Is Bipolar Disorder Really a Diet Problem w/ Dr. Iain Campbell

24:26And for many people, like we've described, they've been told this is a chemical imbalance, a neurotransmitter imbalance. But one of the ways I think about this when you hear this as a patient is it's like if you imagine you were driving down the highway and the car is filling up with smoke, there's clearly an emergency happening. But the way you address that is not necessarily to change the air conditioning. You know, you want to look for like what is causing this to happen more fundamentally. And the neurotransmitter explanation feels as a patient and someone living with a condition to many of us like, you know, we're trying to adjust the air conditioning when there's something much more fundamentally wrong with our engine system.

25:02But if you address the fundamental disruption, which is the engine is on fire, you know, your metabolism is not working, the energy production is not working, it fixes all the downstream problems. You don't have to mix the air conditioning, you don't have to worry about smoke, you don't have to, you know, all the things that can go wrong can stem from this, like, more fundamental disruption. And so this is what people such as yourself, Chris Palmer, are proposing, this kind of energy disruption is the root cause of mental illness. And I think this really resonates with the patient community because it feels much closer to what we're experiencing fixing this kind of engine versus trying to adjust you know very specific aspects of

25:40Dr. Mark Hyman:neurotransmission and so forth so basically it's a metabolic problem it's sort of like diabetes in the brain in a sense like it's a it's a and the brain is the source of uh you know so many mitochondria it's got more mitochondria per cell than any other organ in the body and mitochondria are the little yes energy factories in your cells that take oxygen and food and combust them to turn into ATP or energy. And if there's an energy crisis because you can't make it because there's basically bad energy, you're going to have a whole set of downstream symptoms and problems as a result of that. And for some people, it manifests as diabetes.

26:16Dr. Mark Hyman:For some people, it manifests as schizophrenia, as bipolar disease or as Alzheimer's, which they call type 3 diabetes. So it's the same fundamental problem of insulin resistance and insulin signaling and glucose metabolism that's disrupted that is you know can be caused by many factors yes but but you're basically talking about going upstream and dealing with the root causes yes of the problem insulin singling is a particularly interesting example because i think some of the ways we're trying to treat mental health conditions at the moment are kind of obtusely or bluntly addressing these pathways but they're not giving a full um holistic benefit to the the metabolic problem that's underlying the condition.

26:56So I have a paper in Nature Journal, Translational Psychiatry, called Lithium and Insulin Signaling. And I point out in this paper that many of the major targets of lithium are part of the insulin signaling network.

27:07Dr. Mark Hyman:By the way, lithium is the drug that's used to treat open bipolar disease. You know, the PI cycle, GSK3, AKT, mTOR, these are all parts of the insulin signaling network. For those in English, those are the biochemical pathways that relate to your blood sugar and insulin control that we have many redundancies in. and there are many of those pathways that get interrupted by problems with energy metabolism. Since proposing this, there's been quite a number of studies on it. There was a study in Lancet Journal in neurobiology where Martin Alda, who developed the Alda scale for lithium, for example, and a team investigated this in, they make these kind of organoids, they're like mini-brains, they derive from neurons from bipolar patients, and they found that lithium was modulating this insulin signaling pathway.

27:50but I think the kind of what we might be starting to discover is that we're kind of obtusely or like I say bluntly addressing some of these metabolic pathways through various forms of treatment for example like suppressing metabolism so heavily that someone can't go manic but they also put on 40 or 50 pounds of weight and have diabetes and you know so it's like you're stopping the acute mania which can save someone's life in hospital but in the long run there's this metabolic damage and dysfunction that can happen and there's other medications like lithium which I think address aspects of insulin signaling that can be in the short term helpful for someone but in the long term can lead to damage that leads to diabetes and so forth so I think looking for better metabolic treatments is a really important area for psychiatry research

28:40Dr. Mark Hyman:Hey everyone, I'm Dr. Michael Bruce the sleep doctor. I've spent decades studying sleep, counselling thousands of patients and giving loads of lectures, but there's always more to learn in the world of sleep science, especially right now. That's why I started a podcast, Better in Bed with the Sleep Doctor. In each episode, I leave you with the tools you need to improve your sleep, which in turn will change your entire life. Whether you're entering menopause, trying to get your kid down for a nap, or overwhelmed by which sleep supplements are worth your money, my guests and I are here to help you sleep better.

29:11Dr. Mark Hyman:From Lemonada Media and Sleep Doctor, Better in Bed with the Sleep Doctor is out now. Subscribe on YouTube or follow wherever you get your podcasts.

29:26Dr. Mark Hyman:So we're kind of entering this new era of psychiatry, and sadly, it's not getting to patients who need it most. Before we kind of dive into the biology, I want to really get into the biology of what's happening and the genetics and the diagnostic tools, the blood biomarkers, metabolomics, functional MRI imaging, imaging, you know, the thing about psychiatrists never do brain imaging. It's kind of crazy when you think about it. It's like, but it's like, you want to, you don't want to look under the hood and see what's happening. Someone said that modern medicine is, is like trying to diagnose what's wrong with your car by listening to the noises it makes, you know, instead of lifting up the hood and looking underneath the hood.

30:05Dr. Mark Hyman:But, you know, before we, we get into that, I want to sort of touch on, I think something that's really quite important, which is the field of psychiatry has classically been about this diagnostic manual called DSM-5, which means the Diagnostic and Statistical Manual version 5. Yes. Because there's been one, two, three, four, five. Yes. And the latest version, and basically it's descriptive. Yes. It's a phenomenological description of these symptoms, and if you fall into this category, of these collective symptoms, you get this diagnosis. You get ADHD, you get bipolar disease, and there's subcategories, schizophrenia, depression, different kinds of depression, and it's very, very detailed.

30:51Dr. Mark Hyman:And it's like, incredibly detailed about which type of, each of the mental illnesses you can get, different kinds of anxiety disorders, different kinds of bipolar, different, it's like, and it's fundamentally really flawed, because to kind of get back to your earlier point, there's fundamental underlying biological mechanisms. that are causing people to suffer with these problems. Yes. And unless we take seriously this fact and take seriously the research that we need to undertake to actually investigate these things, we're never going to help address one of the biggest causes of suffering globally.

31:26Dr. Mark Hyman:I mean, yes, the obesity, diabetes, and heart disease, cancer are really the big killers. Yes. But when you look at them, they're also metabolic problems. Yes. And when you look at the amount of, quality of life lost they call it the you know quality adjusted life years or qualities basically how many years have you lost to suffering which you lost many years to suffering when you take that number you know depression and psychiatric illness far exceeds everything else yes and and so this is like a global crisis and and i don't see really except at the margins a lot of work being done around this.

32:06Dr. Mark Hyman:You mentioned the Brzezinski Group, which is a group that sort of helped fund a lot of this work. Only because of luck did someone who was very wealthy have a kid who was bipolar, who went keto, who got better, who said, what's going on here? Let me start throwing millions and millions of dollars at funding this research. Because it's not happening from the academic medical centers really much. It's not happening from NIH very much. It's like maybe a little here and there and it's starting to change but i think i think we have this really fundamental diagnostic flaw and and i think what's really exciting to me is that it's not just me and my little clinic treating patients seeing these things it's now academic scientists starting to kind of dig in and see these problems so what what are the kind of novel and emerging diagnostic tools that we are using to start to map out what is going on with these people and and by the way the whole idea that there's like one cause of depression or one cause of bipolar disease or one cause of schizophrenia or one cause of autism or whatever it is.

