Ketogenic diets for mental health with Nicole Laurent
Welcome, hi, I'm Mikki and this is Mikkipedia, where I sit down and chat to doctors, professors, athletes, practitioners, and experts in their fields related to health, nutrition, fitness, and wellbeing, and I'm delighted that you're here.
Hey everyone, it's Mikki here. You're listening to Mikkipedia. And this week on the podcast, I speak to Nicole Laurent, a licensed mental health counselor who helps her clients use ketogenic diet therapy as a treatment for mental illness and neurological issues. Nicole first talks about her own personal health history, first with the chronic pain condition, trigeminal neuralgia, which then...
moved on into lasting negative impacts of pain medication long after she was off of it. And the chronic fatigue and the brain fatigue she got severely impacted her quality of life. Nicole subsequently found the ketogenic diet was able to fix the mitochondrial and metabolic dysfunction. And Nicole and I discussed the path that Nicole took to learning more about this to be able to help her clients after her success. This is such a great
conversation that I have with Nicole. Nicole is a licensed mental health counselor that helps people use ketogenic diet therapy as a treatment for mental illness and neurological issues. She uses a variety of nutritional and functional methods of treatment in her work and provides evidence-based psychotherapy modalities in adult client populations. In addition to specialized training and clinical skills including behavior therapy, cognitive behavioral
dialectical behavioral therapy and eye movement desensitization and reprocessing therapy, EMDR. She is trained in nutritional therapies for mental health and Nicole and I talk about the courses that she took to help her upskill in this area. Nicole is one of seven pioneers of metabolic psychiatry recognized by the Bazooka Brain Research Fund.
and the Milken Institute with the Metabolic Mind Award in 2022 and the Brains CREA Global Award winner in 2023. And she is well recognized in her field for the accomplishments in the area of mental health. Nicole is such a wealth of information and she provides so much free resource and she has courses as well. And you can find out more about Nicole and her work at mentalhealthketo.com.
And just since we're talking about Nicole's courses, in fact, Nicole has just created continuing education units for non-prescribing mental health types like psychologists, social workers, counsellors, etc. And while these may not be applicable, the education units in New Zealand or Australia, the information in the course will just help inform so many people in the space to then further help them.
help their clients. And this is called her courses, Metabolic Psychiatry for Non-Prescribers, Full Competency for Psychologists, Therapists, and Other Allied Health Professionals. And I'll just tell you a little bit about it. It's comprehensive training to provide an in-depth understanding of metabolic psychiatry, ketogenic diets, and their role in mental health. It's designed to equip non-prescribing professionals with the knowledge and skills to support clients using ketogenic diets therapeutically.
Importantly, the course will also provide a review of the latest research findings in this emerging field. Now, the online training for the course is scheduled for October 27, 2023. So that is in around about six weeks time. And we've got a link in the show notes as to how you can sign up to the course. And as I said, while the CEUs may not be applicable to the New Zealand Australian environment, the knowledge and information pertained within the course.
will be well worth your time and investment. Before we crack on into the interview, I'd just like to remind you that the best way to support the podcast is to hit the subscribe button on your favourite podcast listening platform. That increases the visibility of the podcast out there in amongst literally thousands of other podcasts, so more people get the opportunity to learn from the guests that I have on the show. For now though, please enjoy this interview that I have with Nicole Le Ron.
Nicole, thank you so much for taking the time to speak to me this morning, your afternoon. I'm really excited to talk to you. I've listened to so many of your podcasts and you always give such great information in and around the brain, ketogenic diets, and also of course, your own, not only your professional work, but your own sort of history as well. So
Can we kick off by you giving us a little bit of your background? Can you actually just start by introducing yourself and what you do? So I am a licensed mental health counselor in Washington state in the USA. And I've been in private practice for 16 years now and educated in different evidence-based modalities like cognitive behavioral therapy, EMDR, dialectical behavior therapy.
And I had last six years, I have been transitioning people to a ketogenic diet as a treatment for mental illness.
As I understand it, Nicole, you have a personal story that got you on this path. Can you give us a little bit of that background as well? Sure. So I was a graduate student in clinical psychology when I developed something called trigeminal neuralgia, which is face pain and migraines. I was getting daily migraines. There was some kind of nerve issue going on up in here, which was difficult.
to get to. And as a result of that, after doing all the things I was told to try to fix it, they gave up and they said you need to go on pain medication. And I was very nervous about that. And with good reason because long after that condition was fixed with a neurostimulator operation, I was still stuck on pain medications and the doctors could not get me off with a bridge medication.
very well. So they did eventually get me on a bridge medication, which for people who don't know when you are physically addicted, your body is physically addicted to opioids, there are bridge medications that they put you on to try to make that easier. And the promise was that you could then titrate down off those bridge medications easier. But the reality is that those bridge medications end up being much more difficult to get off of than even heroin.
So it's a big issue and a lot of people are stuck on bridge medications forever because they can't get them off. That last 0.25 milligram is almost impossible. So I found someone with an experimental protocol and I got off of it and it was a really awful process but I'm glad I did. But my brain was quite broken and my cognitive functioning was very low for me.
And when I think back on it, I met criteria for stage one Alzheimer's. I didn't have Alzheimer's, but my brain was that bad where I had the same symptoms as someone who had stage one Alzheimer's. And that's what eventually I heard a podcast with Dom DiAgostino talking about ketogenic diets for people with Alzheimer's and cognitive issues and the effects on brain health. And that got me going down that rabbit hole.
consuming every podcast I could find about it. And I tried one and my brain energy came back on and my brain started to heal from it. So amazing. And obviously we're going to pick up on the ketogenic diet side of things. I have a few questions just on your, on first of all, the inflammation of the nerve that caused the pain. Like how did that originate? How do you get that? Yeah, that nerve pain. Yeah. So, um,
You know, back then I didn't take very good care of myself. My my second child was born. I had had kind of a difficult pregnancy and thyroid issues. I'm sure I had metabolic disorder kind of going on. So inflammation was probably quite high in my body. You add a stressful situation like graduate school on top of that. And my narrative for what happened was I was reading too much because I was, you know, reading four hours a day like this. But it was.
the dark ages before you had the computer and you could like, you know, so I was, it was like this. And in my mind, that's what caused it. That's what started it and wrapped it up. But in an interview I had with Dom recently, he was like, no, I think it was a virus. So I had a, in my youth, I had a chronic fatigue syndrome and tested positive for CMV, which is
a virus that most people's immune systems, they keep it under control, but can reflare up. So he thinks that that might've been a component of it that nobody knew about or brought to my attention then. So it could have been multiple things. I don't think I ever am going to know what caused that. I suppose you're not. So interesting. And Nicole, so the neurostimulator fixed the pain, but your body was still addicted to the medication, to the drugs. So when you tried to come off, what happened?
