good morning everyone. It is morning when we're recording here on the Stay Off My Operating Table podcast with Dr. Philip Ovadia. We are joined today by a guest where it is not morning, and that's kind of why we're recording here in the morning. Mo Annuus, welcome to the podcast. We're glad you're here. Thank you so much. Yes, a little bit further away from you this time, and it's definitely afternoon here. Very good, Phil. I did a little research why don't you give a little bit more of an introduction and then we'll dive into it. Yeah. Excited to finally be able to have this conversation with Moira. She has been doing some amazing work across the pond, as we would say. Over in the UK on you know, brain health mental health and diet. This is you know, part of this very exciting, I guess we could say birth of this metabolic psychiatry movement. And we're gonna talk about some of the work that she's published around that, some of the work that she's been doing. So we've been looking forward to having this conversation for a while. Maura, why don't you give a little bit of your background to our audience, let them know how you got interested in maybe nutrition to start with, and then what brought you to sort of the mental health aspects of it. Definitely. So thank you so much. My background was that I spent 20 years as a senior manager in the NHS, which is the health service in the uk. I was a senior manager managing hospitals, lots of staff, million pound budgets, et cetera. And eventually I started to burn out. Had a high stress load. Probably wasn't eating the best at the time. I began to just not be able to even exercise. Ended up on the couch, couldn't really get off. It couldn't look after my young children. My husband was having to do all the cooking, the housework, everything. And I hit rock bottom really I was diagnosed with burnout and chronic fatigue, as well as a range of mental health problems, including depression and anxiety. At that point, really nobody had any answers for me. I was offered antidepressants. I didn't really wanna take them'cause I thought there might be a better way of doing things. I did see a psychiatrist initially and he actually taught me how to do deep breathing, which was really my introduction to lifestyle medicine, which I kind of credit him with. You know, kind of starting me off on this path, which is perhaps an unusual approach. But it was good for me. So I came away. I did my breathing, I did some meditation, yoga and things got a bit better, but they didn't, you know, they weren't fantastic. I ate better. I wasn't surviving on caffeine and chocolate any longer and slowly my health improved. Wait, you weren't surviving on caffeine and chocolate? Not at that point. I had been. I'm not aware that's even possible. This is gonna be revelatory. While I was in NHS board meetings, I would actually leave the meeting just to go and get my fix. Because I actually couldn't cope without being, having something to keep me going. That's really where I was at that point in time. I didn't realize it back then really what was happening, but I was really struggling with my energy levels to keep kinda keep going. I don't want to stop the flow, but one of the things that occurs to me is. What, how long what, how old were you when this began to manifest? And specifically what I'm thinking about is how many years of this high stress situation Yeah. Led to this. Yeah. So with hindsight, it built for a long time I didn't realize that kind of, you know, when I was falling ill, I was kinda looking for all the usual answers. There must be some, you know, something wrong with my bloods. Maybe I need iron, you know, you know, my bloods were normal. But I'd been under a lot of stress. I was, you know, I was in a difficult job. I was on call as well as a senior manager. I had young children, so there was a lot going on. I had parents, I had some health issues as well, you know, so it was coming from everywhere. And I, so I think with hindsight, it probably built from the day I started that worked, to be perfectly honest. But it didn't really manifest itself in a way that stopped me doing things for at least 10 years, and then the next 10 years was slowly downhill. That's what I think is important. It's very easy, and I've seen this both personally and with other folks. It's very easy to not recognize what stress is doing to your body. In your twenties, you could do things in your twenties that, that would kill anybody and they're older. So it's something that built over a period of years, not days, weeks, months, it built. And you know, one of the early symptoms actually was that I used to go for a run on a Friday night with my friends and then would go for a meal. And I actually gotta the point where I couldn't do the run. I just physically couldn't do the run. So I started going for a walk instead with, and then going for the meal, for example. It was just little things like that where, you know, it was the, it just didn't seem to have that, the energy either in my brain or my body any longer to kind of do things. Yeah, and I did like my job in many ways. You know, there were lots of things that were great about it. I loved the people I worked with. You know, there were lots of positives, but I didn't really appreciate the toll it was taking on my health at that point. All right. Didn't mean to stop the flow, but I wanted to get That's okay. Feel for how much time it takes. Yeah. For these things to manifest. Absolutely. And I think, you know, it's also maybe a good thing to point out from the point of view that, you know, it's not gonna be an overnight fix, is it? You know, if you've had 20 years of, you know, intense stress, it's probably gonna take a little while for things to settle down again. Yeah. So even though I end up quitting my job you know, didn't that wasn't the miracle cure to. Just being, again, so I did get into eating better. That was probably the next thing that I did. And I was eating better. So I was doing, you know, lifestyle things in general, like holistically, but I still wasn't a hundred percent, I was still functioning, you know, like 60, 70, maybe up to 80% at times. But I couldn't race my bike, I couldn't climb the mountains. I couldn't, didn't really feel I could hold down like a job in the same way. And then I got really interested in nutrition, thought, okay, I. I'm interested in this. I'd like to learn more. So I decided I would do a three year diploma course at the Institute, Nu Nutrition in London. And it was really, and I still wasn't a hundred percent well, but I was on my way in the first six months of that course. There was a module that took me down a bit of a deep dive into mitochondria. It wasn't really what the lecturers were expecting us to kind of be going after at this point, but I then discovered the mitochondria. And that really for me is, I feel. They discovered it got me back on track because