Dr. Chris Palmer, Harvard Psychiatrist, Researcher, and Author

Summary

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The Walker Webcast

Episode: Dr. Chris Palmer, Harvard Psychiatrist, Researcher, and Author

Host: Willy Walker

Date: June 4, 2026

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Overview

In this enlightening episode, Willy Walker welcomes Dr. Chris Palmer, a Harvard psychiatrist renowned for his research at the intersection of metabolism and mental health. The conversation dives into Dr. Palmer’s pioneering hypothesis that mental disorders—especially severe cases like schizophrenia and bipolar disorder—are fundamentally metabolic disorders affecting the brain. Palmer recounts his personal connection to the field, breakthroughs using the ketogenic diet in psychiatry, and the implications for both treatment and public health. The episode is filled with personal stories, scientific insights, and hopeful avenues for mental health care, especially for severely affected and underserved populations.

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Key Discussion Points & Insights

1. Dr. Palmer’s Personal Motivations and Story

• Early Life Experience:

  • Palmer’s mother suffered a severe psychiatric breakdown when he was 12, leading to family trauma, homelessness, and a personal sense of betrayal by the mental health field (03:52).
  • His experience fueled both his frustration and determination to improve psychiatric care.
  • Quote:

    "I ended up hating the mental health field. I hated every psychiatrist that had seen her. I hated all the psychotherapists. They all seemed like aloof snobs to me and they were incompetent." — Dr. Chris Palmer (07:20)

• Entry Into Psychiatry:

  • Initially set on medicine or pediatrics, Palmer had an internal drive toward psychiatry despite his criticisms of the field (08:59).
  • Quote:

    "Maybe I can make a difference. Maybe...I'm kind of defiant. Sometimes people tell me not to do something, that I'm going to even embolden myself and go do it." — Dr. Chris Palmer (09:33)

2. Academic and Clinical Career Arc

• Combined Roles:
  • Palmer wears many hats: clinician, researcher, and educator at Harvard and McLean Hospital (11:40).
  • He emphasizes how this interplay improves his effectiveness in each area.

3. The Breakthrough: Ketogenic Diet in Psychiatry

• Initial Success:

  • In 2016, Palmer used the ketogenic diet (KD) for a severely obese, schizoaffective patient seeking weight loss. Unexpectedly, the patient's psychotic symptoms began to remit (13:35).
  • Quote:

    "Within two weeks, I start noticing this dramatic antidepressant effect...his schizophrenia is, like, completely going away. What the hell is this?" — Dr. Chris Palmer (15:48)

• Replication and Research:

  • Similar remarkable results were observed in other patients, compelling Palmer to undertake deeper scientific analysis and publish his findings (17:57).

• The Science Behind KD:

  • The ketogenic diet induces ketosis (fat burning and ketone production), changes neurotransmission, reduces inflammation, regulates insulin, affects the microbiome, and—central to Palmer’s thesis—improves mitochondrial function (22:11).
  • KD is a well-established treatment for epilepsy, which provided historical precedent for its neurological effects (19:58).

4. Mechanisms & Metabolic View of Mental Illness

• Metabolic/ Mitochondrial Model:

  • Palmer posits that impairment in brain metabolism (especially mitochondrial function) underlies many psychiatric illnesses.
  • Treatments (like antipsychotics) may work by suppressing metabolic activity—not just by affecting neurotransmitters (29:57).
  • Quote:

    "They are also potentially primary effects on brain metabolism and that may actually be how they exert their antipsychotic effect." — Dr. Chris Palmer (30:39)

• Fasting and Exercise:

  • Fasting, like KD, creates ketosis, but is not sustainable for long-term psychiatric treatment.
  • Exercise is beneficial for mitochondrial health and can be a stand-alone intervention for milder conditions, but is insufficient for severe illness (25:13).

5. Evidence & Real-World Outcomes

• Case Stories:

  • Highlighted Doris, who recovered from 53 years of schizophrenia after starting the KD—a miraculous case but not always the norm (27:56-34:03).
  • Other patients have gone public with their remission stories, sharing hope for those with treatment-resistant mental illness.

• Weight Gain & Medication:

  • Severe psychiatric medications often cause metabolic side effects (weight gain, diabetes risk).
  • These effects further reinforce the connection between metabolic and mental health (29:57).

• GLP-1 and New Drugs:

  • Drugs like Ozempic (GLP-1 agonists) originally developed for diabetes/weight loss, are now being tested for psychiatric and cognitive disorders, reflecting the convergence of metabolic and mental health research (34:36).

6. Insulin Resistance as a Predictor

• Key Study:
  • A study of 5,000 young people revealed those with high insulin resistance at age 9 were 5x more likely to develop psychosis-at-risk states and 3x more likely to be diagnosed with schizophrenia or bipolar by 24 (37:25).
  • Environmental factors (poor diet, stress, sedentary behavior, poor sleep) are major drivers—highlighting preventability (39:55).
  • Quote:

    "When you look around the world today, it's not necessarily baffling why we have an epidemic of obesity and diabetes and increasingly of mental illness...that's not a genetic problem, that's an environment problem." — Dr. Chris Palmer (39:55)

7. Policy, Access, and Social Implications

• Challenges in Implementation:

  • Insurance rarely covers nutritional counseling for mental illness; dietary interventions are hard to access, especially for disadvantaged populations (50:15).
  • Motivation is often blunted by psychiatric symptoms—support is essential to adherence.

• Homelessness and Mental Illness:

  • Palmer shares efforts to bring the keto intervention to underserved populations, including proposals for shelters and public health systems (55:39).
  • Quote:

    "If we can help them conquer their illness, maybe we can help them become, you know, tax paying, independent citizens living their best lives." — Dr. Chris Palmer (58:18)

8. Public and Scientific Reaction

• Mainstream Attention:

  • Mention of his research by Secretary Kennedy brought both skepticism and big media attention (NYT, USA Today, etc.), ultimately validating his credentials and work (44:45).
  • Numerous controlled trials are now underway or completed with strong early results, including major research funding and clinical trials (47:00).

