Did you know that thousands of people are already using ketogenic therapy to treat serious mental illnesses and even put them into remission?
Transcript:
Can Ketogenic Therapy help treat your mental disorder? Introduction to the THINK+SMART framework.
Can ketogenic therapy help treat your mental disorders like bipolar disorder, depression, schizophrenia, anxiety, or others? It may! And our THINK+SMART framework may help you understand how to implement ketogenic therapy. The “THINK” in “THINK+SMART” stands for therapeutic integration of nutritional ketosis. And it helps to define what ketogenic therapy is. So in this video, I’ll explain the 10 key concepts that define ketogenic therapy, which will provide an important framework before embarking on your ketogenic journey. Welcome to Metabolic Mind, a non-profit initiative of Baszucki Group, transforming the study and treatment of mental disorders by exploring the connection between metabolism and brain health. Thank you for joining us on this journey. Now before we go further though, please remember our channels are for informational purposes only, we’re not providing individual or group medical or healthcare advice, or establishing a provider-patient relationship. Many of the things we discuss can be dangerous if done without supervision, so please always consult your physician, your health-care team, before changing your lifestyle or medications.
How do we define Ketogenic Therapy? What are some resources to get started?
For those unfamiliar with it, THINK+SMART is our community source framework where individuals can share their experiences of specific aspects of how they use ketogenic and metabolic therapies. For instance, how often do they check their ketones and what are their goal levels? What are their go-to meals and what supplements do they take? And so many other specifics. So if you haven’t heard about our THINK+SMART framework, please see the prior video explaining it and click on the link in the description to explore the website. But come right back here before you get started so you can better understand the key concepts of defining ketogenic therapy. So for number one, let’s start with a crucial aspect of ketogenic therapy. What is your plan for clinical oversight and for adjusting prescription medications? As Dr. Chris Palmer says, a mental illness is a serious diagnosis and ketogenic therapy is a serious treatment. Therefore, it’s imperative to have a plan with your clinician for monitoring your condition and potentially adjusting your medications. Now, of course, it’s ideal if your clinician is trained in ketogenic therapy, but even if they aren’t, they can still monitor you for clinical changes and the need for medication adjustments just as they would if they started a new medication. Ketogenic therapy is no different from that aspect. But if your clinician isn’t trained in ketogenic therapy, we recommend working with someone, a dietician, a coach, a therapist, or other provider who can help with the ketosis part and even help communicate with the provider. You can watch our prior video with Hannah Warren discussing some of the nuances of working with or without a trained clinician, but be aware, because ketosis is such a powerful brain-based treatment, it can change the need for psychoactive medications and therefore the doses may need to be adjusted. We have a number of videos covering this topic in more detail as well, which you can see in the description below.
What is the target minimum duration for Ketogenic Therapy?
Okay, number two, what is your target minimum duration for ketogenic therapy? Many experts in the field, such as Dr. Georgia Ede, suggest committing to a minimum duration of four months. Less than that, and it may be premature to decide if it “worked” or not. Of course, we all have heard examples of someone starting ketogenic therapy and seeing immediate and dramatic benefits. It’s fantastic when this happens. But it’s important to realize that that’s not the case for everyone, and many, perhaps even most, will need more time to see the full benefit of ketogenic therapy. So make sure you define your target duration, and you can use our THINK+SMART tool to gauge what others have used.
What lab work will you use to measure your metabolic function, nutritional status and medication levels?
Number three, what lab work will you use to measure your metabolic function, nutritional status, and medication levels? Now, we have a dedicated video to this and a handout that goes into this question in detail, and we hope you can use it along with your care team to decide the best evaluation for you. The key is to check before you start ketogenic therapy and then at regular intervals along the way, just as you would when starting a new medication, right? This is no different than that. But the labs may include medication levels for medications like drugs like lithium, or it may include metabolic parameters like trade glycerides, HDL, fasting insulin levels, and it often includes an LDL cholesterol, although we encourage you to explore our videos about LDL before either overreacting to or completely ignoring the LDL result. But the point is that many factors may change with ketogenic therapy, and it’s imperative to follow them closely for safety.
What nutritional supplements should you take?
Okay, number four, what nutritional supplements will you take? Now, not everybody needs supplements when they’re in ketosis, but things like magnesium and salt or electrolytes are commonly used with ketogenic therapy. And if levels are low, many experts recommend L-carnitine replacements. That may be allowed to check before starting. Others may supplement with B vitamins or vitamin D, as those have been linked to brain-based changes. And this is, again, where our THINK+SMART framework can help give you ideas from others about what worked for them.
What foods should you eat and avoid?