33:11Yes.

33:12Dr. Mark Hyman:Kind of misses the fact that we're all unique and different. Yes. And the different people have different, different combinations of things that need to be treated. And so while they have some common themes, you need to sort of look at the underlying individuality of each person. Yes. And begin to understand how to unravel that accordion not. So, I mean, I mean, I can answer it from a researcher perspective and a patient perspective. As you mentioned, the Buzuki family who are funding metabolic psychiatry research and Matt Buzuki, their son, received a diagnosis of bipolar disorder. And, you know, he had really incredibly severe symptoms.

33:43He was hospitalized many times, went through, and their family really went through, you know, many treatments, like over 30 treatments, having full access to the US healthcare system. And even being able to try every treatment available, nothing was helping his symptoms even as people who had ability to do that so you can imagine what it's like for homeless people for example people that um you know it's very difficult for people even if you can try everything to have any effective treatment in treatment resistant patients and eventually he um went on a ketogenic diet with chris palmer denise potter dietitian and experienced remission of his symptoms and in a kind of parallel journey my father and i were researching this and trying to understand how do we get research to happen to address this.

34:29Dr. Mark Hyman:And your father's a researcher as well. Yes. He worked in developing countries doing global health research through his career. And he's always been interested in, he basically saved my life by helping me through bipolar disorder throughout my life. He's a really remarkable person. And so we really were trying from the research side to understand this. And Matt and his family from the patient side were trying to understand this and it was very hard to get any funding to understand or research this. I had to work a day job for many years to support my research. I was turned down from every fellowship, every grant, every possible way of doing this and I was publishing papers but there was no interest in it.

35:10So eventually I met Jan and Matt Piziki because one of the few things I could do at the time was put up a YouTube video. I put up this 45 minute YouTube video describing some of the things you're describing about the frustration with diagnosis. And I think what we both recognised from either side was that we've been given this label that's bipolar disorder, but underlying that is a biological condition that is running that we don't fully understand. And the explanations we're being given aren't, the map is not matching the territory. We're trying to describe this complex biology, but the maps we're being given for that don't fit the territory accurately.

35:47and so this was the genesis of this research was from the patient side, from research side Jan Buzicki and Dave Buzicki funded our pilot study at Edinburgh and this was after about six years of trying to find support for this and this really was how the field started through the support of the Buzickis putting investment because of their son's journey and so I really find that remarkable how much they've got sort of in the trenches with patients and said we're going to make this happen, we're going to find out what's going on here. And that is an incredibly fortunate thing to have in the world because there's not a lot of mainstream support for these ideas.

36:26But it really came from just reaching a peak of suffering, both their family journey, our research journey, my family, and many others across the world, Shibani Seti, Chris Palmer, that have been working in this field for a long time, Georgia Ede, treating patients, and everyone sort of realizing we have to fix this, this can't continue. so I totally agree the map is not matching the territory and this is we're all trying to to

36:51Dr. Mark Hyman:reconfigure this yeah I don't know if you just came up with that but that was something my professor mentor Dr Sidney Baker taught us which is that we're given the wrong map for the territory of illness we're in yes yeah you know and something I often talk about with functional medicine is a different map yes so how do you if you're given a map for you know London and you're in New Delhi it's not going to help you yes you know and I think that's what we have in medicine and we have the wrong map and across all of, all of the chronic health diseases, not just psychiatric illness. And all these diseases of chronic, chronic suffering that humanity has got right now, which is globally just so incredible.

37:29Dr. Mark Hyman:And it's only in the last 150 years that we've really begun to see the explosion of these chronic illnesses. You know, we now are beginning to finally understand them. And it seems to me like a new kind of golden era of, of medicine and also particularly psychiatry. Now, I want to sort of get into the weeds a little bit, because I think, you know, as people listening often say, you know, just because you know the name of your disease, it doesn't mean you know what's wrong with you. Because you can say, well, I have bipolar, I have depression, but like, what is unique to you? How do we sort of start to think differently about diagnosing people and using our existing tools, which we didn't even have necessarily, you know, 50 years ago, like we've decoded our whole genome.

38:06Dr. Mark Hyman:What does that tell us about our mental health issues? and so i think we have this moment where we can start to interrogate people's biology in ways we never had the capacity before we can do your whole genome we can see all your 20 000 genes but we can see your five to seven million variations in that genetic code we can look at your metabolome which is thousands and tens of thousands of metabolites we can look at blood biomarkers we can look at your microbiome which plays a big role in mental health you can look at your entire profile of of MRI imaging, which is basically now allowing us to look at functional capacity, not just structurally, do you have a tumor, but like what's your brain doing in a functional way?

38:47Dr. Mark Hyman:And what does that tell us about what's happening energetically in the brain? You know, Suzanne Goh from Harvard Oxford trained physician, pediatric neurologist has done a lot of work on autism and also found it to be a mitochondrial energy deficit and treated those kids with mitochondrial therapies and they work. So I guess the question I have for you, Ian, is before we dive into the details of the biology is people say, well, I don't have bipolar disorder. I have anxiety or I have depression or I have, you know, you name it, OCD. Do these share common things? Does this apply also to those from your perspective?

39:19I think bipolar disorder is an extreme version. You know, it's in one, 2 % of the population, but I think it indicates an underlying dynamic that's present in many people. And perhaps by understanding the extreme case, it could be helpful to people who are experiencing lesser symptoms, you know, seasonal affective disorder, depression, anxiety. Bipolar has very severe swings to mania and depression. But I think these happen in a lower level in a different way in many different types of people. I could share some of what the history of the biomarkers and the ways people have conceptualized bipolar and then bring it around to how this might apply to other people.

39:55If you look before the age of psychopharmacology, there was this psychiatrist called Amel Kreplin. In 1921, he published a paper called Manic Depression of Insanity. And he was considered the founder of modern psychiatry. And all he did was observe his patients very closely and try to understand really what is their condition by asking, what are they really experiencing? And this was long before we conceptualized this as neurotransmitters and different types of treatment. He was really just looking at what patients were experiencing, which is my interest as a patient as well. And he noted kind of three core features that were particularly notable about bipolar disorder.

40:32And again, I think these relate to many conditions. And he said there's a metabolic disturbance. He said, all my observations indicate that in bipolar manic depressive insanity patients, metabolic disorders must take place. And then he noticed this... And what do you mean by metabolic disorder? So he would track their body weight, and he would track lots of different metabolic measures that were available at the time. And you can see in this manuscript in 1921, he's drawing diagrams, really detailed diagrams of body weight and how it changes with mood and symptoms. And so he said there's something metabolic about this illness.

