Why Keto for Mental Health May Not Be Working for You - with Dr. Bret Scher
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- Опубликовано: 9 июн 2024
- Ketogenic therapy can be a powerful intervention for many people with mental illness, including those with serious conditions like bipolar disorder, schizophrenia and major depression. Initial data indicates that individual response to ketogenic therapy for mental health may vary. Research is ongoing and needs to further investigate underlying mechanisms and how metabolism impacts brain function in individual patients.
While keto may not be an effective treatment for everyone, there are a number of ways patients can troubleshoot their ketogenic therapy strategy before deciding this treatment option doesn’t work for them. In this practical video, Dr. Bret Scher shares seven common reasons why ketogenic therapy may not be yielding results:
- Ketone levels might not be high enough
- The timeframe may not be long enough-for some patients, it can take up to 3-4 months to see optimum results
All of these factors can also impair results:
- Vitamin & nutrient deficiencies
- Concurrent medical conditions
- Abusing drugs and alcohol
- Some medications make it harder to get into ketosis
- Other lifestyle factors such as poor sleep or too much stress
It is important to note that ketogenic therapy is more than simply following a keto diet. We recommend that anyone attempting to use a keto diet to treat a mental health condition work with a trained clinician.
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/
More helpful resources related to this video:
What is the difference between a keto diet and ketogenic therapy? - with Dr. Bret Scher: • Video
Labs to Check Before Starting Ketosis for Mental Health: • Labs to Check Before S...
Find helpful resources, like how to find a clinician and the labs recommended for ketogenic therapy on this page of our website: www.metabolicmind.org/familie...
About us:
Metabolic Mind is a non-profit initiative of Baszucki Group working to transform the study and treatment of mental disorders by exploring the connection between metabolism and brain health. We leverage the science of metabolic psychiatry and personal stories to offer education, community, and hope to people struggling with mental health challenges and those who care for them.
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.
Timestamps
0:00 Introduction
1:25 The difference between ketogenic therapy and a keto diet
2:09 How ketone levels impact ketogenic therapy
3:14 How time impacts ketogenic therapy
3:54 How vitamin and nutrient deficiencies impact ketogenic therapy
4:30 How concurrent conditions impact ketogenic therapy
4:46 How alcohol and drugs impact ketogenic therapy
5:18 How medications impact ketogenic therapy
6:10 How lifestyle factors impact ketogenic therapy
6:58 Conclusion
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#KetoForDepression
#KetoForBipolar
#DepressionTreatment
#MedicationSideEffects
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Trying a different TYPE of ketogenic diet can also be the culprit. I switched to carnivore (a type of ketogenic diet) after a year of classic Keto, and it was the game changer for me. I finally feel relief from psychiatric symptoms. Some of us need to eliminate even vegetables, at least for a while, to achieve relief. Some of us are more sensitive to certain foods than others, which could unknowingly be impeding progress as well. Dr. Ede’s book explains this very well. She is the reason I have finally found the TYPE of ketogenic diet that works for me. Everyone is different. There is no one size fits all. And that goes for types of ketogenic diets too. Troubleshooting, with proper guidance, is the only way to see what works best for you. Thank you for posting this video, Bret! I had asked you at MHS to please do a video on people who aren’t having the best results, and you did. I’m so glad. Thank you! As Dr. Ede says, people need to know that they don’t have to give up so quickly. Just troubleshoot and keep going. ❤
Yes, I did keto for 7 months, and while I did have some relief, switching to carnivore completely alleviated all of my symptoms. I've been carnivore for 2 1/2 years now and it has changed my life.
@@IxeNixe Betsy, just mute this one. They're rude and not worth our time.
Amazing! Good to know that carnivore was the game changer for you! Thanks for sharing!
