Dr. Shebani Sethi-Dalai (00:00:00):
So, the rates of obesity, and binge eating, and addictive like eating are rising alongside the increasing dominance of ultra-processed foods in the modern food environment. There’s several mechanisms as to how this works.
Dr. Mark Hyman (00:00:20):
Welcome to The Doctor’s Farmacy. I’m Dr. Mark Hyman. That’s farmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. If you’ve struggled with mental illness and are looking for some new insights about why we struggle as a society and individuals with this overwhelming burden of depression, anxiety, and more, then this conversation’s going to matter to you, because it’s with an extraordinary physician, Dr. Shebani Sethi-Dalai, who’s a Stanford and Duke trained, double board certified physician in obesity medicine and psychiatry. Just stop and think about that for a minute. Obesity medicine and psychiatry, they don’t seem connected, but you’re going to find out exactly how they are connected.
Dr. Mark Hyman (00:01:00):
She’s the founding director of the Stanford University’s Metabolic Psychiatry Program and the Silicon Valley metabolic Psychiatry Program, a new center in San Francisco Bay area focusing on optimizing brain health by integrating low carb nutrition, and we’re going to talk about that, comprehensive psychiatric care, and treatment of obesity associated with metabolic disease. She’s just an extraordinary physician. She’s been I think leading the way in redefining what psychiatry is, because for so long we’ve created this stigma of mental illness as sort of a problem that is an emotional problem, but it might be, in many cases, a biological problem, and it might be related to what we’ve eating. I really want to welcome you, Shebani, to the podcast, and thank you so much for joining us today.
Dr. Shebani Sethi-Dalai (00:01:50):
Thank you very much for having me, Dr. Hyman.
Dr. Mark Hyman (00:01:52):
You have kind of an interesting background. You have trained at the best institutions in the world, and you have somehow come to the conclusion that our psychiatric problems may be related to metabolic issues. You coined this term, metabolic psychiatry, which really when I first saw that, I was so excited, because I wrote this book 12 years ago, called The Ultramind Solution, about how the body affects the mind.
Dr. Mark Hyman (00:02:20):
We know about the mind/body effect, but nobody really talks about the body/mind effect. Most psychiatrists think about the brain as sort of disconnected from the rest of the body, and you treat the brain, but what about what’s going on south of the neck? It doesn’t get much attention. You’ve really taken a very different approach. Why don’t you tell us, how did you come to this idea that we should be treating psychiatric issues with nutrition and through metabolic approaches?
Dr. Shebani Sethi-Dalai (00:02:47):
Yeah. That’s a great question. Early on, I knew I wanted to do medicine. When I went into medicine, I saw that there were a lot of conditions that weren’t necessarily addressed with nutrition, and there was a lack of training in the medical education system with obesity, as well as nutrition. With psychiatric conditions, I saw a lot of overlap with nutritional deficiencies and insulin resistance and even higher rates in that population versus the general population. We know in the general population it’s pretty bad already in our country.
Dr. Shebani Sethi-Dalai (00:03:29):
The relationship between mental health and metabolic disease is bidirectional, which means if you have a mental illness, you’re more likely to have metabolic disease and vice verse, and if you have a metabolic disease, you’re more likely to develop a mental illness. You’re more likely to have a heart attack, for example, if you have depression, and you’re more likely to develop depression after you have a heart attack. These observations that I made really put questions in my mind as to there must be something more to what we’re doing that needs further investigation. I believe that there are metabolic issues that are not necessarily addressed within the field that I think needs to start occurring. We need to start including that in the way that we diagnose, and treat, and evaluate disease.
Dr. Mark Hyman (00:04:26):
Yeah. I was sitting here talking earlier about these idea of comorbidities, which is a term we use in medicine to describe diseases that occur in the same patient. If you have high blood pressure, diabetes, depression, reflux, we call these comorbidities, but we were talking earlier about how they may not really be unrelated, that in fact they may be very connected. It sounds like from your observations you made the conclusion that maybe it wasn’t a coincidence, the fact that people who were overweight or unhealthy also had mental health issues. Maybe there was a relationship, nutritional deficiencies, metabolic issues. You talked a lot about insulin resistance. How did you come to sort of understand that that was really going on, that the biology of that was something that was real?
Dr. Shebani Sethi-Dalai (00:05:16):
I originally started off with an interest in learning about nutrition and metabolic issues in obesity, and I wanted to treat obesity. Then I saw that in a lot of the patients there were psychiatric conditions in those patients, so I started to veer into the realm of psychiatry and got very interested in that. What happened was that when I was treating metabolic dysfunction, not necessarily obesity, but metabolic dysfunction, which is problems with blood sugar, or insulin resistance, or high blood cholesterol, I saw improvements in quality of life, in mood, in anxiety symptoms, in psychiatric symptoms essentially. That really got me interested in what is this relationship, why is this occurring, and got me interested in treating these patients in a slightly different way than standard of care, really integrating the understanding of what metabolic dysfunction is. I then started a clinic, and I started to do research. That’s how my path started, and it started early on, developing this clinic, in residency training.
Dr. Mark Hyman (00:06:39):
Which is incredible, because when you look at the level of mental illness in society, it’s one of the biggest causes of disability, and one of the biggest costs is depression and anxiety. I remember when I was seeing patients early on, treating them for insulin resistance, and prediabetes, and other issues, or gut issues, or other factors that were going on related to autoimmune disease or inflammation, and we would get them healthy, they would sort of say, “Wait. My depression went away. My anxiety went away. My panic attacks are gone. My bipolar disease is better. My ADD’s better.” I’m like, well, how did that happen? Then you begin to go down the rabbit hole, and you begin to look at the biology of what’s happening.
Dr. Mark Hyman (00:07:20):
I think one of the greatest discoveries around mental health is that it’s an inflammatory problem very often, that the brain is inflamed, but the brain can’t say, “Ouch,” like you have a sore throat or a swollen ankle. It manifests as all these psychiatric symptoms. I’d love it if you’d sort of take us down the road of how inflammation is connected to mental illness and what the approach is that you’re using to help correct that.
Dr. Shebani Sethi-Dalai (00:07:50):
Sure. That’s quite an important question. When we talk about how nutrition affects the brain, and specifically focusing on reducing that sugar, and processed foods, and refined carbohydrates to improve mental and physical health, we know that consuming excessive amounts of sugar, processed foods, and refined carbohydrates lead to obesity, metabolic problems, fatty liver, heart disease, even cancer. There is evidence for this. The body is really one whole system, and what happens in the body also affects the brain. The brain has a delicate balance of neurotransmitters or chemical messengers. With more sugar and processed foods, these levels really become unbalanced, and they’re significantly off. I’m talking about-
Dr. Mark Hyman (00:08:44):
Wait. Wait. So, your brain chemistry gets screwed up when you eat processed food and sugar is what you’re saying.
Dr. Shebani Sethi-Dalai (00:08:50):
Yeah. I’m talking about ultra processed food also, in particular, because I do think that there’s a difference between processed food and ultra processed food. Ultra processed food is the real sugar, the cookies, the cakes, the chips, the potato chips, these kind of highly processed things, versus minimally processed foods, maybe some oils, vegetables that are frozen. That’s a little bit different than ultra processed food. The research is showing differences between those things in the brain.
