Dr. Calogero (Carlo) Longhitano is an Associate Professor of Psychiatry at James Cook University and a psychiatrist at North Queensland Forensic MH Services. He obtained his MD in 1999 (Italy) before completing his psychiatric residency in Oxford and London (United Kingdom).

Dr. Longhitano has held senior positions in forensic psychiatry across London and Townsville, Australia. Since 2019 he has collaborated with Prof. Zoltan Sarnyai, leading to a PhD project on the effects of nutritional interventions in psychosis. He is the co-investigator at JCU’s randomised clinical trial of ketogenic diet vs standard diet in adults with bipolar disorder and schizophrenia. The project is supported and funded by the US-based Baszucki Brain Research Foundation.

Additionally, Carlo is a member of the forensic faculty of the RANZCP and an Early Career committee member of the International Society for Nutritional Psychiatry Research. He is the author of several peer-reviewed articles and two textbook chapters.

https://youtu.be/gmPuwG4tUig

summerizer

Thesis and framing

  • Serious mental disorders have a metabolic component, including impaired bioenergetics.
  • Ketogenic metabolic therapy uses dietary carbohydrate restriction to induce nutritional ketosis.
  • Mitochondrial function and brain energy metabolism connect metabolic and psychiatric conditions.

Historical and evolutionary context for ketosis

  • Fasting can induce nutritional ketosis.
  • Long-duration fasting is used as historical precedent for ketosis-based treatment.
  • A shift from traditional diets to modern processed diets is linked to a higher metabolic disease burden.
  • Ketosis is positioned as a backup metabolic pathway when glucose availability is low.
  • “Cancer without sugar the tumor can’t really grow” is stated.

History of ketogenic diet in neurology

  • Early ketogenic-diet work at the Mayo Clinic is referenced.
  • Wilder is referenced for early ketogenic diet use in epilepsy.
  • A report is referenced in which ~75% of infants with refractory epilepsy stopped “fitting” on a no-sugar/no-carbohydrate diet.
  • Expansion of antiepileptic medications is linked to a decline in ketogenic diet use.
  • Ketogenic therapy is extended (in scope) from epilepsy to cancer, dementia, and psychiatric contexts.

Metabolic–psychiatric overlap in schizophrenia and psychosis

  • Insulin shock/coma therapy is referenced as historical psychiatric treatment.
  • Insulin shock therapy observations include higher insulin dose requirements in schizophrenia.
  • A 2019 Harvard/McLean sibling study is referenced for insulin resistance in psychosis.
  • Insulin resistance is linked to psychotic disorders in sibling/unaffected-family findings.
  • Antipsychotic metabolic side effects are separated from intrinsic metabolic abnormalities in psychosis.

Metabolic–psychiatric overlap in bipolar disorder

  • Historical observations are referenced for metabolic abnormalities in bipolar disorder.
  • Kinal (2014) is referenced for insulin resistance in the brain in bipolar disorder.
  • Insulin resistance is linked to bipolar disorder in the brain-focused study reference.

Mechanistic model: mitochondria, metabolism, and neurotransmission

  • Mitochondrial dysfunction is used as a unifying model for diverse mental disorders.
  • Ketosis is linked to altered glutamate/GABA system behavior.
  • Ketosis is linked to reduced hunger and reduced carbohydrate cravings.
  • Ketosis is linked to reduced inflammatory markers and oxidative stress markers.
  • Glucose monitoring is used to evaluate metabolic shifts during intervention.

Prior clinical evidence and case reports referenced

  • Chris Palmer case studies are referenced for psychiatric symptom changes on ketogenic diets.
  • An open-label Stanford trial is referenced for ketogenic intervention in schizophrenia with an enrollment count in the low 20s.
  • Judy Ford is referenced in connection with the Stanford work.
  • Albert Danan (France) is referenced for psychiatric ketogenic work and engagement with Stanford work.
  • A seminar paper is referenced with Iain Campbell and Ali Hon (Edinburgh).