I then looked at everything I could do to optimize mitochondrial health and that, you know, and my focus actually was on the physical health at that point in time. It was like phys, I felt there was something physically wrong with my energy. I didn't really understand at that point in time actually could be the same issue affecting my mental health and my brain energy. And it's only with hindsight that I've connected all that together. And now, you know, now I work much more in the field of mental health. But. You know, people with mental health often come with chronic fatigue. You know, people struggle to get outta bed when they're depressed. It's not, you know, it's very much a body wide phenomenon in many ways. Gone a little bit more into the background there. You, so it sounds like you came from sort of a business background. What what, was there something in particular that attracted you to the NHL and healthcare or was that maybe just a happenstance that you know, you had this. Business interest in healthcare and ultimately ended up, you know, more on the practice side of it. The NHS is not really run as a business in the uk, so it was a slightly different so I actually trained as a geologist. I was interested in volcanoes and things, so I did my first degree was in geology. And when I finished that, I'd already met my partner who wanted to stay with the life. And it, you know, being a volcanologist wasn't terribly, you know, it wasn't something that was gonna work well as a partnership with me being in Borneo and being in the uk. So I was looking for an alternative at that point in time. And I actually went to a talk by a guy and I can remember his name. It was Ned Greenwood I can remember 'cause he was a remarkable guy who was recruiting people who wanna work as managers in the health service, which, you know, it is maybe not people's first thought when they're thinking about the health service. Most people are thinking about. Professional clinical role of some kind. But I was really struck by, you know, the potential there. And at that point in time, there was actually quite a lot of money still around in, you know, the coffers in the NHS and there was lots of excitement. You could apply to expand services enhanced things. And of course, over. Time, unfortunately. And one of the reasons I became so stressed was that budgets were cut and cut. Staff were cut, staff were unhappy and, you know, it became quite a difficult thing to manage eventually. But I was really drawn in for the fact that, you know, I wanted to modernize the health service. I wanted to help people. I wanted to, you know, work in this system that delivers amazing care for people because it does, it still does in terms of acute care. It's, you know, lifesaving. It's amazing. But my journey was really interesting because I worked in. Aspects of healthcare. So I actually at one point was a partner in a business running GP practices. So I moved into to that side. So I kind of saw the business side and I also, because I was then in primary care, I was seeing. People coming back through the door all the time with conditions like diabetes you know, obesity and things. Actually, we weren't really fixing, we were just seeing them again in, you know, a few weeks time weighing them, checking the bloods and I began, I'd kind of seen the fact that there was something wrong with the chronic disease side of things, so I kind of had exposures to that prior to doing the nutrition training which I think actually was really valuable from where I am now. Yeah. So I imagine you were sort of starting to make those connections, you know, it sounds like a main motivator was your own health but were you also kind of noticing that all these people that were coming back with all these conditions that weren't getting better and maybe, you know, the food that they were eating was playing a role in that? I'd started to make connections and you know, when we were often tasked as managers at trying to prevent, you know, readmissions and things like this, we were tasked with looking at, you know, what some kind of ways to try and prevent these things happening. So I'd started, but I didn't really have the, I didn't have a grasp of metabolic health, so I hadn't really put everything together. I just knew there was probably something was wrong with the system, the way we were doing things. We weren't really, and you know, I now look back and think, we're not even rewarding, you know, GPS for the best standard occur with things like diabetes, we don't reward them for putting diabetes into remission, for example. There's no standard, you know, that we assess practices by how many patients they have in remission. So actually now I can see it from a very different point of view about, you know, how maybe shifting some of those goalposts would really create a different health system. Yeah, certainly. I think many of us feel that same way. And you know, you have some great examples of that over in the uk. David Unwins work, of course has been groundbreaking in this and unfortunately, you know, still struggles to kind of get the attention that it deserves. So I wanted look at and then, you know, kind of hone in on your nutritional education. And you mentioned how you went down this sort of rabbit hole of the mitochondria. That's very interesting. Certainly not what many people in the nutritional world are focused on. Maybe it should be because, you know, it makes perfect sense, right? That's where the food gets turned into the energy that we need to survive. But where did that kind of lead you in terms of understanding? You know what healthy nutrition might actually be. So when I discovered the mitochondria, I very quickly discovered the ketogenic diet. And that, and I began to understand, just like you say, you know, the mitochondria can use different macronutrients, it can use glucose, they can use fat. And I began to understand that actually maybe trying a high fat ketogenic diet might be supportive for my mitochondria. So I thought I'd give it a go. I was in my first year of training and I kind of, I dabbled in it a little bit and didn't really see the full benefits because I didn't realize we had, I had to do it so sustainably at this point in time. I was kind of doing it for a couple of days and falling off it again, but then I thought, no I'll commit to it. I'll do it for a three month period. So I think I started in the January after Christmas and I did it for three months. And at the end of the three months I did a, my first cycle event that I'd done since I'd been ill and I completed it. It was a hundred kilometer bike ride event called the Lockness Etap in the Highlands. It's quite hilly. And my aim was to do it in under five hours. And I did that and I did it on a fully kitty Jake diet. While everybody else is stopping at all the kind of you know, eating points to eat loads of glucose based products. I, I