June 18, 2024

Metabolic Psychiatry: Can Ketones Transform Mental Health Treatment?

Written by

Carlene MacMillan, M.D.

The fastest way to change your mind may be through your diet. Over 50% of U.S. adults have insulin resistance, which not only affects blood sugar levels throughout the body but also impairs the brain's ability to process glucose. As mental health professionals grapple with the growing crisis of treatment-resistant psychiatric disorders, metabolic psychiatry is gaining traction.

By addressing the underlying metabolic dysfunction that may contribute to various mental health conditions, metabolic psychiatry offers new hope for patients.

Osmind's Chief Medical Officer, Carlene MacMillan, sat down with Dr. Georgia Ede, a psychiatrist specializing in nutritional and metabolic approaches to mental health, and Dr. Bret Scher, a cardiologist and the director of Metabolic Mind, to explore how the ketogenic diet can fundamentally improve brain health, leading to better patient outcomes and transforming the way we understand and treat mental illness.

Read on or listen to the Psychiatry Tomorrow podcast interview to discover:

  • The inspiring story of the Baszucki family and how a ketogenic diet helped their son overcome severe bipolar disorder
  • The science and mechanisms by which the ketogenic diet can improve brain health
  • Insights from leading experts on implementing metabolic psychiatry in clinical practice, including how to assess metabolic health, collaborate with nutrition professionals, and address objections from traditional psychiatry and insurers
  • Practical considerations for patient empowerment and how you can get involved in the growing metabolic psychiatry movement to help shape a brighter future for mental health care

The Baszucki Family Story: A Transformative Journey

To understand the potential of metabolic psychiatry, we begin with the inspiring story of the Baszucki family, the pioneers behind  Metabolic Mind. Their son, Matt, struggled with bipolar disorder, experiencing treatment-resistant symptoms that left him "homeless for a time, hitchhiking up and down the coast," as Dr. Scher recounts. It wasn't until Matt started a ketogenic diet under the guidance of Dr. Chris Palmer that "everything changed and all of a sudden he was well, not just safe, not just treated, not just no longer manic, but well, like living a, as he calls it, a normal life, more normal than any of his friends, as he likes to say."

Motivated by their son's remarkable improvement, the Baszucki family committed to advancing metabolic psychiatry research and education.

From Cardiology to Metabolic Psychiatry: Dr. Bret Scher's Journey

Dr. Scher's journey into metabolic psychiatry began with his work as a cardiologist, where he witnessed firsthand the profound impact of addressing metabolic dysfunction through lifestyle interventions, particularly ketogenic diets. As he explored this area further, he was introduced to the Baszucki family and their incredible story. Inspired by their mission and the potential to make a real difference in patients' lives, Dr. Scher became the director of Metabolic Mind, collaborating with experts like Dr. Georgia Ede to advance education, resources, and research in the field.

The metabolic psychiatry movement brings together professionals from various disciplines, highlighting the importance of a holistic approach to mental health treatment. As Dr. Ede notes, "One of the wonderful things about this movement is how many wonderful people are involved. People, you know, really purpose-driven, patient-oriented, and really trying to move the field forward."

From Standard Care to Nutrition: Dr. Georgia Ede's Evolution

Dr. Ede's path to metabolic psychiatry was a gradual one. For the first decade of her practice, she followed the standard of care, primarily relying on psychotropic medications and psychotherapy. However, over time, she began to incorporate more nutrition principles into her work, driven by a desire to help patients who were struggling despite multiple medications and therapy. Her experience may inspire other clinicians to explore similar approaches in their own practice.

Mechanisms of Action: How the Ketogenic Diet Improves Brain Health

Metabolic psychiatry focuses on understanding and addressing the metabolic root causes of mental health conditions. As Dr. Ede explains, "The more we learn about the relationship between metabolic health and mental health, the more powerful that connection appears to be." The ketogenic diet improves brain health through multiple mechanisms. By lowering blood glucose levels and providing an alternative fuel source in the form of ketones, the ketogenic diet can help mitigate the damaging effects of insulin resistance and impaired brain glucose processing, which are common in many psychiatric conditions.

