AnorExit: A new Treatment Model for Anorexia

Bret: 
Welcome to the Metabolic Mind Podcast. I’m your host, Dr. Bret Scher. Metabolic Mind is a nonprofit 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.

Welcome back to Metabolic Mind, a nonprofit initiative of Baszucki Group. I’m your host, Dr. Bret Scher. Today, I am joined again by Denise Potter, registered dietician and ketogenic therapy specialist, and we’re going to talk about an exciting new venture she’s involved in with Caroline Beckwith, who’s someone we’ve also had on our Metabolic Mind podcast and videos.

And what their venture is called AnorExit, A-N-O-R-E-X-I-T, and you can find it at anorexic.com. And it’s specifically a brand new program looking to help people with anorexia and looking to treat them with nutritional ketosis through a ketogenic diet in a very closely supervised and carefully guided manner to see if they can improve their symptoms or even put their anorexia into remission, as Caroline herself did.

Now, if you haven’t heard the interview with Caroline, I suggest you go back and do it because it’s a very powerful interview that we have on our podcast and our YouTube channel, as well as a few other videos about the case studies, the five patient case study that was published, and a soon-to-be performed study by Dr. Guido Frank.

All of this information is really starting to come together about nutritional ketosis for anorexia, and now we have this exciting new program that people can benefit from. That’s what I’m going to talk to Denise about today. But again, please remember that nutritional ketosis is not an approved therapy for anorexia. It is currently being studied, and we do not recommend anybody try on their own. This has to be done in a carefully supervised environment with experts and with your providing physician.

And that’s one thing you’ll hear Denise talk about that this really is a team effort with the providing physicians. And also, please remember, our channels for informational purposes only. We’re not providing group or individual healthcare or medical advice. Many of the interventions we talk about can be potentially very dangerous, if done without proper supervision. So please, always consult your healthcare provider before changing your lifestyle or your medications. But now, with all that as the long intro, let’s get into this brief interview with Denise Potter to hear more about what she’s up to.

Denise, I really appreciate you coming back on to talk to us here at Metabolic Mind. And we’ve done a number of videos and a number of interviews about this concept of using nutritional ketosis as a potential treatment for anorexia, and each time I bring it up, I mention how it’s like chilling to talk about it because we’ve heard for so long that a ketogenic diet is contraindicated for eating disorders.

And it was like just accepted, that’s the way it is. And now, we’re seeing the exact opposite. So, I wanted to get a little insight from you on what you’ve seen since you’ve been in this field for a while? What you’ve seen in terms of using ketogenic therapies for eating disorders, and specifically anorexia?

Denise: 
Yeah, what’s been really exciting is a colleague of mine, Beth Zupac-Kania, has published a case study where she led someone through ketogenic therapy plus ketamine treatments. And that person has totally resolved, and that’s Caroline, who I know you’ve done an interview with. And then, they went from there and said, wow, we have enough information here to do a study.

So, they did a small study with a few participants. And they also had great success with many of these participants that went through ketogenic therapy and ketamine infusions as well. And so this kind of proof of concept here, that we are seeing some benefits, and we’re seeing things and a lot of the psychiatric conditions overlap, we know.

And with these benefits, we’re excited to see more studies ongoing. And if you feel like it’s enough proof for us to say, let’s start treating some people. Let’s very cautiously start implementing the diet in some people, that are willing and interested in this, and see where it goes. And see if we can also collect, we’re trying to collect, some loose data with the people we’re working with.

It’s not a study, but we’re also just trying to pay attention and get data so we don’t lose that information. 

Bret: 
Yeah, you hinted at working with people and collecting data. So, let’s talk about that. So, now you and Caroline have teamed up to form AnorExit. A-N-O-R-E-X-I-T.

So, I want to hear more about this, and what you’re doing. And what the structure is, who you’re looking for as potential clients ,and how you can potentially help them. 

Denise: 
Yeah, absolutely. And I want to, I’ll clarify too is that I didn’t form AnorExit. I’m working with AnorExit, but her parents, Judy and Caroline Beckwith.

