Metabolic Ketogenic Diet and Mental Health Conditions Two
Lauren’s N=1
If you have a history of psychosis, or have someone in your family with a history of psychosis, I wholeheartedly recommend Lauren Kennedy West’s entire YouTube Channel. If you know nothing of psychosis at all, I also highly recommend her channel.
She has not had an easy time of it shifting to a metabolic ketogenic life and most of the difficulty involves others with psychosis conditions and their families getting very upset at her. Much of the intense negative response comes, unsurprisingly, from a space of unintegrated levels of fear and strong reactions to the threat a new treatment poses to the dogma that defines current understanding of how best to treat schizophrenia.
As someone who has more of a professional preoccupation with her experience, as I worked in the forensic psychiatric and tertiary mental health care system for a while, her anecdotal first-person journey is wonderful and truly transformative.
She would be the first person to agree with the limitations that I would flag having watched her journey from anti-psychotic drug cocktails and periodic involuntary or voluntary inpatient admissions, to an extremely-well-managed chronic condition kept in remission through very close adherence to dietary options and targeted supplementation use. They are:
First of all, there is the cost. Even here in Canada with our universal healthcare, nothing to do with supplements is covered and the supplementation regime for positive long term health outcomes while on this diet is expensive. A meat-heavy diet is also very costly in our countries today as well. Secondly, access to the foods that can maintain a ketogenic state all year involves living in highly industrialized wealthy countries. Thirdly, sufficient food intake in circumstances where options might be limited (travel, visiting family or friends, etc.) could lead to insufficient energy intake. And finally, there are the complicated ways in which long term adherence might be compromised: a crisis, a loss, an unforeseen change in financial circumstances, and just the challenge of feeling connected to the reason for adhering to the diet when recollections of the misery of living before the diet fade from your own memory over time.
Importantly, Lauren is making an informed decision weighing up the risks and benefits of being on the diet vs. the risks and benefits of not being on it. The severity of her symptoms, the long-term serious health implications of the antipsychotic medications she was on, the brittleness and fragility of her mental state despite antipsychotic medications were all sufficiently severe that it merited taking the risks associated with such a restrictive diet. For her.
She is not cured. She is in full remission. And as with those with eating disorders, being in full remission does not mean that a relapse is never on the horizon. Also, as far as I know, she does not have the pull of a history of an eating disorder that would veer her into a space of progressive restriction and damage.
Beyond this heartening n=1 experience, the clinical evidence is at case reports and small trials for suggesting this diet is suitable for kicking the psychosis spectrum disorders into remission and allowing patients to taper carefully off of antipsychotic medication (that entire drug class is metabolically damaging on the body as well [1]). It’s early days. For example, what could happen is that case reports and small trials that show tremendous benefit in using this diet are somehow not realized when a broader population with psychosis is included in larger studies over longer periods of time. It’s possible that there is an accidental subpopulation that is highly responsive to the diet but, for unknown reasons, that response cannot be realized for everyone with the condition.
Given the long history and evidence for using this diet for refractory epilepsy and that the mechanisms of ketosis are well understood in relation to neural function, it’s more likely that the evidence will mount for supporting this diet’s use in the treatment of psychosis spectrum conditions. It’s also helpful that both the short term and long term health risks of using this diet are well understood thanks to its multi-decade use for the treatment of refractory epilepsy and that knowledge can be directly applied to mitigate the risks for those seeking to use the diet for psychosis.
Metabolic Ketogenic Therapy and Eating Disorders
It’s why we are here right? What does all this promising data on metabolic ketogenic therapy have in store for many other kinds of conditions all clustered in the mental health arena?
As you know, I find it most useful to frame eating disorders as being closely related to phobias under the very wide umbrella of anxiety disorders. The misidentification of food as a threat in all eating disorders generates avoidance behaviours that closely mimic what we see for those dealing with phobias and obsessive-compulsive behaviours. It is also why exposure and response prevention therapy has good evidence to support its use for eating disorder treatment. [2]
I prefer to investigate the value of metabolic ketogenesis with anxiety disorders, because much of the research on its use for eating disorders is all about weight loss and “binge cessation” and these things have less than nothing to do with the actual neurological misidentification of food as a threat in the brain’s threat identification system.
Part 3 April 10.
Pillinger T, McCutcheon RA, Vano L, Mizuno Y, Arumuham A, Hindley G, Beck K, Natesan S, Efthimiou O, Cipriani A, Howes OD. Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: a systematic review and network meta-analysis. The Lancet Psychiatry. 2020 Jan 1;7(1):64-77./
Russell H, Aouad P, Le A, Marks P, Maloney D, Touyz S, Maguire S. Psychotherapies for eating disorders: findings from a rapid review. Journal of eating disorders. 2023 Oct 4;11(1):175.
