Is the Ketogenic Diet Effective in Treating Schizophrenia? | with Dr. Chris Palmer

I'm sure you've heard by now the buzz around the ketogenic diet as a potential intervention in the treatment of schizophrenia today we are going to be joined by Dr Chris Palmer who will share more about the science behind this and why ketogenic diet may be an effective intervention for schizophrenia Dr Palmer is a board-certified psychiatrist and an assistant professor of Psychiatry at Harvard Medical School he is also the director of the Department of postgraduate and continuing education at McLean University Dr Palmer recently published his book Brain energy which I would really recommend you check out we will post a link to it in the description below as well as other books that Dr Palmer mentions in this video alright so I'm joined Again by Dr Chris Palmer so excited to have you here talking with us today thank you for joining us thank you for having me on so in this video so in the last video we kind of went over the metabolic component of mental illness and that part of your theory and whatnot and so in this video we're going to dive more into whether the ketogenic diet is an effective treatment for schizophrenia specifically so can you maybe just start off by telling us what exactly the ketogenic diet is so the ketogenic diet although most people know it as a weight loss diet and they a lot of people probably think of it as a fad diet some people might think of it as a dangerous diet I want to point out the ketogenic diet is actually a 100 year old evidence-based treatment for epilepsy it can stop seizures even when medications fail to stop seizures it is also an evidence-based treatment for weight loss we have dozens of randomized controlled trials documenting its safety and Effectiveness for weight loss and it's also an effective treatment for type 2 diabetes we've got lots of randomized controlled trials showing that it can help reduce blood sugars help reduce hemoglobin A1c so what is it in Practical terms it's a diet that's low in carbohydrates moderate and protein and usually high in fat and that last part I'm going to modify because if the person is overweight or obese we may not need it to be a high fat diet we might simply be able to do a low carbohydrate diet and for somebody who has a lot of fat storage on their body it that will be ketogenic on its own so a low carbohydrate diet can be ketogenic but if that person then loses a lot of that weight they may need to add more fat to their diet in order to keep it a ketogenic diet right so do you recommend the ketogenic diet to patients with schizophrenia so I am using the ketogenic diet as a treatment tool in people with schizophrenia absolutely okay and so how long I guess in the last video you mentioned roughly two to four months is that common for people who are living with schizophrenia in terms of how long to be on the ketogenic diet before they start feeling uh alleviation of symptoms or Improvement in mental health yes so the the typical time course that I see is I I usually tell people that I want them to try the diet for at least three months um when we start the diet that first week or two I'm gonna be worried about symptoms getting worse so I'm gonna really warn them I'm gonna educate them I'm going to help them through those symptoms and we're going to manage those in a safe way insomnia for instance is a really common side effect of this keto adaptation and um and as most of you probably know people with schizophrenia or bipolar disorder if they go without sleep their symptoms can actually get worse pretty quickly so that can be a really dangerous side effect um usually within a couple weeks we I started to see an antidepressant effect but usually about two to four months is what it takes to start to see an anti-psychotic effect and then that can build over time people can become even less symptomatic so it's not that you get all of the benefits at two to four months but usually within two to four months we start to see an antipsychotic effect and if we're not seeing it then I don't know that I would ask the person to continue the intervention okay that makes sense um so I had mentioned in the previous video that I had tried the ketogenic diet briefly and you know I you also mentioned that it's it's it was seen as kind of fringe science for a long time the ketogenic diet as a mental health intervention and so you know I had my own skepticism around it and whatnot but um could you maybe tell us what some of the studies that exist are that show or don't show evidence of the effectiveness of the ketogenic diet in treating schizophrenia so so if I can take a quick step back we've got lots of evidence of the ketogenic diet for epilepsy and in fact we have two Cochrane reviews which are the kind of the gold standard meta-analyzes in the medical field showing that this diet is more effective than treatment as usual in treatment resistant epilepsy for schizophrenia the the research is new although we have at least five clinical trials underway already um so lots of research coming down the pipeline but what we've got right now is that um you know actually way back in 1965 there was a pilot study of the ketogenic diet for schizophrenia in 10 women with schizophrenia who are hospitalized and the researchers reported that the diet seemed to improve symptoms of schizophrenia in those 10 women nobody picked up on that nobody really followed through with it I think they thought oh no diet it's hard to do and and we were developing more antipsychotics you know shortly thereafter so I think people were just on the psychopharmacology revolution so it kind