The Keto Psychiatrist: What Keto Is Really Doing To Your Body! Can It Cure 43% Of Mental Illness?

most people will experience tremendous reductions in anxiety within 3 Days To 3 weeks of starting a ketogenic diet in fact we did a study where patients with bipolar disorder major depression or schizophrenia tried the ketogenic diet and 43% achieved clinical remission from their chronic mental illness and 64% of them left un less psychiatric medication because it improves the balance of chemicals in the brain but the question is what's causing those chemical imbalances in the first place and so let's start there Dr Georgia e is a Harvard train psychiatrist who specializes in nutritional science and mental

health she was one of the first psychiatrists to offer nutrition-based approaches as an alternative to psychiatric medications to optimize brain function and enhance performance people need to know how powerful nutrition strategies can be for the brain because if you're feeding at the wrong way things will go wrong and that's exactly what happened to me my health was declining in my early 40s in ways that is true for a lot of my patients chronic fatigue and IBS being really anxious and depressed and so I did all kinds of tests they said there's nothing wrong of course

there was something wrong so I instinctively started experimenting with my diet and the diet that I ended up on was backwards from what we're told is healthy for us it should theoretically kill me but it result every single one of my symptoms and so I studied for years learning things about food that most people don't know and which foods contain the nutrients the brain needs or the ingredients that damage the brain and found three principles of nutrition they can help you in ways no medicine can as well as improved mood memory concentration stamina productivity so

let's unpack that this has always blown my mind a little bit 53% of you that listen to the show regularly haven't yet subscribed to the show so could I ask you for a favor before we start if you like the show and you like what we do here and you want to support us the free simple way that you can do just that is by hitting the Subscribe button and my commitment to you is if you do that then I'll do everything in my power me and my team to make sure that this show is

better for you every single week we'll listen to your feedback we'll find the guest that you want me to speak to and we'll continue to do what we do thank you so much Dr Georg Eid how do you define what what it is you do I am a psychiatrist specializing in nutritional and metabolic Psychiatry so how food affects the brain and how food affects brain metabolism and how brain metabolism affects our mental health this is a fairly new phrase metabolic Psychiatry am I right in thinking that yes it's a really it's a very new field

and really exciting field uh the the term itself was coined by Dr Shabani Sethi who's a metabolic psychiatrist at Stanford University and maybe five years ago or so maybe a little longer than that so it's a very very new field it's even newer than the other exciting New Field in Psychiatry which is nutritional Psychiatry and so and this is a really exciting time to be a psychiatrist uh and it's also a really exciting time or a hopeful time an empowering time for people with mental health conditions because we're finally able to explore um root causes

the real root causes the deeper root causes of mental health conditions that go beyond things like what we're told all the time which are these mysterious chemical imbalances you know that need to be addressed with medication We Now understand that the real drivers the primary drivers of mental health conditions are inflammation of the brain something called oxidative stress which is why we're always told to eat more anti oxidants and insulin resistance or pre-diabetes which is now affects more than 90% of Americans in your work you talk a lot about the ketogenic diet why is that

so prevalent in your work was the ketogenic diet energizes the brain differently so it it really fundamentally changes the brain's operating system so when you switch from a high carbohydrate High insulin diet to a low insulin which is us a low carbohydrate diet ketogenic diet the way that cells uh receive energy the the mixture of fuels that they're using changes and that has profound influences on just about every pathway just about every chemical pathway inside of that cell so it is as though you are fundamentally changing the brain's operating system uh in very healthy ways

that allow not brain cells not only to work better but for uh but for brain cells to heal so the longer you stay on a ketogenic diet the more healing the more brain healing can take place and what is your sort of academic and career experience what's that can you run me through that sort of timeline yeah so I uh got a degree an undergraduate degree at Carlton College in Minnesota in biology so I always have loved science and biology understanding how things work and uh then for years I worked as a laboratory research assistant

different types of research labs around the world Boston Munich including in diabetes research until I figured out what I wanted to do and I decided that I wanted to go to medical school so then four years of medical school at the University of Vermont in Burlington Vermont which is a great place to go to medical school and then four years of Psychiatry residency training um at a Harvard program called Cambridge hospital in Cambridge Massachusetts and then so that was 25 years ago that I finished my Psychiatry residency training and I've been practicing uh Psychiatry ense

and what does practicing Psychiatry involve what it usually involves for most psychiatrists is psychotherapy and medications and for some psychiatrists only medications some psychiatrists prefer to focus exclusively on psychopharmacology or medication management there are some psychiatrists who choose to focus only on psychotherapy and and and don't prescribe medications but the vast majority of psychiatrists offer a combination of both medications and Psychotherapy and when did nutrition become part of your career well I I never thought about the relationship between food and the Brain once um during medical school we had maybe two or three hours worth

of nutrition lectures in four years and in four years of Psychiatry residency we didn't talk about food in the brain once so I honestly had no idea how important it was to to brain health uh so I practiced conventionally as I was saying you know medications and Psychotherapy for the first 10 years of my practice and as much as I loved my work I it was becoming painfully obvious that most people in my practice were just not getting that much better like no matter how hard I tried um and and it wasn't just true for

me you know it wasn't as though I was thinking well you know I don't have an maybe I don't have enough experience or maybe I not reading enough or maybe I need more supervision um when am I going to be able to really be able to help people because when I looked around even very senior psychiatrists who had been in practice for decades the same was true for them I mean we had we've been taught to think of mental illnesses as chronic mysterious and incurable and that the best way you can help people is to

support them with medications and Psychotherapy and uh but but that these are lifelong illnesses that we really don't understand very well and that we can do very little about because you there's like a significant social component to mental illnesses as well right absolutely I mean the brain the brain is a very responsive organ and it's listening to uh it's not just paying attention to the food you eat it's paying attention to every aspect of your life how much light the brain receives how much love you have in your life how how much you love your

work what kinds of people are around you um how you use your body exercise stress um everything everything matters to the brain but most people are led to believe that food doesn't matter that much to the brain and that's partly because we've only recently started to think about it but the other piece um is that the information that we're given about how to feed the brain and the body properly is incorrect and so when people are trying their best to improve their mental health using nutritional strategies those strategies fail most people because those strategies are

grounded in the wrong information and so a lot of people just think oh well you know I I tried eating more Whole Foods or right I tried uh you know I tried putting blueberries on my oatmeal or making my flax seed smoothie every morning or uh eating more plants than animals I tried all of those things and they just didn't help very much so I'm just going to go back to eating everything in moderation um because it doesn't seem to matter but what's really great about you inviting me here to talk with you today is

that people need to know how powerful and intervention uh these nutrition strategies can be they can help you in ways no medicine can in days to weeks in many cases people can experience meaningful Improvement to their mood their memory their concentration their stamina their productivity um and and their their mental stability their their effectiveness in their lives if they have the right information about how to change their diet so you have to know which changes are the ones that are worth making and they're not the ones we're used to hearing about is there a particular

case study that comes to mind when you think about this is there a most prominent case study or a first case study that was a Eureka moment VI I wouldn't say there was a Eureka moment case in my life because I came to it a in a different way uh my Eureka moment really came through my own personal experience I think a lot of Physicians who uh practice nutritional and metabolic strategies most of us stumble into this work accidentally because we're not taught it and most of us stumble into it either because a patient comes

to us and says hey you know I've tried this new way of eating and that's why I'm so much healthier than when you saw me a year ago or the The Physician themselves encounters their own health challenges you know uses the conventional nutrition approaches they don't help and they find that they're kind of left to their own devices to solve their own health problems and that's exactly what happened to me so when I was experiencing all kinds of uh health issues in my early 40s despite doing everything correctly you know eating uh low fat low

cholesterol calorie restricted diet um uh that was high in fiber uh mostly Whole Foods and exercising religiously despite doing all of those things my health was declining in my early 40s in ways that was true for a lot of my patients as well and I had no idea how to help my patients with these issues these were things like chronic fatigue and IBS and fibromyalgia and migrain headaches very common in middle-aged people and older and even younger people nowadays so when I encountered those issues and I was working at Harvard at the time I had

access to all kinds of Specialists caring intelligent thorough they did all kinds of tests all kinds of tests and they said everything is normal there's nothing wrong of course there was something wrong but I I so I instinctively started experimenting with my diet uh and long story short short 6 months later trial and error changes food and symptom Journal at the end of 6 months and this was back in [Music] 2007 um the diet that I ended up on Purely by trial and error was almost upside down and backwards from what we're told as healthy

for us and that was the diet that resolved every single one of my physical health symptoms but as a psychiatrist what really got my attention was that it improved my mental health significantly and I wasn't even trying I wasn't even aware that my mental health needed that much attention I think like most people I was walking around with suboptimal mental health you know more anxiety than was necessary than was I you know I slumping in the middle of the day brain energy you know faltering a couple of hours after lunch coming home at the end