wasn't doing that. I did have a bit of a backup with me just in case I needed it because I was a bit worried in case I could do it. And actually that was the day that I knew I'd kind of cracked my own house. I came across the finishing line. My, my family were there to meet me and I was crying and it was tears of joy. It was, I felt amazing. I felt like I had 120% of my energy back, not just what I'd had before, I'd gone back to like teenage, kind of like energy levels and that was where I thought, okay, something changed and then I got even more interested in trying to understand how what had happened really. And, you know, I now know that mitochondria, you know, have so many different functions. You know, and that the way you treat them, whether it's with food, movement, sleep, light, all these different factors that play into it, you know, they have, it has an impact on how they produce and kind of allocate energy in the body. And. Yeah. And that's, you know, what I'm currently actually writing a book and it's very much based on mitochondria and what happens you know, to the flow of energy in the body because what I've come to understand is that, you know, we have a certain kind of en energy envelope in life. But if things aren't going well for some reason, you know, we've got inflammation or we've got immune system activation, or you not sleeping well, then you know that some of that energy is gonna be diverted to go and deal with the problem. And as a result, that's likely to give us symptoms, you know, which sometimes get talked about as sickness behaviors. You know, that the mitochondria will kind of allocate energy. And therefore they'll also take it away from some other places, and that will tend to make us want to sleep, have a fatigue, put our head down. You know, and what we need to do is kind of, I really the work of a guy called Dr. Martin PCard. I dunno if you've come across him. He's basic at Columbia University in the us but he talks about it. Through a lens of energy transformation and energy resistance. And what he's saying is that we basically need to have the right amount of energy resistance in the body. Not too little, not too much. You know, a bit like if you think of an electrical circuit, if there's too much then you don't get, you know, light from a light bulb. But if there's too little actually it will go on fire. You know? So it's kind of, it's balancing this, and I quite like that concept really, that, you know, we need to kind of get the right balance in our life for our mitochondria. I've never heard that particular analogy before of the, obviously we want to provide the positive power, but I've never heard anybody talk about the energy resistance. That's, we may not go down this road in this conversation, but I'm going to make a note of it and see what I can learn. Yeah I think that work is really fascinating and it's kind of connecting physics with biology. Yeah, which I think is maybe something that is not really, you know, we tend to separate the sciences out and maybe that's what we need to come back to, because at the end of the day, energy is a currency of life. You know, without energy, we are dead, aren't we? You know, that's, that is what death is. Yeah. It's when energy stops flowing. You know, and the most obvious, you know, examples of some of this are, you know. Toxins which block the mitochondria and can kill you like very quickly, for example. You know, so it all comes back, I think, to basically how electrons throw through the mitochondria. It is what's happening and there are so many different systems in the body, you know, even if you were just thinking about, you know, something like how proteins get made, something, which probably nobody thinks about very much, but you know, our bodies are kind of. Everything is built around how proteins are made in the body and how they're then broken down, recycled and reused. And, you know, mitochondria play lots of roles in supporting that function from providing the energy for it to happen. You know, so to helping clearer up, you know, process of if things go wrong. And then there's evidence that, you know, many of these processes kind of, appear in all sorts of different conditions, including mental health conditions as well. As you were kind of, you know, discovering these things learning these things was it kind of, you know, was this something that was supported sort of, you know, by your mentors your education overall? Or was this stuff that you were kinda having to figure out on your own, outside of the sort of standard curriculum maybe that you were being put, you know, put through? So I would say I was figuring some of it out on my own. I think I was very lucky that the place I trained was very, wanted to be really at the cutting edge of nutrition. And so a lot of stuff we were sent away to question to look at and the dean of that institute called Heather Rose, I'm still very friendly with her and she is very much into metabolic health, mitochondria. You know, supportive strategies for those things. And I know they're teaching more of that now than when I was there 'cause it is a few years ago now. So I think, and I think that is changing, but I'm still questioned in the nutrition world about some of what I do, you know, is a ketogenic diet sustainable? Is it good for you? Is it good for your heart? Yeah. You know, all these things. I mean, just this morning I was on a group call with some of the nutritionists and we were talking a little bit about the carnivore diet, which is obviously one extreme end. Does a ketogenic diet. And you know, lots of questions about whether that's actually good for you, whether it's good for your gut, for example. And I'm saying have you looked at the research? Because there's actually a lot of research coming forward now that is suggesting it. It can be a really good therapeutic way of supporting gut health if you've got really inflamed bowels, for example. So yeah, so I think there's still a way to go, but I think it's moving in the right direction. Great. Yeah, let's talk a little bit more about maybe what your personal experience was with it. You mentioned, you know, being able to kind of get back to the racing but talk about, you know, a little bit more, the impact it had on your personal life, and then I'd like to start to kind of hear how you then, you know, put this into a professional practice. Yeah, so it had a amazing impact on my personal life because I got my life back. It literally transformed my life. I mean, I was really at rock bottom. I mean, I actually used to get in the car and drive to a certain crossroads and think, should I just not go home again? And that's really how bad I was. It was, I was really at rock bottom and, you know, to come out the other side. Not only have to have retrained, but have run my own business now for several years and be publishing things like that is amazing really when I look