Dr. Matthew Bernstein | Metabolic Psychiatry: The Future of Mental Health

• How does insulin resistance — including insulin resistance in the brain — contribute to depression, bipolar disorder, schizophrenia, and anxiety?
• Why can ketogenic nutrition succeed where conventional psychiatric medications often fall short?
• How do ketones function as both a fuel source and a signaling molecule for mitochondrial repair and brain healing?
• What is metabolic psychiatry, and how does it reframe the connection between metabolic dysfunction and mental illness?
• Can improving metabolic flexibility through diet, movement, light exposure, and stress regulation lead to long-term mental health recovery?

Who is Dr. Matthew Bernstein?

Dr. Matthew Bernstein is a board-certified psychiatrist and a leader in the emerging field of metabolic psychiatry, which examines how metabolic health, brain energy, and mitochondrial function influence mental illness. Trained in conventional psychiatry and formerly practicing at McLean Hospital, Harvard’s flagship psychiatric institution, Dr. Bernstein treated patients with severe conditions such as schizophrenia, bipolar disorder, and major depression — experiences that led him to question why long-term recovery remained so rare.

His work took a decisive turn after two of his children developed sudden, severe neuropsychiatric symptoms that did not respond to standard psychiatric care. Searching for answers beyond conventional models, Dr. Bernstein and his wife, a psychologist, uncovered underlying metabolic and inflammatory drivers and were introduced to the therapeutic use of ketogenic nutrition in neurological disease. This personal and professional reckoning reshaped how he understood mental illness and brain health.

Today, Dr. Bernstein applies metabolic and ketogenic interventions in clinical practice, where he has seen profound improvements in patients with treatment-resistant psychiatric disorders. He is the founder of Accord Mental Health and an organizer of the first public conference dedicated to metabolic psychiatry, helping advance a new framework that views mental illness through the lens of energy metabolism, insulin resistance, and mitochondrial function.

What did Dr. Matthew and Jodi discuss?

00:00 Intro & Dr. Bernstein’s personal story
04:50 From psychiatry to metabolic medicine
09:00 What is metabolic psychiatry?
13:00 Insulin resistance and the brain
17:30 Ketones as brain fuel & signaling molecules
22:00 Healing anorexia, OCD, and psychosis with keto
27:30 Safety, flexibility, and clinical considerations
33:00 Compliance, ketone tracking, and CGMs
38:00 Cholesterol, statins, and brain health
43:00 The Accord program: Food, light, and safety signals
47:00 Supplements: Carnitine, creatine, iron, and more
51:00 Upcoming research & RCTs in mental health
53:00 Rapid fire: vital signs, tricks, and takeaways
57:00 Where to learn more

Full Transcript:

Dr. Matthew Bernstein: [00:00:00] So that's the fundamental issue, is that we've got this metabolic milieu, this crisis of metabolic health, and it's. Then we start scratching our heads, well, I wonder why there's such a rise in anxiety and depression and autism and A DHD. And you know, I think the idea is that these things are closely connected.

Dr. Matthew Bernstein: This is even more challenging because even people who have a normal insulin level 

Jodi Duval: mm-hmm. 

Dr. Matthew Bernstein: Um, and you think, oh, well this person's not insulin resistant. That doesn't mean that their brain is not insulin resistant. So this is another thing that's really important to understand because, um. Organs become insulin resistant at different rates.

Dr. Matthew Bernstein: And so someone could have a normal insulin, their normal hemoglobin A1C, and yet we know from from good research that their brain could be insulin resistant. And brain insulin resistance is associated with all the major mental health issues. Schizophrenia, depression, bipolar Alzheimer's disease is all associated with brain insulin resistant.[00:01:00] 

Jodi Duval: All right. Welcome to the show, Dr. Matthew Bernstein. It is an absolute pleasure to talk to you today about metabolic psychiatry. I'm very excited. 

Dr. Matthew Bernstein: It's my pleasure to be here. Thanks for having me. 

Jodi Duval: Oh, amazing. So I always start the podcast with, um, your journey. So it's something that I feel that we connect really well to in terms of stories and what brought you to the point of where you're at now and in such a, a huge paradigm shift of, of field and, um, it's incredible work that you're doing.

Jodi Duval: And you've organized the first ever public conference in 2023, three in metabolic psychiatry. And, um, so what, what brought you to this very, very interesting field? 

Dr. Matthew Bernstein: Yeah. Well, yeah, it is a bit of a, a [00:02:00] journey for me and definitely a bit of a personal story. So, um, I'm glad you asked because I agree it's important for people to understand the, the context.

Dr. Matthew Bernstein: So, you know, I was a pretty traditionally trained psychiatrist, you know, four years of medical school, four years of psychiatry residency. I worked on an inpatient psychiatry unit at McLean Hospital. It's part of Harvard. Uh, treating people with severe mental illness, which has always been sort of my passion.

Dr. Matthew Bernstein: People with schizophrenia, bipolar, um, you know, I think we were able to help people quite a bit in those acute crises, but I was always concerned that we weren't really. Seeing people get full recovery from these conditions, you know, we could get 'em outta the acute crisis, but then, you know, people would get stuck on these big medication regimens and not really get back to their full level of functioning.

Dr. Matthew Bernstein: And we would call it a success to say the person wasn't continuing to get hospitalized all the time, but they would still have symptoms. They wouldn't be able to work, they wouldn't be able to often even live independently or have relationships [00:03:00] and, you know, that really didn't feel like a success. 

Jodi Duval: Yeah.

Dr. Matthew Bernstein: Um. You know, I then was pretty influenced by the work of Robert Whitaker. He wrote this book called Anatomy of an Epidemic. 

Jodi Duval: Mm-hmm. 

Dr. Matthew Bernstein: About, you know, sort of cri critical of the way psychiatry is done. And I was really pretty impressed by the rigor of that research. Mm-hmm. So I was already pretty, um, skeptical of sort of what I was doing.

Dr. Matthew Bernstein: And then we had this very intense personal situation where, uh, two of our children, we have three kids, all boys, and two of them at ages 12 and 14, came down with very acute onset out of the blue, uh, very severe depression, OCD and physical symptoms all at once. 

Jodi Duval: Wow. 

Dr. Matthew Bernstein: And, you know, they went from being happy, well adjusted kids to not even being able to go to school, um, you know, being suicidal, like really, really severe symptoms.

Dr. Matthew Bernstein: Unable to read, even though they were avid readers beforehand, their, their brains weren't working. 

Jodi Duval: Oh my goodness. 

Dr. Matthew Bernstein: And, you know, the traditional [00:04:00] paths that we knew about, uh, looked very psychiatric. We were taking them to good psychiatric clinicians and therapists, and they were getting not only no benefit from that, they were, it was actually making them worse.

Dr. Matthew Bernstein: Mm-hmm. So that was a really, you know, difficult reckoning for myself and, and my wife, who's a psychologist. And we really started looking outside of mainstream medicine for solutions. Sort of found our way to functional medicine, eventually figured out that they had, um, autoimmune encephalitis due to tick-borne illness, mold exposure, other toxins.

Dr. Matthew Bernstein: Um, and it was a huge journey of trying to figure out how to get them better. Mm-hmm. And during the course of that, I was learning all this functional medicine and my mind was just blown because I realized that. My traditional training was just scratching the surface of what's going on in the body. 

Jodi Duval: Yeah.

Dr. Matthew Bernstein: Um, and through that process I also got exposed to the work about the ketogenic diet in epilepsy [00:05:00] and saw that it was now being applied in serious mental health conditions as well, and that people were having these amazing turnaround stories. People who had been decades of psychosis, even taking the strongest anti-psychotic medications, their illness was going away completely from being in a ketogenic state for three to six months.

Dr. Matthew Bernstein: Yeah. Which is, you know, at when I first heard about that, I was in a lecture hall at McLean Hospital at Harvard, and I think there were probably 200 people in the room, and I think I was the only one that actually believed what. The lecturer was saying, 

Jodi Duval: I can imagine. I can imagine. 

Dr. Matthew Bernstein: They were 

all 

Jodi Duval: just like, oh, nutrition doesn't fix this.

Dr. Matthew Bernstein: Exactly. Yeah. And it would've been probably my response had I not already had the experience that I had with my kids. Sometimes it does take, you know, your own, you know, something big to sort of shake things up. Absolutely. 