41:02And then the second thing he said was that there's circadian and sleep disruption. And he said that the most striking disorders in Manic Depressives of Insanity are the disorders of sleep and general nourishment. And then the third thing he pointed out was that there was seasonal variation of symptoms. So he describes it kind of poetically. He said, in many of my patients I saw mooniness set in the autumn and Passover in the spring when the sap shoots in the trees. And he was describing that there's a seasonal variation to this condition, and seasonal affective disorder and many other conditions, schizophrenia and so forth, have this kind of seasonal variation.

41:35And so he was taking these as three core aspects of bipolar disorder. And then from there, the reason I think this is interesting is because the seasonal variation of symptoms in bipolar is a seasonal variation energy. So if you speak to bipolar patients in the spring, they have this huge surge of energy and activity They want to move, they want to go out, they want to exercise, start new projects. This kind of mania really comes on strongly in the spring. But it also occurs in the autumn. And this is because the photo period, the length of daylight, changes very rapidly at these times. It's called the equinox, the spring equinox, the autumn equinox.

42:12And if you look at systematic review of when mania occurs in patients by hospitalizations, it occurs at the spring equinox, at the autumn equinox. And conversely, depression happens in the winter. So the same systematic review highlights winter depression, and it occurs around the weeks of the winter solstice when photoperiod is at its lowest. So what we're kind of seeing is Amel Kruppel was describing the seasonal variation of energy and metabolism related to circadian function. And if you look at the natural world, this is a part of the natural world. Humans, for 95 % of our time on Earth, were living in a natural daylight cycle, seasonal variation, and it was essential for survival to be able to allocate your energy optimally.

42:52So in the spring, when there was opportunities for hunting, reproduction, and so forth, it would make sense to have a surge of energy. And in the winter, it made sense to conserve energy, because there's not the same opportunities available. There's extreme examples in the natural world. More in the same amount of food, right? Yeah, exactly, yeah. And so the extreme examples in the natural world are hibernation, torpor in the winter, and migration, hypermetabolic behaviours in the spring. But these mechanisms, the circadian and metabolic mechanisms that do this energy modulation throughout the seasons are conserved in humans.

43:24I have a paper about this called metabolic plasticity. And I think that this is a metabolic energy and circadian regulation disorder. And I think that what it is, the underlying mechanisms, circadian and metabolic mechanisms, are sort of ancient preserved mechanisms of seasonal adaptation and metabolism. And so I think that, I know you've talked about this yourself, these kind of like ancient survival mechanisms, they become dysregulated in our modern environment. A kind of mechanism that could give you optimal energy use throughout the year could be completely dysregulated by artificial light conditions, metabolic factors, diet and so forth.

44:00I think that, you know, we're talking about insulin signaling and in the winter many species suppress their insulin signaling and glucose metabolism. They go into metabolic depression. Like bears, they hibernate. Yeah.

44:10Dr. Mark Hyman:And they gain all their weight in the fall, and then they live off the fat in the winter, right? Yeah, and they do two things. They suppress their circadian rhythm, and they suppress their metabolism. And this is what happens in bipolar depression. Your circadian rhythm suppressed, your metabolism depressed. Obviously, this is just an analogy. It's not a direct comparison. But the same mechanisms underlying these seasonal adaptations are conserved in humans. mTOR, AMPK, sirtuins, AKT, the insulin signaling network. there may be an evolutionary mismatch we're experiencing in some of these conditions where we have these ancient survival mechanisms that our modern world is heavily dysregulating.

44:46Dr. Mark Hyman:The light bulb in the advent of refined sugars and starches led to a big host of chronic disease problems, including mental health. A really great example I could share is, so I mentioned Matt Buzicki, and we have a podcast where we interview patients about their symptoms. And many people have described to us, including himself, that this mania occurs around the time of the changing photo period, changing length of daylight at the spring equinox. And it's really notable, you know, it's at the spring equinox, manic patients become hypermetabolic. They're going out, trying to start new things, exercise and so forth.

45:21And there's a really interesting analogy in the natural world called a zagonru, which is a thing that Johan Andreas Neumann noted. In animals in captivity, many, particularly migratory birds, for example, around the spring equinox become hypermetabolic. They start trying to bang their head off the side of the cage. They're staying up all night. Their circadian rhythm is suppressed. They're having insomnia. They're getting this deep evolutionary impulse and drive that they can't express in the unnatural environment. And it's to migrate at the spring equinox. It happens also at the autumn equinox, this behavior.

45:54So I think these are just analogies from the natural world. Of course, they're not directly related. But I think there's clear evolutionary mechanisms, circadian and metabolic mechanisms, that are active in bipolar and across some of these psychiatric conditions that we need to explore.

46:10Dr. Mark Hyman:Historically, mental health has really been about philosophy and religion and, you know, just psychological explanations, which don't actually fit the current understanding of mental health issues. Yeah, and I think what you're saying about these philosophical assumptions about mental health, they really inform the treatment of patients and how they experience the condition. So, you know, this kind of Cartesian idea that the body and the brain are separate has really informed a lot of psychiatric practice. Emile Kreplin, who was considered the founder of modern psychiatry, in 1921 he wrote books describing this biological basis of mental illness.

46:49But there was a kind of split in psychiatry where Emile Kreplin was looking for what you're describing this biological basis, biomarkers. But then other people like Freud were saying, no, it's to do with psychoanalysis, like he's saying, and issues with your mother and so forth. You're laying on the couch for five days a week for 20 years and you might feel better.

47:08Dr. Mark Hyman:Yeah, exactly. You might feel better. Yes. Now you're getting into the biology a little bit. And so you get through the history of how we sort of began to observe these phenomena, but they were kind of neglected. It was thought to be sort of psychological in nature, or maybe it was a chemical imbalance. And I mean, the chemical imbalance idea wasn't exactly wrong. It is biochemical, but it's just they were looking at the wrong thing. I was like, serotonin, it's dopamine, it's this and that. And I think the genetics are really interesting around this. And there's actually whole genetic profiles we do in our clinic at the Ultra Wellness Center to look at the risk factors for psychiatric disease.

47:42Dr. Mark Hyman:Can you talk about some of those genetics? Bipolar disorder and many psychiatric conditions are quite polygenic, which means that there's not any kind of core gene that can be absolutely identified to cause this condition, like with rare genetic disorders. But there are a combination of genes that contribute to the condition. and I think where it gets interesting is the gene environment interaction you know maybe there's an evolutionary many people have hypothesized there's an evolutionary purpose for things like bipolar it stays at 1 or 2 % in the population consistently you know why would this be conserved in humans why wouldn't it be selected out of the gene pool and many people have said maybe there was some adaptive advantage to this back in our evolutionary history when we were living in natural daylight seasonal cycles and to have this ability to upregulate your energy so much at times of opportunity and to heavily suppress it to conserve energy at times of disadvantage would have been a beneficial survival trait.

48:36And so I think that there might be evolutionary perspectives that can explain this genetic preservation of bipolar, but it's not one gene, it's a combination of genes. Many, many combinations of genes, yeah.

