Ketogenic Therapy: How 3 Patients Put Depression and Anxiety in Remission with Dr. Lori Calabrese

we saw depression go into remission as early as 7 weeks that's amazing that is as good as or better than any anti-depressant medicine we have that's FDA approved period Dr Lori calibra a Connecticut based psychiatrist just published a case series showing complete remission of depression and anxiety in three of her patients using ketogenic interventions so let's hear from Dr calra about these amazing results welcome to metabolic mind a nonprofit initiative of bazooki group transforming the study and treatment of mental disorders by exploring the connection between metabolism and brain health thank you for joining us on this [Music] journey Dr Lori caliy thank you so much for joining me again here at metabolic mind thank you it's a pleasure Brett yeah it was wonderful to to have you on as part of that group interview where we talked about the five patient case study of using ketogenic diet and kety for treating anorexia but now you're here because of a new publication that you have a three patient case series using ketogenic therapy to treat depression and anxiety in three of your patients and and I want to start by just saying why depression and anxiety why did you pick those as sort of the starting point for this case series well I think for two reasons um the first is that this is what we see you my work really comes out of what I do and the most common psychiatric diagnosis that we see across the board are major depression as unipolar depression in practice and anxiety as what I will call a conglomerate of anxiety disorders so generalized anxiety Panic OCD what I really wanted to Showcase and really look at is in real life patients real world patients that we see who walk in the door with a lot of different things going on these days comorbidity is the rule not the exception in real life real life people do they get better can they get better how quickly do they get better and what happens when they're very complex because in the studies published so far diagnoses have been isolated um without comorbidity um I see and we treat people who have many different things going on so what I chose to really do was highlight a real Slice of Life as I call it um and these um patients were patients all in their early 30s they each had five different p iatric diagnosis going on they all had major depression they all had generalized anxiety and then they had three at least three different other things um yeah yeah and you mentioned in the paper they all had ADHD as well and and I think that's such an important Point you're making you know randomized control trials even non-randomized intervention trials have inclusion criteria exclusion criteria whereas for a case series like this someone may say oh it's not research is not a randomized control trial but but it's the case series of the inclusion criteria being just being in the real world and and seeing a psychiatrist and that's what you see so I think it's so important to to have that evidence in addition to the randomized control trials and they they both play a role and both are so important um so so tell us about the intervention that you did with these individuals um well I think the intervention starts with an assessment right it starts with really a comprehensive diagnostic look at what someone is caring when they come in through the door so um that's what we did we started with a comprehensive psychiatric assessment a comprehensive nutritional assessment and then what I call joint feedback which is a chance for um all of us on the team to sit down with the patient um at a zoom at that point so that we're all in the room at the same time and talk about what their goals are and how to get them to those goals so these patients were patients who had all been treated before but had not responded or their treatment had stalled or they were sick of treatments that they'd been on before and they were really very interested in seeing if they could use a different kind of approach so I would say the treatments that we offer are everything that I offer not just a metabolic therapy in this so in this case the question was H would you like to see if we might try something very different to really switch up your whole brain energy the way your brain works the way it functions and see if we can get the anxiety in remission the depression in remission but to do it with food instead of with another medicine so the intervention was then yes that's what I want to do and then um it starts at yes right so it starts at getting the informed consent comparing this to everything that's what we did we obtained informed consent we reviewed all of their other options and then we did a lot of um a lot of looking at Labs at body composition at the amount of skeletal muscle at visceral fat and at all of the like really exciting things that psychiatrists don't usually order like Advanced lipid panels like insulin resistance scores like all of those things so that I could say not just did we miss anything psychiatrically but where are you metabolically because we're going to see that improve too so we did that as a start and then um working with what their preferences were um our preference actually when we're using um ketogenic metabolic therapy or met when we're doing metabolic Psychiatry is to use a very personalized um dietary intervention using whole food so not powders not mixes not keto foods not not that stuff but real food and transition people from where they are carbohydrate wise into a very low carbohydrate um diet with healthy fat with adequate protein to meet their skeletal muscle needs so that they don't lose muscle people wanted to so that they built muscle or for a couple of people in the cas series who were already exercising or wanted to get back into exercising to take all that into account and we personalized that diet and then we started starting means they start the the eating they start transitioning their food and then we really interact with them and watch them so what is that