Jodi Duval: Absolutely. 

Dr. Matthew Bernstein: Anyway, you know, that that sort of began my, you know, when my kids started getting better.

Dr. Matthew Bernstein: I had enough time and resources to devote [00:06:00] to figuring out what I wanted to do with this information. And I think for the people that I work with, I really think that of all the interventions that I learned about in all of functional medicine, this is the most powerful one for the brain for, for severe I mental health issues.

Dr. Matthew Bernstein: Yeah. It's incredibly powerful. And it's, you know, it's not that hard. It doesn't require, you know, you know, going to six different independent labs and taking, you know, 20 different supplements. You know, some of these, you know, protocols that we come up with are really effective, but they could be hard to follow and, you know, takes a lot of executive functioning to follow these protocols.

Dr. Matthew Bernstein: Whereas this is, people need to eat three times a day or two or three times a day anyway. Mm-hmm. If we just make the food. Such that they're going to be in a ketogenic state and otherwise, you know, whole Foods and, um, you know, there's more to it than that, that we can have an enormous benefit on these very severe mental health conditions.

Dr. Matthew Bernstein: And that's exactly what I've been [00:07:00] seeing now for, you know, about four or five years since I've been doing this in my practice. Mm-hmm. Um, I'm just absolutely blown away by how powerful it is. 

Jodi Duval: Incredible. I can't wait to dive into all the detail on you, uh, with this, with, on that, with you. Yeah. Um, but I, I, I must say like the most incredible stories and the, the, the most incredible, you know, thought leaders and, and movement makers are the ones that come with stories.

Jodi Duval: Like, like you, you know, you with, with your own family or your own health, or your own children's struggles. And it, it really does, you know, we sort of land in that place, don't we? To, to be taught these things, to make the changes. And it's very hard to go through and it's, it's so incredibly, um, you know, heartbreaking to see.

Jodi Duval: I've got two kids myself and, you know, you're, you, you, it's the parent's worst nightmare. To have something like these things come to and happen to your children, you wish it would happen to yourself. Um, but to be able to remedy and support and research and come out stronger at the end is just [00:08:00] such an incredible thing.

Jodi Duval: So. Um, yeah, I, I really empathize with you. It's, it's a really hard thing to go through. Yeah. 

Dr. Matthew Bernstein: Thank you. 

Jodi Duval: Um, so I want, I want to first define before we, you know, dive into to ketogenesis and how you've been using this in your practice and, you know, indications and how you see this. But you know how the, the term metabolic psychiatry.

Jodi Duval: Yes. So explain this. 'cause I wanna make sure that everyone starts to hear this more because the more reading I did on what you've been doing and, and what I'm seeing is I couldn't be more on board with this. And I think it's, we need to spread this wide and far. 

Dr. Matthew Bernstein: Yeah, absolutely. 

Jodi Duval: Yeah. 

Dr. Matthew Bernstein: Well, yeah, I mean I think it really, uh, highlights.

Dr. Matthew Bernstein: Fundamental bidirectional connection between metabolic health and brain health. 

Jodi Duval: Hmm. 

Dr. Matthew Bernstein: That those are so closely connected, so intertwined. They're almost the same thing. Mm-hmm. That the way one's brain functions is almost a direct result of one's metabolic health. Um, and there's a lot of reasons for [00:09:00] that.

Dr. Matthew Bernstein: One is that the brain is the most energy intensive organ in the body. Metabolism is a lot about making energy. It's not just that, it's other things too. It's about making building blocks and getting rid of waste and all of these various reactions. But a big part of it is about making energy. And the brain is about 2% of the weight of the body, and it's at any one point using 20 to 25% of the body's energy.

Jodi Duval: Yeah. 

Dr. Matthew Bernstein: Wow. Um, and so when there's an energy problem in the body, it's going to be reflected in how the brain functions For sure. And you compound that with this rampant, um, almost epidemic of insulin resistance that we have based on the way we've been told to eat by our governments for the last, you know, 50 or 60 years to eat.

Dr. Matthew Bernstein: You know, 50% of our calories from carbohydrates and 10% of our calories can be from simple sugar. And of course people are eating a lot more than that in terms of the sugar. Um, you know. Huge percentages of our population have [00:10:00] insulin resistance or pre-diabetes or diabetes. Mm-hmm. It's the majority of people in, in the US meet criteria for one, you know, one of those three conditions and they're just a continuum, essentially.

Jodi Duval: Yeah. 

Dr. Matthew Bernstein: Um, and so it's not a coincidence that we're also having a mental health crisis because these things are so connected. 

Jodi Duval: Yeah. 

Dr. Matthew Bernstein: Um, and there's actually, you know, so there's data showing these bidirectional connections. You know, if you have diabetes or cardiovascular disease or obesity, you're much more likely to end up with a mental health diagnosis.

Dr. Matthew Bernstein: Mm-hmm. If you have a mental health diagnosis, you're much more likely to end up with diabetes or metabolic syndrome or obesity. We know that in adults we see that, but that's really correlation. Mm-hmm. You know, it's not necessarily causation. There's some hints of causation. In the literature though, there's this really interesting study where they looked at kids and followed their metabolic health until they got to be young adults.

Dr. Matthew Bernstein: Mm-hmm. And they saw in the kids who had the highest insulin levels at age nine, there was a threefold increased risk in [00:11:00] psychotic disorders like schizophrenia in their twenties. And so we can see that you start off with the metabolic health issue, bad, you know, very severe mental health problem later.

Dr. Matthew Bernstein: Mm-hmm. Same thing with the kids who gained the most weight during puberty. Fivefold risk of increased risk of depression, major depressive disorder. So yeah, this is, you know, this is really concerning. And, you know, because our metabolic health is getting worse and worse every year. It's not something that's, you know, sort of stagnant.

Dr. Matthew Bernstein: It's like, it's, it's absolutely exploding. Yes. Um, just one other, um, statistic. The rate of diabetes in the US is for type two diabetes, it's around 11 or 12% now. Which is an of adults. It's an enormous number. And unfortunately quite a few kids too. But that's the number for adults. In 1960, it was 1%. 

Jodi Duval: Wow.

Jodi Duval: That is 

Dr. Matthew Bernstein: so, I mean, we're just, you know, we're, we're sters, we're completely different metabolic creatures, you know, organisms than they when we were, you know, just, [00:12:00] you know, decades ago. Um, 

Jodi Duval: absolutely. My goodness. 

Dr. Matthew Bernstein: Yeah. 

Jodi Duval: And kids, you know, in my practice, my naturopathic practice, I am seen at scary levels as well.

Jodi Duval: I've just done a thesis on eating behaviors and diadic responses with, um, parents and in infants may mainly, but it starts then, you know, and it even starts in the mother. We have metabolic conditions through in pregnancy, and then we obviously have tendencies through with children and then feeding patterns.

Jodi Duval: So it starts with the parents, but the, the rise in insulin levels that I see in children, 'cause I measure insulin levels in all my kids because I need to know now because I, after a few cases where I've. Where we've missed things and haven't even measured for celiac disease and inflammation disorders.

Jodi Duval: You know, it's, it's scary. I never ever saw 10 years ago in practice kids with high insulin levels. 

Dr. Matthew Bernstein: Yeah, 

Jodi Duval: absolutely. It blows me away. 

Dr. Matthew Bernstein: It's amazing. Yeah, it's amazing. Yeah. And it's, you know, so, you know, so that's the fundamental issue is that we've got this metabolic milieu, this [00:13:00] crisis of metabolic health, and it's.

Dr. Matthew Bernstein: Then we start scratching our heads, well, I wonder why there's such a rise in anxiety and depression and autism and A DHD. And you know, I think the idea is that these things are closely connected and, um, you know, even the, this is even more challenging because even people who have a normal insulin level 

Jodi Duval: mm-hmm.

Dr. Matthew Bernstein: Um, and you think, oh, well this person's not insulin resistant. That doesn't mean that their brain is not insulin resistant. So this is another thing that's really important to understand because, um. Organs become insulin resistant at different rates. And so someone could have a normal insulin, their normal hemoglobin A1C, and yet we know from, from good research that their brain could be insulin resistant.

