124. Dr. Liester and how Ketamine works
Today I talk with Dr. Mitchell Liester. He talks about treating issues like depression, bipolar disorder, OCD, ADHD, boarder line personalty disorder with ketamine. His results are amazing!
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124. Dr. Liester
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Dr. Mitchell Liester: [00:00:00] I have a patient with borderline personality disorder, which historically is extremely difficult to treat. There are no medications for it. This poor woman had suffered with depression and daily suicidal ideation for over 25 years. She tried to kill herself twice, once by overdosing on medication, and the second time she almost succeeded.
Dr. Mitchell Liester: She walked in front of a semi truck on the interstate, survived with a traumatic brain injury, multiple fractures of shoulder, arms, ribs, in the hospital for a few weeks. Just five days and got out. We decided to try this, to see if it would work for her and Sam, she's had a remarkable recovery. In fact, we're just about to.
Dr. Mitchell Liester: Um, submit a case study to a journal medical journal to report about this because her response was dramatic. Within nine days, she called me and said, Oh, my God, I've never felt like this before. I hope this last when she came back later. Um, she was her depression was improving markedly. Her relationships were improving.
Dr. Mitchell Liester: And by the time she'd gone out for a few months, her depression was in remission. She had no more suicidal thoughts. She was working two jobs. Her daughter, who previously wouldn't even talk to her for a couple of years because her mother was too [00:01:00] emotional and stable, now was calling her for advice. And she's made a really a hundred percent turnaround.
Dr. Mitchell Liester: Her depression's in remission. Her, she no longer meets criteria for borderline personality disorder either.
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Dr. Sam Sigoloff: I first [00:03:00] want to thank you all for joining me and give a shout out to all of my Patreon supporters. We've got 2Tough giving 30 a month. We have The Anonymous Family Donor giving 20. 20. We have The Plandemic Reprimando level at 17. 76 with Tai. Charles, Tinfoil, Stanley, Dr.
Dr. Sam Sigoloff: Anna, Frank, Brian, Shell, Brantley, Gary, and Sharon. We have the 10 Self Made Level with Kevin and Patton Bev. We have the Refined Not Burned at 5 a month with Linda, Emi, Joe, and Chris. PJ, Rebecca, Marcus, Elizabeth, Dawn, Ken, Rick, Mary, and Amanda. We have Addison Mulder giving 3 a month and Frank giving 1. 50 a month.
Dr. Sam Sigoloff: And then we have the Courageous Contagious with 1 a month with Jay, Spessnasty, Darrell, Susan, BB King, Caleb. Thank you so much for supporting, uh, me with my endeavors with this show. Uh, please be sure and check out mycleanbeef. com slash after hours. That's mycleanbeef. com slash after hours. Um, So [00:04:00] today our guest, very special man, met Dr. Mitch Leister at the FLCCC conference. Now, we just happened to sit at the same table and it was a perfect fit, I couldn't have sat at a better table. Uh, we had some interesting conversations, we had common interests, uh, but Dr. Mitch, great to see you again. How have things been with you?
Dr. Mitchell Liester: Doing very well, Sam.
Dr. Mitchell Liester: Thanks. It's great to see you, too. Thanks for inviting me to your program.
Dr. Sam Sigoloff: So, you do the, you're a psychiatrist, correct?
Dr. Mitchell Liester: Yes, I am. Yeah, I'm a clinical psychiatrist, uh, an associate. I'm an assistant clinical professor in psychiatry at the University of Colorado School of Medicine as well.
Dr. Sam Sigoloff: And you have a treatment plan or a treatment regimen that you've discovered over the last few years that helps with certain specific disease processes.
Dr. Sam Sigoloff: Can you get into that a bit and kind of explain what that is and some of the results that you've seen with that?
Dr. Mitchell Liester: Sure Sam, I'm happy to and I also have a slide deck [00:05:00] PowerPoint if that will help explain things too. Yeah. So briefly the treatment we're using is a medicine called Uh huh. Do you want to get the slide deck set up?
Dr. Mitchell Liester: Would it be good to share that now? Yeah. Yeah. I can, uh, let me see if I can get it set up for you. Okay, are you able to see that? What I've got here is a PowerPoint presentation to explain this topic of low dose sublingual ketamine. On the first slide, it's just a title slide. The second slide, Sam, is just a disclaimer one that we have to put in there because this is a, uh, Off label use for ketamine just explains that, uh, not recommending people go out and try this on their own.
Dr. Mitchell Liester: They should consult with their doctor. But the real point behind this topic is that a lot of people in this country are suffering with depression. On the third slide, you see that there are over 17 million adults and almost 2 million kids are being diagnosed with depression. So it's a real problem and it's growing every day, probably for a lot of different reasons, including COVID, post COVID, et cetera.
Dr. Mitchell Liester: And the fourth slide explains that a lot of the traditional medicines we've used for treating depression and [00:06:00] other psychiatric diseases just often don't work. Leaves people feeling depressed, uh, despite the treatment. In fact, on the fifth slide, you see that, uh, as many as a third, close to a third of people who have depression are diagnosed with what's called treatment resistant depression, which means they failed at least two trials of conventional antidepressants.
Dr. Mitchell Liester: They just haven't been effective, which leaves these people suffering. And even the people that do respond sometimes don't have a very good response. Thanks. And not only that, but on the sixth slide it talks about how these medicines also cause, the conventional medicines cause a lot of side effects. On the next slide, the 7th, you see that one major class of antidepressants called SSRIs have a lot of side effects.
Dr. Mitchell Liester: They cause sexual dysfunction, they can cause drowsiness, weight gain, etc. Which means a lot of people just don't even want to take these medicines, and sometimes the side effects are worse than the benefits for some people. So we've discovered an alternative on the 8th slide, which is a medicine called ketamine.
Dr. Mitchell Liester: And ketamine is a very interesting medicine that we'll talk about briefly, but I want Just want to mention that it's an alternative. Some of these conventional antidepressants. Um, [00:07:00] and in fact, on the next slide, you can see what we're prescribing for people. These little squares of orally dissolving ketamine called trochees, T R O C H E, and these ketamine trochees are very low dose, and they have a lot fewer side effects.
Dr. Mitchell Liester: then we see with some of the conventional antidepressants, so not only are they safe, they're effective, and they're a lot cheaper as well. Next slide, slide 10, you can see that, uh, ketamine does not have some of these side effects the SSRIs have. It doesn't cause sexual dysfunction, it doesn't cause weight gain, it doesn't cause dry mouth, fatigue, or some of the shaking you can get with some of the conventional antidepressants.
