I first met Julie King in person at a farm-to-table restaurant in Austin, Texas. She was wearing a gray cowl neck sweater, and her shoulder-length blonde hair was elegantly swept up in an asymmetrical half ponytail. Her sense of humor, warm laugh, and attentive eyes made her easy to talk to. Though our friendship was fairly recent, I felt like we had known one another forever because we shared firsthand knowledge of the darkest facets of severe mental illness and how psychosis can ravage the mind.

Last year, Julie lost her son Andrew King, who would have turned 28 this month, to suicide. “He wanted to be a force for good,” she told me. He was highly compassionate, had a passion for social justice and volunteered for Habitat for Humanity. He was also terrifically smart: He’d gotten an almost perfect score on his SATs. He was insatiably curious, an avid reader and a history and philosophy buff. Despite Andrew’s abundance of promise and potential, the relentless challenges of his mental health condition under standard of care treatments proved insurmountable.

Like me, Andrew suffered from severe mental illness. As a freshman in college, he was diagnosed with schizoaffective disorder bipolar type. Standard of care treatment had him on various cocktails of psychiatric medications, many of which were totally ineffective or had horrendous side effects. I get very emotional when I think about Andrew. I found my way to remission from bipolar, and he didn’t. It isn’t fair, but it also, unfortunately, is common. The statistics for patients with bipolar disorder are sobering: they are twenty times more likely to attempt suicide than someone without a psychiatric condition.  Sometimes it’s referred to as “CEO’s disease” because many exceedingly bright and capable people are diagnosed with bipolar disorder: leaders, entrepreneurs, inventors, artists, writers, and musicians. Bipolar is unique in offering both blessings and curses – experiences and states of mind that are both staggeringly beautiful and horrifyingly decimating – it can be exhilarating and inspiring, but is also often disabling to various degrees, and sometimes lethal. 

Stories of ongoing suffering for individuals with bipolar disorder are common. As with Andrew, the current standard of care falls short for far too many people. Treatment resistant bipolar depression has been reported in about one quarter of patients. In this interview with Metabolic Mind’s Dr. Bret Scher, Dr. Mark Frye, professor of psychiatry at Mayo Clinic, explains that while standard medications are generally effective at controlling mania and psychosis, many patients do not experience remission from bipolar depression. He also details that patients are at an increased risk for heart attack, stroke, diabetes, and obesity, exacerbated by psychiatric medications that worsen metabolic dysfunction, and often have a decreased lifespan. I know this all too well. When I took the antipsychotic drug, Olanzapine, I put on more than seventy pounds. I also experienced cognitive impairment, brain fog and fatigue, and felt stunted emotionally. Particularly devastating to me was the loss of creativity, something I had always cherished and saw as a cornerstone of my life. 

With the current treatments being inadequate and sometimes even detrimental for so many people, we desperately need innovation and new treatment options. A promising cutting-edge treatment, ketogenic therapy–the one that works for me– is positioned to revolutionize the way that bipolar disorder is treated. Ketogenic therapy is a type of metabolic intervention. It involves a high fat, low carbohydrate dietary approach that shifts the body into a state of ketosis, where it primarily burns fat for fuel instead of carbohydrates. Rather than impairing metabolic health, as many conventional medications do, ketosis can lead to mood stabilization and symptom management in some individuals with bipolar disorder. Many individuals report increased clarity of thought and the return of their ability to think deeply and focus. 

Unlike antipsychotics, keto allows me to feel optimally creative again and has restored my passion and enthusiasm for life. The experience of others mirrors my own. More than a dozen people have shared their experiences treating bipolar disorder with ketogenic therapy on the Bipolarcast podcast. Our website, Metabolic Mind, has a vast amount of information about the clinicians spearheading this movement and the state of the evidence, as well as resources for patients and families. And this fantastic article from National Public Radio covers the history and evolution of ketogenic therapy as a treatment for mental illness. 

