In addition to being a respected clinical psychiatrist for more than 20 years, Dr. Matt Bernstein is Accord’s chief executive officer and one of the leading voices in the emerging field of metabolic psychiatry. After graduating summa cum laude from Columbia University in New York, N.Y., with a bachelor’s degree in English literature, he received his medical degree from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, PA. Dr. Bernstein then trained at the MGH McLean Psychiatry Residency Program in Belmont, Mass., where he served as chief resident. He remained at McLean Hospital after residency as a psychiatrist-in-charge and later served as assistant medical director of its schizophrenia and bipolar inpatient program. Dr. Bernstein has developed his passion for community-based care as the chief medical officer at Ellenhorn, a sister program of Accord, where he has pursued alternative ways (such as a focus on metabolism, nutrition, circadian-rhythm biology and exercise) to help individuals achieve their best levels of functioning without relying solely on traditional psychiatric approaches. In addition to serving on the clinical advisory board at Metabolic Mind, Dr. Bernstein is known for organizing the first-ever public conference on metabolic psychiatry in 2023.
In addition to being a respected clinical psychiatrist for more than 20 years, Dr. Matt Bernstein is Accord’s chief executive officer and one of the leading voices in the emerging field of metabolic psychiatry. After graduating summa cum laude from Columbia University in New York, N.Y., with a bachelor’s degree in English literature, he received his medical degree from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, PA.
Dr. Bernstein then trained at the MGH McLean Psychiatry Residency Program in Belmont, Mass., where he served as chief resident. He remained at McLean Hospital after residency as a psychiatrist-in-charge and later served as assistant medical director of its schizophrenia and bipolar inpatient program. Dr. Bernstein has developed his passion for community-based care as the chief medical officer at Ellenhorn, a sister program of Accord, where he has pursued alternative ways (such as a focus on metabolism, nutrition, circadian-rhythm biology and exercise) to help individuals achieve their best levels of functioning without relying solely on traditional psychiatric approaches. In addition to serving on the clinical advisory board at Metabolic Mind, Dr. Bernstein is known for organizing the first-ever public conference on metabolic psychiatry in 2023.
SHOWNOTES:
😴 Can what you eat reshape your mental health and sleep through a metabolic psychiatry lens?
😴 Can glucose monitors and ketone testing unlock hidden insights into your sleep patterns?
😴 What do iron, B12, vitamin D, and carnitine reveal about your brain health and sleep?
😴 Can meditation during the day support better sleep quality at night?
😴 What role do red light, magnesium, and your environment play in deep sleep?
😴 Can tools like ChatGPT help guide your health decisions around nutrition and sleep?
😴 Why are so few practitioners trained in metabolic psychiatry, and how can you find the right support?
😴 Do purpose, community, and lifestyle complete the foundation for better overall health and sleep?
😴 And many more
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Welcome to the Sleep As a Skill podcast. My name is Mollie Eastman and I am the founder of Sleep As A Skill, a company that optimizes sleep through technology, accountability, and behavioral change. As an ex sleep sufferer turned sleep course creator, I am on a mission to transform the way the world.
Thinks about sleep. Each week I'll be interviewing world-class experts, ranging from researchers, doctors, innovators, and thought leaders to give actionable tips and strategies that you can implement to become a more skillful sleeper. Ultimately, I believe that living a circadian aligned lifestyle is going to be one of the biggest trends in wellness.
And I'm committed to keeping you up to date on all the things that you can do today to transform your circadian health and by extension, allowing you to sleep and live better than ever before.
Welcome back to the Sleep is a Skilled podcast. Today's episode is one of those, oh, that's why conversations because if you've ever felt like mental health and sleep are treated like completely separate issues, while your body is quietly running the whole show, this is going to land. We're talking metabolic psychiatry, mitochondrial health, and how what's on your plate can ripple into your mood.
Anxiety and your sleep. Now I'm joined by Dr. Matt Bernstein, a clinical psychiatrist of 20 plus years, and CEO of Accord, who's at the forefront of this emerging field. Now, what I love about Dr. Bernstein is he's not just theorizing, he's applying metabolic interventions to real clinical settings and seeing meaningful results, including with sleep.
We get into why the shift. Two, ketosis can feel bumpy at first, how to reduce keto flu by transitioning gradually, and why tools like ketone testing and continuous glucose monitors can make this whole process more measurable and personalized. So if you're curious how metabolism, circadian rhythm, and mental health all connect and what you can do starting today.
Listen on and listen all the way through. And if you want a clear starting point after the episode, you can always reach out to us to get a sleep as a skill sleep audit, and uncover your biggest levers and build a plan that you can actually stick to. All right, we're gonna jump into this episode with Dr.
Matt Bernstein, and a quick reminder, we would love to also have you on our weekly newsletter sleep sessions. It's been going out every Monday for over. Seven years. You can also sign up for that at sleep is a skill.com. Welcome to the Sleep is a Skill podcast. This is a really exciting episode because one, I'm just personally very excited to hear what our guest has to share on the ground and in the research and what he's discovered and what I believe to be this really important conversation around metabolic psychiatry, mitochondrial psychiatry, and how what we're.
Eating can impact our mental health, and of course by virtue our sleep results. So Matthew, thank you for taking the time to be here. My pleasure. Thanks for having me. Yeah, very exciting. I, I shared before we hit record, that I had seen you, the Metabolic Mind Podcast and just loved what you shared and your vulnerability and sound like years and years of time spent really helping to support people in navigating their mental health and what sounded like.
Excitement for you around some of these kind of seemingly new in air quotes, discoveries, but of how they can really make a difference in quite severe cases from the sounds of it. But I won't get ahead of myself, so maybe you can share just, you know, how you found yourself at the kind of this nexus of looking at metabolic health and psychiatry.