Dr. Shebani Sethi-Dalai (00:09:25):
You need the right raw ingredients for chemical reactions to occur in the brain and elsewhere, like vitamins, and minerals, and nutrients. You need proper functioning of the brain. You need proper speed of transmitting signals. Your brain is composed of electrical cells, and it’s a complicated web of signaling molecules. Those cells need fat to develop and to function properly, so you need those omega-3s in your diet. If you eat sugar and ultra processed foods, the chances are that you’re likely not getting those important nutrients, those vitamins and minerals, for those important reactions that you need, nor are you absorbing them. Most people with metabolic dysfunction actually have nutritional deficiencies and are malnourished.
Dr. Mark Hyman (00:10:14):
What you’re saying is people who are overweight and obese often are very malnourished and vitamin and nutrient deficient.
Dr. Shebani Sethi-Dalai (00:10:22):
Yes. That’s right.
Dr. Mark Hyman (00:10:23):
That’s sort of a paradox. Right?
Dr. Shebani Sethi-Dalai (00:10:25):
Dr. Mark Hyman (00:10:25):
If they’re eating all this food, why are they nutritionally deficient? But they’re actually among the most malnourished.
Dr. Shebani Sethi-Dalai (00:10:31):
They are, unfortunately.
Dr. Mark Hyman (00:10:33):
They’re looking in all the wrong places for the nutrients. They’re eating all the wrong food. I think a study from Kevin Hall and others showed that if you let people eat as much as they want and you give them ultra processed foods versus whole foods, they’ll eat about 500 calories more a day of ultra processed food, because they’ll keep eating, and they’re hungry, and they keep driving. You talk a lot about that in your work, about the biology of what these do to your brain in terms of dopamine and the addiction reward pathways in the brain that make you literally become addicted to these compounds and how that affects you.
Dr. Shebani Sethi-Dalai (00:11:04):
Right. The rates of obesity, and binge eating, and addictive like eating are rising alongside the increasing dominance of ultra processed foods in the modern food environment. There’s several mechanisms as to how this works, some which act directly on the brain and some that indirectly act through hormonal signaling. Our body’s very complicated, and the brain is connected to the body. We used to learn in medical school that you have this blood/brain barrier, that nothing could get across it, but that’s not … It’s like the Berlin Wall, but in reality it does leak. Right? And there are things that do cross.
Dr. Mark Hyman (00:11:46):
It’s more like a coffee filter. You know? It’s a sieve.
Dr. Shebani Sethi-Dalai (00:11:51):
Right. Yeah. Ultra processed food and sugar decrease our dopamine receptors and make us eat more compulsively, much like addictive drugs. The highly processed foods, they trigger dopamine reward pathways, and they invoke addictive like behaviors, which have been well documented and include intense cravings. It includes feelings of withdrawal when cutting down on ultra processed food, continuing to eat these things, despite knowing the adverse consequences to it, and repeated attempts to try to quit. Right? I’m describing addiction here basically and the consumption of larger quantities over time than intended.
Dr. Mark Hyman (00:12:35):
People go, “Oh. It’s emotional eating. It’s not really biological true addiction,” but what you’re saying is it’s really a true biological addiction, just like heroin, or cocaine, or alcohol, that you get withdrawal. You get cravings. You get increased need for more and more of the substance just to receive the same pleasure. You down regulate the receptors for pleasure, so you have to take more of the stuff to actually stimulate that reward pathway. It’s really this vicious cycle that people get into, and then they blame themselves, and they feel guilty for doing it, and they think they just have no will power. But you’re saying it’s much bigger than that.
Dr. Shebani Sethi-Dalai (00:13:08):
Yeah. That’s exactly right. Sugar is an addictive substance. It’s not just something we say. It has a straightforward neurochemical basis in the brain, just like any other drug. I think of sugar as it’s a recreational food. It’s not a food that’s essential for survival. We make sugar through the process of gluconeogenesis through other foods that we consume. It’s really about excess carbohydrates. It’s not-
Dr. Mark Hyman (00:13:41):
I call sugar a recreational drug. I’ve never heard anybody say it, but I always write that in my book, “Sugar is a recreational drug.” If you like tequila, it’s fine, but not breakfast, lunch, and dinner in the quantities we’re having in America.
Dr. Shebani Sethi-Dalai (00:13:53):
Exactly. Yeah. Actually, I would like to share a story about this, just during the era of COVID, since we’re in it. Just to give context as to why I wrote about this and why I’m working on this as well and continuing to feel motivated to continue to do my work is the shelter in place order had come a couple of months back for my county. I’m in California. I live in Menlo Park. When it was announced, my husband … He’s an infectious disease physician at Stanford, and I’m a psychiatrist and obesity medicine physician, as you mentioned. We both felt doubly invested in this pandemic. We went to our neighborhood Safeway grocery store, and we saw many people loading up their carts with Pop-Tarts, Hawaiian Punch, popcorn, anything ultra processed basically, and they weren’t loading up their carts with fresh vegetables. They were out of cookies at the grocery store.
Dr. Mark Hyman (00:14:55):
Yeah. Cookies and toilet paper.
Dr. Shebani Sethi-Dalai (00:14:58):
And toilet paper. Exactly. There was still produce left in the store. It wasn’t like they ran out of produce.
Dr. Mark Hyman (00:15:07):
No. There wasn’t a run on broccoli.
Dr. Shebani Sethi-Dalai (00:15:10):
No. Here I was at the checkout counter, and I was thinking to myself, staring at the person’s cart in front of me that was full of the recreational food, as I mentioned, the food that’s not necessary for survival and detrimental to our health. I thought to myself, this is certainly not preparing them for the pandemic or helping their immune system, and if anything, weakening it. This is our local Safeway. This is the heart of Silicon Valley. In this context, it wasn’t about affordability or access. That is what motivated me to kind of get that public message out on this topic.
Dr. Mark Hyman (00:15:47):
Yeah. You did write a great article on The Hill. I read it. You really talked about the way in which the pandemic we’re facing is much more serious, because of the underlying disease pandemic we have in our society, where it’s driven by this ultra processed food that makes us overweight and sick and causes all these underlying, chronic, inflammatory issues, like diabetes, and heart disease, and high blood pressure, which are really the same mechanisms. If you look at the mechanisms of high blood pressure, or heart disease, and diabetes, it’s insulin resistance. It’s oxidative stress. It’s inflammation. It’s the same thing that’s affecting our psychiatric illnesses, which is so fascinating. Most people don’t think about using the doorway of food to help treat the brain. You’re doing that in your research and in your practice. Tell us some of the things you’re seeing in your patients using this approach? Because it’s pretty radical. You’re going all the way sometimes to ketogenic diets in these patients with bipolar disease, schizophrenia, depression. It’s fascinating.
Dr. Shebani Sethi-Dalai (00:16:43):
Yes. What I have noticed is that a lot of my patients that come for psychiatric treatment and evaluation, a lot of them have prediabetes and diabetes. When I look up the statistics on this in our country, 44% of adults today in our country are either pre-diabetic or they have diabetes. I wonder to myself, what is that doing to our brain? We know that affects all these different organ systems, the liver, the pancreas, the heart, but what is that doing to the brain. Right? I’m happy to talk more about my research and patient care, but one thing that I felt I didn’t completely answer before was kind of how these hormones affect your brain with the addictive piece.
