Healthy Minds With Dr. Jeffrey Borenstein

(gentle music) - [Jeffrey] Welcome to "Healthy Minds."

I'm Dr. Jeff Borenstein.

Everyone is touched by psychiatric conditions, either themselves or a loved one.

Do not suffer in silence, with help there is hope.

(gentle music continues) Today on "Healthy Minds."

(gentle music continues) - We heard this story of somebody who had recovered fully from their bipolar one diagnosis using ketogenic diet.

I was hesitant to recommend something else because so many things that we tried hadn't worked and within four months his symptoms were in remission.

Why would this ketogenic therapy, this simple intervention break that cycle that was making him sick?

And that's a scientific question that we are interested in now with our foundation.

- This diet has been used for 102 years to treat treatment-resistant childhood epilepsy.

It's even FDA approved for that.

It is a difficult diet to be on, and if we can make it an easier diet to stick to for adults, I think we'll really be making some significant progress.

(gentle music continues) - That's today on "Healthy Minds."

This program is brought to you in part by the American Psychiatric Association Foundation (gentle music continues) and the John & Polly Sparks Foundation.

(gentle music continues) Welcome to "Healthy Minds."

I'm Dr. Jeff Borenstein.

(gentle music continues) Can a change in a person's diet help them treat their psychiatric condition?

I first speak with the mother of a young adult whose bipolar disorder did not get better with the typical treatments, but did get better by changing his diet.

(gentle music fades) Jan, thank you for joining us today.

- It's my pleasure.

- I'd like you to share the experience that your son Matt had with you and your husband with bipolar disorder and sort of how the journey went and how it's currently in a good place.

- Sure, it was a long journey for our family.

Our son was 19, he was a freshman at UC Berkeley.

He had been a star in high school, you know, Varsity water polo, chess club, star student.

Took all the math there was to take before his sophomore year and moved on to multi-variable calculus.

And then he went off to college.

And in March he had a full-blown manic episode with psychosis that landed him in the psychiatric hospital in the Stanford psych ward.

He was there for two weeks.

He was diagnosed with bipolar one with psychotic features.

He was put on a high dose of an antipsychotic Zyprexa and released.

And at that time, you know, we didn't really know what to expect.

I started doing all the research that I could, but he had a very, I would say, optimistic psychiatrist at the time who tapered him off of the antipsychotic over a period of time.

He went back to college in the fall and by October he was in another full-blown manic psychosis.

And it kinda went from there for the first two years, where we really couldn't get him stable.

And he couldn't remember that he was sick.

Now and then he would get a grasp of insight and then he would lose it again.

And then he would up the dose of antipsychotic and then it would make him sedated.

And then he would go off the antipsychotic without telling us.

And this is a familiar story I know with people with bipolar one especially.

So for two years he was in and out of the hospital.

He was in and out of school.

He was hospitalized four times in the first two years for psychotic manias.

The last one was after leaving home for two weeks and really being on the streets, we finally got him hospitalized after that episode in San Diego.

And then he got insight.

He had shared much of that journey on the internet, on social media, sharing, you know, himself flushing his lithium down the toilet on a Greyhound bus, on Snapchat, on YouTube.

And so when he finally was medicated enough to come out of his psychosis, he saw the evidence of his mania and he said, "I never want to be manic again.

What do I need to do?"

And he started putting in place all the measures that we're supposed to make him better.

All in all, he was prescribed 29 different medications over the course of five years.

But after that first two years, he got stable on a regimen of five medications.

He was fully med compliant, he was exercising daily, he quit drinking, he quit smoking cigarettes, he quit cannabis.

He was very active in sober community.

He was meditating, he was seeing a psychotherapist.

We tried CBT and DBT, we tried TMS.

And in all that time, he was gradually getting more, I would say stable.

Maybe he was even be called euthymic, but he was definitely not himself and he was not well.

And every spring in March, we would have to go up on the antipsychotic, just to keep him from going manic, just to keep him sleeping in January, February and March.

And then at the five year mark, I happened to hear somebody's story, who told me about using a ketogenic diet, which many people may know has been used for 100 years to treat epilepsy.

It's still the single most effective treatment for pediatric epilepsy.

And we heard this story of somebody who had recovered fully from their bipolar one diagnosis using ketogenic diet.

I reached out to Dr. Chris Palmer, who is a leader in this field, and he helped us get Matt on the diet.