• Drug Industry's Reaction:

  • Surprisingly little pushback—some companies even interested, seeing potential in diet as an adjunct or for mitigating side effects (48:39).

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Notable Quotes & Timestamps

• "I ended up hating the mental health field. I hated every psychiatrist that had seen her. I hated all the psychotherapists..." — Dr. Chris Palmer (07:20)
• "Maybe I can make a difference." — Dr. Chris Palmer (09:33)
• "Within two weeks...his schizophrenia is, like, completely going away. What the hell is this?" — Dr. Chris Palmer (15:48)
• "They are also potentially primary effects on brain metabolism..." — Dr. Chris Palmer (30:39)
• "When you look around the world today, it's not necessarily baffling why we have an epidemic of obesity and diabetes and increasingly of mental illness...that's not a genetic problem, that's an environment problem." — Dr. Chris Palmer (39:55)
• "If we can help them conquer their illness, maybe we can help them become, you know, tax paying, independent citizens living their best lives." — Dr. Chris Palmer (58:18)

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Important Timestamps

• 03:52 – Palmer’s childhood trauma and motivation for entering psychiatry
• 11:40 – His multi-faceted academic and clinical career
• 13:35 – The first breakthrough case using KD for psychosis
• 17:57 – Replication and how the psychiatric field responded
• 22:11 – What the ketogenic diet is and how it acts in the brain
• 25:13 – The roles of exercise and fasting vs. KD
• 27:56 – Rapid and robust responders to KD, e.g., Doris’s case
• 29:57 – Psychiatric drug side effects and deeper metabolic mechanisms
• 34:36 – The psychiatric promise of weight-loss/diabetes drugs
• 37:25 – Insulin resistance’s strong predictive value for later psychosis
• 44:45 – Media scrutiny, Secretary Kennedy reference, and expanding research interest
• 47:00 – Ongoing trials and burgeoning field support
• 48:39 – Pharmaceutical industry response
• 50:15 – Barriers to access: policy, cost, discipline, motivation
• 55:39 – Implementing KD in shelters and possibilities for the homeless
• 58:18 – Vision of hope: treating root causes, restoring independence

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Tone & Language

Throughout the episode, Dr. Palmer speaks with urgency, candor, and hope. His language is both scientific and deeply personal—reflecting on both the limitations and possibilities of modern psychiatry. Willy Walker engages with empathy and curiosity, driving the conversation toward practical, systemic, and human-level solutions.

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Conclusion

This episode of The Walker Webcast offers a riveting journey from personal tragedy to scientific triumph. Dr. Chris Palmer’s transformative approach, rooted in metabolic and mitochondrial health, is opening new pathways for understanding and treating mental illness. The implications for clinical practice, research, and public health policy are profound—and the stories of patient recovery are a source of genuine hope.

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For more:

Check out Dr. Palmer’s book Brain Energy and watch for upcoming clinical studies on metabolic psychiatry.

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Transcript

[A]

Walker and Dunlop brings you insights for

[B]

life,

[A]

Unique perspectives from impactful leaders. This is the walker webcast with willie walker. Good afternoon and welcome to another Walker webcast. It's my great pleasure to have Dr. Chris Palmer join me today to talk about the brain, mental health and some of his extremely cutting edge research on why. We may be looking at the issue of mental health not necessarily through the wrong prism, but but looking for solutions to it in the wrong place. But we'll dive into that. Dr. Palmer, let me do a quick background on you and then we'll dive into our discussion. Dr. Chris Palmer is a Harvard psychiatrist and researcher working at the interface of metabolism and mental health. He is the founder and director of the Metabolic and Mental health program at McLean Hospital. An assistant professor of psychological psychiatry at Harvard Medical School. For 30 years he has held administrative, educational, research and clinical roles in psychiatry. He has been pioneering the use of the medical ketogenic diet in the treatment of psychiatric disorders. In his book Brain Energy, Dr. Palmer proposes that mental disorders can be understood as metabolic disorders affecting the brain. Dr. Palmer got his BS from Purdue, his MD from Wash University and and did his residency at Harvard Medical School. He has successfully treated patients with severe treatment resistant mental illness using metabolic interventions including ketogenic diets. So Dr. Palmer, I fell off my bike. I had a bike accident a month ago and I have been suffering from pretty bad headaches afterwards and have taken all sorts of different supplements and tried to slow down and close my eyes and recover and fortunately the headaches have subsided quite a bit and I feel a lot better today than I did a month ago. I will say in the month it's been very interesting to me to watch my recovery scores that I get from my whoop which have shown that even though I was eating well, not drinking, doing the same amount of exercise and sleeping the same, I was still getting recovery scores that were in the red which was showing me that my body was still trying to deal with the concussion even though I didn't sort of have a broken arm to sort of say, oh yeah, I've got to let it sit for six weeks before it's ready to be used again. And that piece of it was fantastic. But after doing my research on you, I sort of said, gosh, if I knew Dr. Palmer, I would have just gone on the keto diet and I would have started to feel better immediately. Given all the research you've done as it relates to mental health, I want to start with this. Mental health has been in your family and is one of the main reasons you went into this field of study. Can we back up a little bit to your childhood and your own experience with it and what then got you to focus on this as you went to Purdue and then went to med school at Washu? Because I think that your own personal story gives great insight into why you have been such a breakthrough and cutting edge researcher in the area of mental health.

