Traditional biological psychiatry often focuses on downstream neurotransmitters rather than fixing root causes. In this episode, host Zach Gurick sits down with Dr. Matthew Bernstein to explore how brain insulin resistance impacts mental health and cognitive function. They examine why the brain consumes twenty percent of your body’s energy and what happens when brain cells can’t process glucose effectively. Dr. Matthew Bernstein explains how therapeutic ketogenic diets provide an alternate fuel source that rescues starving neurons while triggering cellular repair. You’ll also learn about essential blood tests you can request at your next checkup to catch metabolic issues early. Tune in to discover practical nutrition and lifestyle protocols that protect long-term brain health.

The information presented in Fully Alive is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before making changes to your health regimen. Guests’ opinions are their own and do not necessarily reflect those of the podcast host, production team, or sponsors.

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Reversing Brain Insulin Resistance With Dr. Matthew Bernstein

This show is dedicated to helping you unlock the secrets to living a healthier, happier, and longer life. For decades, we’ve been told that mental illnesses like depression, bipolar disorder, schizophrenia, and even Alzheimer’s disease are primarily caused by chemical imbalances in the brain. What if we’ve been looking at the problem through the wrong lens? What if many of these conditions are rooted in something much more fundamental? A breakdown in the brain’s ability to produce and use energy.

Our guest is helping lead one of the most exciting shifts happening in medicine. I’m joined today by Dr. Matt Bernstein. He is a psychiatrist with more than 25 years of clinical experience. He’s one of the leading voices in the rapidly growing field of metabolic psychiatry. After years of practicing traditional psychiatry, personal experiences within his own family led him to question many of the assumptions he’d been taught about mental illness.

That journey has taken him to the forefront of research, exploring how nutrition, metabolism, and especially ketones can dramatically influence brain function and mental health. Dr. Bernstein is the CEO of Accord, which is an innovative residential treatment program that combines cutting edge metabolic therapies with compassionate psychiatric care. He’s helping redefine how we think about treating and perhaps even preventing mental illness.

In this conversation, we’ll dive into why the brain is one of the most energy hungry organs in the body, what happens when it can no longer efficiently use glucose, and why ketones may offer far more than just an alternative fuel source. We explored a fascinating science behind metabolic psychiatry, the growing evidence linking metabolic dysfunction to mental illness, and what all of this could mean not only for people struggling with psychiatric conditions, but for anyone who wants to preserve cognitive function and optimize brain health as they age.

Whether you’re interested in longevity, preventing cognitive decline, supporting a loved one with mental illness, or simply understanding how to keep your brain functioning at its best. You’re going to find this conversation both eye-opening and incredibly hopeful. Let’s dive in. Please enjoy my conversation with Dr. Matt Bernstein.

 

  

Dr. Bernstein, thank you so much for being with us. You have a fascinating path and journey and I feel like a unique expertise. I’m excited to learn from you myself and excited for our audience to have the opportunity to learn from you.

Thanks for having me. I’m excited to have the conversation.

One of our themes that we seem to cover a lot on this show is that many chronic diseases that we’ve accepted as inevitable have a deeper root cause. You’ve spent many years now asking that same question about mental illness and brain health. Would you say that we’ve been looking at things like depression, bipolar disorder, schizophrenia, even anxiety from the wrong end of the telescope maybe?

Moving Beyond Downstream Psychiatric Drugs

There’s some truth to that. We’re looking at something in biological psychiatry that is downstream from the real fundamental root causes. We tend to look at neurotransmitters, which are important, but they may not be where all of the problems start. That’s what we’re generally doing with psychiatric medications. We’re prescribing drugs that change the levels of neurotransmitters. They have some benefits, clearly, but not everyone benefits.

There’s a lot of people who are considered treatment-resistant to medications. In some studies, 50% of people are treatment-resistant. Sometimes even higher than that. Even when people do well, there’s a lot of side effects. That’s the hallmark of a treatment that’s not getting at the root cause. If you’re downstream from the root cause, you’re going to have benefits, but also a lot of side effects. That’s what we see with almost all psychiatric medications. I do think that trying to get further closer to root causes will improve what psychiatrists can do. I’m seeing that in a big way in the work that I’m doing.

I’d love to dive into a little bit of your story to understand, and maybe if you’re willing to share with our readers, too. What led you down the path to where you are now? As you said, most psychiatrists are prescribing medications. You took this very different path after a while. What was it that made you begin questioning the things you’d learned previously?

I want to clarify. I still prescribe medication. I’m not against medications. Many people are benefiting from them and many people will choose to use medication instead of the other approaches that I’m going to talk about. That’s fine. People should be able to choose. I’m advocating that people should have another choice essentially besides medication. I was a traditionally trained psychiatrist. I had done my residency training at Mass General and McLean Hospital, these two Harvard institutions. I worked at McLean in an inpatient unit for a number of years and did other jobs there.

Eventually, I moved to working in an outpatient setting where we’re doing more psychosocial rehabilitation work with people with complex conditions. I saw how that could improve the trajectory for people to intensively get connected into their communities, relationships and jobs in creative ways that our team was able to do. I started learning that sometimes reducing medications would improve people’s functioning, which was a bit of a surprise compared to what I learned in my training.

A big thing happened, which is that I have three boys, and two of them got very sick with something that looked very psychiatric. They had severe depression and OCD. They weren’t able to read and think in the way that they were before. These were happy, well-adjusted boys prior to this. They were aged 12 and 14 at the time. We ended up learning eventually that the psychiatric treatments and medications didn’t help them at all. In fact, it made them worse.