That’s awesome, @TheLoneCarnivore. Sounds like our experiences with classic Keto and then carnivore are very similar. I too don’t feel as well whenever I have even a bit of vegetables with my meat. Food sensitivities for some of us really make a big difference in how therapeutic our ketosis is able to be. It’s not just about being in ketosis, as I have discovered for myself. It’s also about how each person’s body reacts to certain foods. Some of us can’t process the vegetables as well. And that’s ok. It may be a temporary thing from gut damage, or it may be a sign that your tolerance of those foods is simply lower than other people’s. And it’s ok. Meat and animal fat are giving me my mental health back. It’s not for everyone necessarily, but it’s working for us. And that’s all that matters. These are all personal, individual journeys. It’s fascinating and wonderful.
Same
Keto provided me some relief but carnivore completely alleviates all of my mental illness symptoms. I was keto for 7 months and have been carnivore for 2 1/2 years. I have occasionally tried to reintroduce low carb vegetables, but when I eat them for more than a couple of days I get a return of symptoms, both mental and physical.
Thanks for the tip. I’m trying keto, but it’s good to know about carnivore too!
Thanks for sharing!! Really helpful. I might have to switch from keto to carnivore someday - I've been doing classic keto for a few months but am not where I hoped I'd be mentally despite therapeutic ketosis and well I'm going to lower my antipsychotic because it could also be a confounding variable. I'm doing all this with a keto coach and psychiatrist fortunately.
@@lexamdelac28 I actually wasn't expecting carnivore to completely put my bipolar disorder and debilitating anxiety into remission, despite the fact that I had heard from others who said it had done that for them. I was trying to address severe digestive issues that I'd also had for years, as well as reverse insulin resistance. And even with those things I wasn't where I thought I should be after 7 months on keto, so I decided to try carnivore. Luckily for me it addressed both my mental and physical issues. It's hands down the best thing I've ever done for myself.
@@IxeNixe I assure you I'm not. This is 100% my experience. But you're rude so welcome to mute.
Wow! So inspiring, gives me hope. I'm struggling with these persistent and bad digestive issues too. Carnivore is looking more appealing. Thank you@@HappilyCarnivore
Appreciate all your informative videos. We have been trying the keto diet as a supplemental mental health treatment for several months. Still struggling with getting into and staying in ketosis. So hard to find clinicians willing to support even a trial of ketogenic therapy. even our clinician at the University of Michigan Hospital has been resistant. we have been told it can be tried as a diet, but basically there is no reason to believe it would help with treatment of serious mental illness - they act like they aren't even familiar with the research! Take the pills and try that diet on your own as a supplement has been the message. It is discouraging and frustrating.
Thank you for your this
another clear and straight to the point video 👏👏
Dr Sher-I’m educated and impressed by you. It’s been well over a year for me in the carnivore arena. Your fact based approach will continue to change lives (for the better!!). Many thanks!! 🙏
Improvement in mental health with ketosis is a continuum. Your focus is on serious disorders but i wonder how much of the appalling level of mental health misery in our society could be alleviated by just convincing folks to clean up their diet.
Great question! We agree that cleaning up our diets, eating mostly whole minimally processed foods, would be a huge benefit to our collective mental health.
It’s all over the carnivore and ketovore channels how much it alleviates the spectrum of mental health disorders. Nutrition is truly a medical intervention. But you can’t patent that approach and put it in a pill with a multi billion dollar industry behind it :/
Some patients report a decrease in ketone levels with prolonged usage of the ketogenic diet, as if the body has become more effective at ketone utilization. Does this also decrease therapeutic effect, and if so, what can we do to combat it?
Great question. That is something we hope to learn more about with more research and clinical experience. But there are tips for increasing ketone levels, as we mentioned in the video, including changing macronutrient composition, intermittent fasting, adding MCT oil, etc.
❤❤❤ Thank you 🙏
This is a great concise video on the topic! I'd love a deeper dive video too. I'm wondering if the keto diet can help lower stress levels, why would one still have stress that impacts how the diet works? Not sure if I'm asking clearly.
thank you for asking this, stress and anxiety connected to major depression are possibly part of what is interfering fir the keto intervention to work for me yet it is precisely what I am trying to cure
It is difficult to avoid too much protein because the meat and fish used to obtain fat all seem to have far more protein than fat. A video suggesting specific foods to use to get fat versus protein right would be a great help
Fortify foods with rendered animal fat, butter, or dairy if you can tolerate. You can inquire with your local butcher about acquiring fat trimmings also.