like what does that mean that means we meet with them twice a week short little meetings like 15 minutes but Zoom or in person we invite them to zoom groups where they can meet other patients we invite their families and friends to a zoom group just for families and friends and I always say it's so that like Let them fight with us instead of fight with you they don't like it they they disagree like invite the families and friends so we host a zoom group just for them we um we give them we actually give them we buy and we gave them um a meter a glucose Ketone meter because we wanted them to use and we wanted to make it easy and we wanted it to not be cost prohibitive we gave them an app so that they could take pictures on their phone and photo Journal so that we could see what they were doing and high-five them or thumbs up them or you know as they were going and then we started um offering them drop in Walking groups so we walk four times a week um half an hour 45 minutes in at beautiful sort of little nature based places um a nature preserve a wonderful park near dog park and we invited patients to come out and walk with us just to meet each other and just to move so the intervention I would love to say was the ketogenic diet because it's the main intervention but what we really wanted to do I think I really think was not just bring our team in but create a tribe because I like to say it takes a team and it takes a tribe and if you don't have a tribe at home we'll see if we can create one for you so that you feel part of a community and support it so that's what we did that's how we did it and and all that sounds wonderful I mean it sounds like such a fantastic holistic intervention to just help people in so many different ways but of course the critics would say well you have no idea if it was the diet that did the benefit or if it was the walking groups or if it was the feeling of belonging but you used a word remission you said you know you wanted to see if they wanted to put their condition into remission in your paper you said all three of them put their anxiety and their depression into remission so how often do you see in your practice without ketogenic interventions with with you know other types of interventions and therapy and medications and Community Building how often do you see remission in that setting versus in this setting where you did use a ketogenic diet not often I mean not often I've been in practice for a long time with a lot of patients that I followed over time who don't go into remission they get better but they don't fully say it's gone now it's I'm well now oh my gosh I've never felt so good before so one of the things one of the one of the really important ways that I start my um assessment is to kind of ask a question that most people say they have never been asked before and the question is when was the last time you were really at your best self for a good year top of your game when was that what were you like then what was your best self were you anxious were you do you have an irritable Edge how'd you sleep you best self and it really gets people to understand that wow over the last X number of years despite their treatments they might have improved they haven't ever gotten back to their best self and so the goal is really to get to that best self as you are now years later right with kids or family or bills or taxes doe like to just sort of see what that best self could be like so remission for me really means not just the numbers on the rating scales but it means really being able to say I am at my best self I'm functioning as well as I can give everything that I have on my plate as well as I want to be functioning boy I think that is such such an important point and I'm so glad you brought that up because we hear a time and time again that someone is treated meaning they're safe they're not in the hospital maybe they're not having suicidal thoughts so they're treated but that's very different than being your best self and really engaging in society in the way that you want to do that that is the should be the treatment goal so I'm so glad you brought that up and and that's what we've seen in all in number of anecdotal reports and now with some research showing as well that's where ketogenic interventions can be so beneficial to get people to that next stage of of their best self so tell us a little bit about the time frame that you saw in this case series of these individuals improving and getting into remission so we opened this up because these were these were our patients and we didn't know when we started offering this we didn't know how long it was going to take we didn't know what had happened in a couple days what it happened in a week like what are we really able to look at and so in part we embarked on this um treatment course with them looking at everything all the time or trying to look at everything all the time along the way and what we saw across the board was or what we let me back up what we decided a priori was that we wanted to see if response and remission correlated to serum ketones because that is what's missing in the literature you can kind of see things you might see it now some of the um current studies going on are like wonderful at doing that but in the past when you look even at case reports you couldn't find that kind of correlation or it was missing or it was urine ketones or was breath k u breath acetone um so we wanted to really say let's measure ketones and measure them every day twice a day if we can get them and start looking at rating scales individualized for the patient for generalized anxiety for phq9 for OCD and figure out at what point do they hit therapeutic ketosis that's consistent therapeutic nutritional ketosis that's consistent and then how long does it take from then to get better or to get into remission so so the timelines that we put together showed that we wanted to see like what gets better fast well you know what gets better fast anxiety well does anxiety get better fast and it's striking to it's striking to patients that their