of the day and and being completely spent and not being able to get anything else done after 5:00 being really anxious on Sunday night before Monday morning work um you know being depressed in the winter time I mean all of these things we think of as really normal we've come to expect so little of our mental health we've come to expect poor mental health as normal and it isn't uh if you feed the brain properly it works better and you can expect so much more of yourself so when that happened to me I thought well

that's interesting this diet seems to be good for the brain which diet was that this was a mostly meat low carbohydrate low fiber low cholesterol high fat diet no whole grains no legumes very few plant Foods mostly Seafood meat poultry non-starchy vegetables and fats from Whole Foods it really was as simple as that and a Diet similar to that is um uh one of the starting places in the book so I have a variety of different dietary strategies people can explore in the book not just one so it's different places for people to grab on

depending on what they feel comfortable doing but that but that way of eating resolved all of my physical issues and mental health issues I wasn't even aware needed attention and that that really was what inspired me to begin studying nutrition I certainly did not out and start recommending this dietary pattern to my patients that would have been Reckless I didn't know the first thing about nutrition and based on the little that I did know the diet that I had ended up on should theoretically kill me so it could be dangerous for people and so I

studied for years independently took a graduate course at the Harvard School of Public Health and studied independently read everything I get my hands on studied the the primary literature the actual scientific studies to try to understand okay why why is red meat bad for us what's the difference between red meat and white meat why are whole grains good for us why are whole grains good for us but refined grains are bad for us why do we need a rainbow of fruits and vegetables uh are some of them more important than others are they all equally

beneficial I mean all I just became so curious about food I really wanted to get to the bottom of it so for years I studied nutrition and fell in love with nutrition science and um it's a lot of what I share in the book is all these fascinating things about food that most people don't know um and that can really such as that it's interesting it's useful it's empowering because if you understand which foods contain the nutrients the brain needs which foods contain the ingredients that damage the brain which foods are going to damage brain

metabolism and cause inflammation and cause oxidative stress cause all these things that we're told we need to fight with supplements and superfoods um that's the real power the real power in dietary change is not adding special things to the diet it's actually subtracting the things that are harming the brain and working against your best efforts it's it's it's just like anything you know you don't make money by spending money you make money by by not spending money right so it it's the power of subtraction what are you not doing um and that's really Step One

is first Do no harm understand where the harm is coming from in the diet because it's not where you think it's coming from it's not coming from the red meat it's not coming from the cholesterol it's not coming from the saturated fat so if you understand where the damage is coming from then you can turn things around very quickly you used a word there you used the word explore um as it relates to different diets that you've written about in your book and that you know that are available online I from what I understood there

you're not saying that one diet is the right diet for everybody you're saying that it's almost the word explore suggests sort of experimentation personal experimentation and what worked for you in that case might not necessarily work for someone else in a different situation is that accurate that's exactly right and you're bringing up a really important Point Stephen which is that there are two levels of dietary knowledge so one is that there are fundamental nutrition principles that apply to all human beings these are the rules the cells require these nutrients um and you must consume foods

that provide those nutrients to those cells and you must exclude these certain ingredients that can damage those cells and you must keep your glucose and insulin levels in in the right range for your personal metabolism you have to you have to nourish protect and energize yourselves you must do that but then beyond that so so those rules and and the rules that you have to follow to to get there are not are not not commonly known but then beyond that there's the personalization right because we are all different we're not different in what our cells

need but we're different in what we can tolerate we're different in our metabolic Health we we're different in how old we are how active we are what um what conditions we we already have what conditions we're most at risk for what our goals are what our preferences are what and and whether we have food sensitivities for example um and so all of those pieces you know food intolerances and and different different goals and different aspects of our of Our Lives that's where the personalization comes in and I teach people in the book how to take

these fundamental principles so I teach them what the fundamental principles are which are very simple nutrition is not rocket science um and and then show them how to personalize it to their metabolism to their preferences to their goals what are the fundamental principles let's start there so the fundamental principles are nourish protect energize so nourish what does a brain healthy diet look like and by brain healthy uh we are talking about what's healthy for all cells because it wouldn't make any sense to uh for the human body to require different diet for every organ you

possess so a brain healthy diet is a diet that's healthy for every organ in the body so it's good for the brain it's good for the heart it's good for the liver Etc so what is a brain healthy diet it needs to nourish protect and energize nourish it must contain and be able to safely deliver all essential nutrients to your cells so you have to know where those nutrients are you cannot and using Whole Food principles and not including supplements or specially fortified processed foods you cannot meet that goal without including some animal Foods in

your diet that's just the truth of our biology protect protect the brain from damaging ingredients so what damages the brain inflammation which you can't see or feel it's not as so the brain is red or swollen or sore you we the brain doesn't have nerve endings but many many people have brain inflammation without being aware of it that's a main driver of depression and all kinds of other brain conditions so you need to exclude protection is not about addition it's about subtraction you need to subtract the foods from your diet that cause inflammation that caus

something called oxidative stress which is why we're always told to eat more antioxidants what we really need to be told is what's causing all that oxidative stress in the first place and remove those things because the antioxidant strategy really doesn't work and energize nourish protect energize the third principle is energize which means the brain which is a very high energy electrical organ it needs a constant supply of high quality Quality Clean burning energy and if you're eating the wrong way your brain will not will gradually lose its ability over time to generate energy that's primarily

about getting your glucose and insulin levels into a healthy range not just your glucose although getting your glucose levels in a healthy range is extremely important you have to go one step further because underneath that glucose you need to know what's happening with insulin and that's that's a really EMP powering strategy sort of Next Level right so getting your glucose and insulin levels down will allow your brain to uh uh to energize itself in the most clean efficient um and reliable way possible nourish protect and energize and then beyond there you said there's a level

above there so that's the sort of fundamental level Beyond there you go into sort of personalization what's best for you and is that where the sort of trial and error comes into play exactly so these principles nourish protect energize the nourish you need to include some animal Foods the protect you need to exclude things like refined carbohydrates and vegetable oils uh which are the signature ingredients of the standard American diet or standard Western diet um and the the energize is is the the glucose and insulin levels which for some people this is some a level

of personalization begins here at the energized piece because if you have excellent metabolic health and we can talk about what that means then you may not need to eat a ketogenic diet to to properly n to to really get those glucose and insulin levels under control and thoroughly energize your brain cells but if you have significant metabolic damage if you're sedentary if you're older if you have pre-diabetes or type 2 diabetes um then you may need to reduce the amount of carbohydrate in your diet even from Whole Foods you may even need to go to

a ketogenic level and and that's where that's where assessing your metabolic Health understanding where you stand on the insulin resistant Spectrum the spectrum of metabolic Health that's the empowering piece because if you know where you stand on the insulin resistance spectrum and you can get your glucose and insulin levels into a healthy range you then you have tremendous power over your emotional intellectual and your and your physical health future it's really the number one risk factor for almost all chronic diseases mental and physical so personalization starts with a metabolic personalization so how much carbohydrate can

you safely tolerate that's one example but then there's another level of personalization that has to do with how well does your immune system work how how good is how how robust is your gut function your gut barrier many of us have lost our ability to safely and comfortably tolerate a wide variety of foods that we should be able to tolerate and that's because our environment multiple multiple toxins in the environment are have broken down a lot of our defenses our gut barrier bloodb brain barrier uh and and our immune system has become overwhelmed by trying

to process lots of toxic ingredients in our environment so these are things like Plastics and pesticides and antibiotics and um and and food additives and and all kinds of you know ultr processed foods that we were never designed to handle these are really stressful on the human body and they do break down our defenses over time so this level of personalization is very much about trial and error but to save people some of that frustration of trial and error approaches I I give them very specific lists of foods um that that are more likely to

be culprits than others and so that helps cut back on some of the trial and error elimination this keto diet you um you did a study on the ketogenic diet got the study here the ketogenic diet for refractory mental illness a resp a retrospective analysis of 31 in patients what is the ketogenic diet for someone that might not know so a lot of people think or they've heard about a ketogenic diet as a weight loss diet um they think of it may maybe it's a fad weight loss diet um they think of it as a

very very low carbohydrate diet they might think of it as a diet that's very high in meat and dairy products um and but actually the ketogenic diet was originally created in 1921 more than a hundred years ago to stabilize brain chemistry in children with severe seizures um and this was long before the availability of useful seizure medications so these were children who um uh were having multiple seizures per day in many cases and so the ketogenic diet was designed back then created back then a very strict version of the ketogenic diet um to get as

close as possible to to fasting without Starving Children to death because for Millennia people had noticed that those with epilepsy would often improve if they were fasting but you can't fast forever so how do you get close to fasting this is the original fasting mimicking diet how do you get as close to fasting as you can while still providing some nutrition so that was the original goal of the ketogenic diet and was very successful for seizures more than 50% of children had more than 50% and and adults as well it's it's since been shown more

