can a keto diet treat severe mental illness?
11 minute read
ruby urlocker poses for a photo at her home in ottawa.
tony caldwell
/
ottawa citizen/postmedia
when she was 17, ruby urlocker experienced a mental health crisis that had been building for months. she remembers running to a nearby park intent on throwing herself in front of a train. faced with an unscalable fence, she returned home, where the crisis escalated.
she ended up in hospital near her family’s mississauga home, where she was diagnosed with schizophrenia. the serious psychiatric illness affects how people think, view the world, feel, and behave. it can result in hallucinations and delusions along with disorganized thinking and behaviour. it is treatable, but there is no cure.
for urlocker, now 27, it felt like it was the end of the world.
“it doesn’t feel like an illness. it just feels like pain and suffering that doesn’t stop.”
equally terrifying to urlocker was the impact of the antipsychotic medication she was prescribed to control her symptoms. it made her feel numb and blunted. it smothered her creativity, something that made life hard to bear for the young woman who is a prolific writer as well as a painter. “i never felt happy. i never felt inspired.”
urlocker struggled in the years following her diagnosis. amid periods of stability there were periods of “horrendous instability” according to her father, mike. “it is like a bomb goes off in your house,” he says of the illness.
urlocker was in and out of hospital, on and off her medications, relationships were strained, and she lived for periods in residential treatment, including at a schizophrenia recovery program run by the royal in ottawa. for much of that time she was convinced people around her wanted to do her harm.
a few years ago, during an extended period of stability, she opted to try something new. with encouragement from family, she dramatically changed the way she ate by following a very low carbohydrate, high fat, ketogenic diet.
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the diet, if followed strictly, promotes a metabolic shift from glucose utilization to ketone production, which supports energy needs during carbohydrate restriction. the ketogenic diet lowers insulin levels and blood glucose as well as reducing inflammation.
it is associated with weight loss and diabetes management, but for more than 100 years it has also been successfully used as a medically supervised treatment for drug-resistant epilepsy, especially in children.
more recently, it has been the subject of scientific studies looking at its potential impact on mental illness, part of a broader understanding of the role that metabolism plays in some serious mental illnesses.
researchers in the burgeoning field known as metabolic psychiatry (which treats mental illness by targeting underlying metabolic dysfunctions) are beginning to see early signs that ketogenic diets might have a role to play in treating serious mental illness — but more work has to be done.
it is early days and researchers caution the evidence is not conclusive.
“we need to better understand this science, said harvard psychiatrist and researcher dr. chris palmer, a leading voice on the issue. “does it work? for whom does it work? how do we make it work?”
a selection of good fats sources for keto lifestyle include meat, smoked salmon, eggs, nut butter, nuts, avocado, broccoli, cream cheese, real butter and peanut butter protein.
stephaniefrey
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getty images/istockphoto
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when urlocker began the diet on her own, it was not part of her treatment. her mother arranged to have her meet online with a dietitian to help offer support. at first, urlocker had prepared keto meals delivered. later, she began organizing her own meals with a focus on greens and vegetables, protein and fats.
her symptoms improved to the point she was able to live her life in a way that had been virtually impossible before. soon after starting the diet, she felt a boost of energy and more clarity, and then she experienced more changes.
“i noticed within the first few weeks that i was just more socially open to people. and, then, within four weeks, it got rid of the paranoia,” she says.
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she became less focused on other people — no longer convinced they were dangerous or doing something wrong — and better able to pursue her own interests.
“it gives me responsibility, like it’s my responsibility to be happy. i’m taking life into my own hands.”
today, she lives on her own in a small, bright apartment with some of her colourful paintings on the wall. she works part-time in a wool shop, volunteers with a peer-support organization and tries to find as much time as she can for writing. she recently had a short story published in a capital mystery, an anthology of stories by ottawa mystery writers. urlocker was chosen to read her story at the book launch. she has also written a memoir.
her symptoms have markedly improved and she feels like she is in control of her life for the first time in years. “it’s been a small miracle.”
but it is also a work in progress. urlocker says she has not perfected the diet and has had setbacks. she continues to take her medication, although she has reduced it by 25 per cent under medical supervision.
urlocker believes the difference in how she feels could only be due to the keto diet.
for her father, the change has been nothing short of remarkable. but mike urlocker remains frustrated at the response of the psychiatric community, which, he says, remains skeptical.
“she lost a decade of her life and no doctor we ever met said anything about diet or keto as a treatment,” he says. “they all cross their arms and say there is not enough research.” and, yet, he says, prescribing medications for people with schizophrenia has a low success rate with numerous side-effects.
“this is the first time we ever saw something positive.” patients, he says, are desperate for something that can give them better quality of life.
while psychiatrists must follow the science when it comes to treating severe mental illness, some say they are open to learning more about keto and supporting their patients who try it. meanwhile, researchers around the world are trying to find out more about whether it works and, if so, how.
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harvard psychiatrist and researcher palmer is a pioneer in studying the use of the ketogenic diet to treat severe, treatment-resistant mental health disorders. in his book brain energy, he argues that some mental illnesses are metabolic disorders of the brain. still, he cautions there is not enough evidence to suggest that the diet can cure schizophrenia.
but, at a time when metabolic dysfunction is increasingly seen as a root cause of many chronic diseases, interest and research in keto diets to treat mental illness is exploding.
a research team at stanford university ran a pilot study looking at the impact of a ketogenic diet on serious mental health disorders with positive results. a randomized control study is underway.
stanford psychiatrist and obesity specialist dr. shebani sethi, who led a pilot study of 21 adults, has said ketogenic therapy significantly reduces inflammation in the brain, which is strongly associated with depression, anxiety, schizophrenia and bipolar disorder.
a small study in france found that a whole-food ketogenic diet was safe, feasible and associated with unprecedented improvements in mental and physical health in hospitalized patients with mental illness. the study involved 31 patients, 64 per cent of whom were eventually discharged from the hospital on lower doses of psychiatric medication.
as research into the connection between metabolism and mental illness expands rapidly, there is growing interest by patients like urlocker who are unhappy with the side-effects from antipsychotic drugs.
psychiatrists urge caution, saying ketogenic diets to treat serious mental illness should not be attempted without medical supervision, including blood tests to ensure the eating regimen is doing what is intended. some fear the effects of a keto diet could lead some patients to go off their medications. those medications, while not a cure, are life-saving. reducing or stopping them without supervision can have severe consequences, mental health professionals warn, and worsen long-term outcomes.
