Recent data from the Centers for Disease Control and Prevention reveals that more than 40% of American adults Classified as obese and 36% Report symptoms of anxiety, depression, or both. according to Shibani SethiMD, clinical assistant professor of psychiatry and behavioral sciences, the pandemic is closely linked.
Sethi is board certified in both psychiatry and bariatrics, and is the founder of Stanford Medicine Metabolic Psychiatry Clinicthe first academic clinic focused on treating patients with mental illness and metabolic disorders – conditions such as insulin resistance or diabetes, high cholesterol, high blood pressure, and being overweight or obese.
Sethi coined the term “metabolic psychiatry” in 2015 after witnessing a high prevalence of metabolic disorders among her treatment-resistant psychiatric patients and realizing that to provide appropriate psychiatric care, she needed to address both problems simultaneously.
She spoke with us about how metabolic disorders affect the brain and how treating mental illness with nutrition can provide new hope for patients.
1. How do you define metabolic psychiatry?
Metabolic psychiatry is a new subspecialty focused on targeting and treating metabolic dysfunction to improve mental health outcomes. Increasing evidence suggests a connection between mental illness and altered metabolism in the brain; Thus, treatment that addresses this dysfunction may improve patient outcomes.
Rates of metabolic conditions are already high in the general population. one study It has been found that up to 88% of American adults have poor metabolic health, and in people with mental illnesses, the rates are even higher. In fact, Research From Stanford Medicine Colleagues suggests that developing a metabolic disorder such as insulin resistance can double your risk of depression, even if you have no prior history of mental illness.
The good news is that in our clinic, we have seen encouraging improvements in mental health after treating metabolic conditions with non-pharmacological methods (including diet and lifestyle changes) in addition to medication. Search It shows that those with treatment-resistant bipolar disorder fared better when insulin resistance was treated.
For a long time, doctors believed that nutrition was often a secondary treatment, in addition to medication that might lower blood pressure or improve diabetes. But we realized that nutritional metabolic therapy could be an important medical intervention for mental illness, one that could alter the structure and function of the brain. We are learning lessons from fellow neuroscientists who more than a century ago recognized the connections between brain and body metabolism, successfully treating childhood epilepsy with the ketogenic diet before the first anti-seizure drug appeared.
2. It is easy to see how mental illness can lead to conditions such as obesity or diabetes because a person who suffers mentally may be unable to eat well or exercise. But you say the opposite is also true. How does this work?
We don’t know all the mechanisms, but we do know that patients who were diagnosed with their first episode of schizophrenia — before they were treated with medication — actually had disrupted insulin and glucose metabolism in the brain.
As insulin resistance develops, the brain becomes “more leaky,” meaning more substances can pass through the blood-brain barrier and enter brain tissue. This results in a buildup of toxic substances and increased inflammation. We see inflammation in the brains of people with mental illness, especially in treatment-resistant patients, significantly more than in healthy people.
There were many Research over the past century regarding metabolism and mitochondrial dysfunction, and how this affects brain activity in mental illness. Mitochondria are the site of energy production and consumption in the cell. If they don’t work properly, the connection and communication between brain cells – also known as neural networks – is less stable, which impairs cognition and worsens mental health.
We are examining whether a change in diet, particularly a ketogenic diet, can improve brain instability. Working alongside UCSF neuroscience colleague Judith Ford, we are recruiting patients diagnosed with either bipolar disorder or schizophrenia into A randomized control trial which explores the effects of the ketogenic diet on insulin resistance and neural network stability, as measured by functional magnetic resonance imaging.
3. Can you tell us more about the ketogenic diet and why it might be beneficial for some patients with severe mental illness?
I want to stress that the ketogenic diet is not for everyone. It should really be called a treatment and not a diet, because it is a metabolic intervention carried out under medical supervision.
However, the ketogenic diet is a low-carb, high-fat diet with moderate protein intake. Patients following this diet avoid bread, rice, pasta, and cereals, while consuming whole foods such as eggs, avocados, nuts, fish, and chicken. Vegetarians can also follow the keto diet, but food options may be limited.
Restricting carbohydrates forces the body to burn fat for energy, and also causes the liver to create compounds called ketones, which can be used to fuel brain cells in place of glucose. In our clinic, we try to maintain patients in what we call “nutritional ketosis,” which means their bodies get all the nutrition needed while maintaining blood ketone levels between 0.5 and 5 mmol. (This is very different from ketoacidosis, which is a serious condition of 50 mM or higher.)
Although ketogenic diets sometimes get a bad rap, if grouped with diets that can be dangerous or difficult to maintain, ketogenic diets have been used for decades to treat childhood epilepsy and other neurodegenerative conditions. There is plenty of research showing that the ketogenic diet increases mitochondrial growth and reduces inflammation and oxidative stress in the brain, but to date, no one has studied the effect of the ketogenic diet on mental illness specifically.
4. I recently completed a pilot study of patients with severe mental illness who tried the keto diet for four months. Can you describe some of your initial results?
In this Study pilotIn this study, we taught 22 patients with bipolar disorder or schizophrenia how to maintain a ketogenic diet. It was all realistic, meaning we didn’t control eating in a temporary inpatient setting and didn’t deliver meals, but instead taught patients how to buy and prepare their own food. Despite the seriousness of their mental illness, our patients have been able to successfully adopt the keto diet as a lifestyle change. However, there is a selection bias, as those who participated in the study may be more motivated than the population.
After four months, our initial results were very encouraging: They included a 30% decrease in central abdominal fat, an 11% decrease in body mass index, and a 17% decrease in heart inflammation, as measured by a marker called highly sensitive C-reactive protein. Perhaps most importantly, we saw a 30% improvement in our patients’ Global Clinical Impressions Inventory, which is the gold standard psychological assessment we use to assess symptoms of mental illness. In addition, we saw an improvement in sleep.
We are analyzing the rest of the data and will present our findings at the International Society for Bipolar Disorders conference this June. Also, we enroll patients for randomized control trials comparing a ketogenic diet to diets based on USDA criteria. Dietary guidelines. It’s one step at a time, but if we’re able to change the structure and function of the brain through non-pharmacological methods like diet, that’s a very positive step forward for chronic mental illness.
5. Can you give an example of a patient who could be treated in your clinic? How is your approach different from treating only their mental illness or just their metabolic disorder?
I treat patients with only a psychiatric condition or a psychiatric condition in addition to a metabolic problem, including patients with eating disorders. After conducting a physical exam, taking a complete medical and psychological history, and reviewing metabolic biomarkers, I assess the patient’s intake pattern and medications to see what metabolic interventions might be appropriate.
I rely heavily on non-drug interventions and do a lot of nutritional counseling, which I find very satisfying. My patients often have misconceptions about what is and isn’t healthy, so I start from scratch and teach them Nutrition 101, taking a science-based approach. I also assess whether certain types of therapy or medication might be helpful: Are they emotional eaters or not?
Although medications can save lives, some psychiatric medications can contribute to metabolic dysfunction, so I work with my patients’ other physicians to adjust their medications when possible—avoiding medications that cause weight gain or insulin resistance. After all, in the Hippocratic Oath, we pledge to use all available measures to benefit our patients, including diets.
More resources and information on how to enroll in current clinical trials can be found in Stanford Medicine’s Department of Metabolic Psychiatry Community page.