of got lost we've had several case reports now uh I published a few of them of the ketogenic diet um for schizophrenia improving symptoms one of the cases was really important because what I showed was on off a fact so in two patients with schizoaffective disorder when they were on the diet their symptoms got dramatically better both of them cheated on the diet several times though when they cheated on the diet their symptoms would come back with a vengeance almost like they stopped an antipsychotic medication right symptoms can come back with a vengeance and then when they went back on the diet their symptoms got better again and then if they stopped the diet again they got worse again so there was this on off effect suggesting that the ketogenic diet is in fact like a medication the two heartening studies were two patients who have achieved long-term remission of schizophrenia symptoms off antipsychotic medications one of them was actually 70 years old when she first started the diet she had suffered from schizophrenia for 53 years she ended up trying the diet really as a weight loss intervention what are symptoms of schizophrenia into remission she ended up getting off all antipsychotic and psychotropic medications altogether and was actually stable for 15 more years wow unfortunately she passed away at the age of 85. um of covered pneumonia the keto diet did not kill her she she lost 150 pounds through all of this put her illness into remission was out of hospitals everything the largest study that we've got right now is we a French hospital tried the ketogenic diet in 31 patients with treatment resistant mental illness and the patients had different diagnoses so some had chronic depression others had bipolar disorder and others had schizophrenia of those 31 patients 28 were able to do the diet so off out of the gate 10 weren't able to do this diet and I just need to mention that and be clear about that but of the 28 patients who were able to do the diet 100 of them got at least some improvement in their symptoms 46 achieved remission of illness and these are people with treatment resistant disorders so 28 of 28 patients 46 achieved your mission 64 percent of the patients were discharged unless medicine than they went into the hospital on and so it wasn't that we were increasing meds or even keeping meds stable that a lot of them were actually able to decrease their meds and have symptom Improvement but as I so as I said right now we've got at least five controlled trials underway of the ketogenic diet for bipolar disorder schizoaffective disorder and or schizophrenia great so that what you mentioned about the meds kind of leads me to my next question where you know a lovely goal that I hold for myself is to eventually get off of psychiatric medications and so you know you mentioned a few people but have you found that people with schizophrenia who use the ketogenic diet have been generally able to reduce or even get off their medications or you know our medications still necessary in the treatment you know a lot so I usually keep medications the same when I'm starting the diet because I want to make sure of two things one I want to make sure the person can actually do the diet and stick with it right because if they can't do it then they can't do the treatment and then there's no point in trying to change their meds and the second thing is that I want to I want to see if the diet at least starts to change symptoms so I want it to see at least some improvement in symptoms I don't expect full remission but if by that two to four month Mark I'm starting to see some symptom reduction I'll usually have them stay on the diet for maybe another month or so and then I do start to slowly but surely reduce the medications here's one of the reasons the medications that we prescribe can cause metabolic impairment that's not news to any of you it can they can cause weight gain they can cause type 2 diabetes they can increase your risk factors for cardiovascular disease and those things are working against what we're trying to do with the ketogenic diet so in some ways some of the medications can actually interfere with the full benefits of the diet right but as as you probably hopefully already know getting off meds is very difficult can be dangerous it needs to be done with medical supervision it needs to be done in a very slow gradual Safe Way but when people do that those are actually the people that have the highest likelihood in my experience of achieving a full lasting remission the ones who actually eventually get off all their meds and stay on the keto diet for a while I usually have them throw in exercise I have them do everything they can to improve their metabolic health and those are the people who get the full and Lasting remission right so I guess I'm just kind of you know I've never heard a psychiatrist really talk like this where you know the ideal is to not be using psychiatric medication but to be using other interventions such as diet and whatnot and so I just wonder you know as a psychiatrist how do you kind of balance the current views of using medication and whatnot with this new more holistic perspective you know so I've I've recognized long ago in my career that some patients had adverse effects to psychiatric medications that just like any medication an antibiotic can cause adverse effects in some people and even though antibiotics can be life-saving for others for some people at least a minority of patients maybe they're not the best thing so I have spent a lot of my career trying to balance the pros and cons of medications for different people and if medications are improving symptoms