Oh gosh. So I never, you know, there's a confusion in society about physical addiction and psychological addiction. I never had the psychological addiction piece, but when I, it's like the, it's the worst flu ever. So your guts are on fire. Like I don't know another way to describe it.
When you're on the bridge medication and when they put you on the bridge medication, there's a period of time in which that occurs. You just feel like you're dying. I don't know a better way to say it, but I think you can talk to anybody who has been through opioid withdrawals and I think they would agree with me. There's a little part of you that's like, I'm dying. I'm clearly dying. It's really bad. And your guts feel like it's on fire. Any pain that you had is worse because the
the neurotransmitter imbalance that's happening there, you can't eat. So it's really awful. And the bridge medications, here's the thing, they put you on the bridge medications. And when those bridge medications start to wear off, my experience that I had was I would feel like I would get the flu every day, every day. So I would wake up early in the morning, like the quality of life is really low on these medications. And I, and I, I'm
I think that doctors don't talk about that. And I think that patients just think this is the way it is and they don't complain about it. They just do the best they can with it. But your life really kind of revolves around. So I would wait, my alarm would go off in the dark. I would sit up, I would put it under my tongue and I would lay there and I would fall back asleep kind of elevated, cause you have to leave it under your tongue. And then I would wake up not feeling the flu. But when I first woke up, I woke up every day feeling nauseous. Then I would go to work for three hours.
And I would hurry home, I lived close to home because I felt sick. And I would hurry and I would lay down with my cat and put it under my tongue and wait to feel better. Sometimes I would nap, often I would nap because it makes you a little sleepy. Then I would get up, eat some lunch, and then go back to work for three hours. And then try to get home in time before I felt like I had the flu again. So it was...
It's a really dumb way to deal with it and it's a horrible thing to be stuck on. There are ramifications to these medications. There are hormone disruptors. They cause cognitive impairment, quite frankly. After over a decade of being on some form of opioid medication, whether it's the bridge or the ormorphine, my brain was not in a good place. Then you added on the detoxification protocol and I was just…
I was, my functioning was really, really low. Yeah. So Nicole, with your brain, was it the original, uh, nerve pain that you think caused a lot of the cognitive impairment? Actually, was it the everything that you did to try to resolve it? Everything I did to try to resolve it. Absolutely. So when I was in graduate school, as I was getting daily migraines and face pain and reading those books, I could read a chapter, think about what I read.
and literally visualize it on the page and see the page number. That was my level of cognitive functioning before I started these medications. And when I got done with them, after about 14 years of going through all this, I had stage one Alzheimer's symptoms level of cognitive dysfunction. And that's huge. Yeah. And, you know, like so many people who I speak to are as a nutritionist and they're on.
Um, you know, when you ask them about their medications, um, like a not in substantial percentage are on some sort of pain medication that they've been on for a decade and they're not even quite sure why they were put on it or why they're not on it, but it's just this like, uh, renewing prescription that is, that is on, like, I feel like, um,
It's quite, it's almost normalized to be on some sort of medication that might lead to some of the symptoms that you're talking about. Is that your experience or is, yeah? Yeah, absolutely. Yeah. Absolutely. So, as I said, I've listened to a number of your podcasts because they're amazing. And I know that you were at the time of sort of discovering the ketogenic diet. You were actually already on quite a sort of a paleo-ish.
whole food type approach. It wasn't like you were moving from the standard Western diet to a ketogenic diet. You had already sort of got to this point where your diet was very good anyway. Very clean. Yeah, very clean whole foods diet. And I was with a functional medicine person all those years. And I still declined to that level. But you know, one of the things I learned is I learned, you know, to avoid.
step processed foods and I cooked and or I should say my husband did most of the cooking because I wasn't well most of the time. But yeah, I was eating the quinoa, I was trying paleo, I was gluten-free, I was doing all those things and I was taking a good $500 worth of supplements every month trying to, you know, all the antioxidants, you know, trying to fix it.
That stuff did not work for me. Obviously, while I was on the confounding variable of a very powerful medication, I understand, but afterwards, I would have really hoped and thought that that would have been enough to kind of heal my brain. And it did not do the trick. It was not even close to what a ketogenic diet did for my cognition and for my brain energy and for so many other things that a ketogenic diet does that that functional medicine approach just didn't go near.
Yeah and so when you adopted a ketogenic approach there are of course there are a number of different types of ketogenic diets out there that the classical modified atkins. MCT type ketogenic diet what was your initial approach. Yeah so I remember so my initial report approach at that time it was just you know six years ago or so little bit more.
It was all about weight loss and so the advice was to use net carbs. And I tried a good month using net carbs. I remember I went to ruled.me for my macros, which is, you know, they've been around for a long time. So I went there and I got the chronometer out and I learned how to measure things, which was not easy with my brain as it was, but I did it. And I just have so much love for that woman.
back then trying to figure, you know what I mean? Like when I think about how severely impaired I was and I managed to get a scale and remember what it was I was even measuring and put it in the chronometer, like wow, you know. So yeah, so I used net carbs at first and what I felt, and now lots of people
On ketogenic diets for neurological issues, use net carbs. I know advanced ketogenic therapies, Beth and Denise, they are the dieticians for a lot of Chris Palmer's people and patients and they get great results with it. I know that they titrate them up and down accordingly, but I just could not get a sustained level of ketosis doing net.