back to where I was. And I honestly thought at one time I really lost hope. I, because nobody seemed to know how to get me better again. So I, you know, I have kind of stood in those shoes and realize, you know, now when I'm working with clients, how, you know, I can really empathize about how difficult that can feel. You know, my husband was incredibly supportive and without him, you know, things might, would've collapsed really around the home. I, so it affected me lots of ways, but also, you know, all my interests were outdoor interests. They were active interests, so I'd kind of lost lots of friendships and things because I couldn't participate. So I got back on track and then yeah I, you know, just over time I was able to build a business up again and do it. My own way this time. So not in the not managed by anybody else. You know, I can do it the way I want to do it. And that makes it much more manageable. Because to start with, I was a little bit concerned, you know, could I cope with all this again? You know, so I went into it slowly. And you don't start a business, you know, overnight. You don't have loads of clients. It builds up slowly anyway, and it gives you, you know, and over time you gain confidence. Actually, this is fine. This is sustainable. You know, my energy levels have not, you know, I've not had any kind of derailment of it. You know, I know how to keep myself healthy and fit now. Yeah. You know, we've had, we've been doing this for quite a while over well over 200 episodes, and we've had a lot of people talk about their own personal experience getting healthy. By getting away, by going to a a high fat diet. Most of these conversations folks are talking about the physical benefits. We've had very few who've talked about mental health specifically. Just before you came on, Phil and I were talking about I have a someone close to me who struggled with mental health issues for all her life, and I think, not coincidentally, she's also obese. And I, I just to explore with somebody who's gone through it. Yep. What it's like to have the mental health pro issues. On the inside. We've had Chris Palmer on, we've had Georgia Eid on, we've heard it from the clinical side, but for folks who've, who struggle with the mental health stuff. Yeah. I'm interested in what your experience was, and I mean, it may be super simple, but it fascinates me. Yeah. I mean, the way I felt mentally was. I was drained both physically and mentally. There was nothing more to give. I had really bad brain fog. I was struggling to read a book, for example. I couldn't really concentrate. I, before I stopped work, I was very worried about making mistakes. I'd made a few mistakes on spreadsheets and things I was very worried about, you know, my cognitive abilities things like that. I have a, hi, a family history of dementia and Alzheimer's. None of my family are obese. In fact, we're all very lean. Interestingly. However, I suspect that certainly with my father, for example, I suspect he was quite insulin resistant because he had no teeth left. He, you know, he'd had a high sugar diet. There were other signs. That was probably something going on there. I suppose, you know, I just felt and I did feel like I say like I, I'd lost hope in a way, really, that there was gonna be a way to recover. I felt like I might have to live like this, and that was really quite some thought because I wasn't really living a kinda life that I wanted to live. So I dunno if that explains it enough, but it, I, you know, depression is so common. And my suspicion because I am deeply cynical about the entire pharmaceutical industry is that prescribing anti-depression drugs is a a real cash cow. Undoubtedly there are. There are people whose depression has a psychological root, but it doesn't sound like that's the situation with you. And my suspicion is it might not be the situation with a majority of people who are struggling with depression. Yeah. So I mean, I had severe anxiety as well as depression. Real really severe anxiety actually. What I would say having learned what I now know about the mitochondria, is that psychological stress can impact them just as much as things that you might think of as more physical. Yeah, actually really because. Because, you know, stress can affect your metabolism, you know, so really I don't really separate that out so much now. I just think that probably for the majority of people that are maybe a combined strategy is gonna be a good idea, you know, because some of the work actually that Dr. Martin Pcards looking at in his lab is looking at how positive psychological. Experiences impact mitochondria. Oh, wow. And that's really interesting because that shows actually they have a, you know, positive psychological experience, have a positive effect on the mitochondria. So I kind of look at it from the point of view that I was trying to, I was trying to do that stuff. I was, you know, I was trying to do yoga and meditation and mindfulness and it was helping. It just, it didn't tip, they just didn't tip it enough for me, you know, in the right direction. And I think it was when I added the ketogenic diet in that happened, so I can kind of, it. I kind of think that from, if you thinking from a personal point of view, everybody's gonna be different, and what they need to get well again. And maybe, you know, there comes a tipping point at which the ketogenic diet can correct things that can't be done. You know?'cause people sometimes think how can a diet correct something that's psychological stress? But I think I do kind of believe that's kind of what happened for me. It was, it kind of corrected it more than just the psychological stuff did. So I, yeah, I kind of look at it from a slightly different lens now and think that really, I'm just looking at it through the lens of the mitochondria and, you know, psychological stress adversely affects the mitochondria. Just like high sugar diets do, for example, you know, or toxins or you know, even, you know, if you think of things on a wider basis, we know lots of lonely people are depressed. Yeah. Sure the loneliness is a factor. And again, you know, you know, you could argue there's ways to address that. But again, maybe the, you know, maybe all these things come back to how really simply the electrons flow through the mitochondria and we just need to kind of optimize it. That's where I've come to, which is perhaps a jump for some people. But that's really what I now have come to believe. And I think there's lots of science really that backs it up now from lots of different directions. Yeah, it's it's a kind of fascinating way to look at it. You know, and again, we have seen this over and over again, right? That people that, you know, improve their metabolic health that, you know, may not have had, you know, any sort of significant mental health issue. But you know, they're always like. I just, my mood is better, you