Dr. Mitchell Liester: It doesn't mean ketamine is safe for everybody, and you should just take it as much as you want. There is a problem with recreational use. On the next slide, the 11th slide, you see a picture of Matthew Perry, who was in the news, unfortunately, recently, after he died. Um, the press made it sound like it was because he took ketamine, but, uh, they actually had his autopsy posted online, and I took a look at it.
Dr. Mitchell Liester: Turns out he did have a very high level of ketamine in his system, and it was reported that he was using intravenous ketamine as a treatment for depression, [00:08:00] but the level he had in his bloodstream was much higher than what he would have received from those intravenous treatments. So, in fact, he was probably using recreationally on top of it.
Dr. Mitchell Liester: And that wasn't what killed him, though. What happened is he apparently drowned in his, I can't remember if it was a pool or a hot tub, so he probably fell asleep and drowned, but the press made it out to sound like he was, um, the ketamine that killed him, which wasn't the case. Next slide, slide 12, it talks about the advantages of The sublingual form, under the tongue form, versus other ways that ketamine is being used.
Dr. Mitchell Liester: It is being used intravenously, it's even being used intranasally to treat depression, but the under the tongue has much fewer side effects, it's not as expensive, and the benefits last, whereas with the IV or the sub, uh, intranasal, once you stop the treatment, the symptoms come back. So, in the 13th slide, you see, uh, the first, uh, description of how ketamine came into existence, and it was an interesting story.
Dr. Mitchell Liester: Ketamine was first synthesized in the 1960s, uh, by some scientists at Park Davis, uh, pharmaceutical company. And they were looking for a general anesthetic to put people to sleep for surgery, because the [00:09:00] one they were using had some real problems. It was called Fincyclidine, and when they anesthetized people for surgery, then they woke up, they would be very combative, agitated.
Dr. Mitchell Liester: And the other name for Fincyclidine is called PCP, or on the street it's called angel dust. And at one point that was being used as a general anesthetic, but it didn't work well. So these scientists came up with an alternative, it's a It's a slightly modified form and analog and it's called ketamine. So that was when it was first discovered.
Dr. Mitchell Liester: It was first approved by the FDA in 1970 as a general anesthetic and has been used since then as an anesthetic is still used today. Um, but a long, a little bit later in 2000, on the next slide, slide 14, you see that some researchers at Yale back in 2000 discovered that if they give lower doses of ketamine, a sub anesthetic dose.
Dr. Mitchell Liester: It actually provided rapid antidepressant effects. Sometimes people within hours or within days would report improvement in their depression. So as a result of that, ketamine clinics have popped up all over the country now where people can go in and get an intravenous infusion of ketamine and their depression rapidly improves.
Dr. Mitchell Liester: But there are some problems with that. First of [00:10:00] all, it's very expensive. Um, each infusion can run anywhere from 250 to 1, 000. Not so much for the medicine, but for the time of the physician or nurse monitoring the treatment. Um, people often have sort of a psychedelic like effect that they don't like. Um, and then again, once the infusion stopped, the symptoms can come back.
Dr. Mitchell Liester: Um, so on the next slide, slide 15, you see that, uh, uh, over time they discovered that, um, sublingual ketamine could also be used, um, and it had some real advantages. This is a study from, uh, 2013 showing that, uh, just very low doses, as low as 10 milligrams a day under the tongue, every two to seven days even.
Dr. Mitchell Liester: Improved depression over three fourths of the patients who used it in both unipolar and bipolar depressions was a real breakthrough. But that study just kind of was ignored for a long time. Everybody just, uh, just didn't even look at it. There's not a lot of money to be made in sublingual ketamine, so I think, unfortunately, there wasn't much of a profit motive.
Dr. Mitchell Liester: And that kind of held back the research. Uh, next slide, slide 16, shows that, uh, just a few years ago, some researchers [00:11:00] down in Brazil discovered that ketamine also occurs in nature. They were looking for treatments for parasites and came upon this fungus. Next slide, please. That would kill parasites. They took the fungus back to the lab to see what it was making.
Dr. Mitchell Liester: It turns out it was making ketamine. So you can actually find ketamine in nature if you know where to look. So one of the big questions, the next slide, 17, is how does this work? And how does ketamine treat depression? It's an anesthetic that's used for other things. Sometimes doctors prescribe it for pain management as well.
Dr. Mitchell Liester: But how does it work for depression? Well, slide 18 shows it actually promotes neural regeneration or it stimulates the nervous system to grow and repair. And it does this in slide 19 by increasing a protein that we have in our body and in our brain called BDNF. It stands for Brain Derived Neurotrophic Factor.
Dr. Mitchell Liester: So what is this magic protein that stimulates our brain to grow? Slide 20 shows, uh, it's again B, D, and F, and the next slide, 21, shows a picture from some research at, uh, back at Yale when they took a picture in electron microscope of neurons [00:12:00] before and after ketamine. And what you can see in this picture is that, uh, the top, uh, Red line is a, a nerve or a nerve cell neuron from a rat that shows a couple little bumps on it.
Dr. Mitchell Liester: These are called bulbs or spikes. And these bulb or spikes grow out and connect with bulb or spikes on other neurons and create connections called synapses. And the bottom picture shows that after ketamine treatment, these, uh, bulbs or spikes grew, uh, or much, quite a few more of them. And that was because of the BDNF.
Dr. Mitchell Liester: It actually stimulates the nerve cells to produce new, uh, synapses. There's one other interesting thing about ketamine, on the next slide, 22. In late, uh, 2022, some researchers at MIT wrote a paper about something called silent synapses. And these are connections in the brain that are dormant, and they're just asleep.
Dr. Mitchell Liester: They're not functioning. They're missing a protein that they need to turn them on. And they say as many as a third of the connections or synapse in our brain may be these dormant or silent synapses. And it turns out the protein that's needed to turn them on is something that ketamine triggers the [00:13:00] production of.
Dr. Mitchell Liester: So ketamine may be actually waking up our brain in ways that hadn't been predicted before. And just a few more slides. Slide 23 shows that the Response to ketamine varies with the dose. At low doses, you don't see much response, but as you increase the dose, the body starts producing more of this BDNF, which I think of as miracle growth for the brain.