48:48Dr. Mark Hyman:I mean, when you look at the literature, there's interesting genes that affect mental health, like methylation genes, which involves how we kind of transfer a carbon and three hydrogen chemical group called the methyl group which is basically the currency of our biology. It's involved in everything from neurotransmitter formation to energy production to detoxification and to regulating oxidative stress and inflammation. I mean, and what's really interesting that it's unifying a lot of these mental health issues and chronic disease in general is inflammation. And so what happens is the brain gets inflamed and it gets inflamed because it can handle the load of the stress from our diet in terms of processed refined carbs and sugars.

49:24It can handle the environmental toxins

49:27Dr. Mark Hyman:that we're exposed to, it can't handle the various kinds of stressors. And so we kind of break down. And there's, you know, and like genes like MTHFR and COMT that you can measure now that can tell you what's going on. There's genes that relate to serotonin metabolism, to even to circadian rhythms and clocks and how those relate to mood disorders. So I think those are really interesting. And there's like a lot of circuit stuff. I don't know if you want to say something about the genetics. Well, I wanted to ask you which circadian genes have been noted that you're interested in. There's something called clock genes and...

49:58Dr. Mark Hyman:ART, ARNTL, or ARNTL genes, these are genes that just affect circadian rhythm, they affect our biology in ways that affect mood disruption if their circadian rhythm is disrupted. That's really interesting, because half of my research is on, well, the majority of my research is on metabolic psychiatry, but we also have a lot of chronopsychiatry research led by Professor Daniel Smith in Edinburgh, and the central focus of chronopsychiatry research is the things you're mentioning, clock bm1 per cry and these are your circadian regulators and they basically take signals from the environment the light and they convert this in the suprachiasmatic nucleus of the brain which is kind of like a clock system in the brain and they use that to regulate your metabolism so this happens daily when you go to sleep this um these clock genes uh tell your body it's time to down regulate metabolism and go to sleep but it also happens seasonally uh these clock genes tell your body about the changing light conditions, the changing length of daylight, and they then feed into your metabolic system to tell you whether to have more or less energy to kind of conserve and utilize energy accordingly.

51:03So I think this makes sense in terms of an energy metabolic disorder, these clock genes that you mentioned, clock B-mark, yeah.

51:10Dr. Mark Hyman:And there's also blood biomarkers. You know, I'm curious what kinds of things you're looking at in your research and what you see in literature around things that people can measure in their, not metabolomics, but just like common blood biomarkers that affect mental health. On the circadian side, it's clear these clocking mechanisms feed into bipolar. And on the metabolic side, we use metabolomics to try and understand this. We use this in our pallet study, which I can talk more about in a minute. But we use metabolomics to try and understand what are the differences between a bipolar person and a normal person in terms of their metabolic function.

51:42And the things that we see, again, are these insulin signaling type mechanisms, the phosphatidylanozotol cycle, AKT, mTOR. and these are the kind of differences in bipolar patients in these metabolic signaling networks and again they're kind of related to energy allocation and conservation and I think that so in our pilot study of a ketogenic diet one of the ones we were particularly interested in was lactate in psychiatric wards throughout the 1970s psychiatrists were noting that bipolar patients were having elevated lactate I was just at a symposium yesterday in Toronto with Anna Andresa who studies mitochondrial function, and she's been looking at lactate as a marker of mental health symptoms.

52:27And it's a marker of mitochondrial dysfunction, essentially, when the mitochondria aren't producing energy efficiently. They have this kind of, you know, this output, I think you described it, in one of your books as maybe like an exhaust fume or something. These kind of byproducts of metabolism.

52:41Dr. Mark Hyman:Well, I mean, think about it, when you have lactic acid build up in your muscles from exercising and you feel the soreness and the cramping, in your brain you don't have pain but you have mental illness. Yes, that's what it feels like. It feels like exhaustion. It feels like you've been running in a marathon and you're just paused in that state continually. The energy deficit, yeah. Yeah, that's what I was trying to describe, when I was trying to describe this kind of physiological crisis, it feels like exhaustion. It feels like when you're running a marathon but being paused in that state of exhaustion indefinitely.

53:10And lactate is a kind of marker that makes sense in that context.

53:13Dr. Mark Hyman:You know, those are sort of metabolomic biomarkers. But I want to sort of talk about some of the other things metabolomically that you can look at that have been linked to like amino acids that you can measure, short chain fatty acids that come from the microbiome that modulate inflammation. There are also organic acids that we measure in functional medicine we've been doing for decades, which measure various metabolites like kinuric acid and quinolinic acid, which are metabolites of serotonin metabolites, and they're neurotoxic. And so they're often linked to inflammation. So when I see a patient with a high level of this, and I would see really high levels of these in autistic patients or psychiatric patients, I'm like, wow.

53:54Dr. Mark Hyman:And it would just tell me that there was inflammation in the brain that was causing an interruption in the normal production of neurotransmitters. And that's been linked to depression, schizophrenia, to autism, lactate, you mentioned, and perubate, which are energy metabolic dysfunctions, bipolar disorder, carnitine which has to do with the production of and burning of fat which is often impaired and you see this in autism and schizophrenia oxidative stress and often these I'm coming back to these autistic kids but like anybody with severe psychiatric illness whether it was schizophrenia or bipolar disease and I saw these patients in my practice even though I wasn't a psychiatrist because they were desperate looking for something and you have glutathione depletion oxidative stress markers markers of microbial metabolism I would see often in people with really significant psychiatric illness like OCD or kids with behavioral disorders really high, high, high levels of metabolites from bad bugs in their gut, in their blood, or in their urine.

55:00Dr. Mark Hyman:And so these are the kinds of things you can start to look at. They're not typically part of what you regularly can get at your doctor's office, but it will be soon. And this is the whole field of metabolomics. Essentially, you're looking at the sum total of all the metabolites in your blood. There's, you know, maybe you get your doctor annual visit, you get 19 blood tests. We're talking about thousands and thousands, six, 10 ,000 blood biomarkers that you can check. I went on a long journey with this because I was trying to understand, is there anything, you know, I mentioned making this document and having like everything possible I could try.

55:27And I was, when I read your chapter on energy and metabolism, you'd listed like a coenzyme Q10 and like various things that you can try for this. And I was, you know, meticulous. Like I went through every single thing and I put them in this spreadsheet and I tried, you know, I'd order them, I would like try Coenzyme Q10, I'd try like carnitine, all the things. And I felt like this should be easier, you know, like there should be clear advice on this in mental health treatment. You know, so I think you were describing this way ahead of its time. What we're now coming to is seeing that these kind of mitochondrial markers, energy markers are the things we should be measuring in patients and we should be looking to improve them.

56:04And we saw this in our pilot study, we saw significant reductions in blood lactate on a ketogenic diet in bipolar patients. And this has been a marker for many decades in psychiatry that's been of interest. And we saw it move in these patients. And I can share more.

56:20Dr. Mark Hyman:It's funny that you're talking about, like, in the 70s, they were measuring lactate levels, which is interesting, because it never found its way into traditional psychiatry and to regular practice, right? Yes. And there's also a lot of things. You're talking about this energy problem in the brain. And Chris Palmer talks about his book, Brain Energy. and my friends Casey and Kelly has wrote a book called Good Energy. It's all about our metabolic crisis, which is affecting both our weight and diabetes as well as our brain health and our psychiatric kind of illnesses. And the secondary consequence of these is inflammation, but you can measure things like insulin resistance in the body by simple blood tests.