than 50% response rate in children and and adults and 10 to 20% completely uh free of seizures following a ketogenic diet how is it acting on the brain what's it doing to the brain the ketogenic diet does many many things it's like a multi-purpose tool for brain health so one thing it does because we talked about how uh some of the root causes of mental illnesses which are only relatively recently a focus of research are inflammation and oxidative stress and insulin resistance the ketogenic diet reduces inflammation it reduces oxidative stress and it reduces insulin resistance

uh it also improves the balance of chemicals in the brain so a lot of people think of um uh mental illnesses as problems with chemical imbalances in the brain and these are the chemicals that they're talking about you might have heard of Serotonin or dopamine or norepinephrine there are others glutamate Gaba many different chemicals in the brain are uh associated with or in some cases even very much uh causing mental health symptoms but the question is what's causing those chemical imbalances in the first place and uh one of the things that's causing those chemical imbalances

is that inflammation and oxitive stress but another thing is that the brain is uh if you're feeding it the wrong way it will not be able to in many cases prod produce energy reliably and if it can't produce energy reliably all kinds of things will go wrong and in quite spectacular fashion what actually goes wrong is going to depend on who you are and that's where our individual differences come in so if I eat the if you and I exactly the same bad diet depending what runs in your family and how you've lived your life

to this point you might develop Alzheimer's disease you might develop bipolar disorder you might develop type 2 diabetes you might develop fatty Li disease um I might develop completely different conditions I might I might develop um cardiovascular disease I might develop depression um I might develop um ADHD it and that's where the individual differences are but all of these conditions are just uh metabolic malfunction really at at the heart of it that's what's going on if cells aren't functioning properly you will develop a disease physical and mental diseases and which ones you get it's really

kind of luck of the draw um but you have tremendous control over what you are at risk for if you understand how to help yourselves operate at their personal best can you tell me about what you learned in this study and what this study concluded yes so this was the work of my friend and colleague Dr Alber Dena he's a psychiatrist who's been practicing in tulo France for more than 35 years so after witnessing a young family member someone in his extended family with autism and seizures improve within weeks of adopting a ketogenic diet he

thought well I wonder if this diet could help my patients especially my patients who are not responding to anything else that I have tried to help them Psychotherapy medications hospitalization and so he invited 31 of his most treatment resistant patients with bipolar disorder major depression or schizophrenia to come into the hospital and voluntarily try a very mildly ketogenic Whole Foods diet in the hospital under his supervision to see whether or not they would respond and this was these were folks who these are all adults these were people who had been ill for an average of

10 years some for as long as 30 years these were people who were taking when they came into the hospital at the beginning of the study an average of five psychiatric medications not at all unusual for people with chronic mental illness and all of them had one or more markers of poor metabolic health obesity high blood pressure high blood sugar things like that so these were people with poor metabolic health and poor Mental Health heal and they eagerly came into the hospital to try this intervention because nothing else had helped them and what was remarkable

about what he observed was that of the 31 people 28 were able to stay on the ketogenic diet for more than two weeks which is what you need to do to start to see benefit every single one of them improved to the point that 43% of them achieved clinical remission from their primary psychiatric treatment resistant chronic mental illness and 64% of them left the hospital unless psychiatric medication and all of them improved metabolically as well and that you do not see results like this in conventional psychiatric care so there's a few things that spring to

mind when you talk about the study the first is that they were inside a hospital yes so I guess that's a confounding Factor potentially oh yeah well a blessing and a curse yeah so a blessing is that um the diet was fair was was very carefully supervised six days out of seven they were allowed to go home on Sundays okay and which still I'm I'm just mentioning but that but they had tremendous amount of support and supervision and and that's that's really really helpful when you're switching from a standard High carbohydrate diet to a low

carbohydrate diet they also had very careful medical and psychiatric supervision which is also really important uh because when you when you change to a ketogenic diet brain chemistry fundamentally changes in ways that can at first when you're transitioning from one operating mode to another operating mode it's it's stressful and sometimes you can feel worse before you feel better MH and medications can be affected so medications need to be monitored and everything everything changes these are all really healthy CH your blood sugar can drop your blood pressure can drop especially if you're taking blood sugar lowering

medications or blood pressure lowering medications if you switch to a ketogenic diet it's so effective at lowering blood sugar many Physicians who prescribe blood sugar lowering medications for diabetes need to cut the diabetes medication in half on day one in order to prevent dangerously low blood sugar because you've got a medication that's lowering blood sugar now you've added a diet that lowers blood sugar and this could be potentially dangerous the diet on its own is not dangerous it's the diet in combination with medications so you need to know what you're doing and so yes in

the case of these um 31 adults so a certain proportion of them was it 28 that managed to see 28 31 283 had I just restricted their calories for example but kept them on whatever diet they were on would I have seen an improvement as well that study has not been done to the best of my knowledge however you're bringing up a really interesting point so what a ketogenic diet is it's really not about carbohydrate the definition of a ketogenic diet is any diet that lowers insulin levels uh to the fat burning point so that

if your insulin you can't burn fat if your insulin levels are too high and most people are walking around with insulin levels that are high 24 hours a day they don't even come down overnight because people are just eating too much too frequently in the wrong foods to get into ketosis or generate ketones you need to lower your insulin levels to the fat burning point and when you and if and if you're burning fat vigorously the liver will turn some of that fat chop that fat into ketones which are very small fragments of ready to

burn fat and these cross easily into the into the brain and can be burned for energy and they can Bridge any energy gaps that may be there which many of us have if these people had done the Mediterranean diet would they have seen the same consequences the medit oh sorry say I imagine they were probably on the western diet that like the American diet which is ultra processed high sugar so bringing them into a controlled environment and just depriving them of that would have surely caused just that on its own would have been beneficial yes

so I wrote in the paper I I I and I I mentioned this you're making a really excellent point and I addressed this in the paper is that because when you when you change from a standard junky modern diet to through a ketogenic diet that's Whole Foods you're changing a lot of variables right so how do we know that it had anything to do with the ketones right and and this is a good question and a fair question and we don't know the answer but new studies are helping us to understand that but before we

get to that I just wanted to say the point you're making is so important because there are lots of ways to lower your insulin levels so you can lower your insulin levels through fasting intermittent fasting you can lower your insulin levels through exercise you can lower your insulin levels through calorie restriction if you restrict your calories below 750 gram per day many people will go into ketosis that's another version of a fasting mimicking diet made Popular by Dr wter Longo so there are many ways to lower your insulin levels um the ketogenic diet is just

one way to do that but the ketogenic diet is the only way to safely sustainably maintain a state of ketosis longterm ter so you can initiate you can get into ketosis using these other strategies but it's it you can't fast forever you can't exercise all day long you can't restrict calories below 750 for the rest of your life but you can safely and comfortably eat a a well formulated ketogenic diet which is very low in carbohydrate moderate in protein not excessive in protein and relatively higher in fat depending on your energy needs indefinitely sustainably use

the word sustainably that that's kind of always been my challenge with the keto diet is being able to stay on it I mean you saw in this particular study that even trying to get people to do it for two weeks resulted in some portion of them dropping out yes um why is it so hard to stay on the ketogenic diet I've managed to do it for I I was saying to you before we started recording once a year around this time of year I do it for about eight weeks and it has a really profound

impact on a lot of my life it helps me feel more focused um my body composition radically changes faster than any other diet or thing that I've ever tried faster than just exercise Alone um I I sleep a little bit better as well I noticed but you've been doing it for a long time you've been doing it for roughly almost 10 years for the better part of TW I mean more often I'll say I've been following a ketogenic diet for 12 years and I agree with you it's not always easy I'm not perfect about it

myself but I have been on the kog giant diet The Lion Share of the last 12 years it being hard is an important factor yes because when you're trying to prescribe it to somebody who is got you know treatment resistant depression or is really suffering in some way I imagine they'll find it even harder than I do yes and no okay so uh it's well it's definitely there's no question about it that's hard to eat a low carbohydrate diet in a high carbohydrate world yeah so there's that there's the environmental Temptations and the social Temptations

and the habits and the addiction sugar addiction is a very real biochemical phenomenon so there's that but but it I mean I've been I I had a weight issue growing up everyone in my family did um and I've been on lots of different diets in my life this is the easiest one to stay on I can't say about any other diet that I've follow for 12 years and the reason why is this diet really stabilizes appetite hormones so your cells are getting energized in between meals you're not getting those spikes and crashes in glucose which

cause spikes and crashes in appetite hormones satiety hormones stress hormones reproductive hormones uh brain chemistry um you're not getting you're not on that roller coaster anymore so your cells are are are being satisfied they're getting the energy needs satisfied in between meals and everything is quiet and calm on the inside it doesn't mean you're 100% protected against Temptation uh so I describe it to my patients with food addiction I describe being in ketosis as a suit of armor you know the sword can still get you but you but you know you're not 100% protected but

