But of course, there are a couple of people that maybe are pushing back, and one person even said, with a conventional treatment, it's impossible.

You can't get results like this.

But then also, they didn't believe that this was true either.

They said, in their words, that it was clinically implausible.

Welcome to the Metabolic Mind Podcast.

I'm your host, Dr. Brett Scher.

Metabolic Mind is a nonprofit initiative of Bouzouki Group where we're providing information about the intersection of metabolic health and mental health and metabolic therapies, such as nutritional ketosis as therapies for mental illness.

Thank you for joining us.

Although our podcast is for informational purposes only and we aren't giving medical advice, we hope you will learn from our content and it will help facilitate discussions with your healthcare providers to see if you could benefit from exploring the connection between metabolic and mental health.

If you have multiple psychiatric diagnoses, would you be amazed to learn that one treatment, a nutritional intervention, could put them all into remission?

Well, it's possible.

And a new case report that was recently published shows that someone with bipolar depression, with binge eating disorder, with anxiety, with ptsd, with adhd, was able to put them all into remission with ketogenic therapy.

And I'm joined by Dr. Erin Bellamy, who's a PhD in psychology and from Integrative Ketogenic Research and Therapies.

And she published this case report of a patient she saw with dramatic, dramatic results.

Now, none of this is medical advice, and it may not reflect everybody's response to ketogenic therapy, but the fact that someone could respond so profoundly really should make us all pay attention.

So here's the interview with Erin Bellamy.

Please remember that our channel is for informational purposes only.

We're not providing individual or group medical.

Or healthcare advice or establishing a provider patient relationship.

Many of the interventions we discuss can have potentially dangerous effects if done without proper supervision.

Consult your healthcare provider before changing your lifestyle or medications.

In addition, it's important to note that people may respond differently to ketosis, and there isn't one recognized universal response.

Hey Aaron, welcome back.

Thanks for joining me again at Metabolic Mind.

Thank you so much for having me.

It's always an honor.

Yeah, we had you on before to talk about your PhD thesis publication and but now about a really exciting case report that you published recently that I really want to talk about because it sets so many different examples, right?

The example of the power of ketogenic therapy, the example of the risks and shortfallings of treatment for polydiagnoses and maybe even a whole shift in how we approach psychiatry, the, the transdiagnostic model as, you know, maybe a mechanism instead of a symptom.

So one case report brings up all these different concepts which you explore in your paper.

So let's talk about this case report.

I mean, it was pretty dramatic.

One, the number of diagnoses the person was quote unquote labeled with.

And two, the dramatic impact that ketogenic therapy had.

So start with a little background on who this person was and how you came to work with them.

Yeah, absolutely.

So this was a 38 year old female who came to me back at the end of last year and she, you know, through my private practice, I work kind of one to one with people and in groups with people to help implement ketogenic therapy specifically for mental health.

So I think perhaps she had seen me with, you know, the previous conversation you and I had had and reach out and she, she was really struggling.

And previous to this conversation, you know, I had spoken to her and said, I'm going to be having this chat.

Is there anything that you would like to add?

And she just reminded me that she had felt really lost and broken were her words.

She felt lost and broken.

She had just been doing everything that she thought she should be doing and could be doing.

She had multiple diagnoses, as you see, you know, everything from PTSD, ADHD, binge eating, bipolar 2, depression, anxiety, and she had some physical health issues as well as a result.

And you know, some things had been working to a point but never had really reduced the symptoms for her.

So she was in a really, really difficult place.

And so she reached out and we had a conversation about what she'd been doing and we spoke about ketogenic therapy.

And you know, she had played around with it a little bit.

She had followed an animal based diet for a while, but really she hadn't got the therapeutic levels of ketones, she hadn't tried that and she hadn't been able to reach it.

And so when we implemented it and she followed my guidance on the program, her words, she said that it took her.

I'm just looking now from a mind shattered, now restored.

So she felt completely transformed.

Such a short amount of time.

Yeah.

What was the time frame?

It was like 12 weeks, right?