know, my energy is better. I don't have the brain fog, right? The things like that, that seem to pretty consistently get better when people improve their metabolic health. And you know, I mean, even my personal, you know, me personally I can say right? It was never. I never thought that I had an issue with any of this. You know, I was kind of tired and yeah, I'm a busy surgeon and I'm stressed. But the difference now just how you react to those stressful situations you know, when you have this sort of alteration in your you know, a lot of times people will point to it as sort of a brain chemistry issue. But I kind of. You know, like your perspective, see your perspective on it's really the mitochondrial, it's the energy flow you know, through the brain. Which kind of ties back to what we see on the heart, you know, and the effects of ketogenic diets on the heart, and how it can improve the functioning of the heart because of that effect that it's having on the mitochondria. Absolutely, and I'm actually in the process of publishing a second case report at the moment, which is a case about severe anxiety. And it's actually quite interesting because the reason I've chosen to publish it is because this is somebody who works as a contemplative scientist in. The field of psychology and using, you know, things like meditation and things like that. And yet somebody who was, you know, a scientist in that field couldn't control their own anxiety. And it wasn't until they did a ketogenic diet that they could get the benefits of those things. So again, it kind of shows that the, some effect that maybe a ketogenic diet can just kind of push somebody more towards you know, more, more so than just the psychological aspect alone in some situations. Awesome. Yeah. Which maybe leads us to the first case report that you published about I guess it's been about eight months now middle of last year that you published a pretty dramatic case report on schizophrenia. We'll call it reversal. Some people would call it cure with dietary therapy. So maybe go into that case, report a little bit, some of the unique aspects and then that will kind of lead us. I want to talk about some of the recent controversy here in the us around this idea that you know, psychiatric conditions can be treated with dietary therapy. Yeah, so this was a case report that I published of a young, a relatively young man who had had some difficult life circumstances. He'd had to move out of his family home due to the death of his mother. He'd ended up in a homeless situation. This is prior to me meeting him. He had developed, psychological symptoms that eventually led to a diagnosis of schizophrenia while he was in a homeless hostel, initially he came across a book by a guy called Tim Ferriss, who you might have heard of. Oh, sure. Yeah, he's quite well known called The Tools of the Titans. And in that there is a section about ketogenic diets. Now that book is not a book about metabolism. It's a book. It's like a self-help book too. Improve your life, and that's really what it's about. And in that and so this guy thought you know, my life's pretty terrible. I wanna try and improve it. So he thought, I'll try, keep a junk diet. But he was doing it, you know, a couple of days on, a couple of days off, et cetera to begin with. And on the days where he wasn't doing the keygen diet, he was experiencing, you know, he was eating quite a lot of high sugar and experiencing quite severe mood disruptions. And eventually at one point he was sectioned, so he was in and out of hospital for a few sections. So I dunno what that is in the us but that's where you are forcibly kind of, Oh, okay. Committed. Kept in. Yeah. Committed. Committed. Yeah. Okay. So he was in a mental health hospital. And in and out for several years felt really, and he was getting the kind of usual standard care of treatment. He was on medication, he was getting what we'd call occupational therapy support, which included things like group visits to the library, you know, group chats about your mental health, et cetera. And he didn't really feel any of that improved. His mental health particularly, although it obviously kept him a little bit more stable perhaps in that situation. The interesting thing is that when he was, prior to being hospitalized, he was actually doing the ketogenic diet in a homeless shelter. He had a little mini potable grill and a mini fridge, and he was able to do. On a, you know, he did have access to somebody and he was able to actually manage a ketogenic diet in that situation. So when people say it's really difficult to do, I'm like okay, maybe, but you know, it can be done in quite limited situations. When he came out of hospital, he contacted me, was living with some family. And he wanted to try a ketogenic diet. He, by that time, he'd come across Chris Palmer and George Eid and Metabolic Mind. And he had kind of thought there's something in this. I need to, you know, he thought I did feel better when I was doing it on the days when I did it. So he thought, I wanna do it properly. So we did a very simple approach. It was a, mainly a carnival ketogenic diet. It became purely Carnival when he wasn't able to stay with his family any longer for various reasons. And it had to go back to being a very simple approach. And he basically did a. Two to one ratio, which is two grams of fat for every one gram of protein and carbohydrates combined. We made sure he was getting sufficient protein. You know, so he was. By the time he had moved outta the Family H House, he was actually in homeless accommodation again, which in this situation was a hotel and he only had a microwave to cook with, and he was basically eating beef mint ground mints and tallow. And that was literally it because it was all he could, you know, it was, had to be very simple cooking as well. But he kept religiously to that ratio. And he has not had another episode and I've been in touch with him relatively recently. Another episode of mood disorder again. He is off all his medication and he is now volunteering in the mental health service to help other people. So I wanted to publish it really just to show that, you know. Often there's criticism of ke junk diets being difficult to do, being expensive to do, requiring lots of expensive meat, for example. You know, and the reality is that, you know, I can't remember what the amount was in dollars, but you know, he was spending less than five pounds a day on food, which is really not very much. Yeah, about three and a half dollars. Yeah. So it is, you know, for me, I just think that. Okay. I don't see many people like that in my clinical practice. You know, people like that don't generally come to me, but actually I've just. I'm on a bit of a mission as well. It's not just about me and my business. This is about trying to, I'd like to see mental health services taking this on this approach as an adjunct, you know, adjunctive, if