So I fumbled around for about a month, not doing my electrolytes right, because you just really, unless you have someone hounding you about electrolytes, it's hard to remember to take them and to keep them up to the level you need, that's my experience. But I wasn't feeling good. And then I was like, I'm just gonna lower to 20 total. And that's when my lights came on. So I just did a classic keto, focused on keeping the protein in that range and.
Keeping the carbs low and I got to where I kind of needed to go right where I felt like I could feel my my brain feel better. Yeah so Nicole can you just for people who are unfamiliar with net carbs as a as a term versus total carbs are you able just to differentiate between the two and why why they make a difference. Yeah so I don't I don't know why they make a difference exactly I've heard I've heard some different theories that kind of make sense to me.
But, and like Eric Westman, for example, he uses 30 grams total carbs, which is actually, you know, very low still. So there's carbohydrates. So let's say I have a carrot. There is some carbohydrates in there that are fiber that we're told our body doesn't process as carbohydrates. We're told that that fiber goes through and that no carbohydrates are
absorbed from that intake of that fiber. And so if my carrot has five carbs and there's two grams of fiber in my carrot and I'm only counting net carbs, then I get to eat three grams of carbs, net carbs, or yeah, three grams of total carbs on my thing. So I get to eat more carbs if I'm net carb because I'm making the assumption that those net carbs, that fiber doesn't have any effect on my blood glucose.
I've heard that was not the case for me. And I don't know if it's people's levels of insulin resistance. I don't know if it's a gut microbiome issue where your body figures out how to make some kind of carbs out of it. I don't know what's going on there. I wish someone would tell me. But I find that with my patients and my clients and me when I want to get in a very, very low state, high level of ketosis, going total carb is the most reliable way to get there.
Yeah and Nicole what level of I assume you're measuring via blood ketones what level of ketones did you have a level of ketones which you recognize that your brain started to feel rescued from. Yeah so it's a little bit interesting because when you very first go on a ketogenic diet often your ketone levels are really high you're like oh my gosh.
four, five, right? They're really high and you feel great, but the longer you're on a ketogenic diet, the more your tissues adapt and the better able your body is to utilize ketones and so they just suck them all up in the blood. And so when you prick your finger, your ketone levels are lower, but you still feel really great. So early on, I really felt good at 3.0.
Yeah, 3.0 is where my brain felt like it was the most on I felt kind of the most calm. I felt great energy. I felt you feel kind of you know, when you improve your brain energy, your senses improve. I used to tease my husband and say I got my spider senses are on, you know, because my ketone levels were high. And maybe people in your audience can kind of you know.
I don't sound like a crazy person with that, but it's true. You notice it. So between 1.5 and 3 is where I felt best. And that's quite frankly what I see with my clients too. The therapeutic range is between 1 and 3 for general type of things, 3 to 5 for certain conditions. But most people feel better I think between 1.5 and 3. Yeah, awesome. And I want to get back to measuring ketones in a minute. But what I'm interested in, Nicole.
point of time where, because I'm not sure that you've mentioned it, how many years were you unwell from the medication before you discovered the ketogenic diet? I have not actually, I mean, it was about 14 years. I can't remember the exact kind of date. So there was, you know, the pain onset probably started about 2009.
I went on medication I think about probably in a year. I was really like trigeminal neuralgia is a very, like the wind will blow and you'll get, you know, these kind of this pain. So, and I was already stressed. My tolerance for distress was very low. I did not have the psychological tools to deal with that and go to graduate school and have children and do all the things I was doing. So I think I went on the pain medication.
Fairly quickly, I mean, they tried nerve blocks and physical therapy and all that. And then I was stuck on that morphine for quite a long time. And I, if I had to guess without finding a calendar, I was probably on the bridge medication a good five years where they would go through processes trying to get me off, having it fail.
And then giving up, well, we'll just keep you on there again for a while. And then we go for a while and we try again. Oh, well, that's not working either. We'll do that. I mean, I ended up in the emergency room. Like I'm so sick. I'm so sick. I don't know what's wrong. And seven days prior, they had done a bridge medication thing and that didn't take. And I didn't even make the connection, but the emergency room doctor did. And it was like, oh, that did not take. We have to, now we have to pump you full of morphine and you have to start all over again. So yeah.
Yeah. And I just can't imagine what a transformation it must have been for you and your family to see you come out of this brain fog and this haze that you were in to almost like blossom into the adult that you didn't get the opportunity to become because of all of that pain. Like it must have been quite surreal for you, obviously, but also those around you. Yeah. You know, it wasn't just, it wasn't just the.
the pain. So, um, so my whole life I had always been someone with kind of low energy overall. Um, I wasn't very athletic. I just kind of, I made the decision that that's just kind of who I was. I wasn't a high energy person. I could do activities, but I'd need to recover. I'm not good at this. I'm not good at that. Like I'm, you make these stories about who you are and what you're capable of. And when I look back,
on my young adulthood, early motherhood, I was not functioning. I wasn't able to even know what I was capable of. I had, I think, low-level anxiety that I just thought was normal because everyone else around me was kind of anxious, right? Yeah. And, but I think back, I think, I have great relationship
with my children. But I think I could have been a better mom if I had just unlocked, if I just had the right fuel for myself. I think everybody should get to try their brain on a ketogenic diet and see what happens. Because you might be a race car that runs on a totally different fuel and you don't know what you're capable of until you give yourself the right fuel and figuring out what that is.
Yeah, I wish that had been an option sooner. So yeah, I'm a very different person in a lot of ways. I mean, I'm still me, but I'm a much better version of me since I found this. This is a slight tangent, but I was listening on the radio this morning. There was a news release that the WHO had updated their carbohydrate guidelines.
and sort of reconfirmed that most people should be getting 40 to 70 percent of their dietary energy coming from carbohydrate. And I'm like, there's just no room for actual really important micronutrients if you push your carbohydrate intake to 70 percent. Because of all of the really important, as I understand it, nutrients for the brain come from animal protein and come from fat. So you're not going to get them in.
plants necessarily. And I just went on a whole, this is a bit of a tangent really, but I'm just, like it just surprises me that this is a recommendation, particularly given that than the high percentage of people who are metabolically unhealthy. So even if that wasn't appropriate guideline for a healthy population, which I don't think it is, it's like we're talking about a very, a minority of the Western world, like it's crazy that this is still the prevailing narrative in that diet space. Yeah.
