She Cured 5 Mental Illnesses in 12 Weeks

Erin: 
Of course there are a couple of people that maybe are pushing back, and one person even said, with a conventional treatment, it’s impossible. You can’t get results like this, but then also they didn’t believe that this was true either. They said in their words that it was clinically implausible.

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.

If you have multiple psychiatric diagnoses, would you be amazed to learn that one treatment, a nutritional intervention, could put them all into remission? It’s possible. And a new case report that was recently published shows that someone with bipolar depression, with binge eating disorder with anxiety with PTSD with ADHD was able to put them all into remission with ketogenic therapy.

And I’m joined by Dr. Erin Bellamy, who’s a PhD in Psychology and from Integrative Ketogenic Research and Therapies, and she published this case report of a patient she saw with dramatic results. Now, none of this is medical advice and it may not reflect everybody’s response to ketogenic therapy, but the fact that someone could respond so profoundly really should make us all pay attention.

So here’s the interview with Erin Bellamy. Please remember that our channel is for informational purposes only. We’re not providing individual or group medical or healthcare advice or establishing a provider patient relationship. Many of the interventions we discussed can have potentially dangerous effects of 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.

Hey, Erin, welcome back. Thanks for joining me again at Metabolic Mind. 

Erin: 
Thank you so much for having me. It’s always an honor. 

Bret: 
Yeah. We had you on before to talk about your PhD thesis publication, but now about a really exciting case report that you published recently that I really want to talk about

because it sets so many different examples, right? The example of the power of ketogenic therapy, the example of the risks and shortfallings of treatment for polydiagnoses, and maybe even a whole shift in how we approach psychiatry, the transdiagnostic model as maybe a mechanism instead of a symptom.

So one case report brings up all these different concepts which you explore in your paper. So let’s talk about this case report. I mean it was pretty dramatic. One, the number of diagnoses the person was quote unquote labeled with. And two, the dramatic impact that ketogenic therapy had. So start with a little background on who this person was and how you came to work with them. 

Erin: 
Yeah, absolutely. So this was a 38 year old female who came to me back at the end of last year, and she, through my private practice, I work kind of one-to-one with people and in groups with people to help implement ketogenic therapy specifically for mental health.

So I think perhaps she had seen me with the previous conversation you and I had and reached out and she was really struggling. And previous to this conversation, I had spoken to her and said I’m to be having this chat. Is there anything that you would like to add?

And she just reminded me that she had felt really lost and broken were her words. She felt lost and broken. She had just been doing everything that she thought she should be doing and could be doing. She had multiple diagnosis. As you see, everything from PTSD ADHD, binge eating, bipolar two, depression, anxiety, and she had some physical health issues as well as a result. And some things had been working to a point but never had really reduced the symptoms for her. So she was in a really difficult place. And so she reached out, and we had a conversation about what she’d been doing. And we spoke about ketogenic therapy, and she had played around with it a little bit. She had followed an animal-based diet for a while, but really she hadn’t got the therapeutic levels of ketones. She hadn’t tried that, and she hadn’t been able to reach it. And so when we implemented it, and she followed my guidance on the program, her words, she said that it took her, I’m just looking now, from a mind shattered now restored. So she felt completely transformed. Such a short amount of time. 

Bret: 
Yeah. What was the timeframe? It was like 12 weeks, right? 

Erin: 
Yeah, 12 weeks. So the way I do things is we take some assessment, mood assessments at baseline, and then we do it again at four weeks, eight weeks of people remember, 12 weeks and really all the way up to 24 weeks, six months, that’s the duration of the program.

But by the time 12 weeks came along, she was already scoring zeros across the board and continued to do. And so there’s no point on repeatingly giving the zeros, but we can say from 12 weeks that was the first time she got the zeros across the board and has pretty much maintained that ever since.