Dr. Matthew Bernstein: And brain insulin resistance is associated with all the major mental health issues. Schizo schizophrenia, depression, bipolar Alzheimer's disease is all associated with brain insulin resistance. Mm-hmm. And so [00:14:00] we can still get benefits even with people who look like they, you know, they, they don't have an insulin resistance problem.

Dr. Matthew Bernstein: We can still get benefits with this intervention with those people. And I've seen that now multiple times where normal looking blood work. The ketogenic diet is still incredibly powerful and it doesn't just work through, you know, bypassing insulin resistance. We can get into the mechanisms later if you want, but there's other mechanisms as, as well that, you know, through which this diet works.

Dr. Matthew Bernstein: And, um, so it's not, you know, it's a big part of the story, this insulin resistance, but it's not the only mechanism. Yeah, 

Jodi Duval: yeah. All right. I think that's a good segue actually, 'cause um, let's sort of set the scene in terms of mechanisms. Yeah. And we, you know, talk about primary fuel and, you know, I have this sort of argument with people all the time, well, primary fuel is glucose in the brain, so why do you need care?

Jodi Duval: And so, you know, but that, I think explaining that sort of mechanisms around, you know, how this works. And I think that would be a great leading and, and even, um, testing and markers, you know, we, we do a lot [00:15:00] of, um, metabolite testing here at SNH, um, and in my own practice as well. And so, um, yeah, any insight into how you look and, and without going straight into protocols, but even if you can tie in some of that with a mechanism.

Dr. Matthew Bernstein: Sure, sure. Yeah. So in terms of mechanisms, the one we've been talking about so far, we'll start there. Mm-hmm. So the, the brain, you know, largely does run on glucose. People are not wrong about that. And even in a deep ketogenic state, the brain still uses glucose. It's never gonna stop doing that. So, but what we are providing though, when the brain is insulin resistant, it could have glucose literally bathing these neurons, but the glucose can't get into the neurons for use of fuel.

Dr. Matthew Bernstein: Because of that insulin resistance blockade and ketones bypass that blockade. They don't need insulin to get into neurons to be used for fuel. So we're providing this additional source of fuel when the neuron is. Uh, having an energetic crisis, which is happening right on a regular basis for most people, and that's [00:16:00] manifesting as these mental health symptoms.

Dr. Matthew Bernstein: But we're bypassing that energetic crisis with the ketones. They're this great additional source of fuel. Mm-hmm. Um, so, and, and what that does is it reduces oxidative stress because when the brain cells, when the neurons are starving for fuel, they're creating a lot of oxidative stress. Mm-hmm. Um, and inflammation.

Dr. Matthew Bernstein: So we're gonna reduce oxidative stress, reduce inflammation, um, and provide this additional source of fuel. So, so that's all a very important mechanism. Mm-hmm. But the other really big important mechanism is that ketones are a signaling molecule as well as being a fuel molecule. 

Jodi Duval: Yeah. 

Dr. Matthew Bernstein: And they signal to the mitochondria to.

Dr. Matthew Bernstein: Go through mitochondrial biogenesis to split and make more of themselves. Um, and it causes the mitochondria to, uh, do more autophagy or, you know, essentially recycling of mitochondria, the old, non-functioning mitochondria, and making new, better functioning ones. 

Jodi Duval: Mm-hmm. 

Dr. Matthew Bernstein: And, you know, mitochondria, [00:17:00] you know, super important as you know.

Dr. Matthew Bernstein: Mm-hmm. Uh, not just for producing energy, but now, you know, in the last, you know, 10, 15 years we've seen an explosion of research of all the other things that the mitochondria do. 

Mm-hmm. 

Dr. Matthew Bernstein: Um, besides just make energy. Um, and, you know, so when you have these healthier, better functioning, and more numerous mitochondria, everything's gonna work better.

Dr. Matthew Bernstein: And the brain can literally heal from all of these insults that have been happening over the years, um, by, you know, giving that signal to the mitochondria. Yeah. We, we literally see the brain heal right in front of our eyes. It's absolutely astounding. 

Jodi Duval: Yeah, it, it, it really is. It really is. I, and obviously I'm preaching to the choir here, but, um, it's, you know, I've seen it even, I've had, um, clients this year, two clients with Gillian Bear Syndrome and the incredible change in diet with the, you know, recovery that they would were doing, um, was just astounding.

Jodi Duval: And then that [00:18:00] combination with some other therapies that we use in clinic, like hyperbaric, oh my gosh. You know? Yeah. You're just elevating that healing process so much. But the diet is, you know, it is just, it's so astounding how the ketogenic model can work across so many different fields as well. 

Dr. Matthew Bernstein: Right.

Jodi Duval: Mm-hmm. 

Dr. Matthew Bernstein: Yeah. Yeah. And of course, it, it started in epilepsy and I just wanna back up that claim about healing a little bit. Mm-hmm. Because there's actually really good data in epilepsy that proves that this diet can heal the brain. So I just want to go into that for a second. 

Jodi Duval: Mm, absolutely. Um, 

Dr. Matthew Bernstein: so, you know, the ketogenic diet's been used in epilepsy for over a hundred years.

Dr. Matthew Bernstein: It was invented to treat epilepsy in the Mayo Clinic in 1921. Mm-hmm. There were some precursor versions of it. Even a hundred years before that for diabetes. And, and there's probably some version of it that was used by Hippocrates, an ancient crease where they were, you know, starving people of carbohydrates and really, uh, fasting people to generate ketones and solve seizures.

Dr. Matthew Bernstein: Uh, so anyway, we've had this strong data for epilepsy in kids, and it works even when the medications don't work. [00:19:00] So that's been shown in randomized controlled trials. There's two Cochrane reviews that validate that it's a treatment that is effective even when medications are not effective. But what they've also seen in a few different studies now that they've published, is that these kids who have a really good response to the ketogenic diet for their epilepsy, they can be on the diet for a few years, come off all their medications, get their seizures under control.

Dr. Matthew Bernstein: After a few years of being on the diet, they can come off of the diet and the seizures never return. 

Jodi Duval: Huh. 

Dr. Matthew Bernstein: Which means we've healed the problem. 

Jodi Duval: Yeah. 

Dr. Matthew Bernstein: Uh, we have very few things in, you know, medicine in general that truly heal, especially the brain. You know, the brain is, you know, you know, often was used to be considered, you know, not having the ability to generate new neurons.

Dr. Matthew Bernstein: You know, we can't generate new brain cells. We all know that that's not true anymore, but mm-hmm. We still think of it as one of the, you know, one of the organs that's the hardest to heal of them all. Yeah. Um. This diet actually, you know, [00:20:00] there's real data showing that it heals an analogous, you know, brain condition epilepsy, which is astounding.

Dr. Matthew Bernstein: Um, and you know, and now we're seeing all of these, you know, case reports and pilot trials in mental health and just, you know, literally thousands of stories of people who are turning their lives around, um, using this intervention. 

Jodi Duval: Yeah, it's absolutely incredible. Uh, I'm going in so many different directions in my mind as you're saying this, but you know, there, there's so many connections with, with brain, and when we think about mood and we think about gut and we think about all these things, and the ketogenic diet is helping support all of those energy systems because of the inflammation, because of the insulin, because of the inflamm, you know, it's regulating those systems.

Jodi Duval: So like you say, it's, it's one of these, um, therapies that we can use that is changing function. And so a lot of these medications that we use, they are really me merely just band-aiding function. That's right. Um, it, it's, yeah, it's, it's very cool. Very, very cool. 

Dr. Matthew Bernstein: Yeah. 

Jodi Duval: So diving in, well, you know, diving into [00:21:00] more around, um, or outside of the mechanisms now into yeah.

Jodi Duval: Indications and therefore, you know, looking at, you know, how you measure this. So how are you using, um, continuous keto monitors? Are you using, um, in terms of just the diet? Are you using supplementation as well? And then how do you know that they are at that right level? You know? So is there specific things that you would do prior to seeing clients or starting them on the ketogenic diet?

Jodi Duval: So maybe let's just talk through some of those steps. 

Dr. Matthew Bernstein: Sure, yeah. You know, I do a whole, uh, lab panel looking at mm-hmm. Metabolic status and nutritional status. Um, to, before we start, just to give us a baseline. 

Jodi Duval: Yeah. 