Dr. Mark Hyman (00:17:39):
How does it drive inflammation and all of that? Yeah.
Dr. Shebani Sethi-Dalai (00:17:43):
Yeah. Kind of going back to that, I was talking about the definition of addiction. We know that hormones, like insulin and leptin, which is the hormone that tells us we’re full, it sends a signal to our brain, and ghrelin, that tells us that we’re hungry, these hormones modify natural and drug reward pathways in the brain. They have so many effects on the brain. Our hunger hormones go awry, and it can actually increase the reactivity itself of the dopamine system. This happens when we consume that excess sugar and that excess carbohydrates in our diet. They cause these rapid shifts in blood glucose and insulin levels, similar to other addictive substances.
Dr. Shebani Sethi-Dalai (00:18:40):
My approach in patient care has been to work on this system to decrease these shifts that occur in our blood sugar and our hormone levels to kind of go back to the homeostatic state that our body and our brains were meant to be in. I treat the metabolic dysfunction, and I look at how that improves both metabolic issues, as well as psychiatric outcomes.
Dr. Mark Hyman (00:19:15):
Yeah. It’s fascinating. Basically, you’re treating the body to fix the brain. Right? You’re dealing with these physiologic changes that have to do with our diet and nutritional psychiatry that most psychiatrists aren’t thinking about. Most psychiatrists are thinking about psycho-emotional issues. They’re thinking about medications and prescribing antidepressants, but they don’t really work as well. I’ve just found that the amount of benefit you get by addressing these underlying factors is so much greater than you get with medication, which are marginally effective for most people I think, unless you have really severe depression. But I think the data’s just not that exciting about these drugs. Right? I mean, they can be helpful for people. They can be life saving, but there are also other doorways that you’re exploring, which seem to be way more fruitful. Is that your experience?
Dr. Shebani Sethi-Dalai (00:20:05):
The field has come a long way. There’s a lot of research that’s been done on the biological piece, the neuroscience, and looking at, obviously, the serotonin hypothesis, but that’s a hypothesis and an observation from like 30 years ago. All of these research and money has been thrown on developing drugs, but we’re not necessarily addressing some of the root causes of why are there chemicals imbalanced. That’s an important question that I and others are trying to study through research studies and clinical trials. Like you said, we know that although our medications are necessary and lifesaving for many, they have undesirable side effects that can worsen metabolic health. While it’s helping in one domain, it may in some people also be hindering improvement in psychiatric symptoms, especially if the metabolic health is poor.
Dr. Shebani Sethi-Dalai (00:21:01):
Psychiatric treatment is never going to be a one size fits all approach. Mental health conditions are varied. They’re heterogeneous, and they have different phenotypes or presentation. We don’t have a single mutation, or a gene that we can point to, or a lesion. There’s no smoking gun. It’s a complex relationship of multiple chains and environment. Unfortunately, a metabolic assessment’s not part of that routine care. Stigma certainly plays a role in this. Obesity’s stigmatized, and so is mental health. Education about nutrition and metabolism is lacking in medical education. Most psychiatrists recognize this relationship.
Dr. Mark Hyman (00:21:45):
They do? They understand the connection between food and mood?
Dr. Shebani Sethi-Dalai (00:21:49):
They’re starting to. They understand that there are side effects with psychotropic medications. I think they don’t necessarily have the expertise to treat it or address it. They don’t know necessarily what to do about it, but most psychiatrists that I speak with, and my department certainly has been very supportive of this idea, and someone has to do the research. Someone has to do the work to kind of move the field forward. There is a growing body of other researchers working on this. We hope that evidence based research has to be done to kind of change the mainstream standard of care.
Dr. Mark Hyman (00:22:28):
Yeah. No. I mean, you’re talking about metabolic psychiatry. I was also noticing that Harvard had a whole department of nutritional psychiatry, which seems like bookends on the country. The rest of psychiatric world is thinking about this. But you mentioned earlier that you worked with Bruce Ames, who’s an incredible biochemist and nutritional scientist from California, one of the most published scientists in the world. I spent a lot of time with him. He talks about this whole idea of a metabolic tune up and that so many of our biochemical reactions are regulated by vitamins and minerals and that each of us have different needs for different components of those vitamins and minerals.
Dr. Mark Hyman (00:23:09):
I remember when one guy was … I was sitting in my office one day working on something. I was thinking I might have been working on that book. I was talking to somebody about folate, and B12, and B6. He’s like, “Oh, yeah. I had really bad depression, and I took some of these B vitamins, and it just went away.” I think there are some people who have a higher need for, for example, folate, or B6, or B12, based on these genetic variations that Bruce Ames talks about that really are so prevalent. In fact, one third of our entire genome codes for enzymes, and those enzymes all need helpers, which are vitamins and minerals. We don’t really pay much attention to that.
Dr. Mark Hyman (00:23:46):
When I look at depression or a psychiatric illness, I see so many different things that are going on there, whether it’s insulin resistance, or prediabetes, or vitamin D deficiency, or folate insufficiency, or zinc, or magnesium. All these various nutrients play a role in brain function, and they’re not something we really learn about when with learn about psychiatry. Right? Is that changing?
Dr. Shebani Sethi-Dalai (00:24:08):
I think that is changing. There’s a complex relationship between metabolic dysfunction, and nutrition, food, mental health. I want to start off by saying that the idea of food as medicine is not a new concept, and the field of nutritional psychiatry has really grown over the past few decades by several prominent psychiatrists and researchers. However, the focus has largely been looking at specific foods or supplements, eliminating certain things from the diet, the microbiome, or looking at the mediterranean diet, for example, affecting depression symptoms. These are all very important questions, but what I thought was missing or why I named our clinic and our group [inaudible 00:24:46] Metabolic Psychiatry is to distinguish that this is a study of how treatment of metabolic dysfunction can affect psychiatric symptoms.
Speaker 3 (00:24:55):
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Speaker 3 (00:26:11):
Now, back to this week’s episode.
Dr. Shebani Sethi-Dalai (00:26:13):
If a majority of us are suffering from obesity, type-2 diabetes, insulin resistance, metabolic syndrome, what is that doing to our brain. We know that these disease affect multiple things. Mental illness rates have increased over the past 20 years, in fact doubled. We know that mental illness, like depression, bipolar disorder, psychosis, they’re strongly associated with inflammation. That research is really indisputable. Research is also showing that there’s an energy deficit in these brain illnesses, and the mitochondria, the energy powerhouses of our cells, are not functioning optimally, causing changes in brain signaling itself.
Dr. Shebani Sethi-Dalai (00:26:57):
The thought is if we can target inflammation, insulin resistance, the abnormal blood sugar, et cetera as a method to improve mental health symptoms, then we can really improve our patients’ lives further. Again, mental illness has many different causes, but even if we can 5% to 10% of people have an improvement in these symptoms with this method, then I think that would be a pretty significant improvement of the overall mental and physical health of our country.
Dr. Mark Hyman (00:27:28):
I think it’s a lot more than 5% to 10%. When you think about it, the most amazing thing you just said to me is such a paradigm shift, which is that depression is inflammation in the brain and that when you look at autopsy studies and when you look at the biology of this disease, the brain’s on fire. It’s also on fire in autism, in Alzheimer’s, in schizophrenia, in a lot of these disorders that we think of as mental disorders, but are actually brain disorders that are manifestations of inflammation that show up differently in different people. The question is what’s driving that inflammation? I think diet clearly is probably the biggest factor, which makes it an incredible thing to use to actually alter the course of these diseases, because it’s an easy tool to change and actually get a result. That’s what you’re talking about is your therapeutic use of metabolic medicine to actually fix psychiatric problems, which is pretty amazing.