56:54Dr. Mark Hyman:You know, this is really why I co-founded Function Health, where you can get access to over 110 initial biomarkers and you can add on all kinds of other things if you want to study a lot of the things that need to be looked at, like insulin. Like nobody checks fasting insulin, right? But you can now measure through sophisticated tests, which are not that expensive, we can offer through function, looking at insulin resistance. You can look at cellular insulin resistance by measuring C-peptide and insulin, or you can look at just your cholesterol profile, look at triglycerides and HDL, which is an indicator of poor metabolic health, or looking at your nutrient levels, which is really important, like homocysteine, which measures the B vitamins and vitamin D and B12 folate.

57:36Dr. Mark Hyman:These are really important. And then the inflammatory markers like CRP and IL-6, TNF-alpha, these are biomarkers you can measure in a regular lab test. And even things like thyroid, cortisol, iron, all these play a role in affecting our cognitive function and mental health. It should be pretty carefully looked at. And again, most of these things are available through your basic function panel or add-ons that you can add on. And they should be the standard of care, but people aren't getting them, Which is kind of why I'm like, I'm sick of doctors not doing this. I'm going to co-found a company that can let people find out about this information and take advantage of it.

58:07Dr. Mark Hyman:And that's like you had to do figuring out on your own and suffering for years and years without any help. Well, yeah, I wanted to thank you because you mentioned measuring insulin resistance in one of your patients who had a mental health condition. And this kind of indicating you could improve something. And I really think that one of the best things that could happen in psychiatry is to start measuring that in mental health patients. the HOMA-IR, the insulin resistance marker, because it's not perfect. You know, one measure is going to solve everything, but at least to get a kind of signal of metabolic health from people would be really helpful.

58:40And I'm trying every which way to campaign for this to be a marker that people should look at as markers of insulin resistance in patients, because we know that those markers predict onset of psychiatric illness. In large, like big data studies, we can see that insulin resistance in early life is a marker that predicts future onset of psychiatric conditions. And it also means that people have more severe progression of psychiatric conditions. So if we could get mental health measuring, you know, like you described in this patient, markers of insulin resistance, this would be a real help. I mean, that's terrifying considering like one in four teenagers has pre-diabetes or type 2 diabetes.

59:21Dr. Mark Hyman:And then maybe if you expand the definition of how we define it, which I think is way too narrow, it misses a lot of people who have metabolic dysfunction. You're probably talking about like one and two. I mean, 40 % of kids are overweight. Almost every single one of those has some metabolic dysfunction. Yes. That's some degree of insulin resistance. And you mentioned something called HOMA-IR, which is a calculation that we make to kind of indirectly measure insulin resistance. Yes. I used to do a test. that was called the glucose tolerance test with insulin, where you drink the equivalent of two Coca-Colas and then measure your fasting blood sugar and fasting insulin, and then one and two hour insulin and blood sugar.

1:00:00Dr. Mark Hyman:Most doctors just measure blood sugar. Now there's a test that you should know about, which has just been developed through Quest that uses max spectrometry, which is kind of a more sophisticated way of measuring blood analytes that measures C-peptide, which is a precursor for insulin and insulin, and gives you a ratio. And it's as specific and predictive of insulin resistance as the more very invasive test that you do for research called the euglycemic clamp test. So it's kind of an amazing new advance. And through Function Health, we offer this. I think we're one of the only people actually doing this now.

1:00:32Dr. Mark Hyman:And we're seeing significant issues with this test and the degree of insulin resistance that people have. So I think you sort of look at the energy crisis, and it really comes down to this fuel partitioning problem and lack of ability to actually get energy, make energy. Because when you're even in the midst of plenty of sugar and starch and fuel, which we have an abundance of in Western society, we're still in an energy crisis. So it's like, people are like, what do you mean? I'm like eating plenty of food. I'm eating like a lot of sugar and carbs. Why do I have an energy crisis? It's because at a cellular level, you've kind of busted your cellular machinery that actually runs your metabolism.

1:01:09Dr. Mark Hyman:And that leads to this catastrophic problem, which you know some people shows up as type 2 diabetes and some people shows up as schizophrenia and some people shows up as bipolar disease or depression or you know a million other psychiatric illness i was watching your um interview with andrew huberman the recent one i remember at the end you said um this uh that these kind of like ancient survival mechanisms that kind of we're thinking along the same lines of the you know they regulate your metabolism and that this is kind of um at the root of you know what this dysfunction is and i think this makes sense in terms of mental illness because you know in 95 % of our time on earth we're living in these conditions of scarcity and you can store about 2 ,000 calories of glycogen as sugar in your body but you can store well in excess of 100 ,000 calories as fat so it would be very important.

1:01:57Dr. Mark Hyman:Glycogen is a storage form of carbs. Yes exactly yeah. And the storage form of fat was the fat you see in your belly. Yes yes and so it would be a survival advantage to be able to switch efficiently between these fuel sources and particularly seasonally like you give the example of like you know hibernation in bears for example like they go into this there's some really interesting information about this by someone called Brad Marshall he has a YouTube channel describing this but bears will go into periods of hibernation where they'll burn their body fat and they're going to ketosis for long periods and so you're switching from this like 2000 calorie fuel source to 100 ,000 calorie fuel source and so you guys go from honey to keto yeah yeah absolutely it's a if only that was possible for me but the I guess some people do that but yeah the But, you know, when we're talking about these seasonal variations of energy and metabolism, the most pronounced seasonal change is the switch between glucose metabolism and fatty acid, keto metabolism that happens throughout all of nature, the natural environment.

1:02:55And maybe, you know, when bipolar people in the winter are getting depressed and their metabolism is suppressed, their circadian rhythm is suppressed, they're going to this energy conservation type of mode. Maybe their body's expecting ketosis like the natural world intended, and you continue eating refined carbohydrates and sugars, which just throws these systems into chaos because they're trying to suppress your metabolic function to conserve energy and survive. But you're throwing sugar continually at it instead of giving ketones, which are the evolutionary consistent adaptation that the body is.

1:03:23And to me, that's what ketosis felt like when I described being on the bus. It felt like I was receiving something I'd always been looking for. I was like, this feeling is what I've always wanted to feel, is to feel normal, to feel balanced, to feel stable. And maybe we're bringing back some of these ancient evolutionary mechanisms mechanisms to people and this is what's helping them um in metabolic psychiatry treatment yeah

1:03:43Dr. Mark Hyman:and that's true and i think you know just for people listening there are certain people who really do benefit from being on keto long term but most of us throughout evolution have gone back and forth between keto and carb metabolism between burning fat and burning carbs yes your body's like a hybrid car right you can burn gas you can run electric yes and so that's kind of we've lost that metabolic flexibility, and we get our broken metabolism struggling to continue to run off of sugar when you've beaten it to death with too much sugar that basically leads to this catastrophic downstream consequence that leads to everything from mental health issues to Alzheimer's to cancer to heart disease to diabetes to fatty liver, I mean the list goes on and on.