I mean, and I, you know, I was, in all fairness, I was really trying to be healthy all those years. I was always trying to figure it out. I stopped eating red meat. We only ate chicken for a while. We increased the vegetables and we exercised on this, you know, bike. And we, my husband and I were always trying to figure it out, you know, why do I not feel good? What is going on here? And so I just have a lot of love and compassion for the people out there.
trying to do all the right things, trying to do what they're told and trying to figure it out. Don't give up. You're going to figure it out. So Nicole, with regards to electrolytes for yourself, because of course I want to talk about your practice with patients as well, with your clients. What level of electrolytes did you end up taking initially? Because you mentioned that it was difficult to get that balance right, and I see this all of the time with my clients. Yes.
Well, I did not know what I was doing back then. I was just doing the best I could. So I went down to the corner drugstore and I bought the magnesium oxide. And I had the little potassium, the little 99 milligrams potassium. And I tried to salt my food really good. And obviously that did not work. What I found helped me back then was I, and I, maybe I heard it on a podcast, maybe some, some kind soul said it out loud so I could get the information.
But I started to take a quarter teaspoon every few hours. And that, like, I would, you'd go on Facebook, like, I feel awful. And someone would be like, electrolytes. And they put up that meme, right? That's like this much magnesium, this much. And I go take this huge dose of magnesium oxide, trying to get it. And, and potassium. And then I would take the salt and I'm like, five grams. That's a whole teaspoon. I don't only, you know? And so I just started to do that. And then I started to feel a lot better.
But of course now it's still very similar. I have people take different forms of magnesium. I like a good magnesium by glycinate or another form is fine. And then I have them take a little bit of potassium. Not everybody feels good on potassium. Some people don't, you waste potassium the first two weeks and then it levels out. And some medications can actually inhibit your ability to excrete potassium.
You might even not want to take potassium on your ketogenic diet if you're taking a bunch of NSAIDs or certain medications. And then I just the salt every a quarter teaspoon, three to four times a day. And I find people just kind of level out and they just cruise right along. Yeah. I heard about electrolytes, I think from probably Rob Wolf actually on his Paleo solution. And now of course he's got the healthy rebellion.
podcast and he's also got the element formula, though I very much like that they still have in print like the actual recipe for elements. So if you're not wanting to sort of purchase their supplement, they give you the sort of recipe for the DIY to sort of do that, which I find really helpful. Nicole, how is your diet? So if you started on when you got all of the bits right and you want a classical sort of diet, how has your diet moved over the years? Like, have you had to stay at that level of a ketogenic diet?
have you been able to modify that slightly for your everyday? I have. I have. And people are often worried about that. Like, am I going to have to stay on this forever? And that's not our experience. So for many people. So yeah, I was very classic and I had to stay very classic for a good six months. And I started to kind of experiment. I was probably no more than 30 grams of carbs for a year, but I had a lot of neurodegeneration
And then at some point, you know, you add a few extra tomatoes or you, you know, and you measure like, Oh, I'm up to 40, I'm up to 50. How am I feeling? And I and I moved to that. So 40 to 60 grams total is kind of my sweet spot. And sometimes I go back down to 30 total. But I haven't had to had to have it that low and that restrictive. And there's been times when, you know, we've
I've gone out to dinner and I've guesstimated that it's probably been between 80 and 100. And I'm back actually in ketosis a few hours, about four hours later, two to four hours later. And so I think I developed a metabolic flexibility that I didn't have before. And so yeah, probably I eat about 40 to 60 grams total a day if I was going to start measuring again very carefully.
Yeah. And is that your experience with your clients as well, that they're able to sort of move from a very strict to a slightly less strict or is it quite individual? It's quite individual. But usually, and it's not just my experience as a clinician, it's also, they talk about it, clinicians who work with epilepsy patients that use very strict ketogenic diets for seizure control.
talk about how some of their patients can even just move into something called a low glycemic index ketogenic diet, where they may or may not be making ketones regularly and they still have seizure control. So brains heal often, often brains heal. So whatever is going on, I think improves on a ketogenic diet. And then there's a metabolic flexibility that kind of comes back a little bit that allows people to kind of go up in.
ketones. I'm sure there's people who have stayed very strict for a very long time and that is a fine option. But some people are absolutely able to change their carbohydrate intake and still feel good and still make gains in their brain function and how they're feeling. Now, would I be able to eat a can of Pringles potato chips and keep feeling great? I could
But so I mean again, are you going to be able to go back to your crappy diet that you were on that made you need a ketogenic to begin with? No, probably not. And you're probably not going to keep your gains long term. But maybe, I don't know. I wouldn't recommend trying it because feeling good is a nice thing. Yeah. Yeah, totally. Because it isn't just the level of fat in the diet, it's the micronutrients that those foods are bringing your brain, right? Yes, absolutely.
Yeah, absolutely. Nicole, I was at the metabolic health summit last year in May where Chris Palmer, I believe it was Chris and it might've been Eric, I'm gonna say Eric Vosser and I'm not sure if I've got his last name right, but they were talking about ketogenic diets for epilepsy and I found it remarkable that they were sharing case studies of babies who had hundreds of seizures a day and they were put on a ketogenic approach at about four or five months.
