Why Keto for Mental Health May Not Be Working for You – with Dr. Bret Scher

Bret:
Have you tried a keto diet to improve your mood and mental health, but found that it didn’t work or at least not as well as you had hoped? Ketosis may not have equivalent effects for everyone. Experts in this field suggest that there are a number of things that may diminish keto’s mental health impact, and addressing these issues may dramatically improve someone’s overall experience with ketosis.

So, let’s explore what those are.

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.

We’re at a challenging time when it comes to ketogenic therapy for brain-based disorders. We have personal and clinical experience that it can be a life-changing intervention for many, but maybe not for everyone, right? And research is ongoing that may help us better define for whom ketogenic therapy works best. But for now, we can lean on expert clinical experience to consider what helps ensure the optimal impact of ketosis.

But before we get into the specifics, please remember our channels for informational purposes only. We’re not providing individual or group medical or healthcare advice for establishing a provider patient relationship. Many of the interventions we discuss can have dramatic or potentially dangerous effects of done without proper supervision.

So, please consult your healthcare provider before changing your lifestyle or medications. Now, first we want to emphasize the difference between simply starting a ketogenic diet and initiating ketogenic therapy. Ketogenic therapy is a purposeful, clinician-monitored medical intervention. You can watch our prior video, which goes into more detail, but we cannot stress enough the importance of working with an experienced clinician, either a physician, dietician, therapist, or health coach, preferably someone who can help communicate with the other providers.

That’s the best starting point, and you can start with diagnosisdiet.com/directory. That’s a great place to start looking for a trained provider. So, with that as the background, let’s get started. Here are our top seven reasons why ketosis may not be having the mental health impact someone was hoping for, at least according to the experts.

So, number one, ketone levels. Now there’s still a lot to learn about what an optimal ketone level is and for whom. But many experts suggest aiming for blood levels between one and a half and three millimoles per liter, which tends to be higher than what most people achieve when using a keto diet for weight loss.

And again, this is a big reason why we recommend working with an experienced clinician, is they can help define an optimal ketone range, which is something that may change over time for each individual. And they can help with strategies to increase the ketone levels if needed. And these could include like altering the diets macronutrients, if someone’s getting too many carbs from these keto products or could the protein be too high?

And that’s important to get right because too little protein is also concerning. Or could they add MCT oil or use intermittent fasting to help safely increase ketone levels? So there are many different strategies. The key is finding the right strategy for each individual.

But the other key take home is that simply starting a keto diet and having keto levels in the 0.5 range may not produce the optimal effect for many people. All right, number two. Did someone give ketosis enough time for a clinical effect? We’ve all heard the dramatic stories of someone starting a ketogenic therapy and putting their mental health disorder into remission within a few days or weeks, and while those exist, many experienced clinicians believe they are the exception, not the rule.

Rather, they recommend giving ketosis three to four months before considering it an adequate trial. And that’s part of our definition of ketogenic therapy, that it was for a sustained time and not simply trying the diet for a few weeks. So, while there may be some immediate beneficial effects, many experts suggest three to four month trial for the maximal effects.

Number three, vitamin and nutrient deficiencies can impair someone’s ability to get into ketosis or may affect the mental health impact of ketosis. And these are varied and can include carnitine or B12, B6 or B9, also called folic acid, just to name a few. Many experts recommend checking these levels at baseline and following them over time.

In fact, a recent publication indicated over a third of patients using ketogenic therapy for epilepsy can become carnitine-deficient during their treatment course. And that’s even if they had normal levels at baseline. You can learn more about suggested laboratory workup in our dedicated video. Number four, some concurrent medical conditions may impair the effect of ketosis on mental health.

And again, these are varied but include, hypothyroidism, anemia, and others. And experienced clinicians should be able to rule these in or out with a simple blood test. Number five, alcohol and drugs. And this is a big one in psychiatry as, unfortunately, there’s a high association between having a psychiatric diagnosis and concomitant substance abuse disorder.

Many addictions may be enough to significantly lessen the beneficial effects of ketosis. So, addressing these addictions is absolute key for success. Now, fortunately, some data indicate that ketosis may even be beneficial for alcohol use disorder. So again, working with an experienced clinician can be invaluable for addressing these concerns.

Number six, medications. In Dr. Georgia Ede’s clinician training course, she goes into great detail about the impact certain psychiatric medications may have on ketosis. Some of the main ones include antipsychotics, which increase insulin-resistance and may make ketosis more challenging, or medication valproate, ketosis may actually decrease valproate levels, which can act as an unintentional taper.

Now, for some people that may be a good thing. But for others, it may take away a beneficial medication effect. And third, many stimulants for ADHD or depression may make ketosis more difficult, and there are others, too. So again, it’s important to work with a team of experts who are knowledgeable both in psychiatric medications and ketosis.

And that may not be one person, right? It may be a psychiatrist and another healthcare provider, like a coach, a dietician, or a therapist. And last, number seven, other lifestyle factors. So, sleep and stress are big ones. Someone could be doing everything right with their diet and their nutrition, their ketogenic therapy, but if they’re chronically sleep deprived or unable to manage chronic stress. Everything becomes more challenging, including seeing any beneficial effect from ketosis.

And then there’s exercise. While exercise is generally seen as healthy and beneficial, it is possible to overdo it, especially when transitioning into ketosis when your body’s still getting used to burning fat and ketones for energy rather than glucose. The key may be to start with a mild to moderate amount of exercise, and the definition of which will vary depending on someone’s starting point. But then, increase it slowly and gradually and only start increasing it once someone has already adapted to ketosis.

So, as you can see, while ketosis may have substantial mental health benefits, experts suggest that a number of factors may diminish these beneficial effects. So, it makes sense to pay attention to them and to work closely with an experienced clinical team to address it. We’ll continue to learn more from all the ongoing research. And we hope someday soon everybody who wants to can find an experienced clinician to help them on their mental health journey.

So, thank you for watching. Please share your experience with us by leaving a comment about what helped or hindered your experience with ketogenic therapy. And if you found this helpful, please share this content with anyone who, you feel may benefit. Thanks for listening to the Metabolic Mind Podcast.

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