Latest / The You Project / #2218 Metabolic Psychiatry - Dr. Matthew Bernstein

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#2218 Metabolic Psychiatry - Dr. Matthew Bernstein · The You Project

• 0:00
  Speaker 1: Oh, good day, team.
• 0:00
  Speaker 2: It's your project, Tiffany Ancook, Craig Anthony Harper, and Matthew
• 0:04
  Speaker 2: Gerald William Longfellow Bernstein.
• 0:08
  Speaker 1: What's your middle name, Matt? Do you have one?
• 0:11
  Speaker 3: I do. It's Evan.
• 0:13
  Speaker 2: Evan.
• 0:14
  Speaker 3: Yeah.
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  Speaker 1: That's not very exciting. Let's give him another one. Let's
• 0:18
  Speaker 1: give him another one. I feel like you were close
• 0:19
  Speaker 1: with your guesses, though, Harps. Yeah, not too bad.
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  Speaker 3: Yeah.
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  Speaker 2: Uh sorry about insulting you before we lift you up
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  Speaker 2: matt it's just what we like to do come in
• 0:27
  Speaker 2: low and build to an emotional crescendo how are you
• 0:31
  Speaker 2: i'm good i'm good hey um so thanks for agreeing
• 0:36
  Speaker 2: to chat with us i've done a little bit of
• 0:38
  Speaker 2: i won't say a deep dive but a moderate.
• 0:40
  Speaker 1: Dive on you and your work yeah and i was
• 0:44
  Speaker 1: aware of.
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  Speaker 2: Metabolic psychiatry but not obviously overly familiar because it's somewhat
• 0:53
  Speaker 2: emergent and not for you, but for the rest of
• 0:58
  Speaker 2: us where we like most people, like what even is that?
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  Speaker 2: I kind of know what metabolic is and I kind
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  Speaker 2: of know what psychiatry is, but what are we specifically
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  Speaker 2: talking about?
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  Speaker 1: So for my.
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  Speaker 2: Audience, sorry, Tiff, our audience, could you just layman's version
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  Speaker 2: of what is metabolic psychiatry?
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  Speaker 3: Sure.
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  Speaker 2: Sure.
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  Speaker 3: So it's looking at the idea that when things fail
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  Speaker 3: in the brain, it's usually because of a lack of
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  Speaker 3: enough energy. And metabolism, as you're pointing out, is about
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  Speaker 3: turning nutrients into energy in cells. And so we're thinking
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  Speaker 3: about the metabolic processes in the body and in the
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  Speaker 3: brain as the main issue that's going wrong when people
• 1:43
  Speaker 3: have a mental health problem. And it's also a really
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  Speaker 3: great way to intervene in to help people's mental health
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  Speaker 3: because the interventions are really safe and generally good for
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  Speaker 3: you anyway, other, which is very different in indistinction to
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  Speaker 3: what psychiatrists normally prescribe, which are things that are not
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  Speaker 3: necessarily good for the rest of your body. Yes.
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  Speaker 1: Is, is part of the reason, and.
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  Speaker 2: I know there's, there's pushback, but I think the pushback is, well,
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  Speaker 2: I think there's becoming, correct me if I'm wrong, but
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  Speaker 2: there seems to be more curiosity, uh, more credibility. That's
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  Speaker 2: probably not the right word, but it's like people are
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  Speaker 2: starting to be curious and opening the door and considering
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  Speaker 2: that this is a real thing, which of course it
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  Speaker 2: is a real thing. Is part of the pushback from
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  Speaker 2: mainstream psychiatry, for want of a better term, The fact
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  Speaker 2: that they just don't understand it. They haven't done what
• 2:41
  Speaker 2: you've done. They haven't been where you've been. They haven't
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  Speaker 2: really done any research on this. So they talk about
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  Speaker 2: what they're very familiar with, right? Well, this is what
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  Speaker 2: we know and we know this is proven and that
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  Speaker 2: other stuff.
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  Speaker 1: Well, let's wait and see.
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  Speaker 2: But for right now, is that part of the pushback
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  Speaker 2: just because people can't endorse or... even publicly seem to
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  Speaker 2: be curious about stuff they don't know because that maybe
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  Speaker 2: detracts from their alleged credibility.
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  Speaker 3: Yeah.
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  Speaker 2: Yeah.
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  Speaker 3: I think there's a lot of that. And I think
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  Speaker 3: we're also, we're coming in with a theory that we're
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  Speaker 3: saying it's what we're doing is upstream and more fundamental
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  Speaker 3: and at the root than how psychiatry is traditionally done.
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  Speaker 3: which is more downstream. And, uh, so, you know, we're, we're,
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  Speaker 3: we're kind of coming in, I think a little bit
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  Speaker 3: with a bit of a superiority thing that what we're
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  Speaker 3: doing makes more sense. It's more fundamental, more upstream. And
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  Speaker 3: I don't think people like to be told that, uh,
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  Speaker 3: what they know and what they've spent their, you know,
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  Speaker 3: sometimes much of their life learning and practicing isn't the
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  Speaker 3: best necessarily way of seeing something. I People don't like that.
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  Speaker 3: And I understand that. I mean, who wants to be
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  Speaker 3: told that you spend all this time learning a certain
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  Speaker 3: way of how it's done and how to understand something.
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  Speaker 3: And there may be some serious flaws in that edifice,
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  Speaker 3: you know.
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  Speaker 2: It's so funny how ego and emotions and identity and
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  Speaker 2: self-righteousness and all these very human things just.
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  Speaker 1: Get in the way of science.
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  Speaker 2: Yeah. Oh, yeah.
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  Speaker 1: And progress.
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  Speaker 2: And even the fact that, you know, in a very
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  Speaker 2: simple kind of analogy, so I'm an exercise physiologist and
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  Speaker 2: I grew up running gyms, owning gyms. And forever I
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  Speaker 2: taught the food pyramid because that was the.
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  Speaker 1: Science and that's what I knew.
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  Speaker 2: And so I don't know how many thousand people, thousands
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  Speaker 2: of people I shared that idea with, but thousands. And audiences, one-on-one,
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  Speaker 2: I worked in radio, I worked in television, like a lot.
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  Speaker 2: And then one day you kind of go, oh, there's
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  Speaker 2: this other thing.
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  Speaker 1: There's this other idea. There's this other science.
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  Speaker 2: And I realized in quite a short amount of time
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  Speaker 2: that most of what I thought about nutrition was somewhere
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  Speaker 2: between a little bit right and complete bullshit, right? So
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  Speaker 2: then I had to go, oh. Well, if this is
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  Speaker 2: true and I don't want to share this truth, well,
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  Speaker 2: then I'm the problem. The problem is not the science
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  Speaker 2: or the data or the evidence. The problem is my
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  Speaker 2: ego that I now have to go to people, by
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  Speaker 2: the way, I've been wrong for a really long time.
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  Speaker 2: I think that's always going to be an impediment to
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  Speaker 2: the evolution and adoption of science.
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  Speaker 1: In terms of the timeline.
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  Speaker 3: Oh, yeah.
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  Speaker 1: Yeah.
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  Speaker 3: I mean, you know, that phrase that like, you know,
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  Speaker 3: some things change only one funeral at a time, right?
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  Speaker 2: Yeah.
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  Speaker 3: Like it requires the people who are in power to
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  Speaker 3: no longer be in power for some, some things to change.
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  Speaker 1: Yes.
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  Speaker 3: And I think there's, there's a lot of truth in that,
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  Speaker 3: that we do get, and I'm not, and I'm not
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  Speaker 3: putting myself outside of that. I'm, I'm the same way.
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  Speaker 3: I get wedded to my way of doing things and
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  Speaker 3: my ideas and, And I don't like to be told
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  Speaker 3: that it's not right or see evidence that it's not right.
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  Speaker 3: I will try not to see that evidence. I think
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  Speaker 3: we're all subject to this. Every human is.
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  Speaker 1: Confirmation bias, yeah. Yeah.
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  Speaker 2: What about, so when we look at, do you use
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  Speaker 2: the term conventional psychiatry?
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  Speaker 1: Am I using the right term?
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  Speaker 3: Yeah, we can say conventional or traditional. Yeah, those are reasonable.
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  Speaker 2: Yeah. So as somebody who's not you and has got
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  Speaker 2: a very limited understanding of all of this, it seems
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  Speaker 2: to me as though traditional conventional psychiatry is all about
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  Speaker 2: once the problems have arisen or once there's stuff, then
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  Speaker 2: we treat the symptoms, but not the underlying cause. And
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  Speaker 2: it seems with a small amount of research that I've
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  Speaker 2: done that metabolic psychiatry is is more focused on treating
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  Speaker 2: the problem, not so much managing symptoms over the long term.
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  Speaker 1: Is that correct?