[B]

Sure, yeah. Cut me off if I get too long with. It's a long, long story. So I grew up in Indiana, large Catholic family. We had eight kids. My parents, my father was a pharmacist, started a pharmacy. For the most part, you know, we were living a relatively straightforward, simple middle class life and my mom had no significant psychiatric problems or issues. And then around the time that I was 12, there were a series of family events. Pretty dramatic, almost like a soap opera kind of thing. Nothing that my mother did, but people in our family did that caused overwhelming amounts of stress on her and burden on her. And she ended up having what she called initially a nervous breakdown. And it started out with what today would probably just be diagnosed as severe depression. Quickly included suicidal thinking, and then very shortly thereafter began including delusions where she believed that she was Mary Magdalene reincarnated, the world was ending. A priest that she was going to for counseling was Jesus Christ, who's come back. It's the, it's the next, you know, coming. Armageddon's coming, the world is ending, Jesus has come back. And in that process, she was clearly diagnosed with a mental illness. She got a lot of help. She was hospitalized against her will. She was put on medication, she took the medication, she was going to psychotherapy. She was doing everything she was asked to do. And the mental health field failed to help her. Fast forward. She never really got better. She lived a very different life. For the second part of her life, it led to my parents getting divorced. Through the divorce, she lost everything. She lost custody of all eight kids. She lost almost all of the money and finances and ownership of the business and everything. And. And then at one point I went to live with her as a 12 year old boy. And we started out in a rooming house, ran out of money pretty quickly, ended up living in hotels until the credit card maxed out. And then we were homeless and, and living out of the van, living in a Catholic homeless where I went to my first day of high school from a homeless shelter. And I could go on and on with that story. But again, the bottom line is she never got better. And I think that in particular I ended up having my own mental health struggles as you might imagine. 12 year old being homeless with a psychotic mother, losing my seven siblings, like that wasn't fun for me. And, but you know, I think at the end of the day I, I ended up hating the mental health field. I hated every psychiatrist that had seen her. I hated all the psychotherapists. They all seemed like aloof snobs to me and they were incompetent. It was clear that they were incompetent. They weren't helping her, they weren't doing anything useful. And you know, I think, I think so. It started with, you know, just my frustration, anger, infuriation at this mental health field that could not help my mother, recognizing how much it devastated her life, how it devastated our entire family. And why aren't these doctors able to do more? And, and then, so I ended up going on again. I had my own kind of tragic history with mental health conditions, suicidality, chronic depression, all sorts of things. Somehow I find my way into college, do really well in college, dust myself off, get into medical school. School, do great in medical school, like getting awards for being one of the top students in medical school and end up finding my way into psychiatry, wanting to change this field.

[A]

So where was that when you went to medical school? Was the thought that you would focus on psychiatry or was there another field that you were sort of headed there thinking you were going to do it and then you kind of took a, took a hard left turn?

[B]

Yeah. By the time I went into medical school, I was very convinced I wanted nothing to do with psychiatry. I hated it, hated the field, just saw the whole field as incompetent. So I was actually thinking about medicine, pediatrics, those were the big things. I, because I had done really well in medical school, I had different professors mentoring me, kind of coaching me. What are you going to do, Chris Palmer? What are you going to do? You're one of our top students. What field are you going to go into? How are we going to use this talent? And I remember talking to one of them about psychiatry. Like I did my psychiatry rotation and I was in equally disillusioned and frustrated at what we were doing to the patients in the clinic. And I, I was horrified at what we were doing to the patients in the clinic, like they weren't getting better. And I remember talking to one of the professors. I, I just, I, I kind of said like, oh, I'll probably do medicine or pediatrics, but I don't know, there's something about psychiatry. And he, he Kind of quickly corrected me and said, no way. Don't go into psychiatry. It's a bunch of quackery. They don't do anything useful. And at that point, I don't know, something in my head clicked, like, is that why the field of psychiatry is so awful? Is that none of the smart doctors go into psychiatry and it's just filled with all of the people at the bottom of the class. Maybe, maybe I can make a difference. Maybe, like, I'm kind of defiant. Sometimes people tell me not to do something, that I'm gonna even emboldened myself and go do it. But, you know, realistically, I was. I mean, that's where my passion was. Even though it was coupled with a lot of frustration. I was passionate about these people with mental illness. They haven't done anything wrong. They don't deserve these lives that they're living. They deserve to get better. And this field is completely incompetent. Why can't they do something? Why aren't they doing better? And. And so I went in kind of with that kind of goal and ambition is just maybe somehow or another I might be able to make a difference.

[A]

And always with the thought of being a. Using it from a research standpoint to try and improve the field, or potentially from a clinical standpoint of actually becoming a clinical psychologist.

[B]

So I've. I've actually kind of had the privilege of doing everything in academic medicine. So I've been at McLean and Harvard for over 30 years now. And I have always had a clinical practice. I worked on inpatient units, I worked in emergency rooms, I worked in nursing homes. I've always been involved in research since residency in one way or another. And then I'm also an educator. I'm the director of the Department of Postgraduate and Continuing Education. I educate other mental health professionals. So it's actually been a phenomenal kind of mix for my career. Not everybody gets so lucky to be able to carve that out and have a lot of variety. But it's been amazing. And interestingly, all three aspects of that inform each the other aspects of that. I don't think I would be as good of an educator if I wasn't also a clinician. I don't think I would be as good of a clinician if I wasn't also a researcher. And I'm not. I think all of those fields really inform the others very well.

[A]

And what was the breakthrough point, if you will, as it relates to looking at these issues through sort of a different lens, focusing on the mitochondria Thinking that there was something other than just, if you will, drugs that can help treat things such as schizophrenia and bipolar and other mental illnesses, that you have had such eye popping sort of success and responses in the clinical trials to treating what is a very innovative and kind of breakthrough way of both focusing on it and then treating it.