Understanding Autoimmune Encephalitis and Brain Inflammation

There were a number of body-based root causes that were causing their brain to not function well. The term for this is autoimmune encephalitis, essentially where the immune system starts attacking the brain. It’s usually after certain infections or due to toxins. That’s exactly what we found in our boys when we did a large functional medicine, environmental medicine treatment. It took a number of years of intensive work trying to figure all this out.

All the while, I was learning how important all these things going on in the body are for the brain. Things that I did not learn in my training and started to figure out how to apply some of those things in my practice. What I eventually learned is that it turns out that simple things like diet, exercise, mind-body practices, circadian rhythms, and aligning our rhythms with light exposure can be the most powerful ways to improve brain health that exist. I know that’s a big statement, so I’d be happy to follow up and back it up if you’re interested.

I want to unpack a lot of this a little further. It’s fascinating to hear things like depression and OCD could be caused by something that’s not psychiatric. That’s not what we typically hear.

That’s not how we think about these things. We think those are things that are going on in the brain, or maybe those are things going on in the mind, depending on our orientation. The brain, last time we checked, is very much connected to the rest of the body. It’s constantly in communication with the rest of the body. This idea of splitting off the brain from the body is something that we do in medicine. We isolate organ systems.

It is probably doing a disservice to treating these conditions because there’s abundant evidence now that things like inflammation in the brain are very important to the development and progression of these kinds of conditions. Energy issues and mitochondrial issues in the brain are fundamental to these things we call mental illnesses. Those are very much connected to what’s going on in the rest of the body.

I’d love to unpack these a little bit more with you, but before we do, are your sons now both doing okay? Did you have to clear out some toxins or molds? Are they both in a good place and how did you get there?

We got them both to a good place. It took a little longer for one of my sons than the other. He’s doing well now, the one where it took longer. The other one where he got better quicker, he ended up getting a relapse during COVID. Unfortunately, that’s been very challenging for him to have done all that work to get better and to be able to get knocked back down from a virus that he could contract out in the world. It’s been very challenging for him to deal with. I would love to say both are thriving well. One is, and one is still on his journey, I would say.

Energy issues and mitochondrial issues. A lot of this is a metabolic issue that we’re talking about. You’ve asked that provocative question before. Can you unpack that for us and break that down a little bit? What do you mean?

Fueling the Brain’s High Energy Demands

One thing that everyone first needs to understand is that the brain is the most energy hungry organ in the body by far. It weighs about 2% of the weight of the body, but at any one time, it’s using about 20% of the body’s energy. Sometimes more than that. That’s as much energy as it takes to power like a 25-watt light bulb. That’s what people can imagine. At all times, we need that much energy to run our brain. There’s no energy storage in the brain as well. This is also very important.

We can understand that if you think about the brain runs on the energy of glucose, but if we get hypoglycemic, meaning our blood glucose goes low. We start feeling brain effects immediately because the brain will run out of glucose and can’t power the functions that it normally needs to do. We’ll start feeling like we can’t think. We’re lightheaded. All these things that are brain derived symptoms before the rest of the body would have symptoms. There’s energy storage in the muscles and the liver and all of that.

Most psychiatric drugs target downstream neurotransmitters instead of fixing root causes. Here’s why that matters for brain health.

The rest of the body can run on fatty acids, but the brain can’t. The brain is functioning on glucose most of the time, especially the way that we’re eating in our culture. If the brain runs out of energy, as it will, when certain conditions happen. There’s mitochondrial dysfunction or there’s insulin resistance in the brain. That’s true of all mental illnesses. We know they’re all associated with mitochondrial dysfunction, insulin resistance, which we’ll get into a little more. The brain runs out of energy. These neurons don’t have enough energy to perform their vital functions. Especially in areas that cause psychiatric symptoms like the hypothalamus, the hippocampus and the amygdala.

Those regions of the brain can get very insulin resistant. Therefore, even if there’s glucose around, they can run out of energy very easily and all kinds of problems ensue from there. When there’s not enough energy, we get more oxidative stress and inflammation. Essentially, those neurons are not functioning. They’re not doing what they should be doing, which is making a signal with neurotransmitters to send a signal to the next neuron.

I’ve learned before that there’s just three different types of fuel that our brain can use or that are available to pass through the blood-brain barrier. Is it glucose, lactic acid, and ketones?

That’s right. It’s not that common. We’re going to build lactic acid up if we do a lot of anaerobic exercise, which is good for our brain. If we do anaerobic exercise, make a bunch of lactic acid, that’s a very positive signal in our brain but it’s not common. It’s not something that’s happening most of the time. Most of the time, especially for people eating a regular diet, anything close to a regular diet, it’s 99% running on glucose, our brain.

Does our brain prefer glucose over ketones or lactic acid or does it matter?

We always have to be a little careful when we attribute things like preference. These are human terms to a cell or a neuron.

I’m personifying a brain.

What we do know is that there are these areas in the brain that I was referencing before that are important for cognition, mood, anxiety and fear that require an insulin signal to get glucose into those cells. They use a certain glucose transporter called a GLUT4 transporter that needs an insulin signal to get glucose from outside the cell to inside the cell. If those cells become insulin resistant, they can’t get that insulin signal, those cells start to run out of energy very quickly.

Unlocking Ketones as Alternative Brain Fuel

We also know that if there are ketones around, those cells can take up those ketones and use them as fuel. Those ketones bypass that insulin resistance and they rescue those neurons from starvation, essentially. That’s the mechanism that we think is very important for why ketogenic diets are so good for brain health conditions. There’s lots of evidence in many different brain conditions where ketogenic diets are helpful.