1:04:32Dr. Mark Hyman:And so what people need to understand is that And everybody needs to sort of figure out what's right for them. But learning what's going on in your own biology through blood testing now and biomarker testing, you can do it as functionality as possible. And you can find out if you have some of these issues, even if your doctor doesn't know how to test for them or look at them. And the less than 1 % of all diagnostic tests done in America measure insulin. Or even measure the proper cholesterol profile, which can tell you if you have a more metabolically driven cholesterol abnormality, such as large number of lipid particles of LDL and small particles, which we can now measure.

1:05:07Dr. Mark Hyman:I want to sort of loop back a little bit after talking about some of the blood biomarkers and metabolomics, and we're going to continue to look for these using AI machine learning to have a really deep understanding of what are the patterns in the data. And I know your institute at the University of Edinburgh is actually examining these things, using deep, deep analytics that that we can now glean through looking at millions of genetic variations, tens of thousands of blood metabolites, looking at things that we never could understand before, we can start to kind of peer into the mind in a way we never had the capacity to.

1:05:41Dr. Mark Hyman:So as we're starting to think about looking into the mind, talk to us about imaging, because most people think, you know, if I have a mental health issue, I don't need an MRI. But like, tell us about the idea of functional MRIs. What are those, and what are the kinds of things you're seeing in people with various mental health issues with functional MRI brain imaging. So it's like you say, when you want to look under the hood, when you want to look in the brain when you're addressing psychiatric symptoms, but that's not been the approach of psychiatry generally. It's been very separate from neuroscience because of this rift between Freud and Krapel and so forth.

1:06:15We've not been looking into the brain function through imaging and through these techniques that we have available. And now that we have these, we can look in the brain and see how is metabolism working, how is blood flow, so forth. And I actually did this myself. I went and got a private MRI scan because I was like, I want to understand if there's something wrong in my brain. Is there a brain in there? You know, my wife was joking, like, did they find something? I was really sure. But, you know, I thought there must be something physically wrong with my brain because it's so hard to live. It's so hard to function, to work.

1:06:49But then I got a brain scan and they couldn't find anything.

1:06:52Dr. Mark Hyman:Because they're looking at the structure, not the function. Yeah, absolutely. And so they said it looks normal, like everything seems to be there and thankfully it's okay. But then it left me thinking about, no, my life is very painful and chaotic and I need to understand why that is happening. And so I think, like you say, the structural imaging has not been as helpful necessarily in the psychiatric conditions. But the metabolic imaging, measuring metabolites, has been really interesting and it continues to become more interesting. So the first thing that you see in brain imaging with epilepsy, bipolar, some of the psychiatric conditions is elevated brain glutamate.

1:07:29This is something you've talked about for a long time, but it really, unfortunately, it's only becoming a kind of research trajectory now. In psychiatry, this elevated glutamate is contributing to excitability in the brain, hyper excitability in the brain. Yes. In American English, it's called glutamate.

1:07:44Dr. Mark Hyman:Yes. Oh, yes. Because people are like, what did he say? It took me a minute to actually realize what you were saying. We can't pronounce consonants in Scotland. We only have vowels. Glutamate is sort of an amino acid derivative. Yes, and so you see this in epilepsy, you see this in bipolar, you see this in schizophrenia. And we did this pilot study, the one that I mentioned, funded by Jan Buzuki. And so we looked at brain imaging to see what changes on a ketogenic diet in people with bipolar. and one of the remarkable findings we saw is that brain glutamate came down in these patients and this is something they measure in response like anti-seizure medication.

1:08:25A ketogenic diet was originally an anti-seizure treatment. Mayo Clinic in 1921 developed it for epilepsy where there's elevated glutamate excitatory activity.

1:08:35Dr. Mark Hyman:It was also the treatment for type 1 diabetes back in the day in Jocelyn in the 1900s and early 20s before insulin was developed. Yes, even before the epilepsy application, and I think as far as I understand it, they saw some of the diabetes patients having seizure remission, and so that's how they started looking at its effects on the brain. But there's modern researchers now, Mark Fry at Mayo Clinic is now launching a large$3 million ketogenic trial funded by Busy Keys to go back and revisit this for mental health conditions. Just to give a little bit of context for why glutamate is interesting in bipolar, the elevated glutamate in systematic review is a major feature of bipolar in epilepsy.

1:09:17And reduction of glutamate is considered a marker of response to treatment. And the epilepsy treatments are things like lamotrigine, valparate, carbamazepine.

1:09:27Dr. Mark Hyman:These are used for bipolar disease? These are all used for bipolar, yeah, absolutely. And so many of our treatments for bipolar came from epilepsy. and now we're seeing this other epilepsy treatment ketogenic diet, many patients reporting remission or reduction of symptoms pilot trials, case studies Chris Palmer has been publishing case studies about this for many years, Georgia Eads published a large retrospective analysis Shabani-Seti using our clinic many many patients reporting online, I mean I documented about 164 about 7 years ago and now it's many thousands of patients reporting effects of ketosis And so I think when you see this anti-shizure treatment that is affecting glutamate in the brain, like with the medications, maybe this is another treatment that will come over to bipolar in psychiatry from the epilepsy field.

1:10:14So in the patients in a palate trial, we saw significant reductions in brain glutamate, about 11 % to 13 % reductions.

1:10:22Dr. Mark Hyman:And you can see this on functional MRI brain imaging tests. Yes, and so this was magnetic resonance spectroscopy looking at metabolites that change in the brain. We looked at many, but glutamate was the most significantly changed. And the reduction we saw was about, like I say, 11 to 13%. And the reductions you typically see in like three months, for example, in the motor gene might be like 6%. But we were seeing much larger reductions in six to eight weeks of a ketogenic diet. So this is really interesting because this is a real central marker for epilepsy. This is an epilepsy treatment. We have epilepsy treatments in bipolar.

1:11:00So we're seeing both the treatment modalities and the markers translating. Who knew the diet could treat disease? Yeah, exactly.

1:11:08Dr. Mark Hyman:What a revolutionary idea! I mean, it's moving. I mean, to be clear, this is only a pilot study. It's 20 patients. We can't draw any definitive conclusion, but it is an interesting kind of avenue forward, I feel. And glutamate is a very excitatory neurotransmitter. Yes. it's also the target of treatment in Alzheimer's. Yes. And again, Alzheimer's is an inflammation of the brain. So all these are inflammatory problems that show up in different ways in different people. Yeah. And you see pretty increased levels of glutamate. We all see other things. You see, you know, changes in connectivity in the frontal cortex and the default mode network gets hyperactive.

1:11:50Dr. Mark Hyman:The amygdala gets hyperactive in a lot of these diseases. So you get basically parts of the brain that should not be overactive are overactive and things that are should be active like you know your frontal cortex are yes reduced in their function it's pretty amazing when you see these trials like even using things like intra intranasal insulin yes for depression and cognitive yes impairment right yeah absolutely it's it's it's so interesting how changing the metabolism the brain can fix all these neurotransmitter issues potentially as well like you know fixing the car engine and everything else sorts itself out versus trying to address all the individual neurotransmitters or symptoms.