[B]

You know, I think essentially I spent the first, you know, really 15 years of my career using medication, psychotherapy, hospitalizations, electroconvulsive therapy, all sorts of treatments. And no doubt for some of the patients that I was treating, they were benefiting dramatically. They were getting wildly better with medications or psychotherapy or other things. So by no means am I here to bash the standard existing treatments, but when it comes to psychotic disorders like my mother had and like so many of my patients had, the outcomes were usually abysmal. Even when patients were getting the best of the best care at one of the top ranked psychiatric hospitals in the world. And they weren't just getting care from me, they were getting consultations from leading psychiatrists in and out of hospitals, residential programs, everything. And we were giving them medications and all sorts of other things. And they were still crazy, if you will, like, they were still delusional, they were still having hallucinations, they were severely impaired, they often gained tremendous amounts of weight, they hated the medications, they complained about fatigue, they complained about being a zombie, they complained that it dulled their cognition. And we just encouraged them to stay on those medicines anyway. So that was my baseline. And then in 2016, a patient that I had had for eight years, like that schizoaffective disorder, he had tried 17 different medications. None of them stopped his symptoms. They made up gain a massive amount of weight. He weighs 340 pounds and he asks for my help to lose weight. And for a variety of reasons, we decided to try the ketogenic diet. And at that point I really, I had been using ketogenic diets as a treatment for depression and some other thing conditions prior to that. But I had no hope or expectation that it would do anything for this man's symptoms because he had schizophrenia essentially. And I kind of saw that as almost like a permanent brain condition. It's likelihood of recovery and remission is almost nil. And he's going to be this way until the day he dies. And that's just the way it is. And there's something severely wrong with his brain and we don't know what it is. And it's just, you know, the poor guy. So he asked for my help to lose weight. I Put him on a ketogenic diet. Within two weeks, I start noticing this dramatic antidepressant effect. He's making eye contact, he's talking a lot more, he's smiling more than I've ever seen in the eight years I've been treating him. And then the thing that really just changed the trajectory of my career is that about two months in, he spontaneously starts reporting that his hallucinations are going away, his longstanding paranoid delusions are going away, and he's recognizing that maybe those things aren't true and maybe never were true, and that he's been ill all along and that his illness is getting better. And initially, I was kind of in disbelief. I really was. I kind of questioned my own sanity. And. And I. You know, fortunately, he was very. His father was very much involved in his daily care. He lived with his father. I had another Harvard psychologist doing psychotherapy with him. And I had to go to both of them and say, are you guys seeing what I'm seeing? Because I'm kind of having trouble believing this. It seems like his schizophrenia is, like, completely going away. What the hell is this? And they're like, no, we're seeing it, too. You're the doctor. You figure it out. Like, we don't know what this is, but it's happening. We're here to tell you it's really happening, and you figure this out. And so that really sent me on a journey. I ended up trying it with another patient similar, and she, too, had equally impressive results. Like her hallucinations and delusions were just

[A]

evaporating as quickly as it happened in patient one.

[B]

Yeah. Within it. Within a couple months. Yes. And I was. I really was just dumbfounded. But I recognized at that point, I can't sit on this. I can't ignore it like I. I have. For me, it almost felt like an ethical obligation, like, I have to report this to the world. And initially, I was a little daunted by that because I'm like, well, first of all, nobody's even going to believe me. They're all going to laugh at me. I might lose my job. They're going to probably going to fire me. Like, Chris Palmer, what kind of a quack are you? A diet treating schizophrenia. That sounds crazy.

[A]

So I know you've been on the keto diet. Were you on. Had you done it yourself at that point, or you just prescribed it and then later did it?

[B]

No, I had done it myself long before. So when I was. When I was still in my residency. So really, almost 20 years prior to this occurrence, I had, I had done it and had noticed significant antidepressant effects from it for me. And, and that's, that's what clued me in to start using it as a treatment for depression. But I assumed it's like a treatment for depression and anxiety, not for schizophrenia. And so, and when I was even using it as a treatment for depression and anxiety, again, I was just so reluctant and hesitant to tell the world about what I was doing because I, I really did think I might lose my license, I might get fired. Like the world's not ready to hear this. And. But over the ensuing 20 years, we got more and more clinical evidence of its safety and effectiveness. And, and through that process, so when I see it work for psychosis, I really then did a deep dive into the science. And unbeknownst to me at the time, I had not realized that the ketogenic Diet is a 100-year-old evidence based treatment for epilepsy.

[A]

Right?

[B]

It can stop seizures even when medications don't work. And that was the first really powerful clue to me because I recognized, wait, we use epilepsy treatments like medications, epilepsy medications all the time in tens of millions of people with mental illness. So wait, if this diet can actually stop seizures, maybe there's something really there. And then I did a deep dive into the science of the ketogenic diet. Like, how the hell does a diet stop seizures? And when I. And the more I learned about that, then I'm asking, does this have anything to do with a mental illness like schizophrenia? And I dive into that literature and I realize it has everything to do with schizophrenia. Wow. Who knew? Like, the dots are really connecting. Like these puzzle pieces are really coming together beautifully. Who knew? And so that really launched the next phase of my career. So by doing extensive scientific kind of research analyses, I was able to put together a lot of existing science to make a really compelling case for why people should take this seriously, why the academic community should take this seriously. And to my pleasant surprise, they did. I actually never really got significant pushback from the academic community. I put the science together, presented it in research papers, and most of the editors and reviewers immediately saw the logic and the clarity of why we should consider this. And this field has really, in the last 10 years, has absolutely exploded.

[A]

So if you will talk for a moment about first, what is the ketogenic diet? So what are you eating? What are you not eating? And then walk that through of what it does to your metabolism into your physiology. And that has the impact on the brain that you have now both not only researched, but are watching in clinical trials that actually do it. It's what it, what it's doing.

[B]

So the ketogenic diet for most people who don't know is it's low in, very low in carbohydrates, moderate in protein, and high in fat. The, the ratios can be different for different people. So if, if it's somebody who is really overweight or obese, usually all they have to do is restrict their carbohydrates and they will be in therapeutic ketosis. And by ketosis, I just mean burning fat and turning fat into ketones, which can be an energy source for lots of cells and organs and tissues, including the brain. And so you know, exactly. How the ketogenic diet impacts the brain is actually extraordinarily well studied and researched, shockingly to most people. And why is that? It's because it's a 100-year-old evidence based treatment for epilepsy. And so neuroscientists, neurologists, biotech companies have been studying this diet and its impact on the brain for really decades, trying to understand how in the hell does this diet stop seizures. And they've usually been looking for new medication targets and other things. They're hoping to develop new treatments based on this. And so some of the mechanisms of action that we know are that the ketogenic diet can change neurotransmitter activity, it can reduce brain inflammation, it can change, improve insulin signaling or reduce insulin resistance. It can change the gut microbiome in beneficial ways that impact the brain. Central to my overarching thesis is that it improves mitochondrial function. It stimulates a process in the body called autophagy, in which old or defective cells or cell parts kind of get recycled and then the body makes new ones. And part of that process involves mitochondria. So defective mitochondria get recycled and new mitochondria get made. And I actually think based on a tremendous amount of kind of human biology, physiology, there's strong reason to believe that that may be a central mechanism that's really important that connects this dietary intervention with things like severe mental illness.