I definitely want to talk about insulin resistance and ketogenic diets. All those things, but this is so important. I work at show points. We have a lot of senior demographic here and the biggest fear for everyone and myself included. The biggest fear is losing your cognitive ability. It’s okay if I have some other issues as I age, but if I lose that, then that’s the number one fear. Everyone reading, myself included, are interested in this topic, like how do we keep our brains healthy throughout our lifetimes?

Testing Fasting Insulin for Early Detection

There’s a number of ways to do that and I’m sure other guests have talked about it as well. We know the protective effects of things like exercise, for example, and getting good quality sleep. Maintaining good cardiovascular health but what I’m here to say is that one of the other important elements is keeping an eye on insulin resistance. It’s hard to measure brain insulin resistance. We can’t do that in a clinic very easily, but we can measure a proxy for that, which is insulin resistance in the blood.

It’s a very inexpensive test that people can ask their doctors to run. It does not get run on standard annual physical exams. Although, it should because it’s inexpensive and it gives us some powerful information. That’s what’s called a fasting insulin level. There’s a slightly fancier version of that test called a HOMA-IR, which is a calculation with a fasting insulin and a glucose. The fasting insulin is good enough. It’s usually less than $50.

Insurance should cover it. Basically, what this tells us is that even if the fasting blood glucose looks good, if the hemoglobin A1C, which is the measure of three months’ worth of fasting glucoses or three months’ worth of glucose numbers looks good. Sometimes people can still have an elevated insulin level. An elevated insulin level is the first sign of insulin resistance developing in the body. Sometimes, it can develop 10 or 15 years before anything starts to look wrong on the hemoglobin A1C. It’s getting much closer to finding out a root cause rather than waiting for 10 or 15 years for a hemoglobin A1C to start drifting towards prediabetes.

That’s the fasting insulin resistance test.

Fasting insulin test is what we call it.

You’re suggesting that we should be getting that once a year at our annual check.

Yes. In addition, we need to be stricter than the lab tells us to be in their reference ranges. They’ll say it’s okay to have a fasting insulin of up to 12 or 15, but that’s not okay. The way labs make reference ranges is they’re just comparing it to a thousand people that came into that lab compared to the general population. The general population is extremely insulin resistant. We think that there’s about 12% of people with type 2 diabetes. We think there’s probably about another 35% of adults that have prediabetes. Some of them don’t even know that they do.

Another maybe 30% that have significant insulin resistance that haven’t developed prediabetes or diabetes yet. Most of the adult population is insulin resistant at this point because of the way we’ve been told to eat over the years and because of our sedentary lifestyles. It’s very hard not to develop insulin resistance in America these days if you live long enough. When I say long enough, even people in their twenties are developing insulin resistance or even in their teens. Especially even if you’re eating a very healthy diet and exercising, people in their 40s think they’re very healthy, but they’re insulin resistant.

Can you break that down for us? Why does that happen as a result of our diet and sedentary lifestyle?

Your brain consumes 20 percent of your body’s total energy with zero storage. When fuel drops, cognitive function stalls.

The basic idea is that when we eat certain foods, especially carbohydrates. Even more so as simple carbohydrates, but any carbohydrates, cause us to need to make insulin to bring that glucose that’s streaming into the blood from the gut into and get it out of the bloodstream. Our body is very interested in keeping glucose in a very tight range. Whenever glucose starts to rise above, let’s say 110 or 120 after a meal, our body needs to make insulin to bring that glucose into cells. That’s one of the main functions of insulin.

If we’re eating high carbohydrate meals three times a day, plus high carbohydrate snacks 2 or 3 times a day, our insulin is high all the time. That’s not the way things are meant to be. We never evolved, let’s say eating six times a day. When we evolved, we were lucky to eat 1 or 2 times a day and sometimes not eat for days on end in our evolutionary history. Our system is designed for that. It’s not designed to deal with carbohydrates all day long.

When we’re eating carbohydrates all day long, insulin is high all day long. Eventually the cells, when they’re seeing high insulin levels, don’t respond to it anymore. I use the analogy of like the boy who cried wolf. Eventually, the townspeople don’t come to the boy who keeps crying wolf. The cell doesn’t respond to that same amount of insulin. Our pancreas needs to make more insulin because we still need to bring that blood glucose down. The higher levels of insulin will bring the glucose down, but now the cells are used to a high level of insulin.

Eventually, they need even a higher level of insulin and that’s why we’re testing a fasting insulin level because that’s a sign that our pancreas keeps needing to make these higher amounts of insulin. It’s not going down again. That leads to prediabetes and diabetes. The precursor to that, the underlying problem is insulin resistance. We’re talking about insulin resistance in the blood. Again, we should talk about the brain but this is the fundamental problem where it starts. It’s in our diet, sedentary lifestyle, and leading to that insulin resistance in the body.

This is important for everybody reading, get this test. The fasting insulin test or the HOMA-IR test for less than $50. Probably covered by insurance. Find out what it is. You said that oftentimes it’ll say, we’re within normal ranges if it’s like 12 to 15. What’s a good number?

With a fasting insulin, I like to see it below five.

What’s the normal range?

It’s different with different labs, but sometimes they’ll call 12 or 15 normal, but that’s not okay. We want to see it below five. That’s a sign that you don’t have insulin resistance in the blood or in the body. Now, that being said, there may be a discrepancy between insulin resistance in the blood and insulin resistance in the brain. We can still develop insulin resistance separately in different areas of the body.

