Can the Ketogenic diet cure mental illness? Has it really
been used to cure epilepsy? Is it safe? How does it work? We
answer all of these questions in this conversation with Dr.
Dr. Chris Palmer
is one of the world’s leading researcher on the use of ketogenic
therapies for treating neurological disorders. He has done
extensive research on the intersection of psychiatric disorders
and metabolic disorders (obesity, diabetes, cardiovascular
disease and inflammation). There is a lot of misinformation on the
internet about the ketogenic diet and therapies. Dr. Palmer dispels
these myths in our conversation.
In this conversation Dr. Palmer explains the ketogenic diet, how it impacts your body, what it can and can’t do, and how it can impact not only your physical health, but your mental health as well. We took a deep dive into the connection between the gut microbiome, mental health, and mental illness in this episode as well as how to use the ketogenic diet to reduce symptoms from psychiatric disorders.
Connect with Dr. Palmer and learn more about his work via these links:
resources mentioned in this episode:
The Charlie Foundation for Ketogenic Therapies
Virta Clinic – Keto diet cures diabetes and other health benefits
For weight loss keto, learn more from Dr. Dom D’Agostino
Keto News on Epilepsy.com edited by Dr. Eric Kossoff from Johns Hopkins
Dr. Jong Rho at UC San Diego on diet and neurological disorders
SOME OF THE
THINGS WE TALKED ABOUT:
- What is the connection between the ketogenic diet and mental health?For many years, we have known there is quite a bit of overlap between treating epilepsy and treating numerous other psychiatric disorders. Many of the drugs used to treat seizures are also used to treat other mental illnesses. Likewise, since we know the ketogenic diet has been proven to reduce seizers and symptoms of epilepsy, it makes sense that just like the drugs used for epilepsy, that there could be other psychiatric uses for ketogenic therapies.The ketogenic diet has been around for about 100 years (first described by a physician in 1921). It was first developed for the purpose of treating epilepsy. We have a tremendous amount of evidence that the ketogenic diet is a safe and effective treatment for epilepsy today as proven by numerous clinical trials and clinical cases of positive outcomes. Keto is a very common treatment for epilepsy today.
The most “famous” story of it working is the case of Charlie Abrahams who, at 11 months of age was experiencing multiple seizures per day. After many medications didn’t work, the ketogenic diet stopped his seizures and he has been seizure free and medication free for over 30 years.
- Why are ketogenic therapies not used widely as medical treatment for mental illness today?Most people are not aware of the abundance of evidence in favor of this diet or the basic science of it. This diet has been tested in randomized controlled trials in people with epilepsy.Just the idea of using a “diet” that many consider a “fad” or even “unhealthy” to treat something as serious as a mental illness seems to cause skepticism with most people.
In the field of dietary science, there is a lot of disagreement about what is healthy and not healthy. There are also endless “frivolous” or “quack-ish” claims out there. So, when people hear that Keto can cure seizures, people assume it’s another quack claim.
- Why do so many people struggle to do the ketogenic diet?
Johns Hopkins University did a trial on the keto diet where they screened 1,300 people and only 14 people completed trial to test the impact of the ketogenic diet on disease. That is a dismal outcome which makes us ask why so many people struggle.a) Skeptical people – Many people are skeptical about this diet because of the number and volume of naysayers out there. A lot of people say this diet is bad for you or will kill you and that this diet goes against the grain of everything we have been taught is a healthy diet. However, we now know that much of what we have been taught is a healthy diet, isn’t actually healthy and is the result of food industry lobbying and bad science.b) Immediate negative reaction – The 1st week or two of this diet is extraordinarily difficult to endure for most people. Your body is going through a dramatic shift in fuel sources from sugar and carbohydrates to mostly fats. This is a big change that effects almost every cell in the human body. This causes people to often feel worse at first which makes people give up a few days into it. This is likely why so few of the 1,300 at Johns Hopkins finished the trial.
We need clinics and clinicians who understand this diet, its complications, the dynamics of the keto adaptation phase, and understand the “art” of doing this diet in order to increase adherence so we can complete more of these studies in a meaningful way and help more people.
- What are the obstacles preventing broader use of ketogenic therapies for psychiatric disorders?Obstacle 1: Skepticism about a “diet” as an effective treatment for a serious disorder.Obstacle 2: A lot of people can’t do this diet. There aren’t that many professionals, especially in mental health, who fully understand the diet and how to get people to do it appropriately or how long it takes to work. It’s a very difficult diet in the first couple weeks. Takes a while to work, just like any medication would and often people feel worse before they feel better so they give up too early because there aren’t enough well-trained doctors who can oversee the keto adaptation phase of the diet.
- Can this diet “cure” mental illness?Cure is a strong word and one that Dr. Palmer isn’t comfortable using here. He explains that significant, if not total, symptom reduction is possible in many cases and gives several anecdotal examples in our conversation.Dr. Palmer explains that in the world of epilepsy, people typically fall into three buckets when we monitor reaction to treatment:
1 – Symptoms reduced
2 – Cure – or complete resolution
3 – Treatment did not work
Among the people who get a positive benefit from ketogenic treatment (2 of the 3 buckets), m any of those people are able to come off of the diet after the right amount of time on it, and maintain many of the benefits they received from the diet. Charlie Abraham is the perfect analogy here of what complete resolution can look like for someone with epilepsy.