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  Speaker 3: We think of it that way. Yeah, absolutely. That's what
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  Speaker 3: I was referring to before, that we think we're getting
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  Speaker 3: at something that's more fundamental and upstream, you know, at
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  Speaker 3: the root of what the problems are. And that's why
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  Speaker 3: we do see that this intervention, the same interventions work
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  Speaker 3: on many different types of psychiatric conditions. It's not you know,
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  Speaker 3: only works on this one psychiatric condition, the same interventions
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  Speaker 3: that I'm a proponent of work on schizophrenia and bipolar
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  Speaker 3: disorder and major depression and OCD and even eating disorders, anxiety, ADHD.
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  Speaker 3: Like I'm seeing benefits in all of these things with
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  Speaker 3: the same interventions. And that makes you really question, you know,
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  Speaker 3: how different are those conditions or is there some underlying
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  Speaker 3: underlying similarity of all those conditions that does at least
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  Speaker 3: partly go through metabolism. I'm not saying we have the
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  Speaker 3: full answer here of the root cause. I mean, that
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  Speaker 3: would be too much to be saying, and I don't
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  Speaker 3: think there's nearly evidence for that. But I am saying
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  Speaker 3: that we're getting at something that's more at the root
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  Speaker 3: and more fundamental, and that the intervention does work on, therefore,
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  Speaker 3: all of these things that may be downstream of that.
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  Speaker 2: It just makes total sense to me, because you think
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  Speaker 2: about in psychiatry, for example, where people are given drugs,
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  Speaker 2: So here's a drug, here's an intervention, whatever it is,
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  Speaker 2: you're going to put this in your body to change
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  Speaker 2: biochemistry or change your physiology in some way. We're giving
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  Speaker 2: you this to change what's happening in your body to
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  Speaker 2: change your state or, you know, to alter some of
• 8:58
  Speaker 2: the things that are going on. But then to you go, well,
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  Speaker 2: when I eat food. That changes what's happening in my body.
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  Speaker 2: That changes biochemistry. When I exercise, that affects my endocrine system,
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  Speaker 2: nervous system, everything, right? If I love my dog and
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  Speaker 2: I lie on the floor, this is for you, Tiff,
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  Speaker 2: and I lie on the floor and I cuddle my dog,
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  Speaker 2: my biochemistry changes. Absolutely. If I go walk in nature,
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  Speaker 2: if I love nature. So there's all of these things
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  Speaker 2: that have got nothing to do with a drug, a pill,
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  Speaker 2: an injection, or some kind of magical thing you know,
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  Speaker 2: medicine that change our body in a real way from
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  Speaker 2: a molecular level up. So it makes sense that not
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  Speaker 2: everything needs to come in a wrapper or a pill bottle. Right.
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  Speaker 3: Yeah. Just to emphasize your point, I agree a hundred percent.
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  Speaker 3: There's a study that showed one bout of exercise changes
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  Speaker 3: more than 9,000 different measurable metabolites in the bloodstream. Just,
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  Speaker 3: just exercising once.
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  Speaker 2: The University of Adelaide over here did a study, and
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  Speaker 2: I think it was published in December 2024, or University
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  Speaker 2: of South Australia, I should say. And they were looking
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  Speaker 2: at traditional treatment versus exercise.
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  Speaker 1: So just one.
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  Speaker 2: One single intervention exercise, cardiovascular exercise. And this sounds very convenient,
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  Speaker 2: this number, but it is the number. So it outperformed
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  Speaker 2: the exercise versus the, this is probably a good one
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  Speaker 2: for you to look at. He says, yeah, 150% more
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  Speaker 2: effective thereabouts. And it's like, Also, me as somebody who's
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  Speaker 2: worked with literally thousands of people helping them change their body,
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  Speaker 2: time and time and time again, I've seen people lose weight,
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  Speaker 2: change body composition, improve strength, function.
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  Speaker 1: Strength training improves cognitive function. We know that.
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  Speaker 2: Change the way they look, feel, function. And all of
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  Speaker 2: these unintended psychological and emotional benefits come with this immediate
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  Speaker 2: focus of, let's try and change your body. Not for ego,
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  Speaker 2: not for vanity, just so it works better, just so
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  Speaker 2: it's more functional, just so your back hurts less, your
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  Speaker 2: blood pressure's lower, your body composition's in a better place
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  Speaker 2: for longevity and health and disease avoidance. But so many
• 11:27
  Speaker 2: people go from coming to see me. to that initial
• 11:32
  Speaker 2: kind of target. And then, oh, by the way, I
• 11:35
  Speaker 2: don't feel sad hardly ever. That anxiety I used to get,
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  Speaker 2: I rarely get that. By the way, the peaks and troughs,
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  Speaker 2: those massive peaks and troughs, either non-existent or minor peaks
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  Speaker 2: and troughs. Like it's so integrated.
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  Speaker 3: Yeah. Yeah, the research on exercise helping depression, anxiety is
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  Speaker 3: really robust. There's thousands of studies and it is– intense
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  Speaker 3: exercise is generally more effective than antidepressants for depression. Um,
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  Speaker 3: the trick is it's hard to get people to do
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  Speaker 3: intense exercise when they're very depressed. So mostly these are
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  Speaker 3: people with mild to moderate depression. Once someone has severe depression,
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  Speaker 3: it's very, very tough to get them even to do
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  Speaker 3: a research exercise protocol. Um, and in the clinic I've
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  Speaker 3: seen that, I mean, I've been espousing exercise to my
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  Speaker 3: patients for years and it's sometimes very hard to get
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  Speaker 3: people to exercise. And so, You know, exercise is a
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  Speaker 3: big part of this metabolic psychiatry program, but it's not
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  Speaker 3: the mainstay because of that, mostly because of that, because
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  Speaker 3: it's very hard to get people to do it. But
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  Speaker 3: it works synergistically with the diet part, which is the
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  Speaker 3: sort of the main part of the intervention, I would say.
• 12:52
  Speaker 2: I feel like there's a paper in there, Tiff, the
• 12:55
  Speaker 2: psychology of psychiatry, the psychology of psychiatric interventions.
• 13:01
  Speaker 1: There's a paper in there. I could do that for sure.
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  Speaker 2: Because I'm with you, doc, prof, doc, like the idea
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  Speaker 2: of what, so I take this pill or I run
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  Speaker 2: every day.
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  Speaker 1: Fuck the run. Give me the pill.
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  Speaker 3: Yeah, absolutely.
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  Speaker 2: You know, so that's the, that's the, I guess that
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  Speaker 2: is one of the, psychological and emotional hurdles is i've
• 13:27
  Speaker 2: written a few books and the first book that i
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  Speaker 2: wrote was about literally the psychology of getting in shape
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  Speaker 2: physically because like i started working in gyms when i
• 13:36
  Speaker 2: was 18 i'm 62 right and i haven't stopped working
• 13:39
  Speaker 2: with bodies and people but realizing that oh i can
• 13:45
  Speaker 2: tell this person how to train why to train uh.
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  Speaker 1: And explain you know.
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  Speaker 2: Adaptation and progressive overload and all of the beautiful things
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  Speaker 2: that can happen with exercise and features advantages benefits as
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  Speaker 2: they say in sales training all of that but at
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  Speaker 2: the end of the day it means this person's got
• 14:05
  Speaker 2: to then turn my theory into their practical reality which
• 14:10
  Speaker 2: is that's a whole other issue you know yeah oh
• 14:14
  Speaker 2: yeah so So, yeah, I mean.
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  Speaker 3: As you know, it's hard to get people going with
• 14:18
  Speaker 3: exercise and then, you know, some people get going and
• 14:20
  Speaker 3: then they fall off, you know, something happens. People, you know,
• 14:26
  Speaker 3: the percentage of people who exercise enough is probably pretty low,
• 14:31
  Speaker 3: you know, for optimal health. You know, it's and, you know,
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  Speaker 3: it's part of our culture. It's part of our Western
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  Speaker 3: culture now. I mean, everything is made designed to make
• 14:40
  Speaker 3: things more readily, you know, accessible. in your hands and easier.
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  Speaker 3: And like, this is just, we're back to, you know,
• 14:48
  Speaker 3: just our physical body against the gravity. And, you know,
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  Speaker 3: that's just, it feels very foreign to people, you know,
• 14:55
  Speaker 3: but that's really, I mean, fundamentally we're still, we're, we're,
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  Speaker 3: we're all embodied, you know, no matter how much we're
• 15:01
  Speaker 3: in our heads or our spirits, like, We're really in
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  Speaker 3: our bodies. That's really who we are in many ways. Yes.
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  Speaker 2: And you think about the evolutionary timeline and the habits
• 15:11
  Speaker 2: of most people for most of that time. whether or
• 15:15
  Speaker 2: not it was focused exercise, most of the time not,
• 15:18
  Speaker 2: but we were just very active. We moved a lot.