improving quality of life reducing suffering reducing dangerousness I'm all for them 100 but when I see people chronically tormented by symptoms not really getting better disabled not able to work not able to function in society in ways that they want to and they're taking meds and the meds seem to just be causing side effects causing weight gain and pre-diabetes and diabetes I have long been an advocate for well let's maybe see if there's another way because this path isn't really working out too well anyway right um what I now know with the science is that I'm convinced that sometimes at least some medications might actually prevent this full recovery what's it like for me as a psychiatrist again on one hand when I'm able to help patients and see them fully heal and recover I have people in tears I mean tears of joy I I'm approached by their family members who are also like just like oh my I mean they say things like you've saved our life you've saved you've you've completely changed my life so that is obviously heartwarming it makes me feel good I'm I'm grateful that I could help them and at the same time I'm heartbroken by the thousands of other people who are reaching out to me begging me to treat them who can't find a clinician who understands this or agrees with this or will even give the person a chance at this it's heartbreaking it's frustrating for me and again it's not because I feel like I'm taking some wild specular speculative leap I feel like I'm putting together established science in a concrete logical way that leads to entirely new ways to think about and treat these illnesses the most heartening thing is knowing that schizophrenia does not have to be a lifelong chronic disorder that people can heal and recover from it and you know I'll go ahead and disclose my kind of some of my personal interest in this my mother had a chronic psychotic disorder and it ruined her life and she developed it in middle age and at Fort age 42 and so I saw her before and after and it absolutely ruined her life and she never got better from it and when I think about like how could her life have been different if we knew this then if I knew how to help her if the medical field knew how to help her I think I when I think about how her life could have been so dramatically better than it was when I think about how that impacted me and all of my family I mean it kind of devastated our family and I talked to people every day who are equally devastated people suffering and their family members who are desperate to find new Solutions it you know I'm out there fighting I'm out there advocating I'm trying to educate I'm trying to change and on one hand it's inspiring and motivating and I'm I'm gonna keep going and at times it's it's heartbreaking because I get people who actually say my son is dying they have him on 10 medicines he's in a state hospital he can barely get out of bed you have to help he doesn't have forever he doesn't have 15 years for all these studies to get done he needs help today I want to somehow get through to the clinicians taking care of that man so that so that they know at least there's another possible solution right thank you very much for sharing your personal experience with it as well it helps to know that you can empathize on another level with the patients that you're helping um so I guess my next question would be how would you recommend someone with schizophrenia go about trying out the ketogenic diet as a means of managing their illness you know you've you've said you very much recommend them doing it under the supervision of a practitioner so that of course but is there any other steps someone should take before they try it out so the the first thing that I'm going to say is that your practitioners probably is going to think you're crazy you're crazy or does Chris Palmer person is crazy how dare he put nonsense in your head um how dare he fill you with false hope um so I'm first step is if you can read the book please read the book because I want you to be educated I want you to be knowledgeable I want you to have all the information you can get it from a library I'm not selling a book I don't care that from a library somehow get the information but it is a science book and it's not super easy to understand all of it so some people may if if you're not into science or if your symptoms are preventing you from Reading much of anything and you can't focus I I I know I know this well because I have patience all the time who tell me I can't read the voices distract me I can't pay attention I can't remember what I read then I want you to at least go to a website all free brain energy.com we're working on establishing resources for you so that like we're gonna put together a one-page handout that you can take to your psychiatrist or mental health professional that's going to outline all of this science in a very nutshell it's going to give some of the academic research articles so you as a non-medical professional won't care about them you won't be able to understand them that's okay it's like reading a different language that's all right but the healthcare practitioner it will get credibility with a healthcare practitioner so that the healthcare although this looks legit and oh these are published and really highly reputable journals and oh maybe I need to listen to this or find out a little more and if you can convince your mental health professional to work with you on this then more than likely that person doesn't know anything about the ketogenic diet unfortunately so you can you could either you could work with a dietitian um and that's the best way but the tragic news is