Yeah, well, it is fairly new. I mean, I, I was a traditional psychiatrist for a long time. I've, you know, been in practice for over 20 years and I always took care of people with more severe mental illnesses, but, and other people as well. So all types, but that has been. Part of my specialty and really focusing on sleep along the way because yes, it's so important for mental health and it's very bi-directional.
Yes. Uh, meaning, you know, sleep will affect mental health and mental health affects sleep. So, you know, it's like they're intricately connected. Yes. Um, but you know, about maybe six or seven years ago, I saw a Grand Rounds lecture with Chris Palmer talking about ketogenic diets and severe mental illness.
And that really got me fascinated with that. And I've done a deep dive on all the. Biology of that and also just started applying it in my practice and seeing just incredible results when we improve people's metabolism in terms of their brain health and mental health and including sleep. Um, you know, one of the mechanisms by which ketogenic diets are known to affect brain health is by increasing gaba naturally.
Yes. That is our, you know, relaxation slowdown hormone, our neurotransmitter. Sure. Um, and so, you know, when we increase GABA naturally we would expect some better sleep. And there is actually some studies that have specifically looked at ketogenic diets and sleep, which we can get into later, which are, you know, they're very preliminary.
We actually have. The most research on ketogenic diets and epilepsy. We're now developing research on ketogenic diets and all these mental health conditions, which I'd love to share about. But you know, there is even a little bit of data on ketogenic diets and improving sleep as well directly. Oh my goodness.
Yeah, I would love to hear more about that because one of the pushbacks or areas that sometimes we'll, we'll hear people say to us when we talk about, you know, kind of ketogenic diet or the possibilities of utilizing ketosis to improve blood sugar stability and help support sleep results. Some people say, oh yeah, but it.
Disrupts your sleep and messes with your sleep, or instances of shorter sleep, wake ups, et cetera. What do you say about that and are you hearing that? Does that feel accurate or do you feel like, oh, maybe that's on a short term as you're adjusting, how do you think about that? Yeah, more the latter. It definitely can happen as people are adjusting.
So you know, that's a big change. When you switch from a carbohydrate based metabolism to a fat based metabolism. Everything is changing and all of our cells, it's an enormous adjustment that we're going through, and so. The best way to do that was to actually do it gradually. So, you know, instead of just, you know, one day saying, I'm gonna throw away all the carbs and eat ketogenic food only, you know, that's gonna be tough on your body.
So I would recommend for people, unless there's a really urgent need to do it quickly, yes, do it slowly, you know, start with the one ketogenic meal a day for a week or two, and then maybe go to two ketogenic meals a day, uh, for a week or two, and then finally three meals a day. And that will give your body a chance.
To adjust gradually, and they're much less, they're, you know, then they're someone's much less likely to get those kind of side effects, like some sleep issues or other side effects that are called the keto flu. Keto flu is completely avoidable if one does it gradually and drinks a lot fluids. Um, so it's not something that needs to be worried about or feared if you do it the right way.
I appreciate you calling that out too. And you know, I think that's one of the things that feels like it's missing is the like readily available resources for people to go to of how do I approach this, depending on what my diet has looked like for, 'cause I shared with you that my mom has recently gone keto and yet for most of her adult life, it's really been standard American diet.
And so that kind of process, we had to patchwork together in conjunction with her practitioners of course, but patchwork together an approach that made sense and I'm so appreciative of you sharing kind of what you're finding. Are there places that people can go? Because it still seems like so many practitioners are not in this conversation.
You're certainly a pioneer. So how might you suggest for people that, I mean, it's already challenging for a lot of people to reach proper mental health care in general, let alone someone that's on the forefront. What do you see for that kind of resources? Yeah, I mean, it's unfortunately the case where there's not that many clinicians in the mental health world who understand this important connection between metabolism and mental health.
And yes, are using metabolic interventions like ketogenic diets or time restricted eating or low carbohydrate diets, plus exercise. There's a lot of ways. To do it. There's just not that many of us, unfortunately right now, that are doing that. So, I mean, you mentioned Metabolic Mind. That's a great place to go initially to learn about this, and there are a lot of resources on that website.
Um, you know, I opened up a, a residential program for people with significant mental health conditions Wow. To try to address this. Um, need, and for a lot of people it's hard, you know, if you're already struggling with a pretty significant mental health condition, it's hard to even try to make any changes, let alone something intricate like a full dietary change and, um, circadian rhythm program and.
Sleep program and, um, exercise program. It's a lot of things to try to think about to do. Yes. Um, and so depending on how much support someone has, um, you know, that's why we created this program That's really an immersion in all of this. They come for a monitor two, and then we really teach people how to continue the progress and do it when they get home.
Wow. Oh, that's very cool. I didn't realize that. Okay. So for people listening if for themselves or maybe like a loved one that is, is it for kind of acute situations or how do you Well, I mean, it's not, instead of like, you know, someone really is acute and needs, you know, emergency help, you know, they go to a hospital or an emergency room.
Um, but you know. At some point when people, you know, get stabilized, then they're sometimes experiencing, you know, they haven't gotten full recovery. Yes. Um, they're, um, hit a plateau. The medications might have done something for them or the other therapies they're doing might have done something, but they may be getting a lot of side effects.
Um, and then they start realizing that they wanna do things more naturally. Sometimes they wanna maybe re, you know, reduce the medication or get off medication, reduce side effects or their metabolic health is suffering from. The treatment itself. Um, and so, uh, those are all particular reasons why they may come to us.
Um, and like I said, it's, you know, it's for people who, you know, they really need support and. Instituting all these different interventions. There are some people out there who can do this all on their own or with the help of family, but, um, you know, for a lot of people they do need, you know, some more support to get it, uh, started.