• 15:20
  Speaker 2: We lifted stuff. We walked a lot. We were a
• 15:26
  Speaker 2: very physical, active species and now we're very, very sedentary
• 15:31
  Speaker 2: and we can push the button and get the thing
• 15:33
  Speaker 2: that we used to have to walk for. We don't
• 15:35
  Speaker 2: even have to walk to the restaurant to get our dinner.
• 15:38
  Speaker 2: They come to us and like this idea of convenience
• 15:43
  Speaker 2: and instant gratification, I'm always talking about the psychology of selling.
• 15:48
  Speaker 2: Like if you can give people the idea that basically
• 15:52
  Speaker 2: you can do the work for them, they're going to
• 15:55
  Speaker 2: buy within reason whatever you're selling.
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  Speaker 3: Yeah.
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  Speaker 2: Because hard is not attractive. Easy is attractive. And this
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  Speaker 2: is the constant barrier.
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  Speaker 3: Yeah, absolutely. Absolutely.
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  Speaker 2: And you think about when you do hard, like lift weights,
• 16:10
  Speaker 2: do a run, like do some cognitive process that's hard.
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  Speaker 2: In the middle of that, you become different. Like you
• 16:18
  Speaker 2: build strength and awareness and resilience and all of these
• 16:22
  Speaker 2: cool things versus taking the pill or the metaphoric.
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  Speaker 1: Pill, you get none of that growth or development.
• 16:28
  Speaker 3: That's right.
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  Speaker 2: Yeah. When did you first open the doormat on... metabolic
• 16:34
  Speaker 2: psychiatry did you hear it somewhere did you have an
• 16:36
  Speaker 2: experience what was the genesis.
• 16:40
  Speaker 3: Well yeah i mean i've always been interested in as
• 16:45
  Speaker 3: we're talking about like you know the exercise physical body
• 16:50
  Speaker 3: in my own personal life i was disappointed that i
• 16:52
  Speaker 3: wasn't able to get more people to do that as
• 16:55
  Speaker 3: one of their main ways that they were getting treatment
• 16:59
  Speaker 3: or getting better um And, uh, you know, I, I
• 17:02
  Speaker 3: got really worried too, prescribing all these medications that were
• 17:07
  Speaker 3: causing all kinds of metabolic dysfunction in people and maybe
• 17:11
  Speaker 3: making people gain weight and having their blood sugar be
• 17:14
  Speaker 3: high and their cholesterol be high. And, um, so that
• 17:19
  Speaker 3: was always, you know, really bothered me that I would
• 17:21
  Speaker 3: tell people that you kind of have to take this
• 17:23
  Speaker 3: medication if you want to be mentally well, and it
• 17:25
  Speaker 3: was making them physically unwell. You know, that was always
• 17:28
  Speaker 3: an issue for me. Um, And then we had our
• 17:32
  Speaker 3: experience in our family. Two of my kids got sick
• 17:36
  Speaker 3: with something that looks very psychiatric and it kind of
• 17:39
  Speaker 3: happened all at once. It turned out to be more
• 17:41
  Speaker 3: of an autoimmune process. And it really highlighted for me
• 17:45
  Speaker 3: how in my field, like, you know, because psychiatry didn't
• 17:48
  Speaker 3: help them at all. It actually made them worse, which
• 17:51
  Speaker 3: was hard to admit at the time. But, you know,
• 17:54
  Speaker 3: how little in psychiatry we really connect what's going on
• 17:57
  Speaker 3: in the brain or the mind to what's going on
• 17:59
  Speaker 3: in the body. we don't do enough of a workup
• 18:03
  Speaker 3: to really figure out like what's the body reason why
• 18:06
  Speaker 3: this person's having this mental issue at this time. So
• 18:10
  Speaker 3: it really hit home on a personal level and it really,
• 18:12
  Speaker 3: you know, opened my mind much more. And then, and
• 18:16
  Speaker 3: then I heard a lecture about someone talking about ketogenic
• 18:19
  Speaker 3: diets and how they were able to treat treatment resistant,
• 18:24
  Speaker 3: medication resistant psychotic disorders, which, you know, Psychotic disorders are
• 18:30
  Speaker 3: hard enough to treat. Those were using the really heavy
• 18:33
  Speaker 3: duty medications. And he was talking about some cases of
• 18:36
  Speaker 3: people who had been on medications for decades getting better
• 18:41
  Speaker 3: just from a diet. And that really opened my mind
• 18:46
  Speaker 3: to what this was about. And I sometimes joke, I
• 18:51
  Speaker 3: think I might have been one of the few people
• 18:52
  Speaker 3: in the audience who actually listen to that lecture. I
• 18:55
  Speaker 3: think most people were at, this was, you know, probably
• 18:59
  Speaker 3: about nine, eight, nine years ago now. I mean, before
• 19:01
  Speaker 3: metabolic psychiatry was on the map, this is one of
• 19:04
  Speaker 3: the four, you know, forerunners of it, Chris Palmer, Dr.
• 19:09
  Speaker 3: Chris Palmer. And I happened to know him and I
• 19:12
  Speaker 3: knew that, you know, he was not just blowing smoke.
• 19:14
  Speaker 3: Like this was real. I already had this experience with
• 19:17
  Speaker 3: my kids. So I was very open-minded. So that's what
• 19:20
  Speaker 3: really kind of opened my eyes to it. I started
• 19:22
  Speaker 3: Applying it in my practice a few years later, we
• 19:25
  Speaker 3: still had a lot of work to do with my kids,
• 19:26
  Speaker 3: getting them well. And so we were very busy with that.
• 19:30
  Speaker 3: And then I realized that I really wanted to start
• 19:33
  Speaker 3: changing how I practice based on this information that I
• 19:36
  Speaker 3: had been given and the experience that we had with
• 19:39
  Speaker 3: our family. And so I started applying that in my
• 19:44
  Speaker 3: long-term patients. I started talking to them about it. They
• 19:47
  Speaker 3: were looking at me like, what happened to you?
• 19:50
  Speaker 1: Yeah.
• 19:51
  Speaker 2: Yeah.
• 19:52
  Speaker 1: Your solution is stop eating sandwiches.
• 19:54
  Speaker 3: What? Yeah, exactly. Right. Like exactly. Like that's, that's what
• 19:58
  Speaker 3: you went to medical school to come.
• 20:00
  Speaker 2: Yeah.
• 20:00
  Speaker 1: This is your breakthrough.
• 20:01
  Speaker 3: Yeah.
• 20:02
  Speaker 2: Right.
• 20:02
  Speaker 3: But, but, but I started with people who knew me
• 20:04
  Speaker 3: really well and they knew, you know, I wasn't going
• 20:07
  Speaker 3: to be talking about something that, you know, I didn't,
• 20:10
  Speaker 3: really research and know a lot about and believe in.
• 20:13
  Speaker 3: And so I convinced a few of them to start
• 20:15
  Speaker 3: doing this, you know, more exercise, sometimes some intermittent fasting
• 20:20
  Speaker 3: at first and then low carbohydrate and then ketogenic diets later.
• 20:24
  Speaker 3: And I just started seeing incredible results. I mean, I
• 20:27
  Speaker 3: couldn't believe how much better people were getting. People who
• 20:31
  Speaker 3: I'd been working with for years that, you know, the
• 20:33
  Speaker 3: best ideas I had, we couldn't make that much progress
• 20:36
  Speaker 3: or we got stuck. We would hit a plateau. And
• 20:39
  Speaker 3: we're breaking through these plateaus like you couldn't imagine.
• 20:44
  Speaker 2: Do you think, Matt, there'll come a time in 50
• 20:47
  Speaker 2: years when people look back at the way psychiatry is
• 20:52
  Speaker 2: typically done now and think or say, what on earth
• 20:56
  Speaker 2: were they thinking? Like how much didn't they understand?
• 21:01
  Speaker 3: I mean, my initial response is I hope so. Um,
• 21:08
  Speaker 3: I really hope so. Um, because, you know, we, we,
• 21:14
  Speaker 3: you know, the, the era in which I've mostly practiced
• 21:17
  Speaker 3: up until, you know, maybe about five or six years
• 21:19
  Speaker 3: ago when I started doing things a different way, the
• 21:22
  Speaker 3: outcomes just are not very good. Um, objectively not very good. Um,
• 21:28
  Speaker 3: we've got people with serious mental illnesses dying about 15
• 21:32
  Speaker 3: years earlier than the general population doesn't have one of
• 21:37
  Speaker 3: those illnesses. And most of that is due to cardiometabolic reasons,
• 21:42
  Speaker 3: some of which is intrinsic to the illness, but a
• 21:44
  Speaker 3: lot of it is due to the treatments themselves, the
• 21:47
  Speaker 3: medications that we've prescribed for all these years. People end
• 21:52
  Speaker 3: up on many medications at the same time, sometimes four
• 21:57
  Speaker 3: or five, six, seven medications prescribed by a psychiatrist. And
• 22:03
  Speaker 3: the level of functional recovery is just not at all
• 22:07
  Speaker 3: where we need it to be in terms of, yes,
• 22:09
  Speaker 3: we can reduce symptoms with these medications. And that's mostly
• 22:12
  Speaker 3: how they get approved by reducing symptoms, showing that you
• 22:16
  Speaker 3: can reduce symptoms. But reducing symptoms is not the same
• 22:18
  Speaker 3: thing as functional recovery, like getting back to work and
• 22:22
  Speaker 3: relationships and living independently and being able to exercise and
• 22:27
  Speaker 3: have friendships and all of those things. And that's what
• 22:30
  Speaker 3: people really care about, not do they have lower scores
• 22:34
  Speaker 3: on a symptom rating scale, which is mostly how we
• 22:37
  Speaker 3: measure the medications to get them approved.