[A]

So two things. On, if you will, on, on, on both sides of that, do you get the same impact from, from the diet that you would get from fasting? And then you talked about the mitochondria. Does exercise do the, if you will transition to the mitochondria, that could act as either a supplement or a replacement for the diet.

[B]

Both really good questions. The I'll Answer the second question because I'm forgetting this first one. Second question.

[A]

Can exercise fasting, fasting versus being on the diet, fasting?

[B]

Yes, sorry. So, yes, absolutely. Fasting actually does produce ketosis. The huge difference, huge difference is that you can only fast for so long and then you starve to death and then that's bad. And, and that's actually why the ketogenic diet was initially developed a hundred years ago by a neurologist, is that they knew that fasting could stop seizures. But usually when people started eating again, the seizures would come right back. And so the ketogenic diet is a, is a fasting mimicking diet. So in other words, it mimics the fasting state, but you can definitely get some of the benefits from simply doing fasting. And you can absolutely incorporate intermittent fast fasting or even multi day fasts into the therapeutic kind of ketogenic diet. At the end of the day, especially for patients with something like schizophrenia, it's a longer term treatment. It's going to be at least a couple of years on the diet. You can't just do it for a few days or a month and be cured of your schizophrenia. And so it's going to be a treatment for at least a few years. And so we need to come up with a strategy to produce a state of ketosis and still provide appropriate calories, nutrients, protein, other things to help person remain healthy. Your second question about exercise, can exercise be good for mitochondrial health? Yes, 100%. No doubt about it. Could exercise replace the ketogenic diet for some people with some conditions? Absolutely. So for somebody who is mildly overweight, or has the beginning of insulin resistance, or pre diabetes, or has mild depression, or even moderate depression, maybe has brain fog. Exercise for some of them can be monotherapy, meaning that's all they need to do. If they just add vigorous exercise to their routine, that may be enough to correct their condition. I think for people with schizophrenia and bipolar disorder, their illnesses are much, much more severe. And we have strong, strong reason to believe exercise is helpful. So it can improve overall health, it can slightly reduce some of the symptoms, but by no means is it at all a competitor to ketogenic therapy for the central kind of like hallucinations and delusions and other symptoms.

[A]

You mentioned that with schizophrenia you need to be on the diet for quite some time to start to see the improvement. But in the book you talk about a woman named Doris who seemed to have had, she'd been diagnosed as schizophrenic for I believe 53 years. And in a matter of like two weeks started to see significant improvement. So is she a, Is she a complete outlier or do you see that type of. Sounds like you don't see that type of responsiveness usually.

[B]

I actually don't. I think she was a unique hyper responder and was lucky that she responded so quickly, not necessarily so robustly.

[A]

Is there anything in her physiology that would make it so it. That it would impact her quicker? Was she. I mean, you mentioned previously one of your. Well, the first patient that you worked on this was. Was wildly obese. And so you would think that it took some while for his physiology to get into the shape where it could start to work there. Was she, from a physiological standpoint, more susceptible to the keto diet?

[B]

Well, honestly, she too was obese. She. She was very obese. And that's actually why she started the diet was at a weight loss clinic at Duke University where they happened to be using the ketogenic diet as a treatment.

[A]

And just one quick thing on that, Chris. A lot of these drugs that are prescribed to deal with schizophrenia and bipolar actually end up making it so that you do gain a tremendous amount of weight because they're, they're. They're basically trying to slow your metabolism down. Is that in layman's terms? Not give it to me in the real terms, but from my read on it, that is typically a byproduct of the medicine that is prescribed that ends up having that derivative effect to those people taking it.

[B]

Yeah, I mean, tragically, the medications have significant side effects, and the, the side effects fall largely into two categories. Metabolic. So massive weight gain for some people. For some it's just mild weight gain, but weight gain is very, very common. But type 2 diabetes, increased risk for cardiovascular disease, meaning your lipids are getting worse, your cholesterol is getting worse, your blood pressure is going up, like all sorts of bad things are happening. So those are the metabolic side effects. And they also, antipsychotics in particular, often also include neurological side effects, including tremors, tics, Parkinson's symptoms and other things. And some of those can actually become permanent, that even if the patients try to get off the medicines, those neurological side effects can be permanent. Now, most psychiatrists in our field believe that those are just side effects. And, and I actually would make the argument that yes, they are side effects, but they are also potentially primary effects on brain metabolism and that that may actually be how they exert their antipsychotic effect, that when they do work for psychosis, and they really do work for psychosis, for some patients that it is probably through inhibition of brain metabolism. And yes, it involves dopamine and neurotransmitters and other things. But then one needs to ask, well, what happens when you block dopamine receptors? What happens when you alter neurotransmitters in these ways and you almost always are led to changes in brain metabolism? So yeah, I think that. Back to your question. I think Doris was a rapid responder and, and her story was absolutely true. And you know, for just in case we don't share the end story of hers like it was. She had suffered from schizophrenia for 53 years. She ended up being in remission from schizophrenia within six months of starting the diet. She was able to get off of all of her medications, including all of her antipsychotic medications, and she remained well and healthy for another 15 years. So she was 70 years old when she started the diet. She passed away at age 85. So it's not that the ketogenic diet stopped working. We had a COVID pandemic. She got Covid. She ended up dying of COVID pneumonia. And she did successfully lose about 150 pounds and kept it off until the time of her death. But much, much, much more importantly, 150 pounds weight loss, that's great. But much more importantly, she put her schizophrenia into remission. She didn't have schizophrenia anymore or at least the symptoms of it. She wasn't having hallucinations or delusions anymore. She was able to function independently in the world. She stayed out of the hospital. She stayed off psychiatric medications. I mean, I want to be clear, not everybody gets that kind of a response and like dramatic, almost miraculous response. Not everybody does. I wish they did, but many others do and I am seeing them. And some of them are actively sharing their stories. One of them went on the Today show with me. Some of them are going to on npr. So these people are passionate about sharing their story because their stories are hopeful, hope filled. They're telling people don't give up. If the field of psychiatry tells you there's nothing more that they can do, don't give up. Don't accept that as your final answer. Look into these metabolic treatment strategies. Look into ketogenic therapy because it could be a life changing, life saving intervention.