1:12:29The glutamate story is one of the most interesting because, you know, like a lot of the mental health research is focused on serotonin, for example, like serotonin reuptake inhibitors. But glutamate is by far the most abundant neurotransmitter in the brain. It's in millimolar concentrations and many of the other monomines are only in micromolar concentrations. And so it's a really abundant neurotransmitter. And the The estimates are that maybe 80 % of brain energy is dedicated to this glutamatergic neurotransmission. So in terms of brain energy metabolism, like Chris Palmer talks about, glutamate is contributing to a significant amount of what brain energy is being used for.

1:13:09And it's really much more abundant than the other neurotransmitters. But the trouble is, people have tried to make medications that affect it. And because it's so consequential for metabolism, people get seizures, like significant side effects of trying to change glutamate. so all the research funding and focus went to the other monoamine neurotransmitters where you could modulate them without this risk of glutamate but also arguably it lacked the upside of changing glutamate you know someone I suppose in Toronto just there and Robert McCollum-Smith one of the researchers described it like you know glutamate is the volume dial and the other neurotransmitters are the treble base and you know it's like the big one but you just can't do anything with it without people having severe side effects whereas ketosis is creating like you described, a metabolic shift in the brain that leads to a change in neurotransmission that doesn't have these types of side effects associated with some of the early ways they tried to change glutamate.

1:14:02So I think ketosis as a metabolic way of improving glutamate metabolism in the brain is a promising area for investigation. And I have a paper on this in Nature Journal of Molecular Psychiatry kind of talking about these dynamics of glutamate.

1:14:17Dr. Mark Hyman:It's such a shame because you're talking about such simple interventions that cost very little, that are diet-related, or pennies of potential supplements a day. Yes. And there's funding that comes from interested philanthropists, very little from any governments, and none from the pharmaceutical industry, because it's not in their best interest, number one, to study this, and two, it messes up with their business model, which is selling people lifelong drugs for psychiatric care. In fact, I think it's the third leading class of drugs that are prescribed out there after statins and GI drugs, or maybe a second, it goes back and forth between GI drugs and psychiatric drugs.

1:14:58Dr. Mark Hyman:And many of these drugs are tremendous side effects. They are marginally effective and they don't really cause cure. They don't really cure the problem. They just maybe mitigate something. And they often don't work that well or they may sometimes make things worse in other ways. So for you, you know, and a lot of people you're studying, you know, recovery is possible now. I mean, you know, we never really thought it was possible to cure these problems, but maybe it's not perfect for everybody because there's many complicating factors. But people have such a stigma around mental illness and such a, they're so pathologized in how we talk about mental health.

1:15:33Dr. Mark Hyman:I mean, if you have, you know, rheumatoid arthritis, no one like stigmatizes you. You know, it's always too bad they have arthritis. But like when you have mental illness, it's like, you know, those homeless people on the street or, you know, these, and there it's like, it's such a, it's such a stigma. And how do we need to kind of evolve this whole idea about, about mental illness? I actually wanted to ask you about the Foucault text you mentioned that there's different conceptualizations. I'm interested in that. What were the ones that you noticed? In the book that he talked about? Yeah, I'm interested.

1:16:03Dr. Mark Hyman:I mean, you know, it's a fascinating book. I mean, I read it 40 years ago, so I'm not sure I remember the whole thing, but it really struck me that at each time, in history there were different ideas about mental health and and and it could be that you were you know basically possessed by demons or it could be that you were you were you know kind of you know visited by angels and god you know i mean think of john of arc and she probably was crazy right but what was going on there yes and you know and there's many people about history like that and yes and they they often had outsized effects uh and then you know the freudian view and then now is a different view.

1:16:40Dr. Mark Hyman:But I think now we're coming to a more sophisticated scientific view or be able to ask the questions in a way that we never were able to ask before. So I think this is an incredibly hopeful moment in psychiatry. I think it's not happening fast enough. I think most people haven't heard of all this stuff before, which is why you're coming on the podcast. And I think what I'd love to hear about, you've now presented at Mayo Clinic, you've published in major journals like Nature. This is starting to get some play out there in the scientific world. Tell us about the metabolic psychiatry hub that you helped develop in the UK, and what are you hoping to see in terms of the work you're doing?

1:17:15Dr. Mark Hyman:I know you're developing a large randomized controlled trial, which is sort of the gold standard of evidence. What are you looking to show with that? And tell us more about that. So, I mean, the hub for metabolic psychiatry, I remember, is a really remarkable thing because, as you know, metabolism has not been a major focus in psychiatry for a long time, despite all the metabolic problems patients have had going back to the most earliest observations of psychiatrists. And so we put in a bid to the Medical Research Council in the UK, which is essentially the largest government-funded research funding scheme.

1:17:50And it's a really competitive scheme. Each university gets one application, so you have to be the best application in the university. And then every university in the UK puts in an application and they choose the best ones from those applications. Wow, that's pretty competitive. Yeah, there couldn't be a more competitive scheme, essentially, because it's so high quality. And so we, but I think one of the things that we were able to show, and this is a major patient priority, you know, millions of patients having these metabolic problems alongside their psychiatric diagnosis. We know this, the data has been there for many decades now, and this is a prime concern of patients, a huge contributor to suicidality and poor physical health outcomes.

1:18:31And so it's really clear that regardless of what anyone thinks about what causes psychiatric illness, one thing we do all agree on is that we need to fix physical health and people living with mental health conditions. It's a major priority. And the data shows that psychiatrists know this, clinicians know this, patients know this. We all agree we need to work on this. And so there's a clear area that we can make progress. And so we refunded about$4 million and the Buzuki's also provided co-funding for it to really start a large government funded program to investigate metabolic health and mental illness, which is fantastic.

1:19:05And we have worked streams on genetic research, population health data, clinical trials, patient experience. And really we're trying to bring the patient experience.

1:19:15Dr. Mark Hyman:You got the award, you won the prize. Yes, yes, which is fantastic. Yeah. Congratulations. Thank you, thank you. But I appreciate that people like yourself have been signing the bell on this for decades leading to this. So, you know, it's really like the dam is now - Shouting in the wilderness, and somebody's finally recognizing it. It's quite hopeful. Yeah, but that's what's led to this momentum, is people such as yourselves, like I say, Chris Palmer, Georgia Ede, really ringing the bell for a long time before this came about. And this has led to now the dam breaking, and there's really major government funding coming behind this.

1:19:46And I think it's the right time for it. And I wanted to thank you for raising this and speaking about it for so long before there was support for it. so it's really a remarkable thing to see it now reaching this level.

1:20:00Dr. Mark Hyman:Thank you. Yeah. Well, they, first you say some new idea, they think you're crazy. Yes. And then they say, well, maybe there's something to it. And then they're like, oh, we thought this all along. Yes. Exactly. It becomes something like that. So for people listening out there who are struggling with mental health issues and have tried a lot of things and feel like it's a lost cause, you know, what would you want them to know? It's really hard living with these conditions. I was very fortunate because in my family, my mother, like I said, had a brain aneurysm and really had severe symptoms for a long time.