that's a word. Is it? I dunno. Yeah. You know, an extra thing, you know, in the range of strategies. And, you know, there's more and more interest. I've got PE a few people in the mental health service coming to me to try ketogenic diet so they know how to do it properly, which is really great to see now. And you know, it is gonna be people from the ground up. I think that get the change to happen, that's what I firmly believe. It's unlikely to be the top down. I think it's gonna be a bottom up approach that kind of is a movement. Yeah, I mean, it's just amazing, you know, so many aspects of that case report, right? That dispel all of these you know, myths, right? That people have about ketogenic diets and you know, just the challenging circumstances that he was under and was still able to do this really hopefully will inspire a lot of interest. And you know, you're probably aware that recently over here in the US right Robert F. Kennedy said, you know, essentially that psychiatric conditions can be treated with dietary therapy. And there was just. Amazing amount of pushback against that and that he had just basically made this up and there was no evidence that this worked. You know, so maybe your perspective on that, because obviously there is evidence it's published. You don't, you know, this isn't only case report that I'm aware of. This is something that's now being actively studied in. I think both in the UK and the US that I'm aware of. So talk about, you know, your clinical experience and your perspective on that. Yeah. You know, just as you rightly said, there is lots of building evidence. So there are ca plenty of case reports published in a wide range of mental health conditions. I mean, actually just this week a us mental health counselor, Nicole Lauren, published a case about post-traumatic stress disorder using the ke genetic diet, for example. So the, you know, the, it's growing in its breads. But there are also quite a number of randomized control trials now that have been completed as well for a range of conditions. There was one just, I think it was just two weeks ago in the uk, Oxford University, did the, have done the first uk ketogenic trial for depression, for example. So the, it's building all the time, partly because. The Bazookie Foundation in the us, which is a philanthropic foundation, has invested a lot of money in supporting these trials, you know, in the UK and else in the US and elsewhere now. And you know, and that, that came from the background that their son you know, used a ketogenic diet to recover from his mental illness. So that's all growing in terms of what's actually published in the literature, which is great. And there is more money coming in. You know, in the UK there's actually quite a. Quite a lot of money being put into universities to look at different aspects of metabolic health linked to mental health. And interestingly, some areas are joining up their research between things like cardiology and mental health, which is really fascinating to see. In terms of my clinical practice, I do get people coming with a wide range of different mental health problems combined sometimes with physical problems. I mean, because I have worked quite a lot with chronic fatigue and often people with chronic fatigue have a mental health condition too. So I have a lot of clients like that. I would say that, you know, the vast majority of them see a significant improvement on a ketogenic diet. And, you know, even sometimes people just going low carbs see improvements. But, you know, the ketogenic diet does seem to just have this additional effect for many people that it's just kind of helping. I call it really, it's like resetting their metabolic health and their brain energy and. And you can do it in different ways. I mean, there are, you know, not everybody has to do like a carnival approach, although, you know, that's often does get talked about now. But, you know, people, I've had people even do a vegetarian approach. I mean, I'm not a big fan of vegetarian diets generally, but, you know, there are people who do see benefits from trying these approaches. As long as they're eating enough fat and they're getting the micronutrients in then it seems to be that there is, you know, potential there even on a wide range of ketogenic diets. So you mentioned chronic fatigue. You know, that's still a bit of a black box in medicine, right? There are still many people within the medical world that, you know, would say it's not a real diagnosis. Yeah. But you know, that would seem to naturally point towards, right? It's chronic fatigue. You don't have enough energy. Maybe we should be looking at the mitochondria as. The solution for this. Talk a little bit more about your experience with that. Maybe, you know, talk a little bit about what is chronic fatigue? You know, what, how do we differentiate? Just being tired. Because you know, you have a busy life and you have kids and you have work and all of that stuff, versus you know, when we really can make that diagnosis and how it lends itself to metabolic therapy. Yeah, so you're right, it is, it's a controversial topic still, and you know, very controversially if you talk about chronic fatigue with mental health, because often people don't like the connotation. There might be a link there. I mean, I didn't, so I'm coming from the background. I was very much focused on my chronic fatigue and not my mental health problems to begin with. I felt there was something kind of physically wrong and that was why I gravitated to that side of things. I think with all these things there's a spectrum and actually. Many people with chronic fatigue do have some element of cognition problems, brain fog or you know, more diagnosed mental health issue. There's a spectrum and the same the other way around. So people with depression can be very fatigued, for example. So there's already an overlap there when we're talking, you know, just generally. But I think in terms of you know. Chronic fatigue, then people are tend, we think more about body systems, like muscles for example, and things like exercise intolerance, which is often linked to chronic fatigue where people have a kind of delayed effect. They can, if they over, you know, if they do too much exercise a day, they can't, you know, they feel terrible tomorrow sort of thing. I think all of that really does come back again to the mitochondria because it doesn't really matter whether you are making energy in a neuron in your brain or in your muscle cells. It's the same process to make energy. We all use. The fuel, which is A TP ine tri phosphate, which is basically as you started right at the beginning, explaining, you know, is where we take the nutrients from our food and the oxygen we breathe, they go into the mitochondria and through a process you know, a TP is produced. And and that so that's something that happens in, in. Almost every cell