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dr. david attwood, the former clinical director of the schizophrenia program at ottawa’s the royal and current interim medical director for severe mental illness there, said heightened interest in new dietary treatments for schizophrenia reflected the fact that the outcomes for the debilitating mental illness had not changed much in years and that the evidence-based treatments had difficult side-effects.
“frankly, the science has let people down. despite many advances, the outcomes for schizophrenia haven’t changed much, especially with systems that focus on acute care and do not address the long term consequences of the illness,” attwood said.
he also warned about false hope and anything that might encourage patients not to stick with their evidence-based treatments, but attwood said he had patients on the keto diet and he did not discourage them from trying it, despite the fact that it could be both difficult and expensive.
“i wish them well and encourage them to stay on their treatment plan.”
dr. david attwood is the former clinical director of the schizophrenia program at the royal.
jean levac
/
ottawa citizen
he also says the royal takes a more wholistic approach to wellness, beyond whether the symptoms have stopped, to include whether patients are able to resume their lives and relationships and feel well. when he sees patients wanting to manage their diets and be active agents of change in their lives, including diet and exercise, he is encouraging.
“if someone feels better or more empowered, why would i argue?” attwood said. “the keto diet is expensive, it is very difficult to maintain true ketosis and has some undesirable effects as well. i have grown agnostic to it and other remedies over the years and have learned to do whatever it takes to maintain my relationship with the patient. if they want to try basically any treatment, as long as it’s not harmful, i see no point in arguing about it. after all, believing something will work is a decent predictor that it will work, at least for a little while, so i would not want to deprive anyone the opportunity to feel better, even if i can’t explain why. it’s a humbling illness.”
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robert f. kennedy jr., the u.s.’s vaccine-skeptical secretary of health and human services, recently shone light on the issue, though he misrepresented the science by claiming a keto diet could cure schizophrenia.
in an interview, palmer, who has become a leading voice in the study of ketogenic therapies for mental health treatment, corrected that claim.
“while i greatly appreciate secretary kennedy’s awareness for my work and apparent enthusiasm, i was a little surprised to hear him use the word ‘cure,’” palmer said. “i have never claimed to cure schizophrenia or any psychiatric disorder using any treatment, including ketogenic therapies.
“i think that is a pretty loaded and strong term and i don’t think that’s where we’re at in the field.”
still, palmer said he was “very excited and sometimes just in disbelief” about how rapidly the field of research is progressing. he stumbled on the apparent link between a ketogenic diet and mental illness by accident.
he had a patient with schizoaffective disorder (which includes a persistent mood disorder along with psychosis) who desperately wanted to lose weight and asked palmer for help. working together, they decided he should try a ketogenic diet.
the results stunned palmer.
“i just wanted to help the poor guy lose the weight. and to my complete shock and amazement not only did he start losing weight, but, within a few weeks, i noticed a powerful antidepressant effect. he was smiling more, he was talking more, he was making better eye contact in a way that i’d never seen,” palmer said.
about two months into the diet, the delusions and conspiracy theories that had been a foundation of his illness began to decrease, as did auditory hallucinations he had been experiencing.
in the decade since he started the diet, the patient lost 160 pounds and his symptoms have improved dramatically, although the diet did not cure his mental illness, palmer notes.
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he has not achieved full remission of his illness. some of his symptoms continue to wax and wane, but he is able to function in the world in a much more effective way, is able to hold a part-time job and to go out without fear that people were conspiring against him and ready to hurt him, palmer says. he remains on both his medication and the keto diet.
his is one of the case studies that have drawn attention to the use of a keto diet as a potential therapy for some mental illnesses and have helped spark more research. some patients have experienced full remission of symptoms.
palmer says he hopes the attention on the issue might mean more funding for research because there are still many questions to be answered.
he underscores his concern about the risk of people stopping their medications without medical supervision because of the diet.
“i implore patients with mental illness, regardless of the diagnosis, that, if they are taking psychotropic medications, that they work with a mental health clinician to manage those medications and to manage their illness and symptoms, and that includes using ketogenic therapy.”
dr. sean nestor, a psychiatrist at sunnybrook health sciences centre and an assistant professor at the university of toronto, is part of a research lab working in the emerging field of metabolic psychiatry. his group has received funding to study the impact of combining a keto diet with therapeutic brain stimulation for treatment-resistant depression.
research into the link between metabolism and mental health is gaining attention and could lead to new and better approaches to treating severe mental illnesses, nestor said. but there is work to be done.
ruby urlocker poses for a photo at her home in ottawa.
tony caldwell
/
postmedia
against the backdrop of preliminary research and hope, some people, like urlocker, are finding something they have long craved — a measure of stability and relief.
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she hopes there will be a profound change in the way treatment for schizophrenia is approached.
“i would like to see people being told that they have more options other than just medication for life, and you suck it up and you live with the side-effects.” the keto diet, she said, has helped improve every area of her life.
for her father, he says, “it is like ruby has come back alive.”
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