I think people are overly concerned about "too much protein" when it comes to ketosis. Many experts still recommend at least 1g/kg of lean body weight. Testing ketones and varying protein intake is a great way to learn individual thresholds.
I like to first focus on getting my fats in and then focusing on my protein, I make a coconut oil, peanut butter (no added sugar) and dark chocolate (90% cocoa) which meets about half of my fats, then I just slap mayonnaise or animal fat on my protein and it allows me to achieve high ketone levels
Water fasting seems to work best for me, but I worry about long term effects, and re-feeding seems to put me out of whack again...
It might just be that you're no longer eating vegetables. Have you tried a carnivore way of eating? That was the answer for me. As long as I eat only meat, fish, and eggs my mental illness is completely in remission. When I try and reintroduce some low carb vegetables I get a return of symptoms.
if water fasting helps you, Beef-only diet will be also good for you
It would be interesting to hear any advice on exogenous ketones please
In retrospect, after 9 months...I pushed exercise maybe too much at first. And I let cravings after dinner push me around. The CGM helped a LOT!
I can't achieve medical ketosis despite eating only beef/brocolli/kale/coconut. Ketones were at 3.5mmol before eating a small steak (120g), I tested my blood ketones 2 hours later and they dropped to 0.5!
Please discuss effect of ketones with memory and intelligence
Thanks for the video! I’m getting my KetoMojo in a few weeks so I can officially start tracking my ketone levels. Your tips are important to consider, and I feel will help me navigate my keto journey with more accuracy.
Do you have any research on ketosis and/or electrolyte use for oxalate stones please?
Another aspect of the time involved is that omega-3 fatty acids, DHA and EPA, take some time to impact cell membrane structure. You don't have to emphasize this adjustment in a keto diet, per se, but it is significant for brain health.
I started keto and intermittent fasting for weight loss. The benefit for my mental health has been tremendous. After decades on SSSRI I am very nearly off after around a year of tapering. Exercise too once some weight shifted.
I started very gently and slowly.
Thanks for sharing! Are you interested in sharing your story with Metabolic Mind? If so, please submit it at the bottom of this page: www.metabolicmind.org/my-metabolic-mind. We would love to hear from you. Congratulations on your success!
In regards to Valproate, will the levels keep decrasing or will they eventually stay at a certain level? Thanks
I think one of the key issues is the a ketogenic diet therapy means different things to people. To me it is a generally baseline to which I build nutrient density, fiber and polyphenols for micrrobiome diversity to produce short chain fatty acids (also for metobolic and mitochondrial health), pre-pro and postbiotics (apple cider vinegar in water occassionally) and listen to my body as it has a lot of wisdom. I think regarding fats, there is an issue with obtaining the wide range of healthy fats in the diet, such as EPA (and DHA). When people eat they should relax and promote parasympathetic nervous system to digest their food. People with GI issues really have to take it slow and carefuly. Stomach issues often people can't digest protein well or break down minerals. Other have SIBO and SIFO in which they are fermenting food in the small intestine which should be in the large intestine. And, many other health issues, as you have mentioned some of them, including enviornmental and internal toxins. I"m not exactly sure what people are actually eating when they say they are on a ketongenic diet or doing the therapy. The other issue is that the liver uses butryate produced by the bacteria in the large intestine, it can't use its own ketones which it makes from fat. Learning more about restoring mitochondrial health and brain-body metabolism is exciting. I also think dysglycemia, hyper and hypo glycemia, or fluctuations, even if not pre-diabetes are problematic and lead to brain energy deficient, as in dementia. Thank you so much for your passion, dedication and taking the leap into this important and critically needed new area of health, the metabolic mind. We need more supportive systems and people who get it and want to make a difference.
You , sir , have a much higher confidence in the capability of "my" general practitioner than I. Not a difficult task ,though .