Dr. Mitchell Liester: Stimulates the growth of the nerve cells, new nerve cells are produced, new connections are produced. But if you keep increasing the dose, you actually do more harm than good. If you go too high, The brain stops producing BDNF, you actually get a damage to the nerve cells, something called excitotoxicity.
Dr. Mitchell Liester: And so excessive use of ketamine is not a wise choice. You want to keep the dose down. The next slide, 24, just explains that, um, with ketamine, you start seeing improvement in depression. Um, and with the sublingual ketamine, it's slow, uh, slower than the IV, but it's more long lasting. We're seeing really some dramatic changes in people who have not responded to antidepressants for decades.
Dr. Mitchell Liester: And after sometimes a month or two of this, under the Tunketamine, they're going into remission, they're [00:14:00] feeling markedly improved, and those benefits last, and they continue to grow, so that even though in the first month or two people may improve in terms of their depression, over time other things improve.
Dr. Mitchell Liester: Their anxiety gets better, uh, they sleep better, their PTSD improves, their ADHD improves, um, their obsessive compulsive disorder improves, and it just keeps going. After years or so, we're even seeing some pro cognitive effects. People's memory is improving, their ability to learn improves, um, people are reporting their intuition improves.
Dr. Mitchell Liester: It's just seeing some really remarkable results. And on the next slide, last slide actually, um, this is a poster, a copy of a poster we presented the World Psychiatric Congress last year in Vienna, Austria. showing our results with the first 49 patients we treated with ketamine. It's a little bit complex, but it just shows that 96 percent of the people who we treated with this sublingual ketamine improved to varying degrees.
Dr. Mitchell Liester: About a third got about 50 percent better, about a third got 50 75 percent better, and then about 25 percent went into total remission, no more depression. And only 4 [00:15:00] percent of the people showed no response. And this slide also includes the protocol we used and some possible ways that it works. So, what we're hoping is that by putting this information out there, some other doctors will learn about it and start using it as well.
Dr. Mitchell Liester: We do have doctors now in Phoenix that we know, some colleagues in Tucson as well as Denver. They're trying this and having also remarkable results as they're starting to spread the word as well. So, that's the message I wanted to pass on to folks that are interested is there's a new treatment for not just psychiatry, uh, And, so, based disorders like depression, anxiety.
Dr. Mitchell Liester: We're also seeing some improvement in neurologic disorders. People are spontaneously reporting improvement in peripheral neuropathy. We're also trying in a patient with ALS. Also have seen my colleague here in Carl Springs, Dr. Rachel Wilkinson has had some success reversing dementia in some patients and also seeing some evidence of brain regrowth after sustained treatment with this ketamine.
Dr. Sam Sigoloff: This is incredible. This is, this seems like it's a miracle that you have found that you've helped discover. [00:16:00]
Dr. Mitchell Liester: Well, you know, when it first came out, I was very skeptical, to be honest with you, it sounded a little too good to be true, but when my colleague, Dr. Wilkinson said, you know, Mitch, you know, you won't believe the results with this, I thought, yeah, I've heard that before, but I know her, I've known her for a while and trust her, so I decided to try it.
Dr. Mitchell Liester: And it was kind of funny because in the beginning she said, you're going to see results, just tell people to be patient. And so people would come back after a month or two in the medicine and they were 50 percent better. And I would send her a text in the middle of the day, say, Rachel, I can't believe the results.
Dr. Mitchell Liester: She, this is amazing. I've never seen anything like this. And she'd text me back and say, Mitch, calm down. It's going to get better. And sure enough, patients would come back a month or two later, they'd be 75 percent improved. And I texted her again and said, Rachel, I don't believe the results. This is amazing.
Dr. Mitchell Liester: She texted me back in and said, Mitch, calm down. It's going to get better. I said, how can they get better than this? She said, give it a few more months. People will be in remission. And she was right. And I had to text her back after that and say, I apologize for doubting you. I didn't. She said, I didn't believe in the beginning either.
Dr. Mitchell Liester: She said, I didn't think this was going to be as good as [00:17:00] it is. But she had been prescribing it at that point for two and a half years, had over 200 patients on it. And again, in the beginning, I thought, why would any doctor have 200 patients on this new treatment? Well, Sam, I'm just about there now. I think I've got about 180 patients on it because they're doing so well.
Dr. Mitchell Liester: Uh, I don't want to deny people the opportunity to get better.
Dr. Sam Sigoloff: Wow, this is incredible. So go through a list of some of the things that you've personally seen it work better and and your colleague has seen it improve. So you mentioned OCD, PTSD, depression, ADHD.
Dr. Mitchell Liester: Yes, uh, it's, it's really, I have a patient with borderline personality disorder, which historically is extremely difficult to treat.
Dr. Mitchell Liester: There are no medications for it. This poor woman had suffered with depression and daily suicidal ideation for over 25 years, just miserable and no medicines were helping. She tried to kill herself twice, once by overdosing on medication, and the second time she almost succeeded. She walked in front of a semi truck on the interstate.
Dr. Mitchell Liester: And, uh, survived with a traumatic [00:18:00] brain injury, multiple fractures of shoulder, arms, ribs. She was in bad shape. They took her to the ICU. She's in the hospital for just five days and got out. We decided to try this to see if it would work for her. And Sam, she's had a remarkable recovery. In fact, we're just about to Um, submit a case study to a journal medical journal to report about this because her response was dramatic within nine days.
Dr. Mitchell Liester: She called me and said, Oh, my God, I've never felt like this before. I hope this last when she came back later. Um, she was her depression was improving markedly. Her relationships were improving. And by the time she'd gone out for a few months, her depression was in remission. She had no more suicidal thoughts.
Dr. Mitchell Liester: She was working two jobs. Her daughter, who previously wouldn't even talk to her for a couple of years because her mother was too emotionally unstable, now was calling her for advice. And she's made a really 100 percent turnaround. Her depression's in remission. She no longer meets criteria for borderline personality disorder either.
Dr. Sam Sigoloff: Wow! There's nothing for borderline personality disorder. Those people live this terrible self destructive life for the rest of their life. [00:19:00] And, you know, explosion of relationships over and over and over and, and it's changed. She's no longer meets criteria. That's incredible.
Dr. Mitchell Liester: Sam, it's, it's one of the most amazing things I've been practicing for almost 40 years now.