• 22:40
  Speaker 2: So if you call that like the optimal version of
• 22:44
  Speaker 2: or the optimal outcome with metabolic psychiatry is functional recovery,
• 22:52
  Speaker 2: what would you call what's typically achieved with traditional psychiatry?
• 22:56
  Speaker 2: Would it just be maintenance of symptoms or moderation of like,
• 23:04
  Speaker 2: cause clearly like I know a lot of people who are, yeah,
• 23:09
  Speaker 2: I do know a lot of people who are in
• 23:11
  Speaker 2: that space who are, you know, reasonably significantly medicated for
• 23:16
  Speaker 2: a bunch of things and some of them three, four, five.
• 23:19
  Speaker 1: Six years. And there's, there's no improvement.
• 23:25
  Speaker 2: Like they're less, uh, like the, it's almost like there's
• 23:32
  Speaker 2: this baseline that they never veer away from too much,
• 23:38
  Speaker 2: like happiness, sadness, like disconnection of emotions. I just don't
• 23:43
  Speaker 2: feel much. I just like, I want to, but I don't,
• 23:45
  Speaker 2: there seems to be a lot of blah. Yeah.
• 23:48
  Speaker 1: What's the, so, so what do they hope.
• 23:50
  Speaker 2: To achieve with traditional psychiatry just to reduce the symptoms?
• 23:55
  Speaker 3: That's really, yeah, that's how the medications get approved. And
• 23:59
  Speaker 3: that's often how we're measuring outcome is through symptom reduction scales.
• 24:05
  Speaker 3: What's the reduction on the depression rating scale, the HAMD
• 24:09
  Speaker 3: or the Madras or the PHQ-9? Or what's the reduction
• 24:12
  Speaker 3: on the anxiety rating scale or the reduction on the
• 24:15
  Speaker 3: psychosis scale, the PANS or the BPRS? That's generally how
• 24:19
  Speaker 3: these medications... get approved, and generally how treatment outcomes are
• 24:23
  Speaker 3: measured is through symptom reduction. So it's no wonder that
• 24:27
  Speaker 3: that's what gets prioritized. And as I said, this is
• 24:32
  Speaker 3: something I've known for a long time, even well before
• 24:34
  Speaker 3: my kids had their issue and I learned about the
• 24:38
  Speaker 3: ketogenic diet, I had an issue with this idea that
• 24:42
  Speaker 3: we're okay with reducing symptoms and not getting functional recovery.
• 24:45
  Speaker 3: And we call it a good outcome with someone with
• 24:49
  Speaker 3: a serious mental illness to you know, have lower amounts
• 24:53
  Speaker 3: of symptoms, but essentially not function even close to where
• 24:57
  Speaker 3: they were before that. And they're not getting hospitalized anymore.
• 25:00
  Speaker 3: They're not suicidal, but they're not functioning. And we would
• 25:03
  Speaker 3: call that a success.
• 25:05
  Speaker 1: Yes.
• 25:06
  Speaker 3: Right.
• 25:07
  Speaker 1: Yes. Yes. Yeah. But there's no real purpose or joy.
• 25:12
  Speaker 2: Or I don't know, connection or yeah.
• 25:18
  Speaker 1: So yeah.
• 25:19
  Speaker 2: As much or as little as you want to tell us,
• 25:21
  Speaker 2: just because if I was listening to this at home,
• 25:25
  Speaker 2: I would want to know, hey, Matt, can you tell
• 25:27
  Speaker 2: us about, maybe this is not okay, you tell me,
• 25:32
  Speaker 2: but your boys, like what was.
• 25:34
  Speaker 1: Their issue or issues? What did you do? And what
• 25:39
  Speaker 1: was the outcome?
• 25:41
  Speaker 3: Yeah, I don't like to give all the details just
• 25:43
  Speaker 3: because it's more their story to tell and their- Right.
• 25:47
  Speaker 1: Do you have another patient?
• 25:50
  Speaker 2: Yeah. Can you just get like, I want to know, okay,
• 25:54
  Speaker 2: I've worked with this person. This is where they were.
• 25:57
  Speaker 1: Cause I love stories.
• 26:00
  Speaker 2: And if this is a real case of a real person,
• 26:03
  Speaker 2: then I go, Oh yeah, this is, that's just the
• 26:06
  Speaker 2: way I work.
• 26:07
  Speaker 1: So maybe a case study or two would be great.
• 26:09
  Speaker 3: Of course. Of course. Yeah.
• 26:11
  Speaker 2: Yeah.
• 26:11
  Speaker 3: So, I mean, this is someone who has given me
• 26:13
  Speaker 3: permission to tell a version of his story. And, you know,
• 26:18
  Speaker 3: he had, He came to my program, Accord, a little
• 26:23
  Speaker 3: over a year ago. He had been in and out
• 26:26
  Speaker 3: of psychiatric hospitals and residential programs pretty much straight for
• 26:30
  Speaker 3: the past six years. And he was in his mid-20s
• 26:34
  Speaker 3: when he came. On eight medications for his psychiatric condition.
• 26:41
  Speaker 3: None of them were for... I mean, some of them
• 26:43
  Speaker 3: were to treat side effects of the other medications, but... Yes.
• 26:46
  Speaker 3: And very high doses of... multiple antipsychotic medications including yes
• 26:51
  Speaker 3: the most powerful one we have clozapine um and he
• 26:57
  Speaker 3: had lots of side effects he he didn't he didn't
• 26:59
  Speaker 3: have the metabolic side effects he hadn't gained a bunch
• 27:01
  Speaker 3: of weight but he was very sedated you know he
• 27:04
  Speaker 3: had yes he could he could only be awake for
• 27:06
  Speaker 3: probably about eight maybe 10 hours a day otherwise he
• 27:10
  Speaker 3: was asleep 14 16 hours a day he'd fall asleep
• 27:13
  Speaker 3: in the chair this guy in his mid-20s um And
• 27:17
  Speaker 3: he was enthusiastic about doing the whole metabolic program, which
• 27:22
  Speaker 3: includes well-formulated ketogenic diet, exercise, some mind-body practices, circadian rhythm work,
• 27:31
  Speaker 3: like sunlight in the morning and avoiding blue light at night.
• 27:37
  Speaker 3: And now it's a little over a year later, he's
• 27:40
  Speaker 3: on just three medications. The big one that he was on,
• 27:45
  Speaker 3: the Clozapine, he's on about one-tenth of the dose that
• 27:49
  Speaker 3: he was on when he first came. Wow. He actually
• 27:53
  Speaker 3: has less symptoms than he had when he first came.
• 27:56
  Speaker 3: So even though he was on all that medication, by
• 27:57
  Speaker 3: the way, symptom reduction was not achieved. I mean, he
• 28:01
  Speaker 3: was still having all the symptoms of his condition, which
• 28:04
  Speaker 3: is a psychotic disorder, so he would hear voices. And
• 28:07
  Speaker 3: he still does hear voices, but actually less than he
• 28:10
  Speaker 3: did when he was on all that medication.
• 28:12
  Speaker 1: Yes, yes.
• 28:14
  Speaker 3: And he's maintained being in ketosis. He exercises. He's now
• 28:20
  Speaker 3: at home and he works 20 hours a week. He
• 28:24
  Speaker 3: has full conversations. His affect is bright. He smiles. He
• 28:28
  Speaker 3: makes jokes. He's back to being his, his personality is
• 28:33
  Speaker 3: back in his personality. You know, he's, and he's making music,
• 28:36
  Speaker 3: you know, so this is just a completely, you know,
• 28:41
  Speaker 3: complete turnaround from where he was. I mean, he was,
• 28:43
  Speaker 3: someone who people were just saying, he's going to be,
• 28:46
  Speaker 3: you know, a psychiatric patient for the rest of his life.
• 28:50
  Speaker 3: And now he's back living his life. Not that he
• 28:54
  Speaker 3: doesn't still have work to do. I mean, we're, you know,
• 28:56
  Speaker 3: we're a year in, I predict that a year from now,
• 28:58
  Speaker 3: things are going to be even better. Because that's how
• 29:01
  Speaker 3: it works with this metabolic treatment, which is very different
• 29:04
  Speaker 3: than the medications to the medications, we achieve some kind of,
• 29:08
  Speaker 3: you know, and it doesn't usually get better over time
• 29:13
  Speaker 3: um but that's exactly what we see with this metabolic
• 29:16
  Speaker 3: treatment the longer people do it the more healing occurs
• 29:20
  Speaker 3: and and often the the better functioning um they can
• 29:24
  Speaker 3: be over time.