Dr. Matthew Bernstein: Uh, there's usually nothing on that panel that would rule someone out from doing this. Okay.

Dr. Matthew Bernstein: Um, and really, uh, there's no mental health condition. Pretty much where I wouldn't wanna try this if someone wants to do it. 

Jodi Duval: Hmm. 

Dr. Matthew Bernstein: It works in all of the mental health [00:22:00] conditions that it's been studied in so far. Okay. Um, and so it's not like I can say, well it works in bipolar but it doesn't work in schizophrenia.

Dr. Matthew Bernstein: Or it works in depression, but it doesn't work in OCD. It works in all of them. 

Jodi Duval: Hmm. 

Dr. Matthew Bernstein: Um, including, there's even data that it works in anorexia, which is another one I was 

Jodi Duval: gonna ask you about eating disorders actually. Yeah, 

Dr. Matthew Bernstein: that's 

Jodi Duval: my next question. 

Dr. Matthew Bernstein: It's, it's great for binge eating disorder and people were a little scared to apply it in anorexia, but there was initially a case report, um, and actually know the people, uh, who are involved in that.

Dr. Matthew Bernstein: Um, essentially, you know, someone who is. Been through anorexia treatment for, you know, 15 years, never really got better. Mm-hmm. And, um, a family member, uh, who was a physician suggested the ketogenic diet and they found someone to implement it. Um, and this person had an amazing response and then actually was still having a little bit of food noise even after the ketogenic diet and ended up doing a couple of ketamine sessions and, um, [00:23:00] it all completely went away.

Dr. Matthew Bernstein: And this person's now been in complete remission for at least five years now. And then they did a case series of another five women with weight restored anorexia, and had also a tremendous response. Now there's two large trials going on at University of California San Diego, where they're studying the ketogenic diet in, uh, young women with anorexia.

Dr. Matthew Bernstein: Mm-hmm. Um, and there's a whole basic science component. The, um, investigator has a theory that people put themselves. Into an anorexic state, partly to get into a ketogenic state. They can become addicted to kind of being in ketosis. 'cause when you're, you know, starving yourself, you're in ketosis and it's actually treating a fundamental underlying anxiety that they have.

Dr. Matthew Bernstein: Um, and so that's part of the behavioral, um, addiction to starving oneself for some of these young women is that they're, they, they don't realize it, but they're putting themselves into ketosis. And so the, the idea is, let's make a, a regimented rule of, of a plan where you can feel that just that [00:24:00] way, but you don't need to starve yourself.

Dr. Matthew Bernstein: And, and, and it's really effective it seems. Um, so, so, 

Jodi Duval: and night that innate, that innate and leading to, um, reducing food even when we're unwell in any term. Yeah. 

Dr. Matthew Bernstein: Right. 

Jodi Duval: That it, it's pushing us into that ketogenic state to then have more function in the mitochondria. That's, it's incredible to signal to. It makes sense.

Jodi Duval: Yeah. 

Dr. Matthew Bernstein: It's, yeah. I mean it's e evolutionarily preserved signal. Exactly. Exactly. And of course we evolve going in and out of ketosis. That's another thing that, you know, it's important to say that it's not like that we invented this in the modern world, or even in ancient Greece, you know, millions of years ago are, you know, evolutionary forebearers were absolutely going in and out of ketosis all the time because there wasn't a steady supply of food.

Dr. Matthew Bernstein: And ketones are a survival molecule. They're what allowed people, this allowed us to be here now. Mm-hmm. If there weren't ketones, we never would've made it because they essentially allowed the brain to function really well, [00:25:00] um, when there's no food. In fact, the brain functions better when there's no food, when they're in, when the brain's in a keto state.

Dr. Matthew Bernstein: And so it ensure survival when there was no food for a few days. People didn't get hangry and tired and, you know, discouraged. They were, had ketones on board and they said, you know, we're gonna figure out how to solve this problem. And they, they had the brain power to solve that problem. 

Jodi Duval: Yeah. 

Dr. Matthew Bernstein: Um. Yeah. 

Jodi Duval: I love that.

Jodi Duval: I love that metabolic, um, flexibility term. Just I explain it to my clients in that way because a lot, I get a lot of clients who are insulin resistant. Yeah. And they are shaky and hangry and, and have all these symptoms in between meals. And I had clients that are actually fearful of not, or having breaks between eating.

Jodi Duval: 'cause they know how bad they can feel. That's right. Um, and giving them the power back to be able to actually feel comfortable when they don't eat. And have that fasting state and feel still clear. You know, I know now my body is very good at metabolic flexibility, so I'm actually better if I can be in a ketonic state when I can be talking and [00:26:00] speaking.

Jodi Duval: And with clients I'm much more clearer. But seeing and, and showing clients how that feels is very empowering for them. They, they are blown away how they, they can be so clear with no food. 

Dr. Matthew Bernstein: I agree a hundred percent and I had that same experience myself. Mm-hmm. I was definitely, before I learned about all this, I was eating, trying to be healthy, but I would eat a lot of fruit and I was definitely insulin resistant.

Dr. Matthew Bernstein: I had to eat five or six times a day to be able to keep my brain going. Um, and then, you know, I went through a period where I said, you know, decided to do this. Lowered my carbohydrates, but I also did some fasting became metabolically flexible. And it is not just empowering, it's liberating. Yeah. I mean it's an, it's, you know, you feel trapped.

Dr. Matthew Bernstein: I used to have to take snacks with me everywhere I went because I knew I might need one, you know, to be able to function. And now I feel like, well, I'm walking around with all the fuel I need and, you know, I don't have to worry about that anymore. It's, it's a very liberating feeling. Yeah, 

Jodi Duval: it is. Yeah. But we've, I've been, um, trailing and hiking in the [00:27:00] flat, the flat irons here, um, in Colorado.

Jodi Duval: And I can leave and just like not have breakfast and walk out on an hour and a half hike. And I know I'll be fine. I have great amounts of energy and that for me is like, I can live my life and I can be metabolically flexible and I don't have to worry about when my next meal's gonna come. 

Dr. Matthew Bernstein: Right. 

Jodi Duval: Yeah. So what, I know you said that there's no real, there's no conditions as such that will exclude a ketogenic diet, but is there any that you can think of, um, that you would, would maybe go in a different direction first or not not do a ketogenic?

Jodi Duval: Yeah, 

Dr. Matthew Bernstein: yeah, yeah. Absolutely. Yeah. I don't wanna overstate it. I mean, if someone is in the midst of an acute psychiatric crisis 

Jodi Duval: mm-hmm. 

Dr. Matthew Bernstein: We probably wouldn't say, let's do a ketogenic diet right now. 

Jodi Duval: Yeah. 

Dr. Matthew Bernstein: Uh, you know, if someone is acutely, uh, psychotic and, you know, behaviorally outta control, they can't, first of all make the decision to do this kind of big intervention of course, at that moment and probably can't follow it.

Dr. Matthew Bernstein: So, you know, an acute medic, medical or psychiatric crisis definitely would be something we wouldn't do if [00:28:00] someone's really underweight from their anorexia. I think. Most people are not bold enough to do that. Although I did just speak with some dieticians over the weekend. I was speaking at a conference with dieticians and uh mm-hmm they were telling me that they do.

Dr. Matthew Bernstein: Sometimes, you know, if someone is at the end with anorexia and they're have a feeding tube, uh, there are sometimes now, um, people who are saying, well, this is our chance. Let's do the ketogenic diet. As a last ditch effort. And, um, sometimes it's helpful because, you know, anorexia is the most fatal of all the psychiatric conditions actually.

Jodi Duval: Yeah. So 

Dr. Matthew Bernstein: sad. So, um, so, so there and, and there's a few others, there's a couple medications that we can't combine the ketogenic diet with. Um, some of the, there's one diabetes me class of diabetes medications, the SGLT two inhibitors. Um, you know, a few other things where there's, you know, relative concern, but we still could forge ahead.

Dr. Matthew Bernstein: Mm-hmm. But, but generally in terms of like which psychiatric diagnosis mm-hmm. You know, you know, we really can use [00:29:00] it in almost any of them. There's probably the most data on bipolar disorder though, so that's, you know, one where it really seems to shine, uh, the most. Mm-hmm. Mm-hmm. Uh, but we're seeing incredible benefits in, in actually these chronic psychotic disorders as well, for which there's really no.

