For more than twenty-five years as a psychiatrist and neuroscience researcher, I have been asked the question “What causes mental illness?” countless times by patients and their family members. When I first began my career, I would give long answers that made me sound educated and competent. I’d talk about neurotransmitters, hormones, genetics, and stress. I would describe the treatments we would be using and offer hope that they would make things better. After a few years of this, however, I began to feel like a fraud. You see, people often weren’t getting that much better. Treatments would sometimes work for a few months, or even a year or two, but more often than not, the symptoms would come back. At some point, I began telling people the simple truth: “No one knows what causes mental illness.” Although we understand many risk factors, no one knows how they all fit together. I still tried to offer hope by assuring people that we had many different treatments at our disposal and that we would try one after another until we found one that worked. Sadly, for many of my patients, we never did.
That all changed for me in 2016 when I helped a patient lose weight. Tom was a thirty-three-year-old man with schizoaffective disorder, a cross between schizophrenia and bipolar disorder. He had suffered from hallucinations, delusions, and mental anguish every day of his life over the last thirteen years. He was tormented by his illness. He had tried seventeen different medications, but none had worked. The medications sedated him, which reduced his anxiety and agitation, but they didn’t stop his hallucinations or delusions. What’s more, they’d caused him to gain over one hundred pounds. He had long been plagued by low self-esteem, and being so overweight only added to this. He had become a near hermit, and our weekly sessions were some of his only excursions into the outside world. This is partly why I agreed to help him lose weight: I was the doctor he saw most often, and he wasn’t in the market for a referral to a specialist he’d never met. More to the point, it was highly unusual for him to take action to improve his health in some way. Maybe losing weight could help him gain a sense of control over his life. After experimenting with several approaches without success, we decided to try the ketogenic diet—a diet low in carbohydrates, moderate in protein, and high in fat.
Within weeks, not only had Tom lost weight, but I began to notice remarkable and dramatic changes in his psychiatric symptoms. He was less depressed and less sedated. He began making more eye contact, and when he did, I saw a presence and spark there that I had never seen before. Most astonishingly, after two months, he told me that his longstanding hallucinations were receding and that he was rethinking his many paranoid conspiracy theories. He began to realize that they weren’t true and probably never had been. Tom went on to lose 150 pounds, move out of his father’s home, and complete a certificate program. He was even able to perform improv in front of a live audience, something that would have been impossible for him prior to the diet.
I was flabbergasted. I had never seen anything like this in my entire career. While it’s possible that losing weight might reduce anxiety or depression in some people, this man had a psychotic disorder that had resisted more than a decade of treatment. Nothing in my knowledge or experience suggested that the ketogenic diet would treat his symptoms. There seemed to be no reason it should.
I began digging into the medical literature and discovered that the ketogenic diet is a longstanding, evidence-based treatment for epilepsy. It can stop seizures even when medications fail to. I quickly realized an important connection—we use epilepsy treatments in psychiatry all the time. They include medications like Depakote, Neurontin, Lamictal, Topamax, Valium, Klonopin, and Xanax. If this diet also stops seizures, maybe that’s why it was helping Tom. Based on this additional information, I began using the ketogenic diet as a treatment with other patients and when it continued to be successful, I soon found myself collaborating with researchers around the world to explore it further, speaking globally on this topic, and publishing papers in academic journals demonstrating its effectiveness.
I set out on a journey to understand how and why this diet worked for my patients. Along with its use in epilepsy, the ketogenic diet is also used in treating obesity and diabetes, and is even being pursued as a treatment for Alzheimer’s disease. At first, this was confusing and a bit overwhelming. Why would one treatment work for all of these disorders, even if only in some people? Ultimately, it was this question that opened the door to something much bigger than the inquiry I’d begun with. It forced me to uncover the connections between these different disorders and integrate this understanding with everything that I already knew as a neuroscientist and psychiatrist. When I finally put all the pieces together, I realized that I had stumbled upon something beyond my wildest dreams. I had developed a unifying theory for the cause of all mental illnesses. I call it the theory of brain energy.
This is not a book about the ketogenic diet—or any diet at all. It’s also not solely concerned with serious mental illness; the scientific insights in this book apply to mild depression and anxiety as well. In fact, it may change the way you think about all human emotions and experiences. I am not offering a simple cure-all for mental illness, or advocating for any single treatment. The unexpected effectiveness of that particular treatment was only the first clue that started me on the path to a new way of understanding mental illness. This book will share that understanding with you, taking you on a journey that I hope will transform the way you think about mental illness and mental health.
Here’s a quick overview of what’s in store:
•I’ll begin by reviewing where we are now in the mental health field: the problems and questions that plague us, and why they matter.
•You’ll learn something that may seem shocking—mental disorders are not distinct entities. This includes diagnoses like depression, anxiety, PTSD, OCD, ADHD, alcoholism, opioid addiction, eating disorders, autism, bipolar disorder, and schizophrenia. There is tremendous overlap in symptoms for different disorders, and many people are diagnosed with more than one. And even among disorders with symptoms that are very different, the underlying biological, psychological, and social factors overlap significantly.
•I’ll explore the surprising connections between mental disorders and some physical ones such as obesity, diabetes, heart attacks, strokes, pain disorders, Alzheimer’s disease, and epilepsy. In order to truly understand what causes mental illness, these connections need to be understood as well.
•This will all come together to reveal that mental disorders are metabolic disorders of the brain.
•In order to understand what this means, you’ll need to understand metabolism. It’s a lot more complicated than most people realize, but I’ll do my best to make it as simple as possible. Tiny things called mitochondria are key. Metabolism and mitochondria can explain all the symptoms of mental illness.
•I’ll discuss the differences between normal mental states and mental disorders. For example, we all experience anxiety, depression, and fear at different times in our lives. These experiences aren’t disorders—they are a normal part of being human. However, when these things happen at the wrong time or in an exaggerated way, they may cross the line from mental state to mental disorder. You’ll see that all mental states, even normal ones, relate to metabolism. For example, “stress” is a mental state that affects metabolism—it takes a metabolic toll. If it occurs for prolonged periods of time or is extreme, it can lead to mental illness. But so can anything else that affects your metabolism.
•I will share with you five broad mechanisms of action that can explain the clinical and neuroscientific observations we see in all mental disorders.
•I’ll show you that all the known contributing factors to mental illness, including things like genetics, inflammation, neurotransmitters, hormones, sleep, alcohol and drugs, love, heartbreak, meaning and purpose in life, trauma, and loneliness, can be tied directly to effects on metabolism and mitochondria. I’ll demonstrate how all these contributing factors affect metabolism, which then affects the function of cells, which can then result in symptoms of mental illness.
•You’ll learn that all current mental health treatments, including the psychological and social ones, likely work by affecting metabolism.
•This new understanding of mental illness leads to new treatments, ones that offer the hope of long-term healing as opposed to just symptom reduction. They will sometimes be more difficult than just taking a pill, but they are well worth the effort. While more research will lead to additional new treatments, the exciting news is that many therapeutic options are available today.
To be clear, I am not the first to suggest that metabolism and mitochondria are related to mental illness. In fact, I am building on decades of research. Without these other researchers and their pioneering work, this book wouldn’t exist. I’ll share many of their groundbreaking studies in the pages to come. However, for the first time, this book puts the pieces of the puzzle together to reveal one coherent theory. This theory integrates existing biological, psychological, and social research, and offers one unifying framework for explaining and treating mental illness.
Brain Energy not only provides long-elusive answers, it offers new solutions. I hope it will end the suffering and change the lives of millions of people throughout the world. If you or someone you love is affected by a mental illness, it might just change your life, too.