After Losing His Brother, He Set Out to Reinvent Mental Health Care

Bret: 
Welcome to the Metabolic Mind Podcast. I’m your host, Dr. Bret Scher. Metabolic Mind is a non-profit initiative of Baszucki Group, where we’re providing information about the intersection of metabolic health and mental health and metabolic therapies, such as nutritional ketosis as therapies for mental illness.

Thank you for joining us. Although our podcast is for informational purposes only and we aren’t giving medical advice, we hope you will learn from our content and it will help facilitate discussions with your healthcare providers to see if you could benefit from exploring the connection between metabolic and mental health.

Many of the interventions we discuss can have potentially dangerous effects if done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications. In addition, it’s important to note that people may respond differently to ketosis and there isn’t one recognized universal response.

Kristian Ranta lost his brother to suicide, and that is obviously devastating. But for Kristian, it really forced him to look at the world of psychiatry and ask, “Why did this happen? Why was my brother, who was in the system getting care, not get better? But why did he actually get worse? And what could have been done better?”

And the results for Kristian is Meru Health, and now Meru Health Advanced, who really help take care of people who are treatment-resistant, who have metabolic comorbidities, and doing it better than what you can say, quote, “traditional psychiatry practice” does. And we really have to take a step back and say the way our medical system as a whole, and certainly our mental health system is, the way it’s structured, is not optimal. And how can we optimize that?

So, this is the discussion I have with Kristian today about what they’re trying to do at Meru Health and how it really does this multi-modality approach, the holistic approach, however you want to say it, how it really does treat the patients as individuals and helps them have better outcomes. So, with that in mind and this hopefully new framework that could potentially become the framework that we all deserve and all can practice, I hope you enjoy this interview with Kristian Ranta.

Kristian Ranta, welcome to Metabolic Mind. Thank you so much for joining me today. 

Kristian: 
Thank you, Bret. Pleasure to be here. And thank you for having me. 

Bret: 
Yeah, I’m excited to get into sort of your whole experience with the world of psychiatry, and what motivated you to start Meru, and how it’s different in terms of psychiatric care.

But, before we get into all that, as I like to do, I want to ask you: what do you think is the biggest thing that medicine gets wrong that you really wish were different right now? 

Kristian: 
Yeah, that’s a great question. I used to be in diabetes before coming into mental health. I built my first two startups or businesses, medical technologies, in diabetes.

And what I remember from our chief medical officer from back in the days, he used to tell me that they, he’s an endocrinologist and a PhD and an MD, and he said that medical school used to have one or two hours of nutrition-related education on his, whatever, 10 years of studying from MD to even PhD.

And then, I think that was something, which was an eye-opener for me already back then. That I realized that, wow, that’s pretty crazy. Diabetes and no nutrition education, what? And then, so I would say that nutrition and what we eat, the input, I’m also a very logical thinker, input and output, the input, food, diet. I would say that’s what I think is the biggest miss in medicine today.

Bret: 
Yeah, I think that’s a great point. And so, many people are, you’re right, came out of school and training learning about nutrition as it relates to severe deficiencies, but not to the chronic disease epidemic that we’re in. And so that, I think, absolutely 100% medical education and research and treatment, and just the practice of medicine really does need to be geared around lifestyle, nutrition, intervention, effective intervention for metabolic health.

So yeah, thank you for bringing that up. 

Kristian: 
Sure. 

Bret: 
And it brings in this whole concept of metabolic health is not one thing, right? It’s not Type 2 diabetes. It’s not fatty liver. And it’s not bipolar disorder, schizophrenia. It’s all of that combined because so many of the patients have combined comorbidities, which is part of what I think you’ve, from what I’ve read, you’re designing Meru Health sort of to attack.

But before we get into all that, give us your background, your experience with the psychiatry system and what led you to say we need to do something different?

Kristian: 
Yeah, I appreciate it. Yeah so, unfortunately, what happened to me was that I lost my oldest brother, Peter, to suicide back in the days when I was building my previous business.

And that experience, of course, made me think very carefully, like what happened? What’s wrong? What was going on? And my brother was actually accessing care. He was getting care, but it unfortunately, only made him worse. He was basically just given pharmaceuticals. And then, unfortunately, they didn’t really work. And then, they had side effects. And then, it just ended bad.

