CB Archives - Chris Palmer, MD

Low Carb MD podcast with Drs. Tro and Brian Lenzkes – Treating schizophrenia with a ketogenic diet

Christie Barnett, APN — Sun, 08 Sep 2019 14:05:05 +0000

Show notes for Low Carb MD Podcast Episode 49

00:00 Welcome to the Low Carb MD podcast with Dr. Chris Palmer. He is a Harvard psychiatrist who has case reports and case studies on mental health and the ketogenic diet.
01:23 Nutritional approaches to psychiatric disorders.

Dr. Chris Palmer’s personal health history and metabolic recovery

02:19 Dr. Palmer’s story, 20-25 years ago, “I was one of those skinny, metabolically-disordered people.”
03:19 Chris’s low fat diet.
03:33 Dr. Palmer’s health: “I was pre-diabetic. I definitely had hypertension and I had horrible cholesterol.”
05:36 The effect of low-carb diet intervention, “Everything was better. My LDL plummeted. My HDL doubled. And my triglycerides plummeted into a normal healthy range. I was no longer pre-diabetic. My blood pressure was down to a really good, healthy level.”
06:02 Twenty+ years on a low-carb ketogenic diet.

Lifestyle intervention

09:01 “When I speak to other physicians I often ask how lifestyle interventions are going for their patients? Almost all of them roll their eyes and give a deep sigh of hopelessness and futility. ‘There’s no point. It never works.’ Their perception is that the patients are lazy slackers.”

Change is hard

10:01 “Bad advice doesn’t work. Low-carb, high-fat eating goes against everything that we have believed for decades. Everything that we’ve been taught. Change is hard.”

Global metabolic and mental disorder epidemic

11:44 “In the United States, and around the world, there is something profoundly wrong… Obesity rates are skyrocketing. Diabetes rates are skyrocketing, and my passion, mental disorders, are skyrocketing.”
12:30 Other mental disorders are also skyrocketing at the exact same time that we’re seeing these exploding rates of metabolic disorders.

Ketogenic diet as intervention for treatment-resistant depression and weight loss

13:40 “I’ve been using it with patients for treatment-resistant depression. And, I’ve been using with a lot of people for weight loss and just for general health improvement.”

Speaking out

14:04 Also, I knew I was going against the medical establishment.
14:54 “I can’t stay quiet anymore.”
15:21 “A schizophrenic patient was on every medication. He suffered every day every day.”
16:19 “On psychiatric medication, he gained 150 – 200 lb, he was sedated. He couldn’t function. He couldn’t live alone.”
17:03 “I had worked with him for 10 years. We had tried numerous medications.”

Sometimes medication is not enough when treating schizophrenia

17:22 “And we couldn’t help him. We’re doing our best. The medications are required. They’re essential.”
18:12 “But these medications also made him morbidly obese. These medications are sedating him so that he sleeps 16 hours a day. And these medications are not working for him.”
18:45 “Unfortunately, there are literally tens of millions of people just like him all around the world, and this is what the medical field has to offer them.”

Weight loss and psychosis

19:02 The patient wants to lose some weight.
19:09 “Getting a person with schizophrenia to do a diet though. Everybody thinks that’s impossible.”
20:34 But, at the 3-week mark of doing a ketogenic diet, I noticed something distinctly different about him. He’s losing weight. But he is now starting to be more alert. I haven’t changed his meds at all.”
21:26 At about 6 weeks, “He spontaneously reports to me: ‘Dr. Palmer, you know those voices that I tell you I hear all the time? I think they’re kind of getting quieter and I’m not hearing them as much, they’re not talking as much anymore…’”

Ketogenic dietary intervention takes time to work when treating schizophrenia.

22:01 Another 4 weeks go by, this treatment takes time, he says “Dr. Palmer, you know, I had these delusions? I think maybe that’s not really happening, I think maybe I have schizophrenia and it’s getting better.”

100 pound weight loss and psychiatric symptoms improve

23:48 He loses over a hundred pounds at the one-year mark. He is improved psychiatrically, functionally, and socially.

Going off the diet and symptoms return

24:57 If he does not follow the diet, he can become acutely psychotic again within 24-48 hours. Just like stopping medication. When he resumes the diet, symptoms abate.

Keto diet is not a stand-alone treatment

25:57 Psychosocial and psychoeducational intervention, and sometimes medications, are still necessary. Keto is not a cure-all.

Psychiatric medications

27:43 Medications interfere with metabolism, cause weight gain, diabetes, and increases in blood sugar and insulin.

70 year old woman with schizophrenia improves on keto

28:25 One of Dr. Eric Westman’s patients had chronic paranoid schizophrenic for 53 years. She couldn’t function in life.

Dr. Eric Westman at Duke University

29:24 She had debilitating, disabling schizophrenia and she gained weight up to 330 pounds. Eric Westman, MD treated her at the low-carb weight-loss clinic at Duke University.
30:24 Within 2 months her psychotic symptoms were improved.
30:32 “She has been off of medications now for 12 years, fast forward 12 years. That’s today. She’s lost 150 lb.”
31:14 The patient is symptom-free.
31:16 She’s off all medications.
31:36 “She is so excited to share her message of recovery using the ketogenic diet.”