But it was only a ketogenic diet for six months and that healed and changed that brain metabolism at such a young age that then they showed a picture of a 16 year old girl who was the baby that they were talking about, completely healthy, hasn't needed a ketogenic approach because of that very early life sort of intervention, which is remarkable I think and really speaks to what you were talking about before with sometimes people just don't know how good they could feel.
because they've only ever felt a particular way. Obviously, you know, it scales, but I totally agree with that. Yeah. And it informs your sense of self. Yeah. How crappy you feel. Yeah. Informs your sense of self, and you create limitations on yourself based on that. And you don't even know that you could feel better. I had a functional, I had a functional, my functional person, my medicine person, I was in her office, and she said,
And at that point I had been on so many failed attempts to get me off those doggone bridge medications that I had just decided that I was gonna be on them the rest of my life. I didn't have any hope that I was gonna get off of them. And I was like, this is my function and this is who I am and it's good enough. And that's what happens when we're chronically ill. We go through phases where we are like, this is my reality, it is what it is, whatever. And she said,
We got to get you off of those. And I said, Keisha, her name is Keisha Ewers. I said, Keisha, I can't get off of them. They have tried, they have tried. And she said, she said something, I can't, again, I had such bad brain fog, I don't remember her exact words, but it was something like, you're just half of yourself. You're just, you don't even know. You're just a, not a shell. She didn't say shell, but her, and she was like, you're not all the way you type of thing. And she was, you know,
brilliant and intuitive and probably, you know, could kind of feel me in there trying to get out because that's what you feel like with brain fog. That's what you feel like with cognitive dysfunction. That's what you feel like on those medications. You feel like you're trying to get out all the time. You feel like you're trying to just participate in life. You feel like you're trying to feel your senses. You feel like you're trying to be emotionally present with someone that you care about because you know you need to be and you should and you really want to be and you can't.
the way but you're going to do your best and you're going to tell yourself you did your best because you did in that moment but um but yeah there's there's ramifications to to not feeling well and to allowing yourself to just be okay with it. Yeah Nicole you've mentioned brain fog and anxiety um is just a couple of the uh sort of conditions not that you've spoken about them with regards to your patients but just with yourself like do you
see either a low carbohydrate or a ketogenic diet as feasible options for people to explore if they have anxiety and or brain fog. Because I'm thinking of a bunch of perimenopausal women who come into that sort of stage of their life. And these are two of the most common things that they report. Yeah. Yeah. So I do. When I was creating my own... So I
did this work with people all the time in individual practice and I was creating an online version so I could help more people. And I was doing research and I was going into Facebook groups and trying to figure out who my people were that I wanted to reach out and how to message to them so they could find me. And I came across a Facebook group that was brain fogged.
women in brain fog and I was like, oh, that's my people. I'm going to join this group and I'm going to tell the, you know, I'm going to do some interviews and learn, learn about them. And I'm going to see, see if they want to know about my program ultimately. But when I got on there, that group was being ran by doctors that did HRT hormone replacement therapy and really only hormone replacement therapy. And that's what that whole group was about. And I thought, well, that's great if that helps them out.
But as I would go through my Facebook and do my thing, I would see these posts from these women that were like, I'm on HRT and I've been on it for two years and I guess we can't get the dosage right because my brain fog is awful and I'm so anxious. I just can't even function. And there's a reason for that. It's because HRT doesn't rescue brain energy. And if these women in their middle age have
have had insulin resistance develop in their brain where they can't utilize glucose efficiently for fuel anymore, giving them HRT is not going to do it. And so I see HRT as a useful tool to have and a useful thing to go to, but I don't think of it as root cause medicine for most women. Root cause medicine, when we look at the functional medicine tree, right, remember that little tree? And down here is the roots.
mitochondrial function is at the roots. And if your, your, if your mitochondrial function is not good and your mitochondria can't do the different jobs that it does for hormone production because it's not just an energy fuel for the cell, it does a lot of different important jobs, then that's not going to do the trick for you. So I get a little frustrated when I hear about functional medicine practitioners not addressing
the diet of the patient in a really meaningful way that allows them to save and rescue brain energy but they hand them an HRT. Now why am I upset by that? Because for a whole year these women have dealt with brain hypometabolism and that brain hypometabolism has driven downstream effects around neurodegeneration. And so these women have had one more extra year of neurodegeneration that they didn't need to have.
in their efforts in order to cure brain fog and the anxiety effects. Oh my goodness, there is nothing like a ketogenic diet for anxiety. So how does it stop seizures? It modifies the glutamate to GABA ratio. There's a lot of different factors and we don't know exactly how and why it does seizures. But here's what we think. We think it's because of these profound effects on the glutamate GABA system. Glutamate is this excitatory neurotransmitter.
And when your brain is making, when your brain is responding to what the environment is that you're creating in your body and your brain, let's say I have insulin resistance and my brain is just awash in glucose all the time, more than it wants, more than it can use, and it's causing neuroinflammation and I can't get any energy because my brain cells are not using that well anymore, right? So
What we find is that's an, that's a hostile environment in which to try to make neurotransmitters. And what ends up happening is glutamate goes through the roof, sometimes over a hundred times higher than it should be. And that is neurotoxic and it cannot be converted properly into GABA. What is GABA? GABA is an inhibitory neurotransmitter. It is, I always tell people, you've probably heard this on all my podcast. It is the chill. I've got this. I am not overwhelmed. I am not irritable.
I am in my body, I am present, I feel good. Like it's that neurotransmitter. And so, you know, what do we give people for mood stabilization? Gabapentin, but it's got a bunch of nasty side effects, you know, and it doesn't work very well. So, it's really, you know, I have a whole blog about ketogenic diets for mental illness and for mood symptoms. And yeah, I would...
I would, if I had a menopausal person in my office complaining of brain fog and anxiety, a ketogenic diet would be the first thing that I would bring out because that is a mitochondrial intervention. That is the root of the tree happening. And then if they still have some hormonal dysfunction, well, we would investigate that after. Yeah. And you know, I
I feel like a lot of the symptoms that people experience are normalized because they're so common. And it's just people expect to feel a certain way at a certain time of life, or they expect to this is removed from perimenopause and menopause. They expect to feel a certain way because someone in their family does like my mother's anxious so I'm going to be anxious. You know, it's that whole sort of narrative that you talked about earlier that we sort of tell ourselves.
after we sort of intervened and we didn't put her on a ketogenic diet, but we upped her protein, lowered her carbs a lot. And she came back a month later and said that her, she said, I thought I was an anxious person and I just haven't, haven't felt anxious at all this month. And even my massage therapist said that her tissues felt different. They didn't feel, she didn't feel so sort of strung out. Like
Diet is such a powerful intervention when you need it. And I feel like more people, people are aware of it, but the extent that you're talking about and the type of diet that you're talking about isn't probably as much on their radar as it should be. Yeah, I think people get, I think I've talked about this on podcast. I think people get confused about the difference between nutritional psychiatry and metabolic psychiatry. Yeah.
