the glymphatic system of your brain and being disposed off appropriately.

If you don’t get sleep, those systems back up and your cells can actually get to a state of disrepair. This appears to also include mitochondria. Mitochondria can become dysfunctional for a variety of reasons, they are powerhouses and so they’re burning food and they’ve got lots of electrons flowing through all these membranes. And these electrons are actually– you could think about them almost like acid if you want. Electrons are very powerful and necessary and the system, the biology is amazing and miraculous and spectacular and all of that. And yet these electrons, if they are not managed appropriately, can become quite toxic. And they are the source of what’s called reactive oxygen species or oxidative stress. And that can cause cellular damage and can cause inflammation in the body and brain.

So, mitochondria because they are these hot powerhouses in a way, can become more dysfunctional as well unto themselves, they need either to repair themselves and/or they need to be eliminated if they are really damaged beyond repair and replaced with new ones. If you’re not sleeping that’s not happening which means that over time, your mitochondria as well as other parts of your cell and other membranes and molecules– your mitochondria are going to become dysfunctional and then that can cause a whole host of diseases, both metabolic and mental diseases. Things like heart attacks, your blood sugars can skyrocket from insulin resistance and from type 2 diabetes, but also you can get depressed or anxious or feel this overwhelming urge to go drink alcohol or become psychotic or become agitated.

Cynthia Thurlow: I think it’s really important, one thing I have learned is that lifestyle really is critically important for physical and emotional and mental health. And your explanation about sleep and how critically important that is. Anyone that’s listening, if you’re not getting good quality sleep, you need to figure out why and you need to address it because with the rampant amount of obesity, metabolic disease that we’re starting to really see is most of the bulk of the population. vis-a-vis also mental health issues. This is a very important part of becoming healthier. Now, I’d love to tie in, you have this new definition of mental illness. And I thought this was really interesting that looking at the traditional DSM, which for anyone who’s listening and I may not give it as much justice as you would, but it was the clinical standard of this is how we define mental illness. This is where we put it into a bucket, you have to hit these certain characteristics in order to get these appropriate diagnoses. But you’re proposing a new definition, which I think is much more encompassing and much more comprehensive.

Chris Palmer: Thank you, the quick overview is, first and foremost, we have to distinguish between what is a mental illness and what is a normal reaction to adversity. And right now, DSM doesn’t do that. And the reason it’s so important is because one state– so the symptoms can be identical. People can have the constellation of symptoms that we call depression, so depressed mood, disrupted sleep, poor concentration, changes in appetite, all those kinds of things and even suicidal thinking. There are some human situations that our brains are hardwired to trigger that response and help the appropriate response from the medical field or just from other people who want to help that person cope with the adversity that they just experienced. It’s not automatically just run out and say, let’s put you on a pill because you have a brain disorder right now.

There are other people who clearly have brain disorders. Let me give you just a clear-cut example of this. Let’s say I’m looking at a man and he has a wife and two children. And his wife and two children are tragically killed in an auto accident, that man is going to get depressed very quickly, immediately. And I would argue that is not a brain disorder, that is not major depressive disorder. It is not a disorder. It is a normal human reaction called grief. And the appropriate response from society is to allow that man to grieve, to gather around him to support him, to understand that he is devastated. His world has just been upended. He has lost his support system. He has lost people that he adores and loves and cherishes and his whole life is upended. And of course, he’s depressed. Does he have a serotonin imbalance? No, he doesn’t have a serotonin imbalance. He’s struggling right now with horrible adversity. According to DSM, he’s allowed to be depressed for 13 days. And then if he’s still depressed on day 14, then he has a brain disorder called major depressive disorder. And of course, we lump that major depressive disorder in with everyone else who has even chronic crippling depression for no reason at all.

We assume that his major depression is the same as somebody else’s. So, I would say we first need to look at stress reactions, normal responses to adversity, this is very important to the trauma community. I think people who have experienced trauma often feel pathologized for having the emotions and thoughts that they have. And they actually are outraged or feel at least insulted by it because they feel that they are having normal reactions and that they should not be pathologized and/or necessarily medicated automatically. I’m not anti-medication in these cases. And if medications can help people sleep or calm down and that’s beneficial to them, I’m all for it. But we have to acknowledge this is not a brain disorder. This is a suffering wounded individual, at least psychologically wounded individual and we need to support them.