We do think that people who have a mental health condition or a brain health condition like epilepsy probably have some insulin resistance in their brain, even if they don’t measure it in their bloodstream. Some of the protocols, these ketogenic diets and exercise protocols can still be helpful for brain health, even if there’s no insulin resistance in the bloodstream. That’s a somewhat separate point for people who have a mental health condition or a brain health condition. It’s separate from the general prevention point that I was making before.

That’s a difference between regular insulin resistance in relation to pre-diabetes or diabetes versus brain insulin resistance.

Reversing Brain Insulin Resistance Through Diet

You can be pretty sure that if you’ve got high insulin in your blood, you definitely have brain insulin resistance. You can assume that’s the case. The brain insulin resistance is a major factor in developing dementia. People think that it’s one of the most important factors in developing cognitive impairment as we age. One of the best things you can do for maintaining your brain health over a lifetime is to make sure you’re not developing any insulin resistance in your blood and hopefully then not in your brain through eating lower amounts of simple carbohydrates.

Even I would say sometimes lower amounts of carbohydrates in general and eating less frequently. Not eating six times a day. At the most, eating three times a day, and sometimes even eating only twice a day can be a better strategy to reverse insulin resistance. Exercise as well is a great strategy to reverse insulin resistance. Almost everything that I’m talking about regarding diet is enhanced by exercise as well, including this.

Not just cardio. Not just going for a run or jog or bike ride or walk, but doing some resistance training.

I advocate both. We can get different kinds of benefits. We have to meet people where they are. If they’re not doing anything and all they can do is start a walking regimen, that’s a huge benefit to go from sedentary to walking. If someone’s already doing some cardio, I would advocate adding some resistance training. I also strongly advocate for high intensity interval training or even super high intensity interval training on what they call sprint interval training. As people age, that’s incredibly powerful. It’s something that if we can get ourselves to do it at least once a week as we’re aging, it’s effective.

You’ve said a couple of things that I want to underscore or highlight. Brain insulin resistance is the number one reason for developing cognitive impairment. Everyone reading, probably their antenna went up and was like, “I don’t want that.” You said reversing insulin resistance. It can be reversed through these protocols that you’re talking about like eating fewer carbs, especially simple carbs. Can you define the difference between complex carbs and simple carbs?

Simple carbs are things that are like sugars, actual sugar, but even all these other products that are touted as being more healthy, like honey and agave. These are all simple carbs. They spike your blood sugar very quickly. Your blood sugar rises very quickly upon eating them. Other carbohydrates, and I would include processed flours in there too, such as baked goods, breads, pasta, and rice. Those spike your blood sugar very quickly as well.

Complex carbohydrates are whole grains or things that are wrapped up in fiber. They’re less likely to spike your blood sugar and they may have less of an insulin response because of that. That’s the reason why they can be better. Even a lot of those can cause problems, too. Over the course of a few hours, you’re still going to have needs for lots of insulin over that period of time. It’s one thing for prevention. If you’re exercising, you’re metabolically pretty healthy.

Reducing the simple carbs and getting your overall carbohydrates down to, let’s say, 100 grams a day instead of maybe 200 grams a day, can be effective. If you already have developed insulin resistance that may not be enough. You might need to go to a low carbohydrate diet, which would be below 50 grams a day or even a ketogenic diet which is the most powerful way to reverse insulin resistance. Which is getting your carbohydrate numbers below maybe 20 or 25 grams a day which is very low.

Let’s talk about that. Let’s talk about ketones and a ketogenic diet and what you propose there.

 

  

The first thing is, people hear about keto and they think, “This is like an internet thing for weight loss. A fad diet,” and that’s what it’s become. If you go on the internet, that’s what you’re going to get back if you put on a ketogenic diet. People should know that it’s a medical diet that was invented at the Mayo Clinic in 1921 to treat childhood epilepsy. There’s an article from the Mayo Clinic, 1921, Russell Wilder writing, “We know how to make ketones by using this certain diet. I propose that we try that in a group of children with epilepsy.” That’s exactly what they did.

They saw a tremendous response in epilepsy to this high fat, moderate protein, very low carbohydrate diet that they invented there at the hospital. That was the treatment for epilepsy for a number of years until medications started to become more popular. People are enamored by medications because they’re much simpler than changing a whole diet and eating this completely different way. Essentially, the field migrated towards using medications. In the ‘80s, there was a resurgence of interest in the ketogenic diet for epilepsy because what we realized was that many people were taking 2 or 2 anti-epileptic drugs and they were still having seizures all the time.

Many people were considered treatment resistant, which is a theme because people in the mental health world, many of them are treatment resistant. They started doing randomized controlled trials on ketogenic diets in epilepsy, and they found very high levels of evidence that ketogenic diets work even when the medications do not work in both children and adults. There’s two Cochrane reviews showing that’s the case, which is the highest level of medical evidence that we can have.

It’s without a shadow of a doubt that ketogenic diets work in epilepsy even when medications don’t work. Interestingly enough, in kids who’d have a good response to the ketogenic diet for their epilepsy, many of them can be on the diet for a few years and then come off the diet and retain most of the benefits that they got when they were on the diet. It literally reversed their epilepsy in a fundamental way.

We don’t have almost anything that does that in a brain health condition. That’s very tantalizing and interesting. People have now started to apply this approach in serious mental health since 2016. It’s been taking off. There’s lots of clinical studies coming out every month about using ketogenic diets in major depression and bipolar disorder and schizophrenia, even studies in anorexia.