• 29:27
  Speaker 1: What's maybe in the top five of.
• 29:30
  Speaker 2: Issues that people are uh disorders, whatever, people that present
• 29:36
  Speaker 2: to you typically as a psychiatrist, what's the kind of type?
• 29:40
  Speaker 1: Five-ish kind of things that they present with?
• 29:45
  Speaker 3: Well, again, then we're talking about these diagnoses, right? Is
• 29:48
  Speaker 3: that what you're asking for?
• 29:49
  Speaker 1: Yeah.
• 29:50
  Speaker 3: Okay.
• 29:50
  Speaker 1: Well, yeah. Yeah. So is it just severe anxiety? Is it,
• 29:55
  Speaker 1: is it.
• 29:56
  Speaker 3: Yeah.
• 29:57
  Speaker 1: Debilitating depression?
• 29:59
  Speaker 3: Is it. I mean, it really depends on where a
• 30:02
  Speaker 3: psychiatrist practices. For me personally, I've always worked in settings
• 30:06
  Speaker 3: where people with the more severe conditions come. That's not
• 30:10
  Speaker 3: true of every psychiatrist. Some psychiatrists may have more people
• 30:13
  Speaker 3: that come with mostly ADHD and anxiety and maybe relationship
• 30:21
  Speaker 3: struggles or things like that. But for me, I've always
• 30:24
  Speaker 3: worked with people with things like schizophrenia, bipolar disorder, schizoaffective disorder,
• 30:30
  Speaker 3: severe major depression, severe OCD, PTSD. Um, and I would
• 30:36
  Speaker 3: say the thing that really unites almost everyone who comes
• 30:40
  Speaker 3: to a psychiatrist is, you know, very enriched people who've
• 30:43
  Speaker 3: had more significant childhood traumas than the general population. That's
• 30:48
  Speaker 3: always important to say, because I think it's, it's under, um,
• 30:53
  Speaker 3: I think it's under talked about in my field, even
• 30:55
  Speaker 3: though there is a lot of research to show that,
• 30:57
  Speaker 3: you know, the more adverse childhood events you have, the
• 30:59
  Speaker 3: more likely you are to have one of these psychiatric conditions.
• 31:03
  Speaker 3: And interestingly, the more adverse childhood events you have, the
• 31:07
  Speaker 3: more likely you are to have a metabolic condition as well,
• 31:09
  Speaker 3: which is also really interesting. The metabolism mediates the trauma
• 31:14
  Speaker 3: into the symptoms later on in life.
• 31:17
  Speaker 1: Yeah.
• 31:18
  Speaker 3: It's the way I look at it.
• 31:20
  Speaker 1: Okay.
• 31:20
  Speaker 2: So this is a, probably a question that you don't
• 31:23
  Speaker 2: get asked that much, but a very simple one. So
• 31:27
  Speaker 2: there's going to be people listening to this who don't
• 31:32
  Speaker 2: know exactly what we're talking about when we say a
• 31:35
  Speaker 2: ketogenic diet.
• 31:36
  Speaker 1: Can you just define that simply?
• 31:38
  Speaker 3: Sure. So simple version is any diet that can be
• 31:44
  Speaker 3: Mediterranean style or Western style or Asian style, any diet
• 31:51
  Speaker 3: that makes your body produce these things called ketones. So
• 31:55
  Speaker 3: typically in order for that to happen, it has to
• 31:57
  Speaker 3: be a high fat, moderate protein, very low carbohydrate diet.
• 32:03
  Speaker 3: That's the hallmark of a ketogenic diet, but it can
• 32:05
  Speaker 3: be adapted to different styles and different cuisines. And some
• 32:10
  Speaker 3: people do it. You can do it vegetarian. You can
• 32:13
  Speaker 3: do it more meat based. You can do it fully
• 32:15
  Speaker 3: meat carnivore. There's all different kinds of ways to do
• 32:18
  Speaker 3: it based on preference, but it's just, High fat, moderate protein,
• 32:24
  Speaker 3: very low carbohydrate. And I also want to emphasize that
• 32:27
  Speaker 3: this diet was invented at a hospital for a medical reason,
• 32:31
  Speaker 3: even though now people eat a ketogenic diet and they say, oh,
• 32:34
  Speaker 3: that's what everyone's talking about on the Internet. It's a fad.
• 32:37
  Speaker 3: It's a weight loss diet. But this was invented at
• 32:40
  Speaker 3: the Mayo Clinic in 1921 to treat pediatric epilepsy. That's
• 32:44
  Speaker 3: really important for people to know. It's a medical diet.
• 32:49
  Speaker 2: Is part of the reason why starchy, super carby, super
• 32:55
  Speaker 2: sugary foods are part of the problem that because they're
• 33:02
  Speaker 2: inflammatory foods, they cause inflammation, cellular inflammation in the body
• 33:06
  Speaker 2: and nearly all disease relates to inflammation in some way?
• 33:11
  Speaker 3: It's definitely one of the mechanisms that's really important. It's
• 33:14
  Speaker 3: not the only mechanism, but for sure, the ketogenic diet
• 33:17
  Speaker 3: is a very anti-inflammatory diet and high carbohydrate high sugar
• 33:23
  Speaker 3: diets are very pro-inflammatory that's certainly true and you know
• 33:28
  Speaker 3: mental health conditions having a connection to inflammation is very
• 33:32
  Speaker 3: good science now too so we know that one of
• 33:35
  Speaker 3: the ways in which ketogenic diets improve mental health is
• 33:37
  Speaker 3: through lowering brain inflammation but i wouldn't say it's the
• 33:41
  Speaker 3: most important mechanism i mean there's definitely others that i
• 33:45
  Speaker 3: that i focus on even more.
• 33:46
  Speaker 1: Than that yeah What are some of those other mechanisms, Matt?
• 33:50
  Speaker 2: Yeah.
• 33:51
  Speaker 3: So one of the big ones is that ketones are
• 33:54
  Speaker 3: this additional source of fuel for the brain. And that
• 33:58
  Speaker 3: part of what's going on in a mental health condition
• 34:01
  Speaker 3: or probably other brain health conditions too, like dementia for
• 34:04
  Speaker 3: sure and many others, is that these brain cells, neurons
• 34:10
  Speaker 3: and other microglia, astrocytes, they're running out of fuel. This
• 34:14
  Speaker 3: is our Most energy intensive organ is our brain. It's 2%
• 34:19
  Speaker 3: of our body weight and uses 20% of our energy.
• 34:22
  Speaker 3: And it doesn't store any energy. There's no glycogen storage
• 34:27
  Speaker 3: and fat storage in our brain. It has to get
• 34:29
  Speaker 3: its energy from the rest of the body. And when
• 34:32
  Speaker 3: there's certain areas of the brain that become resistant to insulin,
• 34:36
  Speaker 3: which is a little bit of a complicated concept, essentially
• 34:39
  Speaker 3: they run out of fuel. They run out of energy.
• 34:41
  Speaker 3: And ketones bypass that insulin resistance blockade and there's this
• 34:45
  Speaker 3: additional source of fuel that just diffuses right into the
• 34:48
  Speaker 3: cell and can be burned as fuel. And so it
• 34:51
  Speaker 3: rescues this energy deficit problem. So that's a big mechanism.
• 34:55
  Speaker 2: Hey, Tiff, with your diet, it's surprising you're not in
• 34:58
  Speaker 2: psychosis right now. If Matt knew what you lived on,
• 35:03
  Speaker 2: he'd put.
• 35:04
  Speaker 1: You in a cave and throw in a steak. Pistachio cookies, Matt.
• 35:07
  Speaker 2: I do like steak though.
• 35:10
  Speaker 1: I wouldn't be upset. But you live on chocolate brownies.
• 35:13
  Speaker 3: Yes.
• 35:15
  Speaker 1: You're the outlier.
• 35:17
  Speaker 3: Ketogenic chocolate brownies.
• 35:21
  Speaker 1: They sound terrible, by the way. But anyway.
• 35:25
  Speaker 3: Well, actually, we have a chef at Accord that can
• 35:27
  Speaker 3: make really good keto dessert, believe it or not. Like
• 35:29
  Speaker 3: she makes delicious keto dessert. It's very possible.
• 35:33
  Speaker 1: Yeah.
• 35:35
  Speaker 3: Anyway, so that's a big mechanism. The other really big
• 35:37
  Speaker 3: one is about mitochondria. Yeah. you know, mitochondria are these
• 35:42
  Speaker 3: energy factories in the cells, but they do way more
• 35:45
  Speaker 3: than that. They're like a collective that's controlling many aspects
• 35:49
  Speaker 3: of what's going on in a cell. And mitochondrial dysfunction
• 35:53
  Speaker 3: is well known to be a big part of psychiatric conditions.