Wow. Very cool. Okay, so for people listening that they're saying, or maybe they are experiencing difficulty with their sleep and they have attempted ketosis or they're kind of in the beginning stages or contemplating how might they think about. Different stages that they might go through as it relates to their sleep in this, uh, process.
Right. So early on, you know, their body's adapting. Yeah. We're not expecting a huge benefit for anything for those first couple of weeks. Okay. For most people. There's occasionally some people who, you know, as soon as they go into Nick ketosis, they feel better and their anxiety goes away and their sleep gets better.
That's not what I would expect though. Yeah. Most people, there's this adaptation and you're changing how your cells are using energy. Um, and then usually, you know. If someone you know is in ketosis for a couple of weeks, you know, maybe week two, week three, we start to see those benefits reduced anxiety, more energy during the day.
Um, and then, you know, often, you know, sleep benefits as well where we can start reducing, if they're on sleep medication, I can start reducing those sleep medications and they're still able to sleep really well. Wow. Without it. Um, of course we're also, you know, doing these other things that I'm sure you, um, you know, teach people about all the time, about circadian rhythms and light and, um, you know, those things can make a huge, huge difference as well.
Ugh. And then finally, you know, you know, mindfulness and meditation, you know, relaxation at some point during the day, especially for people with mental health conditions. Hmm. One of those things that has a huge impact and it works together with all the things we're talking about with improving metabolic health through nutrition and with exercise.
It really allows the body to get into those deep rest states that allow for healing and, and, and sleep as well. Yeah, it works together. Yeah, absolutely. And. In this process when making some of those changes, especially with medications and what have you, are there things that you're, you and other colleagues are utilizing to kind of verify that there's adherence or compliance to this?
So whether it's blood testing Yeah. Whether, you know, air breathalyzers, like we have, um, keto Air is coming on the podcast. I dunno if you've seen them. Um, oh, yeah, yeah. That, yeah. Yeah. Sure. Yeah. So any, any use Absolutely. Yeah. That's. You know, if someone's doing this for medical reasons, you know? Mm-hmm. For mental health reasons, yes.
It is really important to check ketone levels. Um, yeah, so we generally use the blood tests, uh, device, a keto mode, but that's the most accurate. Yes. Um, the breath testing is getting better and better and a lot of people don't like sticking their fingers, so the breath, you know, testing can be used for those folks.
Um, but at the program we do use the blood tests. Yeah. Um, we also have continuous glucose monitors on people. Yes. And that's a really great tool as well. While you're making changes in nutrition and exercise to really see what's going on in your metabolism, I think we all often make a lot of assumptions about blood glucose that may not be accurate and.
It's now really easy to know exactly what's going on with your blood glucose every five minutes. Yeah. Those devices are now over the counter. You don't even need a prescription for them. They're not that expensive and they're a really, really good investment in one's health. Um, even just to do it for two weeks at a time.
Yes, and just, you can learn tremendous amounts about what's. Spiking blood sugar. What, when blood sugar's dropping. If there is wake up in the middle of the night, sometimes we, you know, think that it might be a blood sugar issue, but you can really take a look and see on the device, um, you know, in the morning what happened with your blood sugar overnight.
So those are really helpful. And then we do full lab panels as well, which, you know. Testing for various metabolic markers and micronutrients and other things as well. Yeah, so good. I completely agree with you too, and the excitement around the fact that now we can get those continuous glucose monitors so easily and affordably.
Yeah. I mean, yeah, it feels like such a worthwhile investment to your point, even if we were to just use those for a couple weeks at a time in the transitionary period until we kind of get this all locked down. Yeah. Really, really great. Any callouts. You know, there's still fairly new as you're pointing to, but have you seen any callouts for women as you're navigating kind of hormonal callouts or adjustments to be made?
Yeah, I mean, I think it's always, you know, important to call out the differences between men and women. I mean, you know, there's, there are really significant biological differences. Yeah. Um, and you know. Especially women, um, who are, who are menstruating, you know, hormones really affect metabolism quite a bit.
And so we just have to keep that in mind, you know, as we're making these transitions and interpreting what's happening, um, you know, where are things with the menstrual cycle? Um, I don't tend to, you know, change the program significantly, but we do have to, we do may interpret sort of what's happening a little bit differently.
Um, but we don't, you know, we don't prescribe necessarily a different diet necess, um. For, for women versus men. You know, women can do ketogenic diets at any age, for sure. In a very healthy way. Um, and it does provide all the nutrients that are needed. Um, yes. You know, there's not a lot of data on ketogenic diets in pregnancy, so I, you know, I just wanna put that caveat out there that I wouldn't necessarily recommend.
Sure. Ketogenic diets. You know, during pregnancy, there's only a very few things written up about that in the literature. But, um, other than that, you know, you know, if someone's not trying to get pregnant or isn't pregnant, then you know, it, it's, it's really safe. Uh, it's a really safe intervention compared to so many of the other interventions that I've done throughout my career with medications.
I consider this an incredibly safe intervention. Yeah. We're, unfortunately, it seems like there's a number of medications that for more severe mental health issues that disrupt metabolic health, to my understanding, rightly. Okay. Yeah, that's, it's a great question and great to point out. Yeah. I mean the, especially these medications that are prescribed a lot more lately than they used to be, these atypical antipsychotics or second generation antipsychotic medication.
Sure. Are really, really problematic for metabolic health. Okay. But so are mood stabilizing medications? Yes. So are even antidepressants, um, they're really problematic for metabolic health. Not as severely as the atypical antipsychotics, but so, you know, any, you know, an almost any psychiatric medication can have negative impacts on metabolic health and.