And at that point, I was hesitant to recommend something else because so many things that we tried hadn't worked.

But one day I just said to him, I said, "Well, I heard about this ketogenic diet for bipolar disorder, Matt, what do you think?"

And he was absolutely ready at that point to try it.

And so we got ourselves all organized, found a dietician who came out of the epilepsy world, started the diet on January 4th, 2021.

And within four months his symptoms were in remission.

And since that time, he has stayed in nutritional ketosis pretty much the whole time.

He hasn't had a piece of bread or a bite of rice since January of 2021 and he has gotten stronger and clearer and better and more himself, he is completely adulted.

He runs his own life now and every day he wakes up happy and energetic and sleeps well at night and has really a joyful, wonderful life that we never expected him to have.

- Many people with bipolar disorder, the medicines, the typical things we recommend, works, but for many people it doesn't.

As is the case for Matt.

And its extraordinary to hear how a family, how a mother doesn't give up and really keeps looking and looking to help their young adult child.

And this has worked.

Tell us a little bit about the diet.

What does he eat?

You already said some things that he avoids, but what's the diet like, for Matt?

- So there are many different forms of ketogenic diets and the way we define it is just any way of eating that puts your body into nutritional ketosis.

The one that we used is one of the epilepsy diets, modified Atkins basically.

So it's about 60% fat, about 5% carbohydrates, and the rest protein.

And we make sure he gets adequate protein because that's obviously really important for anyone, but especially if you're trying to address a mental health issue.

So, it's a pretty simple diet.

I mean, he eats salmon and meat and vegetables that mostly grow above the ground and berries and some keto treats like, chocolates made with keto sweeteners and that's about it.

There are many variations though.

I feel like, we went on the diet, my husband and I went on the diet at the same time our son did.

And I think he would say he eats like a king.

It's not, you know, we don't get super hungry on this diet because you're eating very satiating foods, high protein, high fat diets are very satiating.

And so, yeah, it's a super simple protein plus veg and a little bit of berries and a tiny bit of chocolate thrown in is pretty much what we eat.

- In addition to helping your own son, you and your husband are on a mission to really support the science behind this in order to help other people and get the word out about it as well.

Tell us about what you're doing.

- Well it really started with, well, I should back up and say that our philanthropy has been really in two phases, in the science world.

When Matt was sick, we had some early liquidity events with my husband's company.

My husband is the CEO and founder of "Roblox."

And so we had some resources to devote toward research and that I would call our desperation phase.

I would say that, I reached out, I did a lot of internet research and then I would reach out to any investigator that seemed, like, they were doing something that might be promising or new in bipolar disorder specifically.

And I would, I learned that I could just reach out to these people and have conversations.

This was during COVID mostly, so over Zoom and learned about a lot of interesting projects.

And that's how we started.

So we had done a lot of grant making in the bipolar research space specifically.

And it was really the seed grants, just anything that seemed interesting, we ended up giving probably 55 grants in the bipolar space.

And then once Matt went on the diet and he started to get better, that was right at the time that "Roblox" went public, actually, right, exactly at the same time.

And Matt started to get better and we had hired someone to run our foundation.

And I kept saying to my husband and kept saying to Carolyn, who runs our foundation, "Could this really be what is making him better?"

And I asked myself that question over and over again, even though I had been studying nutrition for a long time and I had every reason to believe that it was making him better.

It seemed impossible.

And so we wanted to know why is this working?

And so the question I kept asking myself and everyone else was, "Why would this ketogenic therapy, this simple intervention break that cycle that was making him sick?"

And that's a scientific question that we are interested in now with our foundation.

And so at that time we started funding clinical trials.

When Matt got better, I mean, I just looked at my husband and I said, "We have been searching for an answer for our son for five years and we had thought we had turned over every stone.

And here is this solution, potential solution for some people that has been used for 100 years for a brain-based disorder.

Why would we not try it in psychiatry?

Let's build the evidence base, let's run the clinical trials, let's start to educate people."

And so at that time we started not only funding the science, but we started a channel called "Metabolic Mind."

So we have a website and a YouTube channel to try to educate people to share the science and to share people's stories.

And I think that probably will keep us busy for the rest of our lives.

'Cause it's a big job and we have a long way to go.

But we're at least getting started.

