Letter to the Editor Regarding the April 2 news article: “High-fat keto diet may help people with serious mental illness”
As an advocate for Metabolic Psychiatry, I was thrilled to read coverage of Dr. Shebani Sethi’s Pilot Trial to investigate the effects of the ketogenic diet on bipolar disorder and schizophrenia.
It’s painful but important to keep in mind that many with schizophrenia and bipolar disorder are disabled by their illnesses and take their lives at significantly higher rates than the general population. According to the Schizophrenia International Research Society, 1 in 58 individuals with a schizophrenia spectrum disorder dies by suicide. A 2019 Medicine article reports that suicide risk among those with bipolar disorder is, on average, 20 times higher than the general population’s.
Stigma interferes with connection. Patients with schizophrenia or bipolar have not been rallied around the way, say, cancer patients (thankfully) are now. We tend to respond with unconscious pity toward the illness or death of those with ‘serious mental illness’. What else can we do?
While psychiatry has progressed from trepanning and lobotomies, treatments still carry risks. Today’s most powerful and readily accessible therapies are pharmaceuticals. They can be lifesaving, but typically come with side effects, including cognitive dulling, tardive dyskinesia, anhedonia, akathisia, sexual dysfunction, sleep disturbances, anxiety, psychosis, and suicidality. Faced with patients’ debilitating symptoms on the one hand and medications with hard-to-predict results on the other, doctors have done their best – often prescribing meds off-label, in untested combinations, and adding meds to treat side effects. What else can they do?
As the article and Dr. Sethi’s report explain, a common risk of meds is metabolic dysfunction, which leads to obesity, Type II Diabetes, heart disease, and stroke. According to Dr. Sethi’s pioneering work, and that of her colleagues, Dr. Georgia Ede, Dr. Chris Palmer, and others, metabolic dysfunction also causes symptoms of mental illness.
This is why metabolic interventions, like the ketogenic diet, as treatments for serious mental illness, even in combination with medications - which achieved 100% remission for fully adherent participants in the study – are so exciting.
As Dr. Sethi and her colleagues have each demonstrated in their own way, at the intersection of healthy brain function and diet is not so much nutrition as metabolism. Nutrition is important, but metabolism: converting nutrients and light into energy (Brain Energy!), is the crux.
And the promise.
Keeping in mind the gravity of schizophrenia and bipolar disorder, we would do well:
To note that ‘side effects of switching’ to keto can be ameliorated and are temporary
To look beyond social media influencers who are not metabolic experts and even beyond the AHA, which is slow to follow the science about dietary cholesterol, and
To look to general metabolic health practitioners and scientists as our ‘other experts’, such as: Dr. Eric Westman at Duke, and Dave Feldman, founder of cholesterolcode.com regarding the Lipid Energy Model, described here://www.youtube.com/watch?v=pl7t5-tWMG0)
Most importantly, we do well to listen to those with lived experience. One participant in Dr. Sethi’s study said this regarding keto as a metabolic therapy: ‘It can honestly save a lot of lives; it saved mine... '
I see no need to temper my enthusiasm.
Thank you for covering Dr. Sethi’s study, and please continue to delve more deeply into metabolic health.
Sincerely,
Julie King