That's really concerning to me because now I really understand and that there is this incredibly close connection between metabolic health and mental health and, you know, brain health. Yes. You know, we've already talked about the connection between, you know, mental health and sleep that's bidirectional.
Yep. There's also this, you know. Uh, bidirectional relationship between metabolic health and sleep. So if we think about it, it's like we can have this triangle and, and one part of the triangle could be mental health or brain health. Mm. Another point on the triangle is metabolic health, and then another side is sleep, and there's.
You know, bi-directional arrows going between all points on that triangle. Ah. Um, you know, and so, you know, it, you know, just coming on here made me really think about that. That like these things are all closely connected. Ah, so beautifully said. And that visual I think is really helpful to just get how important these things are.
And, you know, so often we like to silo these conversations. And that age old analogy of some of these things are like a garden. You can't just say, oh, well you just need good dirt. You just need water, you just need sunlight. You need the whole thing. So Right. They work together. So you mentioned gaba and just curious too, any callouts, and I know it's a much bigger conversation, we don't need to go into the weeds with medications by any means, but I was just curious because we've had a number of people come on discussing concerns around benzos, like, uh, long-term benzodiazepine use or Z drugs.
And of course we often see those for sleep. So curious if there's any kind of best practices if people are on some of those and now they're gonna be potentially altering their GABA levels with ketosis? Or is that a longer conversation? No, I mean, I, we can summarize it. Okay. You know what, you know what ends up happening when we start a ketogenic diet and someone.
Who's already on me, you know, psychiatric medications has a mental health diagnosis. Um, we wanna give them a period of time to adjust to the diet, start feeling some benefits, but then what often starts to happen is that they do become more sensitive to the side effects of those medications at some point.
Hmm. And so it gives us an opportunity to start gently lowering. The medication, um, which in the long run is going to be, you know, really good for this person. Yeah. Um, but we have to be really careful about going down very, very slowly and carefully. Um, I think, you know. Throughout my career, and I think my profession in general does not recognize how much of a withdrawal syndrome there is from not just benzodiazepines and Z drugs, but all of these medications have withdrawal syndromes.
Yeah. Every single one of them. And when we go down too quickly, we put people at risk of. Additional symptoms and side effects and, and problems. And so, you know, often, you know, I may be in a hurry to get someone down on their medication and they're in a hurry, but we have to restrain ourselves and be careful and just go really slowly and things like, you know, even like a 10% reduction, you know, a month sometimes.
Mm-hmm. If it's been on a medication a really long time. Yes. May not be too slow. That may be exactly how slow we need to go. Yes. Um, with some people for certain medications, you know, over time. So good. I also love that you mentioned, it sounds like you're doing lab work as well. We both had appreciate some of what Dr.
Chris Parmer's sharing, and I know he's noted his underscoring of iron, things like B12 and other concerns for mental health. Are those some of the same things that you are underscoring as well or other callouts. Yeah, yeah, those for sure. I get a full iron panel on people and I'm frequently seeing low iron and low iron storage in all the people who come through, not just women, but, but young men as well.
And sometimes we can't, we don't know the cause, but um, you know, that's the concern for. For mental health and sometimes it needs a medical workup if we can't get the iron levels up. Um, and there's no, you know, specific reason so that for sure, B12, um, I would add in, you know, I like to look at, um, a marker called homocysteine, which is a measure of how B vitamins are working in the body and methylation that's often quite elevated.
And the, the ranges for the lab, you know, I use. Uh, quest, but this is true in a lot of labs. They're not really optimal ranges, right? This is true in a lot of lab work. Um, so, you know, homocysteine, they're saying like anything up to, I think it's like 12.9 is okay, but really optimal is down at about eight.
Um, this is true of a lot of lab work. We check vitamin D for sure. It's very important, uh, for mental health and brain health. Um, and then the other one that's. Um, important I think on a ketogenic diet especially, is this one called carnitine. Um, and that's, uh, you know, a compound that we get in food. We actually get it mostly in animal food.
Um. And it allows fatty acids to get into the mitochondria to be burned for fuel and also to, you know, to make ketones. And so if we don't have enough carnitine, we're not gonna feel as well on a ketogenic diet. We're not gonna make ketones as well. And Carni, low carnitine is also associated with depression.
It's also associated with some psychiatric medications that are used. And so it. It's a really relevant one in my population for sure, to be checking. You know, I check it right when people come in and, and even, you know, a month later and two months later, we keep checking it and sometimes we'll see the carnitine levels drop and we'll have to, and it's an easy supplement to take.
You can, you know, over the counter you can get it. Um, and so someone can't get the lab tests and they're doing a ketogenic diet, but not feeling well. It could be something to try. It's just, uh, you know, empirically trying a little bit of carnitine. Um. The, the one thing I would say is that there's, there's one, one or two case reports of that, uh, carnitine can flip people into mania when they have bipolar disorder.
So I just wanna put that warning out there. Um, it's not a likely thing to happen, but it is something just to know about for people who are thinking about supplementing with carnitine. Oh my goodness. So helpful. I appreciate you breaking those down. And so with that, like I suppose all supplementation kind of, do you suggest low dosing it and up leveling or.
It depends. Yeah, yeah, sure. And if Im going on lab work, and I know it's really low, I may start at a higher amount and I know someone really needs it. Um, and I'm getting, and I have the opportunity to watch them closely. If someone's at home, I would be more cautious with something like carnitine, especially if they have the, you know, bipolar disorder diagnosis or if.
Bipolar disorder even runs in their family, I'd be a little more cautious with it. Um, but other than that, it's a very safe supplement and it generally supports mitochondrial health. It's one of the ones that often gets put on people's list for, you know, mitochondrial supplement as well. That is awesome.