- Jan, I wanna thank you for joining us and sharing this extraordinary experience of your family and your son, Matt, and for the work that you're doing to support further research on this very promising and important initiative.

Thank you so much.

- You're very welcome.

Thank you for having me.

(gentle music) - I now speak with leading expert Dr. Judy Ford about the potential use of diet to help treat psychiatric conditions.

(gentle music fades) Judy, thank you for joining us today.

- Thank you Jeff.

I'm looking forward to our conversation.

- Me too.

And I wanna jump right in and ask you what gave you the idea to start looking at a ketogenic diet for mental illness?

- Well, Jeff, I sort of stumbled into it in a way.

I am not an expert in metabolism, but I had started to do fasting.

I started to do intermittent fasting and I noticed that when I was fasting, I seemed smarter, clearer, more focused, was able to remember things better, better concentration.

And I thought, maybe I could do a study on this, maybe I could actually ask if people with schizophrenia, who have difficulties in all those areas might also improve if they were fasting.

And it was during the pandemic and so I had some difficulty, but I eventually connected with a cardiologist named Ethan Weiss, who was also interested in dietary interventions for his cardiovascular patients.

And we talked a little bit about fasting.

He didn't think that was going to be the answer, but he thought a ketogenic diet might be the answer because he needed interventions for his cardiovascular patients.

And sort of paradoxically this high fat diet that I'll tell you more about later, actually seems to help cardiovascular patients.

So, I told them that my main interest was in improving cognition in people's schizophrenia, but as luck would have it or bad luck would have it, people with schizophrenia also have cardiovascular disease.

In fact, they have a shortened lifespan by 15 to 20 years because of their cardiovascular disease.

That is really what contributes to their shorter lifespan.

So I figured, maybe we could do two things at once.

We could fix their cognition and we could also give them a longer life.

- I just wanna interject, 'cause we know that some of the medicines we use can cause what's referred to as the metabolic syndrome that could cause cardiac problems, but there is also evidence that even separate from the medicine, there's this risk that you're referring to, above and beyond the medicine.

- Absolutely, you know, I've begun to learn a lot about this now and it's fascinating to me that even before we started giving patients these antipsychotics that do increase their insulin resistance, their triglycerides, you know, all of the bad sort of cardiovascular markers, this was true before we had antipsychotics.

It's also true in medication naive patients.

And I have recently noticed that it's also true in family members, who do not have the diagnosis, but who have the same genetics.

- And now what have you found so far in terms of the work on this particular area?

- First of all, let me just back up a little bit.

The study was funded, which was wonderful, and then the Baszucki Brain Research Fund found out about it and offered to help pay for some of the costs of the study.

One of the reasons that this study is expensive is that we provide the food to the patients.

So nobody's doing their own cooking.

A box of food is delivered once a week.

They put the food in the refrigerator and every day they cook these meals, put them in the microwave and eat these meals.

So, so far we're still very much in the middle of the study, I should say.

I have some findings I can share with you, from some of the subjects who have made it through the whole study.

We also have a diet as usual arm, so it's a controlled study.

So, patients are randomized at the beginning of the study to diet as usual or to the ketogenic diet arm.

And one of the things I felt bad about, when I first started recruiting patients and you know, I'm selling this diet, this may be the intervention you've all been wanting and here, guess what?

You're in the diet as usual arm, sorry.

I felt really bad about that.

And one of the things that the Baszuckis have done is they've allowed us to extend the ketogenic diet arm to the diet as usual subjects.

So the diet as usual subjects are in it for four weeks and then they get four months of ketogenic diet.

We do neuropsych testing, we also do brain imaging, and I have no data yet from that, but we do have some data already from the neuropsych testing.

And it looks like, they are significantly better overall in the neuropsych testing, than the diet as usual subjects.

So the diet as usual subjects have basically no change from week one to week four, but the ketogenic diet subjects have a significant improvement in their neuropsych function, which is, you know, a great advantage and something I think will make a big difference to them in their daily lives.

- So, it's early and we don't yet know the full results, but the preliminary information you have is that this is helping people and we'll get more information over time, but that it is helping people.

Are there any risks for a person to be on this type of a diet?

- Yes, there are some risks and but not many.

And we follow them medically, so we have a consultant working with us from Stanford.

She's a psychiatrist who's run her own study using mostly bipolar patients.

We check in weekly with her and the patient.

We also have a registered dietician that checks in with them and goes over what they can eat, what they can't eat.