So yes, we can increase micronutrients by improving our diet. Certainly blueberries, and salmon are great for brains. We know this, but they're not going to save you from a brain hypometabolism going on. But they're good for your brain. You need some of those micronutrients in order to create energy and to improve mitochondrial function. And yes, you're in big trouble if you don't get them. Diet is very important. Ketogenic diets,
are something or a completely different banana. These are a fundamental shift in how the brain uses and makes energy. Are nutrients important in that? Yes, but that is not the therapeutic piece. It is the carbohydrate restriction that allows the ketones to be made that helps with this metabolic change. And this metabolic change is so much more powerful than blueberries and salmon that it can stop seizures in its tracks.
And there's case studies of where it has completely fixed psychotic disorders. My goodness, this is such a different level. And so when I hear people say, oh, I've tried diet before and I've watched what I've eaten and I've taken some vitamins and I've done these things, I'm saying, baby, you have not tried this. Yeah. This is a completely different intervention that you have not experienced before.
And so I just want to make sure your listeners kind of understand that there is a fundamental difference between these two concepts. Even though we talk about diet, we talk about nutrition, and that's huge. I love adding micronutrients to a ketogenic diet because I think about the ketones as like the construction workers and the extra micronutrients are all the building materials. And I like to put those, I don't know, there's no studies about that. Someone please do a study to prove me right if possible. But that's how I like to think about it.
So I'm a big fan of vitamins and supplements, and there's a lot of people out there that are like, ah, supplements, we just get it from our food, we should be eating lots of liver and lots of these things. You are not in a natural environment, you are in a manmade environment with lots of things that deplete your micronutrients, lots of assaults that you aren't even aware of, lots of hindrances to your liver's ability to do what it needs to do. Like if you're off living on a mountain type somewhere,
and you're not getting rainwater with pesticides in it, then great, eat your liver and be good about it. But for a lot of people, I think that those two together can be really brain saving and quality of life saving. I totally agree, because of course, the other prevailing narrative is that you can get everything you need from food. Dietitians, nutritionists, you hear them say it all the time. And I talk to people and people are like, oh no, I like to get all of my nutrients from my diet, because they say it, because they feel like it's a...
possibility and I have to inform them that that is just not even possible. You could do everything in your power to provide nutrients to your diet through food alone and even that wouldn't do it. Nicole, with regards to your patients, we talked about sodium as obviously being important and you did discuss magnesium. What are your recommendations around magnesium in a diet?
Well, your listeners probably know the magnesium content of foods in the soil is much lower than it used to be. There are different types of chemicals that we use in agricultural farming that chelate minerals further from the food supply. And so I think it's really difficult to get enough magnesium. And then if you're having a high carbohydrate diet, particularly standard American diet,
depleting diet because you need magnesium in order to turn glucose into energy. And so that that depletes that as well. So that is probably one of those nutrients that I think people absolutely should supplement. And it depends on what's going on. So in, you know, I work with a lot of people with cognitive dysfunction and brain issues. And when you look at the literature around magnesium, let's say for
Alzheimer's and mild cognitive impairment, it's quite a high dose that they find to be protective and helpful. It's like a thousand milligrams. It's really quite high. But if you're on a ketogenic diet, that is more of a magnesium sparing diet. And my people take anywhere between 200 milligrams a day. Like that's the minimum that I would say you got to take 200 milligrams a day is what I would. But between, you know, 200 to 800 is...
Somewhere is your sweet spot in there. Everybody's a little bit different for purposes. So yeah, I think that is one of the basic supplement needs that people really need to take. Yeah, and what about supplement? You mentioned that you, as you were sort of exploring your dietary options before landing on keto, you were taking a bunch of supplements, including antioxidants and things like that. Like there are a number of popular antioxidant supplements now.
like NAC and I don't know if NR would come under that, but what are your thoughts on supplements that help increase glutathione action or sulforaphane or something like that? Is that something that you'd recommend your clients take or have you found it from a brain energy perspective once they sort the diet that's not necessary as such? I know that in studies ketogenic diets have been shown to increase glutathione production. Yeah.
increase upregulate endogenous glutathione production. And the people I work with have brains that need to be healed. And so we use micronutrients, different nutrients generally to try to increase glutathione production even further because if you have, your body will make as much glutathione as you want or need as long as you have the materials available. So we definitely do that.
sometimes adding N-acetylcysteine, making sure that those micronutrients that are in the glutathione cycle are available in good amounts. So that's part of my program with phase three, we talk about how to detox and how to increase glutathione production because we have brain healing and that sort of thing. But I think that those can be very, very helpful. Are you going to save your brain by just...
throwing down a bunch of glycine and acetylcysteine and a bunch of micronutrients? No. And I think that that is a disservice that functional medicine practitioners maybe just don't understand yet fully, is that if you do not increase brain energy, those things are not going to be utilized appropriately or in a helpful way that actually works. You have to have the workers to do the repairs. And if you don't have that,
that stuff is not going to help people. And I think that bears out for a lot of people who do go into a functional medicine environment trying to feel better. They're a little better. They wonder, would I be worse if I wasn't doing this? But I don't think they're getting the results that they want. And so I think that brain energy piece is really crucial. Yeah, no, that makes perfect sense. Nicole, a number of, I don't know what it's like
Part of the world but but keto gets a bad rap particularly for women and obviously you work with people not just woman you work with with with everyone but i'm one of the issues that i hear. Is thyroid problems with a ketogenic diet like have you come across that in your practice or anything sort of contra indicating that might suggest that it is not a good idea. I have not so.