Dr. Shebani Sethi-Dalai (00:28:26):
Yeah. I’m glad that you bring that up, because I do want to clarify that with inflammation it’s not a complete, clear picture. We know that there’s inflammation, but there have studies showing that treatment with anti-inflammatories, for example, in patients that have inflammation, but not necessarily depression, can actually cause depression symptoms. That’s kind of a little bit of a paradox. Right? People-
Dr. Mark Hyman (00:28:55):
Do you mean like Advil, or do you mean the interferon treatments for MS?
Dr. Shebani Sethi-Dalai (00:29:01):
Yeah. I think it was interferon. I’d have to look back at the studies. There have been studies that have shown differences generally with some of the psychiatric symptoms when you’re trying to combat inflammation and reduce it, but in people that have metabolic dysfunction, I think it’s a different story. That’s what I’m trying to study further. We have to be careful and cautious also, because otherwise we do a little bit of guesswork, if we’re not looking at it carefully. But I think-
Dr. Mark Hyman (00:29:33):
Then you’ve got the microbiome and people talking about antibiotics causing depression, because it destroys the microbiome, and then the microbiome is another huge source of inflammation. You’re talking about diet, and then you’ve got the gut microbiome, and you’ve got environmental toxins and nutritional deficiencies. All these factors are affecting our brains in ways that we actually have a doorway to fix. I’m so excited that at Stanford and places like Harvard they’re actually looking at these issues now, because we do have a pandemic of mental illness. It occurred to me when you were talking that as we’ve seen this rise in mental illness, it’s the same curve as obesity and diabetes. Right? It’s the same curve. Maybe they’re related.
Dr. Shebani Sethi-Dalai (00:30:10):
Yeah. I think that’s what is interesting about that. Even with eating disorders, we are seeing more in that population, too. You mentioned about patients and how they benefited. What I’d like to share is that some of my patients with eating disorders, for example, which traditionally you don’t want them to go on a diet. You want to prevent them from exacerbating their condition, with binge eating, for example. But what I’m finding is that if you tell them not to be afraid of a fat, for example, if they increase the fat in the diet, that’s improving their binge eating. They’re reducing their binge eating. All the studies with diet in the past have been low calorie diets. It hasn’t been looking at-
Dr. Mark Hyman (00:31:00):
And low fat.
Dr. Shebani Sethi-Dalai (00:31:01):
And low fat. Right? Not the quality of the diet itself. That’s another interesting area of study, which I’d like to pursue. I had a patient who couldn’t get pregnant for years, had a history of bulimia, and I found that she was iron deficient and insulin resistant. Once we treated that, she was able to get pregnant, and she cried in my office with the joyous outcome. Another patient who was an athlete suffered from anorexia nervosa and hadn’t had a period in months. I emphasized the fat and the brain needs the fat. When she increased her saturated fat intake, I don’t tell you to decrease the saturated fat, so her symptoms significantly improved, and her menstruation returned. There are a lot of things with diet that we can do to significantly improve patients’ outcomes. Two additional patients, I’ll just briefly mention, while I was in training, they had schizoaffective disorder, and they went completely off just ultra processed foods. They just-
Dr. Mark Hyman (00:32:06):
That’s like schizophrenia. Right? That’s more like-
Dr. Shebani Sethi-Dalai (00:32:09):
Dr. Mark Hyman (00:32:09):
…. where they have psychotic behavior, which you think of as not really an emotional issue, but really a more structural brain problem, but you’re seeing changes with that.
Dr. Shebani Sethi-Dalai (00:32:20):
Hallucinations specifically. These patients had auditory hallucinations.
Dr. Mark Hyman (00:32:25):
Dr. Shebani Sethi-Dalai (00:32:27):
Yeah. With schizoaffective they also had the mood component with rage, raging behavior, as it’s known. That would be something. It’s very interesting. That requires further study, too. The quality of life significantly improved for these patients, which is really fascinating.
Dr. Mark Hyman (00:32:48):
Yeah. I was digging into some of your research, and you’re looking at doing ketogenic diets for things like schizophrenia and bipolar disease, which to me is fascinating, because we think of those conditions as less treatable than depression. You can do talk therapy for depression, but you can’t really talk your way out of psychosis. How does this approach work for those disorders? Because those seem a little bit more intractable, but you’re seeing real changes.
Dr. Shebani Sethi-Dalai (00:33:16):
Yeah. A ketogenic diet is that higher fat, low carb, moderate protein diet. It shifts the body metabolism to utilize fatty acids. Other words, you’re burning fat and ketones as the primary source of energy, rather than glucose or carbs. They’re well known for being powerful in epilepsy, in diabetes, in obesity, in insulin resistance. Now, newer research is showing some improvements in some of the neurodegenerative conditions, Alzheimer’s disease, some autism. Some of the possible mechanisms include the energy metabolism, reducing inflammation, reducing that oxidative stress. Oxidative stress, I like to think of it as the burden to the cell, the environmental burden to the cell. It’s an intervention that’s worth studying for other psychiatric illnesses. We think the diet does similar things in the brain to what psychiatric medications do, like mood stabilizers. In these patients that I saw through my training, I saw improvements when they went on this particular diet. That’s actually why I got really interested in-
Dr. Mark Hyman (00:34:32):
So, who was prescribing it? We’re they doing it on their own, or was there a psychiatrist who said, “You should try a ketogenic diet”?
Dr. Shebani Sethi-Dalai (00:34:36):
This was a clinic that they came to specifically for weight loss, because they were on psychiatric medications. They had some side effects from that. They had weight gain. They wanted to improve. They already had a baseline poor metabolic state from before the diagnosis of schizophrenia, but they wanted to get improvement with that, so they were placed on a ketogenic diet for treatment of insulin resistance, treatment of obesity, and these side effects from the medication. But what was interesting was that there have been some reports about even gluten sensitivity in schizophrenia. Ketogenic diets are gluten free diets.
Dr. Mark Hyman (00:35:26):
Yes. They are.
Dr. Shebani Sethi-Dalai (00:35:26):
Yeah. That’s another added dimension of it, but I think there are a lot of possible mechanisms that I mentioned. What I am studying right now is I’m enrolling patients in a clinical trial looking at how this ketogenic diet intervention, which is really an antiinflammatory and metabolic intervention, how it affects individuals with bipolar disorder or schizophrenia, where we often prescribe these mood stabilizers or neuroleptics for symptom control. I’m also looking at obesity and metabolic dysfunction in these patients. While the trial is still ongoing, the early results are promising. They’re encouraging. Patients have been really thrilled with their results. There have been patients who have been able to reduce their medication dose. They’ve improved their health overall.