People are using them with good benefits in autism. We’re seeing studies in Alzheimer’s disease. People have called it a trans diagnostic approach to mental health conditions. Meaning it transcends diagnoses. You don’t need to use a certain pill for a certain condition. This works for all of these mental health conditions on some level is what we’re seeing.

Should all of us be considering a ketogenic diet then?

I am an advocate and that’s like a leading question for someone like me. I do think it’s closer to the way we evolved biologically, and it’s closer to what our bodies need to thrive. Most people now accept that we evolved going in and out of ketosis for hundreds of thousands of years before agriculture. In the hunter-gatherer way of doing things, we were periods of time without food and then there would be food. During those periods of time without food, we would make ketones.

Ketones would exist essentially to power our brains when there was no food around. When we were in that state after two days of not eating, our body started using our fat storage in a very intensive way. Our brains can’t get those long chain fatty acids through the blood brain barrier. You had mentioned that before. Our liver chops up some of those long chain fatty acids into these littler pieces called ketones that can cross the blood brain barrier.

They’re this great source of fuel for our brain, but also are a signaling molecule to get our brains to do different things than they would otherwise do. This is how we evolve. This is what our brains were used to for hundreds of thousands of years having that ketone signal. We’ve taken that away. It’s not just agriculture. It’s even more so in the last 50 to 60 years since dietary guidelines came out that told us to eat our base of our calories all from carbohydrates.

Since it was possible to have food all the time, this is all very modern. Even a few hundred years ago, unless you were very wealthy, you didn’t eat three times a day. You certainly didn’t eat carbohydrates all the time. You certainly didn’t have sugar all the time. This is very modern and it’s making us very sick. In some ways, getting back to this more evolutionarily appropriate way of eating, makes a lot of sense for a lot of people. It reverses some of the damage that has been done through modern living.

What about supplementing with ketones? I’ve used a couple of different products like deltaG Ketones for doing an Ironman. The thought is, you supplement with those. It gives your brain fuel then your body can use the glucose for the rest of its fuel or I take another supplement sometimes that has the right-handed molecule, the DBHB or D-beta-hydroxybutyrate ketones. It’s bioidentical. That way, I’m fueling my brain, which I feel if I take that. How does that interact with everything else you’re saying or a ketogenic diet?

It’s a proof of concept that your brain likes ketones and can use them as fuel. I don’t think it’s a solution to the problems of modern living that we’re talking about because of a number of things. Number one, it’s not going to lower our insulin and reverse our insulin resistance, which is, as we’ve been saying, the fundamental problem. It’s not going to be 24 hours of the day. You’re going to get a couple of hours worth of ketones to your brain if you take an exogenous ketone.

That’s not the same thing as eating in such a way that you have ketones 24 hours a day, providing fuel, reversing our insulin resistance, but also providing those signals to the mitochondria all 24 hours of the day. That’s a huge part of why this is beneficial. Ketones signal to the cells through this mechanism called PGC1-alpha to make more mitochondria and to make healthier mitochondria out of the old non-functioning mitochondria, this process that we call mitophagy, which is a subset of autophagy.

Ketones are a signal to the cell to do both of those things, mitochondrial biogenesis and mitophagy. That’s incredibly powerful and important because mitochondria are not the energy factories in the cell. They’re doing so many other important things that we’ve now learned over the years. When we make more healthy mitochondria, our cells work better. We’re fixing things at a cellular level with this approach. That’s not in the brain, either.

Almost every cell in our body has mitochondria. Immune cells are going to be working better. Liver cells and kidney cells are going to be working better when they’re getting the signal to do mitophagy and mitochondrial biogenesis. We can fix a lot of things. We’re using ketogenic diets. Other parts of medicine are studying them intensively, too. In oncology, for example. Ketogenic diets are a hot topic. In autoimmune conditions, ketogenic diets are a hot topic. There’s a lot of interest in these, and as I said, in my view, it’s because we’ve lost something that evolutionary, our bodies were used to getting.

It’s very fascinating. We can improve our mitochondria throughout all of our body, which would then lead to better energy production, as you said, throughout all of our organ systems. We’re going to have a lot more energy in general just to do life as well as protect and preserve our brain health.

As I was alluding to, mitochondria do other things. The people are referring to them now as like the little CEOs of the cell. They work in a commune almost communally. They move together and work collectively together. They do things like, in neurons, they’ll huddle around the end of the neuron to help release neurotransmitters.

They can cause transcription of genes in the nucleus of the cell. The mitochondria can signal to the nucleus to transcribe certain genes. Mitochondria involved in the initiation and the resolution of inflammation throughout the body. They’re very important fundamentally to our health. It’s not just about making energy.

Brain insulin resistance starves your neurons. Reducing carbs and snacking helps restore optimal cellular energy.

All of those are like, as you said, the CEO of the cell. If we want to live as healthy as we can for as long as we can, we need to protect, preserve, and take care of our mitochondria.

We do.

Tell us a little bit more, like break it down. I’m assuming that you eat a ketogenic diet.

I do. Since I’ve learned about all of this, I can’t not eat a ketogenic diet.

What does that look like on a daily basis? How often do you skip meals? Tell us about what that looks like.

When I first started doing this, I was insulin resistant. I used to try to eat healthy, but I knew that because I used to have to eat in between breakfast and lunch. I would have a crash. My brain would stop working. In order to stay functioning at a high level, I used to have to eat and I would eat more fruit. I was like a fruit addict, which over time can contribute to insulin resistance. Fruit is generally healthy, but if you’re eating high sugar fruits all the time, that’s also raising your insulin.