Dr. Mitchell Liester: I've never seen anything like it. And the joy now in my practice is seeing people coming in who are doing so much better. For so many different causes. Yes. Yes, about other other conditions. So in psychiatry is also working for people to struggle with bipolar disorder, which can be difficult to treat partly because antidepressants can make the condition worse by triggering what are called manic episodes.
Dr. Mitchell Liester: The ketamine doesn't do that. So it's providing mood stabilization as well as treating their depression. So they're improving. Even they're improving so much, Sam, that a lot of the people we're treating now are getting off their conventional medications. They don't need antidepressants after a while.
Dr. Mitchell Liester: They don't need ADHD medicines. They don't need medicines for PTSD or OCD or ADHD. Uh, and so that's remarkable to see after maybe a year or two. And then Dr. Wilkinson, who's been now prescribing for over four years, [00:20:00] tells me that some patients, after about three years, Don't even need ketamine anymore. So it's as if it's healed their brains and they have remained stable for up to six months so far, even without ketamine, no medication whatsoever.
Dr. Mitchell Liester: So we're really excited about the potential to help people with this medicine.
Dr. Sam Sigoloff: So, kind of walk me through like a treatment regimen, how it works, how it looks from your side and then what the patient typically sees during that, that timeframe.
Dr. Mitchell Liester: Absolutely. So, we, uh, Dr. Wilkinson developed a protocol, I call it the Wilkinson protocol because she's the one that was smart enough to come up with it and we're using it as a starting point.
Dr. Mitchell Liester: What we do is we have people start with just 25 milligrams of ketamine, they put it under their tongue at bedtime. Uh, and the reason for that is some people feel a little bit either, uh, mildly tipsy, some people describe it as like they've had a glass of wine. Or a little bit mildly dizzy if they get up and walk around.
Dr. Mitchell Liester: So if they lay down at bedtime, they just fall asleep. And that if they do experience that mild tipsy feeling, uh, it's very short lived. Usually between five minutes and an hour. Some people find it pleasant. They kind of like it. They just relax and fall asleep. [00:21:00] Some people don't even feel it. And so they take 25 milligrams under their tongue every third night for four doses.
Dr. Mitchell Liester: After that, they take 25 milligrams under their tongue every other night for four doses, and then they increase to 25 milligrams every night. Now, we give it some time, usually within, uh, one to four weeks of that dose, people start noticing improvement. It's gradual. Um, if they don't respond, then we can increase the dose.
Dr. Mitchell Liester: And in some occasion, uh, some instances, that 25 milligrams is a little too strong for people, so we've actually had people who've cut back their dose. So the range we're finding that's effective can be anywhere from, um, Uh, the lowest I have anybody on is 6 mg and the lady is taking it every third day, only twice a week and she's doing marvelously.
Dr. Mitchell Liester: And there are some people that take doses as high as 150 mg to 175 mg and they do well at that dose. So each individual responds differently, so we just start low, go slow until we find a dose that works optimally for people and then we stay at that dose because the benefits keep accruing. For a year, there are even additional benefits the second year, and Dr.
Dr. Mitchell Liester: Wilkinson tells me [00:22:00] even more benefits the third year. So we don't have to keep increasing the dose, we just keep people at a steady state dose.
Dr. Sam Sigoloff: So when you say the third year, the third year of the same treatment dosage?
Dr. Mitchell Liester: Correct, yes. In fact, some people, she tells me, I've only been prescribing this now for a little over a year, maybe a year and a quarter.
Dr. Mitchell Liester: She's been doing it for four years. And says that some people after about that third year start finding they just don't need the ketamines as much, starts cutting back on the dose. And like I said, some people wean off of it, just don't need any medicine any longer. And it kind of makes sense, Sam, that, you know, what we're seeing is a lot of these conditions we've been treating for years, we thought were due to chemical imbalances in the brain.
Dr. Mitchell Liester: It's starting to look like it's more likely due to inflammation in the brain, which could be caused by a variety of things, systemic inflammation, um, autoimmune disorder, stress, a lot of things can cause inflammation in the brain, what's called neuroinflammation, and the ketamine repairs that, so instead of treating symptoms, we're really getting to the root cause of their conditions, we believe, and it's making a huge difference for people.
Dr. Sam Sigoloff: That's amazing. I love getting to the root cause of things. And one thing that, uh, I'm a huge advocate and love [00:23:00] talking about is diet and how that gets to the root cause of even brain inflammation.
Dr. Mitchell Liester: Well, and that's interesting you mention that, Sam, because I just recently was at a conference where they talked about dietary interventions for not only psychiatric disorders, but medical disorders.
Dr. Mitchell Liester: And they were reporting through some dietary changes, some very similar results to what we're seeing. Even the ability to get patients with severe psychiatric disorders off their medications. Um, Dr. Chris Palmer from Harvard was talking about a patient with chronic schizophrenia for 40 years, who after dietary changes was able to get off her medication and remain symptom free for the next 15 years of her life.
Dr. Mitchell Liester: And, uh, I was curious about that. I mean, patient, uh, patient after patient was being described to with bipolar disorder, schizophrenia, and depression. Was able to improve, um, with dietary changes very similar to what we're seeing with ketamine. So I reached out to Dr. Wilkinson, my colleague about this, and I said, how is this possible that we're getting similar results?
Dr. Mitchell Liester: We found out that certain types of dietary changes, particularly low carb [00:24:00] diets, can also release BDNF in the brain, the same sort of miracle grow product that stimulates the brain cells to grow. So it looks like we probably found two different pathways that converge at healing and repairing the brain, and not just the brain, but the remainder of the body as well.
Dr. Sam Sigoloff: Now, I want to mention that if anybody wants to learn more about Dr. Chris Palmer, he was recently on a podcast with Dr. Jordan Peterson, and he talks about that case who had, um, that patient who had, was it, um, um, schizotypal or, or some, A personality disorder and completely reverse their disease just by changing their, their eating habits, doing extremely low carb.
Dr. Sam Sigoloff: I think they were doing carnivore.
Dr. Mitchell Liester: I believe it. And I think Sam, the problem is, as you know, most of us physicians got little or no training about nutrition in medical school. And so I got zero, but not one minute. And so really wasn't aware of the potential benefits. I'm fortunate that my oldest daughter is a registered dietitian.
Dr. Mitchell Liester: It's been trying to educate me for a long time about these benefits. And. I was a little skeptical in the beginning, but now I'm seeing it. She's reversing all kinds of medical [00:25:00] conditions. Patients with diabetes, um, are improving. Some of my patients now that she works with are having significant improvement in their mental health.
