How is a ketogenic diet complementary to psychotherapy?

ketogenic diet

The standard of care for mental disorders is medication and therapy. Even in what are considered to be primarily neurological conditions that are generally treated with medication, psychotherapy is always considered an excellent adjunct that improves outcomes for the patient.

For example, the American Psychological Association lists cognitive-behavioral therapy (CBT) as an evidence-based treatment for a variety of clinically significant disorders such as depression, anxiety, and substance use disorders. For primarily medication-based psychiatric disorders such as some eating disorders and psychotic disorders, CBT is used to assist with treatment and medication compliance. It is also recommended for normal life stressors people encounter that can become difficult to manage, such as issues in parenting, relationships, or life transitions.

In moderate to severe cases of psychiatric illness, medication with psychotherapy is the standard of care.

But what if you have tried medications. Possibly lots of them. And you didn’t respond well or the side effects made you more miserable than the disorder you came to get treatment for? What if you found that you had to take other medications to deal with the side effects of the medications you were already taking?

What if you found that your psychiatric medications were causing additional health problems, such as higher running blood sugars, weight gain, hormonal imbalances, and metabolic issues?

What if the medication only worked for a short period of time? And you made some progress in therapy but then you felt like you got stuck, and didn’t progress past a certain point of symptom relief you were hoping for?

What if you found it was really hard to make progress in psychotherapy because of some of the side effects of your psychiatric medications made it more difficult to think, concentrate, or practice mindfulness?

In moderate to severe cases of mental illness, we use medications adjunctively, in part, to make it easier to participate in psychotherapy. If medication is not working for you, and you are in psychotherapy, you may not be getting the full benefits of either.

As someone who practices psychotherapy AND helps people transition to ketogenic diets, for all the reasons above, I can tell you the work of psychotherapy is exponentially easier when your neurotransmitters are better balanced, you have less brain fog because of less brain inflammation, and your energy is up because you are burning ketones for fuel.

Evidence-based psychotherapy often has homework. Some of the best evidence-based treatments, such as CBT, require worksheets. There are behavioral homework assignments, such as taking walks or implementing sleep protocols. Psychotherapy is work! At least the psychotherapy I do. And as with all evidence-based psychotherapy treatments, outcomes can be better with prescription treatment. Or I would argue nutritional treatments that work as well or better than psychiatric medications available that clients have tried and found unhelpful.

How is this possible? Ketogenic diets affect multiple pathways found to be causal in the creation and maintenance of different brain-based disorders, whereas medications often are only able to influence one or two. You can learn about some of the ways ketogenic diets affect the brain in prior blog posts

Your practitioner should always make available to you the standard of care for your disorder. Always. But it is not ok for your practitioner to not discuss alternative therapies and provide real informed consent regarding your options for treating mental illness and neurological disorders. Sometimes your treatment team does not know about therapies like the ketogenic diet, or they have a belief it will not help, or that you will not be able to sustain it. Sometimes they believe you just wouldn’t be interested in trying it or changing your diet to feel better.

But it is not good practice for them to make these assumptions. Good care means a conversation with you about ALL the options that are showing benefit in the scientific literature. And the ketogenic diet for mental illness and neurological disorders is very much a treatment showing great promise, both in the study of underlying mechanisms and in published case studies. RCT’s using ketogenic diets for epilepsy are well established, and many RCTs for other disorders are in progress, for a variety of mental illnesses and neurological issues.

Do we have RCT’s showing that pairing psychotherapy with the ketogenic diet is as good or better than pairing psychotherapy with medication? Of course not! I am not sure who would pay for those studies, as implementing a ketogenic diet is not a profitable endeavor in our current healthcare model. I would love to see those studies be done, and I have great hope and optimism that they will be. But I see no reason for you to needlessly suffer waiting for the perfectly conducted and funded RCT before you can advocate for your treatment.

I can use my own clinical experiences and those of others who specifically use the ketogenic diet with populations with mental illness and neurological issues. And these clinical experiences report, that for those who adhere to the diet for at least 6 weeks there can be a remarkable improvement in a variety of symptoms.

You can also use your own logic. You may be struggling right now with depression and anxiety, but that does not mean that you are unable to make informed decisions regarding your care.

If we pay attention to the literature that is now suggesting that a ketogenic diet is a powerful intervention for many mental and neurological disorders, then why would we not use it with psychotherapy when attempts with medication have proven ineffective?

If you do not want to use psychiatric medications for whatever reason, or have not had positive experiences using medications, consider a ketogenic diet as a treatment for your illness or as an effective potential adjunct to evidence-based psychotherapy.

Are you already on medications? If you are on any medication at all, psychiatric or otherwise as you read this, please do not attempt a ketogenic diet or reduce or change your medications without the help of a prescriber.

In an ideal world, your treatment team would include a mental health professional and/or a nutritionist or health coach who is trained in ketogenic diets specifically and understand their effects on medications and psychiatric symptoms. They would provide the emotional and behavioral strategy support you deserve when making important lifestyle changes.

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