Bret: 
Yeah. So let’s reflect on that. Zeros across the board. Let’s explain that a little bit more because you know there are these scoring systems, the PHQ-9, the GAD-7, there’s a binge eating score and they’re severe, moderate, mild, and no evidence based, no evidence of disease.

You can rate them like that, and if you get anybody into the no evidence of disease, which for some might be like below seven or below five or something, that’s amazing. But to get down to zero, to get down to zero, where there’s, and some of these are subjective and some are filled out by the patient, some are given by the clinician, but to consistently among multiple different categories have a zero. How often do you think that happens, or how remarkable is that? 

Erin: 
Yeah, it’s remarkable. Even if I look at all the other people that I work with, we usually bring people down into that normal range. So it could be zero to four on a scale is normal and they might just bob around between zero to four or might be zero to five.

They might just bob around between there over every four weeks. That’s typical. That’s incredible too. They’ve come down from severe, in some cases, and they just bob around in that normal range. But to bring it down to zero and then just to repeatedly have zeros, and then also for it to be across lots of different measures of depression, anxiety, PTSD and so on. It is remarkable.

But I think it also just goes to show that it was the one thing that she was clearly looking for, how many people are like her out there? We don’t know. That’s what we’re trying to figure out. But what it shows is that it is possible. And I was looking, I’ve had a great response from this since it came out.

But, of course, there are a couple of people that maybe are pushing back and one person even said with the conventional treatments it’s impossible. You can’t get results like this. But then also they didn’t believe that this was true either. They said, in their words, that it was clinically implausible.

I think we just need to get excited about the fact that actually it is happening for some people and, therefore, it warrants a closer look to see, well what is going on? You know, what is it? Is it the ketones? What is it that’s doing this? That’s, of course, what Metabolic Mind and the researchers are working on right now. 

Bret: 
I think that’s well said, that it deserves a closer look. And that’s really what this is the big flashy neon sign that this is like hey, look over here, look what can be possible. Let’s dig into it more. But so sad that somebody just didn’t believe it. So it is not plausible, so sad. And especially since you published in the paper the qualitative response and the other aspects of her life that changed. It’s one thing to see a score change, but tell us some of the things she relayed about how her life has changed. 

Erin: 
Yeah, exactly, and I think that’s the importance of adding in that qualitative measurement, which I’m so mad about, to me, I say this to my clients all the time, the guests, we’re going to do the charts and we’re going to track your changes, objective measures over time. But really, I care the most about how you feel, what are you telling me about your life? Because these forms don’t pick up everything. If I don’t give you the right form, it’s not going to check

the right thing. So it, when you speak to an individual about their experience and how it’s been, you get so much more about their life. And here’s a young woman who, had put her life on hold. She wasn’t able to pursue her postgraduate or her postgraduate education.

She wanted to move into private practice, but she didn’t think she was able to. When we met, she was off work. She wasn’t in a position to maintain and keep and hold the job that she had. It was that tough. And so after just a couple of months for her to then say, I feel. It’s not that she’s bouncing off the walls with joy.

Absolutely not. It’s more that she feels that she’s able to get up in the morning and she can take on whatever the day throws at her and she knows that she will weather it and navigate it no matter what She has the words that come up often, not just from her but from other clients, are words like resilience and confidence in themselves and their ability, and also in their ability to manipulate ketones to get them where they want to feel good as well. So having that growing sense of confidence and the ability to get through the day and also know that her mood is going to stay stable as long as she ticks the boxes that are important to her with ketogenic therapy and other therapies, other metabolic therapies like sleep and so on.

She’s able to get through the day without issue, and now she has set up her private practice. Something that she thought was absolutely out of reach she’s able to do. And also just simply, as she said previously, just simply being able to show up in life as the person that that she is, she knows she is.

Bret: 
Yeah. So getting a score on a clinical scale is great, but getting your life back is really what it’s all about, and so impressive. 

Fellow mental health clinicians and healthcare providers, you now have access to a suite of free CME lectures on metabolic psychiatry and metabolic health. Each of these CME sessions provide insight on incorporating metabolic therapies for mental illnesses into your practice.