Dr. Mitchell Liester: So I think, yes, I think dietary interventions are hugely important and we're excited about, we're starting to combine dietary interventions with ketamine to try to, Uh, boost the response people are getting. So, uh, we're starting to publish some papers, hopefully very soon about this, uh, and I hope we'll have more to publish in the future, and hopefully we can stimulate other people to do some research as well.
Dr. Sam Sigoloff: One thing you mentioned in your, in your, uh, presentation, you said excessive use. When you have excessive use, the return becomes less and actually can be seemingly harmful. Um, by excessive use, do you mean dosage at one time or dosage, same dosage over time? So like same dosage every day for multiple days in a row.
Dr. Mitchell Liester: Yeah, great question. So there are two things that could happen with higher doses of ketamine. The first thing is you actually shut off production of BDNF instead of increasing it. Um, if you go to too high of a dose, single dose, [00:26:00] you don't get any BDNF release. That's one problem. The other is something called excitotoxicity, which is a process that occurs.
Dr. Mitchell Liester: When you have too much of a, um, amino acid, that's also a neurotransmitter called glutamate in the system. And in the brain, if you have too much glutamate, it damages neurons. It kills them. And, uh, ketamine does work on glutamate. So stimulating a little bit of it can be helpful, but too much is not good.
Dr. Mitchell Liester: It's like what we learned in medical school. The only difference between a medicine that poisons the dose. And that's certainly true with ketamine. So you can actually reduce healing of the brain, If you go to higher, but if you go excessively high, you can actually damage the brain. And, uh, that's where people need to be careful to using it recreationally, because if they go too high, they're going to actually do some damage.
Dr. Sam Sigoloff: And when you say recreationally in those high doses, are those the kind of doses that drug users and abusers, when they call keyhole, when they just kind of disappear into nothingness, is that the kind of high dosage that you're talking about?
Dr. Mitchell Liester: Probably. Yeah. At higher doses than we're using, ketamine has very [00:27:00] different effects.
Dr. Mitchell Liester: Uh, again, the low doses, it hardly has any. perceptible effects on consciousness is very mild if any. As you go up on the dose like with the IV doses, which are still safe, and that's about usually a half a milligram per kilogram is the typical dose that they infuse over about 40 minutes intravenously, people have psychedelic like experiences, but they're not doing damage to their brain.
Dr. Mitchell Liester: But unfortunately, recreationally, some people go much higher using ketamine. And when they do that, yes, they go into the K hole, the keyhole, where they have not only profound changes in consciousness, but again, sometimes they have Neurotoxic changes their brains as well, and that's not a good thing.
Dr. Sam Sigoloff: So, kind of walk me through the patient experience and, and like how they take the medication. Because you, you mentioned those little, they look like little pieces of paper. Or is it a liquid, or how does that work from their perspective? And then
Dr. Mitchell Liester: Sure. Yeah, sure, Sam. It's, it's a gelatinous like substance.
Dr. Mitchell Liester: That the pharmacy makes it has to be made at a [00:28:00] compounding pharmacy, the average pharmacy or local pharmacy won't have this. It doesn't come from pharmaceutical companies this way. It has to be made and we have a wonderful pharmacist here in Colorado Springs that knows how to make it. And he's been doing it for several years now.
Dr. Mitchell Liester: It's spreading. They're also pharmacists. We work with pharmacies in other. Um, cities around Colorado, and I know there's a friend of mine is a compounding pharmacist in Mesa, Arizona, and also makes sublingual ketamine, these ketamine trochees. So, what people do when they get them, each trochee is typically, that we make, is 100 milligrams.
Dr. Mitchell Liester: So, the patient cuts it in fourths, and just puts a quarter of that little square under their tongue. And, uh, what people describe oftentimes initially is the taste is unpleasant, it's got a bit of a bitter taste. So the pharmacies will often put a flavoring in it. Sometimes they use wintergreen, I've had patients have bubblegum flavored or uh, cherry marshmallow, candy, cotton candy, all, watermelon, all kinds of flavors try to cut that bitter taste.
Dr. Mitchell Liester: But it's not bad enough that anybody stopped the medicine because of the bitterness. Some people say it's not bad at all and they use it unflavored. And once it's under their tongue, um, people [00:29:00] start feeling relaxed and calm typically. If they feel anything, some people feel nothing and that calm, relaxed feeling helps some people just fall asleep.
Dr. Mitchell Liester: Occasionally, maybe less than 10 percent of the time, some people have an opposite reaction where they feel energized like they've had a cup of coffee. If that happens, we have two options. We can either cut down the dose to relieve that or some people take it earlier in the day instead of at bedtime. If they do that, I just ask them not to drive for an hour.
Dr. Mitchell Liester: The reason being that if they do feel that sort of tipsy feeling, we don't don't want them on the road and that pass is usually Um, and less than an hour. And, uh, that tipsy feeling, like I said, for some people is very pleasant. Um, if people get up and go to the bathroom during the night, they can, they, they feel a little lightheaded or dizzy, but nobody's hurt themselves or fallen from that.
Dr. Mitchell Liester: Um, and then that wears off within an hour and the next morning people feel nothing. It has a very short half life, um, which means it's out of our system after taking it sublingually probably within about 10 hours or so. So if you take it at night by the time you wake up the morning the medicine's out of your system and you just go on about your normal day.
Dr. Mitchell Liester: And the biggest challenge for people is [00:30:00] to be patient because most of the time for the first four to six weeks people feel nothing and then very gradually once the medicine starts working they start noticing just gradual improvement. They say that I'm feeling a little bit Uh, less depressed or a little less anxious or I'm sleeping a little better.
Dr. Mitchell Liester: Um, and then that gets progressively worse. There are some ups and downs over time, but the gradual improvement is pretty noticeable. I sometimes tell people it's like watching your own hair grow from day to day. You don't see any change, but week to week or month to month, you know when the hair is getting longer.
Dr. Mitchell Liester: And that's what people describe with the medicine. There are some fast responders. I had one lady that went from severe depression. Um, to no depression within one month, but that's unusual. Usually that takes two or three, maybe even four months. Um, but people do notice gradual improvement. And then it's interesting because people will start adding additional comments about additional observations they've made.
