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Integrative Psychiatry

Ketogenic Diet: Indications in Psychiatry and Neurology By Marvin Singh, MD

By August 31, 2020No Comments

Nowadays the word diet is often used as a term to convey what we are eating instead of it being identified as a lifestyle. We want to make sure that diet is identified as being adaptable, adjustable, and personalized aiming for a variety of fresh organic foods, avoiding processed food and even looking at the type of water we are drinking in which details that filtered water is an important component of nutrition.

Just because it is a ketogenic diet doesn’t mean you have to eliminate vegetables and fruits out of the equation. The Ketogenic Diet is considered as a therapeutic diet serving a specific purpose. Although it has been sensationalized it has been present for almost 100 years and was even used to treat epilepsy in the 1920s.

The key concepts of diet and nutrition focuses on consuming low carb and low sugar fruit and vegetables. Considering doing dirty keto often times includes highly processed foods which is another form of Junk food which impacts the microbiome negatively.

Research have shown that Ketogenic Diet does change the microbiome in a way that a high fat diet alters the setting of the microbiome and that certain shifts can occur in a variety of different conditions which can be therapeutic in particular people.

FULL TRANSCRIPT:

We only use the word diet because that’s what we humans like to use as a term to convey what you’re eating, what it really is, is a lifestyle. So, we want to make sure that in the long run diet is adaptable, adjustable, and personalized. We want to aim for a variety of foods because it’s the variety that actually makes the microbiome stronger. We want fresh food that’s organic and not genetically modified, preferably avoiding the processed foods, fast foods, junk foods, even looking at the kind of water that you’re drinking. Filtered water actually is an important component of nutrition and we want to have plenty colorful vegetables and fruits. Don’t forget that just because you’re thinking and talking about the ketogenic diet. That doesn’t mean that vegetables and fruits are out of the equation they are still a very important part of the equation.

How does the ketogenic diet fit in all this? We want everybody to keep in mind that the ketogenic diet should be considered a therapeutic diet, a type of diet that serves a specific purpose. The ketogenic diet is not a new thing, it’s become more sensationalized lately, but it’s been around for almost 100 years now. In 1921 Russell Wilder used it to treat epilepsy. Ketogenic diet is where you’re shifting your metabolism from a glycolytic energy production to fatty acid beta oxidation and ketone body production.

The main cycle that we talk about is all about energy production. We’re eating different kinds of foods and the purpose is to create energies to create fuel. Glycolysis will convert sugar to pyruvate and ATP. These are kind of main ingredients in order to enter the Krebs cycle where you get fatty acids, and the Acetyl-CoA converts crosses into the blood brain barrier and goes into the mitochondria and directly goes into Krebs cycle so there’s a lot less steps involved.

What are some examples of keto friendly food? Focus on the low carb vegetables, Arugula, Spinach, your leafy greens, mushrooms, Broccoli, Zucchini, Brussel sprouts, Kale, Cabbage, all these you can still eat. You want to focus on fruits as this is where people get messed up a little bit. You want to focus on the fruits that are really the lowest sugar. So why is dirty keto bad for you? It often includes a lot of highly processed foods and it ends up being just another form of junk food. These can be very high in food additives and toxic chemicals, they often lack essential micronutrients and fiber and they can impact the gut microbiome negatively at the end of the day, we always want to come back to understanding what’s happening in the microbiome.

The ketogenic diet does change the microbiome. Plenty of research shows how the microbiome is altered in the setting of a high fat diet. When you’re thinking about the microbiome, and you’re thinking about how things affect the microbiome, even when you’re thinking about genes and how things affect your epigenetic expression of your genes, the theme is that the ketogenic diet does impact the microbiome and that certain shifts can occur in a variety of different conditions when the ketogenic diet is present and that these can be therapeutic in those particular people.

Remember again, the ketogenic diet is a therapeutic diet. We don’t really know if the ketogenic diet is good for 80 years. There are people that say they’ve been on a ketogenic diet for many years and they’re doing well, and that may be good for them, but that doesn’t mean that as good for you, it’s effects may be modulated by changes in the microbiome. There is certainly evidence in psychiatric and neurologic conditions. We definitely need more studies, particularly with humans as opposed to animals and we need better safety and efficacy, long term use, as mentioned, as well, it may not be for everyone. But it may also have a role as well. Just watch out for some of the withdrawal symptoms, the keto flu symptoms, and know that there are things that we can do to try to manage that accordingly.

Sara Reed, MS, LMFT

Sara Reed is a Licensed Marriage and Family Therapist and CEO of Mind’s iHealth Solutions, a digital health company that provides evidence based and culturally responsible mental health services for underserved groups. As a mental health futurist and clinical researcher, Sara examines the ways culture informs the way we diagnose and treat mental illness. Sara’s prior research work includes participation as a study therapist in psychedelic therapy research at Yale University and the University of Connecticut’s Health Center. Sara was the first Black therapist to provide MDMA-assisted psychotherapy in a clinical trial and continues to engage in ongoing advocacy work around health equity in psychedelic medicine.