As Dr. Ede explains, "So when you go on a ketogenic diet, you lower insulin levels to the point that fat will burn. You chop some of that fat into ketones. Ketones are fed into the brain. They cross easily into the brain, even if you have severe insulin resistance, and they bridge that energy gap. And that's why I believe you see in so many people, within sometimes just three days of starting a ketogenic diet, people say things like, 'My brain just woke up, the lights turned on, I can think again.' Mental clarity, mental clarity, mental clarity."

In recent years, there has been a growing interest in the use of GLP-1 agonists, such as Ozempic and Mounjaro, for improving metabolic health. These medications can be effective in changing the way the body processes insulin and responds to carbohydrates but do not induce ketosis.

As Dr. Ede explains, "There are lots of different ways to improve your metabolic health. I personally prefer food-first approaches, lifestyle approaches first. That's just my philosophy, what I'm passionate about, but people deserve a choice. And so not everybody is going to want to change their diet, but they still may have metabolic issues that need to be addressed."

By empowering patients to make sustainable changes to their eating habits and overall lifestyle, metabolic psychiatry aims to provide a more comprehensive and long-lasting approach to improving mental health outcomes.

A Growing Body of Research Supports Metabolic Psychiatry

A growing body of research, including case studies, pilot trials, and even small randomized controlled trials, supports the efficacy of the ketogenic diet in treating a wide range of psychiatric disorders. Dr. Ede highlights the work of Dr. Albert Danan, who invited 31 of his most treatment-resistant patients with serious mental illness to try a ketogenic diet in a hospital setting.

The results were remarkable: "28 of those 31 patients were able to stick with a diet for two weeks or longer, which you do need to do in order to start to see results. And all 28 of those patients improved. And they didn't just improve a little bit, they improved a lot. Substantially."

Implementing the Ketogenic Diet in Psychiatric PracticeFor psychiatrists interested in incorporating the ketogenic diet into their practice, Dr. Ede emphasizes the importance of assessing metabolic health through key markers and tests. She recommends testing the following:

  • Fasting insulin levels
  • Triglycerides
  • HDL cholesterol
  • Waist circumference

These metrics provide valuable insights into a patient's metabolic status.

Addressing Traditional Psychiatry Objections

Some traditional psychiatrists may object to incorporating metabolic psychiatry approaches into their practices. Dr. Ede acknowledges that on social media, there seems to be a group of people drawn to metabolic psychiatry who are hostile to traditional psychiatry and see it as an alternative that negates the rest of psychiatry.

However, she emphasizes that metabolic psychiatry does not need to be an either-or approach. "I have lots of patients who use ketogenic diets and other types of nutrition strategies in combination with conventional care strategies. You don't necessarily want to throw the baby out with the bathwater. There are medications that sometimes are very useful and important and continue to be important in a person's full recovery, even if they're eating the healthiest diet in the world."

For psychiatrists who feel they lack the necessary expertise, Dr. Scher suggests collaborating with dietitians, therapists, or health coaches. "You don't have to find a keto psychiatrist or a metabolic psychiatrist to get started, you just have to find somebody who can talk their language and speak with them and help make sure you're getting the care you need while helping you get started."

Dr. Ede also stresses the value of collaborating with nutrition professionals to ensure proper implementation of the ketogenic diet. While she initially incorporated these principles into her practice without the help of a dietitian, she recognizes the importance of working with nutrition experts to support patients in making dietary changes and to alleviate the burden on psychiatrists to become experts in this area.

As more clinicians receive training, such as through Dr. Ede's clinician training course, patient access to comprehensive care will improve.

Addressing Insurer Objections and Emphasizing Cost-Savings

IInsurers may object to covering metabolic psychiatry interventions due to a lack of evidence supporting their efficacy and cost-savings. Dr. Scher explains, "The short term, I think it's not going to happen, unfortunately, and you know, months to years, but hopefully beyond that it will as the science catches up. And that's usually what has to happen for insurance to cover it. Not just signs showing efficacy, but showing cost savings. That's what the insurance companies are usually after."

