A terrific piece, Dr. Muir. We'll put this on our web site as a less biased and clearer-eyed view than the one that reigns in our parts. Thanks for the nice shout-out at the end. Matt remains in full remission, no episodes, no symptoms, tapered off lithium a year ago, continuing the taper for the other meds. Questions: What would it take for an unconventional psychiatrist like yourself to make patients aware of this intervention? Given it is well established for weight loss and treatment and prevention of diabetes, should psychiatrists make their patients aware even if the evidence in psychiatry is still emerging? Should psychiatrists be responsible for treating the metabolic syndrome the meds they prescribe induce? I am not convinced that a blinded trial is ethical. If you put a member of this vulnerable population through the trouble of going on a ketogenic diet for three of four months, it feels nasty to undo their progress with a glucose shake every day. And then you would have to blind them to their ketone levels, which could be quite tricky. It may be more important to map metabolic and psychiatric effects to ketone levels. We are trying to make sure our studies use ecological momentary assessments, especially for bipolar, to catch daily mood shifts. I'll pose to our network if there have been blinded keto trials in epilepsy. Anyway, excellent piece. Bravo.
The methodology in the article was actually from the brain of David Carreon, so I can't take credit. I think the informed consent needs to be part of the process--but and IRB might demand concurrent lithium or the like.
Thanks for reading, and sharing. I will have more thoughts on the other questions soon, but will probably do them in a article format...unless you want to do a podcast version :)
Well written, as usual. I have epilepsy -- the doctor calls it "seizure disorder." The Keppra and Gabapentin seem to work, mostly. Once in a while I have a seizure. My ex-wife recommends the "mediterranean diet" -- is this close to what you're talking about here? Lots of olive oil. Thanks.
This is a crucial point: every diet that doesn't keep your body in ketosis is not a ketogenic diet. With a ketogenic diet, you're not eating more than the bare minimum of carbohydrates. It's a lot of protein, it's a lot of fat, it's a lot of vegetables, and those get turned into ketone bodies when you've run out of glucose entirely. You're flipping a metabolic switch by tricking your body into thinking since starvation mode, so it starts metabolizing proteins and fats. This means the fuel your brain runs on ketone bodies, not glucose, so every diet that has enough carbohydrates to let your body metabolize those into glucose and not have to flip the ketogenic switch isn't a ketogenic diet.
A terrific piece, Dr. Muir. We'll put this on our web site as a less biased and clearer-eyed view than the one that reigns in our parts. Thanks for the nice shout-out at the end. Matt remains in full remission, no episodes, no symptoms, tapered off lithium a year ago, continuing the taper for the other meds. Questions: What would it take for an unconventional psychiatrist like yourself to make patients aware of this intervention? Given it is well established for weight loss and treatment and prevention of diabetes, should psychiatrists make their patients aware even if the evidence in psychiatry is still emerging? Should psychiatrists be responsible for treating the metabolic syndrome the meds they prescribe induce? I am not convinced that a blinded trial is ethical. If you put a member of this vulnerable population through the trouble of going on a ketogenic diet for three of four months, it feels nasty to undo their progress with a glucose shake every day. And then you would have to blind them to their ketone levels, which could be quite tricky. It may be more important to map metabolic and psychiatric effects to ketone levels. We are trying to make sure our studies use ecological momentary assessments, especially for bipolar, to catch daily mood shifts. I'll pose to our network if there have been blinded keto trials in epilepsy. Anyway, excellent piece. Bravo.
The methodology in the article was actually from the brain of David Carreon, so I can't take credit. I think the informed consent needs to be part of the process--but and IRB might demand concurrent lithium or the like.
Thanks for reading, and sharing. I will have more thoughts on the other questions soon, but will probably do them in a article format...unless you want to do a podcast version :)
Is the brain energy book worth reading as a MD or its for too broad an audience?
I enjoyed it, but more for the meta-value of how he build the argument and book. If you are also a popular press science doctor ....
Well written, as usual. I have epilepsy -- the doctor calls it "seizure disorder." The Keppra and Gabapentin seem to work, mostly. Once in a while I have a seizure. My ex-wife recommends the "mediterranean diet" -- is this close to what you're talking about here? Lots of olive oil. Thanks.
This is a crucial point: every diet that doesn't keep your body in ketosis is not a ketogenic diet. With a ketogenic diet, you're not eating more than the bare minimum of carbohydrates. It's a lot of protein, it's a lot of fat, it's a lot of vegetables, and those get turned into ketone bodies when you've run out of glucose entirely. You're flipping a metabolic switch by tricking your body into thinking since starvation mode, so it starts metabolizing proteins and fats. This means the fuel your brain runs on ketone bodies, not glucose, so every diet that has enough carbohydrates to let your body metabolize those into glucose and not have to flip the ketogenic switch isn't a ketogenic diet.
Aha.
Now go forth and share the news(letter) with the world.
lol...here you go...