I love that. Okay. And in conjunction with that, certainly as we speak to things like iron stores and, and I know this is always controversial and there's, I'm sure always ways to work around, but on conversations around getting sufficient protein and iron levels, do you have an extra kind of red flag if you're working with someone that tends to be more plant-based and trying to bring that plant-based approach into ketosis?
Any thoughts there? Yeah, I think it's harder to do a plant-based. Ketogenic diet. Yeah. That's tricky. Know, I do know one person who does a vegan ketogenic diet and it's very, very hard to do. Do well. Yeah. She had to work pretty closely with a dietician to come up with something that could work for that.
Okay. In general, you know, I, I. Give people the option of course. But I do recommend for Best Brain Health and metabolic Health that some animal products, you know, really are helpful. Yeah. And that's true for multiple reasons. Um, you know, there's certain nutrients that we just. Get, you know, better levels of, from animal products, things like iron and zinc and B12 and carnitine and creatine.
These are all things that are involved in energy production and much better to get, you know, you get, get at them in animal sources, you know, not from plant sources. Sure. The other one is, is the amino acid profile and protein. You know, animal protein has different amino acid profile than plant protein.
Plus. Another thing people don't appreciate as much is that plant protein is only about 70% bioavailable, and whereas animal protein is, is usually about a hundred percent bioavailable, meaning we only absorb about 70% of the amino acids when we eat plant protein. So when you think you're getting, you know.
20 grams of protein in your, you know, plant-based protein, you know, bolus. You're actually getting only 75% of that. You're only getting 15 grams, not not 20 grams, um, of usable, you know, that you can actually use. Plus it doesn't have some of these very important amino acids, so, you know, so, so when someone is, wants to be plant-based, we can work around it.
We have a great dietician who's able to figure out workarounds, but I don't think it's optimal. And so if someone's doing it for health reasons, I try to, you know, give them that information. If someone's doing it for other reasons, they just don't like eating animal products or, you know, ethical reasons, then of course, you know, that's their, their prerogative.
Absolutely. Now, certainly the next thing I wanna say is absolutely with lots of asterisk and caveats around working in conjunction with a trained practitioner like yourself, knowledgeable, and yet, I do wanna point out that it's been interesting we've been starting to see in the last year or so, people sharing, you know, whether it's on our newsletter.
Social media or podcasts or what have you, people sharing about utilizing AI and having it help guide them on this journey for, you know, 'cause this process of going from potentially a standard American diet or however we might be eating for decades and to ketosis can have a lot of growing pains and it's been.
Really interesting to hear of the number of people that are kind of praising chat, GBT or Gemini or what have you, in helping to sculpt their plates with the proper macros and taking pictures of their menus and asking to, you know, when they're eating out, how to make. This, what can I order that's, uh, keto friendly?
Just bringing some of this conversation in so that we can democratize this conversation as well. Now, of course, don't want people to get the wrong idea and you know, any sort of just being guided, uh, potentially in a large language model that's still working out some kinks and what have you. But I do, I'm curious your thoughts on that.
Do you see potential there? Yeah, I mean, I think, you know, there's certainly potential. I mean, from my experience, I don't have a vast experience with AI at all, but Okay. My limited experience, it can be really useful to summarize things, but I've also seen it make a lot of mistakes. Sure. I do. I do worry about people trusting it for some really important health decision.
Yes. You know, certainly if it's helping to, you know, figure out what's on the plate or what to order at a restaurant and it's, you know, a quick question. Yes. That doesn't have huge consequence then. Great. Yes. I love the idea of people, you know, get benefiting from the tool. Um, but you know, in terms of like a really important, you know, decision around, you know, should I be taking this medication or, you know, you know.
Are, are these ketone levels enough for my condition? Like, yes, I wouldn't necessarily trust AI for something like that at this point. Totally get that. Hopefully in the future, you know, it'd be a, you know, blend of, you know, people in AI really figuring out, you know, great solutions to some of our. Our health problems.
I'd love to, yes, totally. Real quick, and I'm excited too to hear how you're managing your own sleep, given that you've thought about this for quite some time. So I'll shift to that in just a second. But curious, I know you mentioned call outs around avoiding mania for groups of individuals that might be dealing with bipolar or just, you know, being cautious.
And I love that you pointed to circadian rhythm entrainment or circadian health. Any call ups there as people might be really looking to take on their metabolic health and they're getting more sunlight, more. Using light boxes or anything that you've seen that's works or doesn't work? Yeah. Well, I, I mean, I'm a big believer in natural sunlight as opposed to light boxes.
Yeah. Um, I think it's just, you know, there's, it's just much more effective and powerful than any, you know, any light box. Yeah. You know, even on a cloudy day, um, we're getting more, uh, you know, good. Yeah. And it's the correct, um, type of, you know, sun, it's the correct type of wavelengths of light, you know, when we're outside.
Yes. Um, and so, yeah, I think. It's, you know, circadian rhythms are really important for sleep, but they're really important for metabolic health as well. It's what allows ourselves to know, should they be doing, you know, building things right now, or should they be breaking things down for energy right now?
You know, when everything, when the circadian rhythm is entrained, it's like an orchestra that has a really good conductor that ev all the parts are working in unison and we have this beautiful music of. Health. And you know, when the circadian rhythm is off, it's like there's no conductor there. People are playing a whole different song in this section than that section off tune.
It's off key and people feel terrible. And so it's, it's really foundational for health, um, to, to have good circadian rhythms. And it's one of the things that's gotten so off in our culture in the last, you know, 20 years with the advent of, you know. These wonderful, you know, technological devices, but there's a downside to them as well.
Yes, yes. And people have these devices on at night. I mean, um, you know, all about this, but it causes huge disruption in circadian rhythms. Not, you know, sleep of course, but other parts of our circadian rhythms and the way to, you know, get back in tune is to, you know, get back in tune with the natural light cycle and eating cycle and be in, you know.