Yeah, 12 weeks.

So the way I do things is we kind of take some assessment, mood assessments at baseline and then we do it again of four weeks, eight weeks, if people remember 12 weeks, and really all the way up to 24 weeks, six months, that's the duration of the program.

But by the time 12 weeks came along, she was already scoring zeros across the board and continue to do so.

And so there's no point on repeatingly giving the zeros.

But we can say from 12 weeks that was the first time she got the zeros across the board and has pretty much maintained that ever since.

Yeah, so let's reflect on that.

I mean, zeros across the board, let's sort of explain that a little bit more because, you know, there are these, these scoring systems, the PHQ9, the GAD7, there's a binge eating score and they're sort of like, you know, severe, moderate, mild, and no evidence based, no evidence of disease.

You can sort of rate them like that.

And if you get anybody into the no evidence of disease, which for some might be like below 7 or below 5 or something like, that's amazing.

But to get down to zero, to get down to zero, where there's, you know, and some of these are subjective and some are, you know, filled out by the patient, some are given by the clinician, but to consistently among multiple different categories have a zero.

I mean, how often do you think that happens or how remarkable is that?

Yeah, it's remarkable.

I mean, even if I look at all the other people that I work with, we usually bring people down into that normal range.

So it could be 0 to 4 on a scale is normal and they might just kind of Bob around between 0 to 4 or, you know, might be 0 to 5.

They might just bob around between there over, you know, every four weeks.

That's typical.

That's incredible too.

You know, they've come down from severe in some cases and they just kind of bob around in that normal range.

But to bring it down to zero and then just to repeatedly have zeros and then also for it to be across lots of different measures of depression, anxiety, PTSD and so on is remarkable.

But I think it also just goes to show that, you know, it was the one thing that she was clearly looking for.

You know, how many people are like her out there?

We don't know.

That's what we're trying to figure out.

But what it shows is that it is possible.

And I was looking, you know, I've had a great response from this since it came out.

But of course there are a couple of people that maybe are pushing back and one person even said, you know, with the conventional treatments it's impossible, you can't get results like this.

But then also they didn't believe that this was true.

Either they said, in their words, that it was clinically implausible.

I think we just need to get excited about the fact that actually it is happening for some people and therefore it warrants a closer look to see, well, you know, what is going on?

You know, what is it?

Is it the ketones?

What is it that's doing this?

That's, of course, you know, what Metabolic Mind and the researchers are working on right now.

I think that's well said that it deserves a closer look.

And that's really what this is.

The big flashy neon sign that this is is like, hey, look over here, look what can be possible?

Let's dig into it more.

But so sad that somebody just didn't believe it.

So it's not plausible.

I mean, so sad.

And especially since you published in the paper the qualitative response and the other aspects of her life that change.

I mean, it's one thing to see a score change, but tell us some of the things she relayed about how her life has changed.

Yeah, yeah, exactly.

And I think that's the importance of adding in that qualitative measurement, which, you know, I'm so mad about.

To me, I say this to my clients all the time, that, yes, we're going to do the charts and we're going to, you know, track your changes, objective measures over time.

But really, I care the most about how you feel.

Like, how.

What are you telling me about your life?

Because these forms don't pick up everything.

You know, if I don't give you the right form, it's not going to check the right thing.

So when you speak to an individual about their experience and how it's been, you get so much more about their life.

And so, you know, here's a young woman who, she had put her life on hold.

You know, she wasn't able to pursue her postgraduate or her postgraduate education.

She wanted to move into private practice, but she didn't think she was able to.

When we met, she was off work.

She, you know, she wasn't in a position to maintain and keep and hold the job that she had.

It was that tough.

And so after just a couple of months, for her to then say, you know, I. I feel it's not that she's bouncing off the walls with joy.

Absolutely not.

It's more that she feels that she's able to get up in the morning and she can take on whatever the day throws at her and she knows that she will weather it and navigate it no matter what.

She has the words that come up Often not just from her, but from other clients are words like resilience and confidence in themselves and their ability and also in their ability to manipulate ketones to get them where they want to feel good as well.