So, that’s something which made me think very carefully, like just look into the research. So, my background is in medical technologies, healthcare. I studied computer science and information systems in my undergrad and graduate studies. And then, I ended up in a healthcare company. And then, founded my first own healthcare startup and so forth.

And then, I realized that this is the field that I want to be in. That it’s really motivating for me to be able to combine technology with doing good things, helping people live better, higher quality or better life quality, and stuff like that. The experience with my brother, and then me selling my last company in 2015, made me very seriously consider what do I want to do next, and how could I help people like my brother?

And that then took me down the path of founding Meru Health in 2016. So, a decade ago. And it also made me think that there’s got to be a better way than what my brother was getting. And that’s when I went into a lot of the research, and I was just started, like reading and immersing myself. I started kind of understanding. And then, I realized that, wow, we’re completely ignoring the physiology, the biology In mental health care.

We really don’t have any blood work. We’re not doing anything like that. We’re not using any wearables. We’re not collecting any any biosignals for most parts. We’re not measuring the effectiveness of care. Even if we have some self-report scales and stuff, we’re not using them for a majority.

We’re not actually measuring care. We don’t know what works, what doesn’t work. So, there was just a lot of things that I discovered. And then, having been a biohacker myself also for a long time, I knew from my own personal experiences also that if I don’t sleep well, if I don’t eat well, I may start feeling depressed.

I may start getting these symptoms myself. And then, I’m like, wait a minute. These need to be connected. So, that’s how we founded Meru Health as a whole person mental health company to not only do therapy or medication, but also include diet, sleep, exercise, even biofeedback. Things like these.

Bret: 
Yeah, and I’m so sorry to hear about your brother. But you’re doing so many amazing things in his honor, and really trying to make a difference in care. And I was reading some of the things that you’ve written, and you mentioned about this term treatment-resistant. That he was labeled as being treatment-resistant. And then, that’s far too common.

And then, I don’t know, like the thinking shuts down, or the ‘what else can we do?’ shuts down almost. Here’s our guidelines. Here’s our protocol. If it didn’t work, it’s treatment-resistant. And I know nobody wants to practice that way, but it it seems like the way the system has been set-up.

So, was that your experience as well? 

Kristian: 
Yeah, definitely. It definitely was. And I think there’s, yeah, we accept the reality like, oh, we couldn’t do anything, and it’s just how it is. And I just really realized that I don’t want to accept that reality. I want to try to do something else.

Bret: 
Yeah, and I like what you wrote, though. I forget if you said 5 years from now or 10 years from now, treatment-resistant depression is going to seem as ridiculous as untreatable Type 2 diabetes, or you know, diabetes unable to be treated. So, now we know we can put Type 2 diabetes into remission with lifestyle.

Doesn’t even take medications, and we can control it with better medications, but put it into remission with lifestyle. And so, maybe something similar with psychiatric care? So, what do you, what are the main components that are being added? You’ve mentioned a lot of them already. But when you look down and say, this is the checklist of things that we’re missing and really are going to make a bigger impact in individuals’ care, what’s your checklist?

What are the main things? 

Kristian: 
Yeah. So, I think first and foremost, metabolic health. We have to include metabolic health in psychiatry, especially for people who are really treatment-resistant, or who have more severe conditions. And what do we mean by metabolic health? We basically do blood work.

We look at the person’s not only psychiatric condition or psychiatric symptomatology, but also what’s going on the physical health side. So, we first have a kind of a proper evaluation. A very comprehensive evaluation with an MD, with a doctor, with a psychiatrist to then understand the lifestyle factors, but also the psychiatric history and so forth.

And then, we go into the blood work, 30 to 50 biomarkers. Metabolic, hormonal, deficiencies, inflammation, things like these. And then, that helps us formulate a picture of what’s going on with this person. What maybe other chronic illnesses or other issues the person may be having in addition to the psychiatric issues?

And then, we’ll tailor a care plan. We’ll introduce a dietician. We’ll introduce a therapist, a care navigator, and a coach to help the person with like a full care team. And very important component is the diet, the dietary component. And in that regard, we have two main tracks, basically.