• 35:57
  Speaker 3: There's really good science showing that all kinds of mitochondrial
• 36:00
  Speaker 3: dysfunction in these serious mental illnesses that I described. And
• 36:04
  Speaker 3: ketogenic diets, ketones themselves activate this pathway called PGC1-alpha, which
• 36:11
  Speaker 3: causes the cell to make more mitochondria and also to
• 36:14
  Speaker 3: recycle the old damaged mitochondria and turn it into new
• 36:17
  Speaker 3: ones that are functioning better. And PGC1-alpha is also turned
• 36:22
  Speaker 3: on by exercise, by the way. So exercise and ketogenic
• 36:26
  Speaker 3: diets work together to really boost the health of mitochondria,
• 36:30
  Speaker 3: which is a huge important mechanism in how this works.
• 36:33
  Speaker 2: Yeah, yeah.
• 36:35
  Speaker 1: So I'm going to ask you a hard question now.
• 36:37
  Speaker 1: I've given you all the easy ones.
• 36:41
  Speaker 2: Could you tell us what you eat in a day?
• 36:44
  Speaker 2: I know it varies, but what's a typical Matt day
• 36:47
  Speaker 2: of eating look like?
• 36:49
  Speaker 3: Sure. So I just want to caveat this with just
• 36:52
  Speaker 3: because I eat it doesn't.
• 36:53
  Speaker 1: Mean that's what other people eat. It's not a recommendation.
• 36:56
  Speaker 3: It's very individual. You know, what works for people is
• 37:00
  Speaker 3: very individual. But a typical breakfast for me is I'll have– uh,
• 37:04
  Speaker 3: some Greek yogurt, whole fat, actually more than whole fat.
• 37:08
  Speaker 3: Cause I mix in this homemade yogurt that I make
• 37:11
  Speaker 3: that's way higher fat than even whole fat yogurt. That's
• 37:14
  Speaker 3: has special probiotics in it. Um, and then I put
• 37:18
  Speaker 3: basil seeds in there, which has some fiber and some, um,
• 37:22
  Speaker 3: iron and some other good stuff and a little bit
• 37:25
  Speaker 3: of berries, maybe some raspberries and a little bit of
• 37:28
  Speaker 3: some keto granola. So that's breakfast, typical. Either that or
• 37:33
  Speaker 3: maybe four eggs and some bacon and some avocado or
• 37:37
  Speaker 3: something like that. And then lunch, if I'm at work,
• 37:41
  Speaker 3: I'll just have like a tin of salmon or sardines
• 37:46
  Speaker 3: and some almonds, typically, something like that. Unless I get
• 37:49
  Speaker 3: to go to a court in which I'll have a
• 37:50
  Speaker 3: delicious salad or with some protein in it.
• 37:54
  Speaker 1: So no kissing for you in the afternoons? Hey, come on.
• 38:01
  Speaker 1: Keep going. I'm into it.
• 38:03
  Speaker 2: Good.
• 38:05
  Speaker 3: And then dinner is just like, yeah, it's protein and
• 38:08
  Speaker 3: a veggie and, you know, good amount of fat in
• 38:11
  Speaker 3: there in the sauce. Usually. I mean, my wife's making
• 38:15
  Speaker 3: dinner right now. She's making spinach salad with shrimp, bacon
• 38:20
  Speaker 3: dressing and pecans and, you know, something like that. So like, yeah,
• 38:26
  Speaker 3: you know, veggies and protein with fat. You know, that's
• 38:29
  Speaker 3: basically it for dinner. Yeah.
• 38:31
  Speaker 2: The other day for the first time in a long time, Matt,
• 38:33
  Speaker 2: you'd be kind of proud of me. I don't eat
• 38:36
  Speaker 2: lunch or much lunch just because I tend not to
• 38:38
  Speaker 2: be hungry, but I was out, I was meeting someone
• 38:40
  Speaker 2: for coffee at lunchtime and.
• 38:43
  Speaker 1: I was hungry.
• 38:44
  Speaker 2: So I got scrambled eggs. I said, I just want,
• 38:48
  Speaker 2: I don't want the bread. So it had onion, tomato, ham, butter,
• 38:54
  Speaker 2: and eggs. It was like Nirvana. It was just like
• 39:00
  Speaker 2: just a mouth orgasm. It was the best thing ever.
• 39:04
  Speaker 2: It was so good and not a carb to be seen.
• 39:08
  Speaker 2: And I did not feel hungry for like eight hours.
• 39:10
  Speaker 1: That's the problem.
• 39:12
  Speaker 2: Yeah.
• 39:13
  Speaker 3: Oh, and that's the thing too is, I mean, I
• 39:14
  Speaker 3: love food. I mean, when I started eating this way,
• 39:17
  Speaker 3: I was a little scared because I love eating so much.
• 39:21
  Speaker 3: I thought I was going to feel deprived. But as
• 39:23
  Speaker 3: you said, like you feel very, very satisfied.
• 39:26
  Speaker 1: Delicious food.
• 39:27
  Speaker 3: Sometimes I'll have a little chocolate. after dinner but when
• 39:31
  Speaker 3: i say chocolate it's like i use eat like 95
• 39:34
  Speaker 3: dark chocolate like that's what i like but yeah yeah.
• 39:38
  Speaker 2: In terms of the the broader uh field of psychiatry
• 39:44
  Speaker 2: or profession.
• 39:47
  Speaker 1: How is it, like you.
• 39:48
  Speaker 2: Said, eight or nine years ago, it was essentially unheard
• 39:51
  Speaker 2: of metabolic psychiatry.
• 39:53
  Speaker 1: What's the kind of vibe now?
• 39:55
  Speaker 2: I know that's not a very academic or medical or
• 39:58
  Speaker 2: scientific term, but what's the vibe, Matt, amongst all of
• 40:03
  Speaker 2: your kind of colleagues in the field? Is there more interest,
• 40:08
  Speaker 2: more curiosity, more acceptance, less?
• 40:12
  Speaker 1: How's it being adopted or not?
• 40:16
  Speaker 3: Definitely more of all of that in the past year,
• 40:20
  Speaker 3: I would say I'm seeing a big change. You know,
• 40:22
  Speaker 3: when I was talking to people about this three, four
• 40:26
  Speaker 3: years ago, I would get some serious looks like what
• 40:30
  Speaker 3: is going on with this guy? Yes. And I don't
• 40:35
  Speaker 3: get those looks anymore. People are really interested. They want
• 40:38
  Speaker 3: to hear more. They want to, you know, they want
• 40:40
  Speaker 3: to learn about this and they want to hear what
• 40:43
  Speaker 3: papers to read and, you know, how to do it.
• 40:47
  Speaker 3: I'm getting invited to a lot more mainstream conferences and
• 40:53
  Speaker 3: grand rounds at hospitals where they want to hear about this.
• 40:56
  Speaker 3: And so the mainstream traditional psychiatrists are now saying, this
• 41:02
  Speaker 3: is interesting. And I think partly because they're hearing it
• 41:05
  Speaker 3: from their patients that the patients are coming in and saying, hey,
• 41:10
  Speaker 3: I heard about this thing. It's really exciting to me.
• 41:13
  Speaker 3: I want, I want to learn more. I want to
• 41:15
  Speaker 3: do this. And, and there's very few things that people
• 41:18
  Speaker 3: get excited about in mental health care. I can tell you,
• 41:23
  Speaker 3: you know, having been in that world for many years. Oh,
• 41:26
  Speaker 3: the people don't get that, you know, the mainstream people
• 41:28
  Speaker 3: don't get that excited. Oh, the brand new medication that
• 41:30
  Speaker 3: came out or the new psychotherapy that just had a
• 41:33
  Speaker 3: study on it. People get excited about this. They, they're,
• 41:36
  Speaker 3: they're pretty excited about psychedelics too, as, as a treatment
• 41:39
  Speaker 3: in psychiatry. But But those are some of the few
• 41:43
  Speaker 3: things that people get excited about in the general public.
• 41:45
  Speaker 3: And I think that's a big part of why people
• 41:48
  Speaker 3: in my field are paying more attention is because patients
• 41:52
  Speaker 3: and families are demanding it. They're coming in and saying, hey,
• 41:55
  Speaker 3: this is what I want to do. This is how
• 41:58
  Speaker 3: I want.
• 41:58
  Speaker 1: To get better.
• 41:58
  Speaker 3: I want to get on less medication. I want to
• 42:00
  Speaker 3: feel more vitality. I want to take care of my
• 42:05
  Speaker 3: own health in this different way.
• 42:08
  Speaker 2: Do you get Do you get people to, like with
• 42:13
  Speaker 2: my clients back in the day, they'd.
