Metabolic Therapies for Psychiatry: State of the Evidence
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- Опубликовано: 18 май 2024
- Metabolic health is strongly connected to mental health, and metabolic therapies, like nutritional ketosis, or the insulin-sensitizing medication metformin, can improve psychiatric symptoms or even put them into remission. But how strong is the evidence connecting metabolic and mental health? Stanford psychiatrist Dr. Shebani Sethi and Dalhousie psychiatrist Dr. Cynthia Calkin help us explore the state of the evidence. And importantly, they help put the evidence into perspective. For instance, what level of evidence do you need if you are a prescribing psychiatrist versus a mom desperate for help for her child? Drs. Sethi and Calkin conduct research in this area and are experienced clinicians treating patients regularly. This combination gives them the insight to help us better understand the state of the evidence.
Experts featured in this video:
Shebani Sethi, MD. Clinical Assistant Professor in Psychiatry and Behavioral Sciences and Director of the Metabolic Psychiatry Clinic at Stanford University.
metabolicpsychiatry.com/stanf...
Twitter @ShebaniMD
Cynthia Calkin, MD. Associate Professor in Psychiatry and Medical Neurosciences at Dalhousie University.
medicine.dal.ca/departments/d...
Academic papers referenced in this video:
Treating Insulin Resistance With Metformin as a Strategy to Improve Clinical Outcomes in Treatment-Resistant Bipolar Depression (the TRIO-BD Study): A Randomized, Quadruple-Masked, Placebo-Controlled Clinical Trial pubmed.ncbi.nlm.nih.gov/35120...
The relationship between bipolar disorder and type 2 diabetes: more than just co-morbid disorders
pubmed.ncbi.nlm.nih.gov/22621...
The Role of Ketogenic Metabolic Therapy on the Brain in Serious Mental Illness: A Review
www.ncbi.nlm.nih.gov/pmc/arti...
Table of Contents:
0:00 - Introduction
2:11 - Interview with Dr. Shebani Sethi
11:42 - Interview with Dr. Cynthia Calkin
15:23 - Continuing Interviews
32:41 - Conclusion
Follow our channel for more information and education from Bret Scher, MD, FACC, including interviews with leading experts in Metabolic Psychiatry.
Learn more about metabolic psychiatry and find helpful resources at metabolicmind.org/
About us:
Metabolic Mind™ is a nonprofit initiative incubated by Baszucki Group. Our mission is to provide education and resources in the emerging field of metabolic psychiatry, including ketogenic interventions for mental disorders.
Our channel is for informational purposes only. We are not providing individual or group medical or healthcare advice nor establishing a provider-patient relationship. Many of the interventions we discuss can have dramatic or potentially dangerous effects if done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications.
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#BipolarDiet
#Science
I started keto a year ago. I had depression for over 45 years. I am off all medication. The improvements are amazing.
Thank you for sharing your story, and congrats on your progress!
Sounds amazing ! What did you eat and what were the main changes in how you felt - did you lose weight and if so, do you think that was the main driver of your improvement, or was it more fundamental than just weight ?
I lost weight. It’s about a high fat low carb diet, no sugar, no grains, no processed foods just real food (nutritional keto). I sleep soundly and have lots of energy and only two meals a day no snacking.
@Leona Edwards thank you and all the best 👍
A close family member in 20’s, who took a whole cocktail of meds for years for schizoaffective and got obese, got on the keto diet last year and lost weight beautifully along with huge reduction in meds. However after stopping the last remaining med the person got very psychotic and ended up in several hospitalizations. Huge mistake with stopping the last med abruptly. Can you advise on how to find a ketogenic educated psychiatrist in the US as back to meds cocktail to cure the psychosis?
