It’s the mitochondria, stupid !

This past spring in Santa Barbara, California, I had the opportunity to listen to and meet Dr. Chris Palmer at the 2022 Metabolic Health Summit. Palmer is currently the Director of the Department of Postgraduate and Continuing Education at McLean Hospital and an Assistant Professor of Psychiatry at Harvard Medical School.

Since that time, we’ve kept in touch via numerous email exchanges where he has been very generous with his time and responses to all my lengthy comments and numerous questions. Many of these email exchanges were prior to the release this past November of his new book, Brain Energy: A Revolutionary Breakthrough in Understanding Mental Health—and Improving Treatment for Anxiety, Depression, OCD, PTSD, and More. Many of his replies in these exchanges noted that my comments or questions were addressed in his then forthcoming book.

So, when I finally received and read his new book, much of the material wasn’t as revelatory for me as it has been for other people. That current treatment protocols, including medications, aren’t effective with all people, plus may actually do long term harm, was something I already knew as was the notion that diets, including ketogenic diets, plus a whole list of other lifestyle factors play a large and direct role in one’s mental health. Honestly, to me this was and still is sort of “like duh”. But needlessly to note, in an upside down world, what should be obvious gets lost when dogma, people’s ego’s and corporate profits are involved.

Now, I note none of this to take anything away from the book. Quite the contrary, I strongly believe that Palmer’s new book should be compulsory reading for anyone with a head attached to his or her body especially if that person is a patient or healthcare practitioner.

Why?

Too often with modern medicine, health issues have been compartmentalized into separate silos filled with different specialists. This has been especially true with the brain and the rest of the body. So, what Palmer’s book does is look at mental or brain health more holistically within the broader context of metabolic disease. And what’s truly brilliant is how he ties together a lot of disparate theories as to what exactly causes mental “illness” by exploring the evolving research on mitochondrial function and dysfunction. His “Brain Energy” theory does this more specifically by looking at a wide array of variables (diet, hormones, sleep, etc) that adversely impact the wide array of functions mitochondria play in metabolic health. And in a very adept balancing act, Palmer’s book is both accessible for the lay person and scientifically rigorous for academics and fellow clinicians.

With that forward, what follows is some Q & A with Dr. Palmer. I submitted a long list of questions, and once again he was incredibly generous with his time to respond to all of my questions. My questions are proceeded with bullet points, and his responses are in bold face.

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• The limitations of contemporary psychiatry, for me, weren’t revelatory, but does the field generally think that this is the best that it can do, that is reduce or suppress symptoms of what’s considered a chronic illness?

Most of the mental health professionals and researchers that I know think they are doing the best they can do.  We all have patients/clients who get better, and we tend to focus on them as proof that our treatments work. For the others (who actually comprise the majority of people getting mental health treatment), clinicians can get lost in the chaos of trying different medications or therapies, seeking out different diagnoses, or looking at changes in the person’s circumstances (such as new stressors, trauma, substance use, medication non-compliance, etc.) as reasons for the ineffectiveness of the treatments.

• Is the refusal to accept that psychiatric conditions are not a chronic condition often construed as being in denial?

For diagnoses like bipolar disorder and schizophrenia, yes, the field currently tells people these are lifelong disorders and refusal to accept this is seen as denial.

• Is the reluctance to look for underlying conditions and root causes, before writing prescriptions, a reflection of a medical care system reliant on expediency where doctors don’t have much time to spend with patients?

If you look at the progression of the field, we have a history of spending lots of time and money looking for root causes. People were asked to participate in years or decades of psychotherapy looking for the root cause(s) of their unconscious conflicts. It was hoped that once these were identified and resolved, the person would get better. For many people, this didn’t pan out. Researchers have studied thousands of patients with different psychiatric conditions looking at blood tests, brain scans, and other tests, hoping to find the root cause or at least a diagnostic test. This, too, didn’t pan out. At this point, yes, medical professionals are expected to assess and treat these conditions in less than an hour. The easiest thing to do is assign a diagnosis and prescribe a pill.

• Not to be too overly cynical, but is the reliance on prescriptions also a reflection of a system that looks for quick fixes as well as lifelong pharmaceutical customers?

I think most clinicians honestly hope that the pills will put illnesses into remission and the person will fully recover. Sadly, it doesn’t work out that way for the overwhelming majority of people getting treatment. I don’t think the clinicians are looking for lifelong pharmaceutical customers, but in a way, they participate in a system that ends up delivering that result

• Are many in the psychiatric world married to the current pharma paradigm because they’ve invested too much of their professional prestige, reputations and recognition in the current neurotransmitter models?

I  think there are some researchers who fall into this category. They have spent their careers pursuing the neurotransmitter hypotheses of mental illness and it will be difficult for them to “change their minds” now. 

• Now shifting base, given your brain energy model with mental health being a metabolic disease, would a more fitting and specific description of such disorders or mental illness instead be mitochondrial disease?

I don’t think so. There is already a category of diseases called “mitochondrial diseases” and these largely refer to rare genetic mitochondrial abnormalities. I would prefer the term “metabolic brain disorder,” as this encompasses both mitochondria and the environment, which includes diet, stress, sleep, toxins, and other factors that play a role in mitochondrial function.

• Have you considered using as a tagline or printing on tee shirts a paraphrase of James Carville’s famous quote, “It’s the mitochondria, stupid” ?

I love it!

• When looking at mitochondria is there a certain threshold or “mitochondrial allostatic load” that has to be exceeded before a patient’s mild impairment becomes a “disorder” or worse a psychotic break?