And then we have daily blood tests using this system called Keto-Mojo.

This is, again, one of the advantages that the Baszuckis have provided for us.

People stick their finger every day and report what their ketone levels are.

So if they get outta whack, if they go way high, then we tell them to back off, we suggest maybe they have a little, some carbohydrates.

We monitor them because you do wanna be sure they're in the right range.

I think once you've been in the diet for four weeks, four months, you begin to really understand how it works and you probably have less need to check in with your doctors, but people who are listening are thinking, "Oh, I'm gonna do this myself."

You should always check in with your doctor before and after you start, just to be sure that all of your blood values are in the right range and are not being disturbed.

There's also something starting at the very beginning of the diet, that is referred to as keto flu.

We've only had one person in this whole study out of, like, 30, who have experienced that.

And it usually goes away after about a week, but you feel kinda rotten for a week, but you stick with it and it improves and you go on to be able to be fat adapted and the diet works for you after that.

- So a message for anybody watching is, this is still a work in progress.

We're really speaking about science as it's happening right now, but if somebody is interested in this approach, they should speak to their psychiatrist, to their internist, or their treatment team and get their input.

And if they were gonna try something, do it very carefully in conjunction with their treatment team.

- Absolutely, Jeff.

Absolutely.

That's a very important part of the story.

- Now, what's the understanding of the mechanism of action?

Why would this work?

- One of the things I've learned in the process of writing the grant proposal and conducting the study, something I think I probably knew all along is that the brain is actually very small compared to the rest of my body.

So my brain is like only 2% of my whole body volume and yet it uses up 20% of the energy that my body needs, that my body does, you know, for function.

So it's very vulnerable to changes in energy metabolism.

So, one of the things that happens, and this actually happens every day to everybody, when you go to sleep at night, you're not eating, assuming you're not eating in the middle of the night and you wake up in a fasting state and you are actually, probably, your ketone level is probably slightly high at that point because your body can't always have glucose and glycogen on demand.

So what happens is, in the liver, the liver senses that the glycogen stores have run down and it needs to take care of that.

So it starts taking the fatty acids that are in your liver and makes them into ketone bodies.

And the ketone bodies are then used throughout the body and in the brain, in the brain they are 27% more efficient than glucose.

So using ketone bodies to fuel your brain is a very efficient thing to do.

Glycogen stores run down and you've gotta do something.

So your liver starts to burn fatty acids, makes them into ketones, sends them up to your brain and your brain uses ketones instead of glucose to do its activities of daily life.

- In some ways it sounds so simple, but obviously these are very complicated mechanisms and teasing them out, understanding them will help us do a better job giving guidance to patients to help them.

- Absolutely.

- So all of these ideas are still a work in progress and we are hearing about this work as it's going on.

It's not yet ready for prime time as they say, but it seems very hopeful for people.

- [Judith] Yeah.

- And as we get more information, more will be known and more options for treatment potentially will be available for people.

- You know, one of the things that I always tell the patients when I'm talking to them about the diet is that, this diet has been used for 102 years to treat treatment-resistant childhood epilepsy.

It's even FDA approved for that.

So it is a known commodity, we know how to do it.

And you could ask yourself, "If it's approved for childhood epilepsy, what about adult epilepsy?"

And answers vary.

But I have a friend who does epilepsy work at UCSF and she commented, "The reason it doesn't work for adults is that, adults can eat whatever they want, but children, their eating is being monitored by the family and their food is totally controlled."

So, again, that comes back to, it is a difficult diet to be on and if we can make it a easier diet to stick to for adults, I think we'll really be making some significant progress.

- Judy, I wanna thank you again for joining us today and for the work that you're doing in this area and the work that you've done over the years in multiple aspects of mental health.

Thank you so much.

- Thank you, Jeff.

(gentle music) - Today we heard an inspiring story of a mother who wouldn't give up on her adult child who has bipolar disorder.

And we heard about the ongoing work scientifically about understanding, how potentially dietary changes can make a big difference in the treatment of psychiatric conditions.

That work is ongoing and we'll see where it leads, but it certainly demonstrates that with help, there is hope.

(gentle music continues) (crystal chimes) Do not suffer in silence, with help, there is hope.

This program is brought to you in part by (gentle music continues) the American Psychiatric Association Foundation (gentle music continues) and the John & Polly Sparks Foundation.

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