I was in that trap. I started off doing low carbohydrate diets and intermittent fasting. Eating only for a six or eight-hour window per day. Once a week I would do one meal a day and that helped reverse my insulin resistance. I started seeing huge benefits. I never thought I could go a whole day without eating and realize that, once I trained my metabolism to now be able to access my fuel storage. We’re all walking around with months’ worth of fuel on our bodies. Why do people run out of fuel when you could stop eating and live for months.

This is always very helpful for people to understand this. We’re designed to have all this subcutaneous fat that serves as storage fuel. That’s how our bodies are designed. We have more subcutaneous fat than almost any other species. This is compared to other primates, for example. We have way more subcutaneous fat. That’s to provide energy. When we don’t have food, that’s what it’s there for. If someone’s walking around with all that energy, why are they running out of fuel like I was? My brain would run out. I couldn’t function.

It’s because of insulin resistance. My insulin’s high. I can’t access the energy in my fat cells, because essentially insulin prevents the burning of fat also. When insulin is low, then we can start accessing the fat storage and accessing that fuel. Once I reversed my insulin resistance, it was very easy to go 24 hours without eating.

My ketone levels would rise a little bit during that period of time and I’d feel great. I realized I want to feel that way all the time. Let’s lower the carbs even more and have a steady level of ketosis going. It’s not that hard to do once you know how to do it. I love to eat, and I still enjoy all my food. It’s just that I’m eating different things. It’s the things that most people might think of that they want that maybe I’m not having, but I find the food very satisfying.

Typically, after 2 or 3 weeks, your gut microbiome changes and sends different signals to your brain then you crave those things differently. As you said, you tested your ketone levels, so you can see the data to show the changes that took effect.

Although, when I started making these changes, as I said, doctors don’t measure insulin. At that time, I didn’t even know what my insulin levels were. By the time I was doing all of this, it was too late to catch my insulin resistance. I’m not insulin resistant anymore, but I can infer that I was before I started this.

I’m assuming you have a lot more energy, though. Do you notice that?

Yes. I can think and work all day. I can then go exercise and have time to enjoy time with friends and family. I’m a very busy person. I feel like I’m functioning as if I was twenty years younger than before I started this, which was maybe in 2010. I literally feel twenty years younger than I did then.

That makes sense, though, talking about mitochondria as a CEO of your cells. All of those functions are elevated and optimized. For those that are new to a ketogenic diet, tell us what do you eat and how often do you eat now, now that you’re in that state?

I do eat usually three times a day and sometimes twice a day. At this point, I’m trying to optimize building muscle. I want to turn my muscle synthesis on first thing in the morning. I will have some protein in the morning. Sometimes then I’ll skip lunch and then have dinner. Things like for breakfast might be eggs and avocado. Maybe a little bit of sausage with that. Maybe a couple of some berries on the side. That could be breakfast. Sometimes I’ll have full fat Greek yogurt with some basil seeds in it.

Sometimes I’ll add a little MCT oil in there or some other oil. Again, with a little bit of berries. There’s a pretty good keto granola that I like. That’s basically just nuts and seeds. It’s not a typical granola and it doesn’t have any sugar in it at all. That could be breakfast. Lunch is usually pretty light. I may have a can of salmon or sardines and some almonds or macadamia nuts. Occasionally, I might have a salad with a lot of dressing and maybe a little bit of protein in there.

For dinner, it’s like a protein and vegetable with some fat in addition. I try to get veggies and some plant products. I want to be heavy on things like herbs. I like nuts and seeds as part of this. Also, trying to get the highest quality ingredients possible. I do think organic and wild caught fish, grass fed beef does make some difference. I’m lucky enough to be able to afford those things. If you can’t, it doesn’t mean you can’t still eat healthy, but those things do make a difference on the margins.

That’s great. Thanks for sharing some of that. Do you have any keto apps or things like that you would recommend to people if they want to try it out?

Real brain health recovery requires an all-in strategy combining nutrition, movement, circadian rhythms, and sleep.

I don’t necessarily, but there’s a lot of great content online where you can learn about how to do keto well. For example, Metabolic Mind is a great website. That’s all about ketogenic diets and mental health, but there’s also a lot of good practical tips on there. In Accord, the program that I run, we have a talented chef that works there. She’s very inventive. I keep learning more great ways to do this from her, too.

How long did it take or how long do you see for other patients that you’re treating to notice the benefits or see those changes start to take place?

It depends on the person and what they’re looking for. Some people can see some benefits pretty quickly, like within a couple of weeks. Cutting out processed food, eating a whole foods diet, and getting rid of excess carbohydrates. Lowering that insulin level. If you’re doing it all at once, which we do in our program, you can get into ketosis in 4 or 5 days. I don’t necessarily recommend that for people at home if you don’t have a professional working with you.

You have to be careful not to slam yourself into ketosis like that. You can get something called the keto flu. It’s a big shift in your energy metabolism. If you’re not doing the right amount of fluids and electrolytes and doing it with guidance. You don’t necessarily want to do it all immediately like that. You can do it more gradually, like one keto meal a day for the first week. The second week, you can do two keto meals a day, then the third week, you can do all keto meals. You’re not likely to get any of those transition side effects that we call the keto flu.

Again, it’s good to measure it. The best way to measure it is with a finger prick. A little bit of blood, that’s the most accurate. A breath meter can be used and it’s somewhat accurate. I don’t advocate people only using urine strips because they’re not very accurate. They’re not giving you a sense of how much ketones you’re making. It’s just whether you’re in ketosis or not. It’s also delayed by a few hours because the urine takes time to collect. They’re not as ideal, but it depends on what someone’s using it for. It could be enough for certain situations.