• 42:14
  Speaker 1: All present.
• 42:19
  Speaker 2: Basically for one reason, one commonality, and that is they
• 42:22
  Speaker 2: want to change their body in some way. And obviously
• 42:25
  Speaker 2: that can be represented by a lot of different factors
• 42:28
  Speaker 2: or variables. But I would get them to, for the
• 42:32
  Speaker 2: first 100 days at least, but for the first 100 days,
• 42:35
  Speaker 2: assume they work with me for three months or more,
• 42:38
  Speaker 2: I get them to diarise everything that they do from,
• 42:42
  Speaker 2: you know, waking, sleep, going to bedtime, tea, coffee, fluids, food,
• 42:50
  Speaker 2: as much as possible, possible micros, macros, like exactly what exercise.
• 42:56
  Speaker 1: They did, sets, reps, cardio.
• 42:59
  Speaker 2: So we would try to almost do a little N
• 43:01
  Speaker 2: equals one observation of them, Because obviously, as you indicated before,
• 43:07
  Speaker 2: when you were talking about your diet, everybody responds at
• 43:12
  Speaker 2: least a little bit differently to the person next to them.
• 43:14
  Speaker 2: Or generally, the same stimulus will create or the same
• 43:18
  Speaker 2: intervention will create a different outcome with different people. But
• 43:21
  Speaker 2: what I found over time is people could start to
• 43:25
  Speaker 2: figure out their own physiology.
• 43:28
  Speaker 1: To an extent.
• 43:30
  Speaker 2: They might not understand the science, but they know when
• 43:32
  Speaker 2: they do this, they feel like that. Or when they
• 43:35
  Speaker 2: do this, they sleep better. When they do that, they
• 43:38
  Speaker 2: sleep worse. When I eat that, I get indigestion and heartburn.
• 43:41
  Speaker 2: When I stop that, then I don't. When I train
• 43:45
  Speaker 2: this way, I'm sore for three days. So there's this
• 43:48
  Speaker 2: kind of self-education. I feel like that is a really
• 43:52
  Speaker 2: worthwhile addition to any, whatever the other intervention is or
• 43:57
  Speaker 2: protocol or I feel like people try to build a
• 44:01
  Speaker 2: connection with an understanding of their own body rather than
• 44:06
  Speaker 2: outsourcing everything to another person who says you should do
• 44:11
  Speaker 2: that with your body and your brain.
• 44:14
  Speaker 3: Oh, I couldn't agree more. I mean, what you just
• 44:16
  Speaker 3: described is probably one of the most important health interventions
• 44:20
  Speaker 3: that anyone can do is to really pay attention to
• 44:25
  Speaker 3: to their habits, their food, their movement, their fluids, and, and,
• 44:30
  Speaker 3: and the effects that all of those things have and
• 44:33
  Speaker 3: really figure out, make those connections for themselves of what
• 44:37
  Speaker 3: is good for my body and what is not good
• 44:40
  Speaker 3: for my body. The more people pay attention to that,
• 44:43
  Speaker 3: you know, that's like, no one gives you an owner's
• 44:46
  Speaker 3: manual for your body. And the smartest doctor in the
• 44:49
  Speaker 3: world can't give you an owner's manual for your body.
• 44:52
  Speaker 3: Only you can develop your own owner's manual, and it's
• 44:56
  Speaker 3: only through careful observation like you just described that you
• 44:59
  Speaker 3: really find those answers. And it's so powerful because there's
• 45:04
  Speaker 3: so much individuality in between different people. So I'm sure
• 45:09
  Speaker 3: you notice all the time what was the thing that
• 45:12
  Speaker 3: was so great for this person made this person feel terrible, right?
• 45:17
  Speaker 3: It always happens, right?
• 45:19
  Speaker 1: Hey, nuts.
• 45:21
  Speaker 2: Rest my case dairy rest my case absolutely speaking on
• 45:26
  Speaker 2: a stage rest my case.
• 45:28
  Speaker 3: I do great with dairy and there's many people where
• 45:30
  Speaker 3: it's the worst thing for them you know.
• 45:32
  Speaker 2: Yes um yeah yeah yeah yeah yeah i um i
• 45:38
  Speaker 2: was gonna ask also what did i say i am
• 45:41
  Speaker 2: tiff could you take that out no it doesn't matter
• 45:44
  Speaker 2: so matt how do we know if uh.
• 45:50
  Speaker 1: Well, I would guess, am I.
• 45:51
  Speaker 2: Accurate when I'm saying some people are genetically more predisposed
• 45:55
  Speaker 2: to have issues?
• 45:56
  Speaker 1: Is that a correct or incorrect statement?
• 45:59
  Speaker 3: That's correct. Yes.
• 46:02
  Speaker 1: Do we know what that percentage is?
• 46:08
  Speaker 3: Yeah. There are studies that have been done about the
• 46:10
  Speaker 3: heritability of various psychiatric conditions. And you can compare that
• 46:16
  Speaker 3: with the heritability of other physical conditions, like The heritability
• 46:21
  Speaker 3: of someone's height, for example. And I'm going to butcher
• 46:25
  Speaker 3: this a little bit because I don't remember all the
• 46:27
  Speaker 3: figures exactly. But if I remember something like height is
• 46:30
  Speaker 3: about 80% heritable. 20% has to do with your environment,
• 46:35
  Speaker 3: but 80% has to do with your genetics. And something
• 46:39
  Speaker 3: like bipolar disorder is pretty high up there. That's one
• 46:42
  Speaker 3: of the most heritable things in psychiatry is bipolar disorder. Meaning,
• 46:48
  Speaker 3: you know, it could be close to like 75, 80% heritable.
• 46:52
  Speaker 3: And alcoholism also is very heritable. That's one of the
• 46:55
  Speaker 3: really high ones in psychiatry. Some of the other ones
• 46:59
  Speaker 3: are lower, you know, but still the genetics play a role. However,
• 47:04
  Speaker 3: genetics are not destiny. When I say heritable 80%, that
• 47:07
  Speaker 3: doesn't mean, you know, anything close to like if, you know,
• 47:10
  Speaker 3: I have a parent with bipolar, I have that risk
• 47:13
  Speaker 3: of getting bipolar. It's not even close to as high
• 47:16
  Speaker 3: as that. You know, it's much, much lower. You know,
• 47:18
  Speaker 3: it's like one parent with bipolar, maybe a one in
• 47:21
  Speaker 3: 20 or one in 30 chance of getting bipolar. And
• 47:25
  Speaker 3: it's so all these things also are so much impact
• 47:28
  Speaker 3: from the environment. So, you know, really most of the
• 47:32
  Speaker 3: game here is the environment. And that's when I say environment,
• 47:35
  Speaker 3: I mean things like all the things we've been talking about.
• 47:37
  Speaker 1: Yeah.
• 47:39
  Speaker 3: Your your amount of trauma, your your, you know, how
• 47:43
  Speaker 3: much love and care you have in your life, your food, your.
• 47:47
  Speaker 1: Work environment.
• 47:49
  Speaker 3: Yeah, work environment, your relationships, all that. That's what ultimately
• 47:53
  Speaker 3: makes the biggest difference in terms of whether you're going
• 47:56
  Speaker 3: to develop one of these conditions.
• 47:58
  Speaker 2: I do lots of corporate speaking and work and consulting.
• 48:02
  Speaker 2: And one of the things I ask the boss, whoever
• 48:06
  Speaker 2: he or she is, or the bosses, is do your
• 48:11
  Speaker 2: staff like coming to this place? Like, do they like
• 48:15
  Speaker 2: working here?
• 48:16
  Speaker 1: Do they.
• 48:17
  Speaker 2: I'm not saying are they in love with you, but
• 48:19
  Speaker 2: do they like you?
• 48:21
  Speaker 1: Yeah.
• 48:22
  Speaker 2: Because so many people tolerate work, right? Somewhere between tolerate
• 48:28
  Speaker 2: and hate, but they've got to do it to meet whatever,
• 48:31
  Speaker 2: all these needs, which I understand. So when I go
• 48:35
  Speaker 2: into businesses, I don't talk about business. I talk about
• 48:39
  Speaker 2: I just finished my PhD in psych as well, so
• 48:42
  Speaker 2: I splash myself all around, right? That's not true. I
• 48:45
  Speaker 2: just handed in my thesis. So there's still a bit
• 48:48
  Speaker 2: to go. But so we talk about the psychological, emotional, sociological,
• 48:52
  Speaker 2: physiological components of building a culture. And, you know, you
• 48:57
  Speaker 2: think maybe you're at work depending on, you know, what
• 49:00
  Speaker 2: job and what the setup is. But a lot of
• 49:02
  Speaker 2: people are at work 40 or 50 hours a week.
• 49:05
  Speaker 2: And imagine having that much of your waking hours being
• 49:10
  Speaker 2: in an environment or energy or culture that That is
• 49:14
  Speaker 2: bad for you. That you don't, you just tolerate it.