I find it fascinating that critics of ketogenic diets and the role of dietary fats in brain health don’t really question the so called normal standard American diet which is so high in carbs, sugars and seed oils. This is amazing given the increase in psychiatric disorders, especially depressive, bipolar, and adhd disorders. It would seem that they are more interested in finding a pharmaceutical wonder drug to fix the issues which I believe are caused at leased partially by our current way of eating than beginning to investigate the problems from a systematic perspective. I so applaud this series and Dr. Scher’s approach to exploring the issues and raising important questions. Having autistic and anorexic family members, I truly believe that a dietary and life style approach for them would be invaluable.
Well said!
I find it fascinating that so many people aren't comfortable with the studies currently available on the ketogenic diet (in any context) but those same people are very comfortable prescribing medications "off label" to treat symptoms
I am 72 years old and have been on a keto diet (followed Dr. Westman at Duke) for over 4 years now and very familiar with the program. My wife followed my lead and is now a carnivore. We both feel better than ever and full of energy. The floaters in my eyes are gone (anecdotal) and my diverticulitis has been under total control since I began the diet. My trips to the commode have been reduce from a morning of 5 visits to start my day to once a day - going on my fifth year. Blood work is normal.
I tell you this because I have a 35 year old son who was stricken with schizo-affective disorder in his early teens. He has been on all kinds of psycho drugs over the years and none have helped. He took it upon himself to get off all meds (due to terrible side affects) last April and I supported that decision. His condition has not worsened, although it is still dibilitating, it is somewhat subdued versus when on medication. I have been informing him about the benefits of keto, but he finds it difficult to cook for himself (he lives alone). He was under care of a psychiatrist but he then informed my son he could not see him anymore unless he is medicated. What?? Kickbacks?? Also, very few psychiatrists are experienced in treating schizo patients, but will accept them anyway. What I found is most want to treat drug addiction. More money in that I assume (see government programs available). We live in central Florida and have access to Orlando, Tampa and Gainesville (U of Florida). Last time I called UF, they were not accepting new patients for outpatient care (let alone keto treatment).
Keep up the great work on this channel and all the research. Bart Kay is another great channel for low carb health for mental illness. I would love to if there is anybody in our area who will help treat my son.
Hello, our son is 19 with the same diagnosis. We are trying time restricted eating (7 or 8 hr window) with a largely keto diet otherwise but adding in high value carbs such as wild rice and sprouted lentils, and various vegetables and blueberries. Perhaps a bit over 50 grams carbs per day, but the breath keto meter shows frequent ketosis. Also using berberine for improving insulin sensitivity. I have a relative living in Clearwater who had terrible triglyceride numbers, until I told him about time restricted eating. After one year his doctor said she'd never seen such a dramatic improvement in such a short time and he got off his heart meds. Note that he is somebody who has mental health issues & continued to smoke, drink and eat pizza. This shows me that time restricted eating has massive benefits, and if you throw in the other things like we're doing, well I guess time will tell. We are also doing things to feed the gut microbiome Yeah like resistant starch, in you're in flax and psyllium husk fibers, and Are using chicken and cod liver along with beef liver at times, bone stock, and Mushrooms that have been shown to be neurope protective. Also using CBD which has been helpful in treating schizophrenia. His previous psychotic breaks that resulted in hospitalization were generally associated with THC consumption and it's possible that he may have avoided those trips had he abstained. at least for now he's continue to abstain from THC. Also, check out sleeping grounded, it is an important anti-inflammatory and quality of sleep booster. Lastly, our son's room had mild mold issues for years. We suspect mycotoxins played a role in pushing him over the edge with his first and some following breaks. We're using activated charcoal in the morning to sop up mycotoxins now, as well as better air filtration. All food is organic/self-harvested or backyard grown of course. He also does cross country with the school team. Note he has spent several months in hospitals and group home environments so his condition was very serious...
While this may all sound like a lot, I see it simply as returning to a lifestyle that most humans have enjoyed for most of our history, at least when there was abundant food available...
I listen to a lot of podcasts during a two-hour-long daily commute. "Metabolic Mind" is one of the very best, bar none.
Dr. Scher's upbeat, informed explanations are awesome, and every expert brought onto this podcast has been a wonderful, insightful guest.
