Metabolic Ketogenic Diet and Mental Health Conditions Four

Celiac Disease as a Lesson 

You all know I have celiac disease. There’s not much to really do about that beyond replace gluten in your diet with gluten-free options. And that doesn’t really lower the long-term increased risks of lymphoma it seems, but it does allow for continued absorption of nutrients because the villi in the intestines aren’t destroyed by the immune system’s response to gluten. By far the best thing that could have ever happened for me would have been to never have contracted an intestinal infection that activated the genes on my maternal side to generate immune reactivity to gluten. Prior to that, those genes and my celiac disease were dormant. I effectively had no celiac disease and no risks of long-term complications associated with it, while it was dormant.

Given that I have celiac disease now, I have a path for living the best quality of life I can by replacing gluten in my diet with gluten-free options. I would prefer there was an option to eat gluten and not destroy my villi, because sourdough bread, but it is the reality of what treatment is available and gluten replacement is all there is.

Beyond the sourdough, all diets that restrict macronutrients in one way or another limit your length and quality of life. I would’ve had better morbidity and mortality outcomes had I never activated celiac disease.

So here’s the lesson: if you have an active eating disorder, the best scenario by far is to wrestle that condition to remission (dormancy, latency) so that you get to eat an unrestricted diet. It puts all the morbidity and mortality odds back in your favour. We are omnivores and have two energy extraction pathways (glucose and ketone bodies) because both provide unique benefits to our living system. 

However, for those who have crashed out of recovery efforts countless times; have racked up a cornucopia of prescriptions to try to manage symptoms and it’s all failing; have mounting health problems directly attributable to how progressive energy depletion harms the body; and feel like the day will never come where embracing eating whatever whenever is doable, metabolic ketogenic therapy may offer a toehold in some quality of life where nothing else has come close to date.

I would want for everyone who has had to navigate an eating disorder to be in full remission and enjoy an omnivore diet, not only because it is optimal for morbidity and mortality outcomes, but most especially because it is a joy. Everyone deserves joy.

But life and wellbeing are complicated and if you want to embark on a metabolic ketogenic diet because nothing else has worked to get that eating disorder into remission, then by all means dive into the online information, get a good medical workup to confirm you don’t have any hidden contraindications, and if you’re so inclined, tell me how it goes.

None of these decisions to find a treatment approach that works will ever be devoid of risk. We are more than the sum total of the food we consume, or don’t consume, and yet we are forever sucked into the next great diet solution for very complex chronic conditions.

I just read that Gwyneth Paltrow has undergone essentially a blood transfusion to address the ongoing complications from a Covid infection of brain fog and fatigue. It will work for a while. Unfortunately, SARS2 is a virus that takes up permanent residence in organs including the brain and a blood transfusion won’t eradicate its presence.

Maybe refractory eating disorders have an infectious agent at play. Perhaps it is one that we have long assumed was benign and that our immune system “got rid of it,” and instead it’s persistent and actually implicated in triggering and maintaining a dysregulated the threat identification system in the brain that miscasts food as the enemy. And maybe a ketogenic diet will work for a while, like a blood transfusion for Covid, or maybe it works until such time as the mythical pathogen finds a way to mutate to leverage the ketone bodies instead of glucose. I have no clue and am merely spit-balling. 

I am confident that eventually the metabolic ketogenic diet will maintain value but have an adjustment downward in expectation as the clinical trials unfold, but I am also excited to think that those who have absolutely run out of options and have zero quality of life might get tangible improvement by using it.

Twelve heavy duty prescriptions and 23 electroconvulsive therapy sessions is a life with little quality and to go from that to one prescription and having both the schizophrenia and anorexia nervosa in partial remission is not something to dismiss. Thirteen prescriptions and 24 years of active schizophrenia and anorexia nervosa to complete remission is also not something to dismiss. It is equally foolhardy to extrapolate from exceptional results in cases studies to assume that the results will automatically be replicated for all patients everywhere.

I will keep you updated over the next few years as I expect more solid trials to complete and be published on this topic.