So having that, that growing sense of confidence and the ability to get through the day and also know that there that her mood is going to stay stable as long as she ticks the boxes, you know, that are important to her.

With ketogenic therapy and other therapies, other metabolic therapies like sleep and so on, she's able to get through the day without issue.

And now she has set up her private practice, something that she thought was absolutely out of reach.

She's able to do.

And also just simply, as she said previously, just simply being able to show up in life as the person that she is, she knows she is.

Yeah.

So getting this score on a clinical scale is great, but getting your life back is really what it's all about.

And so impressive.

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And they're completely free of charge on mycme.com now back to the video.

So you mentioned the ketones, so I want to sort of narrow down on that because you also mentioned in the paper that she had been on an animal based diet, so essentially like a low level keto diet, but didn't get the same effects that she got when she was in a more formalized ketogenic medical therapy with you, where her ketones got in the 3 to 5 range and then that seemed to make the difference.

So again, a suggestion doesn't prove it, but certainly a strong suggestion that the higher ketone level is kind of what our brain needed to, to reset or to heal.

So tell me about that aspect.

Yeah, absolutely.

So for her it did seem like those higher ketone levels are what she needed, not doesn't seem to be for everyone.

Right.

So when she was doing the animal based approach, before she came to work with me, she was getting ketones kind of up to about 1.5 ish, but she wasn't able to keep them there.

She also, as as many women do, you know, the ketones kind of ebb and flow with the menstrual cycle.

And so she had times in the month where the ketones were just so low and she really wasn't able to get them up.

And that brought with it a lot of negative symptoms.

So she really struggled to get ketones up to above 1.5.

She gained a lot of weight on, on that diet as well.

And though physically she noticed some benefits, she wasn't getting the mental health benefits that she was after.

And so when we swapped it, then I started with her on a 1.5 to 1 ketogenic ratio and we've kind of slowly moved to a two to one ratio.

Once she started increasing the fat within a couple of weeks, you know, the difference was, was I could observe it and she could observe it, you know, very early on she was saying, you know, I'm already feeling so much calmer, that kind of morning dread is not there.

And she noticed that once she was able to get the ketones up to kind of like high twos, threes, that's really where she felt the symptoms subside.

Then when she came down, if she had periods of time where, especially with sugar, around Christmas time, as you'll see from the graph, when the ketones came down, her symptoms came back quite full on.

And so then she'd have to bring the ketones up, back up to that 3, 4 range for her to really feel that symptom relief, which, you know, that higher end of the therapeutic level.

Not everybody needs to be there.

You know, I have other people who don't need to be that, that high in order to get that relief, but it just shows that some people do and she doesn't get the benefits when she's in, you know, the high ones, low twos, so she only gets it at the higher range, which I think is really interesting.

Yeah, super interesting.

And, and also shows, you know, we often hear, well, maybe people get better on a keto diet just because they're eating better and they're cutting out the, you know, the processed foods and the, and, and the high carb foods and the junk and, and that's why they get better.

But this sort of gives some evidence that, well, no, I mean, eating better can certainly help, but, but maybe it's not the therapeutic, you know, the therapeutic arrow that really is going to make the difference.

And that's where ketogenic therapy and really titrating those ketones up can make a difference.

But as you say, it's different for everybody too.

And that's part of the frustrating part, right?

Somebody can see amazing benefits with the ketone levels of one and some need to push it to three or four.

And that's where we sort of need to learn more about who, who's in what camp and how to address them.

Yeah, yeah.

I think the, you know, it says a lot like we've come a long way with our research and with the clinical application.

But you know, you could read this case study and say, I just need to do that and I'm going to get those results.

And it's not, you know, you don't see the behind the scenes like the tweaking of the diet each week to move from a 1.5 to a 2 to 1 ratio.

You know, you don't see all of the other like the other metabolic therapies that we bring in gradually and you know, just her being completely 100% compliant, you know, with the ketone levels and the glucose levels daily, really just being fully committed to feeling better.