in the body. And that's why I think, you know, that when people do studies on conditions like chronic fatigue, they tend to be looking at one, one kind of element. So they're looking to see is there an immune problem? Is there a viral problem here or is there, you know. You know, some kind of, you know, is it about insulin or glucose or is it you know, something in the brain, you know, you're separated out in many of these times, but, or is it about inflammation? Inflammation's always a big one. And the reality is that. I I think when you think back to how the mitochondria partition the energy that they use, it's not surprising. Some people might have a slightly different set of symptoms to somebody else, because we're all different and our bodies are gonna respond differently to the situation we're in. So whereas somebody might end up with a very raised inflammatory response and somebody else might end up with, you know, slightly different presenting pattern, it might still be that it's mitochondrial dysfunction that's underneath both those situations. It, I hope I'm making sense here, but it I kind of think that I quite like the view that Chris Palmer has when he talks about this for mental health.'cause he kind of talks about it being a trans diagnostic approach. And I actually think that applies to chronic fatigue too. In that, you know, many of the markers you know, that can be measured. So inflammation being a good one. If you know, if you do a trial. If you measure inflammation in mental health disorders you know, there's usually a finding that, you know, inflammation markers are raised, and that's the same in chronic fatigue, for example. It doesn't mean that every single person in that trial had a raised marker. It just means that the average is gonna be that, you know, you are more likely to see it if you've got chronic fatigue. And he also talks about the fact that ketogenic diet is trans diagnostic because it is tackling the same processes with, you know, so the metal metabolic process. And the inflammatory process. And I think that's because when you come down to the level of the mitochondria, the way we make our a TP varies a little bit depending on whether we use fat and ketones or whether we use glucose and. What we want to do is create as little inflammation during that process as possible. So we have things called reactive oxygen species that are generated when we are making a TP. It's kind of, it will happen anyway, and we need a certain amount to send the right signals to the body. There is this kind of signaling component, but if we make too many of those if the mitochondria become. Slightly kind of uncoupled. And we create, we allow more reactions with oxygen, then we get more of these reactive oxygen species. And that is really what starts the inflammatory process. It creates oxidative stress and tissue damage. And if there's enough damage, it'll start to affect organ function, tissue function, organ function. And of course that can be different in different places in the body because, you know, the mitochondria are amazingly clever. They're involved in ma, you know, you know, and they make lots of important things like hormones in some places in the body, for example. You know, if you are experience a lot of metabolic stress in. An organ that makes hormones, you're probably gonna have hormonal dysregulation, for example. So it's complicated and it's probably too complicated to go into the detail here today, but I do think that, you know, it, we are beginning to understand how this works, and I think we are, that's partly why we see different patterns in different people is that the mitochondria might be more affected in whatever body than another. Yeah. It's really fascinating. And I think people don't, you know, maybe get down to that level often. And we talk about even within the metabolic health space, right? We talk about your body's either using, you know, glucose and sugar for energy, or it's using, you know, fats via ketone for energy. But we don't really think about right? It in the end. We only use a TP for energy, right? It's just what is that a TP being made from? And even the whole just sort of, evolutionary theory and history around, you know, where the mitochondria came from, right? And that these are maybe remnants of bacteria or viruses that were incorporated into, you know, the first sort of cellular organisms, multicellular organisms and that the mitochondria really is a sort of life entity of its own. Yeah. And you know, I mean, when we come back to talk about, you know, mental health, we talk about the brain. You know, a TP is involved in so many processes from growing you know, creating new neurons creating synapses. The connection between the different cells in the brain, the, you know, the release of neurotransmitters. It all requires energy. They're all energy dependent. They all requires a TP. It requires mitochondria to be in the right place, in the right concentration, and that requires. Different proteins to shuttle them in the right place. You know, so it is complicated, but I think we're beginning to understand how some of these things, you know, work together and how, you know, different, you know, somebody who's got a bi bipolar diagnosis, somebody who's got a depression diagnosis. You know, there's, it is just that things are being impacted in a slightly different way. Probably we don't know all the detail, but the reality is that, you know, one aspect of that. That, you know, neuro transmission or brain connection is gonna be affected more in one person and in a different way, in another person probably. But the amazing thing is that ketogenic diets can work, you know, to you know, not only, you know, deliver energy. You know, more effectively really. But, you know, they're anti-inflammatory in several different ways. They've got a directly anti-inflammatory impact. They help support the things like brain plasticity and neuro transmission and things. So there's a lot of reasons actually that ketones in the brain in particular, you know, can be really beneficial. Yeah, that reminds me about that ketogenic diet has been known to help with epilepsy. For over a hundred years is is my understanding. So that would make sense. I'm sorry, Phil, I didn't mean to interrupt you, but No I was gonna follow up just on the ketone you know, sort of issue. What are your thoughts on, you know, we'll call it endogenous, right? Ketones generating it with your diet versus what role Exogenous ketones we now have ketone supplementation products of in various forms. And where do you see that playing a role in this as well? I have to admit, I don't do a lot of work with exo, with exogenous ketones. I have experiments a little bit myself, but I generally do it by diet with my clients. For, and that's not to say that somebody shouldn't try that, it's just that I think there are additional benefits from doing it with the