Nutrition Doc: Cognitive Dissonance and Ignorance of Ketogenic Nutrition
Anyone in Germany who has ever heard of nutritional medicine can’t avoid Matthias Riedl. His influence on what patients believe is possible is correspondingly large. He is part of, if not the face of, the well-known NDR series “Die Ernährungsdocs,” and a practising nutritional physician.
Episode 76 of the Ernährungs-Docs Podcast is about “Psyche and Nutrition.” (sorry, in german)
Throughout the episode, connections between nutrition and the psyche are mentioned repeatedly. Prominent: overweight and underweight, but also a great many other hormonal aspects.
My Context
I have been able to track the effects of the ketogenic diet on my own body, and not least my mental state (above all: focus) for almost 14 years, and wouldn’t want to do without these effects - and this without having previously suffered from any psychological symptoms.
Since 2012 I’ve been following the research around and application of ketogenic nutrition, which is reaching wider and wider circles. Initially popular mainly for weight loss, it now covers very many non-communicable diseases. These are increasingly being traced back to metabolism and nutrient supply - either as a cause or as a contributing factor.
In the psychological area, Metabolic Mind stands out: they have resources there for medical staff as well as patients, now with initial studies and for longer with plenty of anecdotal evidence: Case studies that beat drug treatments by a wide margin.
Conditions treatable with the ketogenic diet according to Metabolic Mind include disorders on the schizophrenic spectrum, bipolar disorder, depression, anorexia. For anxiety disorders and ADHD there is research and concrete results.
With this knowledge in the background, I recognised many of the situations and questions described in the mentioned podcast episode, and kept expecting ketogenic nutrition to be brought up by the nutritional physician as at least one dietary option.
Matthias Riedl on Ketogenic Nutrition in This Episode
From 42:00 in the episode, the discussion turns to ketogenic nutrition specifically for about 2 minutes.
Against the backdrop of having expected more optimism for a nutritional approach from the “posterboy” of German nutrition docs (I had actually expected him to bring up promising research himself), I was more than mildly shocked at the statements, which take hope away from the patients asking and the listeners, and discourage them from starting a ketogenic experiment.
It begins with the description of the ketogenic diet as
very very very low-carbohydrate nutrition, rich in fats and protein
and this statement alone took all my hope of an objective assessment. I am aware that I am criticising a trained doctor: this person, although well trained in this field, doesn’t even describe the absolute basics of the ketogenic diet correctly: ketogenic nutrition is rich in fat, but uses protein only in moderation. From an acknowledged nutrition expert, I really expected more.
Next comes
The problem with the ketogenic diet is simply the long-term aspect — most people don’t manage to implement it correctly on a lasting basis
Wherever he gets his information about the scale of “most people”, and even regardless of that scale: nutrition, unlike medication, can be considered side-effect-free. The experiment is cost-neutral for patients (they have to eat anyway).
And because the doctor presumes that patients won’t stick with it anyway, the remedy is completely discredited and not even considered.
Even if they only stick with it for a month and then relapse, they have the chance to experience changes in their symptoms after a very short time (some patients report days).
I myself have been following the ketogenic diet continuously for nearly 14 years, because I was so overwhelmed by the results that I didn’t even need lessening psychological symptoms as further motivation. The focus I’ve achieved, the clarity, and the sustained energy independent of blood sugar fluctuations are enough for me on their own.
We only have small studies […] it is highly controversial at the conferences to use it for depression or other indications
I’m not at those conferences, I don’t know which ones he means. But Matthias Riedl himself is very fond of arguing that nutritional therapy helps with many symptoms and conditions that “normal” medicine doesn’t connect with nutrition. Virtually all other episodes of the podcast and TV shows contain this wisdom.
Note the word choice: he explicitly says “controversial.” That means there are both proponents and opponents. He does not say “refuted.”
it can have consequences, it can have side effects, it’s difficult to carry out, it’s not particularly good for quality of life
Some consequences come to mind — independent of psychological symptoms: clarity, sustained energy, no brain fog. Those are also the side effects that come to mind. I’d be curious what other side effects he is thinking of. Especially compared to the documented side effects of the usual medication for psychiatric conditions.
Let alone the lack of quality of life caused by the underlying psychiatric condition.
And finally I find it presumptuous to want to judge patients’ quality of life without giving them the option themselves. An alternative would be to let those affected choose: “Do you prefer the current medication, or would you also be willing to try a diet that in some cases has shown that one can completely do without the medication?”. Even if controversial.
Many patients would be grateful if they were shown ways in which they can under certain circumstances contribute to reducing symptoms from their own resources (I won’t even say ‘healing’).
“What would you prefer? Medication-induced brain fog…” (one of the usual side effects) “…or a diet that sometimes requires a little explanation in social situations?” (…those explanations you can give with a clear head)
First, Do No Harm!
Primum non nocere is a principle of medical ethics.
First Do No Harm is the title of a film (1) depicting the real-life situation of a child with epileptic seizures. The child’s doctors were on the verge of performing brain surgery, in which several neural pathways would have been severed, because they hadn’t even mentioned the ketogenic diet to the parents as an option — it was “too difficult and not maintainable long-term.”
By now (as Matthias Riedl also notes in the short clip) the ketogenic diet is explicitly recognised as very helpful in treating epileptic seizures.
The Charlie Foundation writes (2) :
In 1993, 11 month old Charlie Abrahams developed difficult to control epilepsy. As a last resort, while Charlie was experiencing multiple daily seizures and multiple daily medications, his parents turned to a Ketogenic Diet for help. The diet worked. Charlie became seizure and drug free within a month. He was on the diet for five years and now eats whatever he wants. He has never had another seizure.
and on further research
New applications of the Ketogenic Diet for cancer, autism, ALS, Parkinson’s Disease, type-2 diabetes, and traumatic brain injury have emerged. Scientific data regarding these new uses of diet therapy is accumulating rapidly. Variations of the Ketogenic Diet for these other disorders are being developed. Today, it is the Charlie Foundation’s expanded mission not only to champion Ketogenic Diet therapy for epilepsy, but provide up-to-date information regarding its expanded use and variations. To this end we have re-named ourselves “The Charlie Foundation for Ketogenic Therapies”.
The Cognitive Dissonance
Directly after this ketogenic misstep, Riedl confirms the connection with sugar:
of course there’s a connection between psychological wellbeing and sugar consumption. And anyone who has done a sugar challenge and moved away from it will notice ‘Hey, I’m actually much more vital’
Any nutritional physician should know what the body considers “sugar”: everything that significantly raises blood sugar levels. Or to put it briefly: everything that arrives in the small intestine as sugar (glucose) is sugar as far as the body is concerned. In other words: carbohydrates, whether “complex” or “simple.”
Let’s compare 100g of “complex” and 100g of “simple” carbohydrates, and how they arrive in the digestive tract:
A ketogenic diet that reduces carbohydrates to a minimum is a radical — if not the ultimate — sugar reduction. Which is, in the end, exactly what he recommends.
Conclusion
Admittedly, I had suspected that Matthias Riedl doesn’t think much of ketogenic nutrition. But that he doesn’t even correctly reproduce the absolute basics (High-Fat-Moderate-Protein), let alone know the more recent research on it, characterises it as merely “controversial,” discredits it, and denies patients the stamina to try it: That does shock me.
Informed patients (3) are thereby denied an important option they need in order to make their choice.