[A]

Just sticking on the, on on the weight issue for a moment, Chris, if

[B]

you

[A]

has the development, the advent of Ozempic and other weight loss drugs been a big help to the psychiatry field in the sense that previously you prescribe it, one of the side effects would be significant. Weight loss. Are doctors like yourself prescribing both simultaneously so you don't have the weight loss side effect which then allows for better general health and fitness?

[B]

It's a great question and an important one. So, yes, there is increasing interest and research on using GLP1s like Wegaby, Ozempic and others to prevent the massive weight gain. Unfortunately, most insurance companies won't cover that right now because they say you have to gain the massive amounts of weight first and then we'll cover it. But interestingly, like those weight loss medicines, I mean, those weight loss medicines are a great testament to my overarching hypothesis that metabolic health and mental health go together. And so those weight loss medicines were actually initially developed as type 2 diabetes medicines. They're actually diabetes medicines that we're now using massively for weight loss. And there are now clinical trials of those medicines for the treatment of Alzheimer's disease, bipolar disorders, schizophrenia, depression, alcoholism, opioid addiction, cocaine addiction, all of these mental illnesses. And the trials are not just, can we mitigate the side effects of the medications. The trials are, do these medicines actually reduce these symptoms of these severe brain conditions? Like, do these medicines stop the cognitive decline of Alzheimer's disease or slow it? Can these medicines prevent Alzheimer's disease in people who are at high risk for it? Those are the trials right now. And so that whole field speaks very strongly to this intersection between what we call metabolism and mental health.

[A]

You mentioned a moment ago insulin resistance, and I heard you talking on a previous discussion about a clinical trial of 5,000 kids between 0 and 24, and what you saw when heightened insulin resistance appeared in the kids by age 9. Talk about that for a moment. Because I, I think that, that a lot of people, My understanding is when someone gets diagnosed with schizophrenia or bipolar, typically it happens by the time they get into their 20s. But the diagnosis age is average, is somewhere in there. You've kind of gotten through adolescence and you're into your 20s, when all of a sudden it's like this person has some significant issues. And their diagnosis, schizophrenia or bipolar. But you're winding the clock back to sort of an early indicator in this study as it relates to insulin resistance. Talk about that for a moment.

[B]

Yeah. So the researchers followed kids, like you said, from the. From essentially birth to age 24. And they found that the kids with the highest levels of insulin resistance beginning at age nine were five times, that's 500% more likely to develop a psychosis at risk mental state. And they were three times more likely to already be diagnosed with bipolar disorder or schizophrenia by the time they turn 24. And that is a really important study because those kids weren't diagnosed with mental illness at age 9. So something was happening in their physiology that was causing insulin resistance. The way that I think about it is the same things that were causing the insulin resistance were also changing the these kids brains that put them at much higher risk for developing schizophrenia and bipolar disorder. And I just want to point out, like a lot of times people talk about genetics and you know, genetics are a risk and yes, genetics are a risk. There are almost no genes, very, very few, like really tiny handful, and they are extraordinarily rare genes that confer more risk for schizophrenia than a five fold increased risk. And so this insulin resistance, which is largely thought to be driven by environment. So what do I mean by environment? Lots of things can drive it. Food, ultra processed food, junk food, a lot of sugar, sedentary behavior, high levels of stress and trauma. All of those poor sleep because you're on a screen all night. All of those things can contribute to insulin resistance. When you look around the world today, it's not necessarily baffling why we have an epidemic of obesity and diabetes and increasingly of mental illness, the mental illnesses, bipolar disorder. In the last 20 years, the rates of severe bipolar disorder in youth and children and young adults has doubled. Doubled. And like that's not a genetic problem, that's an environment problem.

[A]

And when you say insulin resistance, you just mentioned five or six things that play into it. But if I'm a parent of a nine year old, is it, is it, what's, what's my marker in the sense of I'm not taking my, my kid's not in the study and I need to be observant of, are they sleeping enough, are they eating healthy food, are they getting too much screen time? Does all this come out of, generally speaking, just body mass? And is that where, I mean, can you look at it and say from a body mass index standpoint, if a child is over X, you can look at it and say that they have a high imbalance as it relates to insulin. Or is it, is, is it, is it, is it more detailed than that?

[B]

So the real answer, the scientific answer is it is more detailed than that because you can be thin and still have insulin resistance. So we can't, it's not a 100% screening tool or 100% accurate screening tool. However, with that said, the overwhelming majority of children and adolescents who are overweight or obese do have insulin resistance. And most thin Otherwise healthy kids who have enough energy to run around and play sports and do other things and do not have overt signs or symptoms of mental illness. Most of those kids do not have significant insulin resistance. Again, there can be some outliers and exceptions to the rule, but that is the rule of thumb. And again, tragically, when you look at the data, the rates of childhood obesity are skyrocketing, skyrocketing exponentially. And I just want to say, like, ask the question, like, what does that mean for the future of our country? What does that mean for the future of the world? That these people are not only going to be metabolically unhealthy, but more and more of them are going to be mentally unhealthy. And when you are both metabolically and mentally unhealthy, some people can hold a job and pay taxes and do everything they need to, but some of them can't. And like, what does that, what does this mean for our society? We're allowing this chronic disease epidemic that we're allowing so many people to become so profoundly ill.

[A]

I'm assuming that the School of Public Health at Harvard is wildly interested in what you're studying in your research.