Dr. Mark Hyman (00:36:21):
That’s really striking when you think about it, because there has not been a lot of advances in schizophrenic care since I’ve been a doctor. I mean, there’s better medications, but it’s still the same old antipsychotic medication, which often have a lot of side effects. This is a radically different idea. I think I read once that about 17% of schizophrenics have elevated gluten antibodies and about 20% of autistic kids do. Gluten is something that causes damage to the gut, that causes inflammation in the brain. I think that these are all patterns that connect. You’re connecting dots that haven’t really been connected before in the field of psychiatry, and it’s pretty stunning, because if what you’re saying is true, and I believe it is, because I’ve seen this in my practice over the last 30 years, that the doorway to the brain is really through food and through your metabolic pathways and optimizing those, it often is more effective than medication, and the side effects are all good ones, like weight loss and energy. It’s pretty exciting.
Dr. Mark Hyman (00:37:26):
The other thing you sort of mentioned that I don’t want to skip past is you talked about energy in the brain. You talked about inflammation, and you talked about mitochondria and energy. These are the little energy factory in the brain. It made me think of this researcher from Harvard I think that was in San Diego, Suzanne Goh. I don’t know if you’ve heard of her. She’s a pediatric neurologist who studied autism. She’s done very sophisticated studies in the brain looking at the energy deficits in autistic kids’ brains, which are, by the way, also inflamed. If you have inflammation, it also causes damage to the mitochondria. It’s sort of a vicious cycle. She found by giving these kids mitochondrial support, nutrients, like CoQ10 and carnitine, various compounds that the mitochondria need to function, she was able to help these kids improve their autism. I’m wondering, in some of these metabolic disorders where there are energy deficits in the brain, in psychiatry if that would be a fruitful area for research or if there’s any research on that, looking at using mitochondrial therapies to approach and treat psychiatric issues.
Dr. Shebani Sethi-Dalai (00:38:34):
I think that’s a really great question. I don’t know the research on that. I don’t know whether there’s been a focus on that, but I think that’s a really important question and something I would love to look into further.
Dr. Mark Hyman (00:38:51):
Well, we know that there’s mitochondrial deficits in autism. We know there’s mitochondrial deficits in Alzheimer’s and Parkinson’s. Parkinson’s is a huge area where mitochondrial therapies have been used. ALS, there’s a lot of mitochondrial issues and therapies that are used. It’s something we don’t really learn about in medical school. We don’t learn about mitochondria in the sense of how to treat them. We don’t learn about inflammation in the brain or how to really treat that. We don’t learn about nutrition. All the things that seem to be the most relevant now as science advances are sort of gaps in our training. Now, we sort of have to put the pieces back together to try to sort through what to do. Functional medicine is really a map for helping us figure that out. That’s why I found it so effective, and like I jokingly said and I called myself the accidental psychiatrist, because I was treating people for all these physical issues and their mental problems get better. You know?
Dr. Shebani Sethi-Dalai (00:39:41):
Yeah. It’s really interesting. It’s fascinating. Yeah. I’m not an expert in kind of the nutritional supplements and how that affects mitochondrial function, so I really focus on the metabolic part of treating metabolic dysfunction and how that improves how your brain kind of self-corrects some of that mitochondrial dysfunction.
Dr. Mark Hyman (00:40:11):
Yeah. Well, talk about the ketogenic diet and mitochondria, because it’s really one of the key ways that it works, by improving the function and health of the mitochondria in the brain and also reducing inflammation, which seems kind of paradoxical, because you think, “Oh. I’m eating a high fat diet. That seems very inflammatory and bad,” but it turns out it’s the opposite. Can you explain how that works and the biology of how the ketogenic diet is affecting the brain?
Dr. Shebani Sethi-Dalai (00:40:36):
Yeah. With the mitochondria specifically? Because there are a lot of other mechanisms.
Dr. Mark Hyman (00:40:39):
Well, in every way. All of it. All of it, insulin resistance, the brain, inflammation, oxidative stress, mitochondrial function, all those things that we know now are the underlying biology of brain disorders. How does a ketogenic diet influence those?
Dr. Shebani Sethi-Dalai (00:40:55):
Yeah. I will give an example of in particular the clinical condition, food addiction or binge eating. The ketogenic diet-
Dr. Mark Hyman (00:41:07):
By the way, how prevalent is that? Is this like 10% of the population, 30%, 2%?
Dr. Shebani Sethi-Dalai (00:41:15):
Ultra processed food addiction is about 40/50% in patients with obesity and about 40/50%, similar, to patients with binge eating disorder.
Dr. Mark Hyman (00:41:28):
If you’re overweight, 40% of the people who are overweight or binge eating have this issue.
Dr. Shebani Sethi-Dalai (00:41:34):
Dr. Mark Hyman (00:41:35):
Wow. That’s a lot.
Dr. Shebani Sethi-Dalai (00:41:35):
It is a lot.
Dr. Mark Hyman (00:41:36):
Considering 75% of us are overweight, this is probably the biggest addiction in America.
Dr. Shebani Sethi-Dalai (00:41:42):
This is a big addiction in America. That’s right.
Dr. Mark Hyman (00:41:45):
Dr. Shebani Sethi-Dalai (00:41:45):
Yeah. The ketogenic diet stabilizes blood sugar, as I mentioned, but you avoid these hormonal shifts. We think that’s a big reason, because that affects the dopamine reward system in the brain. What we also know about binge eating disorder in particular and ultra processed food addiction is that the functional connectivity, which is really the amount of connections between your nerve cells, networks, in the frontal lobe, which is responsible for your planning and your executive functioning, even with the reward pathway, the reward processing, these networks are actually a lot less. That functional connectivity in people’s brains are less. We know that from imaging.
Dr. Mark Hyman (00:42:33):
That’s the adult in the room. The adult in the room that is managing your impulses, your basic impulses is not functioning, because of the food you’re eating. You can’t make good executive decisions based on the dysfunction in your brain is what you’re saying.
Dr. Shebani Sethi-Dalai (00:42:48):
What we do know is that the imaging studies show that these folks have less connectivity. I don’t know that anyone’s proved that it’s related to what we’re eating or metabolic functions per se, but that’s something that we hope to learn more about.
Dr. Mark Hyman (00:43:05):
But the grownup’s left the building basically.
Dr. Shebani Sethi-Dalai (00:43:09):
What’s really interesting is that the ketogenic diet increases expression of that Miracle-Gro that you described in your book, that BDNF. Right? That has been linked to decreased food intake. These diets high in sugar and refined carbohydrates have been shown to decrease that BDNF expression and actually make you hungrier. There’s something about ketosis or the ketogenic diet that dampens down that reward signaling and the excitatory activity in the brain, which leads to a rise in the GABA inhibition. Interestingly, in addiction, we use medications that increase that GABA inhibition, so indirectly the ketogenic diet may be doing something similar to what medications are doing in playing a role in altering that neurotransmission.
Dr. Mark Hyman (00:44:04):
Wait. So, let me get this straight. Basically, when you eat a diet full of sugar and processed food, it turns off this Miracle-Gro in your brain called BDNF, or brain derived neurotrophic factor, that makes more connections in your brain and allows your brain to work better and make better decisions. When you cut that out and you eat a ketogenic diet, you actually increase this Miracle-Gro in your brain. You increase the connections, and you get to make better decisions and choices about what you’re eating and your life in general.
Dr. Shebani Sethi-Dalai (00:44:37):
Dr. Mark Hyman (00:44:37):
That’s pretty amazing.