Be rhythmic about these things. So it's a, it's a huge part of what I talk about with people and recommend to people and, and you know, when we get into what I do, I'll, I'll talk about that for myself as well. Yeah. Amazing. So good. Okay. So yeah, very curious. 'cause as you pointed to, sleep has been a focus in your conversations with, uh, your clients.
Presumably in your own life over the years. So really can't wait to hear how you're managing that currently. So the first question that we ask everyone is, what is your nightly sleep routine looking like right now? Okay, so it starts with, um, I put on red light glasses. Um, yes, about two or three hours before bed.
Um, and so those are like the really goofy looking ones where it's like, you know, the lenses are bright red and yes, everything looks pretty red, but that's really, I find the most convenient way to. You know, completely block out blue light in those couple of hour period, that critical period before bed.
Um, and then, you know, I'm at some point, you know, turning off my phone. I literally, you know, power it down and shut it off. Um, I have a. Uh, I have a phone, like a, a landline phone, believe it or not. Whoa. By, by my bed. Because as a doctor I need to be reachable overnight. Yeah. But I don't want my cell phone on The So cool is, this sounds almost so foreign.
It sounds high tech that this is like the, you know what I mean? It's like, wow, that's such a great idea. It's like, oh yeah, we did that for a long time. Yeah. That's brilliant though. Yeah. Great. Okay. So if someone needs to reach me, they're calling overnight. They're calling the landline, you know, and, you know, it doesn't, like, luckily I'm a psychiatrist.
I don't have that many emergencies overnight. But you know, when they, when it happens, they, they call me on the landline. Um, and then, you know, I do take a few things before bed. I take some magnesium. Three in eight. Mm-hmm. Which I really like. Mm-hmm. Sure. Um, in terms of, you know, muscle relaxation and just sort of general sort of relaxation, um, I sometimes take some l-theanine, which I think also a nice, natural sort of relaxing thing for me.
Yeah. Especially if I had an anxiety provoking day. Sure. Um, you know, I like I, I mentioned meditation before, you know, to me like that's a really important. Factor. I don't usually do it at night, but if I had meditated at some point during the day, which I try to do as many much as possible, yes, I usually will sleep better at night.
I find there's a really close connection for me. Hmm. And then, you know, sort of do all my sort of bedtime routine stuff, you know, get into bed. Um, I have a, uh, a, a a night light or like a little light that shines on my book that is a red light as well. Yeah, me too. Yeah, so I take the red light glasses off 'cause I need reading glasses at my age.
Ah, but, but I have that like red light that I read by essentially. Um, and so, you know, really avoiding any blue light at night. Um, and then, you know, I usually set my alarm, which. Generally I wake up before my alarm, but I have an alarm that's one of those alarms that, you know, is a light alarm essentially.
Sure. Gradually, you know, lightens up the room. Um, we've got the, you know, blackout shades, cool room I actually use. Um. I tend to like using, um, earplugs as well. Mm-hmm, sure. Just to block out any, any sound 'cause that, you know, tends to wake me up sometimes and, um, you know, just better not to be woken up by sounds if I can.
I guess that's, that's most, that's most that's great. That's most of what I can think of. Yeah. Yeah. Yeah. Fantastic. And the meditation, are you doing that in the evening as well, or earlier in the day? I usually end up doing it earlier in the day. Sure. Yeah. Not, not in the evening, but, but like I said, it, I think people think of meditation as it only helps just in that moment, or you know, only, oh, I be it help you fall asleep.
For me, I don't usually have any issues falling asleep if I'm gonna have a problem that's usually in the middle of the night. Mm-hmm. But if I meditated during the day, I tend to avoid any middle of the night. Wake up or problems. Yeah, I love that. And 'cause we'll have some people that sometimes can have the counter effect at times when they, you know, they're trying to bring, they're like all freaked out about the night anyway, and then they try to bring in meditation or breath work or what have you.
But certainly at times the meditation then they kind of end up falling asleep and they almost get themselves a nap and now they're awake and they don't have as much sleep pressure and it's a whole thing. So to your point, just having that. Time where possible carved out in the day to train for that parasympathetic response.
So, great. Okay. So then the second question would be, what might we see in your morning sleep routine with the idea that how we start our day can impact our sleep? So yeah, I mean that one, you know, I started doing a few years ago, which is I, I get outside in the morning Yes. And get. You know, natural sunlight in the morning.
Yes. And I think that is like, it's incredibly powerful. We were talking about circadian rhythms before. That is the most powerful way to entrain circadian rhythms is that morning sunlight as early as possible. Um, you know. In, in where I am in Massachusetts, you know, now it's, you know, sunrise is very early.
I'm not, I'm not getting out for sunrise right now. Um, but interestingly, I will some, I do wake up earlier in the, in the summer. Like I just, my body is just, I think, just entrained to the light a little bit more. Sure. Um, and you know, just getting outside, we have a dog, so take the dog for a walk first thing in the morning that morning.
Sunlight I think is super helpful. And then, you know, I also. Tell people, and I do myself too, is I try to get outside multiple times throughout the day as well. Mm-hmm. Because our, you know, our super chiasma nucleus can discern the difference between 7:00 AM sunlight, 10:00 AM sunlight, 1:00 PM sunlight.
So every time I get out and I. Get sun into my retina and, and, you know, through my optic nerve to that nucleus. I'm telling it what time it is. Yes. And that is helping my brain know that exactly what time it is and how to do the right things at the right time. And so, you know. Come, you know, nine o'clock at night, like my brain knows it's it's bed, you know, getting close to bedtime and I'm getting tired.