We’ll either go into more like a low carb-ketogenic diet where we can offer that for people who are suitable, or to whom that could be suitable for. Or then, if there’s another, the other track we call like a general nutrition track, which is more like optimization for, or towards, like a Mediterranean diet.

So, I’m sure there’s a lot of evidence also on the benefits of Mediterranean diet, and that seems to work pretty well for a lot of people. But it’s not maybe something that works that well for the more, you know, severe end of the spectrum. And therefore, we also have built in the capability of doing a low carb or keto diets.

Bret: 
Yeah. Now, if you think about your traditional psychiatry practice. You come in to see your psychiatrist. You’ve got 15 minutes, probably, and there’s no chance to cover all these things in a visit. And if they tried, it would likely be overwhelming, like drinking from a fire hose. So, how is what you’re doing different?

How do you have the time, the feasibility, and how do you keep it from overwhelming people with the amount of information? Because it’s all great stuff, and it’s amazing stuff. But it’s got to be done in a way that they can incorporate into their lifestyle and actually make it work, right? So, how do you balance those?

Kristian: 
Yeah. That’s very important. So, we first, instead of a 15-minute appointment, we start with an hour-long appointment. And we collect certain data beforehand so we even can spend that hour on not collecting data, but actually going into what we learned from the data. And then, collect more data as we talk to the patient.

Then, after that, we do the blood work, lab testing. And after that, we have another 30 minutes with a psychiatrist to really go over, what did we find? What’s the conclusion here? What are we going to be recommending? Things like this. And then, we bring in the full care team. So, in this way, we have more time, more face time with a very capable psychiatrist. And we will be equipping the doctor with all the data from self-reported, from historical data, but also the lab work data.

And then, after that, we’ll piece by piece, start moving forward with the care plan with all the other practitioners as well. Bringing in the therapist, bringing in the dietician. So, that’s how we’ve staged things so that it’s not too overwhelming. We go piece by piece. And again, very important point, as what you’re also making, is just the fact that you need to have enough time for proper diagnosis instead of the 15 minutes.

Bret: 
Yeah. That’s a great point, too. We focus so much on treatment that sometimes we forget about diagnosis, whether it’s thyroid or vitamin deficiencies or hormonal dysfunction or whatever the case may be. It may not be like an all-in-all cure, but sometimes it is. And then, sometimes certainly could help symptoms as well. But if those are overlooked, then you’re really swimming upstream with any treatment you might be trying.

Kristian: 
Yeah, exactly. 

Bret: 
But what’s preventing this type of multi-modality holistic care? What’s preventing it from scaling and being the treatment that everybody gets, who has a diagnosis of depression or bipolar disorder, et cetera?

Kristian: 
I mean, one of the challenges is the payment infrastructure. Health insurance and employers who are usually sponsoring for most of the healthcare. Here in the US, the challenge is that these kinds of treatments historically have not been reimbursable, and that’s partially because of lack of evidence.

I think there hasn’t been enough evidence to support some of these treatments, and that’s one thing. But also, just the fact that the system is also quite slow in adapting. And sometimes it’s for very good reasons. We don’t always want to rush in things in medicine. So, there’s also good reasons for that.

But I think it’s largely because of the reimbursement, structures and the challenges with the reimbursement structures, and that’s actually something which we are excited to see is changing. And there’s definitely more and more openness for more lifestyle medicine-type of treatments to be reimbursed.

But there’s also a lot of just technicalities, and, the current, especially for the health insurance companies, it’s very much about the CPT coding and how do you fit into the CPT codes. But then, there’s actually another way that’s emerging very strongly nowadays, is that there’s all these value-based, outcomes-based reimbursement frameworks that are actually starting to become much more common.

And that is, I think that’s what I’m seeing personally and with Meru Health, is allowing for a reimbursement for some of these treatments much more, much faster than trying to fit into the CPT coding, more rigid schedules. 

Bret: 
Yeah, I think that outcome-based reimbursement is really impressive wave of the future and practices, like the Toward practice for metabolic health, or Virta Health, or Meru Health that institute this, are really paving the way for this to say, “Look, pay us only if they get better.