generalized anxiety gets better fast and it's striking to us I like to say that they stop calling us so that then it's not the it's not the email it's just the like ah it's like they feel so much better in terms of obsessive brooding generalized anxiety social anxiety even and guess what then they start like coming on the walks and joining the groups and depression takes a little bit longer but here's the surprising thing we saw depression go into remission as early as seven weeks that's amazing that is as good as or better than any anti-depressant medicine we have that's FDA approved period period and in one in one of the cases took a little longer and I like to say it's because some people like take a little longer they screw around a little bit they're not exactly consistent or because something else gets in the way and in this case it was just that if you delay early um screening sometimes you find out something a little bit too late that you would have fixed earlier that maybe would have helped everything earlier and so one of those you know one of those labs was something that the minute that we jumped in on and addressed and sort of got that good got that into a good place boom like remission happened like in a heartbeat you'll see that in the in the like timeline yeah I think that's amazing that depression took a little longer but still was in that 7 to 12 week period which isn't really that long I mean that's really impressive yeah and and also want to go back to something that you said before that you you checked all these things that psychiatrists don't usually check and don't usually monitor for and I mean that's on the one hand understandable because a lot of this isn't taught in Psychiatry training and residency you know metabolic Health that metabolic mental health connection the importance of measuring and monitoring metabolic health so what do you think it's going to take to change that will will case series like this and and talking about and publicizing it is that enough to start getting into the psyche of psychiatrist to make them realize they need to start changing this or what's it going to take um well I think I think what you're doing and what metabolic mind is doing is a huge First Step patients all over are talking about this you see the buzz you see the social media you see the excitement and and then when I think you know what like people patients out there adults out there sometimes adolescents are looking for this and are reaching out to say I you know like I I want to learn about this I want to do this patients will come to their doctors and they'll say I want this you know and I think that will help Drive um Physicians who don't know a lot about it to learn more about it certainly that was my certainly that was my case this was something that I came to from you know very traditional psychiatric training with psycho Farm you know um Interventional work all different kinds of things and then I realized like oh this is the coolest science out there this is something that we we should know about we should know about mitochondrial Health we should understand this we should go back and sort of figure out how we can optimize how the brain works um and we can do it with food it's like it's like you teach man to fish right and you teach a man to fish and then he can feed himself for life and so that's what's so exciting about this kind of thing and it's What's um exciting about the followup because I had a couple of responses um and emails so far saying hey are you still like do you know anything about what happened here and I said yeah because I still see all three and and so I can see like what they're doing on their own who said thanks so much we worked with you for a little while and like now we're doing this on our own but still follow me for my viance or whatever um so I see that and I see the I see the maintenance the ability to maintain and to flourish yeah that's fantastic now um now in the beginning you mentioned how everybody had you know five diagnoses coming into this to this um to to see you and you know from a drug perspective you've got one drug for mania one drug for psychosis One Drug for depression you know one drug for this and you got your little silos in your drugs but here we're talking about ketogenic therapy addresses it all which on the one hand sounds like amazing and on the other hand a skeptic would be like no it can't work that way so so how do you reconcile that that instead of one drug for everything we've got one therapy for brain health and mental health how do you reconcile that um I reconcile that by kind of going back to the science um rather than looking at drug efficacy studies so we have you know we have a lot of efficacy studies for different medicines that that were based on theories and some of those are now outdated right if we look at the science of what happens actually with brain energetics or what ketones can actually do at the level of the gut at the level of the gut microbiome at the level of intracellular health and especially in the brain well we find is that they not only affect metabolism but they they affect signaling and so Ketone bodies like beta hydroxy butyrate do something like super cool so when I dial this down and explain it what I say is they change the energy that your brain run on runs on and that allows your brain to experience so much more energy than it ever used to be able to produce and it tamps down the abnormal firing that produced Panic or obsessive thinking or explosions of anger right so it does both it elevates the the energy it Ts that down how does it do that I can show you the science so sometimes I'll show patients the science and then I'll say and it does something else really cool it can actually change the way your mitochondria work and it can turn on new genetic expression it can turn on new genes that were quiet so it changes your future why because it changes the way your mitochondria are going to be for you in the future there is nothing else that we have that does that we don't have anything else that does