So, you know, you could take this at face value and say, oh, this is great, it's going to be easy.

It's not easy, but it's definitely easier if you've got guidance and support and whatnot.

But it does go to show that there is that personalization that needs to happen.

And I always say, you know, I say to people, we're heading for the therapeutic range.

If you feel better before we get there, happy days.

Right.

You can either stay there or you can experiment and see if higher feels even better than how you feel.

If we get to the therapeutic range and you don't feel anything, we're going to hang out there for a little while and see how you do.

And then we might come back down and see if it changes.

Because you don't want to follow a super restrictive diet if you are feeling benefits at a lower level of ketones.

But then likewise you might need that higher range or that higher level in order to feel the relief that you need.

And you might need to hang out there for a while before you truly feel that.

So again, it's not always quick like 12 weeks, you know, often it can take a little bit longer as well.

It's important to mention that.

Yeah.

And then the other aspect of it, I mean there's the ketones and there's the what the diet can do to your body.

But then there's also sort of the slippery slope of the trigger foods like she was a self admitted sugar addict and that definitely seems like it tripped her up, you know, over the holidays like you mentioned.

So having, that's where maybe having a so called stricter diet could be beneficial to really get rid of all those trigger foods and, and really limit the risk of that.

So I think that's another important example.

Absolutely.

And she was very, you know, with, with things like ultra processed food addiction and binge eating, you.

There are phases of being in that.

Right.

And you have to get to a point where you are open and honest with yourself about what foods take you down because there might be foods that are quote unquote ketogenic that are going to take you down and you are going to end up binging on.

Like common ones are like things like cheese and nuts and, and, and heavy whipping cream.

So it's not always the ultra processed foods.

Sometimes it moves or it shifts to things that are quote unquote keto.

So, you know, she was very honest from the start, which is important.

And she was able to notice which foods she had to remove because she was just not getting on with them or they were causing her a lot of food noise.

And as you can see from the study, she, she kind of, she reduced her, the, the variety of foods down to just a couple of different things that she feels that she can eat safely and she doesn't get food noise.

She doesn't feel the need to binge.

It's predominantly animal based for her.

That's what she, that's what she works well on.

But she feels comfortable and safe around those foods.

And the other thing to note is that, you know, often we talk about tracking food on an app so that you can learn about the macronutrients and so on.

It's a very important part of the process because you need to learn how many carbs are in different foods and you need to know how much fat and how much protein.

And so in the beginning when she was tracking, it brought up, and this is, this is quite common, it brought up a sense of wanting to restrict food because she had had eating disorder history.

She had even been in hospital for some of the eating disorder behaviors and so on.

And it got quite dicey and quite bad at one point.

So it brought up these feelings for her.

And so we had a conversation about it and I said focus on learning or reminded her, should I say focus on learning.

Learning about the macronutrients.

We're not bothered about the calories right now.

If you want to gain weight, stay the same or lose weight, we could figure that out.

But we're not, that's not the purpose of this.

We're trying to understand macronutrients.

We're not tracking calories.

It's just the macros.

When you Calculate them, give you the calories.

So as soon as she shifted her thinking to, oh, I am learning about macronutrients and learning how to make and create my plate, I'm not worried about calories, once she made that shift, those feelings melted away and she was able then to get on fine with the tracking until such time as she was able to just create the meals without needing to track, which is where she is now.

Yeah, such an important point, how the tracking can really teach you so much and then you won't need it potentially as you move on.

So that's great.

Well, now let's use this case example though, as sort of like a broader example because it's easy to think of bipolar disorder as one thing, anxiety as one thing, binge eating as one thing.

But no, in the real world it's messy and there is frequently a combination of symptoms which will lead to multiple diagnoses.

So you brought up in the paper this concept of a sort of a trans diagnostic system or focusing on mechanisms rather than symptoms.

Tell me how this case sort of helps you think about that.

Well, I think it was shouting at me and also shouting at Nicole who is the co author on the paper because there are so many or there were so many diagnoses there.

So which one were we targeting?