Dr. Matthew Bernstein: Good treatments. Um, you know, the antipsychotics sometimes reduce symptoms, but they have so many side effects and they often don't take away the symptoms either. So it's frequently people are coming to me, they're on two or three antipsychotic medications at once, plus some mood stabilizers and there's so many side effects and mm-hmm.

Dr. Matthew Bernstein: They're still having all the symptoms. 

Jodi Duval: Mm-hmm. Yeah. I say 

Dr. Matthew Bernstein: they do. Yeah. And so, you know, with those folks, it's really a great intervention because we can get their energy back. We can start the process of lowering these medications and hopefully getting them off. Many of them. Um, and people get their energy back.

Dr. Matthew Bernstein: They get their thinking and their cognition back, and then [00:30:00] often if people are able to stick with it, those psychotic symptoms start going away as well. And. Sometimes they go completely away on the ketogenic diet, which is just amazing. These people, you know, again, just like epso epilepsy where the medications didn't work, this intervention can work.

Jodi Duval: Yeah. 

Dr. Matthew Bernstein: Um, 

Jodi Duval: yeah. And it's so accessible, and this is why I love talking about this. I was talking about a co to a colleague yesterday. Um, 'cause I've interviewed many people who are in the, the research space of treatment res resistant depression and body dysmorphia. And you know, we, we, we talk about ketamine a lot.

Jodi Duval: We talk about psilocybin a lot, but they're very, um, quite inaccessible treatments because of the cost, because of the accessibility of country, um, you know, regulations, things like that. And training, you know, having good centers. But a ketogenic diet can be followed by anyone and can be accessed by anyone in as long as you're doing it in a way that is suitable for you.

Jodi Duval: And you have some, you know, guidance in that way. Uh, it, it, it's, it's for anyone. And that's why I feel like this is so [00:31:00] powerful. A powerful as well, you know, powerful treatment. 

Dr. Matthew Bernstein: I agree a hundred percent. I mean, we're putting the power back in the individual's hands that, you know, this is not, I mean, of course it's, it's really helpful and really important to get some guidance from a practitioner or clinician who understands how to do this so that you, you can do it, right.

Dr. Matthew Bernstein: It's, it's easy for people to say, oh, I tried a ketogenic diet, it wasn't for me. And you found out, you know, they tried it for a week or two and they probably weren't in ketosis. Um, yeah. So it is really important to work with someone who can educate you or really figure out how to educate yourself, but once that education process occurs, yeah, this person now has complete control over their health.

Dr. Matthew Bernstein: Um, as opposed to needing a clinician to prescribe them something and do a test, and do a procedure. I mean it, you know, talk about, you know, really helping the, you know, the grassroots from a grassroots level. I mean, this is, this is food and it's, yeah. It's the basics, not 

Jodi Duval: the shiny things. 

Dr. Matthew Bernstein: Yeah. Done just the right way.

Dr. Matthew Bernstein: It really [00:32:00] is the most powerful treatment. 

Jodi Duval: Yeah. So in when you are, when you're seeing clients, those patients, um, and are you, are you seeing any specific compliance issues, you know, or difficulties in the beginning and are you having to use ketone endogenous ketones? Are you having to do, um, yeah. So is there certain parameters that you see that are commonality among treating patients?

Dr. Matthew Bernstein: Yeah. Well, I mean, first of all, we have to get someone interested. You know, that's the art of it in some ways is, you know, I'm talking about something that they've, you know. What, you know, it's same, same response as the clinicians. You know, our whole culture has the same response. Are you kidding me? This is just food.

Dr. Matthew Bernstein: How could it possibly do something that, you know, all of these, you know, expensive medications and doctors who've done, you know, decades of training, can't f you know, do for me. How could it possibly, you know, the solution be in food? Mm-hmm. So there's a lot of convincing and education that has to happen at first.

Dr. Matthew Bernstein: And what we've often do see [00:33:00] actually very common is that families will learn about this and be very convinced they'll learn all about it. And then they'll be trying very hard to convince their family member to do this. And, you know, often they're able to convince their family member, um, and then, you know, of course it's not the easiest thing to give up these addictive foods.

Dr. Matthew Bernstein: You know, people come in. We, we have a, a center, a program where people come in and stay with us. Mm-hmm. And that makes it a lot easier, you know? Mm-hmm. I also do this with outpatients who are doing this at home. Mm-hmm. And, you know. To do it on your own at home, even with a lot of advice and help is a little more challenging.

Dr. Matthew Bernstein: It definitely can be done. 

Jodi Duval: Mm-hmm. 

Dr. Matthew Bernstein: Um, but you know, for people who have a harder time with their executive functioning, they're having a lot of symptoms, they may be having a lot of side effects from the medications they're already on. Um, this program really can be helpful because they come in, they see me, we have this, you know, wonderful.

Dr. Matthew Bernstein: Program director, social worker who does therapy with them. We have a dietician right on site who's crafting the [00:34:00] meal plan. And then we have a, a chef who's making delicious ketogenic food. And so that makes it a lot easier for people. Yeah. And we use a lot of technology. We use, um, continuous glucose monitors.

Dr. Matthew Bernstein: We don't have access to continuous ketone monitors. I can't wait until we can get them in the us. Um, but we don't have them yet. Um, so, but we do check, uh, blood ketone levels at least once a day. Um, we check body composition and follow that parameter, and then we follow their lab work. And we're also measuring their, you know, mental health rating scales and functional rating scales.

Dr. Matthew Bernstein: And, you know, the results we're getting are. Absolutely amazing. You know, when people do the whole program and we can talk a little more about what the whole program is. 'cause it's not only food, um, you know, we, there's more to it than that. A lot of adjunctive things that really go along with the, the diet that can really support it and make it even more powerful.

Jodi Duval: Hmm. I absolutely would love to dive into that, but just to sort of have, have a completion around this, you know, timing of these sorts of protocols. You know, a lot of [00:35:00] people ask me, oh, am I gonna be on this forever? Um, you know, or is it pulsed in and out? Um, is my cholesterol gonna go through the roof?

Jodi Duval: Right. You know, like all these simple things that people are worried about. Right. And it's like, well, you just don't, you wanna get better. Like, you just, yeah. So what, what do you, you know, say to those sorts of things when you're asked 

Dr. Matthew Bernstein: Well. If they're using it for a more serious mental health condition, I tell them that we just don't know the answer to how long they need to do it.

Jodi Duval: Mm-hmm. 

Dr. Matthew Bernstein: The research just, we don't have enough science about that yet for mental health. 

Jodi Duval: Mm-hmm. 

Dr. Matthew Bernstein: I do talk about the kids who you know, only need to do it for a few years with epilepsy, but I say, well, that's also a different disorder, and it's kids whose brains are a little more plastic than an adult, and so I can't promise that.

Dr. Matthew Bernstein: If they're gonna be able to go off the diet and, you know, after a few years and have, retain all their benefits. Mm-hmm. But it's possible. Mm-hmm. I do know a couple of adults who've done it for a few years and come off and are able to retain their benefits. Mm-hmm. So, um, I've seen it a few times. I just can't promise that.

Dr. Matthew Bernstein: Um, so what I say is, you know, first you [00:36:00] gotta try it for three months and see if you're getting benefits. And usually people do, they're getting benefits and they want to keep going. Um, sometimes people say, well, how long? And I say, well, we just don't know. Mm-hmm. Now that you're getting benefits, let's see how good.

Dr. Matthew Bernstein: It, you're gonna feel, you know, after a year of doing this 

Jodi Duval: Yeah. 

Dr. Matthew Bernstein: And we can keep lowering medication so we can get you off more medication. Um, you know, let's just see how good this can get before we start thinking about, you know, the whole end of this story. You know, it took probably many years to get to this situation.

Dr. Matthew Bernstein: It's gonna take some time to heal as well. We, we, you know, we have to be patient, which again, in our culture, you know, hard, uh, you know, we're not, we, we don't learn patience and none of us practice it enough as, as we should. Right. So, 

Jodi Duval: absolutely. 

Dr. Matthew Bernstein: Yeah. Regarding the, the cholesterol issue, you know, I, I have spent a lot of time educating myself about, you know, what all this means.