Only if we save you money, do you pay us.” And that just makes so much sense, right? Rather than getting paid for treatment that doesn’t work, you should get paid for treatment that does work. It just makes too much sense. Yeah. But you mentioned, you mentioned evidence. So, you have a very good point.

You can’t just hang up a shingle, and start doing things differently and say everybody should do it this way. You need to prove in some way, as best you can, that it’s effective. But you have a number of published studies from your practice, right? And what have those shown?

Kristian: 
Yeah. So, I’m sure you’re well aware of the saying that strong claims require strong evidence. So, it’s like that. We started the company, initially with working, collaborating with UC Davis and Stanford, early on because we had an idea of a more kind of a whole person or integrative therapy, which we’ve been now offering for the last seven years in the market.

And but we also realized that we don’t have enough evidence to be able to. At that point, we were guessing. But we knew or guessed that, hey, we’ll need to get evidence to be able to get insurance or employers to start reimbursing for this. And we then went to Stanford and UC Davis, and we told them like, “Hey, we have this vision.

We have this product. We’ve built a prototype. We have some early data. Would you be willing to study this with us?” And they both said, “Yes. This is fantastic. We’re actually very eager to study something like this.” And then, we started like a multi-year collaboration where we then ran several clinical trials with them, large single-arm trials, also RCT, randomized control trials, the gold standard.

And what we’ve shown over the years is that the Meru’s therapy offering, which is already more of an integrative, whole person therapy offering, is broadly speaking, 50 to 100% more clinically effective than standard therapy or medication for depression, anxiety. And then, we’ve shown that it also, because of the strong behavior change component, that’s another thing we’ve interwoven into our offering.

That instead of just doing daily, or instead of just doing weekly or biweekly visits, we actually interact very proactively with the patient on a daily to bi-daily basis so that we make sure that while in treatment they are very much cared for and also nudged. And it’s a carrot and a stick.

We also hold them accountable. And these two components, the whole person components and then the kind of behavior change components, have produced these great results where we see that people get better efficacy, but also maintain the results a lot further than in traditional therapy.

And we published one and two-year data. So, even up to 24 months post-treatment data, that shows that a majority of the gains are maintained because people actually learned a lot of these behaviors and these skills that they can now use even way after they graduated from our offering. 

Bret: 
And is the whole thing virtual, or are there initial in-person and then a lot of the virtual support, or how does that work?

Kristian: 
Yeah, it’s all virtual. We are a virtual clinic. We don’t do any in-person or in brick-and-mortar visits. So, it’s all virtual via Zoom or video calls. And then, we can help people in every state. So, we’re available in every state currently. 

Bret: 
Yeah. Now, just I’m curious. I think you’re from Finland initially, is that right?

Kristian: 
Originally, yes. 

Bret: 
Yeah. So, how does psychiatric care in the US compare to Finland? I’m just curious. I know nothing about it. And would something like this work in Finland as well? 

Kristian: 
Yeah. That’s a great question. Finland has universal healthcare. So, it’s kind of something that many people know about Finland that, yeah, there’s this universal healthcare system.

But to be honest, actually, psychiatry is very overlooked in Finland. So, what I mean by that, there’s very limited psychiatric resources for people in Finland available through the public system. Of course, private. You can always cash pay. But if you want to go for something inside the public system, there are a lot of limitations, like just being able to do therapy for even few sessions or few weeks or something.

That’s not covered at all. So, there’s that. I think that’s a massive gap in the system, unfortunately. 

Bret: 
Okay. Yeah, and the fact that your program is virtual, I think can really help because there are so many people living in areas where you don’t have access to psychiatrist or a therapist that’s accessible that you can, that takes your insurance, that you can easily go see and helpful.

So, have you found that you’re able to reach those people who wouldn’t otherwise be getting care? Because as you mentioned, your brother was getting care. He was in the system and still not improving. How many others are not in that position to even get care that you can then reach? So, have you found that?

Kristian: 
Yeah, for sure. We’re available nationwide. And we’ve had a lot of people from places like Alaska, as an example. I just remember one example recently when someone sent us like a testimonial, like some feedback after they had gone through our therapy program. And this person was in Alaska and very far away.