insurance won't cover it right now so Insurance isn't going to pay for this dietitian so if you can afford a dietitian that is the easiest best strategy if you can't I will recommend a book ketogenic therapies by Eric kosov k-o-s-s-off that is a guidebook of the ketogenic diet for brain disorders primarily epilepsy but we're using it in the same way we're using this as a brain treatment and so I want you to get that keto information there are lots of Keto doctors and books and websites that all sorts of misinformation out there so I really want you to have access to the medical version of this diet where we're using this diet for brain is a brain treatment because that's what you're going to be using it for and if you can put those two things together so now you've got kind of accurate good information on the ketogenic diet and how to do it then you've got your mental health professional on board figure out a start to update figure out like when's a good time to get this going if you can if you can enlist friends or family to help you that can go a long way even just one friend or a family member somebody who's gonna support you through this if they are willing to do it with you even better they don't have to necessarily do it with you they just need to know that you're doing this you're doing this as a brain treatment it's really important and they're going to be there to support you they're going to be there so when you're tempted to cheat they're gonna be like no no this is part of your treatment don't give in don't have the bread um or they're gonna help they're just gonna encourage you motivate you like you're doing it yay keep it up um that can go a long way and then as I said make a commitment I'm going to do this for at least three months and then see what happens and because it you may not notice Improvement in symptoms right away I can already tell you the first week or two you're gonna feel like there's no way I can do this diet forever oh my God this is horrible this is the worst diet ever I want my bread and ice cream and everything else that's the way it's gonna feel if you can actually get through three months three or four months you start to lose those cravings and if your symptoms start to go away it starts to become a no-brainer that's when my patients are saying why would I ever like I remember loving all that food and wouldn't that be nice to be able to eat it but I can't go back to being tormented by hallucinations and delusions I'm done with those like this this new way of eating is like I've got a new brain this is great so for those of you watching we will link in the description to the books that Dr Palmer recommended but I guess do you have any practical information or practical tips in terms of what to adhere to around macros in terms of treating schizophrenia with the keto diet like amount of carbs someone should be consuming to be treating the medical condition so as a rule of thumb I'm I'm going to say this the the beautiful thing about this diet is that we have objective tests that will tell you whether you're doing it right or not you can measure your ketones so the cheapest way to measure ketones is through these urine strips so you can buy these urine strips on Amazon or at a drugstore most drug stores have them and you basically just urinate right on the strip and then either the strip turns a certain color or not if it turns a color it will tell you how your ketones are if you can afford to get a blood Ketone monitor that is much more effective and accurate they're expensive the strips are about a dollar a piece but if you can afford to do that that's great so if you can afford a blood Ketone monitor for schizophrenia I'm gonna ask you to achieve ketones greater than 1.5 usually somewhere between 1.5 and 5. depending on the meds you're on and other factors that may or may not be easy to achieve sometimes it can be really hard to achieve but that is your goal okay blood ketones greater than 1.5 and then keep them there for three months if you can ketones will go up and down throughout the day so don't freak out if you know sometimes it's points 0.7 and other times is 1.8 close enough if you're getting above 1.5 at least every other day you're definitely in the range um and and then so how to do the diet again it really is going to depend on how much body fat you have on your body it's also going to depend on any psychiatric meds that you're taking so if you're taking something like olanzapine or which is Zyprexa or Seroquel or cetipine those increase insulin levels a lot and that means it will be harder for you to achieve ketosis so the meds are going to kind of work against the diet in a way um but as a rule of thumb what I would say is aim for 20 grams of carbs or less a day um try to if if you're not you know if you're a vegan or a vegetarian we there are actually specialized diets that we can come up with for you you can do a vegan ketogenic diet or a vegetarian ketogenic diet so those are possible I will be honest vegan keto is hard because vegan is kind of sort of hard on its own keto is hard on its own you put the two together it's kind of really hard so um so I'm not necessarily recommending vegan but if you are a vegan and you're a vegan for ethical reasons or any other reason and you say I am not going to defy that we can work with you we can get you on a vegan keto diet um but as a rule of thumb I'm going to say less than 20 grams of carbs a day try to get some vegetables in every day but you can like low carb vegetables so those are going to be things like broccoli cauliflower spinach kale salads those kind of things you're going to be able to eat eggs meat