you've got a real fighting chance and for for anybody who's never tried a ketogenic diet and been on it for at least I would say six to 12 weeks it most people have no idea how much easier it is um to follow to follow a healthy eating plan when their appetite is in good control a lot of people know they've shifted into ketosis without even checking their Ketone meter because they can go for so long without eating without even thinking about food they can work through lunch and not even realize that they've missed a meal

most people the way we eat most of us now are thinking about food all the time you haven't even finished breakfast and you're already thinking what what can I have for lunch you're carrying food around with you everywhere you go you're eating at least six times a day in many cases this is not the I mean we would never have survived as a species if we needed to eat six times a day so we're not eating in a way that is that is nourishing us and and satisfying us we're eating in a way that's making

us hungry I find what you've said there to be sort of true in my experience especially in the context of the roller coaster analogy so when I'm not on key ketosis I do feel like sometimes I'm in a bit of a roller coaster of like Temptation craving Etc and then when I do ketosis and I get past the first week or two the the roller coaster seems to stop right I'm I'm off the roller coaster it's then maybe six eight weeks later you're busy life happens you're traveling you're tired that Temptation Creeps in and it

just takes that one moment of weakness in my head to then fling me off ketosis and all my effort is gone and in my head the way I've always thought about it and I'm sure this is wrong but I've thought about it like it takes a couple of days to get into a state of ketosis and then once you're in and I usually get a headache yeah on my way into ketosis I feel a little little bit bad on the way in and then once I'm in there it's fine so when I have something that

breaks my keto this is what I refer to me and my girlfriend talk about I've broken my keto whatever I think oh my god I've got to go through another headache and another five days of you know uh getting back into it what is that correct it's a very common experience because there are these adjustments uh that happen inside uh with your physiology uh as you're shifting from one operating system to another when you're shifting from carbohydrate burning system to a more you're shifting your ratio of your fuels so the body and the brain are

hybrid engines so we're never burning 100% fat um we're burning a mixture of of fat and carbohydrate when you're shifting from a from a system system that's fueled almost entirely by carbohydrate almost all the time to a system where you're burning more fat than carbohydrate um that's uncomfortable for some people shifting back and forth especially if what they have if if the reason why you've quote broken your keto is because you've had something um that has a lot of refined carbohydrate in a lot of sugar or flour in it for example um so it depends

on what you've eaten and how much and for how long um but but many people do experience the so-called keto flu when they are shifting from a carbohydrate based system to a fat-based metabolism and some of this can be uh much of this can be prevented in a couple of different ways one is with electrolyte supplementation supplementing electrolytes to keep your your salt balance even as you're transitioning and another uh is by transitioning slowly onto the ketogenic diet rather than all at once and so and there are many there are other tips in the book

about how to do this more comfortably but those are the two big ones uh and going slowly so in the book I don't recommend that people start on a ketogenic diet just straight away like learn about it on a Monday started on a Tuesday but ease into ketosis over a week or two and uh there's a there's a kind of a moderate carbohydrate plan in the book that allows people to do this so you you follow that plan for a couple of weeks to gradually lower those glucose and insulin levels it's going to be a

lot more comfortable it's be a lot less of a shock to the brain and body um and and if you're supplementing electrolytes and going slowly most of these quote keto flu symptoms will uh will not occur or they'll be very brief and Mild so um again these are posit it's a positive change to have these electrolyte changes and um it's it's all of these things are are good but there is this transition period which can sometimes be uncomfortable and this is um not to say that it's dangerous again it's a very we're designed our biology

is designed for us to be able to shift back and forth between fat and carbohydrate as fuel sources but many of us have lost some of our metabolic flexibility because we've done some damage to our metabolic engines by eating the wrong way for too long so we don't shift as comfortably back and forth as we used to be able to I guess most people don't even know what foods are included in a keto diet because most diets are restrictive to the point that you know people think they just make your life miserable but what are

the sort of big misconceptions you've seen with the foods you're able to eat on a ketogenic diet yeah so because a ketogenic diet it because the definition of a ketogenic diet is any way of eating okay that lowers insulin levels enough to turn on fat burning and generate ketones in the blood because because it's about insulin it the it's not a food list so you can you can it's not about plants and animals it's not even about fat or carbohydrate it's about understanding how to lower your insulin levels which you can do with a vegan

dietary pattern with a vegetarian dietary pattern uh with an omnivore dietary pattern um uh with or even with a carnivore dietary pattern so whatever your dietary preferences are you can get the benefits the brain healing benefits of of ketosis so it's not about the foods you're eating um it's it's more about understanding what raises and lowers insulin the things that raise and lower insulin are refined carbohydrates Whole Foods carbohydrates refined proteins like protein powders whole food sources of protein and guess what barely touches insulin at all fat fat is metabolically the quietest and safest macronutrient

you can eat because it barely stimulates insulin is ketosis a state like do I is it like a binary State like now I'm in ketosis and now I'm not so yes but there's there's a yes um let me put it this way that most experts will agree that um in order to be quote in ketosis um your level of beta hydroxy butter rate on a blood Ketone meter uh a blood Ketone meter U um is PR finger and and put a drop of blood on this little test strip and it will read the amount of

a particular Ketone in the blood called beta hydroxate and it it will give you a reading if that reading is point is 0.5 Millo or higher you are in ketosis in ketosis so what does that mean why why is the cut off 0 five because three things have to happen for you to get to at least 0. five one is your glucose levels have to come down the second thing is is your insulin levels have to come down the third thing is you have to burn off a certain amount of the stored starch in your

liver we have a a storage tank for carbohydrate in our liver it's not very big it holds less than a day's worth of carbohydrate because really as animals we're designed to store energy as fat carbohydrates there for quick Energy emergency short-term um the fat we For Better or For Worse we have almost an unlimited capability to store fat we can store months and months and months wor of fat and so um but we can only store a very small amount of carbohydrate so if your storage tank in the liver is full your body will not

switch to fat burning because it says oh we've got plenty of starch to burn let's start there once it comes down to a certain point the body goes oh running out of energy let's go to fat now and that's when the the liver will start breaking fat down whether it's fat on your body or fat from your plate and start chopping it up into these ketones and uh but so those three things have to happen and once that happens that you'll see the Ketone levels rise on the meter so most people who are not eating

a ketogenic diet are walking around with Ketone levels either undetectable or they're 0 2 or they're three they might they might float up into above 05 every once in a while if they're not eating for a long time or um uh or if they've just exercised but for the most part most people uh eating a typical diet are not in ketosis and when you get above 0.5 a lot of metabolic magic starts to happen because there are lots of Pathways in the body and brain that uh are not very active unless you're in ketosis and

those are the healing Pathways the recycling and maintenance and cleanup Pathways the recovery Pathways all of us this is something that I I came to appreciate a number of years ago as I've been studying this is that there are many people unfortunately or fortunately there are many people who discover with mental health issues that they need to be in ketosis long term in order to be well but I've become convinced by the science that all of us need to be in ketosis um at least intermittently all of us need to spend some time in ketosis

on a regular basis or else we can't heal we'll only be it it's like a it's like a manufacturing plant where the plant is just running 24/7 12 months a year and and they never take time to replace the parts or clean up the floor or you know they never do any maintenance work or repair work and So eventually everything breaks down and when you say ketosis again you're not saying the the keto diet you're saying the low levels of glucose um and Insulin exactly in the blood and that can be achieved by calorie restriction

potentially fasting I guess you could achieve it and other diets like the Mediterranean diet if administered in the right sort of doses right well um we we should come back to the Mediterranean diet a minute but first the first part of your question is important because ketosis is you can as you said you can get into ketosis a variety of different ways if you're eating properly and this would have been our evolutionary Heritage our ancestors especially our prehistoric ancestors um they have access to these lots and lots of refined carbohydrates a long time ago um

they were eating carbohydrates from uh Whole Foods uh fruits and starchy root vegetables right and uh and so even grains and beans are very very relative relatively much newer sources of carbohydrate so let's think about fruits and vegetables but so they they would have been we can only guess B look looking at their diets we don't have proof of this but think about it if you're eating in a way where your insulin levels are allowed to come down overnight if you're eating if you're eating a a balanced diet so to speak but it's got everything

it needs in it and it's not giving you exaggerated spikes in your glucose and exaggerated spikes in your insulin and you're not eating six times a day or all day long your insulin levels will naturally come down overnight and that will that will allow you to go into a healing mode so I believe that if people have the right information about what a healthy diet is supposed to look like they may may not even need to in many cases especially if you're younger or athletic or don't have a lot of metabolic damage already um you