These CME sessions are approved for a MA category one credits, CNE nursing credit hours, and continuing education credit for psychologists, and they’re completely free of charge on my cme.com. Now, back to the video. 

So you mentioned the ketones. So I want to narrow down on that because you also mentioned in the paper that she had been on an animal-based diet, so essentially like a low level keto diet, but didn’t get the same effects that she got when she was in a more formalized ketogenic medical therapy with you, where her ketones got in the three to five range.

And then that seemed to make the difference. So again, a suggestion doesn’t prove it, but a certainly a strong suggestion. That the higher ketone level is what her brain needed to, reset or to heal. So tell me about that aspect. 

Erin: 
Yeah, absolutely. So for her, it did seem like those higher ketone levels are what she needed, doesn’t seem to be for everyone.

So when she was doing the animal-based approach before she came to work with me, she was getting ketones up to about 1.5-ish, but she wasn’t able to keep them there. She also, as many women do, the ketones ebb and flow with the menstrual cycle and so she had times in the month where the ketones were just so low and she really wasn’t able to get them up. And that brought with it a lot of negative symptoms.

So she really struggled to get ketones up to above 1.5. She gained a lot of weight on that diet as well. And though physically she noticed some benefits, she wasn’t getting the mental health benefits that she was after. And so when we swapped it, then I started with her on a 1.5 to 1 ketogenic ratio, and we’ve slowly moved to a 2 to 1 ratio. Once she started increasing the fat, within a couple of weeks, the difference was I could observe it and she could observe it. Very early on she was saying, I’m already feeling so much calmer. That kind of morning dread is not there. And she noticed that once she was able to get the ketones up to like high twos, threes, that’s really where she felt the symptoms subside.

Then when she came down, if she had periods of time where, especially with sugar around Christmas time, as you’ll see from the graph, when the ketones came down, her symptoms came back quite full on. And so then she’d have to bring the ketones up back up to that three, four range for her to really feel that symptom relief. You know, that higher end of the therapeutic level.

Not everybody needs to be there. I have other people who don’t need to be that high in order to get that relief, but it just shows that some people do. And she doesn’t get the benefits when she’s in the high ones, low twos. So she only gets it at the higher range, which I think is really interesting.

Bret: 
Yeah, super interesting and also shows, we often hear, maybe people get better on a keto diet just because they’re eating better and they’re cutting out the processed foods and the high carb foods and the junk, and that’s why they get better. But this sort of gives some evidence that, no, eating better can certainly help, but maybe it’s not the therapeutic arrow that really is going to make the difference.

And that’s where ketogenic therapy and really titrating those ketones up can make a difference. But as you say, it’s different for everybody, too. And that’s part of the frustrating part, right? Somebody can see amazing benefits with the ketone levels of one and some need to push it to three or four.

And that’s where we need to learn more about who’s in what camp and how to address them. 

Erin: 
Yeah. 

Bret: 
Yeah, 

Erin: 
I think it says a lot like we’ve come a long way with our research and with the clinical application, but you could read this case study and say, I just need to do that and I’m going to get those results. 

And it’s not. You don’t see the behind the scenes like the tweaking of the diet each week to move from a 1.5 to a 2 to 1 ratio. You don’t see all of the other, like the other metabolic therapies, that we bring in gradually and just her being completely a hundred percent compliant with the ketone levels and the glucose levels daily. Really just being fully committed to feeling better.

You could take this at face value and say, oh, this is great. It’s going to be easy. It’s not easy, but it’s definitely easier if you’ve got guidance and support and whatnot. But it does go to show that there is that personalization that needs to happen. And I always say, I say to people, we’re heading for the therapeutic range, if you feel better before we get there, happy days, right? You can either stay there or you can experiment and see if higher feels even better than how you feel. If we get to the therapeutic range and you don’t feel anything, we’re going to hang out there for a little while and see how you do, and then we might come back down and see if it changes.