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Jeffrey Guss, MD is a psychiatrist, psychoanalyst, and researcher with specializations in psychoanalytic therapy and the treatment of substance use disorders. He was Co-Principal Investigator and Director of Psychedelic Therapy Training for the NYU School of Medicine’s study on psychedelic-assisted psychotherapy in the treatment of cancer-related existential distress, which was published in Journal of Psychopharmacology, 2016. He currently is a study therapist in the NYU study on Psychedelic-Assisted therapy in the treatment of Alcoholism, a collaborator with Yale University’s study on psychedelic-assisted therapy for Major Depressive Disorder and a study therapist with the MAPS (Multidisciplinary Association for Psychedelic Studies) study on treatment of Post Traumatic Stress Disorder with Psychedelic-Assisted Psychotherapy. 

Dr. Guss is interested in the integration of psychedelic therapies with contemporary psychoanalytic theory and has published in Studies in Gender and Sexuality and Psychoanalysis, Culture and Society. He has published (with Elizabeth Nielson, PhD) a paper on “the influence of therapists’ first had experience with psychedelics on psychedelic-assisted psychotherapy research and therapist training” in The Journal of Psychedelic Studies, August, 2018. He is an Instructor and Mentor with the California Institute of Integral Studies’ Center for Psychedelic Therapies and Supervisor in NYU’s Fellowship in Addiction Psychiatry. 

Dr. Guss maintains a private practice in New York City.

Will Van Derveer, MD

Will Van Derveer, MD is Co-Founder of Integrative Psychiatry Institute and Integrative Psychiatry Centers. Dr. Van Derveer was co-investigator on a phase 2 MAPS study of Psychedelic-assisted psychotherapy for treatment-resistant PTSD, and co-authored the publication of this study in 2018. He has also provided Psychedelic-assisted psychotherapy in two MAPS training studies. An active provider of KAP at his clinic in Boulder, CO, he has been teaching others KAP therapy for several years. Dr. Van Derveer contributed a chapter on mescaline in the 2021 "Handbook of Medical Hallucinogens" (edited by Charles Grob and Jim Grigsby). He is co-host of the Higher Practice Podcast.

Dr. Van Derveer regards unresolved emotional trauma as the most significant under-recognized root cause of psychiatric symptoms in integrative psychiatry practice, along with gut issues, hormone imbalances, inflammation, mitochondrial dysfunction, and other functional medicine challenges. He is trained in Somatic Experiencing, EMDR, Internal Family Systems, and other psychotherapy techniques. His current clinical passion is psychedelic-assisted psychotherapy, which he mentors interested doctors in providing. An avid meditator, he has been a meditation instructor since 2004.

For the past several years Dr. Van Derveer has taught psychiatrists and other psychiatric providers integrative psychiatry in a number of settings, including course directing the CU psychiatry residents’ course as well as with Scott Shannon and Janet Settle at the Psychiatry MasterClass.


Scott has been a student of consciousness since his honors thesis on that topic at the University of Arizona in the 1970s under the tutelage of Dr. Andrew Weil. Following medical school, Scott studied Jungian therapy and acupuncture while working as a primary care physician in a rural area for four years. Psychedelic-assisted psychotherapy became a facet of his practice before this medicine was scheduled in 1985. He then completed a psychiatry residency at Columbia program in New York. Scott studied cross-cultural psychiatry and completed a child/adolescent psychiatry fellowship at the University of New Mexico.

In 2010 he founded Wholeness Center in Fort Collins. This innovative clinic provides cross-disciplinary evaluation and care for all mental health concerns. Scott serves as a site Principal Investigator and therapist for the Phase III trial of psychedelic-assisted psychotherapy for PTSD sponsored by (MAPS). He has also published numerous articles about his research on (CBD) in mental health. Currently, Scott works extensively with psychedelic-assisted-psychotherapy. He lectures all over the world to professional groups interested in a deeper look at mental health issues, safer tools, and a paradigm-shifting perspective about transformative care.

Will Van Derveer, MD is co-founder of Integrative Psychiatry Institute (IPI), along with friend and colleague Keith Kurlander, MA. He co-created IPI as an expression of what he stands for. First, that anyone can heal, and second that we medical providers must embrace our own healing journeys in order to fully command our potency as healers.

Dr. Van Derveer spent the last 20 years innovating and testing a comprehensive approach to addressing psychiatric challenges which transcends the conventional model he learned in medical school at Vanderbilt University and residency at University of Colorado, while deeply engaging his own healing path.

He founded the Integrative Psychiatric Healing Center in in 2001 in Boulder, CO, where he currently practices. Dr. Van Derveer regards unresolved emotional trauma as the most significant root cause of psychiatric symptoms in integrative psychiatry practice, along with gut issues, hormone imbalances, inflammation, mitochondrial dysfunction, and other functional medicine challenges. He is trained in Somatic Experiencing, EMDR, Internal Family Systems, and other psychotherapy techniques. His current clinical passion is psychedelic-assisted psychotherapy, which he mentors interested doctors in providing. An avid meditator, he has been a meditation instructor since 2004.

For the past several years Dr. Van Derveer has taught psychiatrists and other psychiatric providers integrative psychiatry in a number of settings, including course directing the CU psychiatry residents’ course as well as with Scott Shannon and Janet Settle at the Psychiatry MasterClass. In addition to his clinical work and teaching, he was co-investigator in 2016 a Phase II randomized clinical trial, sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS). He continues to support this protocol, now in a Phase III clinical trial under break-through designation by FDA.

Dr. Van Derveer is a diplomate of the American Board of Integrative and Holistic Medicine (ABoIHM) since 2013, and he was board certified in the first wave of diplomates of the new American Board of Integrative Medicine (ABIM) in 2016.