• 49:18
  Speaker 2: You kind of hate it. but you feel like you
• 49:21
  Speaker 2: have to do it. I mean, that's going to put
• 49:23
  Speaker 2: people in all sorts of trouble.
• 49:25
  Speaker 3: Absolutely. I mean, that's a recipe for chronically elevated cortisol,
• 49:29
  Speaker 3: metabolic problems, mental health problems, all of it. Absolutely. And
• 49:34
  Speaker 3: yet it's what so many people are forced to do
• 49:38
  Speaker 3: to survive, right?
• 49:39
  Speaker 1: Yes.
• 49:41
  Speaker 3: This is a big part about why we have both
• 49:43
  Speaker 3: a metabolic health epidemic and a mental health epidemic across
• 49:48
  Speaker 3: the world is exactly what you're describing.
• 49:52
  Speaker 2: Do you think if we jump– I know you've got
• 49:55
  Speaker 2: to go. I know we're nearly up to an hour,
• 49:57
  Speaker 2: but this is kind of interesting, very interesting. Do you
• 50:00
  Speaker 2: think if we jump back 200 years, let's say 200 years, Matt,
• 50:03
  Speaker 2: and I know this is just you and me talking. Yeah.
• 50:06
  Speaker 2: This is not– data evidence this is two blokes chatting
• 50:10
  Speaker 2: and a girl every a lady every now and then
• 50:12
  Speaker 2: about her cookies uh if we went back 200 years
• 50:18
  Speaker 2: would we find the same incidents of all of these
• 50:22
  Speaker 2: issues uh now i know there's a lot of well
• 50:25
  Speaker 2: they weren't identified or known or treated or but do
• 50:28
  Speaker 2: you think the numbers would be if if we had
• 50:32
  Speaker 2: all the knowledge that we have now or they'd be
• 50:35
  Speaker 2: way less.
• 50:39
  Speaker 3: Um, it's, it's a hard question to answer because I
• 50:43
  Speaker 3: think many people 200 years ago were under a lot
• 50:48
  Speaker 3: of stress too, different kinds of stress and they had
• 50:50
  Speaker 3: different ways of managing it. And, you know, certainly, you know,
• 50:55
  Speaker 3: there weren't a bunch of psychiatrists like me going around
• 50:58
  Speaker 3: and with a DSM and putting them into categories and
• 51:02
  Speaker 3: calling them this and that and this and that, right.
• 51:05
  Speaker 3: but it doesn't mean there wasn't a lot of mental
• 51:07
  Speaker 3: suffering at the time. It just was so different the way.
• 51:10
  Speaker 3: And so a lot of this is cultural, you know,
• 51:13
  Speaker 3: what we're describing here, it's, it's a product and based
• 51:16
  Speaker 3: in and within our culture. And this is kind of
• 51:19
  Speaker 3: how we see it now, but it was seen very
• 51:21
  Speaker 3: different 200 years ago and even way different than that,
• 51:24
  Speaker 3: you know, 600 years ago or in the ancient world,
• 51:27
  Speaker 3: you know, so different.
• 51:29
  Speaker 2: Right.
• 51:29
  Speaker 3: And in, in more traditional, you know, cultures, you know,
• 51:34
  Speaker 3: you know, Very, very different.
• 51:37
  Speaker 1: Very different.
• 51:38
  Speaker 3: And so, yeah, I mean, I think in traditional cultures,
• 51:44
  Speaker 3: no matter what was going on with someone's mental status,
• 51:47
  Speaker 3: they were held within the culture, right? And so they
• 51:50
  Speaker 3: weren't extruded out and called different or crazy or any
• 51:55
  Speaker 3: of those things. That was a more recent phenomenon more
• 51:59
  Speaker 3: in the Western world that we identify certain people as
• 52:04
  Speaker 3: not fitting in and need to be sort of extruded
• 52:07
  Speaker 3: from the society or from the tribe. That did not
• 52:13
  Speaker 3: used to exist as much in the past. All right.
• 52:18
  Speaker 1: Last one. Research. Current research, future research. What's happening?
• 52:25
  Speaker 3: There's exciting research. So, I mean, we have a lot
• 52:29
  Speaker 3: of basic science stuff. That's really solid. You know, the mechanisms,
• 52:32
  Speaker 3: it's all been studied because of the epilepsy literature and
• 52:35
  Speaker 3: how effective ketogenic diets are for epilepsy. So we have
• 52:38
  Speaker 3: tons of mechanisms and basic science. The clinical science, we
• 52:42
  Speaker 3: have some really interesting case series and pilot trials, non-controlled trials.
• 52:50
  Speaker 3: A couple of randomized controlled trials have come out. recently
• 52:54
  Speaker 3: one on treatment resistant depression, where it showed positive effects
• 52:57
  Speaker 3: of the ketogenic diet. Um, and another one in, um,
• 53:01
  Speaker 3: more severe mental illness, um, that came out this year
• 53:04
  Speaker 3: that was partly randomized controlled trial, partly not. Um, and we,
• 53:10
  Speaker 3: we know there's a bunch of other randomized controlled trials
• 53:12
  Speaker 3: going on now. And, um, and so we're going to
• 53:16
  Speaker 3: see the results of those. So very exciting times. I mean,
• 53:19
  Speaker 3: I think we, we have some interest now, but as
• 53:21
  Speaker 3: those randomized controlled trials come out, we're going to get
• 53:23
  Speaker 3: a lot more interest in this.
• 53:26
  Speaker 2: Well, I would love to talk to you in a year, Matt,
• 53:29
  Speaker 2: and just see where we're at, see what the developments
• 53:32
  Speaker 2: have been and see what you've learned. And if you're
• 53:35
  Speaker 2: up for that, I'll get Melissa or Tiff to reach
• 53:39
  Speaker 2: out to you in about 11 months.
• 53:41
  Speaker 1: You and your team. Let's do it.
• 53:43
  Speaker 3: Yeah. Yeah.
• 53:44
  Speaker 1: Fascinating stuff, really.
• 53:46
  Speaker 2: It excites me because I think it's so groundbreaking and
• 53:49
  Speaker 2: it's so I don't think it's the answer, but I
• 53:54
  Speaker 2: think it's definitely a valuable, it can be a really
• 53:58
  Speaker 2: valuable intervention, part of people's recovery and healing rather than
• 54:04
  Speaker 2: just symptom management. How do people find you, connect with you?
• 54:09
  Speaker 2: Have you got a book you want to sell? This
• 54:12
  Speaker 2: is your time to shine. How do people do all that?
• 54:16
  Speaker 3: I haven't written a book, but people can find me
• 54:20
  Speaker 3: two ways. One is I mentioned the program Accord, and
• 54:23
  Speaker 3: there's a website for that, accordmh.com, A-C-C-O-R-D-M-H.com, where we have
• 54:30
  Speaker 3: a whole education section, including me giving a bunch of
• 54:33
  Speaker 3: academic lectures. So if people want to hear more about
• 54:36
  Speaker 3: the science or the mechanisms or the academic side of it,
• 54:40
  Speaker 3: they can find some lectures on the blog section and
• 54:43
  Speaker 3: some things we've written there. And then people can reach
• 54:46
  Speaker 3: out to me individually on LinkedIn. I'm not on a
• 54:48
  Speaker 3: lot of other social media, but I am on LinkedIn.
• 54:50
  Speaker 3: And if people have questions for me, especially if they
• 54:55
  Speaker 3: want to hear more about something specific about what I
• 54:58
  Speaker 3: said here, happy to answer there.
• 55:01
  Speaker 1: That's very generous. You're a ripper, as we say in Australia.
• 55:06
  Speaker 1: You're a ripper. You're a beauty. They're two good things.
• 55:09
  Speaker 3: Yeah.
• 55:11
  Speaker 1: And, mate, I appreciate you. Really nice conversation. I enjoyed it.
• 55:15
  Speaker 2: We'll say goodbye off air, but for the minute, Matt,
• 55:18
  Speaker 2: thanks so much for being on the You Project.
• 55:21
  Speaker 3: My pleasure. I'm going to have to tell my son
• 55:23
  Speaker 3: that I'm a ripper and a beauty because he just
• 55:25
  Speaker 3: spent a semester in Australia and Brisbane, so he's going.
• 55:28
  Speaker 1: To know what I mean.
• 55:28
  Speaker 3: Oh, did he? Even though I don't.
• 55:29
  Speaker 1: Well, you're both a ripper and a beauty. Yeah. Thank you.
• 55:32
  Speaker 1: I'd probably need one more chat, then I'll call you
• 55:35
  Speaker 1: a mate.
• 55:36
  Speaker 3: Okay. Sounds good.
• 55:37
  Speaker 1: So we'll get that notched up.
• 55:39
  Speaker 2: All right.
• 55:40
  Speaker 3: Sounds good. Waiting for it.