1:20:35And my father essentially looked after whilst working, whilst looking after all of us. And at the same time, I was living with bipolar disorder. And I was very fortunate to have a family that were supportive of me, particularly my father. He was looking after not only my mother, but also myself. And I was very, very fortunate to have that. And I really empathize with people that don't have that kind of support in their life. And so I would say that the first thing is to find someone that can really look out for you and that you can trust. And hopefully that's a family member. But maybe if not, it can be a psychiatrist, a doctor.

1:21:09And if you don't find the right one, you just keep trying until you find you really need one person in your life that's looking out for you, that's going to not give up. And for me, that was my family. My wife has been very supportive, my father. but I'd say that's one of the keys to surviving this is to really have someone that you can trust because there's times when your brain isn't working well enough to know what to do yourself and you need someone that you can trust to speak to and the second thing is just to really educate yourself about the condition because we're advancing science very quickly now and understanding these conditions and our understanding is evolving each year and these metabolic aspects the condition are becoming much more in focus as we go on and so to really access resources try to understand what the condition is beyond these maps that don't fit the territory there's so many maps that we've been through and there's new maps evolving that are better fitting the landscape and I think metabolic psychiatry there's resources like Metabolic Mind or YouTube channels or places where you can find information about mental health and metabolic health that could be useful.

1:22:16Dr. Mark Hyman:That's amazing. So thank you Your work is just so tremendous, and I can't wait to see what comes out in your clinical trials. We're going to be keeping a close eye on what you're doing at the University of Edinburgh. From my perspective, there's so much hope out there for people who are struggling with mental health issues, because we now have a new way of thinking about it based on root causes, based on the body as a system, and systems, basically medicine for psychiatric illness. It's the application that it's functional medicine, but a lot of people who are outside of functional medicine are coming to the same conclusions just by seeing what the data shows and following the breadcrumbs and the data, which is what I did.

1:22:53Dr. Mark Hyman:And we're using multimodal diagnostic tools, genetics, blood biomarkers, metabolomics, brain imaging to really move beyond this whole just listing of symptoms and one size fits all. You have bipolar disease, you get this cocktail drug, you're schizophrenic, you get this cocktail drug, you're depressed, you get this cocktail of drugs. That era is over. For anybody still trying to figure this out, try to find a good functional medicine doctor. You can go to ifm.org. You can come see us at the Ultra Wellness Center. We've been dealing with this for a long time with great success. And we have to kind of move away from this idea of just this maintenance of drug therapy and compliance with drug therapy instead of kind of moving to a more recovery model where you can recover.

1:23:36Dr. Mark Hyman:Can you recover from autism? Can you recover from Alzheimer's? Can you recover from schizophrenia? Can you recover from bipolar disease? The answer, if you would ask, you know, most physicians would be no, but we're now learning the answer is hell yes, you can. And there's examples of this all around. And I've seen it personally. I've had patients with this who've recovered over and over again using this model. So to me, it's an incredibly hopeful time. And what we really needed, and you know, instead of a bunch of guys who aren't, you know, scientists like me, I'm a doctor, you know, just saying a bunch of stuff that sounds crazy.

1:24:11Dr. Mark Hyman:We now have folks like you who are actually doing the hard academic work at top universities around the world, like Harvard and Stanford and Mayo Clinic and University of Edinburgh, who are actually mapping out what a future of psychiatric treatment might look like that destigmatizes illness, that gives people hope, that provides a roadmap for trying things. And people can try things. I mean, you know, I think that's really why I write the books that I've written. The Ultra Mind Solution is a little dated, but it's still ahead of its time. And if you follow things in there it often will work you know i have so many patients that go people go to me just say dr hyman i read your ultra minus solution i cured my bipolar so i'm like you did i'm like yeah good okay i mean like reading that chapter back it's funny how much it fits the now the research trajectories that are coming into mainstream it's really remarkable mitochondrial function energy metabolism those kind of biomarkers god microbiome all of it yeah and now we have things we can potentially do you know we need to do large RCTs we're in the early pilot stages of research so you know I'm not going out saying everyone with psychiatric conditions should just do a ketogenic diet we need to really research this in detail and do the RCTs and really understand this before but at least there's there's things that are possible at the moment you know I mean as a therapeutic trial for six to eight weeks it takes a little while to become fat adapted but you know six to eight weeks, 12 weeks, along with a multivitamin, fish oil, vitamin D, the magnesium, the methylating nutrients like B12, B6, folate.

1:25:40Dr. Mark Hyman:There's pretty little downside to that for most people. And there's a lot of upside. And so whatever you're suffering from, if you can't find someone to tell you what to do, learn about it yourself. And now that we have access to, I mean, think about it. You know, the average person today has access to more knowledge at their fingertips than ever before in human history. You know, some person in Bangladesh has more access to the world's knowledge than the president of the United States had in the 1960s or 70s. Yes. Yeah. And I think that there's abundant opportunities to participate now in investigating this.

1:26:19You can sign up for clinical trials as a participant, and you'll have full support of a psychiatrist, dietitian, and exploring this as a treatment. So this trial's launched all over the world now because of Busy Key. There's other public funders coming into this now. So there's many opportunities to do this in a way that's safe working with a psychiatrist, dietitian. And it would give you an opportunity to contribute to the scientific understanding at the same time. So I really recommend people, as patients, try and get involved and try and let's move this forward. Let's understand how it works, what are the biomarkers, and let's make it.

1:26:52Dr. Mark Hyman:Amazing. So we're going to put links to everything, the MedicsBlockPsychiatryHub.com, which is your hub in the UK. Metabolic Minds from the business group is great. There's a lot of papers we talked about. We'll link to those in the show notes. Ian, thank you so much for the work you do, for being on the podcast and giving hope to millions and millions of people around the world who are struggling, a billion people. It's a billion person problem, right? Thank you so much for helping me on my personal journey with your books and for setting the alarm on this for a long time. I appreciate it. Well, thanks so much, Ian.

1:27:26It's been great to have you on the podcast.

1:27:27Dr. Mark Hyman:Hey, everyone. I'm Dr. Michael Bruce, the sleep doctor. I've spent decades studying sleep, counseling thousands of patients, and giving loads of lectures. But there's always more to learn in the world of sleep science, especially right now. That's why I started a podcast, Better in Bed with the Sleep Doctor. In each episode, I leave you with the tools you need to improve your sleep, which in turn will change your entire life. Whether you're entering menopause, trying to get your kid down for a nap, or overwhelmed by which sleep supplements are worth your money, my guests and I are here to help you sleep better.

1:27:58Dr. Mark Hyman:From Lemonada Media and Sleep Doctor, Better in Bed with the Sleep Doctor is out now. Subscribe on YouTube or follow wherever you get your podcasts. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to The Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in.

1:28:30Dr. Mark Hyman:We'll see you next time on The Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic, and Function Health, where I am Chief Medical Officer. This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services.

1:28:59Dr. Mark Hyman:If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness Center at ultrawellnesscenter.com and request to become a patient. It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public. So I'd like to express gratitude to sponsors that made today's podcast possible.

1:29:29Dr. Mark Hyman:Thanks so much again for listening.