What path should I take? Nutrition for mental health, keto diet, and metabolic therapies.

[sillysausage333]

Hi guys, I'm wondering how I can combine both of my interests of mental health and nutrition. I am interested in the treatment of more severe mental health issues such as bipolar spectrum disorders and schizo-type disorders. I have been doing some reading on the keto diet and metabolic psychiatry, I'm wondering how I can do what a metabolic psychiatrist does without going to med school. I dont necessarily want to prescribe medications. I'm mostly interested in the diet and metabolism part for the treatment of bipolar and schizo spectrum disorders. Maybe I can work alongside a psychiatrist for medication management for my client? I am more than willing to get my doctorate in other areas, the idea of going into med school seems horrifying to me. For some background I am a recent graduate with a dual degree in psychology and neuroscience and have planned my life to become a clinical psychologist until recently when I discovered the amazingness of nutrition and metabolism therapies for severe mental illness. Any honest advice is more than appreciated!

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[brazilianpsych]

I don't know how to explain this nicely, but I think your idea is very out of touch and not grounded in reality. I cannot see it working or being realistic. Who would pay for that? Are you going to charge cash? I am assuming insurance won't pay for a psychologist to give diet advice.

 

[Bartelby]

It sounds to me like career choices that could make sense include:

- being a nutritionist and counseling patients about diet. You would probably want to serve a larger segment of the population than just seriously mentally ill patients, it would likely be hard to fill a practice with only SMI patients seeking nutritional advice.
- become a researcher. Earn a doctoral degree and do research on nutrition, including the ways in which dietary choices can benefit people with mental illness.

Being a psychiatrist who limits themself to only counseling patients about nutrition does not make sense. If you do want to be a physician, though, you could be a psychiatrist who uses diet and exercise as two more tools in your toolbox. I talk about exercise with patients every clinic day, and I often provide dietary advice too. This is only one small slice of good psychiatric practice though.

 

[sillysausage333]

I don't know how to explain this nicely, but I think your idea is very out of touch and not grounded in reality. I cannot see it working or being realistic. Who would pay for that? Are you going to charge cash? I am assuming insurance won't pay for a psychologist to give diet advice.

Sorry I didn’t make myself clear. I typed that up fast. Nutritional psychology is a thing with the right certifications. I know a few PhDs and PsyDs who have added certifications that help with diet and other lifestyle changes. The thing is I don’t think they deal with the more severe population, more just general advice… I think. So I was wondering if it would make more sense for me to go to dietetics school to learn about keto and metabolism to help aid in the treatment for more extreme mental health issues instead since it’s such a new and emerging area! Here’s some links to what I’m talking about Sleep, mood disorders, and the ketogenic diet: potential therapeutic targets for bipolar disorder and schizophrenia. Pilot study shows ketogenic diet improves severe mental illness

Metabolic Psychiatry

www.metabolicpsychiatry.com

 

[sillysausage333]

It sounds to me like career choices that could make sense include:

- being a nutritionist and counseling patients about diet. You would probably want to serve a larger segment of the population than just seriously mentally ill patients, it would likely be hard to fill a practice with only SMI patients seeking nutritional advice.
- become a researcher. Earn a doctoral degree and do research on nutrition, including the ways in which dietary choices can benefit people with mental illness.

Being a psychiatrist who limits themself to only counseling patients about nutrition does not make sense. If you do want to be a physician, though, you could be a psychiatrist who uses diet and exercise as two more tools in your toolbox. I talk about exercise with patients every clinic day, and I often provide dietary advice too. This is only one small slice of good psychiatric practice though.

Yes, I would likely serve other people too. I’ve always been told it’s good to have a niche. There’s a lot of talk recently about this type of treatment for SMI patients. Still in the early stages of this research but it looks promising! In the future it will be big I feel. Thank you for your advice!

 

[TexasPhysician]

I discuss diet with the vast majority of my patients. The majority do not want to discuss it long. I once went as far as contracting a dietician for current patients that might be interested. Despite advising many and advertising to current patients, a total of 0 patients scheduled. I ended the contract.

While I believe a healthy diet plays a role in our daily well-being, patients rarely seem to take this seriously. Convincing those with psychosis is exponentially harder. Long acting injectables exist because patients can’t consistently take a single pill daily. Instead of convincing someone to take a single pill, you are talking about convincing them to change their grocery shopping habits, daily eating habits, and how they evaluate menus in restaurants. That is orders of magnitudes more difficult.