may not need to you may not need to lower your carbohydrate intake during the day you might just need to be careful about what kinds of carbohydrate you eat and how often um so for example it's known that in children um they're who are eating a regular diet many of them wake up the next morning in ketosis they're metabolically much healthier than uh we are as we get older so they're much more metabolically flexible um and uh so now they didn't go on a ketogenic diet they were eating a regular diet they slept overnight didn't

eat anything the next morning they're in ketosis that's not true for all children but it's true for enough children that we know it's possible most adults it takes them several days at least to get into ketosis even if they're not eating anything at all so f fasting can take 2 to 3 days at a minimum for most people to get into ketosis but some people it can take a whole week and you talked about children there one of the big conversations at the moment around children is the the rise in ADHD diagnosis and there's a

lot of different sort of thoughts on the causal factors of this and what is it that's making children be diagnosed at higher and higher rates with these sort of neurod Divergent disorders is there any evidence to suggest that what we're eating is playing a role in these neurod Divergent disorders yes the first thing I would like to tell you about is that there were studies quite a few studies back in in 80s 90s and early 2000s in Europe by variety of different research teams that explored exactly the question you're asking and what they did um

was they placed children with ADHD some quite severe ADHD even Hospital level ADHD and put them on something called a few Foods diet this is uh the scientists call it an oligo antigenic diet which just means it's kind of a low allergen diet so it's they removed all of the common culprits and they focus mostly on just a few Whole Foods uh and and and a few extras so very specifically describing this diet most of these diets were um chicken lamb fruits vegetables um and sometimes they throw in some apple juice and margarine because they

couldn't use butter because Dairy is a common allergen so but these were mostly Whole Foods diets you know uh uh poultry red meat fruits vegetables um and there 62 to 82% response rate to these diets no matter which study you looked at and in some of these studies there was a 70% cure rate within weeks of changing the diet to a few Foods diet so what does this tell us it doesn't tell us which foods were the problem it tells us that food can be the problem that if you make diet the right dietary changes

it's possible for children even with very severe ADHD to improve within weeks to the point that they no longer qualify for having ADHD anymore because there's a change in the symptoms oh yes um the children's uh Behavior as rated by parents and teachers um and the researchers themselves so just uh did some research to find some stats on this sure diet modification isn't widely prescribed as a way to alleviate ADHD symptoms is it it says as of 2019 major health organizations including the American um Academy of Pediatrics and the National Institute of Health and Care

Excellence do not recommend dietary modifications as standard treatment for ADHD due to insufficient evidence a 2014 review found elimination diets might offer minor benefits in sub in a subset of children particularly those with food sensitivities or allergies however these benefits are not substantial enough to advocate for widespread dietary changes in ADHD management so what I would say to that is uh there are multiple studies all pointing in the same direction that I think give parents and families and children tremendous hope with really no risk MH what are we doing instead we're medicating children we're giving

children stimulants which can stunt their growth make them anxious um and and cost money MH and is I mean I I'm one of the reasons I do this work is because I really don't think that for most people the right thing to do is to medicate our way out of this situation I mean just about every mental and physical health issue we have is we think about we've just kind of been condition to think about medications as the solution but medications don't solve problems they cover them up and what we really want to do is

want to get to the root of these problems and not just treat them which nutrition interventions can do in many cases but perhaps even prevent them from happening in the first place can they all be treated by because you know I I was I guess technically diagnosed with ADHD but I don't take any medication for it I'm it's a personal choice I personally just um don't think that the net impact has on my life is worth taking any medication I also have friends with ADHD who have significantly worse symptoms when I say worse I mean

more pronounced symptoms than I do so my personal decision was just not to take the medication however I sat here with a guy called Dr aan Who has a daughter who had ADHD she got the medication and it turned her life around like she went on to become super successful but was like struggling in school so it's really difficult isn't it because it's such a personalized sort of personal decision and some people have it more extreme and in a way that makes their life more dysfunctional than others you know and my some some of my

friends do really say they say I took this medication for my ADHD or my my tension issues whatever and it's been revolutionary for me they just like they they just offload on me how profound it's been for them so I guess it goes back to being a personal it does but you know so I have a lot of experience treating ADHD because I worked for two years at an ADHD Specialty Clinic called the Hallowell Center outside Boston I also worked for 13 years in college mental health at Harvard and at Smith college and saw lots

and lots and lots of students with ADHD most of who actually had it some of who didn't who're just looking for stimulants but I I can tell you as a psychiatrist who's prescribed medications for 25 years the stimulants are some of the most effective medicines we have in our toolbox for the people it works for it works very very well so and it can be life-changing a lot of people think of ADHD as oh a minor issue oh you can't concentrate or or maybe you're Daydream or maybe you're fidgety or you know maybe you get

distracted 8 HD can be a really serious condition just like all mental health conditions it exists on a spectrum of mild to very severe and so people with ADHD are at much higher risk for suicidal ideation they're much higher risk for substance abuse they're at much higher risk for accidents they're much higher risk for depression for anxiety these and and twice the twice the rate of divorce in people with with adults with ADHD these are serious can be for some people really disabling conditions people cannot function in their lives they can't function in their relationships

they can't hold a job you know they they feel so frustrated and Powerless I mean I was telling you that I worked with students in in in you know these Elite universities right these are very intelligent people who were struggling 10 times harder than their peers in in classes they had to work so much harder they had to stay up four or five hours later than everybody else and and and they did because they were hardworking but they're really suffering and this discrepancy between how smart I am and how much I think I should be

able to do and how much I'm actually able to do makes me feel bad about myself right they feel bad about themselves and because they know they're capable of more but they can't get there and it's a real biological condition now the great thing about this is a perfect example that you could we could have this conversation about any mental health condition but ADHD is a great example because there's always a risk benefit analysis when you're thinking about how are we going to treat this condition uh so do you want to take medication what are

the pros and cons of that does the medication work for you does it give you side effects can you access the medication uh can you afford the medication um how hard is is lifestyle change for you one of the most powerful interventions for edhd and I think probably the a just maybe one of the most Stellar examples I can think of is this change your lifestyle to suit your strengths play to your strengths and don't try to swim upstream against your weaknesses people with ADHD often have tremendous talents in certain areas and are tremendously gifted

in certain ways because they can make connections because they don't always think in a straight line because they they often have very diverse interests and they can pull different kinds of information together and you know given the right path they can be hugely successful right but that's not possible for everybody and for more severe cases of ADHD it's not possible at all has there been any studies on the link between the ketogenic diet and ADHD so not yet but I'm I'm very excited to to to be involved in two brand new studies of the ketogenic

diet for ADHD so one is a uh ketogenic diet for uh adults with ADHD and depression that's getting started at Oxford University in 2025 and the other is a study of uh ketogenic diets for ADHD and adults at the University of Michigan it's also going to be starting in 2025 we have no data on ketogenic diets and ADHD but we have good reason to believe the reason we were able to get funding for these studies is because there's there's reason to believe that it could be useful and because when you look at ADHD you see

Clues to poor metabolic health so for example children with obesity are twice as likely to have ADHD obesity is a marker for insulin resistance adults with type 2 diabetes are twice as likely to have ADHD type two diabetes is severe endstage insulin resistance and the ketogenic diet is the most effective way to address insulin resistance that we have at our disposal is it hard to establish cause and effect there I was thinking about the the diabetes one where if you've had ADHD maybe your life has been harder again I don't know what I'm talking about

here but maybe your life has been harder and if your life has been harder you're more likely to be obese potentially if you've been gone had more stress and you've you know you've had a a worse a worse more challenging job and so is it you know and will will a test be able to exclude these sort of confounding factors to the point that we'll know for sure I think that would be a very difficult study to to design but I think what I can tell you from my clinical work CU I work I'm a

general psychiatrist so I see adults of all ages and with all psychiatric conditions from major to minor and I've worked as I said with people with ADHD of you know hundreds and hundreds of patients with ADHD what I can tell you is that it's the same with medication um if someone comes in and says to me uh I can't tell if this medication is working um uh so should I keep taking it and I'll say well you know if you can't feel it working then it's not working uh so when the diet works it works

regardless of what's going on around the person so and this is true for all conditions that I've worked with so people with bipolar disorder people with depression people with ADHD people with PTSD people with anxiety as you have said we talked about the ketogenic diet is not easy to stick to right people fall off the ketogenic diet all the time uh sometimes accidentally sometimes intentionally right and you can see their symptoms come back within often 24 hours even though their external factors have not changed so life hasn't changed it's the diet and when you follow

the actual Ketone levels daily you can make that correlation so what's really exciting about both of these studies is it's not just getting somebody into ketosis it's it's tracking um on a data to-day basis their Ketone level and their attention symptoms and seeing if we can see them go up and down together and we've always get a little bit of data already from a pilot study at U um uh um by Ali Houston at uh at Oxford University we're starting to see some signals there but it's too early really uh we need to actually launch