Dr. Matthew Bernstein: There's a few things you can say. Number one is that if you're starting off metabolically unhealthy and [00:37:00] overweight, carrying extra weight, this is absolutely going to lower your 10 year cardiac risk. Mm-hmm. Um, in a ketogenic state. Mm-hmm. Even if your LDL cholesterol goes up a little bit, all the other parameters get better.

Dr. Matthew Bernstein: If you're starting off thin and somewhat fit and you're exercise and you do this, there is this subclass of people called lean mass hyper responders mm-hmm. Who have a very high LDL on a ketogenic diet and they have a very high HDL as well and extremely low triglycerides, you know, very good. Um, low insulin.

Dr. Matthew Bernstein: And there's a lot of research being done on those folks and it looks like this does not confer. Cardiac risk, even with these super high LDLs. Mm-hmm. But that person would always have the, um, option to take something to lower their LDL cholesterol, whether it be an herbal supplement or a medication if they wanted to.

Dr. Matthew Bernstein: Mm-hmm. I generally would recommend not to because I think, you know, it's not necessary, but if someone was concerned and they were otherwise feeling good, we're not trapped at that point. We [00:38:00] don't have to go off the diet. There's definitely options at that point. Mm-hmm. But there's also reassuring data that even with a very high LDL, if, as long as those other parameters in place and there's low inflammation that we're, we're not, uh, adding cardiac risk.

Jodi Duval: Yeah, no, I absolutely agree with you. I have many a client come to me with these concerns and you know, I do all the homocysteine. We do the folate, we do the B12, we do you the metabolites for those as well. And we do the, you know, high sensitivity CRP, we do, um, you know, as you say, insulin, and it's subsequent of that rising, you know, the fats of the diet that is going to rise the LDL.

Jodi Duval: But if everything else in genetics look good and we do a, you know, cardiac panel and, you know, it's, it's, it's all in the data, isn't it? You know, so it's Right. It's matching that. And it's a very interesting concept, like you said, these hyper responders. Um, and we also know the data around needing to have cholesterol for, you know, that's right.

Jodi Duval: This is the whole premise of what we're talking about today for having good mental health and, and good, you know, brain function. 

Dr. Matthew Bernstein: That's right. [00:39:00] 

Jodi Duval: Mm-hmm. 

Dr. Matthew Bernstein: Yeah. Yeah. I mean, uh, you know, cholesterol is essential for hormone synthesis and, you know, membranes of all the brain cells, you know, of course, incredibly important.

Jodi Duval: Mm-hmm. 

Dr. Matthew Bernstein: Uh, molecule. And, you know, um, it's not to say that. We can guarantee that, you know, a high LDL with other factors is fine. It's not, I mean, there's definitely some concern about high LDL if you're not otherwise taking care of all the other parameters. But what I'm talking about is high LDL in isolation.

Dr. Matthew Bernstein: And also we get this, uh, NMR fractionated, uh, cholesterol panel sometimes where we can see what type of LDL and there's the small dense ones that are more dangerous. There's these large, fluffy ones. If they have the right pattern, that's another reassuring sign. And finally, if someone really was worried still and they weren't sure if they wanted to go on a medication, we can always get, um, a cardiac calcium score or even a CT angiogram to really see.

Dr. Matthew Bernstein: Is there any, that's the gold standard, not LDL measurements at all of heart disease. You know, the gold standard is looking at [00:40:00] the vessels, which now is accessible with imaging and without invasive imaging. So. 

Jodi Duval: Yeah, absolutely. No, I love that you comment on all of this. It's so good. 

Dr. Matthew Bernstein: Yeah. 

Jodi Duval: Yeah. I, I'm, I see in practice now, actually, in all honesty, I'm worried about two, two lower levels of cholesterol and people on medications because I know to the detriment that is to the brain and the hormones, and so I see this swing now that I'm actually really concerned.

Jodi Duval: Now I see people with really low levels of cholesterol, and it's, it's, it's worrying. 

Dr. Matthew Bernstein: It's definitely worrying. Yeah. There's definitely data about, um, cholesterol being too low, being associated with aggression, violence, and suicide. Um, uh, and so, you know, it's not causal data, but there's definitely an association get, you know, getting cholesterol too low or sometimes it's naturally too low.

Dr. Matthew Bernstein: Um, I had one person in my practice many years ago before I knew about this. I wish I knew about this then. You know, one of those situations who had naturally had extremely low cholesterol, her total [00:41:00] cholesterol was always below a hundred. Her LDL cholesterol was always below 50 with no medication to lower the cholesterol.

Dr. Matthew Bernstein: It's just natural. And she had a very severe mental health condition. Um. And if I, I wish I knew, like I said, you know about this, I would've advised her to, to raise her cholesterol and it might have made a difference. 

Jodi Duval: Yeah. Yeah. My goodness. All right, so let's jump into the program before we run out 'cause I run outta time.

Jodi Duval: Sure. I really wanna run through and get the complete contextual look at what other things that you use in conjunction with this. Um, so yeah, let's step through that. Sure. 

Dr. Matthew Bernstein: You know, synergistic with the ketogenic diet absolutely is exercise. Mm-hmm. Um, and so we get people moving their bodies no matter where they're starting, we're going to, you know, get them moving and increase their movement.

Dr. Matthew Bernstein: Um, so we get 'em in the gym, we get 'em doing some strength training. Um, we have people walking after each meal and out in the sunlight. Um, which is also another part of the program mm-hmm. Is, you know, morning sunlight. Sunlight throughout the day, multiple times [00:42:00] throughout the day to entrain our circadian rhythms, which is so important.

Dr. Matthew Bernstein: But also light is a nutrient for the mitochondria as well. And so we're giving the mitochondria of multiple signals there, you know, from the diet, from the ketones, from the exercise, from light. And then finally we give the mitochondria safety. And so everyone we try to convince to do a regular mind body practice, whether it's a breathing practice or a meditation practice, or some people like doing more movement based mind body practices, but there's so much good evidence now about.

Dr. Matthew Bernstein: Mind body practices being not just good for mental health, but good for metabolic health. 

Jodi Duval: Mm-hmm. 

Dr. Matthew Bernstein: And you know, again, it's giving that safety signal to the mitochondria, um, so that they can, you know, take care of the cell and make the cell function. Yeah. 

Jodi Duval: I love this. The cell danger response. And this is the thing is that we just get these, um, you know, hyper responds and there's never completion cycles here.

Jodi Duval: So, and it's, it's this psycho neuro immunology that's spoken [00:43:00] about so much now is that we are having these overarching threat systems that are always thinking that everything is out to get them. And I love that you use the term safety, 'cause I use this a lot too. 'cause it really explains that we need to have the body safe.

Jodi Duval: Yeah, that's right. 

Dr. Matthew Bernstein: Yeah. We, we, we see this all the time in the program. If someone is doing everything right. But they're not taking care of that part, that mind body piece, that safety piece. 

Jodi Duval: Yeah. 

Dr. Matthew Bernstein: See problems. Um, and so like for example, it's pretty frequent. People will come up to us and say, you know, what's going on?

Dr. Matthew Bernstein: My continuous glucose monitor is telling me that my glucose is all the way up at 150 and I swear I didn't eat any carbohydrates or sugar. And you know, the first question we ask is, well, what's going on with your anxiety right now? And they say, oh, well it's through the roof. I'm practically having a panic attack.

Dr. Matthew Bernstein: I'm scared about this and this and this. And we say, okay, let's, let's breathe. Let's do a breathing exercise. Five minutes later, the glucose is down in the normal range, down [00:44:00] to 90. It's an amazing demonstration and learning experience about this mind body connection that just having anxiety, panic will cause your whole metabolic system to change and just calming down that anxiety.

Dr. Matthew Bernstein: Getting to safety and your metabolic health improves in five minutes. 

Jodi Duval: Yeah. 

Dr. Matthew Bernstein: Um, and like when that happens, it's a great opportunity because people really get it. They're like, oh, okay, now, now I understand what you're talking about, how important that part is. Right. Um, and it's very important. Yeah. 

Jodi Duval: I saw this first happening myself when I was wearing a CGM and I, um, I live near the ocean in Australia and so I hopped into the ocean and then I looked at my data at the end of the day and the time, the exact moment I walked into the ocean and went for a swim, my glucose dropped.