fish poultry pretty much almost as much as you want um you're gonna add some fats so like adding butter or olive oil or other things like that some people really like heavy whipping cream heavy whipping cream is a way to get in some fats in a delicious way so you can whip it up you can add vanilla you can add cocoa powder and then it turns into vanilla or chocolate if you freeze it it turns into ice cream if you put it in the refrigerator it turns into mousse it's really some people drink it straight so there are lots of things you can do with heavy whipping cream so there are tons of delicious recipes you can have sweet things Savory things normal things so all a wide range you can have Mexican dishes and Italian dishes and meat and potato potato but meat and vegetable dishes and fish and vegetable dishes so lots of different options so one of the reasons that I stopped the ketogenic diet was because I was reading a lot of things that were coming up around how it was potentially unsafe to do this diet for prolonged periods of time so I'm wondering if you can speak about this is this the case or can you speak more to why it's not it is so I firmly believe it is not um so but again it depends on what version you're doing so first and foremost if you're worried about safety you're going to work with your medical professional have them check your blood pressure check your insulin or glucose levels and check your lipids your cholesterol levels and your triglyceride levels have them check those before you start the diet because those are the things everybody's going to freak out about the keto diet is going to cause you to have a heart attack well I just told you the main risk factors for heart attacks if those things all get wildly worse on the keto diet then yeah you've got something to be concerned about but the reality is the overwhelming majority of people who do the ketogenic diet will notice their blood sugars come down their blood pressure comes down in a healthy way their triglycerides usually plummet in a very beneficial way they're HDL cholesterol which is good cholesterol will go up here's the caveat your LDL cholesterol which is supposed to be the bad cholesterol might also go up that is what your doctor might focus on and say oh your LDL cholesterol went up we got to stop this dangerous diet well so I want to tell you about a study there's a study called the virta trial or the virta clinic they are using the ketogenic diet with people who have type 2 diabetes over 300 people they've now been followed for over five years the people in that trial have a lower risk for heart attacks than when they started the trial even though they're LDL cholesterol did go up a little bit LDL cholesterol is one of many biomarkers for cardiovascular risk so just because one got slightly worse you can't ignore the fact that your blood pressure went from high blood pressure to low blood pressure you can't ignore the fact that your triglycerides which are really dangerous and not good for your cardiac health they were really high before and now they're normal or they're even kind of on the low side we should ignore those biomarkers so I would pay attention to that but as I said the virta trial is probably some of the best evidence we have people with type 2 diabetes are already at high risk for heart attacks the people in that trial who got treatment as usual had worse I had more risk for a heart attack after five years which is normal that's what we see in people with type 2 diabetes it just progressively gets worse until they have a heart attack but the people on the ketogenic diet actually had a reduction in their heart degree heart attack risk we do we do even have long-term data in the epilepsy World there are people who have done this diet for 40 years because they have maybe a rare genetic condition that causes them to seize and the ketogenic diet is the only thing that stops their seizures and so some of those people unfortunately can't stop the diet after two to five years they have to stay on it for life or just seize every day and so they make the decision well I'm not going to seize every day I'll just do this time like I'll do this diet if I can prevent seizures every day so they do that for the most part they have not been shown to have increased mortality rates um and again we've got patients it's not thousands and thousands of patients who've been on this for decades but we've got enough patients who've been on it for decades to know well it doesn't seem to be killing people right and left like everybody warn like everybody freaks out about like oh you're gonna die I'm a heart attack well no these people on it for 40 years should have died of heart attacks then and they aren't dead yet so okay well that's good to hear um so is there anyone who may have a schizophrenia Spectrum diagnosis that you maybe wouldn't recommend this intervention for you know one caveat would be somebody who is already underweight and has an eating disorder I'm it's not even that I wouldn't use the treatment for that person quite honestly because I I have used the treatment in some patients with a history of anorexia or even one person who had anorexia right um and the intervention ended up helping one woman in particular had she's one of the people who had long lasting remission of schizophrenia symptoms she had a history of an eating disorder I'll share the whole story of her her story though she was overweight when she started the diet she started the diet she ended up losing a lot of weight and then actually started to notice that she some of her symptoms of anorexia were coming back she ended up getting 30 pounds