the official study so in my patients it's it's a phenomenon I've seen over over and over and over again um a great example is I have a patient um that I worked with for a couple of years who had a a condition called bipolar disorder type two so it's a it's a form of bipolar disorder uh bipolar disorder people used to call manic depression you've got periods of mania often followed by periods of deep depression bipolar type 2 is a milder form where you don't get quite as manic um and but you still can can

get very depressed so he had bipolar to um and whenever so so uh he came to me because he wanted to try a ketogenic diet for bipolar disorder because um uh uh he had heard it might help so the other issue he was dealing with was that he um and his wife were having some difficulties some difficulty in their relationship that had started up a few years before and you know every time they got into an argument he would want to die and he would start to think about ways of killing himself self every single

time he went on the ketogenic diet the suicidal ideation went away even though his wife had not so he used to associate the depression with the marriage but he learned over time to associate it with his metabolic state that when he was in ketosis he could then imagine other ways of coping with the stress in his marriage other than just killing himself so he it a lot of people say to me that the ketogenic diet gives this space it allows them to pull back and see things from a different perspective it buys them time perspective

it's like a buffer so that people people aren't reacting as reflexively to difficult situation situation hasn't changed but people are able to deal with the situation in a more effective way they feel they have more control not just over their emotions but also over their behaviors and how they react to situations at my company flight Studio which is part of my bigger company flight group we're constantly looking for ways to build deeper connections with our audiences whether that's a new show a product or a project it's why I launched the conversation cards I've relied on

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you to all of you for listening to my show we're giving you a trial which is just $1 a month you can sign up by going to shopify.com Bartlet that's shopify.com Bartlet or find the link in the description below and for people that have food addictions and binge eating problems the ketogenic diet I guess it's knocking you off that roller coaster what well being in a state of ketosis is knocking you off that roller coaster of craving eating craving eating craving eating is that accurate is that what it's doing yes so um the ketogenic diet

by lowering and stabilizing glucose and insulin levels the thing about insulin is that a lot of people think about insulin as a blood sugar regul later they think of it as oh you know it uh when your glucose goes up the insulin brings it down and and that's true but that's it's just one of many important roles that insulin has it's the one it's most famous for but the thing that uh what is not well known is that insulin is so much more than a blood sugar regulator it's actually a master metabolic hormone and it's

regulating the activity of every cell in the body every cell has an insulin receptor on its surface multiple insulin receptors to pay attention to the insulin level in the blood and so uh when you're on a glucose and Insulin roller coaster that's just where the trouble begins insulin is talking to and controlling the behavior and levels and activity of many other hormones in the blood including stress hormones like adrenaline and cortisol um reproductive hormones like estrogen and testost cherone your blood pressure regulating hormones your satiety hormones the hormones that make you feel full after you

eat your hunger hormones so many other hormones are on this roller coaster uh that you're unstable from within and people often will think well I'm stressed and that's why I'm eating I I I feel really anxious um I get irritable I get stressed I'm hungry I need to eat and then I feel better and that's true they will they will feel better for a few hours but what what happens four to five hours later if they've eaten something that's spiked their glucose and Insulin again is they're going to get there's this great study with um

healthy teenage boys they took healthy teenage boys and they gave them either a sugar-free Cola uh caffeine-free or a caffeine-free Cola sweetened with sugar and the boys who had the sugar sweetened Cola their adrenaline levels their stress hormone levels of adrenaline quadrupled four to five hours after drinking the soda and the boys who drank the other soda stayed flat it's the food that's causing the stress that's causing the food eating you so there's this vicious cycle if people understood that most of what's happening there it's not your fault that you want to overeat those Foods

they are designed to be overeaten like chemical Engineers these this is very very intelligent um engineering that's going on very clever and uh you will sell more of a product if you make it irresistible and if you make it unsatisfying how many people feel that they can't control their consumption of certain foods that's by Design if you if you want to keep eating it you'll buy more of it if you eat real food you have to stop after a little while they're so satisfying things like meat Seafood poultry eggs fruit veget Veges even fruits fruits

some people will overeat fruit but but fruit has fiber it has water it's really hard to eat you know 10 pieces of fruit very easy to drink you know a bottle of several bottles of fruit juice very easy um to eat multiple packages of candy because those what happens with ultr processed carbohydrates these refined carbohydrates they blow past your hormonal stop signs and that's not your fault but if you understand that that's what's happening then you can takes a few days you got to step away from them but but on the other side is tremendous

freedom and control the gentleman you mentioned in that case study a second ago you referred to as Carl which I guess is a cloaked name um he's the one that had the bipolar disorder uh no Carl is a different case ah okay tell me about Co yeah so I opened the book with the story ofl Carl who has you know generously allowed me to share his story um a gentleman great guy in his mid-60s who had had lifelong depression and anxiety and uh for years he he didn't seek any treatment and then maybe about 15

years or so before he consulted with me he went to an A A psychiat A Psychiatry specialty clinic for some specialized brain Imaging and uh extensive evaluation and lots and lots of specialized tests and he left the clinic with thousands of dollars later with three diagnosis depression anxiety and ADHD and three prescriptions one for depression one for anxiety one for ADHD so he started those medications and his depression got a lot better but he then uh had a brand new problem on his hands which was he was becoming Manic and he had never had Mania

before so he was been uncharacteristically um energetic and uh um uh irritable and unpleasant and so it was changing it was changing his character his personality a certain his behavior in a certain way that was becoming very unpleasant at work and at home so he then turned to marijuana to try to take the edge off developed a marijuana addiction now he's got another problem and so he thought to himself you know this isn't this isn't what I signed up for I was trying to solve a problem and now I've got two new problems on my

hands so he took himself off the medications and said you know I I I can't use medication medications is not for me I'm going to try to manage my mood issues my depression anxiety with rigorous exercise I'm going to let exercise be my medicine and he started cycling uh bikes over a 100 miles a week and it actually helped a lot it didn't completely resolve all of the symptoms but it brought them down to um a very manageable level uh for years so exercise was his medicine exercise improves metabolic health and so he was still

eating a standard American diet he'd never tried any dietary changes before and then um what happened is as he entered his 60s the depression anxiety started to rise in the background exercise wasn't working quite as well as it had and then uh just before he met with me something stressful it happened at work and it was essentially a shift in his job description which was making him anxious and he started experiencing very suddenly these bouts of um agitation and anxiety and restlessness and exercise being his medicine he would he would cycle on the weekends and

at night if it was a if it was it was happening on a week night a work night he would be walking because he couldn't bike at night when it was dark he would walk sometimes eight even 25 miles to try to get rid of this excess energy and he said I don't have time for this I can't exercise enough to keep my symptoms under control he didn't know what else to do he starts searching online for Solutions came across information about carnivore diets and mental health contacted me for a consult and said I want

to try the carnivore diet for my for my anxiety and I mean there were lots of other things we could have done uh to improve the quality of his diet but this is what he wanted to do because he was hoping that would bring him the most the the fastest relief so switched to a carnivore diet 3 to four pounds of fatty meat per day mostly pork and beef this was dairy free no plants and uh he checked his ketones using urine testing which Which is less expensive than blood testing uh he's in mild ketosis

every day using urine strips and uh he started to improve by week three by week six his score was zero on all his depression and anxiety scales he had no symptoms at all of of depression anxiety not just of those recent extreme symptoms that he was experiencing but the symptoms that went back his entire life that had never completely resolved before so he said you know I I this is the I've never felt this well in my entire life and so this is the power of these strategies is they don't just reduce symptoms a little

bit they actually have the power to heal the underlying problem in ways that I mean this is a phrase I've heard so many times I feel better than I've ever felt in my entire life you don't hear that when you prescribe medications for people generally that was in 2019 was it uh I couldn't tell you what year but that sounds right how is he doing now yeah I mean we we are still we we still talk with each other uh several times a year he's doing very well in fact so he one of the interesting

things about what happened with this diet is that during that long period of of intermittent agitation uh he you know he's a very physically fit guy because of all the exercise and he and he was lean he lost 10 pounds during that period of agitation that he could not afford to lose when he first started working with me he was underweight and despite eating four pounds of fatty meat per day he couldn't regain that 10 pounds unless we added uh back some carbohydrate into the diet this is really this is a subtle point but for

athletes sometimes especially in the early phase of the transition um there needs to be a certain amount of carbohydrate in the diet um to support high performance he didn't stay on the carnivore diet no he did not so he was on the car carnivore diet for many months and then be but because he couldn't regain that weight I asked him I said well you know I think we need to put some carbohydrate in to help you uh regain this weight and so I asked him which foods he missed the most gave him a list of