Dr. Shebani Sethi-Dalai (00:44:39):
Yeah. Ashley Gearhardt and I have been collaborating on this particular topic. She developed the Yale Food Addiction Scale. We try to use that in our studies, because we’re trying to look at how many of these people are actually identifying as having this ultra processed food addiction and suffering from the binge eating and the food addiction. Another thing that we know mechanistically with ketogenic diets are that it includes a moderate amount of protein, and that protein has been shown to dampen reward response to processed foods and reduce ghrelin, which is our hunger hormone. That might be another possible mechanism, and so there’s exciting work being done in that area.
Dr. Mark Hyman (00:45:22):
So, you have your good quality protein, lots of fat, and very, very little starch and sugar. You’re talking about like 5% carbohydrates. Right? This is a very, very low carbohydrate diet.
Dr. Shebani Sethi-Dalai (00:45:32):
Right. For a ketogenic diet that I’m talking about would be 5/10%, more like 10.
Dr. Mark Hyman (00:45:40):
Have you seen people with schizophrenia, for example, stop their psychosis and auditory hallucinations by using a ketogenic diet?
Dr. Shebani Sethi-Dalai (00:45:49):
I have seen two patients that that has occurred with. Yes.
Dr. Mark Hyman (00:45:53):
Yeah. This is probably like eureka. Right? This is Nobel Prize kind of stuff. Right? I mean, this is a big discovery.
Dr. Shebani Sethi-Dalai (00:46:01):
It’s really fascinating. I can’t say-
Dr. Mark Hyman (00:46:03):
I can say I knew you when.
Dr. Shebani Sethi-Dalai (00:46:05):
No. There are a lot of other researchers working on this. I’m really interested in helping these patients, because I really just felt, day after day just felt that there was something missing, and we really needed to address this. There’s so much heterogeneity, as I was mentioning, in psychiatric conditions that I do think that there’s something more organic about some of the illnesses. Then I think there’s different phenotypes, different presentations where we diagnose the same condition, but these strategies may help some people more than others. Many, many years ago, thousands of years ago, we still had documentation of these illnesses, psychiatric illnesses, and so we’re-
Dr. Mark Hyman (00:46:59):
Dr. Shebani Sethi-Dalai (00:47:01):
Yes. Before McDonald’s. There’s something happening. Also, I’d like to point out that even psychological stress and major events in your life increase inflammation. Diet is very powerful. Physical movement, lifestyle things are helpful, but I think diet is probably more powerful than some of the other things. I do think that ultra processed food and sugar is really, really messing up our health. I’m pretty worried about this country, because I think that we’re not recognizing it as a society. It’s all around us. We think we’re eating healthy food, and it’s marketed as healthy food, but it’s not. I spend a lot of time reeducating my patients about what to eat.
Dr. Mark Hyman (00:47:51):
It’s true. It seems like our whole definition of mental illness is coming into question. I remember once having a conversation with Thomas Insel, who was the former director of the National Institutes of Mental Health. I said, “What do you think of the DSM IV?” at the time. Now, it’s the DSV V, which is the manual for categorizing psychiatric illnesses. It’s based on grouping people together who share symptoms. If you are sad, and hopeless, and helpless, and you have no interest in life and sex, and this and that, you have depression. If you have this and that, you have schizophrenia. He said, “Well, it’s 100% accurate, but 0% valid,” meaning that it was very good at grouping people into categories according to symptoms, but it didn’t tell you anything about the cause or the mechanism.
Dr. Mark Hyman (00:48:36):
What you’re doing is you’re saying, “Wait a minute. Just because we say you have schizophrenia doesn’t mean we know what’s wrong with you.” Right? Just because we say you have depression doesn’t mean we know what’s wrong with you. It just means that you have these symptoms, and it could be a lot of variables. Right? It could be some psychological stress, but it could be also your diet, or it could be a nutritional deficiency, or it could be your microbiome, or it could be a thyroid problem, or it could be gluten, or it could be whatever. We don’t learn how to think that way in medical school, and yet this is really where medicine is moving at a pretty rapid pace, when you look at systems biology, when you look at the emerging concepts of network medicine. The body’s a network. Everything’s connected by these biological mechanisms.
Dr. Mark Hyman (00:49:13):
The things you talked on the show today, insulin resistance, and inflammation, and mitochondrial energy issues, and oxidative stress, these are the fundamental things that tend to go wrong across almost all diseases that are chronic. They show up differently in different people, but the doorways to fix them may be very similar, through diet and using food as medicine. That’s what you’re doing. As a psychiatrist, you’re using food as medicine in a pretty radical way, which is just so exciting. I think the fact that you’re seeing people with schizophrenia stop hearing voices by giving them a different diet, whether it’s the gluten, or the sugar, or the insulin resistance, or the inflammation, or the up regulation of their mitochondria through the ketogenic diet. All those pathways are active, and you’re actually activating the body’s own healing systems, rather than trying to interrupt some pathway or up regulate some pathway. That’s just what we typically do with drugs. Right? They’re much more we call it pleomorphic in the sense they have multiple effects when you look at the effects of lifestyle and diet that are so much more complicated than just a single drug pathway. Right?
Dr. Shebani Sethi-Dalai (00:50:20):
It is a lot more complicated than a single drug pathway. I agree with that. One thing is that the SSRIs are targeting-
Dr. Mark Hyman (00:50:30):
That’s like Prozac.
Dr. Shebani Sethi-Dalai (00:50:32):
… serotonin. Like Prozac. Right. They target the serotonin, and thy increase it in the brain. It’s supposed to rebalance your neurotransmitters. It’s helpful for many people, but exercise also helps with depression symptoms. One of the ways that we think SSRIs may also be helping is through a different action. That’s antiinflammatory action. There are some antiinflammatory component. They measured inflammatory markers with SSRIs, and it decreased. It’s very interesting mechanistically to kind of understand what we are doing and what we’re hitting.
Dr. Mark Hyman (00:51:11):
That’s true. I mean, statins are the same way. It turned out that maybe the effect of statin drugs that lower cholesterol aren’t for lowering cholesterol, maybe because they’re causing a lower level of inflammation. They have a side effect which lowers inflammation. I remember one of the big studies, called the Jupiter Study, they found that if they lowered LDL, but they didn’t lower inflammation, there was no benefit. If they lowered inflammation, then there was benefit. I think the inflammation story is really central to everything that’s happening in chronic disease.
Dr. Mark Hyman (00:51:39):
I think that’s why with COVID-19 we’re seeing such a problem in our society, particularly in America, because we are among … There’s a few countries, like Mexico may be worse, but we’re among the worst in terms of our metabolic health. You wrote about it in your article, like 12% of us, down from 19% of us, are metabolically healthy. That means 88% are not metabolically healthy and are experiencing some degree of this level of inflammation and even mood and cognitive issues. I think what advice would you give people who are listening who are at home still struggling with the shelter at home, still struggling with trying to figure out how to get through this, and feeling depressed, and filling their shopping carts with Hawaiian Punch and Pop-Tarts? What should people be doing to protect themselves, both physically and mentally?
Dr. Shebani Sethi-Dalai (00:52:27):
I would say to any American listening, whether they have a preexisting, chronic medical condition or not, the single most effective intervention that they can take today, besides not smoking obviously, especially now, is to not overload their body with that excess sugar and the highly refined carbohydrates. It causes a lot of damage to the body. We really should be encouraging improvements to health and immunity in every way possible. We should look to other ways to increase our dopamine, for example, and improve our immunity. Sleep is really important. Physical movement. We may not necessarily have the same access to the gyms that we do before, but even if you can just move, that’s going to be helpful. Getting connected to close friends or family and not feeling that loneliness of that isolation. Physical distancing is different than social distancing.