Because you don’t want to follow a super restrictive diet if you are feeling benefits at a lower level of ketones. But then, likewise, you might need that higher range or that higher level in order to feel the relief that you need. And you might need to hang out there for a while before you truly feel that.

So again, it’s not always quick, like 12 weeks, often it can take a little bit longer as well. It’s important to mention that. 

Bret: 
Yeah, and then the other aspect of it. There’s the ketones and there’s what the diet can do to your body. But then there’s also the slippery slope of the trigger foods.

Like she was a self-admitted sugar addict and that definitely seems like it tripped her up over the holidays, like you mentioned. That’s where maybe having a stricter diet could be beneficial to really get rid of all those trigger foods and really limit the risk of that.

So I think that’s another important example. 

Erin: 
Absolutely. And she was very with things like ultra-processed food addiction and binge eating. There are phases of being in that, right? And you have to get to a point where you are open and honest with yourself about what foods take you down.

Because there might be foods that are quote unquote ketogenic that are going to take you down and you are going to end up binging on common ones. Things like cheese and nuts and heavy whipping cream. It’s not always the ultra-processed foods. Sometimes it moves or it shifts to things that are quote unquote keto.

She was very honest from the start, which is important. And she was able to notice which foods she had to remove because she was just not getting on with them, or they were causing her a lot of food noise. And as you can see from the study, she reduced the variety of foods down to just a couple of different things that she feels that she can eat safely. 

And she doesn’t get food noise. She doesn’t feel the need to binge. It’s predominantly animal-based for her. That’s what she works well on, but she feels comfortable and safe around those foods. The other thing to note is that often we talk about tracking food on an app so that you can learn about the macronutrients and so on.

It’s a very important part of the process because you need to learn how many carbs are in different foods, and you need to know how much fat and how much protein. And so in the beginning, when she was tracking it brought up, and this is quite common, it brought up a sense of wanting to restrict food because she had eating disorder history.

She had even been in hospital for some of the eating disorder behaviors and so on. And it got quite dicey and quite bad at one point. So it brought up these feelings for her. And so we had a conversation about it, and I said focus on learning or reminded her, should I say, focus on learning about the macronutrients. We’re not bothered about the calories right now. If you want to gain weight, stay the same or lose weight, we could figure that out, but we’re not, that’s not the purpose of this. We’re trying to understand macronutrients. We’re not tracking calories. It’s just the macros when you calculate them, give you the calories.

So as soon as she shifted her thinking to, oh, I am learning about macronutrients and learning how to make and create my plate, I’m not worried about calories. Once she made that shift, those feelings melted away and she was able then to get on fine with the tracking until such time as she was able to just create the meals without needing to track, which is where she is now.

Bret: 
Yeah. Such an important point that how the tracking can really teach you so much and then you won’t need it potentially as you move on. Yeah. So that’s great. Now let’s use this case example though, as like a broader example, because it’s easy to think of bipolar disorder as one thing, anxiety as one thing, binge eating as one thing. 

But no, in the real world it’s messy. And there is frequently a combination of symptoms, which will lead to multiple diagnoses. So you brought up in the paper this concept of a sort of a transdiagnostic system or focusing on mechanisms rather than symptoms. Tell me how this case helps you think about that.

Erin: 
I think it was shouting, it was shouting at me and also shouting at Nicole, who is the co-author on the paper because there are so many, or there were so many, diagnoses there. So which one were retargeting and which takes priority? And really none of them take priority. They are all as important as one another.

And after a conversation and going through the research and referring back to Dr. Chris Palmer’s paper on a transdiagnostic model, we’re reminded that actually pretty much all of these mental health conditions have shared mechanistic pathways. Things like oxidative stress, inflammation, brain glucose, hypometabolism, all of these things are shared across all of these mental health conditions and I tell people all the time, I’ve never met two people with the same diagnosis who have the same symptoms and who are acting the same. 