Whole Foods to choose from and the things he missed most were uh potatoes and yogurt so some starchy root vegetables some plain unsweetened yogurt um up to about 100 grams of carbohydrate per day seemed to be about right for the days when he was e excuse me exercising on the days when he wasn't exercising he would cut it back so he was tailoring it to his personal energy needs and so so this is another um uh interesting thing about what happened for him is that um I mean his his scales are still at zero but

he has been uh as we've talked to each other on and off over the years he has been able to make adjustments to his diet understanding the principles if you understand the principles then you know which changes you can get away with and which changes you can't and he has stayed well there's a couple of key things people always talk about when they hear the carnival diet the first is they say there's nutritional deficiencies to the diet that aren't like sustainable so if you eliminate certain food groups like fibers vitamin C's vitamin E magnesiums Etc

then which are essential nutrients then you're going to have problems so a carnivore diet theoretically does provide all essential nutrients so if you look at what is inside animal Foods you will find all essential nutrients you can't say that of any plant food there's not a plant food on Earth that can that provides all essential nutrients animal foods can uh I would say meet Seafood poultry eggs are missing a couple of nutrients and dairy is missing even more um but uh meat seafood and poultry contain every nutrient we need the question is how much do

you need like fiber oh well fiber is not a nutrient oh okay but do you get fibr in a carnivore diet there are different definitions of carnivore but the strictest sort of purest definition of carnivore is animal Foods only and fiber comes from plants so it's fiber free a true carnivore diet is fiber free so could you lost on a true carnivore diet without getting some kind of like microbiome issue or some kind of because you need fiber right why thought it was good for like digestion and your microbiome and stuff like that what does

it do a lot of people tell me that it prevents glucose going into the blood or something where's the glucose coming from so you don't need it fiber fiber is very helpful and I spell this out in the book so because there's we have a lot of Hal truths in our minds about food um even people who are paying really close attention to the to nutrition science have a lot of half-truths in their minds about food so yes fiber for example you're exactly right lowers glucose spikes but the glucose is coming from a diet that's

too high and sugar and so you won't get glucose spikes if you regulate your glucose levels um so so that's one uh interesting thing about fiber so if you're eating a high carbohydrate diet fiber can soften your glucose spikes and that's a plus but there's a more effective way to lower your glucose spikes is to not get a glucose spike in the first place um and that may not require taking all the carbohydrate out of your diet it might just mean lowering it to your personal tolerance um another thing people often say about fiber is

that it sweeps your colon clean of toxins and kind of um um and uh that might otherwise build up and cause problems but fiber um there's no evidence that fiber is sweeping anything clean or there's never been a study that demonstrates this it's really just a belief about what we imagine fibers being like the broom of the intestines but there's no that that's just a belief there's no science behind that whatsoever um the the intestines clean themselves the lining sheds regularly actually very frequently and has and the border of the intestines um sweep themselves clean

so they the intestine knows how to take care of itself that way but the biggest myth about fiber is that it's good for digestion because fiber by definition is indigestible by humans so there are two kinds of fiber there's soluble and insoluble and the soluble is um you know the kind that holds water it's like in an apple and the insoluble is the kind of tough stringy Woody stuff that you might find in like broccoli for example so the soluble fiber the bacteria and the lower parts of our intestine can ferment that to a certain

extent um but uh but then we but then we can't make use of the sugars that it's releasing um right here fiber traditionally considered essential for feeding beneficial gut bacteria and promoting regular bowel movements yes okay so a couple of things to unpack there so one is that the uh a lot of people uh there are quite a few papers on this uh claiming that we need fiber because we need to feed our cells butyrate which is a breakdown product of fiber but butyrate if you think about what a ketone is it's beta hydroxy vate

feeds the intestinal cells just as well so you don't need to eat fiber to feed your cell's butyrate if you think that the cells need butyrate then you can get it from a ketogenic diet um so I explained that in the book too is that there's more than one way to generate that molecule can someone exist on the carnivore diet like the extreme version of the carnivore diet for a long time without any supplementation so you we really don't know and we really don't have any long-term data on on any dietary pattern I think this

is really important for people to understand is it's very common criticism of diets that we feel uncomfortable with or might be worried about like ketogenic diets or carnivore diets because they're so different from what we're told we're supposed to eat there's a lot of fear and worry uh about them and so think well okay it's it's um it's normalized my blood sugar level I used to have type two diabetes um you I've lost 50 pounds um my depression went away um my uh I normalized my coronary artery calcium scores I'm at lower risk for cardiovascular

disease my triglycerides came down um you know I feel better I'm I in every way like all of my health markers have improved and so when you show people study after study after study of a ketogenic diet um improving multiple aspects of metabolic health and physical health and mental health it's cured my seizures it's cured my bipo whatever it was the only the only last sort of the last thing somebody could say is well well yes okay it's made you extraordinarily healthy now but I wonder what's going to happen 20 years from now MH nobody

can tell you that because there's no way you could design a 20 year long study of any diet so you could say this about the Mediterranean diet you could say this about a carnivore diet you could say this about a vegan diet well vegan diet unsupplemented is is fatal um it's it has dangerous nutritional holes so why aren't we saying this about vegan diets when we can look at a vegan diet and see that it that that it's incompatible with human life unless you eat fortified processed foods or supplement which most people in the world

cannot do um we look at a carnivore diet and you can actually find all of the nutrients in these animal foods and that's the diet that you're more worried about because theoretically longterm something bad might happen now I am not at all saying that a carnivore diet is the right diet for everybody um or that it's even the right approach for everybody to consider but I think we have to keep an open mind and stay curious and look at the biology of food and allow people to make their own I'm nutritionally pro-choice which means I

would if you came to me with a mental health issue um I would support you in optimizing the diet of your choice and making it as brain healthy as I possibly could because I because uh it's very important that you feel comfortable with the diet that you're eating and so there are lots of ways to do that but I think it's really important and one thing I encourage people to do in my work and in my book is to open our minds and get curious about food the biology of food the biology of the brain

because most of what we hear about nutrition doesn't come from biology it doesn't come from Clinical experiments or uh information about how cells work or about what's actually inside food it comes from this type of study called A nutrition epidemiology study which is just questionnaire based guesswork untested theories about what we should eat most of what we believe about nutrition is untested theories wild guesses and Wishful Thinking many of the people that choose a keto diet do it for very sort of superficial reasons sure you know I think it's probably one of the reasons why

I do it once a year um for a couple of weeks um why does it help you to lose weight is that again just because of calorie restriction so it's insulin so it it everybody out there who's trying to lose weight they need to know one thing and it works if you cannot burn fat if your insulin levels are too high so if you know what rais insulin you can lo you can turn that insulin knob down if you know how to do that you will lose weight it's a biological fact so when you turn

down insulin you will burn fat so a ketogenic diet you can't produce ketones unless your insulin is low enough so a ketogen the ketones on that meter are showing you that you are burning fat you can't make ketones unless you're burning fat so you can't you really cannot burn fat unless you're in ketosis you don't necessar have to be in ketosis all the time you don't necessarily have to have very high Ketone levels but if you're not in ketosis you're not burning fat so um if you're not in ketosis the brain can't even see that

you've got energy spare energy to burn you might have 200 300 pounds of stored energy as fat the brain will still ask you to eat to eat more carbohydrate because it's not in fat burning mode so it's in car carbohydrate burning mode when it's hungry it's going to look for more carbohydrate you have to you have to teach it you have to bring your body into fat burning mode and and train your body give your cell some time a few weeks to learn how to burn fat again and stay there my mother is 91 years

old she has lost 50 pounds on a ketogenic diet it is never too late to all she has to do is make sure those there are ketones on her meter when her glucose meter was nice and stable she wasn't losing weight because the insulin was still too high the ketones tell you the ketones are essentially a mirror image of your insulin level so we don't have a home insulin level test yet we have fabulous continuous glucose monitors which I recommend anybody out there with a mental health issue or physical anybody out there who can afford

$5 or $50 for a single two week glucose sensor which are now available in the United States over the counter which they weren't before um I think you've had them in the UK for a lot longer you can see what your glucose levels are doing in response to your lifestyle your food choices your exercise Etc they can't it can't tell you what's going on with your insulin level so you can have a nice beautiful stable glucose level nice in the healthy range your insulin can still be too high and you still might just be you're

burning all that glucose for energy a ketone meter will tell you if you're burning fat I'm on Amazon now it says sort of $50 or yeah there's ones for $40 as well yeah one for $30 as well yeah interesting okay think I'm going to try one I've never actually done one before so I I guess I didn't really know if I was in ktis ketosis or not but I just oh it's so useful because um uh if you're if you're following a ketogenic diet um the thing that makes it ketogenic is the ketones yeah and

so I you were telling me before before we started recording that um you're always looking up okay which foods are keto which foods aren't keto and it's really not so much about that you could eat almost anything on a ketogenic diet if you if you understand you know how much to have and when um and but uh uh in any case um the Ketone meter will tell you you're in ketosis and if you're not in ketosis you can tweak your your plant so all of this is in the book but um but you can the

really the the most important thing about a ketogenic diet is getting into good consistent daily ketosis for at least six weeks straight that sends the daily signal to your cells we're burning fat now we're burning fat now we need to learn how to burn fat there are enzyme systems and Pathways and cells that need to ramp up and and that takes time so it takes a while for the body and brain to kind of learn how to burn fat again and uh it doesn't happen overnight in terms of energy there are so many reasons why