Another potential problem is that there is a new medication class on the horizon for psychosis that will effect metabolics significantly less. I’d expect this to be around by the time you finish school. GLP-1’s are becoming more common, and I expect them to be started by psychiatrists more commonly at some point in the future as ease of administration improves.

If your goal is to be a dietician, I think that is great. Try to accumulate whatever patients you prefer to work with, but keep in mind that this won’t be an easy niche to obtain patients. This is likely one of the most difficult populations to obtain.

Other area of study to consider is researching the psychology of food and what compels someone to manage their diet better. Alternatively become a counselor that utilizes CBT and other behavioral strategies to help convince patients that diet and a healthy lifestyle should play a more strategic role in their life.

 

[thelastpsych]

This type of focus is best served in research, where you can hone in on a specific area such as metabolic psychiatry. In clinical practice, that would be a very small part of your routine, even if you pivot for it.

Another interesting path as TexasPhysician noticed would be as a psychotherapist working with patients with eating disorders, but the focus would not be so much on the metabolic side, and more on the behavorial, so I dont know if it would scratch that itch for you.

Why dont you look around for combined MD-PHD programs? These are very much made for physician scientists. The downside is the longer training, you have to REALLY like it.

 

[calvnandhobbs68]

As others have noted OP, this is really essentially an area of research right now...that link you link to at Stanford is primarily a research department which is currently enrolling clinical trials to study these things. It's not fully established.

Clinical Trials — Metabolic Psychiatry

www.metabolicpsychiatry.com

I also think the original post here is that mindset I see a lot from other people where they simply what we do into psychiatrists are just there for "medication management" and must not do anything else with their patients. As @TexasPhysician alluded to, a lot of us do discuss diet, sleep, lifestyle factors with patients. The issue is that they just don't want to do anything about it. I can count on one hand the number of people who have actually returned a sleep diary to me when they come in complaining about their "insomnia" all the time. Same thing applies for keeping track of diet and making any actual sustained changes. Most of this is actually behavioral, there's a zillion resources on how to shop for a keto diet or Mediterranean diet, the actual difficulty is sticking with this. Neurology (especially peds neurology) clinics are very familiar with the intensive monitoring you have to do to make sure their patients are staying in ketosis for seizure disorders.

 

[sloh]

Hi guys, I'm wondering how I can combine both of my interests of mental health and nutrition. I am interested in the treatment of more severe mental health issues such as bipolar spectrum disorders and schizo-type disorders. I have been doing some reading on the keto diet and metabolic psychiatry, I'm wondering how I can do what a metabolic psychiatrist does without going to med school. I dont necessarily want to prescribe medications. I'm mostly interested in the diet and metabolism part for the treatment of bipolar and schizo spectrum disorders. Maybe I can work alongside a psychiatrist for medication management for my client? I am more than willing to get my doctorate in other areas, the idea of going into med school seems horrifying to me. For some background I am a recent graduate with a dual degree in psychology and neuroscience and have planned my life to become a clinical psychologist until recently when I discovered the amazingness of nutrition and metabolism therapies for severe mental illness. Any honest advice is more than appreciated!

Do you actually want to make money and get paid?

 

[smalltownpsych]

A belief in “metabolic psychiatry” without solid research is dangerous. Our patients and their families are desperate for answers and vulnerable to following trends like this to their own detriment. I have two cases with multiple hospitalizations and aggressive behavior directly tied to family’s insistence that the keto diet will cure schizophrenia. I second the responses that if this is your area of interest, research it.

Edit to add: Just to clarify, the aggression appeared to be linked more toward frustration with not being able to eat what they want than the diet itself. Would also need research to look at that though.

 

[Merovinge]

A belief in “metabolic psychiatry” without solid research is dangerous. Our patients and their families are desperate for answers and vulnerable to following trends like this to their own detriment. I have two cases with multiple hospitalizations and aggressive behavior directly tied to family’s insistence that the keto diet will cure schizophrenia. I second the responses that if this is your area of interest, research it.

Edit to add: Just to clarify, the aggression appeared to be linked more toward frustration with not being able to eat what they want than the diet itself. Would also need research to look at that though.