There are other people who do have a major depressive disorder and I’m convinced of it as a psychiatrist. There is no doubt in my mind, it is real and it exists. And in fact, Hippocrates talked about it, he called it melancholia. This has been around for centuries– millennia. And it has been well described for millennia that there are people who are just depressed all the time for no good reason. And they’ll even say that to me as the psychiatrist, they’ll say, “I don’t know what’s wrong with me. My life is actually a good life. I have a loving family, I have a decent job, I’m well off and for some reason, I’m just miserable. I don’t know why I can’t snap out of this. I don’t want to feel this way. I shouldn’t feel this way but I do. Can you help me?”

And I think those people do have a brain disorder. That’s step one, separating normal responses to adversity from brain disorders. Step two is then looking at brain disorders, what do we call them? The thing that I actually love about this theory is it answers so many questions that we’ve not been able to answer in the mental health field. It might be surprising to people because, on the surface, it makes sense that we have schizophrenia and bipolar and depression and alcoholism and anorexia nervosa. Those are all very different disorders with very different symptoms and different treatments needed. And on the surface that makes sense. But if you look at any one patient with anorexia, turns out patients with anorexia often also have depression and anxiety, maybe even some substance use issues. And they can often get diagnosed with borderline personality disorder or even bipolar disorder. 

And they start to actually– all the disorders start to mix and match and merge and one large study looking at people treated in a mental health clinic, on average people have three and a half diagnoses. And these are not as distinct brain disorders and entities as everybody makes them out to be. And when you look at root causes of brain disorders and mental illness, this cortisol dysregulation that I mentioned. If you just look at that cortisol dysregulation? What exactly is that associated with? Which mental disorders is that associated with? Turns out it’s associated with all of them, every single one, bipolar, schizophrenia, depression, PTSD, eating disorders, substance use disorders, it’s associated with all of them. When we look at the root causes, they actually don’t easily go to any specific diagnosis. And instead, I am arguing that we need to look at mental illness as a metabolically compromised brain. And what that means is that there are parts of your brain that are not functioning properly. Why are they not functioning properly, because of metabolic dysfunction or dysregulation. And that depending on what brain region is compromised, you’re going to have different symptoms. And it’s that simple. Now, it doesn’t mean that symptomatic treatments or specific treatments for specific behaviors or emotions can be really helpful because I think they can be extraordinarily helpful and useful. So, sending an alcoholic to Alcoholics Anonymous is a really powerful intervention. Should everybody with every mental disorder go to Alcoholics Anonymous? No, absolutely not because they’re not having that symptom of the illness of a brain illness.

I do think that we have specific treatments that can be enormously helpful for people with different symptoms or disorders right now. But the easiest way to look at this is metabolic dysfunction. And once we understand that, we can develop broad-based treatments that many of you already know about diet, exercise, sleep, managing substance use, stress reduction, all of these things that can actually have important and dramatic and beneficial effects on all of the mental disorders. And in case it sounds like “Chris Palmer has gone off the deep end, and I’m just making stuff up, and how dare he go against DSM-V? Who does he think he is?” And I can see why some of you might think that I am not alone, the National Institutes of Health abandoned DSM diagnoses over a decade ago because they recognized everything that I just said. They are not valid diagnoses, even though on the surface they make sense, they are not valid diseases. They’re not valid constructs. And one of the really important messages of this, right now we tell people with schizophrenia, you have a lifelong brain disorder, and you’re going to be on meds forever. My theory says otherwise. My theory says they have a metabolically compromised brain. And we can figure out based on strategies and tools that we have available today, we can figure out how to restore their brain health and put that illness into remission.

Cynthia Thurlow: That’s incredibly powerful. Dr. Palmer, thank you for your work. Thank you for giving so many listeners and their families hope. Please let my listeners know how to connect with you. Obviously, this podcast episode will be dropped right when your book comes out. Let them know how to connect with you on social media.

Chris Palmer: Thank you so much, so people can go to the website brainenergy.com to learn more about the book but also get involved with this whole new approach to the mental health field and helping people recover as opposed to just treating symptoms. So, brainenergy.com. You can also go to my website, chrispalmermd.com, and learn more and I’m most probably active on Twitter so you can follow me there, @chrispalmermd and I think those are some of the best ways to check out what I’m up to.

Cynthia Thurlow: Awesome, thank you so much for our conversation.

Chris Palmer: Thank you, Cynthia. It was really a pleasure to be here.

Cynthia Thurlow: If you love this podcast episode, please leave a rating and review. subscribe and tell a friend.