Dr. Mark Hyman (00:53:30):
Yeah. I know that’s true. I think we are I think needing to think about different ways to raise our dopamine. I think that was a really brilliant thing you just said. Dopamine is the pleasure stimulating amino acid in the brain. It’s a neurotransmitter. We look to stimulate it in a lot of different ways. Most of our society uses sugar, and starch, and processed food to stimulate it, but things like love, and connection, and exercise, and sleep, meditation, yoga, all those things, food, the right kind of food. Right? That’s also so interesting to me. When you look at the brain biology of what happens to the pleasure center in the brain when you eat starch, and sugar, and processed foods, your ability to receive pleasure goes down the more you eat it, so you need more and more of it to get the pleasure, which is really the sort of definition of addiction. Right?
Dr. Shebani Sethi-Dalai (00:54:28):
Dr. Mark Hyman (00:54:28):
I drink a glass of wine, I can barely walk up to my room at night, and some people who are alcoholics can drink a bottle or two and they’re fine. I think that’s what’s really going on in our society. If I have a sugar load, I’m like … I feel pretty wired, but it really is a matter of redesigning your biology. What do you see in your patients? How long does it take them to sort of break out of the sort of pattern that they’re in and see the changes? Does it take months? Is it days, weeks?
Dr. Shebani Sethi-Dalai (00:54:58):
It really depends on the individual and what they are coming to me with. There’s a wide variety of different complications and symptoms. Usually, within a couple weeks to a month there’s significant improvement in their health, but there are patients that have a little bit more trouble, because they’ve had past trauma or a significant adverse childhood event that’s still affecting them today. I do think that that takes talk therapy, as you said, or psychotherapy to kind of get them ready to make any changes in what they’re eating, for example. For some people weight can be protective. Weight can be protective for them to feel more secure, because of past trauma.
Dr. Mark Hyman (00:55:47):
That’s real. Those are issues that really have to get sorted through, but the food part is an interesting therapy that goes along with the talk therapy and other modalities to help people deal with these psychological issues. It’s often not used. In my experience, it just accelerates people’s progress. I always sort of joke, if you’re eating junk food or if your thyroid not working, or you’re gluten sensitive and you’re eating gluten, it’s a lot harder to talk through your issues until you get your brain working properly.
Dr. Shebani Sethi-Dalai (00:56:25):
Yeah. That’s exactly right.
Dr. Mark Hyman (00:56:26):
What do you think about things like ADD and nutrition? I think you have a number of papers on your site looking at, for example, artificial colors, and additives, and omega-3s, and stuff, but just in terms of general nutritional quality and ADD, are you seeing this sort of epidemic of ADD and autism connected to our diet?
Dr. Shebani Sethi-Dalai (00:56:46):
I do think it’s connected to our diet. Like I mentioned before, these conditions are heterogeneous. I think that the number of cases of autism over the last 20 years has doubled, even maybe tripled. Both autism and ADHD is just rising. I don’t think that we’re giving … we’re not feeding our brains the right fuel. That does affect attention. That does affect memory. That makes our brain cells more lazy or tired, not working properly. Those are conditions that require behavioral changes with autism, and improvements in memory and concentration is really important, so I think what you’re eating is so important for that.
Dr. Mark Hyman (00:57:42):
Yeah. Now, I know you said you mentioned you read my book, The Ultramind Solution. I don’t know if you saw the case of this little boy who had ADD and his handwriting before and after he got treated-
Dr. Shebani Sethi-Dalai (00:57:52):
Dr. Mark Hyman (00:57:54):
That was really what got me to write the book was when his mother brought in his handwriting before and after, two months later, after he started changing his diet and fixing his nutritional deficiencies. His handwriting went from completely illegible to really perfect penmanship. My thought was, well, how did his brain go from being totally chaotic, and asynchronous, and uncoordinated to being coherent, and functional? I thought, wow, this is incredible, if that is really true. People can talk about their behavior and their mood, it’s more subjective, but when you see this objective reality of handwriting before and after, and it was like he took penmanship lessons, what’s actually happening in the brain?
Dr. Mark Hyman (00:58:34):
When I went back to look at this kid’s history, it was fascinating, because he had a lot of inflammation. Right? If you look at all these comorbidities that he had, he had asthma, and allergies, and eczema, and hives, and plus he has irritable bowel, and he had all these sort of physical issues that were inflammatory, but they were coming from his inflammatory diet. The kid never had a real food in his life. He never even probably saw a vegetable in his life. He had high levels of trans fats in his blood. He had no omega-3s. He had very low levels of B6. He had low levels of zinc and magnesium.
Dr. Mark Hyman (00:59:10):
It was really pretty striking. When we just cleaned up his diet and we got him on some basic supplements, just a multi, and fish oil, and vitamin D, literally his brain completely changed within just two months. He became functional, and his ADD went away, and all his asthma went away, and his gut issues went away. It’s a few years later now, and he graduated in astrophysics from University of Colorado or something. This kid got kicked out of kindergarten, was on Ritalin for years, and yet this is not something that most psychiatrists even think about doing with their patients, which is so frustrating to me, because as a family doctor and someone who does functional medicine, this just seems so self-evident. Your work is just such an example of how things are really changing. Do you find that your colleagues are like, “What are you doing, Shebani?” Are they like, “This is interesting”? Are they giving you a hard time?
Dr. Shebani Sethi-Dalai (01:00:08):
No. I completely believe that story you told me. I could believe that a patient with ADHD has significant improvement after what you treated him with. My colleagues have been pretty supportive actually, and very interested to learn more, and very open to making that change. In fact, just last week, one of the … We have different clinics based on sub-specialties, like neuropsychiatric clinic, or mood disorder clinic, or depression clinic. The depression clinic, and the bipolar clinic, and these women’s wellness clinics, they all reached out to me and want to collaborate. One of the attendings told me last week that 40% of his patients have metabolic issues and talking about weight gain. Most likely, I think a lot of people have nutritional deficiencies. We already know the general population has a lot of nutritional deficiencies, so if we look at the population in mental health, we’re going to see even more. I do think that this is something that’s going to change. I’m optimistic. I think you can tell.
Dr. Mark Hyman (01:01:20):
Yeah. Well, you’re changing it. You’re clearly at the forefront. Are you a lone wolf out there, or are there other people out there in the psychiatric world who are on your same path?
Dr. Shebani Sethi-Dalai (01:01:29):
I think there are other people out there on the same path. I think that metabolic dysfunction per se is not necessarily looked at as much compared to nutrient deficiencies or specific vitamins and supplements, for example, but I do think that a combination. These are all important topics and all important things to work on.
Dr. Mark Hyman (01:01:54):
Last question. Looking forward 5/10 years, how does the field of psychiatry change? How would you like to see it change in how we treat mental illness based on what you’re learning in your research?
