If you’re considering using ketogenic therapy to treat serious mental illness, you want to do it with your physician and not by yourself. But what if your physician isn’t knowledgeable about nutritional ketosis? This discussion between Dr. Bret Scher, MD FACC, Harvard-trained psychiatrist Georgia Ede, MD, and Argentinian psychiatrist Ignacio Cuaranta, MD, provides an overview of the key concepts and helpful resources to help you have a productive conversation with your physician.

What is therapeutic nutritional ketosis or ketogenic therapy?

Dr. Bret Scher: Therapeutic nutritional ketosis or simply starting ketogenic therapy is a powerful health and medical intervention that can change your body’s metabolism and can dramatically alter brain function medication levels, sleep patterns, energy levels, and other physiological functions. You should not start your ketogenic therapy alone, whether or not you have a psychiatric diagnosis or symptoms or take psychiatric medications.

Why is it important to work with your doctor on this, and how can you go about this conversation?

Dr. Bret Scher: Your doctors have dedicated their work life to helping others. It isn’t their fault that the healthcare system devalues prevention through lifestyle and nutrition, or that it essentially “shoehorns” them into a five or ten-minute office visit. I believe it helps to get past those external restraints and tap into a physician’s core desire to help, and there are different ways to do this. Here’s a potential script you could use just for reference:

“Hi Dr. So-and-So. I’ve heard from different doctors online that I can use nutrition along with my medications to treat my (fill in here whatever condition is appropriate for you, whether it’s depression or bipolar disorder, schizophrenia, or also OCD, PTSD, anxiety, and other mental health conditions.)”

After you fill in the condition that’s appropriate for you, you say, “I’d like to try it as I’m eager to find anything that can help, but the online doctors also mentioned potential concerns, especially when starting a ketogenic therapy. They mention I should work closely with my treating physician, so I want to ensure that we can work together as a team to ensure I do this safely. I plan to continue my medications and hope to try this as a four-month experiment. Are you able to help me? I’m happy to share some of the resources from the other doctors I’ve been following if you think that would be helpful.”

You don’t have to use this script. I just use this as something that I think could be a good starting point because it emphasizes teamwork and collaboration and sets this up as a timed experiment rather than a forever treatment.

In addition, and this is important, it emphasizes that you’re going to stay on your medications and that you’re willing to share doctor-vetted resources. Personally, I find tremendous value in lived experience and personal stories, but I think we have to acknowledge that most doctors are much more receptive to information from other doctors, especially those in psychiatry.

Why are doctors resistant to therapeutic nutritional ketosis at times?

Dr. Ignacio Cuaranta: I do find some of the same resistance and arguments that I see in the United States since I started going to conferences, and ketogenic diets have regained some popularity. In fact, some of these attacks on ketogenic diets come from people who don’t understand its potential as a therapeutic intervention.

When I have the opportunity, I try to speak with other professionals, other psychiatrists, neurologists, cardiologists, and of course, internal medicine doctors here in Argentina. I try to come from a place where I propose and convey the idea that this is a highly potent therapeutic tool. The aspect that has to do with weight loss, which is one of the most sought-after effects of a ketogenic diet in the community as a whole, it’s only the door. It’s one of the main reasons why people come into the diet, but when they start seeing that it has multifaceted benefits and it can impact overall quality of life, not only objectively, in their clinical measurements, and in their clinical analysis, but also in the subjective measures, which are, more often than not, disregarded in the medical community.

But people start feeling better. They not only lose weight, but they start thinking clearly.

How do I address the common misconception that there is a lack of evidence for the keto diet?

Dr. Georgia Ede: For people who need long-term randomized controlled trials, we may be waiting a while, but they’re coming. We’ve got some wonderful research in the pipeline, thanks in no small part to generous funding by the Baszucki Foundation. What I like to say when people ask me, “Why would you want to use an intervention like this when there’s so little clinical trial evidence to support its use?” I often will say to them, “Well, why wouldn’t I want to use this intervention? When you compare it to all the other interventions available, there are many, many advantages that this one has over the others.” From a scientific standpoint, what I like to say is, “We have over 100 years of clinical and research evidence supporting the safety and efficacy of ketogenic diets in epilepsy.” I like to point out that epilepsy is a neurological condition that affects the brain, whereas psychiatric conditions are neurological conditions that affect the brain. The brain isn’t divided into neurological cells and psychiatric cells. It is one organ and, therefore, it stands to reason that a dietary intervention that stabilizes brain chemistry in the case of epilepsy could also stabilize brain chemistry in the case of, say, bipolar disorder. Bipolar disorder and epilepsy, we know, share many common underlying features. We even use a lot of the same medications to treat the two conditions, so that’s what I say when people say that there’s not enough science. I actually can’t think of another intervention where there is this much science available for us to draw upon.

Final takeaways

Dr. Bret Scher: Many doctors won’t have any of those concerns and will be happy to work with you, but for those who do have some of these concerns, I think it’s important that you’re prepared ahead of time, not to be confrontational or to suggest you know more, but to help point your clinician to resources that maybe can help them understand more, learn more, and be able to work with you better. Unfortunately, doctors aren’t taught nutrition very well, especially low-carb or ketogenic nutritional interventions, and I hope we can all start to change that.

To learn more, watch the more in-depth part 1 and part 2 videos on How to Talk to Your Doctor About Keto for Mental Health.