The vegan ketogenic diet I practice for postpartum bipolar one has absolutely changed my life for the better. I couldn't do that long commute without it! There have been many other benefits. I still take my two "old school" bipolar meds, but one is now at a reduced dosage.
My vegan KMT (ketogenic metabolic therapy) has become, to paraphrase Matt Baszucki,: "my new identity and I'm fine with that!"
Once again, thanks for an outstanding, inspiring podcast.
Thank you!
This channel is vitally critical, thank you so much. Having the scientists who are studying the impact and options for metabolic approaches to mental health treatments is encouraging in ways that are hard to describe.
Thank you! 🙏👍🏼🧠👏🏻💝🤞🏻
Thank you for your comment!
I wish MDs who are required to take continuing education could be mandated that some of that be metabolic and nutrition study. An endocrinologist, allegedly, is well schooled in metabolism. My endocrinologist is stuck in the "order the typical labs and interpret the numbers using the scales imposed by the manual" approach.
Posting this reply I made to a comment here as more folks may want to see it:
Hello, our son is 19 with the same diagnosis. We are trying time restricted eating (7 or 8 hr window) with a largely keto diet otherwise, but adding in high value carbs such as wild rice and sprouted lentils, and various vegetables and blueberries. Perhaps a bit over 50 grams carbs per day, but the breath keto meter shows frequent ketosis. Also using berberine for improving insulin sensitivity. I have a relative living in Clearwater who had terrible triglyceride numbers, until I told him about time restricted eating. After one year, his doctor said she'd never seen such a dramatic improvement in that short a time, and he got off his heart meds. Note he is someone with his own mental health issues, & continued to smoke, drink and eat pizza. This shows me time restricted eating has massive benefits, and if you throw in other things like we're doing, well I guess time will tell. We are also doing things to feed the gut microbiome like resistant starch, inulin, ground flax and psyllium husk fibers, and are using chicken and cod liver along with beef liver at times, bone stock, and mushrooms that have been shown to be neuro protective. Also using CBD which has been helpful in treating schizophrenia in the literature, and avoiding gluten and sticking with raw sheep dairy. His previous psychotic breaks that resulted in hospitalization were generally associated with high THC consumption, and it's possible he may have avoided hospital trips had he abstained. At least for now he's continuing to abstain from THC. Also, check out sleeping grounded, it is an important anti-inflammatory and quality of sleep booster. Lastly, our son's room had mild mold issues for years. We suspect mycotoxins played a role in pushing him over the edge with his first and some following breaks. We're using activated charcoal in the morning to sop up mycotoxins now, as well as better air filtration. All food is organic/self-harvested or backyard grown of course. He also does cross country with the school team. Note he has spent several months in hospitals and group home environments, so his condition was very serious...
While this may all sound like a lot, I see it simply as returning to a lifestyle that most humans have enjoyed for most of our history, at least when there was abundant food available...
Could you please open a clinic here in Sta. Rosa City, Laguna, Philippines Or train doctors, nutitionists and personnel for a ketogenic-psychiatric treatment.
Are you aware of any research with APOE genetics with changes in lipid metabolism as it relates to mental disorders other than Alzheimer’s? I see parallels with Feldman’s research and the brain energy model. Keep up the great work!
I’m a PMHNP student starting clinicals. Metabolic therapies that target insulin resistance is not something that is being taught in schools or in clinicals. So what recommendations do you have for a provider to get trained so that we can deliver these therapies to patients?
This is such an excellent question. I wonder whether Nick Norwitz has anything to offer? He's at Harvard medical school and is a metabolic health advocate.
@@jan_ellison_baszucki I will try to get in touch with them. Thank you for your efforts in changing the SMI paradigm! Best regards.
Traumatic experience are extreme stressors which the biochemistry of the body responds to and is affected by… long term stressors created deeper “patterns” of physiology and allostatic load. Stressors are environmental including food, pathogens, and toxic chemicals and biopsychosocial stressors. Support a healthier environment in general and activate healing responses including deep relaxation and healthy diet.