Dr. Mitchell Liester: For example, I've heard the word resilient more in the last year than I've heard in my whole career. People will come in and say, I'm just more resilient. I can just handle things better. The things that used to [00:31:00] bother me just don't bother me as much anymore. And people are describing some really remarkable changes, um, past traumas, uh, things that have happened to them in their childhood or when they were younger, just that they used to bother them still that doesn't bother them anymore.
Dr. Mitchell Liester: They said, you know, I've, I've dealt with it. I've thought about it. It just doesn't have the same impact on me anymore. People are even healing relationships that have been broken for decades. Um, and this resiliency is really amazing. And it's allows people sometimes. Yeah. To, um, also think creatively and problem solve.
Dr. Mitchell Liester: Um, and it doesn't mean people are more passive people. Sometimes they're getting out of jobs that weren't working for them because they say, I just don't have to put up with that or tolerate it anymore. I was before I felt like I just had to hang in there. Now I don't feel that way anymore. So people are finding it easier to make constructive changes in their life as well.
Dr. Mitchell Liester: That's kind of fun to hear. And then sometimes we're even hearing spontaneous reports of improvement neurologic conditions. One of the most common is peripheral neuropathy. I must have had seven or eight patients just voluntarily say, That's great. Dr. Leaster, I don't know, I not only feel less [00:32:00] depressed, but my peripheral neuropathy pain is either markedly reduced or it's gone.
Dr. Mitchell Liester: And not everybody experiences that, but a high percentage of people do. I'm also hearing people report their fibromyalgia is better now. Um, and people are even saying, you know, I think it's because I'm emotionally more stable. I don't have the, I don't feel the stress I felt before. My fibromyalgia pain is just improving.
Dr. Mitchell Liester: It's really fun to hear all the different things that people come in describing, all the different kinds of improvement. I had one gentleman who had, um, post COVID symptoms. He lost his smell and taste and had tinnitus ringing in his ears for seven months. We started him on ketamine for, uh, depression.
Dr. Mitchell Liester: And his tinnitus went away quickly and his taste and smell are now are starting to return finally, um, for the first time. So, we're just getting a lot of, uh, reports of additional kinds of benefits. I'll tell you one other. My sister even, uh, was started on it. She has a neurologic condition, a pain disorder called CRPS, complex regional pain syndrome.
Dr. Mitchell Liester: And she also had damage to the ulnar nerve in her left arm from a car accident 30 years [00:33:00] ago. So, her doctor put her on the ketamine because it's reported to help with CRPS. But what she didn't expect was that the Damaged her left ulnar nerve, um, which caused her left pinky finger and ring finger to be numb for 30 years, suddenly got better too.
Dr. Mitchell Liester: And she can now feel those fingers for the first time in 30 years after taking ketamine. We didn't expect that. And I keep checking with her. Can you still feel those fingers? And she can, it's been months now and it's still the same.
Dr. Sam Sigoloff: How long on treatment before she could feel those, that, that
Dr. Mitchell Liester: I don't remember exactly how many months, but it was a, it was a few months within maybe two or three months.
Dr. Mitchell Liester: She started noticing improvement and also her CRPS, she, her feet had been numb and they're no longer numb after treatment with the ketamine.
Dr. Sam Sigoloff: Wow. I mean, just everything that you're mentioning, I can, I can picture a patient in my head that I think might benefit from this because we all, So, you know, if, if you're in this profession, we all have patients that are, have these, these incurable problems.
Dr. Sam Sigoloff: And it's just so heartbreaking that we can't offer anything.
Dr. Mitchell Liester: Exactly. So, I mean, that's what's made this so [00:34:00] much fun for me is that people that used to be considered treatment resistant, there was no hope for them. Now there's not only hope, but significant improvement. Um, And I think that's why it's spreading so fast.
Dr. Mitchell Liester: And when I've told some of my colleagues about it at first, they were very skeptical, but I, as I was in the beginning, but it's so much fun. I just got a call from a psychiatrist friend in Denver last week. She's saying, Mitch, I have to talk to you. I've been using your sublingual ketamine protocol. It's working great.
Dr. Mitchell Liester: Can we talk? I said, yes. So we got on the phone and she was describing how much improvement she's seeing. Um, I also have a friend who's a, uh, a doctor practicing position in Mesa, Arizona. He says the same thing. I have one other colleague here locally in Colorado Springs. He's a neuro oncologist, a very, very bright neuro oncologist.
Dr. Mitchell Liester: When I first told him about this, he was very skeptical and said, show me the studies. So I did. I sent him several studies showing this, how this worked. He read them. He said, you know, this looks like it might work. I think I'll try it. And when I saw him the next time, a month or two later, he said, Mitch, he said, it's working great.
Dr. Mitchell Liester: He said, a lot of my patients responding, he said, the biggest problem I'm having those when I try to talk to my colleagues, the other [00:35:00] neurologists, they don't know anything about it. They don't understand it. And they won't take the time to read the papers. He said, they're just not considering the possibility.
Dr. Mitchell Liester: So he said, I'm having a hard time convincing my. Colleagues to try this piece that I'm having great success with it. So I think that's the challenge, Sam, is that most physicians aren't yet aware of this, they don't understand it. And so they're a little hesitant to try it, but I'm hoping that through your podcast, thank you.
Dr. Mitchell Liester: And through other recent, um, podcasts we're doing and papers we're writing that hopefully physicians will become more familiar with this treatment and begin using it themselves because any physician. Can prescribe ketamine as long as they have a DEA license. It's what's called a schedule 3 medicine. So it's lower on the scheduling than even something like Adderall or many narcotics.
Dr. Mitchell Liester: So it's easy to prescribe. You just need to find a compounding, compounding pharmacist that will make it. And the cost is also important. I should mention that I talked about earlier how these Intravenous infusions can run thousands of dollars for people over time, which is just cost prohibitive for a lot of people.
Dr. Mitchell Liester: The ketamine trophies, um, they, [00:36:00] when they make the 30 little squares, it's approximately $60, and if people stay on just the low dose, 25 milligrams, that will last 'em four months. So we're talking maybe $15 a month. And even if they increase their dose, it's typically not more than maybe $30 a month. So it's very affordable for people.
Dr. Sam Sigoloff: That's incredibly affordable compared to, you know, 600 for an IV session that you do maybe three or four of those a week for six weeks.
Dr. Mitchell Liester: Exactly. So it's less expensive, fewer side effects and lasting benefits over time, which is really exciting. So I, I think in the going forward in the future, I think this will probably become the future or the treatment of choice for many disorders once people learn about it. And if, you know, further studies confirm our results, but uh, It's, it's really remarkable and it's, it's just such a joy to see people improving.