All right, number five, identify the specific foods you will or won’t eat. Now, with ketogenic therapy, the rules don’t have to be complicated. Most people can do really well in being ketosis, eating less than 30 grams of carbs per day, getting adequate protein around 1.2 grams per kilogram, and filling the rest in with fat. But whether you do that with a vegetarian diet, a carnivore diet, a mediterranean diet, or other diet is really up to you. You can pick the dietary pattern that works best for you. And it really helps to have some go-to recipes picked out ahead of time, so you kind of don’t get caught unprepared, and you always have the ingredients available. But we have to recognize that food isn’t like taking a pill, right? The food we eat is influenced by taste, by emotion, by culture, and those don’t really affect how you take a pill. So please remember that you can tailor just about any diet to fit with ketosis. So you should pick the diet that works best for you.
What should your macronutrient ratio be?
But this brings us to number six, which is along similar lines, and that’s picking your macronutrient ratio. For instance, is it 5% carbs, 25% protein, and 70% fat? That’s a good starting point for many. But some people may want, say, higher ketone levels, and find that they can get there by eating less protein, maybe something like 5% carbs, 15% protein, and 80% fat. But keep in mind, many experts caution against going too low with protein, usually not below one gram per kilogram of body weight, as protein is beneficial for metabolic health, for body composition, and for satiety. So the key is to know where you want to start and adjust as needed, depending on how you respond.
Should you use a time restricted eating or fasting pattern?
So next, number seven, will you choose a time-restricted feeding or fasting pattern? Many who start a ketogenic diet find they naturally fall into a time-restricted eating pattern as their hunger diminishes. But that doesn’t mean you have to do that. It’s likely best to try to reduce or eliminate your snacking, but beyond that, it really depends on how you feel during the day and how many meals you need to eat to feel satiated while still eating adequate calories and nutrients. Some find skipping a meal can make them edgy or cranky or even trigger cravings, in which case you probably shouldn’t do it. And some find they skip meals without even thinking about it. So again, plan on what you want to do and adjust as needed based on how you respond. Now let’s get into ketone levels.
What level of ketones should you target?
So number eight, what are your target ketone levels? And this is a big one for what separates And this is a big one for what separates ketogenic therapy from simply eating a keto diet. If you haven’t thought about this before, we do have a video that explores some of the specifics, but in general, many experts recommend blood ketone levels of about two to three millimole per liter, for brain-based disorders. But again, this may vary for each individual. We’ve heard from individuals who feel great at levels of five, but notice their psychiatric symptoms can return at levels of two, so while still in ketosis, while others have had complete remission at levels between 0.5 and 1. So you can learn more by watching our video and discussing this with your care team to set your initial goals.
How should you measure your ketone levels?
And along those same lines, number nine is how will you measure your ketone levels? Now most experts recommend a finger stick device like a keto mojo, as those tend to be the most accurate. Now urine tests tend to be a little less helpful for determining specific levels, although they can be helpful for saying if someone is in ketosis or not. And breath analyzers continue to improve, but likely lie between finger sticks and urine tests in terms of accuracy. Although they do have the benefit of not having to prick your finger if that’s an issue for you. And they also tend to be a little bit more expensive. Now we eagerly await more widespread availability of continuous ketone monitors, which are not yet really available in the US, but until that time, finger sticks are likely the best.
How often and when should you check your ketones?
And that leads us to number 10, still sticking with sort of ketone levels and checking ketones, how often and when will you check your ketones? As I mentioned before, CKMs or continuous ketone monitors may be the holy grail, but they’re not yet widely available. And we know that ketone levels tend to vary during the day. So many people recommend testing multiple times a day, at least initially, to find when your levels are at their lowest and when they’re at their highest, and use that to help gauge when you will continue testing during the day. Now upon waking and maybe an hour or two before your main meal, tend to be the most common times to check. But again, see what your pattern is and adjust accordingly. And we’re excited to hear more from our participants at THINK+SMART about when they check and why, and what kind of patterns they see and what’s most helpful for them.
So that wraps up our 10 points of defining ketogenic therapy. I hope this gives you an idea where to start when you engage with our THINK+SMART framework, and helps you prepare to get started with ketogenic therapy with proper guidance and supervision. Now I mentioned a number of videos that expand further on these concepts, and we’ll link to those and other resources in the description below. And please let us know your thoughts. What are your thoughts about THINK+SMART, or about your journey as you prepare for ketogenic therapy? We’d love to hear from you, and we’d love to hear your questions and comments. So thank you so much for watching. I’m Dr. Bret Scher. We will see you here next time at Metabolic Mind, a nonprofit initiative of Baszucki Group.