Not Judy, sorry, Carl Beckwith, are the ones that formed AnorExit, and I work with them. Okay, so I just want to clarify that it’s their creation, their company. And the concept here is to provide dietician coaching for ketogenic therapies along with peer coaching, peer counseling.

But also along with that, these patients are medically managed, where they have their psychiatrist, they have their primary care physician, they have their therapist because we can’t replace any of those critical members of the team. So, all these people are on the team, and then myself, or someone on my team, which is advanced ketogenic therapies, we come alongside and provide the ketogenic part.

And then Caroline is there to provide intensive peer coaching supporting. So, she’s meeting with them twice a week. I’m meeting with them once a week. And then they have the rest of their team, which frequently involves therapy weekly and different meetings with the doctors and keeping an eye on their weights and testing their ketones.

And so it’s comprehensive. The physician part of it, those things that they bring their own team in as far as that, and then Caroline and I are providing the support that we provide. 

Bret: 
Yeah, and I really like how you laid that out, that the team approach, and we’ve said this in a number of other videos and interviews, that this isn’t something that’s proven and widely accepted that everybody can run out and do.

This is something that if someone’s going to use nutritional ketosis to treat a disorder as potentially dangerous as anorexia, that it should be done in a team approach in a very controlled environment. So, it sounds like you’ve set that up with yourself, with Caroline, and then also working with the physicians and counselors that the patient is otherwise working with.

On the one hand though, it could be like, who can do that? That’s complicated to do and how can you find, but maybe that’s how it has to start? But so, are you finding, as you’re looking for people, that this is something people are open to and interested in working as a team?

Or do you think you’ll have success in getting people to work in that type of framework? 

Denise: 
Yeah, I think people are very open to it. The current treatments for anorexia are not working great. There’s not a medication people can take. They may have some success rate with just weight regain. But with weight regain, that doesn’t correct the mental side, the emotional side, the issues that are ongoing.

And so sometimes, when they look at success, if it’s just about weight, that doesn’t mean that the person is healthy. And so, as people continue to look for what’s the next thing? And they sometimes go through numerous treatments, which happens in all these psychiatric conditions that we’re working with.

We’re seeing people have been into in-patient treatment centers sometimes numerous times, and sometimes they fail those. And if things go great and they prosper with that, great. We don’t need to replace something that works, but what we’re trying to do is provide an alternative when the current standard of care isn’t working because it just isn’t working for everybody. 

Bret: 
And I think the other important concept about the team approach, is it isn’t just change what you eat and everything magically falls into place. There are still so many other parts of your lifestyle, of your thought process, of your therapy progress, that all need to be addressed as well.

So, it truly is, ketosis may be a cornerstone of the physiologic and the metabolic changes, but so many of the other psychological changes and lifestyle changes, just getting your life back in order, so to speak, need to happen.

So, is that sort of where Caroline fits in, and she helps address those issues with the individuals?

Denise: 
Yeah, absolutely. Because where I will help with trying to, what to eat and the specifics. And how do you incorporate enough fat? And how do you keep the protein at a good level on those items? Caroline’s going to come alongside, more practically, and I try to be practical, too, but she can go on a deeper level as someone who walked through this and someone who understands what these people are feeling, and at a level I can’t understand. I don’t know if I’m forgetting your original question.

But yeah, we’re trying to tag team with that and say, yeah, here’s one aspect and then she can take it just, again, next level and have more insights then I think, not that you have to have a condition to treat a condition of course, but a peer counselor gives, againsights that we just can’t have.

And so, unless a dietician also has anorexia there, there’s just a piece that I can never understand, which is true with a lot of conditions that I treat that I don’t have. But still, this one, it’s just, there’s so much going on there internally for these people. And I can’t understand some of the ways that they behave around food.

And I can read about it. I can learn about it, but to fully grasp it, that’s where that, again, peer counselor comes in. 

Bret: 
Yeah, that’s such a great point and such a special and important role for Caroline, the role that she can play there. Now are there certain criteria for the people that you’re looking to enroll?

Do they have to be weight stable or does that not matter? Or is there a timeframe that they’re in? Give us some more of those details. 

Denise: 
That’s a really good question, and it is hard to answer because we’ve had this discussion. And there’s the question of saying, and I know like specifically with the study they did, they had a lower BMI limit that they would allow, and they wanted people stable. And I absolutely respect that.