Dr. Sam Sigoloff: Have you seen any, anybody with brain injuries, like let's say stroke or traumatic brain injury? I think you mentioned one patient, your, uh, borderline personality did have some traumatic brain injury, but to help improve with those specific symptoms.
Dr. Mitchell Liester: It's a great question. [00:37:00] Yes, I'm working with another young man who unfortunately had a couple of severe traumatic brain injuries. He was, uh, in high school. He was camping in the mountains near where we live here. It's pretty common for the kids to go up camping in the mountains. And he decided in the middle of the night that he didn't want to stay so he was driving down the mountain by himself and went off the side of the road and this car tumbled a couple hundred feet and he was stuck in a gully down below and he couldn't get out of the car.
Dr. Mitchell Liester: Um, yelled for help. There was nobody out. It was the middle of the night. He was there for hours until the next day when somebody happened to be driving along. I heard him screaming. They flight for life into the local hospital, had a significant traumatic brain injury, um, recovered from it, but later had a second car accident with another traumatic brain injury that left him disabled, um, for years living at home with his mother and father, struggling.
Dr. Mitchell Liester: So just to get through the day, he's very depressed, very irritable, cognitive impairment. So we decided to try it for him and he's doing wonderfully. He's much more happy. He's not depressed. He's not so angry. Um, he's becoming more social. So we're seeing some [00:38:00] real progress. And I'll tell you briefly about a patient, Dr.
Dr. Mitchell Liester: Wilkinson's, who, uh, was experiencing some atrophy of her occipital lobes in the back of her brain. And this was documented by MRI. She was seeing a local neurologist and Dr. Wilkinson put her on. Sublingual Ketamine, and after nine months, her functioning started to be improving. So they, at that point, did another MRI and saw that her occipital lobes were regrowing.
Dr. Mitchell Liester: There was actually regrowth. In the back of her brain, which is, was not known to be possible. That can't happen, allegedly. That's what I was taught, Sam. But we've got MRI evidence to document that it did. So that's pretty exciting. When we start seeing it's kind of a paradigm buster. Yeah, it can do things.
Dr. Mitchell Liester: We just didn't know it was possible doing. And the nice thing about this too, is, you know, we're not the only ones looking at this. There are some folks at UC Davis in California. Who have come to understand that there are medicines that can stimulate the brain to grow and repair. They've put a new name or label on these medicines.
Dr. Mitchell Liester: They call them psychoplastogens, which is a big, [00:39:00] uh, big name. But they say these are medicines that stimulate the brain to grow and both, and improve both functionally and structurally. And they're looking for additional medicines that will do the same thing. What's odd about this is that many of the medicines they found that do this already are what are called psychedelic medicines.
Dr. Mitchell Liester: Uh, medicines like psilocybin does the same thing, uh, in their lab. It stimulates the release of BDNF, but these medicines aren't yet available in most places. They may become available. There are clinical trials demonstrating that, uh, psilocybin can have very beneficial effects similar to the ketamine, but, um, they're not yet legally available.
Dr. Mitchell Liester: In the meantime, ketamine is legal, legally available, so it's much easier to use.
Dr. Sam Sigoloff: Yeah. Some of those things you mentioned were schedule one, which means no medical use, but ketamine is schedule three, which means it's even easier to, to get to your patient. That's incredible.
Dr. Mitchell Liester: It's very easy. You know, it just takes the pharmacy a day or two to make it and they can start on it and then you get to wait to see them back and see how they're doing now.
Dr. Mitchell Liester: I will mention again, it doesn't work for [00:40:00] everybody. You know, we do have a small percentage of people who don't seem to benefit. We don't know why yet. Um, there may be a variety of reasons. I did have one gentleman who was doing great on it and then started to relapse back into depression. I asked him, has there been any change in your life?
Dr. Mitchell Liester: He said, no. So, are you doing anything differently? He said, the only thing I'm doing differently is having a few drinks at night. I said, well, how many? He said, maybe three to six beers a night. I said, well, can you cut back on that a little bit? He said, sure. So, he came back next time. He was doing well again.
Dr. Mitchell Liester: He said, I just stopped drinking. I just didn't need it. So we do know that excessive amounts or higher amounts of alcohol interfere with ketamine. And we believe the mechanism may be that it's causing inflammation of the brain. We know that alcohol can inflame the brain, especially at higher amounts. Um, so that may be one reason some people don't respond.
Dr. Mitchell Liester: There may be other reasons that some people don't respond. We don't know what they are yet, but I think as research continues, hopefully we can find out what some of those barriers are and work around those as well.
Dr. Sam Sigoloff: That's incredible. That's just, that's the most amazing thing I've heard all year.
Dr. Mitchell Liester: I got to tell you, [00:41:00] Sam, it's a lot of fun being a psychiatrist these days and being able to help people, especially some of these folks that.
Dr. Mitchell Liester: I've been working with for years that, you know, really there wasn't a lot of hope for you. I mean, we kept trying different things, but nothing was working. And suddenly now, you know, they're coming in and telling me not just how well they're feeling, but, uh, but their friends, they're telling you about, I have one lady, when she goes to church, she's telling everybody at church, you know, that they need to try this.
Dr. Mitchell Liester: If they have these problems, because she's had such great results. I said, well, no, it's not for everybody. And they need to get in and see their doctor for an evaluation first. But, uh, people are, uh, promoting it because of the great results they're having. And they're so happy with it.
Dr. Sam Sigoloff: It's great to see treatments that are actually safe, actually effective, and people are happy to tell their friends to go see doctor, um, to get this for yourself because it's helped me so much.
Dr. Sam Sigoloff: It's, it's good to see that coming back to the world.
Dr. Mitchell Liester: It's wonderful. You know, it's wonderful that people, and it's affordable, people can do this treatment. Anybody can just about can afford this. And so it's accessible, which is nice. I mean, some of the new medicines, when they come out in psychiatry, some of the antidepressants, [00:42:00] ADHD meds, they may be 700, 000 a month.
Dr. Mitchell Liester: That's just not accessible. And for some people, even if they have insurance, insurance won't cover these medicines, they're too expensive. So it really has hampered people's access to mental health treatment. But this one is pretty affordable, affordable for just about anybody. So I think we're going to be able to help a lot more people with it also.