Jodi Duval: Like there was nothing else. And that happened multiple times. I repeated the experiment, I'm like, wow, ocean work drops my glucose and so amazing. Yeah. Other things like stress, you know, work and everything. No, no [00:45:00] food involved in that and up goes my glucose, so exact same mechanism. It's just incredible.

Dr. Matthew Bernstein: Absolutely. It's really powerful. The other thing, great thing about the CGM is we see people's, you know, glucose hover on the low end as well when they're in a good ketotic state. 

Jodi Duval: Mm-hmm. 

Dr. Matthew Bernstein: Um, and people say, well, you know, isn't this a problem? Like, you know, the alarm is going off, we, then we shut the alarms off.

Dr. Matthew Bernstein: Of course. Um, but you know, they say This is a problem. My glucose is, you know, 53, you know, isn't this a problem? Do you feel okay? No, I feel great. I have all the energy I need. And it's, again, another demonstration of, you know, the energy is not just from glucose. You're, you've got your energy now, you know, working well from these other sources.

Dr. Matthew Bernstein: You've got fatty acids and ketones fueling yourself. You don't need as much. Your body's saying, we don't need as much glucose right now. Your, your liver's not gonna make as much and release as much. Great. Yeah. You know, this is, this is, again, this is a sign that everything is working as it should. 

Jodi Duval: Mm-hmm.

Jodi Duval: Absolutely. So [00:46:00] we've gone through lifestyle, we've gone through diet, we've gone through, um, education, you know, talking through, showing them how to make, so it's an incredible program that you've got there. Is there anything else in terms of supplementation or the, as I said, exogenous ketones or anything that you're actually using as a buffer or a, you know, a supporting, um, external influencer?

Dr. Matthew Bernstein: Yeah. Well, we don't generally use exogenous ketones. Often we do use MCT oil, which is sort of a, you know, hybrid, you know, it's, it's not exogenous ketone. It's a, it's a fat molecule, medium chain triglyceride. Hmm. It does, it's a very ketogenic fat, and so it is a way to help people, especially in the early stages, who are not used to eating so much fat.

Dr. Matthew Bernstein: Mm-hmm. If they can get a little MCT in a smoothie or in their coffee or some other way, then we, we can boost the ketones, um, that way without needing to eat quite as much fat so that we do use that. And then supplementation is really based on [00:47:00] the individual situation. So, you know, you know, if someone has, you know.

Dr. Matthew Bernstein: Issues on their lab work that I can see, we will supplement based on that. I do tend to see, um, elevated homocysteine levels a lot. It's very common. Mm-hmm. And of course the lab tells us this ob absurd number that it's okay to be up at, you know, 13 or 14 or something. And, you know, we, we wanna see them much lower.

Dr. Matthew Bernstein: Um, the other one that we test for is carnitine. Very important tests when you're doing ketogenic diets. It's an amino acid that, um, allows the fatty acids to get through the inner mitochondrial membrane for useless fuel. And if you run out of carnitine, you know you're gonna run out of the ability to, to be in a good ketotic state.

Dr. Matthew Bernstein: Uh, and so we check that in the beginning. We do check that at month one. It's associated low. Carine is also associated with depression. Um, so that's an important one. And we do end up. Supplementing carnitine sometimes. Um, and then there's just some ones that a lot of people just benefit from it.

Dr. Matthew Bernstein: Someone's energy is kind of low, even though they're [00:48:00] doing the right things. We might supplement with some creatine as well, which give them some energy for workouts. And also there's now some good data about it, helping with mood and cognition and bone health. So, um. So creatine is a, is a really good supplement too.

Dr. Matthew Bernstein: Uh, but I try to be a little bit minimalist when it comes to supplements. Yeah. Because I know how hard it is for people to take. They're already taking all these medications, we're asking them to do all these lifestyle changes. Yeah. And so I only want to use the ones that are, are really important for that person.

Dr. Matthew Bernstein: I thought of another one that's important that we do see a lot is low iron. Um, which is really interesting because, you know, the, the lore is that, you know, only, you only see low iron in, you know, menstruating women or someone who has some kind of bleed, but. Low iron is rampant in the population that I see.

Jodi Duval: Mm-hmm. 

Dr. Matthew Bernstein: Including young men, um. Mm-hmm. And, you know, I could do a full panel with ferritin and so even sometimes their iron is okay, but their fer, their storage is very low. Um, and so, you know, sometimes, we'll, depends on the severity of it. Sometimes we'll [00:49:00] see if the diet will fix that. Um, uh, 'cause it could be an absorption issue.

Dr. Matthew Bernstein: I think for, I, I don't really know the, the reasons, I don't know the answer, but, mm. My, my hypothesis is that there's an absorption issue with the standard diet that people are eating. Yeah. Um, but it could be, you know, more than that with some people. And if it's really significant, we'll certainly supplement that as well.

Jodi Duval: Yeah. Yeah. I love iron mechanisms and biochemistry, so because again, I have a, a client need and demand for it. I have so many women, children, men, athletes come in and they are so low in their storage, and so I dive deep into iron metabolism and it's really fascinating. It is more of this evolutionary perspective of information and the hepcidin and the storage.

Jodi Duval: And so I also see it in illness and sickness, obviously, you know, the pool back of the storage and the rising hepcidin. So we actually have, if we have long-term chronic inflammation like your patients would, um, yeah. Then iron is always at an evolutionary point of protection, so it doesn't actually want to be.[00:50:00] 

Jodi Duval: Out into the bloodstream. So then, you know, pathogens can fade, right? So I see over time that the body learns to actually have a lower storage or learns not to actually have that absorption rate. So yeah, it fascinates me. 'cause I was also at the same point going, what, what's, what's going on with everyone?

Dr. Matthew Bernstein: Right? Right. 

Jodi Duval: These people aren't menstruated. Like they, they don't have heavy bleeds. What's going on? No. Yeah. Thank 

Dr. Matthew Bernstein: you. 

Jodi Duval: It's a fascinating thing. Yeah. And then thyroid obviously has such an impact and 'cause it is such a key nutrient or mineral for so many other markers, um, and enzyme reactions and, uh, systems that, yeah, it, it puts everything in a, a really bad state.

Dr. Matthew Bernstein: Yeah. Yeah. And of course iron, uh, you know, people think of it about it just as, you know, helping to make red blood cells, but we now know that it does so many other things, but especially it's part of those electron transport chain proteins in the mitochondria. 

Jodi Duval: Yes. 

Dr. Matthew Bernstein: And so if you don't have enough iron, your mitochondria can never function optimally.

Dr. Matthew Bernstein: Right. So, you know, this whole point [00:51:00] of all of this we're doing here is to improve the mitochondria so they can then, you know, help optimize our health and heal us. So we, we definitely need to get. Iron straightened out in order to have that really work. Yeah. 

Jodi Duval: Mm-hmm. I love seeing the patterns in clinical practice, like you said, carotine too.

Jodi Duval: Like I see so much canine deficiency when we're testing the metabolites in terms of that, you know, ketone pathway. It's just fascinating for me when you see, see, you know, clients after clients and you see these patterns and you can almost then become much more or much better at your judgment and, and treatments because you are, you are picking up on the patterns.

Jodi Duval: Yeah. Yeah. It's fascinating. Um, all right, so we've talked about all of that. So what, what is next for metabolic psychiatry? What is, what, what are you most excited about at the moment? And I know you, you may have events that you're probably gonna be doing. Um, I know you've already, we've, you've done one major event, so talk to us about what you've got coming up.

Dr. Matthew Bernstein: Well, yeah, so [00:52:00] what's happening in metabolic psychiatry is really interesting. So, um, you know, there's been, like I said, a bunch of, uh, pilot trials and case large case series that have come out, but right now there's been a whole round of funding of multiple randomized controlled trials, uh, to look at, um, you know, um, you know, look at this from a more, you know.

Dr. Matthew Bernstein: Gold standard science kind of perspective. I mean, I sort of put that in air quotes a little bit. Yeah. Because, you know, we definitely can get lots of valid information from other sources than randomized controlled trials, but it does convince people, it does convince people in the medical establishment.