So it’s never made sense to me the way we practice and the way we treat. So after thinking about it and going over, or discussing, the idea of this being transdiagnostic remission across all of these diagnosis, it makes sense because what we’re doing is if we’re targeting this shared pathways, those symptoms are just, they’re all going to subside.

It doesn’t matter if the anxiety is from the PTSD or the anxiety is in with the depression. The ketones are anxiolytic, so they’re not saying we’re going to target the PTSD anxiety and not the anxiety associated with depression. They’re just anxiolytic and they’re going to reduce the anxiety.

And so I think actually this is quite important because it would be great if we would start looking at perhaps symptom clusters. We can continue to look at diagnoses for sure. But what if we also looked at cluster of symptoms, like grouping people, not by diagnosis, but their most significant or severe symptom is anxiety. And so let’s have a close look at that.

Or really it’s that morning dread and that deep depression. Let’s have a look at that. Or, maybe it’s their cognitive deficits and their inability to focus. Let’s look at that rather than sticking with the diagnosis label because there’s definitely some bleeding between the diagnosis because of those shared pathways.

Bret: 
Yeah, and if you say, let’s look at that, but you’re really saying, let’s look at a potential sort of root cause or mechanistic impact there, then that’s where ketogenic therapy can potentially be so beneficial. Because, like you said, it’s not a drug for one thing. But it’s treating mechanisms, and you list a number of them in your paper about the insulin resistance and altered glucose metabolism and neuroinflammation and that kind of goes against this concept of a very elegant, targeted pharmaceutical.

It’s almost the opposite of that, which I think, maybe is why some people are a little reticent to embrace it because just the concept is hard. I like how you highlighted that in your paper. So do you think we should be saying, let’s treat mechanisms rather than symptoms or diagnoses?

Erin: 
I think we could be guided by the mechanisms. And then treat the symptoms just because I have an issue with labels. But maybe that’s just a me thing, but I definitely have an issue. 

Bret: 
And it’s hard to assume that we know every mechanism, too. So that is absolutely fair. 

Erin: 
Yeah. And that’s why I’m saying both because I think I said this last time we were talking, like when I did my PhD, I found like 53 mechanisms of depression and then 53 ways that the ketones can counteract that. And then I was like, whoa, what am I doing? And so can you imagine if we spend at least a year on each of those, that’s 50 years just looking at those 50 mechanisms of depression and we don’t have that.

And the amount of time just to hang around and wait because people are sick, and they need the support and guidance now. So that’s why I think we’ve got fantastic researchers right now that are really working on understanding the mechanisms. And we’re doing it at the speed of light too. So that’s great because we’re getting that information in quick time. 

Then at the same time, while we’re waiting for more of those mechanisms to become visible, we can treat those the symptoms, right? The anxiety, depression, low motivation, the other thing that I say to people is when we look at those shared pathways, oxidative stress, neuro inflammation, brain hypometabolism, insulin resistance and so on, there’s about five or six that are, there’s probably more, but those are the ones that I’m very familiar with, in terms of those being shared across different diagnoses. 

And I say to people, we don’t know which one caused your mental health issue. Was it the neuroinflammation? Was it the oxidative stress? We don’t know. Was it a neurotransmitter imbalance?

We can’t actually test that. So we don’t know. We can test neurotransmitters, but we can’t test for the imbalance. So we don’t know. And you can take a drug or you do a therapy to target those. So if you go to the doctor, they’ll say, yeah, you got a neurochemical imbalance, neurotransmitter balance.

Take this medication. Then it’s does it work? Does it not? We don’t know what the cause is. And they all overlap. So the insulin resistance influences inflammation. Inflammation influences oxidative stress, throw in the medications. They all have a high metabolic price tag. So then they cause a bunch of issues, too, though they can be extremely effective in, they can be lifesaving in certain circumstances.