that so when you can do that and then you can do it for yourself and you realize what a powerful tool what happens is I see the mom then the dad comes in then the kid comes in and then everybody in the house says like show us how show us how to do this yeah I mean it is remarkable the the science behind it and then on top of that just the Improvement in metabolic health and that plays into the whole to the whole scheme of how the brain works as well so it's so impressive the the many different constellations of how it works but I guess the other push back is oh it's too hard to do especially for someone who's living with depression and or anxiety it's just going to be too hard for them to do so what did you find or what do you find in your practice about the efficacy of people being able to to start it and stick with it so that's a really common Mis perception it's the wrong belief I just spoke to someone this morning with um one of the patients that I was see and follow up who has early Parkinson's who went to her doctor and depression and she's seen me for a while and when she got diagnosed with Parkinsons and panicked she's what can I do and I said ketogenic diet now finally you've been seeing so so she went back and her doctor said oh it's so great that you're doing this and yes uh yeah and in fact you have less Tremor and yes you actually look really good and it and he said but you know I don't really talk to people about this because like it's too hard for people to do what we found is that that's actually not true and the reason it's not true that it's hard for people to do is because education opens the way to making this easy and so one of the things that we assess when we're talking to people is not just their like Readiness and interest but we assess their learning style why because some people really learn better visually they want to see a picture they want to see the food they want they want us to show them their like portions of like what's good for them in their macro ratio some people want the papers you know to the um patient with Parkinson's disease I actually sent her five different research articles on the ketogenic diet in Parkinson's right some people really just need to hear it so we have a book club so that patients can like hear from other patients as we're reading books because they don't like learn by reading they learn auditorily so I think if you think about could you do this how do you do this what do you do you have to meet people where they are and sort of teach them what might work for them in terms of the diet you have to let them adapt at a level and at a pace that they want to so some people say just tell me how just tell me what to do and other people say wait wait wait wait wait like I've got to like get my restaurant eating under control I've got to like figure it out so if you can be flexible with them to do that they'll they learn they do and then when they really feel good they say oh my gosh I'm just not yeah I just never want to go back right so yeah it seems like there's a clear divide like those people who just don't really know a lot about it or have much experience with it say it's too hard to do and those people who have really looked into it and know about it and have experience with it know that it's not too hard to do especially for the patients that see dramatic benefit and and as you know we can read in this case series these three individuals their lives are completely changed now forever and improv so dramatically so it's clear from an individual standpoint people can change their lives but what about you in your medical practice has has instituting metabolic and ketogenic therapies changed how you see your medical practice or your joy for practicing medicine oh totally totally it's changed um I I you know I have three arms to my practice and this is sort of where the future is what's happened in fact even in patients that I see with medicines in my own patients and patients that I treat with other Interventional treatments when they say what can I do to get even better what can I it's metabolic it's it just goes to metabolic so if they're appropriate and they don't have a contraindication to a metabolic therapy then this is a way to think about use this as your treatment don't do it as a diet it's not a diet it's not like a Tim limited thing it's a way to say wow you if you could sort of change your if you could change your future why wouldn't you do it like why don't you try it so no it's it's been exciting and it's been fun because actually you know we're for the first time really patients see me like in tennis shoes they've never seen me in tennis shoes like if we're out walking in the woods they see me in tennis shoes and in like you know leggings and it's a very different way of saying we live this way too we cook this way we live this way like um we can we can help you because we've you know we've seen it we're doing it well thank you so much for joining me today it's been wonderful to hear your experience and and to dig into the paper a little bit more and I know you're a very busy clinician so I know not easy to take time out to prepare a case series and submit it for publication and to take that extra step because you want to contribute to the field and contribute to the science and contribute to the literature and help others understand that this can and should be a way people you know practice and integrate in your practice so I really appreciate you taking the time for that and um where can people go if they want to kind of find out more about you and and follow what you're doing oh I think they can go to my website it's just my name loric calibra amd.com great thank you for having me oh my pleasure thanks again thank you

Channel: Metabolic Mind

Views: 10,052

Keywords: metabolic psychiatry, keto, ketogenic diet, keto for mental health, nutritional psychiatry, mental health, mental illness, bipolar, schizophrenia, depression, alternative psychiatry, metabolic health

Id: EuFhJeOf2Jc

Length: 25min 8sec (1508 seconds)

Published: Mon Jun 10 2024