And then, he was saying like, “Hey, this is like life-changing because I was not able to access almost any care here.” So yes, I think you’re spot on. There’s definitely that component that telehealth and remote care can really help people in these locations. And we’ve definitely seen that, in our experience.

Bret: 
And you’ve mentioned nutrition a lot. So, you mentioned like the Mediterranean-type approach, and then the low carb keto approach. Who makes that decision? Is it the patient comes asking for it, or does the psychiatrist decide which they think would be best? Because you’re not like a keto program, right?

It’s not like people are coming to you specifically for keto necessarily. So, how is that decision being made? Or maybe I’m wrong. Maybe they are? So, you tell me.

Kristian: 
It’s kind of bit of both. So, we will be, if someone comes in and has heard that, hey, you guys offer keto for mental health struggles. Then we’ll, of course, take that very serious.

Okay, hey, you’re here for that. And then, we’ll still do the evaluation, the diagnosis, and have that discussion with the psychiatrist. Does the psychiatrist also feel this is actually appropriate for the person? And then, if yes, then we’ll definitely offer that. But in case someone just comes in and isn’t primed with that idea, then we will just run the evaluation. And then, if someone is having metabolic challenges, maybe insulin resistance or other kind of markers that point that way, then our psychiatrist will make the determination that, okay, hey, we have something that could actually help you.

Are you willing to try something like this? 

Bret: 
Yeah, and I’m actually curious about your psychiatrist because you, obviously, you existed and you were a clinic before any decision to have a keto offering, and before really metabolic psychiatry had really taken off. So, for the psychiatrists that were already working with your program when the decision was made, we should look into ketogenic therapy, what was their reaction?

Were they fully on board, or were some of them skeptical? Or how’d that go? 

Kristian: 
I think at Meru, we’ve employed psychiatrists that are generally quite integrative in nature anyway because our earlier offerings. Also, it’s not like a keto diet, per se, but it already touches upon like diet and sleep and exercise and biofeedback.

So, our psychiatrists were already a little bit different than maybe the sort of like mainstream psychiatry in a way. And therefore, they were pretty open. And we’ve also had them go through various new trainings from Georgia Ede and some of the other experts in the field to just get even better, a better understanding on how do we work with these kinds of interventions?

Bret: 
That’s great. That’s great. Yeah, and at Metabolic Mind, we’re establishing a community of practice of physicians in this and of clinicians of any kind in the field. So, we’d love to have them part of it. So, we should talk about that offline when we’re done with this. 

Kristian: 
Yeah. For sure.

Bret: 
And then, the other thing you had mentioned is like the wearables and the other data. What have you found to be most impactful with those wearables that really help kind of dictate patient care, help the patients understand what they can do to improve? 

Kristian: 
Yeah. No, that’s one of my favorite topics.

So already, like years ago, we brought in HRB, heart rate variability biofeedback. So, basically, a device that’s basically a heart rate monitor. So, it’s a small device that clips on your ear or your finger to detect your pulse. And then sends that via Bluetooth to our app to an algorithm that’s like a breath, like a pacer, where you breathe with the pacer, and it gives you feedback and adjusts your breathing pace.

And what that does, and what we’ve seen it do, we’ve done a study with Harvard on that, and we also have been, like, just doing it with, tens of thousands of people already. And what we consistently see is that when people notice that actually they can control their own mental and emotional states pretty quickly with just their breath. And actually seeing the data, it’s not like that I’m thinking or just believing something or whatever. It’s actually happening, and I can see it in my nervous system.

It is adapting in real time as I’m doing these practices or this deep breathing. So, that’s something which is really cool because it then instantly shows people that you are actually much more in control than you thought. And often, the story is to people that you got to take these kind of medications, or with this label for the rest of your life. And you’re depressed.

You’re a depressed person or whatever. And then, when people start realizing that, whoa, I can actually impact this with my own actions pretty quickly, that’s really powerful. So, I think that’s one of the main kind of things that we’ve learned. Of course, just sleep tracking, other things also are very helpful when people can objectively see that, wow, my sleep is really improving.