What about SSRI, Sertraline ?
Hey, quick question! Is the ketone level the only measure to keep an eye on, or is the GKI measure important too? So should I just worry about being above 1.5mmol/L or worry about GKI too? Thanks!
Great questions. We don't fully know the answer to those questions yet. My personal guess is that the ketone level is more helpful than the GKI, but that is a guess at this point. Hopefully future research studies will look into this!
Question for Dr. Bret…. I am currently tapering of my Lexapro and am having some moderate withdrawal symptoms. Has keto ever been tested to see if it helps antidepressant withdrawal symptoms?
That's a great question. I'm not aware of any studies that have looked at this, but there may be small numbers of personal or clinical experience. Working with an experienced clinician is so important for untested areas like this!
Please reach out. I help people with protracted withdrawal
It would be really appreciated if Metabolic Mind could recommend an Australian psychiatrist (preferably in Victoria) who supports a medical ketogenic diet. Thank you.
Thanks for your comment. We recognize it can be difficult for everyone to find a metabolic psychiatrist in their area. We recommend people visit www.diagnosisdiet.com/directory and see if they can find a doctor, or maybe even a therapist, dietician, or mental health coach who can help with ketogenic therapy and communicate with a treating psychiatrist to make sure everyone is on the same team. We hope that helps.
Thank you for this. We had only found one in Eastern Australia and hoped there may have been others. It is very challenging as it seems we will have to do this independently. The psychiatrists in our area are not progressive.@@metabolicmind
Thank you very much. Pardon me for my misunderstanding but I got the feeling that we are now heading back toward the old school of ketogenic diet (where kids were fed only fat). Also, I think that the idea that you need an expert to succeed might make people hate trying keto. (Mohamed)
We did not mean to imply that we need to go back to the 4:1 very low protein/high fat diets for ketosis. But for people who have metabolic dysfunction, eating a high protein diet can lower ketone levels. But most epcerts still recommend starting at 1g/kg of lean body weight, which is by no means a "low protein" diet. Sorry if the video wasn't clear. Also, we feel it's important to work with a clinician when using ketogenic therapy to treat a medical condition, the same way someone would with a medication. We have seen too many examples of people giving up, saying "keto doesn't work," or others experiencing unwanted side effects. Both situations can usually be prevented with clinical guidance.
@@metabolicmind Thank you very much. Your videos are very clear and informative, I'm the one who is apologizing for not getting the point.
I can’t afford a clinician , I’m sure like many
So trial n error
After three weeks, I’m doing ok
Felt muscle weakness and nausea, so upped my carb intake to 30 grams. Assumed I jumped in too quickly
Have hypothyroid, so not sure what to go about that
Have found Ritalin did help energy levels. Which I was missing
Now focusing on fat levels. I’m giving this a four month try.
Is there a Facebook group for this? Would love a support group
Ther is a Fbook group for bipolar, but this isn’t on their radar
Hey another question! I understand that the fat to protein ratio is critical (im on 3:1 at the moment), but does the amount of protein have a limit in relation to your body weight, or is the ratio all that matters. For example if someone weighs 150 and eats 95g of protein and 210g of fat but wants to put on muscle mass weight, they would need to increase their calories and also protein to put on the muscle. Now if they increase the protein only then the ratio gets messed up. Can they just increase both at an equal proportional amount so that they increase their total protein and total calories but also maintain the fat to protein ratio? Sorry if this was worded poorly and its okay if you dont have an answer to this question. Thanks!
Good question. One very interesting thing about protein is that some people can eat a lot of it (up to 2g/kg or more) and still be in ketosis. Much of it has to do with underlying metabolic health. That's the beauty of being able to test ketones, so someone can do their own experiment and see how their ketones react to eating more protein. Here's an interesting article from a few years ago about an experiment the former COO of Diet Doctor did. We hope his experience is helpful. www.dietdoctor.com/how-much-protein-can-you-eat-in-ketosis
What if doctors prescribed CKM & CGM ? Wouldn't that be helpful if combined with a diary/log book of the lifestyle and dietary actions of the patient?