Dr. Shebani Sethi-Dalai (01:02:06):
I would like to see it change actually across the board, even in medicine, to focus on nutrition and metabolism. I think over time we need to really include that as part of the assessment in the initial history that we take. We have to have a careful intake history about nutrition and what people are eating for breakfast, lunch, dinner, snacks, their drinks, how they’re sleeping, how they’re looking at food. I think that should change. I also think that the treatment of insulin resistance and detecting insulin resistance, because I often find that it’s not being detected. I’m not necessarily the doctor that sees them as frequently, and so that’s something that I feel needs to change within our whole system.
Dr. Shebani Sethi-Dalai (01:03:04):
We need to think about, aside from just looking at blood sugar every now and then and the thyroid, we also need to look at their fasting insulin level. What is their consumption? What is that early process? The things that make us sick later start early. It’s this gradual process towards decline. What if we intervened earlier, detected things earlier, asked about things earlier, so that we can prevent what happens later? We know what happens later. Right? I think that should change.
Dr. Mark Hyman (01:03:46):
That’s just a radical idea. Right? That doctors should ask their patients what they eat. That’s the future of medicine. No one can come and see me in my practice unless they fill out a three day diet record. Then, on top of that, you can’t get an appointment unless you also agree to see the nutritionist, because if food is medicine, I can’t practice without a nutritionist. The other thing you said that was really important is that the most common disease in America, insulin resistance, the most common problem that affects hundreds of millions of Americans, is not diagnosed 90% of the time by their doctor. That’s a shocking stat.
Dr. Shebani Sethi-Dalai (01:04:25):
I think we’re missing a lot of it, unfortunately. I think we’re missing a lot of it, and I think we don’t necessarily know how prevalent it is as a medical society perhaps, as a whole. We don’t necessarily know how common it is, and it’s really common. Every time I mention that statistic, people are shocked. Yeah. With kids now, too. It used to be that the majority of liver transplants in this country were done because of alcohol cirrhosis, and now the majority are being done because of fatty liver caused by fructose and high consumption of sugar.
Dr. Mark Hyman (01:05:06):
Even in young adults, which is terrifying. I was at the Obesity Conference, and there was this guy there who was a pediatric gastroenterologist. I’m like, “What are you doing here?” He said, “Well, we see a lot of fatty liver in kids, five year olds.” I’m like, “Really?” That’s what we used to see in old people with diabetes. Right?
Dr. Shebani Sethi-Dalai (01:05:27):
That’s very sad.
Dr. Mark Hyman (01:05:29):
Make sure you do your three day diet record. The other thing is ask your doctor for a fasting insulin. This is something I’ve been measuring for 30 years, and I almost never see it done by most physicians. It’s probably the most important test, because your fasting insulin goes up way before your blood sugar. That’s something you can easily detect by checking your blood test. It’s an easy blood test. I’ll tell you, if your insulin is over five, you’re heading towards trouble. If it’s over 10, it’s not great. If it’s way more than 10, you’re in trouble. That’s an easy thing to measure, and it’s something that will tell you where you’re going, and it affects your mental health.
Dr. Mark Hyman (01:06:05):
I would say to people who are listening, if you have mental health issues or you know someone with mental health issues, you should really think carefully about the role of food and nutrition and how that plays a role in what’s going on. Experiment, because there’s really very little harm to cutting our processed food and sugar. In fact, there’s only benefits. Even trying something more aggressive, like a ketogenic diet, often with the help of a physician or someone who knows what they’re doing, can be helpful, but these are simple things that have low risk, high benefit, and they’re actually being validated in the research.
Dr. Mark Hyman (01:06:38):
Your work is just so exciting to me, Shebani. I think this is really the future of psychiatry and mental health in this country. I hope that you can become a bigger voice than you already are, because I think the world needs to hear this. I think our government needs to pay attention to this in terms of our policy of funding research in this area. If I can help you get millions of dollars from the NIH, I’m going to do what I can.
Dr. Shebani Sethi-Dalai (01:07:01):
That would help. I do need some research funding.
Dr. Mark Hyman (01:07:04):
All right. If anybody’s listening, you can find her-
Dr. Shebani Sethi-Dalai (01:07:06):
Dr. Mark Hyman (01:07:06):
Dr. Shebani Sethi-Dalai (01:07:10):
I did want to just say, add a comment to what you were saying, is that because people are listening, I want to make clear that it’s not just people with obesity that have insulin resistance, but people who are even just normal weight can have this insulin resistance. It’s really important to think about that as you decide whether you want that assessment, because you may not even know that you may be insulin resistant, and you may not know that you have a high blood sugar. You think you’re eating healthy, but there are a lot of foods out there that you think are healthy that are not and have a lot of added sugar in these things.
Dr. Mark Hyman (01:07:48):
Well, that’s a really important point, because there’s a lot of people walking around saying, “Well, I eat a lot of sugar, but I’m skinny, so it doesn’t matter. It doesn’t affect me.” Well, it does. In fact, about 20 to 40% of skinny people are metabolically unhealthy, meaning they’re what we call skinny fat or metabolically obese normal weight. You look thin on the outside, but you’re fat on the inside. You’re maybe not overweight, but you’re over fat, and especially around your belly fat, which is what the dangerous fat, as that drives all the insulin resistance. It’s important to really have a real look at this for yourself. I think I’m so encouraged by this conversation. I can’t even tell you. I’ve been waiting for you for 30 years to talk to you. Now, you’re doing this incredible work at Stanford. It makes me so happy.
Dr. Shebani Sethi-Dalai (01:08:30):
That’s very sweet. Another just comment is that with excess weight and that visceral fat that you were getting at leaks inflammatory molecules and causes damage in the body as well. How much of that is contributing towards mental health and mental health symptoms is also an important question. I just wanted to mention that, because sometimes that fat is not fat you can actually see. It’s fat that’s built around the organs and around the arteries and things like that.
Dr. Mark Hyman (01:09:06):
Yeah. I just want to honor you for your work. I want you to keep at it. I want you to convince all your colleagues, and I want nutritional psychiatry and metabolic psychiatry to be actually the first thing that psychiatrists think of when they’re treating patients. Then medications are useful, but it shouldn’t be the first thing that we think of I think in this situation, because it’s clear that this is such a powerful intervention, when other things often don’t even work.
Dr. Shebani Sethi-Dalai (01:09:28):
That’s great. Mark, you’ve had these ideas long, long before, and you’ve been treating all these patients. It’s so wonderful. It’s really a fresh of breath air to meet someone who has these ideas and have them independently.
Dr. Mark Hyman (01:09:45):
Yeah. Well, you should come learn about functional medicine. I think you would love it. It’s exactly what you’re doing, even though you don’t know you’re doing it.
Dr. Shebani Sethi-Dalai (01:09:50):
Yeah. Great. Great.
Dr. Mark Hyman (01:09:54):
Thank you so much for being on the Doctor’s Farmacy. I hope you loved this conversation. If you’re listening to it and you liked it, please share with your friends and family. Leave a comment. We’d love to hear from you. Subscribe wherever you get your podcasts. We’ll see you next time on the Doctor’s Farmacy. If you’re interested in Dr. Shebani’s work, check out her website, metabolicpsychiatry.com. You can find her on the Stanford website as well. Just type in metabolic psychiatry. She’ll pop up all over the place on Google. I’m excited to have had you on the podcast. Thanks for joining us.
Dr. Shebani Sethi-Dalai (01:10:23):
Thank you for a great conversation and for inviting me to your podcast.