Dr. Matthew Bernstein: Mm-hmm. Uh, the benefits. And so I'm really excited to see that research come out. There's studies in various disorders, like we talked about, the ones in anorexia. Mm-hmm. Um, but there's ones in schizophrenia, major depression, bipolar disorder. Um, there's actually some trials going on in children as well, uh, with mental health issues.

Dr. Matthew Bernstein: So in the next few years we're going to see, um, you know, all of that research data come out in journals. And I think we're [00:53:00] gonna see a huge amount of excitement about this field, because those of us who are in it already know that this works really well. Mm-hmm. But we're gonna learn, not just, you know, we're gonna learn a lot about the mechanisms because many of these trials also have basic science components with.

Dr. Matthew Bernstein: Functional imaging neuroimaging. We've got metabolomics and proteomics and genomics data attached to a lot of these trials. And so we're gonna really learn more about exactly the mechanisms and how to refine to do this easier and better for people. Um, and so, you know, it's something right now where anyone can access this, but I think it's gonna become much more mainstream in the next few years, which I'm incredibly excited about.

Jodi Duval: Hmm. And you, you're exactly right. It gives it more validity, you know? Yeah. By doing it in these pathways. And then it's a much faster way to get it straight into clinician's hands to be able to then do the treatment and then make the difference. Yeah. 

Dr. Matthew Bernstein: That's right. 

Jodi Duval: Yeah. So, um, at the end of the [00:54:00] show, we always ask sort of three rapid fire.

Jodi Duval: So one's personally applied to what we've been talking today, and then we've got two others that I'll ask as well, so, okay. Uh, it doesn't have to be, you know, complicated answers or anything, but, so the first one for you is, which biomarker do you believe that will become Psychiatry's next Vital sign? 

Dr. Matthew Bernstein: Uh, it, it'll be, uh, the beta hydroxybutyrate in the blood.

Jodi Duval: Okay. There you go. Yeah, I saw, I sorta know that one was coming. 

Dr. Matthew Bernstein: Yeah. 

Jodi Duval: Um, and then the next one is, top Trick to Live Smarter Not Harder. 

Dr. Matthew Bernstein: Hmm. That's a good one. Yeah. 

Jodi Duval: Yeah. 

Dr. Matthew Bernstein: Yeah. I mean, I think, you know, you know, understanding and, uh, using the power of sunlight, you know. 

Jodi Duval: Mm-hmm. 

Dr. Matthew Bernstein: Um, sunlight is, is all around us and we don't make use of it.

Dr. Matthew Bernstein: We don't allow ourselves to receive its benefits 

Jodi Duval: mm-hmm. 

Dr. Matthew Bernstein: In our [00:55:00] modern world, living indoors. Mm-hmm. Um, and, you know, working indoors and not getting out and, um, you know, that's a great way to, you know, just, you know, very easy, very accessible and pleasurable and yet so beneficial. Yeah. 

Jodi Duval: Yeah. And we are so scared of it in Australia, we so fearful.

Jodi Duval: Huge crisis of Vitamin D deficiency. 

Dr. Matthew Bernstein: Oh, we've done a, yeah. The, um, we've done a great disservice with all this fear about melanoma and skin cancers from sun exposure. It's not that that isn't a real association in some people, but mm-hmm. It's much more complicated than the dermatologists would have us believe.

Jodi Duval: Absolutely. 

Dr. Matthew Bernstein: Yeah. 

Jodi Duval: So, and the final, um, quick questions. Is your top tool, trick or supplement for health? 

Dr. Matthew Bernstein: Um, I would say, you know, we already mentioned it, but, uh, creatine, you know, I think creatine is really beneficial for so many people. Um. And I guess the other [00:56:00] one is a, a little bit of a trick, which is for people who, uh, aren't so sure about these metabolic changes, they're not sure if it's for them.

Jodi Duval: Mm-hmm. 

Dr. Matthew Bernstein: I really like the intervention of getting people to fast and take MCT oil. Mm-hmm. And I've had tremendous success from so many skeptical people who come back and they, they weren't listening to what I was saying, they didn't care. They, and what they did hear of it, they said, what's gone wrong with this guy?

Dr. Matthew Bernstein: You know, what's, what's he talking about? Uh, and I tell them to just try that, you know? 

Jodi Duval: Yes. 

Dr. Matthew Bernstein: Get yourself up to fasting for, you know, 16 hours, have some MC to MCTO when you wake up at hour 12 and just see how you feel. Hmm. And they make ketones and they invariably come back and say, wow. 

Jodi Duval: Yeah. 

Dr. Matthew Bernstein: Now I'm interested in hearing what you have to say.

Dr. Matthew Bernstein: Yeah. Because yeah, they, they really feel what it's like now. You could do the same thing probably with a exogenous ketone, but I still would, you know, getting people, the [00:57:00] fasting and the MCTI think is even a, a better approach if you can get 'em to do that. 'cause they feel like they did something wasn't just a, a chemical that did it to them, you know?

Jodi Duval: Yeah. Yeah. You just can't knock it until you try it, can you? 

Dr. Matthew Bernstein: Yeah. Right. 

Jodi Duval: Um, that was my first response when I actually tried a bulletproof coffee. 

Dr. Matthew Bernstein: Right. Yeah. 

Jodi Duval: And I, I was like, oh, whoa, this is my brain awake. 

Dr. Matthew Bernstein: That's right. I had the same experience. I mean, I think almost everyone does and Yeah. And so they really get a little taste of what, you know, being a ketotic state feels like from that.

Dr. Matthew Bernstein: Mm-hmm. Not the full version. You get a little taste and you say, whoa, you know, that's powerful. And, and then I just say, you haven't seen anything yet 

Jodi Duval: Exactly. 

Dr. Matthew Bernstein: Be being ketosis for, you know, a year. And you, you, you just won't imagine how your body, brain will function. Yeah. 

Jodi Duval: Wow. Oh, it's, it's so exciting. Um, I am just thrilled that this is making its way into psychiatry more and more, and 

Dr. Matthew Bernstein: yeah.

Jodi Duval: So where Matt, can people find more about you, [00:58:00] your programs? Where are you speaking next? Like, where do they need to follow you? 

Dr. Matthew Bernstein: Sure. So I'm on, uh, LinkedIn. I'm not on any other social media. I really am just sort of, of the mind that this is not so good for me. So, uh, yes, but people can find me on LinkedIn and if they send me a message, I'd be happy to respond.

Dr. Matthew Bernstein: I'd love to answer any questions or just, you know, say hi on LinkedIn. Um, and then the program that I was describing is called Accord, spelled A-C-C-O-R-D, and people can find that, uh, the website is accord mh.com. Uh, and so there's a wealth of information there about metabolic psychiatry. There's a whole, uh, you know, hour long academic lecture I gave about metabolic psychiatry on there and Wells.

Dr. Matthew Bernstein: Lots of their blog posts. We have our data. To show about the kind of results that we're getting. Mm-hmm. And so people can learn about it. And people have come from all over the world to come to our program. 'cause we're really the only ones who are doing this for this particular purpose, you know, for people with [00:59:00] serious mental health conditions.

Dr. Matthew Bernstein: And we have that expertise, we have the expertise about deprescribing properly and all of that. So, um, so, you know, people can think about whether this might be good for them or a loved one, and contact us and consider maybe giving us a call. Yeah, 

Jodi Duval: yeah. Absolutely. Incredible. So we'll be sure to include all of that in the, the notes section.

Jodi Duval: Um, and this will come out on YouTube as well, and. Yeah, it's just been such a pleasure and connecting with you, Matt. It's, um, I, I, I love this part of my job and just connecting with incredible people doing amazing work that I wouldn't find out about otherwise. So thank you so much. 

Dr. Matthew Bernstein: Well, really wonderful to, to meet you and talk with you and, uh, yeah, this was really enjoyable and um, thank you for the work you're doing as well.

Dr. Matthew Bernstein: Yeah, 

Jodi Duval: no, absolutely. And, uh, yeah, I hope to be in touch very soon and I'll be following your work for sure. 

Dr. Matthew Bernstein: Sounds good. Thank you. 

Jodi Duval: All right, thanks [01:00:00] Matt.

Find more from Dr. Matthew Bernstein:

Accord Program: https://accordmh.com/

LinkedIn: https://www.linkedin.com/in/mattbernsteinmd/

Instagram: https://www.instagram.com/accordmh/

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