Any idea if the same study has been conducted in Quebec or any province in Canada?
The education is great but how to get help for someone with schizophrenia? I called Stanford Clinic and they didn’t want to talk unless my loved one was referred. Kaiser is extremely hard to deal with. My loved one is 29 years old. Her life is shattered. In the last 2 years she was prescribed many antipsychotics and none work and often make things way worse. It’s a bit scary to go to clinics that are not large institutions due to accountability. I’m willing to try anything at this point. Can you give any institution such as Stanford or UC Davis or something like that where my loved one can be helped to go through the Keto diet? Than you
I want the same answer for my daughter, this is the million dollar question, how do we get our loved ones help with these doctors ? Great to have all of the knowledge but HOW do we get this specific help for our loved ones??
Looking for the same answer
We hear you. Unfortunately, it can be challenging to find a psychiatrist who supports a ketogenic intervention. You can try diagnosisdiet.com/directory to search for someone. Many professionals recommend using a team approach, so maybe working with a dietitian or coach who can help with the nutrition part and communicate with the treating physician. It may be worth investigating.
Keep in mind, my biggest concern is what to do if her hallucinations get worse. I can do the cooking, follow instructions and make sure the nutritional aspect is done. But, if the hallucinations get worse I wouldn’t know what to do. When you go to the ER, all you get is security guards, a 5150 hold and you get to wait on average 5 hours before you see an online psychiatrist who prescribes the next set of medications. The last time this happened, the meds had such a bad reaction that we had to stop. We talk a lot about taken care of the mentally ill but from were I stand, is all talk. Frustrating, to say the least. Your link shows me what I already mentioned: Stanford Clinic which I’ll be happy to try but all you get is an answering machine. You can’t talk to anyone. Your channel is great but it’s geared towards intellectual pursuits. It does nothing for the people facing serious mental issues. Nothing personal, just extremely disappointing.
Thank you. I followed your link and signed up. I was given a phone number to follow up if I don’t hear from them in a few days. Thank you so much!
Can you expand on the concept of needing to stay in ketosis. According to Dr Valter Longo, with his fasting mimicking diet, the body cleans out damaged cells during the fast days four and five being in ketosis, but the stem cells kick into action with the refeeding stage after day 6 and the following three weeks. I'm suspecting that it's a case of what level/depth of ketosis and the time frame. With people with seizures, it's very clear when they have flooded the brain with too much glucose and fructose. I'd like you to expand on the recommendations for people with bipolar. Does it need to be constant ketosis, light ketosis, avoiding insulin spikes and swings in and out of ketosis?
Great questions. I am sure we will learn more of those details as the research expands.
Is Mayo Clinic in MN doing any trials? I live in MN and I’m hoping I can get some help there, it’s very hard to find a doc that supports keto or any doc that even knows about how effective keto is for mental health.
We hear you. Unfortunately, it can be challenging to find a psychiatrist who supports a ketogenic intervention. You can try diagnosisdiet.com/directory to search for someone. Many professionals recommend using a team approach, so maybe working with a dietitian or coach who can help with the nutrition part and communicate with the treating physician. It may be worth investigating.
We are meeting with Mayo soon and pitching a metabolic psychiatry clinic. They are open to it but there that is likely a ways off. I hope you can find someone on the directory.
Do you have to continue the diet through out life or you can stop it after some time?
That's a great question. In epilepsy, it's often used as a temporary intervention with lasting results. We don't know if that will be the same with mental illness. For now, it seems most experts recommend continued maintenance of ketosis, but I am sure we will learn much more about this as we gain more clinical and research experience.
Using ketones strips in the deep pink zone. Typical day full beefburger and small pork chop with garlic butter and boiled eggs.
Second meal beef burger and black pudding with butter. Drinking loads water and coffee with full fat cream. On it two weeks Have developed red cheek rash but never had roseacha. Dont know why ?
May be dairy
Any psychiatrist in Poland ..working with this diet..anyone knows?
The only harm of a Keto diet comes from bad cooking...
Haha good point 👍🏼