And you know, which takes priority and really none of them take priority.

They are all as important as one another.

And so it, you know, after a conversation and going through the research and referring back to Dr. Chris Palmer's paper on try on a trans diagnostic model, we're reminded that actually pretty much all of these mental health conditions have shared mechanistic pathways.

You know, things like oxidative stress, inflammation, brain glucose, hypometabolism, all of these things are shared across all of these mental health conditions.

And I tell people all the time, I've never met two people with the same diagnosis who have the same symptoms and who are acting the same.

So it's never made sense to me the way we, the way we practice and the way we treat.

So after thinking about it and kind of going over or discussing, you know, the idea of this being trans diagnostic remission across all of these diagnoses, it makes sense because what we're doing is if we're targeting the shared pathways, those symptoms are just, they're all going to subside.

It doesn't matter if the anxiety is from the PTSD or the anxiety is the anxiety or anxiety is linked in with the depression.

You know, the, the ketones are anxiolytic.

So they're not saying we're going to target the PTSD anxiety and not the anxiety associated with depression.

They're just anxiolytic and they're going to reduce the anxiety.

And so I think actually this is quite important because it would be great if we would start looking at perhaps symptom clusters.

We can continue to look at diagnoses for sure.

But what if we also looked at cluster of symptoms, like grouping people not by diagnosis, but, okay, their most significant or severe symptom is anxiety.

And so let's have a close look at that.

Or really it's that morning dread and that deep depression.

Let's have a look at that.

Or, you know, maybe it's their cognitive deficits and their inability to focus.

Let's look at that rather than sticking with the diagnosis label, because there's definitely some bleeding between the diagnosis because of those shared pathways.

Yeah.

And if you say let's look at that, but you're really saying let's look at a potential sort of root cause or, you know, mechanistic impact there, then that's where ketogenic therapy can potentially be so beneficial, because like you said, it's not a drug, for one thing, but it's treating mechanisms of.

And you.

And you list a number of them in your paper about the insulin resistance and altered glucose metabolism and neuroinflammation.

And that kind of goes against this concept of, you know, a very elegant targeted pharmaceutical.

It's almost the opposite of that, which.

Which I think maybe is why some people are a little reticent to embrace it because of the.

Just the concept is hard.

So I like how you highlighted that in your paper.

So do you think we should be saying let's treat mechanisms rather than symptoms or diagnoses?

I think we could be guided by the mechanisms and then treat the symptoms just because I have an issue with labels.

But maybe that's just a me thing.

But I definitely have an excuse.

And it's hard to assume that we know every mechanism, too.

So that.

That is absolutely fair.

Right?

Yeah.

And that's what I.

And that's why I'm saying both, because I think I said this last time we were talking, like, when I did my PhD, I found like, 53 mechanisms of depression and then 53 ways that the ketones can counteract that.

And then I was like, whoa, what am I doing?

So can you imagine, like, if we spend at least a year on each of those, that's 50 years, just looking at those 50 mechanisms of depression, and we don't have that an amount of time just to hang around and wait because people are sick and they need the support and guidance now.

So that's why I think, you know, we've got fantastic researchers right now that are really working on understanding the mechanisms and we're doing it at the speed of light too.

So that's great because we're getting that information quick time.

But then at the same time, while we're waiting for more of those mechanisms to become visible, we can treat those, the symptoms, right, the anxiety, depression, low motivation.

The other thing that I say to people is when we look at those shared pathways, so oxidative stress, neuroinflammation, brain hypoglucometabolism, you know, insulin resistance and so on, there's about five or six that are, there's probably more, but those are the ones that I'm very familiar with in terms of those being shared across different diagnoses.

And I say to people, we don't know which one caused your mental health issue.

Like, was it the neuroinflammation, Was it the oxidative stress?

We don't know.

Was it a neurotransmitter imbalance?

We can't actually test that.

So we don't know.

We can test neurotransmitters, but we can't test for the imbalance.

So we don't know.

And you can take a drug or you do a therapy to target those.