Dr. Ede adds, "I believe the precedent has already been started to be set by Virta Health where they treat type 2 diabetes with low carbohydrate ketogenic diets. They've gotten the blessing of insurance companies in California to cover this treatment because they showed through lots of hard work that the ketogenic diet can re saves money and that improving people's health saves money."

The long-term cost-saving potential of addressing the underlying metabolic dysfunction contributing to mental health disorders should be emphasized to insurers. Dr. Ede explains, "Medications are a lifelong intervention and getting specialized help for ketogenic diets is a short term intervention. Once you know how to do it, once you've been transitioned onto it, once you have all the tools at your disposal and you know how to safely continue it, you don't necessarily need to go to your prescriber every one month, two months, three months to get refills and be monitored. You generally need less care over time."

Mental health professionals can advocate for the inclusion of metabolic psychiatry interventions in insurance coverage by highlighting the growing body of evidence supporting their efficacy and the increasing demand from patients and clinicians alike.

Conclusion: A Bright Future for Metabolic Psychiatry

Metabolic psychiatry holds immense potential to revolutionize mental health treatment by addressing the underlying metabolic dysfunction that contributes to various psychiatric disorders. The ketogenic diet, in particular, has shown remarkable efficacy in improving brain health and patient outcomes, even in cases of treatment-resistant mental illness.

As Dr. Ede powerfully states, "These types of interventions are really the most powerful tools I've ever had at my disposal for helping people with all kinds of mental health problems." By embracing this emerging field and incorporating metabolic strategies into their practice, psychiatrists can unlock new possibilities for their patients and shape a brighter future for mental health care.

Metabolic Psychiatry Resources for Further Learning and Support

About Dr. Georgia Ede:

Dr. Georgia Ede, MD is a Harvard-trained, board-certified psychiatrist based in Northampton, Massachusetts, USA. Her interest in nutrition arose after discovering a new way of eating that reversed several bewildering health problems she had developed in her early 40s, including fibromyalgia, migraines, chronic fatigue syndrome, and irritable bowel syndrome (IBS).

Dr. Ede acquired her bachelor’s in biology from Carleton College in Minnesota. Then, for seven years, she worked as a research assistant in the fields of biochemistry, diabetes, and wound healing. She earned her MD from the University of Vermont and completed her residency in general adult psychiatry at Cambridge Hospital in 2002. After five years in general practice, she joined Harvard University Health Services from 2007 to 2013 as a staff psychopharmacologist and was the first psychiatrist there to offer nutrition consultation as an option to students, faculty, and staff with mental health concerns.

From 2013 to 2018, she was the psychiatrist for Smith College in Northampton, Massachusetts, where she provided nutrition consultation as well as medication and psychotherapy services to Smith students.

Now, Dr. Ede devotes all of her time to nutritional psychiatry and directs her efforts on studying, writing, and speaking about the strong scientific connection between food and brain health.

Dr. Ede writes frequently for Psychology Today and has her own website at Diagnosis: Diet. In 2018, she independently published a paper in the Journal of Evolution and Health. Dr. Ede is on Twitter, LinkedIn and Facebook.

About Dr. Bret Scher:

Dr. Scher is the host of the Metabolic Mind YouTube channel and podcast. He is a board-certified cardiologist, lipidologist, and leading expert in therapeutic uses of metabolic therapies, including ketogenic diets. Prior to joining Baszucki Group, he was the medical director at DietDoctor.com, an online platform promoting improving metabolic health through low carb nutrition.

Bret has spent most of his 20-year career as a preventive cardiologist, helping people improve their metabolic health and preventing heart disease using low-carb nutrition and lifestyle interventions.

His passion for educating the public about the benefits of metabolic therapies grew from his experience with the prevailing medical teaching, which frequently misrepresents nutrition science and undervalues metabolic health. Bret received a BS in biology from Stanford University and an MD from The Ohio State University College of Medicine.

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