Compliance

32:21 Compliance is a huge issue.

Food as medicine?

35:00 Food can act as medicine?
36:11 It’s not a conclusion. It’s a question.

Quackery?

36:42 Quackery… skepticism.
37:54 “We have more basic science research and knowledge and understanding of the effects of this [ketogenic] diet on the human brain than we do any other dietary intervention and than we do for most psychiatric medication.”
38:14 “Thousands and thousands of studies published in some of the best medical journals neurology journals.”

Keto for epilepsy

39:14 Twenty to 30% of treatment resistant people treated with the ketogenic diet are seizure-free. “These are the worst of the worst. They’ve tried everything they suffered for years or decades and nothing is working for them. And this diet can make 20 to 30% of them seizure-free.” But, some can’t stay on the diet.

Cochrane review

39:50 “The Cochrane review on the ketogenic diet for pediatric epilepsy in particular, and it is unequivocal in its conclusion: The ketogenic diet is an effective treatment for epilepsy.”

“Off-label” treatment

40:59 A ketogenic diet is shown to work for epilepsy. Every anti-epileptic medication is used in psychiatry. “We use benzodiazepines, Depakote, Lamotrigine and Tegretol. We use all of it. Every anticonvulsant medication is used in psychiatry sometimes on label, sometimes off label.”
42:45 “When we combine two psychiatric medications, that’s off-label.”
43:41 “We use every epilepsy treatment in psychiatry. We often treat patients off-label in psychiatry… why should I even consider using the ketogenic diet today in a patient with a treatment-resistant mental illness? [It is] because it’s a proven treatment for treatment-resistant epilepsy and you’re going to use it off label. So the way I look at it is, I am using an off-label established treatment for epilepsy in psychiatric disorders.”

Time with patients

47:15 “…one of the great things about being a psychiatrist is that we are probably the last of the medical professionals who still get to have a relationship with our patients. Who still get to talk about whatever we think is important to their health.”

The mental-metabolic connection

51:24 “We have hardcore epidemiologic data… obesity affects diabetes and diabetes control affects cardiovascular disease.”
51:59 Sleep and metabolism.
53:59 Bipolar disorder.
54:43 Treatment-resistant depression. “Dramatic Improvement in mood disorders and anxiety symptoms…”
55:23 Caveats: Keto adaptation-keto flu is a serious medical risk. People may get worse initially, before they get better.
56:13 Transition from utilizing glucose for fuel to using fat for fuel takes time and the process initially deprives cells of energy.
57:48 Metabolic disorders and energy deprivation.
58:56 Medical monitoring necessary for people with serious disorders.
59:52 Medical risk, powerful intervention.
1:02:47 “Mental health and metabolic disease are intimately related.”

Karl Goldcamp interviews Dr. Palmer for Keto Naturopath – Addiction and keto

Christie Barnett, APN — Tue, 03 Sep 2019 12:17:50 +0000

Part 1: Episode 63 – Keto Naturopath by Karl Goldcamp interviews Chris Palmer

Show notes – Addiction and ketogenic diet

This podcast discusses behavioral disorders and a ketogenic therapeutic intervention.

Diet and addiction

3:20 Nora Volkow, MD. Director National Institute on Drug Abuse. Research implies some foods activate the same reward pathways as addictive substances.
6:02 Alcohol and insulin resistance.
7:02 Study of ketogenic diet and alcoholism.
13:25 Alcohol converts to acetone and fuels the brain. (The big three ketone bodies are beta-hydroxybutyrate, acetoacetate, and acetone.)

Chris and his father’s success stories

16:55 How Chris Palmer discovered low-carb dieting and his own metabolic dysfunction.
23:45 Chris’s father’s story of diabetes and recovery.
39:11 Chris’s personal diet and exercise plan.

Part 2: Episode 64 – Keto Naturopath by Karl Goldcamp interviews Chris Palmer

Exercise

8:05 Karl – Hard to encourage exercise to the non-athletic.
8:42 Chris – Growing up with poor diet and no exercise

On a ketogenic diet people feel more energetic and want to start exercising

10:33 Mental and emotional changes with ketogenic diet

Metabolic – mental connection

13:36 Mental disorders
14:35 Stigma of mental illness
15:49 Mental disorders as metabolic disorders
16:36 Diabetes and insulin resistance in mental disorders
16:55 At onset of mental illness patient’s weight is normal. But their insulin resistance is already measurable.
19:39 bidirectional relationship between mental and metabolic disorders

Ketogenic diet as a therapeutic intervention

23:14 Ketogenic diet can stop seizures
24:37 Epilepsy treatments are commonly used in psychiatry
25:22 Metabolic defects in mental disorders
28:15 More research needed
30:00 Off-label treatments
32:24 My hope is to better understand this metabolic-mental overlap
33:29 Metabolic interventions don’t work for everyone. I wish they did. I’m using them to help those with serious, treatment-resistant illnesses.
33:46 New schizophrenia research by Chris Palmer, MD
35:46 Dream of a residential treatment program
39:02 Hopeful that this is a game-changing way of thinking about and addressing these disorders