So we might see a reduction in T3 and we kind of have to watch it because as soon as that scene people want to adjust medications. What's theorized to be happening is that we just become more sensitive to our thyroid hormones and therefore our body is likely making less. I think that people come into ketogenic diets. So here's a whole other rabbit hole. I don't know if you want to go down this with me or not.
I'll mention it because it might be a rabbit hole that helps someone else find a way to feel better. I think that a lot of us are coming into ketogenic diets with thyroid problems because we are iodine insufficient or just starkly iodine deficient. We've had a couple babies, that's depleted our iodine store, we start to get thyroid problems. The medical establishment doesn't look at iodine levels in any way.
helpful or useful or thoughtful. Iodine is required by glandular tissues all through your body, not just your thyroid. Brain, glandular tissue. Breasts, glandular tissues. Overeas, testes, those are all glandular tissues. So I think that that is a huge missing piece in the low carb space is this understanding about that. Now if anybody wants to
go down that rabbit hole, there is a fantastic YouTube video with nutrition with Judy and Mary Riddick, R-I-D-D-I-C-K. There's also books about iodine with Dr. Brownstein, I believe it is. Brownstein, I think she has an interview with him also. You can kind of think about that. I use iodine as part of my supplementation.
and I have encouraged it with people, nobody's died, it's not a dangerous, dangerous thing. So that's a rabbit hole to go down if you're having thyroid issues. Also selenium, so again, if you are insufficient selenium that is required in order to convert thyroid hormones. That could be all it is. That could be the whole reason that you are having thyroid issues is you are not getting enough selenium.
Don't tell me you're eating a single Brazil nut or two Brazil nuts a day because there is a different amount of selenium in every single one of those Brazil nuts. So if you have thyroid issues, for goodness sakes, know how much selenium you're getting and test it from time to time because you don't want to get too high. But there's these insufficiencies that fuel this stuff that have nothing to do with the ketogenic diet that the ketogenic diet is being blamed for, I think. So I'm really interested in seeing additional research for that kind of stuff later on.
Yeah, that's such excellent points. And particularly, if I'm thinking about thyroid issues in women, like they, I mean, as we head into period, like our thyroid function starts diminishing as we age anyway, so that these things are just going to be exacerbated. If you're low, you're right. Nicole, with your patients, do you get them to measure blood ketones? Or have you found that something like...
The mojo, the keto mojo or some sort of breath ketone analyzer to be as efficacious or blood ketones is the way to go in your mind. I really like, well, you know, I that in my journey, I had the keto mojo and I found that really helpful. So for seizure control, the research shows, you know, because we're not going to make the babies prick their fingers every day. You know what I mean? Trying to check their ketones.
We often, if they're old enough, they use the breath ketones. And that actually correlates very well with blood ketones. So if you're not doing a ketogenic diet because you're afraid to prick your finger or you just don't like that, get a really good, like Biosense, I think is a good meter. You're gonna invest more money in it, but if that's worth it to you to not have to prick your fingers, that's great. But you don't get the glucose reading.
and that glucose reading with the blood ketone can actually be very helpful and provide you something called a GKI index. And for neurological issues, that is very valuable. You want it to or under. You want that GKI index to or under and that is where you divide one number into another and Keto-Mojo calculates it for you. I won't go into the math, but and you can look
That's a valuable mesh metric to get. Yeah. Um, and to have, and that's glucose to ketones. Isn't it the GK is glucose ketones. Yeah. No, that's perfect. Um, and Nicole, your educational background initially was in psychology, and but you're clinical psychology, clinical psychology, but of course you've upskilled into the nutrition space. Once you realized the, um,
how effective this sort of diet therapy was. What would be your recommendation for anyone who is interested in understanding more the role of diet with mental health disorders? I mean, obviously we are familiar, well, it's obvious to me, Chris Palmer in his book, Brain Energy is amazing, but for someone who wanted some more sort of formal training, what did you find most helpful? Yeah, so I went back and I got a,
postgraduate certificate from Maryland University of Integrative Health and Nutrition and Integrative Health. And there was nothing about ketogenic diets in there. It was just very kind of standard. So I was very frustrated and disappointed, but I had this piece of paper to say, I could give you advice on this and not get in trouble. So that was worth it. But if you wanna do ketogenic diets with people, I don't recommend them. I was in one of the first few trainings with Georgia Ede.
I took it and I didn't get CEU credits, but I wanted to learn how to do it. That was CMEs, CME accredited, but not for us therapist folk or psychology folks. And so I would take Georgia's less Georgia's AIDS training at diagnosisdiet.com. If you are interested in walking people through how to do ketogenic diets for mental illness or neurological disorders. It's wonderful. Wonderful. Now,
If you are a mental health clinician who wants to use this, wants to help patients with ketogenic diets, but you do not feel qualified or able to walk them through the dietary portion of it and the supplementation portion of it and that sort of thing, I actually, you are my first podcast, I'm talking about this on. This is exciting for me. I'm excited about this. So I am creating a
for non-prescribing mental health professionals, which includes psychologists, counselors, therapists, social workers, and other allied people. And it's going to be about how to support someone on a ketogenic diet. Amazing. And that's a huge topic all by itself. First of all, they have to come to us and have us be knowledgeable enough about the literature that we don't tell them they're gonna get an eating disorder. Yes.
We have to know the literature. We have to be able to not bring our own weird eating disorder stuff into session to manage our biases ethically. Let's say we are vegan and we think ketogenic diets cause all kinds of problems in the environment and are cruel, we gotta leave that out because the ketogenic diet could be someone's ticket to recovery. So it talks about that. It's gonna talk about
watching for potentiation effects. So mental health professionals, like counselors that get to meet with people every week are actually very, very helpful to our patients on ketogenic diets. Because every, and I say this loosely, every four to six weeks or so, or three months or two months, there's a worsening of symptoms that happens sometimes when people are on psychiatric medication.