We have to ask the question of, if someone has a low BMI when we’re not really comfortable with, if they’re being cared for by their physician? If their labs are being monitored? If they’re a willing participant, are we willing to work with them if everything else medically is safe?

Because I also have this ethical feeling of, if I’m holding a treatment that may help you, but I say, but you’re too sick with this illness for me to give you the treatment. And so it’s really, and what was really exciting to me is, I have heard wind of some other people that have done well with anorexia and keto. And I’m excited for when even more data comes out. I’ll just say this, these are things that just kind of I’ve heard, and I think that’s going to help us as people who have done well, continue to publish this data. So, we can say, wow, we’ve worked with someone with A BMI of 14 or 12 or 15, and they’ve done well because we’re putting these people into treatment of some type.

And so is this okay? But again, we have to have close management. We can’t just have them out trying to do this, perhaps doing it wrong and unsafely, and then they’re hyper bulimic or they’re purging, things could happen. And so it, so that’s terrifying, honestly, as practitioner, which is why, again, would never do it on my own as a dietician without physician support. 

Bret: 
Yeah, such an important point. And, you as like a true clinician, someone who wants to help people knowing you have a potential tool in your hand. But to then have some barriers to not be able to help somebody who needs it, just doesn’t sit well.

And I can see the way you said that. It just doesn’t sit well. And that’s when something’s new like this, right? We have to be honest, anorexic is in its early phases. You’re probably going to learn who does better, who struggles, in different enrollment criteria. But for now, it seems like you’re open to engaging just about anybody and seeing if you can do it in a safe and controlled way, then you’re willing to do it.

So, how can they find you and Caroline to sign up or inquire to learn more about this? 

Denise: 
Absolutely, and before I say that, I’ll say almost anybody, I’m sure I have a line, I’m sure I have a line somewhere, but I’m excited to try to help people.

And I had another thought, but I just think that. Oh, I know what I was going to say. That so many of the medications that we use, and I’m not against all medications by any means, but we use a lot of medications that have a lot of critical, horrible side effects. Yet, we use them when they are needed to get to an outcome, to get to an end game, and hopefully, help somebody, cure somebody, relieve symptoms, and so on.

And so, when we look at ketogenic therapy and whether this is for anorexia, for bipolar, for epilepsy, for Parkinson’s, you name it, I want to encourage other clinicians that maybe haven’t heard of it to realize that this is a tool in their belt. And while there are a few, and although I dare say minimal side effects of ketogenic therapy, not to jump to a conclusion that, oh, that’s bad for you, and that’s a bad therapy and that’s dangerous.

Because it is much less dangerous than many medications used in these treatments for the conditions I’m talking about. And treatments just, in general, that physicians do prescribe knowing that there’s a necessity to the medication, and we’re willing to take some of these risks.

And so I’m just saying, just as a prescriber has to shoulder some of that risk, I’m willing to say there may be a risk of weight loss. There may be a risk of kidney stones, although it’s very low or a risk. Our biggest one, constipation, that’s my biggest concern anyway. So, all that to say, I think that we talked about dangers and there are potential dangers, and we want to be very careful at the same time.

I feel like there they’re not so big as we think when we’re paying attention. 

Bret: 
Makes a lot of sense. All right, so thank you for that clarification. I appreciate that. And where can people go to learn more?

Denise: 
AnorExit.com, and so it’s A-N-O-R-E-X-I-T.com and the information’s on there to learn about the program, and hey screen to evaluate, to see. And then even before they’re admitted, labs are performed before someone’s admitted to the program.

And we have a full nutritional assessment at the beginning. And then if everything, you know, looks good there, then they can be admitted to the program. 

Bret: 
I appreciate you and Caroline’s family taking this important step to provide this resource to people who really need it, and really being on the cutting edge of therapy.

And as we hear about a study from Dr. Guido Frank and more research catching up, it’s really going to be this interesting intersection of clinical experience and research coming together to see if this is a potential therapy for a lot of people. So, thank you again. I really appreciate you joining us and telling us about this exciting new opportunity.

Denise: 
Thank you, Bret. 

Bret: 
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