Those finger prick tests, though, are pretty inexpensive.

The machine itself is inexpensive. I like the Keto-Mojo machine, but then there’s strips you have to buy. The same as a glucose monitor. The strips can add up in terms of cost over time. In the beginning, it’s important to check more often. If someone, again, is using this mostly for lifestyle and not for medical reasons, you don’t necessarily have to keep checking all the time.

Once you get into it and you know what produces ketosis and you’re basically eating the same things and you feel the same. You don’t have to keep checking every day anymore. You can check once a week or even once every two weeks later on down the line. In the beginning, it’s helpful to check daily sometimes to know what’s going on.

To see how you’re adapting and everything. The Keto-Mojo machine is helpful. Tell us a little bit about Accord and the work that you’re doing there. How are you changing people’s lives?

I started doing these approaches with people maybe about five years ago or so. I was blown away by how powerful and effective it was. I’d already been a clinical psychiatrist for twenty years at the time and knew what worked and how well it worked. I was seeing that this was working when all these other treatments weren’t working some of the time. Sometimes, allowing people to get on lower doses of medications, reduce their side effects and get to much higher levels of functioning than they could achieve without it.

Integrating Lifestyle Protocols in Residential Care

What I also found is that it’s not that easy for people who are already struggling with a mental health condition to make all these lifestyle changes and dietary changes in their lives on their own. People need a lot of support sometimes. We started this program called Accord, which is a residential program. It’s just a house outside of Boston where people come. Some are local. Some people are coming from parts of the country or all over the world to come in.

We have a keto dietician, a keto chef and a program director who’s a great social worker who’s coordinating all of this and helping with some psychotherapy. I’m doing the psychiatric part. We order this very thorough set of labs to look at metabolism and nutritional status and other things that might be affecting their brain health, then we’re immersing people in all these approaches. Ketogenic diets, exercise, mind-body practices, which has its own strong literature in mental health.

It’s very synergistic with the other approaches. Also, circadian rhythm alignment, which is also very powerful for our biology and for our brains, especially. We’re combining all of that at once. People usually stay for a minimum of four weeks. Sometimes up to 8 or 12 weeks to start feeling better. We might start making some medication adjustments. Also, most importantly, they’re learning how to do this so that they can sustain it when they get home.

Learning why it works, how it works, but also the practical things they need to know like how to cook these meals. There’s a lot of cooking classes with the chef and going out to grocery stores with the chef or the dietician. Going out to eat or ordering takeout and learning how to order a healthy keto meal from wherever the restaurant is. In order to sustain this, you have to know how to do it in the real world and your real life. The goal is for people to keep doing this after they leave for a long period of time. Not to just do it for a few months and then stop.

That’s great. On that note, you made me think of a question. When you do go out to eat, what are some of the restaurants you like to go to? Even quick food. If you were going to Chipotle or something.

In fact, I came on a long drive the other day and we stopped at Chipotle. My son likes it. I can eat keto at Chipotle just fine. You order the salad. You get the protein. Usually, I get double protein. You can get a little of the medium salsa, which is basically just spicy peppers chopped up in there. You can get guacamole, which is a great healthy fats. You can get some cheese and some sour cream for more fat. It’s a very ketogenic meal. It’s quick and easy.

I wouldn’t want to eat Chipotle every day, but when I’m on the road, that’s a great place to go. You can get a keto meal there. Even if you’re at McDonald’s. You can get a burger with no bun and cheese on it. You can put a little mayonnaise on it. It’s not great, but in a pinch, you’re not going to starve no matter where you are.

It does seem like that maybe there’s some options for eating keto out at restaurants. It maybe is a little bit easier than vegan, for example, or some of the other diets.

It probably is. Certainly, easier than like if you’re truly celiac and need to be gluten-free for sure and no contamination. That’s very hard. Vegan can be very challenging too in many places. This is far easier because you can modify a meal. Ask them to modify the meal that they were going to serve you. If you get a piece of chicken or fish or beef or pork or whatever, and it has a veggie.

 

  

Usually, it’s going to come with some starch. You just ask them no starch, double veggies. If it doesn’t seem like it has enough fat on it, you can always add some butter or olive oil to it. Usually, if you’re in a restaurant, they’re using a good amount of fat. You have to be careful that you’re not having a sauce that has a bunch of hidden sugar in there. You have to be careful sometimes about that.

I know we’re nearing the end of our time here, but as we conclude, and maybe this is a little bit of a recap too. If someone’s reading and they’re struggling with depression or anxiety or brain fog, or they’re watching somebody that they love suffer from something like that. What’s the message you’d most want them to hear? Where would they start?

When you see that or you’re experiencing that, you have to think about it. In my view, there’s something going wrong in my metabolism and it’s affecting the energy production in my brain. That’s why I’m experiencing those things. We need to look for that problem in metabolism and think about the ways that we can fix it.

The good thing is that these problems are largely very reversible and it doesn’t take that long to reverse them. That’s the good news. The not so good news is that it does require some effort and work. This is not as easy as just taking a pill once or twice a day. It can be incredibly powerful and sometimes even more effective than any of those pills. That’s the most important message.

If they were going to start somewhere, would you say doing the insulin resistance test?

That’s one place to start. They could also look at their body composition. There are machines in a lot of gyms called in-body machines. There’s also DEXA scans that now you can go and get a DEXA scan at a local place. They’ll tell you a score called visceral fat. That’s a sign that you’re having real metabolic problems if you’ve got high visceral fat. You want that visceral fat to be almost zero. Visceral fat is the fat that’s hanging around our organs. That sits on top of our heart and our intestines, our pancreas, or infiltrates our liver.