Absolutely, just because Harvard and Stanford have a few people talking this up a bunch it gets into the zeitgeist. Not only am I almost certain the results of good science will show it to be far less effective than its current pundits are hoping for, setting the bar for a ketogenic diet for someone dealing with SMI is just so laughable and out of touch with reality. My frontal cortex, statistically speaking, is in at least in the top 1% and I don't think I could sustain it for any extended period of time.

Schizophrenia is an awful illness. I will never forget on one of my ACT team experiences (was lucky enough to do this in both med school and residency), seeing a man get close to tears because he got a dollar store bottle of body wash. He had never had his own bottle of body wash before because apparently all the intuitions he has been in only gave out bar soap. A few weeks later he had to be hospitalized because he was trying to attack demons (the demons were, in fact, people).

 

[comp1]

The OP is going to elicit some very strong feelings. Nutrition as a concept is grossly abused for financial gain. I would go so far as to say that most, although certainly not all, people who make nutritional claims related to some illness outside of clear metabolic conditions like diabetes and heart disease, do so with essentially no evidence and make a very tidy profit doing so. I concur with others that this solely an area of research. It is not clinical practice, nor is it likely to become so during the OP's education. There is no evidence based diet to treat psychotic disorders. There are some to treat certain forms of epilepsy, but this is extremely different. Even if such a diet did exist, implementing it would be massively challenging outside of institutional facilities that have all but been eliminated. What I think I'm most interested in what experience the OP had that made them think there were in fact nutritional interventions that had any significant impact on psychotic disorders in practice.

 

[Ironspy]

Also at least in the US, many people with SMI live in poverty and often in group home. Their access to nutritious food is limited by $$ and their ability to adhere to keto will not improve with “education “

There are research studies looking at dietary and exercise approaches to help manage SMI that look very promising. However without big pharma money and insurance coverage for healthy food I don’t see how it would be scalable in our current system

The main market clinically for nutritional psychiatry is high functioning patients with mood, anxiety, sleep, attention issues and I do a lot of this type of work with moderate success

 

[Candidate2017]

I have been doing some reading on the keto diet and metabolic psychiatry, I'm wondering how I can do what a metabolic psychiatrist does without going to med school.

I am more than willing to get my doctorate in other areas, the idea of going into med school seems horrifying to me.

So ya wanna do doctor things without having to do pesky medical school and residency? I suggest stopping by the midlevel or social worker forums.

For some background I am a recent graduate with a dual degree in psychology and neuroscience and have planned my life to become a clinical psychologist until recently when I discovered the amazingness of nutrition and metabolism therapies for severe mental illness. Any honest advice is more than appreciated!

Don't keep the amazingness to yourself. Run down to skid row and toss fresh legumes to everyone you see responding to internal stimuli. But do this to only one side of the street because the other side will be the control.

Here’s some links to what I’m talking about Sleep, mood disorders, and the togenic diet: potential therapeutic targets for bipolar disorder and schizophrenia. Pilot study shows ketogenic diet improves se

Hmm, I've never heard about diet and nutrition affecting mental health. I don't think most psychiatrists are aware. Honestly, we don't have time to keep up with the science, or even listen to patients, because we sling pills all day long, especially the expensive useless ones for which Big Pharma lucratively pays us to push.

I discuss diet with the vast majority of my patients. The majority do not want to discuss it long. I once went as far as contracting a dietician for current patients that might be interested. Despite advising many and advertising to current patients, a total of 0 patients scheduled. I ended the contract.

You're doing it wrong.

Many patients are extremely interested in learning how incorporate cannabis into their diet.

 

[thelastpsych]

My frontal cortex, statistically speaking, is in at least in the top 1% and I don't think I could sustain it for any extended period of time.

"To be fair, you have to have to have a frontal cortex in the top 1% to understand metabolic psychiatry..."

 

[smalltownpsych]

I am concerned that research methods was not covered better in the two undergrad degrees. If OP continues on with their education, I sincerely hope that they get education on this so that they are not susceptible to the overpromising of slick salesmen. If not, they will be just one more person adding to the long history of sham treatments that take advantage of the vulnerable. If you want to find out about neuroscience and behavior start looking at the neurobiological underpinnings of emotional regulation and interpersonal connections. There is way more exciting information to be found in that than chasing nutritional rainbows in my mind.