Part 3: Episode 65 – Keto Naturopath by Karl Goldcamp

Like-minded researchers and clinicians around the world

16:41 Others currently investigating the ketogenic diet for mental illness.
18:45 Many clinicians unwilling to use the ketogenic diet with the most serious. disorders. For example, bipolar, schizophrenia and chronic-disabling depression. Using the medical-ketogenic diet as a treatment requires a multi-faceted approach.
20:40 I desperately want to improve the lives of psychiatric patients
21:40 I want to motivate other mental health clinicians to learn about the ketogenic diet.
22:40 It is going to take a movement to spur change.

Mechanisms of Action

25:16 Medical practitioners require a mechanism of action
25:57 History of ketogenic diet
25:57 Better understood than any other dietary intervention
27:49 Neurologist have been studying this since the 1970s
28:23 Probably 20 different mechanisms of action have already been elucidated. They suggest why the ketogenic diet can stop seizures .
29:19 Increasing GABA, a primary inhibitory neurotransmitter in the brain.
31:24 This diet also increases activity of Adenosine.
33:10 The ketogenic diet helps repair mitochondria.
34:19 The ketogenic diet stimulates some pathways that result in anti-aging.

Fasting and the origin of the ketogenic diet

37:39 Fasting and the ketogenic diet both significantly change metabolism.
38:15 Fasting has a long history
40:16 The epilepsy world put it to some rigorous tests and they found it actually works for a real brain disorder, and you know they have been using it for a hundred years.
41:08 Does not stop seizures 100%
42:08 Some are skeptical of it because it doesn’t work immediately.

Lab testing

44:19 Lab monitoring
46:39 Cortisol.

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Ketogenic diet helps young Ecuadorian twins improve their schizophrenic symptoms

Christie Barnett, APN — Mon, 03 Jun 2019 19:26:10 +0000

Chris Palmer, MD was a co-author of this Chris Palmer, MD was a co-author of this 2018 case study which showed an improvement in schizophrenic symptoms in young Ecuadorian twins on a ketogenic diet. They were a male and a female, diagnosed with schizophrenia at the ages of 14 and 18. At the time of the study they were 22 years old.

What can we learn from this study?

A central focus of this study was to assess how the ketogenic diet would affect these patients’ schizophrenic symptoms.

This pilot study employed a 6 week intervention of the ketogenic diet for these two people with schizophrenia. (A pilot study is a small study used to test whether the study question warrants a full-scale investigation. It is a building block for future medical research.) After allowing them to adapt to ketosis for 15 days, the twins’ psychiatric symptoms were evaluated. This evaluation was conducted by a psychiatrist who was unaware of the dietary intervention.

How did 15 days on the ketogenic diet affect the twins’ symptoms?

First off, they both lost weight. An effect well known for the ketogenic diet.

A second, and more important outcome was an improvement in their schizophrenic symptoms.

How were their schizophrenic symptoms measured?

The measure used in this study was the Positive and Negative Syndrome Scale (PANSS). The PANSS is an assessment used to evaluate the positive and negative symptoms of schizophrenia. It is often used in patient care in psychiatry. It is also used in studies done to evaluate the efficacy of new medications. Therefore, it was an appropriate tool to use to evaluate this dietary psychiatric intervention.

Positive and negative symptoms of schizophrenia?

Yes, schizophrenia has symptoms which are both positive and negative.

Positive symptoms are the presence of abnormal characteristics. One group of positive symptoms is hallucinations (false sensory experiences that feel real). Delusions (false beliefs that persist despite a contradicting reality) are another set of positive symptoms. Negative symptoms are the absence of characteristics that would be present in a typical person. These include a lack of motivation, diminished thought content, lack of social interaction, diminished emotional responsiveness and expression, and loss of pleasure. Together the positive and negative symptoms form the bulk of some of the basic dysfunctions in schizophrenia.

The case study results

It is important that a tool that can measure both positive and negative symptoms was used in this study. Despite not being able to maintain high levels of ketosis for long periods of the experiment, the PANSS scores improved for both twins, that is, their schizophrenic symptoms got better. This improvement lasted only as long as the patients stayed on the diet. At the end of the study the participants went back to their normal diet and their symptoms returned. The exacerbation of symptoms while off the diet is a further vote of confidence that it was the diet that spurred the improvement.

What does this case study mean about keto and schizophrenia?

Because this was a small, pilot study, it does not demonstrate anything conclusively. It does provide another bit of evidence to support the idea that more research is called for to explore the efficacy of the ketogenic diet for the treatment of schizophrenic symptoms.

Another case study about the efficacy of the ketogenic diet might also be of interest to you, see Dr. Palmer’s case study. The ketogenic diet and remission of psychotic symptoms in schizophrenia: Two case studies.

See the Ecuadorian twin study for yourself.

More on the ketogenic diet – mental health – and metabolic connections

Our research and how to participate
Continuing education for professionals

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