So if you go to the doctor, they'll say, yeah, you got a neurochemical imbalance, neurotransmitter balance, take this medication.

But then it's like, well, does it work?

Does it not?

We don't know what the cause is.

And they all overlap.

So the insulin resistance influences inflammation, inflammation influences oxidative stress.

Throw in the medications, they all have a high metabolic price tag.

So then they cause a bunch of issues too, though they can be extremely effective in, you know, they can be life saving in certain circumstances.

So then you're just like, well, how are you meant to figure out what caused it?

And then you have to figure out what caused it in order to treat it.

But ketogenic therapy, we have research to show that ketogenic therapy improves every single one of those.

And so I say that to people, let's use the ketogenic therapy.

Now you can go and figure out what the root cause was.

But in the meantime, the ketogenic therapy is improving your metabolic and mental health.

And that's, I think that's the safest way to approach it, right?

Now, rather than just waiting to try and figure out what the root cause is, to then find a treatment that's very specific.

Makes a lot of sense.

Makes a lot of sense.

And.

And I guess another point to bring up is it's.

I don't mean to portray it as a ketogenic therapy or medication, one versus the other.

Right.

So, you know, in this particular case, she wasn't on medications, but you have patients you work with who use ketogenic therapy as sort of adjunctive therapy or adjunctive treatment to their medications?

Yeah, absolutely.

Absolutely, I do.

I've got a bit of a mix of everyone, and some people find that the ketogenic therapy is enough, so they get the support of a psychiatrist, and then the psychiatrist supports them to taper down.

Sometimes people come off the medication altogether and they maintain ketogenic therapy and are very strict with it.

Other people will lower the medication, but keep a low level of medication at the same time as having the ketogenic therapy so that they've got a little bit of peace of mind.

The medication is still doing what they believe it's doing for them.

Maybe it's keeping the hallucinations, delusions down, maybe it's keeping their mood stable.

And so.

And then other people have already come off medication previously with the support of a psychiatrist, but they are not feeling good.

And then they've used ketogenic therapy, which has then helped to improve their symptoms.

So I'm very much on the same page as you.

It can be done at the same time as using medication.

And, you know, ketogenic therapy will often offset a lot of the metabolic complications that come with taking some of the medications.

Like, for example, you know, if you're taking olanzapine and olanzapine is, you know, you're.

You're gaining weight as a result, using ketogenic therapy, that can help to bring the weight down.

And then at the same time, you get the benefits from the olanzapine if you feel like you're benefiting from it.

So they can definitely, definitely be working together.

But ultimately, some people do want to see if they are able to reduce their medication and use the ketogenic therapy as their main therapy.

And so you know that that is possible for some people, but may not be possible for everyone.

And that's okay, because we're not here to say that ketogenic therapy is the standalone, number one thing that's going to do it for you.

It might be in this case, in this case, in this case that I've presented, but for other people, it's a combination.

It's usually ketogenic therapy, other metabolic therapies, good sleep, hygiene, morning light, movement, connection with ketogenic therapy as the foundation and then with the other things added in.

And that's more so what it looks like.

Yeah.

Yeah.

Well, such a great way to sort of just summarize what this individual case report brings up.

So many different topics, so many different considerations.

But like you said, something that should get everybody's attention to have them looking into it further, considering it if they're a clinician and certainly saying, how can I learn more about this if I'm a researcher and a patient?

So I want to thank you for taking the time to publish it.

I know busy clinicians to take time to research and write is very challenging and for your patient to be willing to sort of share her story with the world.

So thank you very much.

And if people want to learn more about you and all the work you're doing, where can we send them?

So yeah, you can find me.

You can just put my name into Google and I'll pop up, but you can also find me@ikrt.org that is the name of my private practice.

And I not only work with people one on one and in groups, but also work with training clinicians and open to research collaborations as well.

So anybody can feel free to reach out to me and to contact me if they need guidance, support, or they want to collaborate in some way.

That would be great.

Perfect.

Well, thank you so much.

Thank you so much.

I'll speak to you soon.

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