I first learned about methylene blue from owning fish tanks. You clean fish tanks with them, or it's a thing you use. Now there's a lot of interest in methylene blue ever since a video of Robert Kennedy putting methylene blue in his water on a plane kind of went viral.

Methylene blue has been around a very long time. What are your thoughts on it? What does it do? Is it going to help mitochondria? Is it for everybody? I don't take it. I don't take it either, and I've not used it in any patients so far, but I'm very interested in possibly starting to use it in controlled ways in patients who clearly need something more.

We're doing all of the right things. We're doing the lifestyle things. We're doing ketogenic interventions or other things, and they still are not well. There's still room for improvement. So methylene blue, as you said, has been around for a long time. It's relatively cheap as a fish tank cleaner.

Methylene blue, fascinatingly, is primarily exclusively a mitochondrial agent. So it is an electron acceptor and donor. So that is what methylene blue does. It can accept electrons, and it can donate electrons. So it's an electron shuttle, if you will. And how does that relate to mitochondria? Mitochondria, as they are producing ATP, electrons are flowing down the electron transport chain, and that is what results in the production of ATP.

If it gets shuttled through the uncoupling protein, it results in heat production. And when electrons flow out of that system, when they leak out of that system, it creates reactive oxygen species, which, again, are very harmful to both mitochondria and cells. So if you have dysfunctional mitochondria that don't seem to be able to contain the electrons appropriately, electrons are leaking out.

So these would be mitochondria that are producing more reactive oxygen species than they should. Does that ever happen in biology? One hundred percent. We've got decades of evidence that aging, neurodegeneration, even obesity, type 2 diabetes, and a wide range of neuropsychiatric disorders are associated with that process. The increased levels of reactive oxygen species, often referred to as oxidative stress.

So we've got decades of evidence strongly supporting that. Can methylene blue play a role in that? Absolutely, because methylene blue can come in and take some of these wayward electrons and prevent them from creating reactive oxygen species, which might help calm things down. One of the challenges with methylene blue, as we discussed before, you can have too little and too much, same with methylene blue.

You can have too little and too much. You don't want to accept too many electrons. These electrons need to be flowing to the places they should be flowing. As opposed to oxidative stress, the polar opposite of that is called reductive stress. And that too has been found in people with schizophrenia and bipolar disorder and some other disorders.

So it's really about dysregulated kind of balance between oxidative and reductive stress. And methylene blue, if you take it in overdose, could become a reductive stressor. So you don't want too much. But, so we do have pilot trials. Again, small, not super well done pilot trials in a wide range of neuropsychiatric disorders.

Depression, bipolar disorders, schizophrenia, Alzheimer's disease, others. Many of them suggesting a benefit. Do you know what the dose range is? I don't. I don't either. I don't know off the top of my head. Yeah, because I, because methylene blue, as I understand, has some MAO activity. The, can adjust some of the enzymes that in turn adjust levels of serotonin.

Which is why I haven't taken it. I've just been cautious about, I don't really want to boost my serotonin. There's this recent study out of a lab at Stanford showing that the rewarding properties of various things, as we know, increase dopamine in anticipation of a reward, but also important, it seems.

These are mouse studies, but serotonin drops as dopamine goes up. And that drop in serotonin is at least as important as the increase in dopamine for the reinforcing properties of certain behaviors and substances. And I, I'm very reluctant to tamper with anything that would raise serotonin because in these studies or these experiments, or in these experiments, I should say, increasing serotonin offset some of the rewarding aspects of otherwise rewarding things.

So I want things that are rewarding to feel rewarding. And so this, this difference between dopamine and serotonin seems pretty vital. I mean, that's not to say I'm like terrified of anything that increases serotonin, but to do it pharmacologically, it just seems a little, a little sketchy, given I don't have a clinical need that I'm at least not that I'm aware of.

Well, and that's actually one of the warnings with methylene blue is that if you, if taken in to have a dose, you can actually get serotonin syndrome. Could you explain what serotonin syndrome is? So serotonin syndrome is just like really excessive deluge of serotonin in the system. more often than not, it's completely unrecognized.

Really? It gets mistaken for psychiatric symptoms. So people can have anxiety. They can have panic. In extreme cases, you can get nausea. You can get fevers. You can get, I mean, in extreme cases, it can be fatal. So it's a serious thing, but more often than not, it gets dismissed because serotonin syndrome is most commonly experienced by people taking SSRIs.

And by definition, they are psychiatric patients or they have a mental health condition. And so when they come in and say, I'm feeling nauseous, I feel anxious, I feel jittery, I feel, I don't feel right. They get written off more often than not. Or given more medication, perhaps. Yeah, let's increase your dose.

Let's increase your dose or whatever. So it's actually really tragic. I mean, one woman actually reached out to me who, after learning about my work, reading my book, she talked to her psychiatrist, tapered off all her meds, and it became clear that she probably had serotonin syndrome for a long time.

Wow. To both her and her psychiatrist. So the meds were causing the problem. And the meds were causing the problem, and nobody really recognized it. Goodness gracious. Again, so it's, so anyway, methylene blue can cause serotonin syndrome. So I think if people are going to, if people want to consider using it, I would, number one, make sure you get a very reputable source of it.

Make sure you're consuming it in a way that makes sense. I mean, it can stain your teeth blue and all sorts of stuff. So make sure urine blue, your tongue blue. But people will do IV infusions of methylene blue. So yeah, no, that's, I've seen people kind of hooked up to IVs with a bag of methylene blue.

Do they turn blue? And they, I hope not. Smurf, smurfing. But it is a medically approved treatment. And I think it can be done in safe ways. Again, it's off patent. Nobody's going to stand to make any money off of doing large, well-designed trials of methylene blue. But I'm really interested in it as this, as it has these properties.

In addition to just being this electron acceptor and donor, there's some evidence that it may improve mitochondrial biogenesis, that it has anti-inflammatory effects, and that it can do other things that may be beneficial. And I think it's a very special.