 

[R. Matey]

I am concerned that research methods was not covered better in the two undergrad degrees. If OP continues on with their education, I sincerely hope that they get education on this so that they are not susceptible to the overpromising of slick salesmen. If not, they will be just one more person adding to the long history of sham treatments that take advantage of the vulnerable. If you want to find out about neuroscience and behavior start looking at the neurobiological underpinnings of emotional regulation and interpersonal connections. There is way more exciting information to be found in that than chasing nutritional rainbows in my mind.

Yeah, novelty bias is a big problem in our field. I'm not sure that undergrad methods courses do a great job of covering it.

 

[Merovinge]

I am concerned that research methods was not covered better in the two undergrad degrees. If OP continues on with their education, I sincerely hope that they get education on this so that they are not susceptible to the overpromising of slick salesmen. If not, they will be just one more person adding to the long history of sham treatments that take advantage of the vulnerable. If you want to find out about neuroscience and behavior start looking at the neurobiological underpinnings of emotional regulation and interpersonal connections. There is way more exciting information to be found in that than chasing nutritional rainbows in my mind.

Not to excuse anyone with a BS in psychology from a reputable school from not having research methods well understood (as psychology almost certainly teaches research methods better than any other degree, except maybe econ if you go to UofC and get to learn from John List), but again this is being spouted off by folks actively running labs at Harvard and Stanford and going onto high profile podcasts. If I was 22 and hearing that the literal top programs in the country had labs doing this and people were speaking about it, I would be influenced as well.

 

[R. Matey]

Not to excuse anyone with a BS in psychology from a reputable school from not having research methods well understood (as psychology almost certainly teaches research methods better than any other degree, except maybe econ if you go to UofC and get to learn from John List), but again this is being spouted off by folks actively running labs at Harvard and Stanford and going onto high profile podcasts. If I was 22 and hearing that the literal top programs in the country had labs doing this and people were speaking about it, I would be influenced as well.

Fair point. It's easy to be caught up in the rhetoric of a researcher hyping up their program, no matter how clinically actionable it may or may not be. Even more so when they come from a reputable institution. I mean, how much money did Amy Cuddy make on power posing? How many books did Angela Duckworth sell before grit was shown to be essentially no different than conscientiousness? Even if concepts like validity and researcher biases are covered, it's probably asking a lot of undergrads to put those pieces together for themselves.

 

[aim-agm]

Also at least in the US, many people with SMI live in poverty and often in group home. Their access to nutritious food is limited by $$ and their ability to adhere to keto will not improve with “education “

Keto diet is also much more expensive - carbs can be very cheap (beans,rice), protein not so much.

 

[sloh]

Stop listening to Huberman!

 

[Merovinge]

Stop listening to Huberman!

I have to listen to him a bit so I know what information my patients are taking in!

 

[sloh]

I have to listen to him a bit so I know what information my patients are taking in!

I think each episode is like 3 hours long. Don’t waste too much time haha. Your brain might melt

 

[Merovinge]

I think each episode is like 3 hours long. Don’t waste too much time haha. Your brain might melt

I listen to him on 2x speed, 1.5x speed for the podcasters I like. I sometimes skip ahead on his too .

 

[annoyedpsychiatrist]

Hi guys, I'm wondering how I can combine both of my interests of mental health and nutrition. I am interested in the treatment of more severe mental health issues such as bipolar spectrum disorders and schizo-type disorders. I have been doing some reading on the keto diet and metabolic psychiatry, I'm wondering how I can do what a metabolic psychiatrist does without going to med school. I dont necessarily want to prescribe medications. I'm mostly interested in the diet and metabolism part for the treatment of bipolar and schizo spectrum disorders. Maybe I can work alongside a psychiatrist for medication management for my client? I am more than willing to get my doctorate in other areas, the idea of going into med school seems horrifying to me. For some background I am a recent graduate with a dual degree in psychology and neuroscience and have planned my life to become a clinical psychologist until recently when I discovered the amazingness of nutrition and metabolism therapies for severe mental illness. Any honest advice is more than appreciated!

it seems youre interested in nutrition as a whole, then perhaps your best bet would be a registered dietician, as that is a graduate type program that is highly valid and they work in most hospitals and in many clinics. Nutritionist is often a title earned by instagram influencers through questionable online degrees, while registered deitician is a valid pathway of training