underweight you see notice like wow I have control and power like I used to be overweight and now I'm skinny and I can get even skinnier and I know how to manipulate my carbs and and she got a little a little bit of a high or power or sense of control something from that that resulted in her getting underweight she worked with her psychotherapist to talk about that like this is not okay you got to gain that weight back like let's get you to a normal healthy weight she's able to do that and able to stay at that normal healthy weight for five years plus now probably seven years now at this point and um and actually finished her Master's in Social Work works as a social worker in a clinic nobody knows that she had been diagnosed with schizophrenia for 20 years nobody knows and she in particular is not willing to be public because she has a new life she and nobody knows about her old life and um so she's an example of where this diet may need to be managed in a safe way and people who have an eating disorder or a history of eating disorders there are some people who have rare genetic metabolic disorders where they can't metabolize fat effectively usually uh usually people should know that they've got that disorder but if we're really talking about people diagnosed with schizophrenia we may not they may have an unrecognized genetic metabolic disorder that resulted in psychotic symptoms nobody ever did an appropriate medical or neurological or genetic workup and they just assumed well this is just schizophrenia and so um but you they're very rare disorders um and you almost always people know and they had failure to thrive as a child they had other symptoms as a child so if you have if you've had a long history of medical problems dating to childhood I'm regardless of what they are whether they're GI problems or failure to thrive problems or brain symptoms or anything and now your diagnosed with schizophrenia I would want you to really actually go and get just tell somebody I think it's time for a decent medical work up to just make sure I don't have some kind of a genetic thing because I'm thinking about trying this ketogenic diet and I want to make sure I don't have some rare metabolic disorder but those would all be symptoms of that person might have a genetic metabolic disorder um and it was showing itself all along right so I kind of want to wrap this up just by giving people kind of guidance on how to go about this so you mentioned like some tools that you have on your website about how to bring this as a proposition to your medical practitioner if they maybe aren't well versed in the ketogenic diet as a therapeutic intervention but if your practitioner is not familiar or able to support you with that you know how do you find adequate support you mentioned trying to find a nutritionist but if someone can't afford that what do you recommend doing in order to try to incorporate this as part of your treatment for schizophrenia let's see the most important thing that I want to say is please sign up for our newsletter brain energy.com it's free because I am being asked that exact question by hundreds of people yeah we and we are doing everything in our power to develop support groups and or clinician trainings or patient and family educational resources and so I'm really hoping that over time we're going to have a lot more of those resources to offer you but I really do have to come back to if you're on five medicines or ten medicines and you can't find a healthcare practitioner who's gonna support you in this it's really hard to do this treatment on your own because part of the treatment is not is no longer just the diet part of the treatment might be safely slowly trying to reduce some of those meds that are interfering with the full benefits of the diet so those meds you know doing the ketogenic diet while on seven medications might help you get a 50 reduction in symptoms that's great but I want you to get a remission I want your symptoms gone and that means according to the brain energy theory that means we need to start slowly but surely safely reducing these meds to help you at least have a chance at a full lasting remission and um I I can't in good conscience tell people to Wing that I can't and could conscience tell people to do that on their own because it's just so dangerous to do on your own right okay well thank you very much like thank you so so much for sharing all your knowledge and expertise in this video and in the last video I know I learned a ton and it was really really wonderful having you with us on the channel thank you thank you Lauren for having me so a really big thank you again to Dr Palmer for joining us in today's interview I know I learned a lot from him today and I hope that you as the audience did as well just a reminder to check out his book Brain energy which we will link to in the description below as well as the other books that Dr Palmer mentioned and recommended in the video today I would love to hear from you our audience as well do you have experience trying the ketogenic diet as an intervention for schizophrenia please share with us in the comments below we would love to hear from you thank you so much everyone and as always wishing you and your loved ones good health we'll see in the next video bye

Channel: Living Well with Schizophrenia

Views: 36,570

Keywords: schizophrenia, schizoaffective, schizoaffective disorder, mental health, mental illness, metabolic disorder, metabolism, metabolic health, brain energy, chris palmer, dr. chris palmer, brain energy theory, keto, ketogenic diet

Id: ej8MvCdg4NE

Length: 40min 53sec (2453 seconds)

Published: Sat Feb 25 2023