Most Replayed Moment: This Diet Could Fix Your Mental Health! - Dr Georgia Ede

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This keto diet, you did a study on the ketogenic diet for refractory mental illness, a retrospective analysis of 31 inpatients. What is the ketogenic diet for someone that might not know?

A lot of people think or they’ve heard about the ketogenic diet as a weight loss diet. They think of it maybe as a fad weight loss diet. They think of it as a very, very low-carbohydrate diet. They might think of it as a diet that's very high in meat and dairy products.

But actually, the ketogenic diet was originally created in 1921, more than 100 years ago, to stabilize brain chemistry in children with severe seizures. This was long before the availability of useful seizure medications.

So, these were children who were having multiple seizures per day in many cases. The ketogenic diet was designed back then—a very strict version of the ketogenic diet—to get as close as possible to fasting without starving the children to death.

For millennia, people had noticed that those with epilepsy would often improve if they were fasting. But you can't fast forever. So, how do you get close to fasting—this is the original fasting-mimicking diet—how do you get as close to fasting as you can while still providing some nutrition? That was the original goal of the ketogenic diet, and it was very successful for seizures.

More than 50% of children had more than a 50% response rate—and adults as well, it's since been shown. More than 50% response rate in children and adults, and 10 to 20% become completely free of seizures following a ketogenic diet.

How is it acting on the brain? What's it doing to the brain?

The ketogenic diet does many, many things. It’s like a multipurpose tool for brain health. So, one thing it does—because we talked about how some of the root causes of mental illnesses, which are only relatively recently a focus of research, are inflammation, oxidative stress, and insulin resistance.

The ketogenic diet reduces inflammation, it reduces oxidative stress, and it reduces insulin resistance. It also improves the balance of chemicals in the brain. A lot of people think of mental illnesses as problems with chemical imbalances in the brain.

The chemicals that they're talking about, you might have heard of—serotonin, dopamine, or norepinephrine. There are others: glutamate, GABA, many different chemicals in the brain are associated with, or in some cases even very much causing, mental health symptoms.

But the question is, what's causing those chemical imbalances in the first place? One of the things that's causing those chemical imbalances is that inflammation and oxidative stress. But another thing is that the brain, if you're feeding it the wrong way, will not be able to, in many cases, produce energy reliably.

If it can't produce energy reliably, all kinds of things will go wrong in quite spectacular fashion. What actually goes wrong is going to depend on who you are. That's where our individual differences come in.

If you and I eat exactly the same bad diet, depending on what runs in your family and how you've lived your life to this point, you might develop Alzheimer's disease, you might develop bipolar disorder, you might develop type 2 diabetes, you might develop fatty liver disease.

I might develop completely different conditions. I might develop cardiovascular disease, I might develop depression, I might develop ADHD. And that's where the individual differences are, but all of these conditions are just metabolic malfunction, really at the heart of it. That's what's going on.

If cells aren't functioning properly, you will develop a disease. Physical and mental diseases, and which ones you get, it's really kind of luck of the draw. But you have tremendous control over what you are at risk for if you understand how to help your cells operate at their personal best.

Why is it so hard to stay on the ketogenic diet? I've managed to do it once a year—I was saying to you before we started recording—once a year around this time of year, I do it for about eight weeks. It has a really profound impact on a lot of my life. It helps me feel more focused. My body composition radically changes faster than any other diet or thing that I've ever tried, faster than just exercise alone.

I sleep a little bit better as well, I noticed. But you've been doing it for a long time. You've been doing it for roughly almost 10 years?

For the better part of 12 years. I've been following a ketogenic diet for 12 years and I agree with you, it's not always easy. I'm not perfect about it myself, but I have been on the ketogenic diet the lion's share of the last 12 years.

It being hard is an important factor because when you're trying to prescribe it to somebody who has treatment-resistant depression or is really suffering in some way, I imagine they'll find it even harder than I do.