About a third of American adults have fatty liver. It’s all from metabolic problems. It used to all be from alcohol from many years ago. Now, it’s all from high carbohydrate diets and sedentary lifestyles that cause insulin resistance that causes fatty liver. That’s another place they can look at that. You can even just tell some of the blood work. If your triglycerides are high, or your HDL is low, or if you have a large waist circumference. That’s a sign of visceral fat.

Even putting a tape measure around your waist or if you’ve noticed that you’re gaining adiposity around your belly, waist adiposity. That’s a sure sign that you’re becoming metabolically unhealthy. If any of those things are happening, it’s a sign that we should make the connection. The metabolic problem is connected to this mental health or brain health problem. These are not separate things. They’re the same process. That’s the most important message.

This is extremely helpful and you’ve given us a lot to consider and think about. Perhaps, even some people reading might change their diets and try this out. I like that it’s something that you could also just try. It’s not like you have to commit to this for life, but you could try it for 2 weeks or 3 weeks and see how you feel.

I would probably give it a little longer than that because first, you want to spend probably 2 or 3 weeks just getting into ketosis and measuring that you’re in ketosis. I then would give it a couple of months to make sure you can see how it’s affecting you. For some people, they’ll feel those immediate benefits. Some people, it could take two or three months to feel the benefits of being in ketosis. You have to make sure you’re in ketosis. You want to be patient and give it a little bit of time. Your insulin resistance and mitochondrial dysfunction didn’t develop overnight. It developed over the course of probably decades. Give it a few months to try to reverse it.

That goes for people of all ages, whether you’re 15 or 85.

That’s right. This can be beneficial for people of any age. The strongest literature we have is in childhood epilepsy. We know it’s very safe for kids. I’m not a child psychiatrist. I generally don’t work with kids, but there are plenty of keto dietitians who’ve been working with kids for decades doing these types of diets. Parents out there, if they’re thinking about their kid who’s got attentional problems or maybe is changing their mood or their anxiety in certain ways. This is something to consider. At least cleaning up the diet, getting rid of the ultra-processed foods and the sugars and getting them moving and exercising. Even that for a kid can make a huge difference. They don’t necessarily have to go for a full ketogenic diet for kids for those kinds of situations.

This is extremely helpful and you’ve given us so much to work with here. Thank you so much for being with us. Thank you for sharing your expertise, wisdom and experience with us. Where can people connect with you? Where can they find out more and do a little deeper dive?

I mentioned those two websites earlier, AccordMH.com is my program. We have a whole education section on there that people can look at and see articles. There’s some long form academic lectures that I’ve done there. Metabolic Mind is another great place to learn about this metabolism, mental health, and brain health connection. If people want to reach out to me individually, they can find me on LinkedIn. I’m not on other social media. I’m the age of psychiatrists that didn’t do social media for many years. I’ve only done LinkedIn, but people can find me there. I’d be happy to connect with people that way.

This is so helpful. Thank you so much for being with us. I appreciate it. You’ve given me a lot to think about personally, too. I want to get that test done. I had some blood work done, so I want to see what some of my numbers are and see how that compares to what you mentioned with my insulin resistance numbers. I’m going to check that out and see if maybe I need to make some changes myself. Thank you so much for being with us, Dr. Bernstein.

My pleasure. Thanks for having me.

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What a fascinating conversation. I learned so much today from Dr. Bernstein. He is someone who has a ton of energy, wisdom and experience. I hope that you picked up a few things that can be helpful to you. I know a few things that resonated and stood out to me is the prevalence of insulin resistance in our population and in our culture. Getting that relatively inexpensive and easy to do fasting insulin test can be super helpful.

Oftentimes, it’s less than $50 or usually included in your insurance. You could cover it perhaps that way as well or the HOMA-IR test is another one that you can check out. It’s something that’s not typically requested by your doctors, but you can easily ask to get that test done. We went over my blood work after we stopped recording and he was telling me about some of my numbers. Most of them are looking pretty good, but there are a couple of things that I need to work on so it can be helpful.

We talked a lot about the keto diet and ketogenic diet. I never knew that it was invented by Mayo Clinic in 1921 and has been around for that long. That was interesting to learn about and to realize that it can reverse things like epilepsy, even be used to treat things like autism and Alzheimer’s. We dove into a lot of the different use cases there like oncology and autoimmune disorders.

We talked about the mitochondria being the CEO of the cell and how having proper fueling can significantly impact your health and your energy in so many ways through all of those different pathways that the mitochondria interact with. Maybe that’s something to check out. Maybe try the Keto-Mojo machine to see if you’re in ketosis. As like he said, try it out for a few months to give your body a chance to reverse that insulin resistance and see how you feel. It can take a little while for those effects to take place.

It’s something I want to explore a little further for myself. I hope that you’ll check him out as well at AccordMH.com. There’s blogs and articles, and lectures on there. As well as another website he mentioned is Metabolic Mind. Check those websites out if you want to do a little further research and get some more resources there as well. Thank you so much for tuning in. I hope that you take something away with us that can make an impact in your life. We appreciate you being with us.

 

Important Links

• Dr. Matthew Bernstein on LinkedIn
• Accord Metabolic Health
• deltaG Ketones
• Metabolic Mind
• Accord Metabolic Health on Facebook
• Accord Metabolic Health on X
• Accord Metabolic Health on Instagram