Yeah. Yes. It's truly magical and life changing when people start enacting this. I mean, I shared with you too, that I grew up in Maine, went to school in Syracuse, like Northern New York. Yeah. And lots of snowy winters, and lived in Manhattan for years. And I've moved to Austin since then. Like a large part of the reason that I moved was for the sun for more ample.
Sunlight to able to, you know, podcast outside. No, it is really hot. I will say that, but especially these Austin Summers, not for the faint of heart, literally, but you know, I will say that you're a hundred percent right, just makes such a difference. And one of the cool things that we'll see for people is when they start bringing about this kind of circadian rhythm entrainment into their lives.
When we go through these programs that often people are shocked that they weren't even trying to have. Some of these effects that they start having, like they aren't trying to necessarily lose weight. They aren't necessarily trying to gain more muscle mass. They aren't necessarily trying to lower their heart rate, improve their heart rate variability, so they just wanted sleep better or whatever.
But in the, by virtue of giving the body this level of. Strong signaling and entrainment. It's part of that beautiful kind of all over response. So love that you're pointing to that and helping people with that. So do you have people when your, your clients start to try to bring that up in as much as possible?
Absolutely. Yeah. Oh yeah. This is one of the big parts of. The, the program that I mentioned, you know, we're getting people out. Sounds amazing. Morning and walking multiple times throughout the day. Yeah. Um, and, you know, talking to people about this all the time, 'cause I know how powerful it is. You know, once you experience it, you, you realize like, this is not a small thing.
Like, people think of it like, oh, it's just a little bit of light. Like, what can that do? It's powerful. All of our hormones are connected to our circadian rhythms. Yes. And so, you know, we're, if you wanna maximize. Important hormones like getting your thyroid hormone locked in or your, um, for men, their testosterone or women, their estrogen and progesterone, like this is all connected to circadian clock and these things have powerful effects on our physical health and mental health.
How do we get more. Doctors like yourself, like how do we get more access if people are listening saying, okay, but my doctor's not saying any of these things. Not in this conversation. I know I kind of hit on this a little bit, but you mentioned metabolic mind. Maybe you're the person to start like facilitating this.
Any other call outs of just how can people find someone like you that gets this? Yeah, there aren't that many, like, you know, functional psychiatrists or, or metabolic psychiatrists, but there are some out there. Um, okay. And so, you know, people can look, you know, look up that sort of term, either like integrative psychiatrist, functional psychiatrist.
Metabolic psychiatrist near me. Um, okay. There's, there's another website that has, um, a list of practitioners as well. That's, um, Dr. Georgia E'S website called Diagnosis Diet. Oh, and on her website, she collects all the people who did her training program. She's trained many physicians, but also therapists and nutritionists and dieticians and all kinds of.
You know, practitioners and, and so on her, on her website, you can put in your location and you can find who's been trained, uh, in her program. Um, and you know, she, she has a great book as well that I highly recommend Change Your Diet, change Your Mind. We mentioned Chris Palmer, but those are sort of the two sort of North Stars in Metabolic Psychiatry, the two of them.
Yeah, for sure. A hundred percent. And I feel like she does such a great job at kind of getting a bit more in the weeds on. You know, approaches and call outs in, in such a really responsible manner of groups that might wanna be more cautious or need additional support or alternative approach, all of that.
So, great point. And I did not know about that directory, so I'll find out about that and we'll add that in the show notes too, so really good. Great. Okay, so then that covers your nightly routine, your morning routine. What might we see on your nightstand or in your environment? I know you already called out quite a few things.
Did we cover a lot of those or anything else? Yeah, I think we covered most of what's on my nightstand. You know, I got my, my earplugs and my landline and my, you know, you know, light alarm that I usually wake up before. Um, and then I guess I have like a lamp that has a, a, a, an el, uh, an red light, you know, as well.
So, I mean, that's that one you can change. It's one of those LEDs that you can change it to different types of light, but Sure. I have it set on red light because, you know, it's like the night, that's the light that we use, like, you know, to make sure we're not like falling down when we're, we're getting into bed or whatever.
Yes. So that's on my nightstand as well. And then usually a few books because you know, I, I'm a reader so, um, I do sometimes read to fall asleep, but Sure. Usually I fall asleep very quickly once I start reading. Yeah. Love it. Okay, beautiful. And then the last question so far to date, what would you say has made the biggest change to the management of your sleep?
Or said another way? Biggest aha moment in managing your sleep. I really think it's the, the morning sunlight thing. I, I think it's absolutely crucial for me. Mm-hmm. But I think it's also game changer for so many people once they start doing it. Yes. One of those ones that people don't think about as being powerful and they're kind of reluctant to do a lot of the time.
Yes. You have to really talk to people many times about it and like you just have to try it. Yes. Immediately when waking up. And sometimes it really is what allows people to change their sleep schedule completely as well. I have a lot of people who I work with who are, you know, late night people. Yes. And they're sleeping late into the morning.
And you know, the key when people are trying to move, you know, shift that sleep schedule is also getting that morning sunlight at first thing because then the next night, then they're, they're. Gonna fall asleep at an earlier hour. Yes. Uh, I don't know if I shared my backstory, but about a decade ago, and through a period of insomnia that just, ugh, changed the course of my life and resulted in this entire company.
But back then, I was the exact opposite type of lifestyle that what I have now and just upside down kind of zombie. Uh, I work with a lot of high stakes poker players, and so very much almost a poker player schedule very late nights, wake up the sunglasses, the hats, the, you know, the whole thing. And to have it, like if, if I could go back in a time machine and tell that person that, no, you're gonna love the mornings, like it's gonna be your favorite time.