Yes and no. So, it's definitely—there's no question about it that it's hard to eat a low-carbohydrate diet in a high-carbohydrate world. So, there's that. There are the environmental temptations, and the social temptations, and the habits, and the addiction.

Sugar addiction is a very real biochemical phenomenon, so there's that. But I had a weight issue growing up, everyone in my family did, and I've been on lots of different diets in my life. This is the easiest one to stay on. I can't say that about any other diet that I've followed for 12 years.

The reason why is this diet really stabilizes appetite hormones. So, your cells are getting energized in between meals. You're not getting those spikes and crashes in glucose, which cause spikes and crashes in appetite hormones, satiety hormones, stress hormones, reproductive hormones, brain chemistry. You're not on that roller coaster anymore.

So, your cells are being satisfied, they're getting the energy needs satisfied in between meals, and everything is quiet and calm on the inside. It doesn't mean you're 100% protected against temptation.

I describe it to my patients with food addiction, I describe being in ketosis as a suit of armor. The sword can still get you, you're not 100% protected, but you've got a real fighting chance.

For anybody who's never tried a ketogenic diet and been on it for at least, I would say, six to 12 weeks, most people have no idea how much easier it is to follow a healthy eating plan when their appetite is in good control.

A lot of people know they've shifted into ketosis without even checking their ketone meter because they can go for so long without eating, without even thinking about food. They can work through lunch and not even realize that they've missed a meal.

Most people, the way we eat most of us now, are thinking about food all the time. You haven't even finished breakfast and you're already thinking about what you're going to have for lunch. You're carrying food around with you everywhere you go. You're eating at least six times a day in many cases.

This is not—we would never have survived as a species if we needed to eat six times a day. So, we're not eating in a way that is nourishing us and satisfying us; we're eating in a way that's making us hungry.

I find what you've said there to be true in my experience, especially in the context of the roller coaster analogy. So, when I'm not in ketosis, I do feel like sometimes I'm in a bit of a roller coaster of temptation, craving, etc. Then when I do ketosis and I get past the first week or two, the roller coaster seems to stop.

I'm off the roller coaster. It's then maybe six, eight weeks later, you're busy, life happens, you're traveling, you're tired—that temptation creeps in. It just takes that one moment of weakness in my head to then fling me off ketosis and all my effort is gone.

In my head, the way I've always thought about it—and I'm sure this is wrong—but I've thought about it like it takes a couple of days to get into a state of ketosis. Once you're in, I usually get a headache on my way into ketosis, I feel a little bit bad on the way in.

Then once I'm in there, it's fine. So, when I have something that breaks my keto—this is what my girlfriend and I talk about, "Oh, I've broken my keto"—I think, "Oh my god, I've got to go through another headache and another five days of getting back into it." Is that correct?

It's a very common experience because there are these adjustments that happen inside with your physiology as you're shifting from one operating system to another. When you're shifting from a carbohydrate-burning system to shifting your ratio of your fuels—the body and the brain are hybrid engines, so we're never burning 100% fat. We're burning a mixture of fat and carbohydrate.

When you're shifting from a system that's fueled almost entirely by carbohydrate almost all the time to a system where you're burning more fat than carbohydrate, that's uncomfortable for some people shifting back and forth.

Especially if the reason why you've quote "broken your keto" is because you've had something that has a lot of refined carbohydrate in it, a lot of sugar or flour in it, for example. So, it depends on what you've eaten and how much and for how long.

Many people do experience the so-called "keto flu" when they are shifting from a carbohydrate-based system to a fat-based metabolism. Much of this can be prevented in a couple of different ways. One is with electrolyte supplementation, supplementing electrolytes to keep your salt balance even as you're transitioning.

Another is by transitioning slowly onto the ketogenic diet rather than all at once. There are other tips in the book about how to do this more comfortably. But those are the two big ones.