diet in my view. Because as soon as you stop taking a supplement, then you know, you gotta stop ma you won't have the ketones for start. You know, if you're trying to heal a condition, I think you really need, you know, especially a brain health condition, you really need the brain to be continually exposed to ketones, is my view. I mean. Some of the supplements are quite expensive too, which is a bit of an issue. You know, so I think, I mean, I do sometimes use things like MCT oil, which is a kind of key. It's not a, it's not a ketone itself, but it's quite ketogenic. And that can be helpful, especially if people are struggling a bit to get the ketones up initially. Sometimes it can be helpful. It can also be really helpful if people are traveling and things like that, and that they've maybe not got as much access. I mean, I've done ketogenic diets, climbing in the Swiss Alps and things you know, I do realize I appreciate it's difficult. Do, and you have to kind of think and plan ahead. You know, especially if you are not in control of your food, it is more difficult. So I think there's definitely a role for things like that. I just, I haven't really used 'em so much in clinical practice to be honest. So you've maybe got more experience than me. Yeah. You know, and I think one of the other interesting aspects that maybe the exogenous ketones miss right? Is that you know, ketones aren't one thing. You know, there are a lot of ketones that our bodies make, right? When we're in a ketogenic you know, metabolic state. Whereas, you know, we. When we're measuring ketones we're only really measuring one particular ketone beta hydroxybutyrate. And then a lot of the exogenous ketone products, you know, they're all a particular ketone, right? Yeah. That they're providing. And I think you're right that there's a lot, you know, it's still a little bit different than when you're just in a ketogenic metabolic state and your body's probably making, you know, many different, types of ketones that have these different effects, the anti-inflammatory and the various other effects that we see from ketogenic diets in general. And I just add to that, that I think the other benefit of doing it with diet is that you're really trying to get a micronutrient rich diet and at the same time, you know, and so that, although. That I think is important too especially for some people who might be missing micronutrients to begin with. So I think that there's two things happening at the same time, in a way with a ketogenic diet is if you do it a well-formulated ketogenic diet, then you're getting the micronutrients and the high fat content. So for me, that I think that's probably a better approach. But, you know, there's definitely a role for exogenous ketones, you know. Potentially, you know, I think they've been used in dementia a bit, for example, where it's maybe more difficult to get people to eat ketogenic diet. You know, and I know that there's been experiments you know, in the military and other ways where they found sort of positive benefits there. Yeah. Yeah, certainly. I guess, you know, as we kind of, are approaching the end of the conversation here where are you hoping this goes next? What are you working on and what do you hope to see happen now that we, you know, have this accumulating evidence of the benefit of ketogenic metabolic therapies? So I would really hope that it takes taken up mainstream, you know, maybe not overnight, but you know, I think there's a lot of people who are really dedicated to trying to make this happen now in the research field, in the clinical field and the expert patient field because there's a lot of people who have, you know, benefited now who are speaking up. So there's all of that. I mean, personally. I'm actually, I have written a book. It's being edited at the moment which is really all about how mitochondria work, how energy flows in the body you know, so I'm hoping that I'll help get the word out to a kind of wider audience as well. And I'm, I will be launching a group. Coaching cohort later this year because I haven't done that up to now. I've always worked one-to-one with people, but I am aware there's a greater demand and also, you know, people who don't have the budget to always work one-to-one with people as well. So that's on the horizon for me. And I'm actually a. I'm on the Scientific Committee of the Public Health Collaboration, which is a UK charity, which has a mission to improve society's metabolic health. And, you know, they are very much in, you know, promoting you know, ke well not, you know, low carb and ketogenic diets. For a variety of conditions really. And just, you know, campaigning to try and get our government to listen. You know, there are people on there. We were just looking the new NICE guidelines for diabetes were published the other day, and there's a little bit of disappointment that people that, you know, some of the, science that's been presented hasn't, doesn't feel like it's been taken on board again, but we have to keep trying. That's the thing. And I've currently got a petition out on change.org if anyone wants to sign that, to try and get our UK government to follow suit and review the dietary guidelines. Full stop. That's one of my aims at the moment. Yeah. Excellent. Maura, give us the where do folks. Who are eligible to sign that if you're in the uk? Yeah. So you're eligible if you're in the us. Yeah. They don't care. No, it's not. It's more UK people after for that it, it's change.org. The petition is called Overhaul the UK dietary guidelines. Overhaul of UK dietary. Okay. I'll make sure that shows up in the show notes as well. Yeah, that's great. And yeah, anybody who's wants to know more, I've got quite a few blogs and, you know, free downloads on my website if anyone wants interested. I've got a nice 10 tip ebook on there. And you can find me by my name. I'm the only MO in us in the world luckily for me, so I'm quite easy to track down. Excellent. Yeah, we'll definitely make sure all of the resources are there. I think you know, I definitely encourage people to follow your work. Looking forward to the book, looking forward to the the next case report that you're working on and you've been doing some great work over there. Thank you so much. It's been a real pleasure to talk to both of you, Philip and Jack. So thank you very much. I appreciate your time to do this. Very good. The Maura's website is maura newest.co.uk. Did I get that right? I believe so. Yeah. That's right. Yeah. Maura newest.co uk. She's on LinkedIn. She's on YouTube. She's got a lot of good stuff on her website. And that is certainly applicable to anyone regardless of where you live. And then of course, for those UK residents the change.org petition. I'll make sure that's also on the show notes. Alright, this has been Stay off my operating table, our guest. It's Been nice. Thanks for being with us. We'll talk to y'all next time.