- Is the ketogenic diet safe? How long can someone be on the diet? Dr. Palmer explains that there are numerous variations of the ketogenic diet, and there are multiple use cases as well. The answer to questions like these depends on which version of the diet and what your reason is for a ketogenic diet. There are weight loss versions, medical versions, and some are more restrictive than others as far as what you can consume.If someone is having 20 seizures per day and they are completely disabled from living a normal life, and a ketogenic therapy can control their disability, then the consequences of taking the diet (some perceived, and some real) are worth it when you consider that having sever epilepsy for your entire life is far worse than any potential negative side effect of the keto diet.
- Is it true that people are curing diabetes with the keto diet?The Virta Clinic is the best source for information here. They have published research on trials they have conducted where they put 300 people through a weight loss version of the keto diet and found that many of the people who had diabetes were able to stop taking all diabetic medication. Check out their research here.
- Are exogenous ketones (supplements) good, bad, helpful?The ketogenic diet as many effects on the body. The primary mechanism of action in the keto diet is a change in gut microbiome. The food you eat during this diet, and the way your stomach digests that food can profoundly changes the gut micro biome. Just taking a supplement or an exogenous ketone avoids a lot of those gut microbe reactions that drive positive benefits for the body and brain.According to Dr. Palmer, there is no evidence that exogenous ketones (supplements) have an impact on mental disorders or epilepsy. That’s not to say they can’t and won’t work, but there has yet to be any real evidence through controlled trials to prove the connection.
- If I want to do the ketogenic diet correctly, how do I get started?If you want to use the keto diet to controls symptoms of a psychiatric disorder then you should seek the help of a professional to guide you through the diet, monitor you, help you, and ensure adherence in a healthy way. Here is where you can start your research if you are trying to use the diet for one of these issues:Epilepsy – go to a neurologist and Keto diet center for help properly executing the diet
Diabetes – The Virta Clinic is a good place to start. They are a remote / virtual treatment program that works with your PCP to help you with the diet. There are others like them out there, so do your own homework on what may be best for you.
Treat Mental Illness – You need to work with psychiatrist. SMIs are dangerous life-threatening disorders. This diet is a very powerful intervention (the medical version is far more than a diet; it is a medication). You need to be monitored by someone who knows what they are doing and can help you navigate the negative side effects in the early days of keto adaptation.
- Can the keto diet cure other diseases like Cancer and Alzheimer’s?There is current research ongoing about the impacts of the ketogenic diet on cancer treatment. There have been no cases where the keto diet cures cancer or removes a tumor, but there has been evidence that the diet can slow tumor growth. There are currently trials underway to analyze this.Some people have wondered if we could treat Alzheimer’s with the keto diet. This is a hot topic in the research community and is currently an emerging field. There is some evidence that Alzheimer’s relates to problems with glucose metabolism in the brain. If that’s the case, then changing the brain’s fuel source could logically have an impact on the disease. The keto diet provides an alternate fuel source to brain cells, so if those cells are not getting enough fuel from glucose, then the change to a different fuel source could be one of the solutions. Some people are referring to this as “type 3” diabetes today.
There are some animal trials going on right now with regards to the keto diet and Alzheimer’s. One of those is taking place at Johns Hopkins and one at another university. Both trials show that a keto diet results in improvement in biomarkers for Alzheimer’s, improved cognition in about 6 weeks, and improved energy levels in about 6 weeks. There is much more to learn on this topic.
- What do the naysayers of the keto diet say? Who is working against the Keto diet?There are a lot of people who dislike the ketogenic diet. Many people say it isn’t good for you or has negative side effects or that it defies basic nutrition guidelines. The primary voices of naysayers are medical professionals that truly believe that saturated fats are toxic and will kill people by causing strokes if they eat a ketogenic diet.These medical professionals have been educated this way by the system and taught these concepts their whole career and failed to ever question the science, or the data to come up with their own thoughts. That’s what Dr. Palmer has done and why he has come to the conclusions that he has.
A lot of medical professionals (who are good people, who have a goal of saving lives) truly believe this diet can harm people. Dr. Palmer disagrees with these doctors and is vocal about this because he welcomes an open dialogue about the science and the data for the advancement of public health. A great resource to begin doing your own homework here is the Virta Clinic research on the diet.
In addition to these doctors, there are others who oppose the keto diet as well. This includes the broader plant based dietary movement. Some people don’t eat animals for ethical or religious reason. Other people prefer plant-based foods because they think that raising animals for consumption is bad for the environment. Dr. Palmer isn’t arguing for or against any of those positions, but rather just stating what opposing views are out there.
One point we would like to make here is that an obese person, with multiple co-morbid problems is having a profoundly more negative impact on the environment in m any other ways than they would be having if they were eating animal-based food. Dr. Palmer explains this in the conversation.