So then you’re just like, how are you meant to figure out what caused it? And then you have to figure out what caused it in order to treat it. But ketogenic therapy, we have research to show that ketogenic therapy improves every single one of those. And so I say to people, let’s use the ketogenic therapy now.

You can go and figure out what the root cause was, but in the meantime, the ketogenic therapy is improving your metabolic and mental health. And that’s, I think, that’s the safest way to approach it right now rather than just waiting to try and figure out what the root cause is to then find a treatment that’s very specific.

Bret: 
It makes a lot of sense. Makes a lot of sense. And, I guess another point to bring up is, I don’t mean to portray it as a ketogenic therapy or medication, one versus the other. in this particular case, she wasn’t on medications, but do you have patients you work with who use ketogenic therapy as adjunctive therapy or adjunctive treatment to their medications?

Erin: 
Yeah, absolutely. Absolutely. I do. I’ve got a bit of a mix of everyone. And some people find that the ketogenic therapy. Enough so they get the support of a psychiatrist, and then the psychiatrist supports them to taper down. Sometimes people come off the medication altogether and they maintain ketogenic therapy and are very strict with it.

Other people will lower the medication. But keep a low level of medication, at the same time, as having the ketogenic therapy, so that they’ve got a little bit of peace of mind. The medication is still doing what they believe it’s doing for them. Maybe it’s keeping the hallucinations, delusions down.

Maybe it’s keeping their mood stable and and then other people have already come off medication previously with the support of psychiatrist, but they are not feeling good. And then they’ve used ketogenic therapy, which has then helped to improve their symptoms. So I’m very much on the same page as you.

It can be done at the same time as using medication, and ketogenic therapy will often offset a lot of the metabolic complications that come with taking some of the medications, for example, if you’re taking Olanzapine and Olanzapine, you’re gaining weight as a result using ketogenic therapy that can help to bring the weight down.

And then at the same time, you get the benefits from the Olanzapine if you feel like you’re benefiting from it. So if they can definitely be working together, but ultimately some people do want to see if they are able to reduce their medication and use the ketogenic therapy as their main therapy. 

And so you know that is possible for some people, but may not be possible for everyone. And that’s okay because we’re not here to say that ketogenic therapy is the standalone number one thing that’s going to do it for you. It might be in this case that I’ve presented, but for other people, it’s a combination.

It’s usually ketogenic therapy, other metabolic therapies, good sleep, hygiene, morning light movement, connection with ketogenic therapy as the foundation, and then with the other things added in. And that’s more so what it looks like. 

Bret: 
Yeah. Yeah, so such a great way to just summarize what this individual case report brings up so many different topics, so many different considerations, but like you said, something that should get everybody’s attention to have them looking into it further, considering it if they’re a clinician, and certainly saying, how can I learn more about this if I’m a researcher and a patient. 

So I want to thank you for taking the time to publish it. I know busy clinicians to take time to research and write is very challenging and for your patient to be willing to share her story with the world. So thank you very much. And if people want to learn more about you and all the work you’re doing, where can we send them?

Erin: 
Yeah, you can find me, you can just put my name into Google and I’ll pop up, but you can also find me at ikrt.org. That is the name of my private practice, and I not only work with people, 1-on-1 and in groups, but also work with, training clinicians and open to research collaborations as well.

So anybody can feel free to reach out to me and to contact me if they need guidance support or they want to collaborate in some way. That would be great. Perfect. 

Bret: 
Thank you so much. 

Erin: 
Thank you so much. Thanks. Speak to you soon. 

Bret: 
Thanks for listening to the Metabolic Mind Podcast. If you found this episode helpful, please leave a rating and comment as we’d love to hear from you.

And please click the subscribe button so you won’t miss any of our future episodes. And you can see full video episodes on our YouTube page at Metabolic Mind. Lastly, if you know someone who may benefit from this information, please share it as our goal is to spread this information to help as many people as possible.

Thanks again for listening, and we’ll see you here next time at The Metabolic Mind Podcast.