So, in the book, I don't recommend that people start on a ketogenic diet just straight away, like learn about it on a Monday, start it on a Tuesday. But ease into ketosis over a week or two. There's a moderate carbohydrate plan in the book that allows people to do this so you follow that plan for a couple of weeks to gradually lower those glucose and insulin levels.

It's going to be a lot more comfortable, it's going to be a lot less of a shock to the brain and body. And if you're supplementing electrolytes and going slowly, most of these keto flu symptoms will not occur or they'll be very brief and mild.

Again, these are positive—it's a positive change to have these electrolyte changes. All of these things are good, but there is this transition period which can sometimes be uncomfortable.

This is not to say that it's dangerous. Again, it's a very—we're designed, our biology is designed for us to be able to shift back and forth between fat and carbohydrate as fuel sources. But many of us have lost some of our metabolic flexibility because we've done some damage to our metabolic engines by eating the wrong way for too long, so we don't shift as comfortably back and forth as we used to be able to.

I guess most people don't even know what foods are included in a keto diet because most diets are restrictive to the point that people think they just make your life miserable. What are the big misconceptions you've seen with the foods you're able to eat on a ketogenic diet?

Because the definition of a ketogenic diet is any way of eating that lowers insulin levels enough to turn on fat burning and generate ketones in the blood, because it's about insulin, it's really not a food list.

So, you can—it's not about plants and animals, it's not even about fat or carbohydrate. It's about understanding how to lower your insulin levels, which you can do with a vegan dietary pattern, with a vegetarian dietary pattern, with an omnivore dietary pattern, or even with a carnivore dietary pattern.

Whatever your dietary preferences are, you can get the benefits, the brain healing benefits of ketosis. So, it's not about the foods you're eating, it's more about understanding what raises and lowers insulin.

The things that raise and lower insulin are refined carbohydrates, whole foods carbohydrates, refined proteins like protein powders, whole food sources of protein. And guess what barely touches insulin at all? Fat. Fat is metabolically the quietest and safest macronutrient you can eat because it barely stimulates insulin.

Is ketosis a state? Like, is it a binary state? Like, now I'm in ketosis and now I'm not.

Yes, but there's a—most experts will agree that in order to be "in ketosis," your level of beta-hydroxybutyrate on a blood ketone meter—you prick your finger and put a drop of blood on this little test strip and it will read the amount of a particular ketone in the blood called beta-hydroxybutyrate, and it will give you a reading.

If that reading is 0.5 millimole or higher, you are in ketosis. So, why is the cutoff 0.5? Because three things have to happen for you to get to at least 0.5. One is your glucose levels have to come down. The second thing is your insulin levels have to come down.

The third thing is you have to burn off a certain amount of the stored starch in your liver. We have a storage tank for carbohydrate in our liver; it's not very big. It holds less than a day's worth of carbohydrate because, really, as animals, we're designed to store energy as fat.

Carbohydrates are there for quick energy, emergency, short-term. The fat we have, for better or for worse, we have almost an unlimited capability to store fat. We can store months and months and months worth of fat.

But we can only store a very small amount of carbohydrate. So, if your storage tank in the liver is full, your body will not switch to fat burning because it says, "Oh, we've got plenty of starch to burn. Let's start there."

Once it comes down to a certain point, the body goes, "Oh, running out of energy. Let's go to fat now." That's when the liver will start breaking fat down, whether it's fat on your body or fat from your plate, and start chopping it up into these ketones.

So, those three things have to happen, and once that happens, you'll see the ketone levels rise on the meter. Most people who are not eating a ketogenic diet are walking around with ketone levels either undetectable or they're 0.2 or 0.3.

They might float up above 0.5 every once in a while if they're not eating for a long time or if they've just exercised. But for the most part, most people eating a typical diet are not in ketosis.

When you get above 0.5, a lot of metabolic magic starts to happen because there are lots of pathways in the body and brain that are not very active unless you're in ketosis, and those are the healing pathways: the recycling and maintenance and cleanup pathways, the recovery pathways.