North Queensland RCT: design and population

  • A randomized trial compares ketogenic metabolic therapy with a guideline-based comparator diet.
  • The comparator diet is the Australian Guide to Healthy Eating.
  • The ketogenic intervention is a “well formulated ketogenic diet” aligned with a Volek protocol.
  • Recruitment focuses on stable community patients rather than acute inpatient populations.
  • Diagnosis eligibility includes schizophrenia and bipolar disorder.
  • Vegetarian participants are eligible and vegan participants are excluded.
  • Exclusion criteria include active substance use and other clinician-determined contraindications.

North Queensland RCT: delivery, adherence, and safety workflow

  • Diet support includes weekly sessions of approximately one hour, predominantly face-to-face with some phone sessions.
  • The intervention focus is diet change rather than medication change.
  • A multi-disciplinary team supports delivery.
  • Home cooking and supermarket shopping are required for participation.
  • Participant expectations include effort and structure, with no “magic” solution.

North Queensland RCT: measurements

  • Continuous glucose monitoring is used, including a 2-hour pre-dinner measurement timing rule.
  • Blood ketones track ketosis, with a target range of ~0.5–3 and observed peaks around 4–5.
  • Weight and body composition are tracked.
  • Physical activity is tracked with a wearable device.
  • Sleep is tracked with an Oura ring.
  • Psychiatric rating scales include PANSS.
  • Daily self-reports include mood and energy ratings via visual analog scales.
  • Cognitive measures and biomarkers (including stool samples and hair cortisol) are included in the protocol.

Reported trial experience and preliminary outcomes

  • Both diet arms produce some weight loss.
  • The ketogenic arm is preferred by some participants relative to portion-control guidance.
  • The comparator arm is experienced as difficult by some participants.
  • Anecdotal reports include reduced anxiety and increased social engagement during ketosis.
  • A case example includes long-standing auditory hallucinations resolving during the ketogenic period.
  • Interim analysis is pending at the time of the talk.

References

  • xepMEnglish
    2·
    2 days ago

    I started reading about the effects of metabolic health on BPD because of a friend with the condition. Unfortunately, she also has bulimia and it makes it very difficult for her to restrict what she eats.

    I’ve learned that Epilepsy, Schizophrenia, BDP, depression and anxiety are very often co-morbid and that it can be difficult to cleanly delineate one condition from the other. However, recent development in the field of metabolic psychiatry, in particular from doctors like Chris Palmer, Iain Campbell, and the doctor in this talk appear to show very promisingly that a ketogenic diet greatly improves these disorders across the board.

    Speaking from personal experience alone, I can vouch that going from the standard diet to LCHF greatly improved my mood. It was an incredible feeling.

    • jet@hackertalks.comOPMEnglish
      1·
      2 days ago

      I just got the fourth phase of water!

      Bulimia : yeah that’s tough, I suppose you already pitched eat as much meat and fat as you like, no restrictions!

      There does appear to be a unifying metabolic basis for these related disorders.

      I also think I am in a more chipper and energetic mood when I am clean

      • xepMEnglish
        2·
        2 days ago

        You are going to love the book, I liked it so much I ordered his next book as well. I also love Dune very much!

        Unfortunately I feel a little bit guilty because I pitched TCR and I suspect it tipped her over to binging again. It was clear to me that she was still going through carbohydrate addiction. I’ve gently walked her through all the possible things that may happen and she also has the support of her psychiatrist, but for now I think she should get back to not binging before trying again.

        • jet@hackertalks.comOPMEnglish
          2·
          2 days ago

          People with an eating disorder, obviously you should speak to a professional to guide them. For people who aren’t quite to that level, I found success by very slowly asking them to limit their carbs to an 8-hour window, to a 4-Hour window, then to one meal a day. It’s kind of like intermittent fasting, but just for carbs. It’s reasonable, they don’t have to deny themselves very much. And it’s a stepping stone too. Hey, if you feel good now, you could feel so much better later. If you take out all the carbs. Let’s just do one day of carbs per week!

  • jet@hackertalks.comOPMEnglish
    2·
    4 days ago

    21:30 “If your a mouse and have got schizophrenia I can cure you!”

    29:17 “Its just very difficult to do the ketogenic diet and vegan because you just have to eat carbs all day” WRT why vegans are excluded from the study.