I'm a big matcha fan if you don't already know by now and so much so that I actually invested in the UK's leading matcha company called perfect Ted and one of my favorite perfect T products is these delicious matcha pouches that come in every flavor from salted caramel to Peach flavor to mint flavor to Berry flavor one of my favorites is this vanilla flavor which I'm going to make in just just two seconds you just take this mixer here get a little bit of the powder pop it on top of the shaker like that put

the lid on shake shake shake delicious if you haven't tried this yet you can find perfect Ted at Tesco and Holland Barrett stores or online where you can get 40% off with my code diary 40 head to perfect ted.com and put in code diary 40 to try this delicious multi-flavored match now highly recommend and if you do it please tag me send me a message online what part of your work sort of overlays with psychology you know when someone comes to you and they they're experiencing some anxiety or depression or something and they they're describing

their life and their life is full of trauma and hard things and they got fired from their job it seems a little bit peculiar to talk to them about diet in that moment it seems peculiar did do you ever think first about like some kind of psychological prescription oh you know I got some my training at Cambridge hospital uh in psychiatric residency is very Psychotherapy focused I got really excellent training in Psychotherapy and I still use it every day in my work it we're not throwing the baby out with the bath water here in fact

the psychology of people's relationship with food is really important to address I mean most of what I do I mean I could I could teach you in an hour um everything you needed to know about why you should switch to a ketogenic diet for mental health and and I could give you a little sheet and you could go off and do it right I would I would be rapidly obsolete um which would be a good problem to have right um but what actually is happening most of the work I'm doing is not about here's the

science here's why you need to do it here's what's happening in your brain here's the food list it would be so easy if that's what it were we are human beings and we have really complicated relationships with food we have history with food we have spiritual attachments to food cultural attachments to food political ATT beliefs about food and and a lot of us have addictions and attachments to food that go back a long way so most of it is about helping people understand and and sort of hold their hand through that proc process of making

that behavior change and it's and whatever is going on in their life is also important so how did you approach that with your patients so in the first in the first interview with somebody I usually take 90 minutes to two hours when I'm first uh working with a patient and I might do that two or three times before we actually begin uh discussing what to do with diet because I really want to understand um all of the different pieces of the puzzle not just oh what are you eating here's what you should eat M that

doesn't work for most people and because there are going to be challenges that come up and if the better I know that person the better I can help them through those challenges so it's not it's definitely not um it's not like I hand them a prescription for a diet and send them out the door I love understanding where people are coming from they're you know the the challenges they're facing in their lives and how that all intersects with their metabolic Health their their exercise you know why are they not exercising um how is their sleep

how are their relationships who in their life is supportive of them changing their diet um is who in their life is skeptical and worried and because that could be a major factor for people if one person in the family wants or needs to go on a ketogenic diet for mental health and nobody else in the family thinks it's a good idea that's really tough for people you you've got to plan for all of that and talk it through say okay here are the roadblocks we might face how are we going to how are we're going

to deal with these when they come up so I could give many many examples but the Psychotherapy the psychology of it is why using ketogenic diets to treat mental health conditions is usually best done as a team ideally if you can a keto dietician or nutrition therapist who's very skilled skill at using ketogenic diets designing them and personalizing for whatever you like to eat um so you'll have an enjoyable diverse diet that meets your needs and your desires um so you won't get bored and you'll enjoy the food you're eating um and a prescriber if

you're especially if you're taking medication or have any mental or physical health issues you'll need a prescribing professional primary care doctor um or a psychiatrist or both depending what's going on for you to manage the medications and help you through that transition period where there are so many different things changing in your physiology that can sometimes be uncomfortable if you don't plan properly um and set the person up for Success um and a coach a therapist a psychologist or a coach to for motivation and support and it could be a cheerleader but also to reflect

back to you how things are going and and and keep you moving forward because the first few weeks are the hardest and once you get past about week three week three is a real turning point for a lot of people your cells just kind of settle in to a new way of operating and it's this very noticeable shift that takes place in people's bodies and brains and that many people have never experienced before as it relates to anxiety um what does the research say about the role that keto can play in reducing someone's anxiety yes

so anxiety uh if you talk to any practitioner who has been using ketogenic diets in their work um whether it's a a psychiatric practitioner or a medical practitioner there are a couple of things they'll tell you that are most U the most predictable benefits of a ketogenic diet one is reduced anxiety and the other is mental Clarity so most people will experience tremendous reductions in anxiety um Within often within three days to three weeks of starting a ketogenic diet and the mental Clarity is is one of those things that you hear almost from almost everybody

so the anxiety is uh remember we're talking about this roller coaster those stress hormones are on a roller coaster life can cause stress and stress can unbalance your your Chemistry there's no question about that but your food can also do that your diet can also unbalance your stress hormones so and this is comes back to your question about you know life stressors you don't want to ignore those because they still count and they're still affecting your metabolic Health stress raises your cortisol levels and cortisol levels are dangerous for long-term brain health High cortisol levels most

mental health conditions come along with disregulated or poor regulation of cortisol levels in the brain and too much cortisol can over time damage the brain including uh the hippocampus which is the brain's learning and memory Center so Str add whether it's coming from inside the body from the foods you're eating or outside the body from your life both of those need to be addressed not just the dietary stress there's some studies that I just found um a 2023 systemic review examine the E efficacy of low carbohydrate ketogenic diets and treating mood and anxiety disorders the

review highlighted potential benefits but emphasized the ne necessity for randomized control trials to establish definitive conclusions that was the Cambridge University press and slightly separate to that um on serious mental illnesses I think you talk about this in your work as well a 2024 pilot study conducted by Stanford medicine investigated the effects of a ketogenic diet on participants with schizophrenia and bipolar and participants reported improvements in energy sleep mood and quality of life suggesting that ketogenic diet May stabilize brain functions in serious mental illnesses as well really really fascinating really fascinating I never really thought

about the ketogenic diet's impact on my mental health I used to think I be honest the reason I do it is um helps me become more focused it changes my body composition and really at the end of the year for me or at the start of the year it's a nice way to kind of reset that's the kind of how I see it I want to come into the year feeling good and strong and focused so I do it over sort of Christmas New Year January time every year with my partner um but I never

really considered the downstream consequences things like mental health and those other things but it it makes sense we have a closing tradition on this podcast where the last guest leaves a question for the next guest not knowing who they're leaving it for and the question that's been left for you is what would you say to someone who wanted to have less regret and more contentment and peace on their deathbed I'm trying to think about what for myself personally what I would have regretted um you know you might want me to say that I would have

regretted not having written this book and that's true but honestly it's about finding a really good healthy relationship in your life I mean if I hadn't accomplished that in my life I would have more regrets than not writing this book Thank you thank you for writing this book because it's such a comprehensive analysis of this poorly understood link between the things we put in our mouth and the impact it has on our mind holistically and I don't think enough people especially if we think back decades even thought to really uncover this sort of link I

never I think before even starting this podcast never really understood the concept of metabolic and metabolic Psychiatry and that there was an association between the two the great thing about your book is that you don't need to be a scientist to understand it it's clearly written for people like me who are don't have a profound knowledge of Science and um medicine and Psychiatry but are able to learn in advance the decisions we make just by reading your book it has been such a Smash Hit for so many people I was looking at some of the

reviews earlier on and people really really love it you wrote it you published it this year January January January and uh I highly recommend anyone that is intrigued by any of the subject matters that we spoke about today to go and get a copy I'll link it below um and it has some extraordinary people on the back who some of which I've interviewed at least one of which I've interviewed um in Jason um is there anything else you wanted to say about who this book is for yeah I mean I really want people with mental

health conditions even if they think they've tried everything if you know if you're willing to try one more thing hope is on the menu a powerful plan to improve mood overcome anxiety and protect memory for a lifetime of optimal mental health thank you so much for the work that you do thank you very much Stephen for your work do you know that 80% of New Year's resolutions fail by February it's because we focus too much on the end goal and we forget the small daily actions that actually move us forward those actions that are easy

to do are also easy not to do in life it's easy to save a dollar so it's also easy not to making one small Improvement each day one tiny step in the right direction has a big difference over time and that is the 1% mindset which is why we created the 1% diary a 90day journal designed to help you stay consistent and focus on the small wins and make real progress over time it also gives you access to the 1% community a space where you can stay accountable motivated inspired along with many others on the

same Journey we launched the 1% diary in November and it sold out so now we're doing a second drop join the wait list at theed diary.com and you'll be the first to know as soon as it's back in stock I'll put the link below [Music] oh [Music]