All of us—this is something that I came to appreciate a number of years ago as I've been studying this—is that there are many people, unfortunately or fortunately, there are many people who discover with mental health issues that they need to be in ketosis long-term in order to be well.

But I've become convinced by the science that all of us need to be in ketosis, at least intermittently. All of us need to spend some time in ketosis on a regular basis, or else we can't heal. We'll only be—it's like a manufacturing plant where the plant is just running 24/7, 12 months a year, and they never take time to replace the parts or clean up the floor. They never do any maintenance work or repair work, and so eventually everything breaks down.

And when you say ketosis, again, you're not saying the keto diet. You're saying the low levels of glucose and insulin in the blood, and that can be achieved by calorie restriction, potentially fasting, and other diets like the Mediterranean diet if administered in the right sorts of doses, right?

Well, we should come back to the Mediterranean diet in a minute, but first, the first part of your question is important because ketosis—as you said, you can get into ketosis a variety of different ways.

If you're eating properly—and this would have been our evolutionary heritage, our ancestors, especially our prehistoric ancestors—they didn't have access to these lots and lots of refined carbohydrates a long time ago. They were eating carbohydrates from whole foods: fruits and starchy root vegetables.

Even grains and beans are very, very relatively much newer sources of carbohydrate. So, let's think about fruits and vegetables. They would have been—we can only guess based on looking at their diets, we don't have proof of this—but think about it: if you're eating in a way where your insulin levels are allowed to come down overnight.

If you're eating a balanced diet, so to speak, but it's got everything it needs in it, and it's not giving you exaggerated spikes in your glucose and exaggerated spikes in your insulin, and you're not eating six times a day or all day long, your insulin levels will naturally come down overnight.

That will allow you to go into a healing mode. So, I believe that if people have the right information about what a healthy diet is supposed to look like, they may not even need to—in many cases, especially if you're younger or athletic or don't have a lot of metabolic damage already—you may not even need to lower your carbohydrate intake during the day. You might just need to be careful about what kinds of carbohydrate you eat and how often.

For example, it's known that in children who are eating a regular diet, many of them wake up the next morning in ketosis. They're metabolically much healthier than we are as we get older. So, they're much more metabolically flexible. They didn't go on a ketogenic diet; they're eating a regular diet, they slept overnight, didn't eat anything, the next morning they're in ketosis.

That's not true for all children, but it's true for enough children that we know it's possible. Most adults, it takes them several days at least to get into ketosis even if they're not eating anything at all. Fasting can take two to three days at a minimum for most people to get into ketosis, but some people it can take a whole week.

What you just listened to was a most replayed moment from a previous episode. If you want to listen to that full episode, I've linked it down below. Check the description. Thank you.

This keto diet, you did a study on the ketogenic diet for refractory mental illness, a retrospective analysis of 31 inpatients. What is the ketogenic diet for someone that might not know?

A lot of people think or they’ve heard about the ketogenic diet as a weight loss diet. They think of it maybe as a fad weight loss diet. They think of it as a very, very low-carbohydrate diet. They might think of it as a diet that's very high in meat and dairy products.

But actually, the ketogenic diet was originally created in 1921, more than 100 years ago, to stabilize brain chemistry in children with severe seizures. This was long before the availability of useful seizure medications.

So, these were children who were having multiple seizures per day in many cases. The ketogenic diet was designed back then—a very strict version of the ketogenic diet—to get as close as possible to fasting without starving the children to death.

For millennia, people had noticed that those with epilepsy would often improve if they were fasting. But you can't fast forever. So, how do you get close to fasting—this is the original fasting-mimicking diet—how do you get as close as fasting as you can while still providing some nutrition? That was the original goal of the ketogenic diet, and it was very successful for seizures.

More than 50% of children had more than a 50% response rate—and adults as well, it's since been shown. More than 50% response rate in children and adults, and 10 to 20% become completely free of seizures following a ketogenic diet.

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