Research in this field is exploding, with Baszucki Group as the dominant funder but others are joining rapidly, like Lewis Sanders, who recently donated $3M to metabolic psychiatry pioneer, Harvard psychiatrist and author of Brain Energy,  Dr. Christopher Palmer, in order to launch the Metabolic and Mental Health Program at McLean Hospital, Harvard’s flagship psychiatric hospital. Initial trials of ketogenic therapy for bipolar disorder have shown promising results, and active studies include five Randomized Controlled Trials (RCTs), considered the gold standard for scientific research. These trials will help elucidate underlying mechanisms that make ketogenic therapy effective, as well as work toward pinpointing biomarkers to determine the patients most likely to respond to this form of treatment. Just as not all psychiatric medications are effective for all patients, there are likely to be some non-responders to ketogenic therapy. Seeing the success of myself and others, however, I am optimistic that ketogenic therapy has the potential to benefit a large percentage of patients, impact millions of lives, and revolutionize the way that bipolar disorder is treated. 

The Rise of Metabolic Psychiatry: We are not waiting

I have been using ketogenic and other natural metabolic therapies, including exercise, meditation, and journaling, as my sole form of treatment for more than two and a half years. I have put bipolar 1 disorder into complete remission, and have become passionate about spreading awareness of this form of treatment. While many clinicians want to see finished RCTs and a more robust evidence-base before recommending that their patients implement ketogenic therapy, as a former patient and current advocate, I feel differently. While we know it’s likely that not all patients will experience complete remission with ketogenic therapy, we also know from more than one hundred years of research in epilepsy that it is a safe intervention. Because it’s a relatively low risk intervention overall, with potentially transformational outcomes for at least a subset of patients, I will do everything in my power to raise awareness and ensure patients know that it is an option they can explore. So many people with bipolar disorder are desperate for better solutions now and cannot afford to waste more precious years of their lives. 

The Baszucki Family, who founded Metabolic Mind, and my friend Julie King feel the same way I do. Julie is dedicated to raising awareness, even in the midst of her own grief. She says, “What patients like Andrew need are psychiatrists trained in implementing metabolic interventions while managing medications.” Julie advocates for patients, families, supporters, and clinicians to share information about continued education in metabolic psychiatry to prescribers, and to contact their state’s Psychiatric Association with information about the metabolic psychiatry movement. On her website, One of One Billion, designed to be a “source of hope and engine for change,” Julie provides a simple template and contact information for each state. 

The evening I met Julie for dinner, she gave me a pencil from Andrew’s workspace. Intuitively, I knew what she meant when she gave it to me, but at the time, we both teared up, and were too emotional to speak about the meaning of the gift. Later, I got an email from her that I printed out and will keep for the rest of my life: 

“I think you know this, but I wanted you to have a pencil from Andrew's workspace because I know you understand what it is like to have a brilliant mind besieged by illness or dulled by medication. Andrew's pencils remind me of the rich satisfaction he took from applying his mind, whether reading, doing academic work, devising a workout plan, or journaling. His mental energy was a beautiful thing–and something I recognize in you–and my intention is to celebrate that!”

While it is tragically too late to save Andrew, there are countless others who need hope and cannot wait for the results of randomized controlled trials to try a safe and potentially life saving metabolic treatment. This World Bipolar Day, with the urgency of the mental health crisis in the forefront of my mind, I will think of them and mourn the loss of Andrew to his family and the world at large. I will also focus on Julie and her admirable ability to celebrate others who are healing, even in the wake of her own devastating loss. My plan is to take Andrew’s pencil, and start drawing a portrait of him. I intend to work on it very slowly. I wouldn’t be surprised if it takes me more than a year. With ketogenic therapy, I experience a wonderful new type of creativity: instead of a boiling,  frenetic energy like in hypomania, it is calm and gently simmers over time. Every time I work on the drawing, I will be honoring Andrew's memory and thinking of the countless others who have lost their lives to mental illness. I will draw him meticulously and steadily, until every detail is captured, and until the pencil inevitably runs out.