All this, it just would've just sounded. Sane. And yet it's absolutely possible for anyone and it's very exciting. You know, one of the top episodes that we've done to date was with Dr. Sachin Panda outta the Sul Institute and fantastic information research. And so some of his research is. It's not saying there's no chronotypes and don't get me wrong, but he is pointing to some kind of provocative information around, have we taken it a little too far with this idea that, oh, well I'm a night owl, so see you later.
I'm gonna go to bed at 2, 3, 4 in the morning, and kind of the self-fulfilling prophecy when, yeah, maybe there's. Differences, but that we largely are meant to be tethered to these rhythms of nature. We've had sleep anthropologists on the podcast that study the Hudson Tribe in Africa and other groups, and they often see that they're.
Always tethered to these rhythms when there's an absence of electronic lights, and that's what we see. So I think that's an, an amazingly good point. I think in our culture, we have taken this idea of like night owls and early birds. Way too far. Yeah. Um, there's, there's a little bit of, you know, biological reality to this.
It is not destiny. Um, yeah. And it can be, it can be changed and it's not a good reason to be going to bed at 2:00 AM and you know, waking up at 11:00 AM um, you know, and you know, if someone has to do that from their, for their shift work, make a living, of course. But if someone's just doing it because they think they are just that type or.
Somehow that's just fine. They ought to try, you know, a different schedule and and see how much better they feel. Yes, yes. I always encourage people to look at those studies too at the University of Colorado where they took people camping and they took people camping. That worked. Proclaimed night owls and these night owls in a very short period of time, measurably started shifting their melatonin earlier just by virtue of being outside camping.
No electronic lights, like the power of this is quite profound, and I'm not trying to be over zealot or what have you. Of course we wanna. Still maintain and work and be mindful of exactly what you pointed to, which is maybe a great segue to, it sounds like what you're helping to facilitate for people is expanding the aperture of this conversation around mental health and the many facets that go into mental health, whether it's what's on our plate, exercise, light, mindfulness, so maybe a little bit more about that and how people could be a part of your world.
Yeah. I mean, I think as you said, those are the aspects and, and you know, I would add in one other thing, which is just making sure people have like meaning and purpose in their life. Yes. You know, community, you know, people to, to connect to, you know, all of these things we talked about, you know, biological realities that are so powerful.
Sure. You know, in the end, you know, even if you did all those things but you didn't have meaning and purpose and community, you still probably would have. You know, problems with mental health. So, you know, all those things kind of work together and, you know, it can seem daunting if you don't have, you know, a lot of those things in place to try to, how am I gonna put all those things into place?
Yes. You know, I think, you know, you have to figure out where to start, you know, for where, where's the biggest for bang for your buck For some people's having, you know, someone's having terrible insomnia. The, you know, doing a program like yours to work on their sleep can give a huge kickstart to the other aspects.
'cause all Sure, sure. The brain's gonna work. They have energy, all these things for other people who are eating a terrible diet. And that's the biggest, you know, drag on their health. You know, cleaning up the diet could have the biggest bang for the buck. Yes. So find somewhere to start, you know, and, but ultimately you gotta think about that big picture and adding in, you know, probably all of these elements and thinking about how much they work together.
And so as you're going through and adding, you know, in a health journey, you might have to, you know. Get to the next sort of module, you know, of what, what am I gonna work on next? Um, but either way, you know, even if you do one module, you're gonna get benefits enough to have the energy to do the next module is the way I, mm.
Love that. Okay. That's fantastic. Is there a place that they should go for that or any call outs there? Yeah, yeah, yeah. So we have a website for the program that I was mentioning. Our program is called Accord, and the website is accord. mh.com stands for Accord Mental Health. So A-C-C-O-R-D mh.com. Mm. And there's a lot of resources on there about some of the things I've talked about.
There's a whole lecture that I gave about metabolic psychiatry on the blog section there. Um, if people wanna get into more of the, the data and the science and the academic part of it. Um, and then I'm on LinkedIn. I'm not on a lot of other social media, so if people wanted to reach out to me directly on LinkedIn, they can find me there.
And I would definitely respond. Anyone who wanted to reach out and connect with me that way. Oh, amazing. So great. Well, I so appreciate the work that you're doing. Just absolutely. Life changing and just so, so needed, and we just need to clone people like you. So that's the, that's the next thing. Um, thank so much.
Yeah. I really appreciate the kind words, and, and I love what you're doing as well. I mean, I think, you know, helping people with their, with their sleep is incredibly. Cool and powerful and can have so many important benefits for their physical and mental health. So, uh, well, thank you for saying that. I, and I truly feel like I dodged a bullet because part of my story was I was traveling internationally at the time when I was going through this pyramid, insomnia.
And I went to a doctors in Croatia and Budapest and Florence and just a bunch of other places along this. The travel journey and each time left with sleeping pills and people wanna help. But even out of Harvard Med, we're still seeing that doctors are still getting around two hours of training and sleep.
Yeah. And it's just systemically such a problem, you know? And they want to, I'm sure, absolutely make a difference, but it's, I'd imagine for the information that you've now gleaned for yourself, you've probably had to do a lot of research on your own to Oh, yeah. Right to gain. I didn't get trained and most of the things I talked about today Yeah.
At all in any of my medical or residency training. Sure. All been, you know, things that I've learned since then and you know. That's, that's, that's the way it goes, I think. Yes. You know, so a message to any, any clinicians or, you know, whether they be mental health clinicians or other kind of clinicians, you know, keep learning because you know, what you learn in school is not the state of the art anymore, most likely.
Yes. Yeah, exactly. Well said. Oh my goodness. Well, thank you for your time. Thank you for the work you're doing and definitely wanna stay abreast of the work that you're putting out into the world. So maybe a part two down the road as things develop. But thank you so much. Thank you. You've been listening to The Sleep Is a Skill Podcast, the top podcast for people who wanna take their sleep skills to the next level.
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