[B]

They, they are, along with, I mean, lots, lots of other people. I actually, yeah, I, I, I hear from people from the federal government, the state government, advocacy organizations, nonprofit organizations. Like, I think there's a tremendous amount of interest in this topic. And you know, in case, in case it sounds like maybe like new or cutting edge to anybody, I just want to like, reassure you. We have decades and decades of evidence to support what we're talking about. We've long known that physical health and mental health have bidirectional relationships, meaning if you have poor physical health, you're more likely to have poor mental health, and if you have poor mental health, you're more likely to have poor physical health. So we've, even though we put them into different categories and we have different types of professionals treating them, and insurance companies sometimes kind of gives different levels of benefit for mental versus physical health, the reality is they are inseparable. And that's really what this research is trying to do. It's trying to integrate it really in a scientific, rigorous way. How exactly are they related? And more importantly, based on that information, what can we do? What can we do to help people restore their health and restore their lives?

[A]

You mentioned that it's gotten a lot of attention. The Secretary Kennedy mentioned your research a couple weeks ago. Has that been good? Because it's put a lot of eyes on you and therefore sort of promulgated the research and made it so that lots of people are coming and saying, let me fund your research. Isn't this great? Or has it been the other side of the coin, which has been a lot of naysayers sort of saying, what's going on? This isn't the end all, be all of mental health.

[B]

You know, it's. It's interesting because after Secretary Kennedy made those remarks, the New York Times ran a piece within 24 hours, essentially bashing him and bashing all of this. This is nonsense. How dare somebody suggest that a diet can treat schizophrenia? And they referenced me in that article. They said they had reached out to me. They reached out to an obscure email that I don't really check. And so. So that gave me then the opportunity to reach out to them and say, hello, would you like to interview me? I'd be happy to speak on this. And I ended up in the New York Times not once, but four times over the ensuing two weeks and lots of other press. So I think, you know, when he made those comments and when. When people make comments that aren't fully nuanced, which happens every day in our media, like mainstream media, social media. Nuance. Nobody's got time for nuance. Nobody's got. Nobody's got time for the details and the caveats and the exceptions to the rule. They. They want sound bites. And so he delivered a sound bite, and people reacted very passionately against it. But the reality is it opened many doors for me that probably would have never ever been opened before to the New York Times, to the USA Today, to new scientists, to lots of leading mainstream media outlets. And I think that after they had their initial reaction, they initially kind of sought out, is there any credibility to anything he just said? And then they found me in my work and they're like, wait, this guy's legit. He's a Harvard psychiatrist. He. Wait, he has published on this in leading psychiatric journals. Wait, this. What. What the hell's going on? So I think that opened doors for them to then be curious and interested and, you know, to share, just to share with people. You know, I shared some anecdotes or some case reports with people, but at this point, we now have over 25 controlled trials recently completed or underway of ketogenic diet as a treatment for severe mental illness. Two randomized controlled trials of the ketogenic diet as a treatment for schizophrenia just wrapped up. Those publications are going to be coming out in the next six months, and I'm a consultant on One of them. And I'm very excited and eager to see those results released because they are very positive. Like they are just overwhelmingly positive and even to me in a shocking, heartwarming, surprising way. And. But we have randomized controlled trials of ketogenic diet for the treatment of depression just published in JAMA Psychiatry, one of the leading psychiatric journals in the world. Systematic reviews and meta analyses. The Wellcome Trust in the UK just funded a $10 million study of the ketogenic diet as treatment for bipolar disorder. It'll be the largest dietary intervention ever studied for bipolar disorder. So this field is exploding and I think among clinicians and scientists there is wild excitement and enthusiasm because this represents a completely novel new way to think about treating severe mental illness when all else has failed.

[A]

And so the drug companies, Any pushback from the drug companies as they see this coming as a potential threat to their revenue streams?

[B]

Not, not yet, honestly, surprisingly, I've. Some of the drug companies, I think, have almost embraced it as a way to mitigate the side effects of their medications. And for the. But for the most part, you know, I was, I won't name names, but I was actually invited by a pharmaceutical company to give a presentation to their internal team on this, all of this research. And so they're very interested in it and I was very supportive of them. Like, there is a tremendous amount of science and physiology here and they can develop new drugs and new targets for treatment and we can develop better treatments. And I'm all for that because adhering to a ketogenic diet is not easy and some patients just can't do it despite our best efforts to get them to do it. And so we.

[A]

Is that just from a discipline standpoint, Dr. Palmer, or is that a cost standpoint? Is it a access standpoint? I mean, as you sit there, and I mean, first of all is, if you think about fast food in America, one of the big issues here is that to go to Whole Foods and buy a well balanced meal, it's very, very expensive. To go to McDonald's and buy a Happy Meal for $3.50, maybe it's gone up a little bit from that. Is a cheap. You get a lot of, you know, you get a lot of bang for your buck, if you will, but it's also the wrong bang for your buck. Is it discipline of sticking with it? Is it cost or is it access or is it a combination of all three?

[B]

I think it's all three. So unfortunately, right now, insurance companies, including Medicare and Medicaid will not pay for people with mental illness to see a dietitian. The only real indications to see a dietitian are. It's not even obesity. Believe it or not, if you have Medicare and you are obese, it will not pay for you to see a dietitian. It will pay for your GLP1 receptor. Yeah, it'll pay a thousand or more a month for that, but it won't pay for a dietitian. The, the, the two primary indications to see a dietitian are diabetes and renal disease. So if you have diabetes or renal disease then you can get insurance to cover it, but otherwise good luck.

[A]

And a lot of those nine year old kids, sorry, a lot of those nine year old kids with insulin resistance are going to end up getting type 2 diabetes, correct?

[B]

Yes, yeah, but, but, yeah, but, but insurance won't cover the dietitian to prevent.

[A]

Right, Won't, won't cover it. At 10 years old, they'll prevent anything.