Yes!
I'm still trying to figure out keto. Keto works great for about a month, then I start feeling numb, not feeling anything, not happy, not depressed. So I think why bother with keto and quit it. Maybe I should stick with it for longer, at least 12 weeks, maybe
It takes months for some people to become fat adapted. You need to also look into dry fasting
I agree that 12 weeks (3 months) of a ketogenic diet and fasting are important for both forming the habit and feeling the full effects.
I'm not including the initial habit transition/training period in those 3 months.
6:14 Sleep quality and stress management. Odd that these don't get emphasized enough generally. They are so important.
Hi,i want to ask,ive been on keto diet for about 1.5 months without medication,is there a possibility for me to relapse because i do keto without medication?
We recommend everyone works closely with their prescribing physician as a relapse or return of symptoms is always possible and should be carefully monitored.
I am taking topiramate/topamax. Apparently i can't do keto on this medication. My doctor is not supportive about my idea to start keto so idk what to do. I really want to give this a shot but my doctors tells me to just keep doing what i do since i am quite stable compared to 2022 and 2023. I am from a small island called malta i tried to do some research but couldn't find a doctor who seems to be informed about metabolic therapies. Any advise?
Thanks for your comment. One option that has worked for many people is to work with a coach, therapist, or dietician who can help with ketosis and also make sure the treating doctor is involved in the process. That may be worth a try!
Thanks for the answer! But the medication I am on doesn't allow me to be in ketosis. What can I do about that?
metaboloc mind
I am willing to start keto and carnivore diet.pls help me in finding clinical practioners following keto diet in India
I took antipsychotic medications last year for 6 months due to it I got cognitive impairment and memory loss.now I am unable to read and undetstand.currently I am pursuing MBBS I need tp complete my course
If I consume carnivore diet will my cognition be back in 2 to 3 months
pls reply fast
Thats a difficult question to answer as everyone can have a different experience, We recommend finding a doctor, therapist, coach, dietician, or other healthcare professional who can work with you to ensure safety and efficacy. You can search diagnosisdiet.com/directory to look for a trained professional
We need agi recipe already
This message is for the Metabolic Mind staff. Hopefully you read the comments 😄
For patients that can’t produce high ketone levels it might be helpful to do a keto-flex diet combined with the supplement uralithin A. Both ketones and uralithin A signal the cells in the body to undergo mitophagy which I think is what’s improving mental health. I’ve found that the combination of keto-flex and uralithin A is more effective for my mental health than very strict keto.
Thank you for sharing your experience!
It’s not so much keto the diet itself it’s keeping your blood spikes down that is why fasting works just as good if not better.
its about being in ketosis. while you fast you are in ketosis
Is medication just as important for schizophrenia/schizoaffective?
Living Well With Schizophrenia channel is basically saying keto is king and medications are not important.
I’m asking because you’ve been on her videos.
We definitely do not believe that medications aren't important, and we're pretty sure Lauren doesnt feel that way either. You may want to check with her on that. And here's a video we did on how some experts approach tapering medications with ketogenic interventions. ruclips.net/video/dUy_1VW797k/видео.html
Some real problems with this advice: First, lack of grasp of depression. Seriously depressed people are NOT going to engage in an adventuresome search for a new doctor. This is the opposite of the demotivated, expected behavior. Second, the meds being taken (that should not be arbitrarily dropped) can completely mask/prevent improvements.
We understand your criticism. We think it is important to acknowledge that people with mental illness are all unique. As you mentioned, some patients might have trouble being motivated to search for support. Others might be desperate for solutions and more than willing to do everything they can to pursue this new form of treatment. Our goal is to make people aware that ketogenic therapy is an option that can be extremely effective for some people. We never recommend people try to go off medication quickly on their own. Many people experience extreme benefits using ketogenic therapy as an adjunctive treatment that pairs with their current medication and can even help counter side effects related to metabolism, like weight gain.
Stay skinny, it can only help ! 🚴♀️
Skinny? I would say stay healthy!