And we think, oh no, this means the ketogenic diet is not working. They need to go and get some more medication or we need to stop this diet. When really what needs to happen is they need to lower their dose of their medication. They're getting side effects from their old dosage because their brain health has improved that much. And if they go and they're not aware that this, in my experience, very rarely do I have someone come to me unless it's their fourth time we've adjusted them or we've had them adjusted.
they're making the connection that they're having potentiation effects. So a mental health counselor that can be like, you were feeling pretty darn good for four weeks and all of a sudden there hasn't been an increase in your stress in life in general, but you are getting suicidal ideation or you were getting this or you were getting depression or you were getting mood symptoms. Let's talk to your psychiatrist or let's have you talk to your psychiatrist. Counselors are great at teaching people how to self advocate for themselves.
but they have to be on board and understand what's going on. So these are all the different ways and more, like how do you help someone rebuild their sense of self after a chronic mental illness when they have these deep grooves about what they're capable and not capable of that need to be rebuilt? So therapists and psychologists are uniquely able and...
skills. We've got all the skills that they need to make these dietary changes, these lifestyle changes. And quite frankly, I would say this paradigm in clinical psychology around nutrition or no nutrition, this absolute phobia about restriction, where we tell everyone that if they're restricting, they're going to get an eating disorder, is a huge barrier to metabolic
Because if I have a relationship with my therapist and I trust them and they warn me off of the ketogenic diet, I'm not gonna go there. So I see this ignorance in the clinical psychology field as big of an obstacle to people getting better as big pharma. Yeah, yeah. And it needs to be addressed. Awesome, and your course then, when are you launching that, Nicole? It's gonna be on October 27th. The date is set and it is,
NBCC, so in the States that's National Board Certified Counselors. And so people can get credit for that. I don't know about your country, but I'm happy if you help me get certified there, I'm happy to do one there as well. Yeah, amazing. And even just having that knowledge, you know, like it's like it's not you. This isn't common knowledge. So having more opportunities to learn CME or not for
I'm people in this field i think would be super helpful even the call even nutritionists because we don't know the stuff as you know you cuz you've done you know you i mean you you've you've done some qualifications in nutrition this isn't common knowledge and the prevailing narrative is that keto is a fringe diet if you like for rather than a very real option particularly because it's always sold as
being super hard, unsustainable, you know, like, it's almost like seed at the same time. Ketogenic diet is unsustainable was almost like what you hear is a truth rather than, you know, it's just, I don't know, an opinion. And I would challenge, I mean, I'm assuming that dieticians and nutritionists have ethical guidelines, to some degree.
And I would say that's an ethical issue because if you're telling someone that a ketogenic diet is unsustainable because you yourself have had an issue or you can't imagine not eating these things, that is not you managing your bias. That is not ethical practice. And I think that we need to use that word ethical more because it calls people on their baloney a lot quicker and it makes them think a lot quicker.
But we don't like to use the word ethics. We don't like to look at our behavior about whether we're being ethical or not. And I think that there's more discussion that needs to happen around that. Yeah, that's a great point, Nicole. Nicole, you are a wealth of information and I know I sent you through like a whole bunch of things to talk about and we probably only got about three of them discussed, but can you for the listeners tell us where
we can find out more about you and what you're up to in your practice. And of course, where they find your blogs and everything like that. Yeah, absolutely. So I have a blog called mentalhealthketo.com that talks about how ketogenic diets modify some of the underlying pathological mechanisms of many mental illnesses. It's not exhaustive. I still need to do that eating disorders one. I'm kind of waiting for more trial stuff to drop.
to make that better, but that is a great resource. So mentalhealthketo.com probably should be a go-to if you're considering ketogenic diets for mental illness as a treatment. So you can understand your scientific why. Why am I gonna do this? And understanding how it works. And they can learn about my online program. I have actually people in Australia and New Zealand in my online program.
that come to my Q&A's and stuff. And that's at mentalhealthketo.com. It's called Brain Fog Recovery Program. And there's people there with all kinds of different levels of cognitive issues and mood issues getting help in that format. And I really like that format. I think it's kind of superior because you've got the group of people going through it with you, which is nice. And let's see, I'm very active on Twitter, at Keto Counselor on Twitter.
And they can subscribe to the blog. Right now I have a little newsletter kind of going out weekly, but I do provide updates about different things there as well. Amazing. Um, Nicole, there was actually one last thing I was going to ask you when we were talking about ketones. Do you use continuous glucose monitors? I don't, but I do. I don't. I really love them for behavioral change though. So when I get like a...
When I get a client or a patient that is having a hard time with behavioral change and they just are not making the connection between what they ate two days ago with how crappy their brain feels later, I will have them get a continuous glucose monitor for a couple weeks or if they already have a diabetes diagnosis, I'll have them bug their doctor trying to get it paid for. But that is a huge behavior change tool.
that I will bring out if I cannot quite help them make that connection between their food and their carbohydrate intake and how it affects their neurotransmitter balance and how their brain feels. Yeah, that's how I see it as well. Super interesting. And that, you know, in your role as a clinical psychologist, like you are, you are all about behavior change, you know, that you've got all of those. Yeah, so great that you've got all of the skills and the tools available to be able to help with that.
Nicole, thank you. You have a wealth of information and I'm really looking forward to hearing more about your course. And I really thank you for your time today. The stuff you put out is so valuable. And so much of it is just out there for people to read and absorb, which is really great. So thank you so much. You're so welcome. Thank you for having me.
All right, team, hopefully you really enjoyed that. Such a fascinating conversation. And if you recall, I interviewed Dr. Chris Palmer about this time last year, actually, with his work in this space as a psychiatrist. And there are so many overlapping themes here. So we will pop a link in the show notes to that interview as well, in case you missed it. And next week on the podcast, I have returning guest, Darren Ellis.
strength and conditioning coach talking about getting into shape for the spring-summer season. And actually just the things that are important with regards to strength and conditioning. And I think you're really going to enjoy that interview too. All right team, any feedback, comments, questions, please don't hesitate to touch base, DM me over on Instagram and Twitter @mikkiwilliden, that's threads as well, Facebook @mikkiwillidennutrition
I am running my fat loss 101 mindset and metabolism course starting tomorrow Thursday. So there is still time to sign up. It runs for five days from Sunday through to the following Thursday. Would love to see you there. All right team, enjoy the rest of your day.