I’m actually sleeping a lot better, a lot more than I used to. So, these are some of the most powerful things that we’re seeing. 

Bret: 
Yeah. Yeah, that’s a great point. And actually, since you mentioned medications, I need to follow up on that. We haven’t talked much about medications.

We’ve been talking about lifestyle and therapy. But is, I mean, is this a practice that also uses medications as, and all of this is, adjunctive and used together? Or is it a one versus the other? 

Kristian: 
Yeah. We also prescribe medications, when needed. So definitely, we have the capability, and there are very good reasons, and very good kind of situations where medication is needed and helpful.

it’s just not the only tool in our toolbox. It’s more so that we first want to understand what else is really going on because a lot of these people who come to us, they’ve already tried a lot of different medications. And that’s usually the challenge that they come in with, “Oh, I tried this and that and it’s just not working. So, what do we, can we do something else?”

And that’s why we don’t just instantly rush into just prescribing a yet another medication. 

Bret: 
Yeah. So, do you see patients who are first prescribed, first diagnosed with depression and never been started on anything all the way up to people with treatment-resistant serious mental illness who’ve tried everything under the sun?

You see like everybody in between? 

Kristian: 
Yes, we do. But mostly, the most like naive patients usually come into the therapy program, which is for more, a bit more, milder members. So, with our psychiatry program with Meru Advanced, we tend to see people more on the kind of higher acuity end.

So, most of these people have already been on medications or been in therapy for a long time. 

Bret: 
So, you’ve got the, what you would call, the standard Meru program, and then the Meru Advanced program, which sees the sicker patients with more comorbidities. And that’s where you get a lot more of the metabolic interventions as well.

Kristian: 
Yeah, exactly. 

Bret: 
Okay. And then what? What’s coming down the pike in the future? What other advancements or new things are you trying that we should look for in the future from Meru Health? 

Kristian: 
We’re always excited about innovating and building new cool things. So, one thing we’re working on now is just to enable broader wearable integration so that we can collect different data to understand people’s behaviors better, to better individualize care, and to also track progress better or not. Also, track if someone’s not progressing.

That’s also very important. So, that’s one thing we’re working on that we’re really excited about. And then, we’re also constantly looking and talking to people who are innovating in psychiatry and mental health care. In terms of how could we maybe better incorporate exercise, or how could we maybe prescribe exercise in a more convenient manner, or how do we just also make the user experience good?

Because it’s not the tools alone that will do it. You’ll also need to really carefully understand how do we incorporate these things into people’s lives and how do, like you also said earlier, how do we make sure that people are not overwhelmed with things? So, how do we stage things so that, hey, this comes first, and then this and then next week and next week something else?

Bret: 
All right, very good. \This has been a great discussion, and I’m so happy to hear about this integrative, really multi-modality, treatment program because I think it’s so important. And unfortunately, your brother did not have this. But just think of all the people, who could’ve been in a similar position as your brother, who might not be because of an advanced treatment program like this.

You’re really honoring his memory, and I think that’s wonderful. And I really hope this can scale up and that the system of psychiatry really understands how important this type of treatment can be and how effective it can be. So, thank you so much for all you’re doing. And thank you for joining me today.

Kristian: 
Thanks so much, Bret. Really appreciate it. 

Bret: 
I’m pretty inspired to hear about the type of treatment Kristian and his team are providing for people. And it often does take someone outside of the medical world, right? He wasn’t in psychiatry. He was in, I guess you could say, tech and diabetes, but not in the psychiatry world.

But it took this unfortunate experience with his brother to really see things and say, “What are we missing, and what can we do better?” And I love that spirit of what can we do better? How can we help more people that aren’t being helped right now? And that’s really at the spark of what Maru is, and as it continues to advance now with Maru Advanced.

And I really hope his concept that he talked about, value-based care, outcome-based care that really catches on more because that’s where you’re really providing so many benefits, not only to the health of the individual, but the finances that will make more people want to accept that.

The finances shouldn’t be a barrier to people getting better, especially when it can actually help the finances as well. But I can see how insurance companies would be hesitant without decades of data, but this outcome-based care really makes a difference. Anyway, that to me, that was inspiring what he has accomplished and the offerings they have.

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