[B]

They'll pay for it once it sets in. And then it's often very much, much more challenging to address it because the illness is now festered for 20 years and it's become quite severe. So that's part of it. And so it's hard for patients and patients with severe mental illness or even just mild mental illness, just mild depression. Part of mild depression is just being brain fogged. Low motivation, low energy levels, losing your drive, losing your passion, losing kind of your purpose. And so feeling like, well, why would I do, why would I try to improve my health? That's hard. I don't have the energy, motivation. So even mild mental illness can impair people's ability. I want to be the first to say that with adequate support, a lot of patients can do it. I can't say all of them can do it, but a lot of them can. But they do need help. They do need encouragement and motivation and education and coaching and like, and they're not perfect. They're not perfect and that's okay. Like they'll fall off the wagon a month or two in and that's okay. We pick them right up, dust them off and get them back on the wagon. And, and that's how you do this treatment. And, but a lot of people don't have access to that kind of mental health care, those kind of services. And they are impaired in motivation and discipline and other things. And so it's challenging. We are working, you know, I and many others are working tirelessly to change that, to try to get insurance companies to reimburse for these services, to try to get more clinicians on board to offer these services. Because again, in 2026, for a lot of patients with schizophrenia, bipolar disorder, chronic depression, and other severe mental illnesses, the alternative is to live the rest of your life severely ill and impaired and disabled and miserable and suffering. That is the alternative. That's what we, the mental health field, are telling millions of people. Sorry to. Sorry, we don't know what we're doing. Sorry we can't offer better. This is all we have to offer. So although what I just said may sound like a monumental uphill battle to get that kind of wraparound service and, you know, work on people's motivation and energy and discipline, yes, it's a lot of work. Let me be the first to say it is worth every penny. It is worth every ounce of effort, because these are people's lives, and they deserve a better life. They deserve to not suffer. They deserve to, like, be able to go out and get a job and live an independent life. And the great news is I'm seeing patients right and left who are actually doing precisely that. They were diagnosed with bipolar disorder, untreatable treatment, resistant, and they are now working jobs. They have girlfriends and boyfriends and. And they're living their best lives. Like, let's not stand in the way of that.

[A]

Homelessness is a huge issue at Walker Nellock. We invest a lot of money in. All we do on an annual basis at W and D is invest in nonprofits that work on the issue of homelessness. And we sponsor three of them and try and get people off the street, try and get people back into the mainstream economy and establish their lives. And one of the key issues that all programs trying to help with homelessness face is in many instances, the people who are on the street suffer from mental illness. Have you seen or done anything as it relates to trying to put the keto diet into homeless shelters or interim or longer term housing to see the benefits of kind of a control group that would be in that type of an environment.

[B]

So I am working on it. I put together a proposal to try to work with underserved mental health clinics providing patients with free food, free ketogenic food through a medically tailored meals program. We have one of the largest medically tailored meals programs in the United States here in Boston called Community servings. So there are lots of opportunities. So right now, Community servings actually has never really worked with people with mental illness, and they've never offered a ketogenic diet. So this would be new territory for them. But I'm working on It I anecdotally, I know of a few people who have been homeless with schizophrenia. One person in the uk, homeless, schizophrenic, living in a tent. She, he worked with a clinician in a shelter to figure out how to do a ketogenic diet. Cans of tuna, we're talking, that's what he's eating. And you know, and some type of oil, olive oil, something else to get some fats in. And he experienced remission of his longstanding hallucinations and delusions. And we talked about that, that like he's in a tent now there. I do not want to take away from his grit, his strength, his perseverance. He is a remarkable human being. Not everybody else who's homeless can do what he did. But if he can do it, maybe others can too. And God forbid, what if we offered them more support? What if we offered them free food? What if we offered them housing that included ketogenic meals? Like, what have we offered them? A dietitian and a psychiatrist to boot. Like, imagine what might happen. And so I'm actually really excited because I think in those types of cases, if you can help somebody get better with, you know, if you give them, if we, you know, some people push back against this, they're like, oh, you know, that's socialism. You're going to take care of these people forever. And I'm like, no, we don't need to take care of them forever. How about we take care of them long enough to get them back on their feet, to get their brains working properly so that they can then become self sufficient, so that they can go out and get jobs and be tax paying citizens so that they can contribute to society. Because I can tell you, as a psychiatrist working with patients for 30 years, the overwhelming majority of patients that I work with, like almost across the board, all of them, they desperately want to be independent. They desperately want to be able to look themselves in the mirror and respect themselves. They want to be contributing citizens. And more often than not, it's their illness that prevents them from doing it. And so if we can help them conquer their illness, maybe we can help them become, you know, tax paying, independent citizens living their best lives.

[A]

It's such a hopeful way to end our conversation. I find it. I'm in Los Angeles today at one of our offices and I went to have a coffee with a client and we had a, there was no table at the coffee shop. So the two of us went out for a walk right near the UCLA campus. And we didn't go a block without coming across numerous homeless people. And I looked it up and there's 71,000 homeless people in LA county right now. And that fits SOFI Stadium. So that massive, huge bowl that is filled on Sundays with lots of football fans and people who go to concerts, that's the homeless population in LA county right now. And I just sit there and there's all this talk about we need to do this, we need to do that. And I just wonder if we could get your diet implemented, how many of those people wouldn't need to be on the medication or get to the medications that many people say are either too expensive, change their physiology, et cetera, et cetera. So I want to pick this up with you because you and I might want to try and fund some side project here with one of the nonprofits that WND underwrites every single year. But the Dr. Chris Palmer, your book is fantastic. Your research is cutting edge. And yes, I get your point about saying that this has been out there for decades, if not centuries. And at the same time, it's the research you're doing and the outcomes that you are bringing to life that is making a difference. And so to that, I'm just super appreciative of all you do. And thank you for joining me for this hour on the Walker webcast.

[B]

Willie, thank you so much for inviting me and for an amazing conversation. And I'm I really just want to appreciate and applaud all of your efforts to help people with mental illness and homelessness. And just like, that's truly incredible. Thank you.

[A]

Well, thank you very much. Thanks everyone, for joining us today. Appreciate it. And we'll be back next week with another Walker webcast. Thanks, Sa.