Dr. Sam Sigoloff: Um, when you get to a point where you have more information or another paper published, you have access to my show anytime you want,
Dr. Mitchell Liester: just let me know. Well, thank you, Sam. I appreciate that. Well, we've got several papers that we're submitting. Like I said, we do have. The case report of the patient has borderline personalities or had borderline personalities or doesn't anymore.
Dr. Mitchell Liester: We're also hoping to submit a paper. We've looked at the potential of ketamine to heal spinal cord injuries. The reason to believe that it may help those with spinal cord injuries because of this neuroplastic effect that it has in the nervous system. There's a interesting case report, um, of a man here in Colorado who wasn't on ketamine, but, uh, he [00:43:00] was, um, kite skiing, which I had to look that up and see what that was.
Dr. Mitchell Liester: Because he was out skiing in Chile, South America. with a, like, parachute like device, a kite, that would carry him across the plains on snow. And when a gust of wind picked him up and slammed him into the ground, and he fractured nine vertebrae, he was paralyzed from the chest down. Um, he had spinal decompression surgery, went into rehab, and he got to where he was able to walk with a walker, but still was pretty much paralyzed.
Dr. Mitchell Liester: He went to a concert, and some friends gave him some psilocybin mushrooms, and he started feeling muscles firing in his legs that weren't firing before. And he continued to take it, and now he's able to mountain bike, ski, he's walking. And so that led us to think, you know, what is it about psilocybin mushrooms?
Dr. Mitchell Liester: Well, it turns out they're one of these cycloplastogens that stimulate the nervous system. But a lot of people's spinal cord injuries may not want to take psilocybin, but could ketamine potentially do the same thing? We found out that there are studies showing that other cycloplastogens do show evidence for, uh, helping heal spinal cord injuries.
Dr. Mitchell Liester: So we hope to suggest this and [00:44:00] put a paper out there. So maybe some neurologists will pick it up and do some research into it.
Dr. Sam Sigoloff: Wow, that's just a miracle. I mean, making the lame walk kind of miracle.
Dr. Mitchell Liester: It's amazing. The things we're seeing really truly are miracles considering what past medicine could and couldn't do.
Dr. Mitchell Liester: We're doing things that didn't happen before. And it's just, it's so wonderful to be able to help people in this way.
Dr. Sam Sigoloff: Yeah. And with the occipital lobe regrowing, that's the blind scene. I mean, that's, it's all that.
Dr. Mitchell Liester: Sam, it's amazing. Yeah, that, um, that case is supposed to be presented at Harvard Medical School this year.
Dr. Mitchell Liester: They've asked her, the, the patient to come to Harvard and talk about her case because they want to understand what happened because that shouldn't normally happen, but it did. And they have, like I said, radiographic evidence. They have MRIs showing it worked. And we ran this by our friend, a neurologist, just to make sure we weren't imagining things.
Dr. Mitchell Liester: He said, no, this is truly remarkable. Wow.
Dr. Sam Sigoloff: That's incredible.
Dr. Mitchell Liester: So. Yep. So we're hoping that, uh, uh, and thanks to [00:45:00] your podcast and others that maybe more people will learn about this, hear about it and pursue it. Uh, I don't think we have all the answers. I think we're just scratching the surface, but we need help, you know, doing research and, and uh, getting more people out there exploring this and, and finding out maybe are there other regimens of dosing that might work better?
Dr. Mitchell Liester: Are there different doses that might work better? You know, we're going with what works for us, but I'm sure there's still a lot we can do to improve what we're doing. Still too. Even adding in things to boost the effectiveness of the ketamine are possible. Um, studies that could be carried out in the future.
Dr. Sam Sigoloff: Yeah, diet mixed with ketamine might, might have even faster
Dr. Mitchell Liester: improvement. Absolutely. Absolutely. That's one of the things that excites me the most. Yes. Making dietary changes that we know stimulate BDNF and exercise. We know exercise stimulates BDNF, not at the level that ketamine does. Yes. What if you start combining treatments?
Dr. Mitchell Liester: How much better could that be for people? And maybe it would accelerate the growth. We don't know, but it's possible.
Dr. Sam Sigoloff: That's amazing. Well, Dr. Leister, thank you so much for coming on with me, sharing so much. Um, this has been just [00:46:00] shocking. I've just been standing here just like, wow, I know a patient that that could help.
Dr. Sam Sigoloff: I know a patient that could help. And, you know, I've got them in my mind of who, who I would like to try this for, if they'd be willing to try it.
Dr. Mitchell Liester: Well, Sam, I know a good pharmacist in Phoenix that can get you the medicine if you decide you want to start prescribing it for your patients. Awesome.
Dr. Sam Sigoloff: Um, and if people want to get ahold of you, is there a way that people can look at your, your work or find your papers, or should they go to NIH and search your name?
Dr. Mitchell Liester: Uh, yeah, I don't have a website, I'm old and so I haven't got my own website, so there are a couple of places, uh, they can go through, they can Google, um, my name, they can, uh, there's a website called ResearchGate that can be accessed by Academicians where I've published all the, all the papers we've done so far.
Dr. Mitchell Liester: Uh, and they can also write to me, um, I'm not taking new patients, but I'm glad to share information. My email address is dr. Do I-E-S-T-E-R at proton, P-R-O-T-O-N. Dot me me. And I'll be glad to send people whatever information I have. I [00:47:00] have tons of papers, many, many, many papers about ketamine. It's therapeutic use and I'm glad to share information with anybody that wants to read about it and learn more.
Dr. Sam Sigoloff: Well, thank you so much. I, I am so. Grateful that you were able to come and share your, your best wealth of knowledge on this particular subject that I've never heard about before. And I am so grateful to God that you and I just happened to sit at the same table and start talking about these things.
Dr. Mitchell Liester: Well, Sam, there are no coincidences in life.
Dr. Mitchell Liester: I don't think it was an accident. I was so happy when you sat down at the table too. And I'm so thrilled that we met and that we're getting to continue as friends and colleagues. And I hope we can continue this collaboration relationship.
Dr. Sam Sigoloff: Yes, sir. God bless you and keep doing his work.
Dr. Mitchell Liester: Thank you, Sam.
Dr. Mitchell Liester: We're going to do our best.
Dr. Sam Sigoloff: Just a reminder for everyone out there, in duty uniform of the day, the full armor of God, let's all make courage more contagious than fear.[00:48:00]
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