I think so, but at this point, we don’t have the technology to study mitochondria in vivo in different brain regions to be able to assess this definitively. However, based on all of the roles that mitochondria play in cells and all of the factors that we know can exacerbate symptoms of mental illness or cause a new-onset mental disorder, it is clear to me that the mitochondrial allostatic load is the only way to connect the dots of mental illness. When the allostatic load is marginal, it would result in mild symptoms during times of stress. When the allostatic load is further impaired, it would result in more significant symptoms that might become chronic.

• If yes, is this threshold typically more the accumulation of various factors including environmental, physiological and nutritional factors rather than just one thing in some or many people?

Yes, we know that many factors impact mitochondrial function and in most people, it is the accumulation of these factors that results in symptoms.  However, there are situations that result in abrupt and definitive assaults to mitochondria that can result in immediate-onset mental symptoms. These include things like having a stroke or being exposed to a mitochondrial toxin, such as arsenic or carbon monoxide.

• With certain conditions for certain patients, can a stressful event or sleep disruption/deprivation be the proverbial straw that broke the camel’s back…meaning a certain event that caused the threshold of mitochondrial dysfunction to be exceeded and lead to a psychotic break? 

Absolutely! It is already well established in the mental health field that sleep deprivation can trigger episodes and symptoms in people. Up until now, however, it wasn’t clear why or how. Understanding the connections between sleep, metabolism, and mitochondria help us connect the dots.

• Obviously, every person is going to have a different matrix of factors that get each person to his or her threshold, so is personalized care with a thorough assessment of a person’s sleep, diet, blood work, diet, life history, etc all part of your intake protocol?

Yes, this should all be included in every mental health intake. We need to be looking for all of the contributing causes and then designing a treatment plan around these.  

• How does such a protocol work in today’s commercial healthcare insurance model where many people still can’t even afford major medical insurance?     

It will take time to develop cost effective protocols, but there is no doubt in my mind that this type of systematic assessment and customized treatment plan aimed at addressing the contributing causes of illness will result in far superior outcomes and will save the healthcare system money in the end. Mental disorders are the leading cause of disability on the planet. This can and should change. Under this new model of care, patients will not become chronic patients taking expensive prescription medications for life. Instead, they will receive appropriate care initially and we will help people fully recover after an episode.

• In order to shift paradigms, is this change going to need to come from patients demanding change rather than from academicians many of whom have never experienced what patients have gone or been through with experiences including treatments?

Yes, I think it will take a grassroots movement to create the changes that are needed in the mental health system. Without one, it’s unlikely that the establishment will implement such a disruptive new model of care.  

• Your book, while packed with information, also seemed like just the tip of the iceberg on this subject matter. Were there many other topics you wanted to expand upon or include that were omitted to keep the book from being too voluminous?

Yes! At one point in drafting the manuscript, I was only half-way done with the book but had twice the word count of the final book. I had hoped to write chapters on many of the different hormones and how they play roles in the brain energy theory, but I ran out of space.  I also wanted to include chapters on toxins, other substances of abuse, temperature, and many other factors related to the brain energy theory. Maybe at some point, I will have the opportunity to write another book.   

• For example, I was very curious about the role of of the hormone “vitamin” D3 in its various forms on mitochondrial function. Certainly D3 deficiency has been shown to contribute to depression, but can such a deficiency also lead to mitochondrial dysfunction and further reinforce your brain energy theory? 

Yes, Vitamin D3 plays a direct role in mitochondrial function, and therefore, plays a role in the brain energy theory.

• If yes, thus couldn’t UvB radiation from sunlight that makes the initial D3 be a factor in treating depression? 

Absolutely!

• And lack of such radiation, particularly in winter months without UvB available resulting in lower D3 and thus mitochondrial dysfunction lead to depression including Seasonal Affective Disorder? 

Absolutely!

• Given the importance of cortisol in mitochondria function, what about melatonin, what role does it play?

I could do an entire chapter, or probably an entire book, on melatonin. Unbeknownst to many people, it is derived from serotonin, is produced largely within mitochondria, and plays a role in their function and health.

• And more broadly, what about circadian rhythms… do shift workers have any higher incidence of mental health or mitochondrial disease than people who work regular schedules?

Yes, it’s long been known that shift workers have higher rates of both mental and metabolic disorders, which is completely aligned with the brain energy theory.

• Given the onset of more severe mitochondrial disease like schizophrenia with college age students, could the lack of structure with circadian rhythm disruptions and melatonin/cortisol cycle disruption lead to a psychotic break?

Yes, this can definitely be a contributing cause. Substance use, such as alcohol and marijuana, are also common in college students and these can also play a role.

• Given the impact on melatonin, has anyone looked at the impact of late night blue light exposure on mitochondrial health?

Yes, we have some research on this. For example, this study in flies demonstrated that blue light exposure is associated with neurodegeneration and the mechanism of action appears to be mediated through mitochondrial dysfunction.

• Also with modern faces due to modern diets, as shown over 80 years ago in Weston Price’s research, there’s a lot of poor facial cranial development leading to varying degrees of disordered and sleep disordered breathing that can also spike cortisol as well as insulin levels. Has much research been done on how these breathing issues impact mitochondrial dysfunction?

We don’t have a lot of research on this specific topic, but we do know that disordered breathing in sleep is associated with a higher prevalence of both mental and metabolic disorders. This study looked at the effects of sleep apnea on mitochondria and found that it induces oxidative stress and more mitochondrial DNA mutations.

End of Q & A.