Interview with Frank

This is an interview with patient Frank, who has generously given permission to share the transcript. He struggled with atypical bulimia and bipolar illness in the past, however recently struggles with binge-eating. He decided to join a study that requires him to follow the ketogenic diet to assess changes in his metabolic health and mental health. At time of this interview, month 2 of the study, he has already seen immense symptom improvement from symptoms that were long standing.

*UPDATE: Frank has now been on the ketogenic diet for 10 months (and finished the study 5 months ago). He continues to do well. He has lost over 30 pounds and has maintained this despite the COVID pandemic. According to assessments, he has shown an improvement in mood, sleep, anxiety, and quality of life. What is most impressive is that he no longer binge eats, abstains from disordered eating and has already shown improvements in triglycerides, HDL and blood pressure from just 10 months ago. 


Q: Hi Frank! Thanks for speaking with me. Could you start off by talking about what health conditions you struggled with in the past, and currently? Anyone in the family with these issues?

A: Of course...I have struggled with my weight through my childhood. I don’t have diabetes or any heart conditions, but weight, blood pressure, and cholesterol have been my biggest issues. I did have some diagnosed mental illness--very slight bipolar disorder, but it is being managed. My father was also diagnosed with bipolar disorder and PTSD from the military service. Also, my sister was overweight for a while, but it is manageable now for her. It was not as severe as what I have gone through. 


Q: What did the binge-eating look like to you? When did the episodes start?
A: It generally manifested itself as a lot of late-night eating. It was not based on hunger, but rather boredom. I don’t suffer any other addictions, I have never had a drug or drinking or smoking problem. Food was my fix. It was about quantity over quality. Binge-episodes consisted of lots of processed foods and snack items. I had an immense sweet-tooth so chocolate or something sugary. It was very rarely a meal, but whatever was close and convenient. And a lot of dairy, and I am lactose-intolerant which was never a good combination. The episodes started in my early teens and has continued on and off for the past 30 years. 


Q: At what point in your life did you realize this behavior was deviant from the norm?

A: Oh, from my early teens itself it was abundantly clear that I was deviant from the norm of 3 meals a day. 


Q: What do you think may have triggered the binge-eating?

A: There was no one specific trigger point, it was more boredom. It was a way to relieve stress and was a fix. I had an uncontrollable need and couldn’t help myself. But I can’t think of one particular thing that triggered it. Part of my childhood may have contributed. I grew up in a family that was constantly eating. Most of my family came out of the Great Depression. They lived their life without that much food when they were kids, so their mentality for us was “eat eat eat” if you can. So my sister and I were constantly eating, and my family rewarded good behavior with food. I was a fat kid through most of my adolescence. I grew up in an Italian American family, and it is a running joke to say “you don’t eat enough”. My grandma would always say, “you don’t eat enough”, but I was 250 pounds, I was fine!


Q: Run me through a typical day when you would binge, and what symptoms presented as. 

A: On a typical day, I would never eat breakfast. I would rarely eat lunch. I would nit-pick on snacks--candy, crackers, whatever was in the office. After work, I would come home and be really hungry. I would eat processed food for dinner, like a Weight Watchers type thing. By the time it was 10 pm, I would be hungry again. That is when I would eat really badly. And the cycle would repeat. I would not eat breakfast again the next day because I went really overboard last night, and need to balance out the scales. I needed to compensate. It was a consistent process of repeating the mistakes over and over again. 


Q: How was your mental health, during the time of your disorder? 

A: I dealt with a lot of guilt. A fair amount of self-loathing. I was very self-aware and knew what I was doing was bad. But I couldn’t help myself. In the last 3 years, I gained 40 pounds. I had gone through a divorce, which put a lot of stress on me. In parallel, I had stopped running. I had always been a runner. The combination of binge-eating and stress stopping running was bad. I lost the desire to run, and still haven’t run since. Once I put all the weight on, I didn’t want to run because I was embarrassed of my size. 


Q: What was the recovery process like? Specifically, this ketogenic diet treatment that you have been on for the past 2 months?

A: I have been in therapy for years since my mid-20’s. A lot of it was focused on my eating and self-worth. I haven’t been back, because it is really hard to find a therapist out here. 

With this current treatment, I am on the keto diet. It is a low carb, no sugar diet. So quite frankly, it is not that complicated. I understand the basic physiology of insulin production and fat adaption. I track my food intake, but not from a calorie perspective, more of a carbohydrate perspective. I don’t eat starchy vegetables, but I eat high-quality fats and lots of green vegetables. All my meals are homemade, meal-prepped. For lunch, I eat omelets, with cheese and meat. For dinner, I will eat chicken, or ground meat and salad. I make keto-based desserts too and don’t feel deprived. 


Q: What is the progress you have made on the ketogenic diet, both in terms of weight loss and binge-eating?

A: I have lost about 20 pounds. I lost 2 inches off my waist. My blood pressure is lower. I feel much better, physically. There has been no binge-eating now. My eating schedule is normal now, I eat lunch and dinner. Maybe a healthy snack in between, like a cheese stick. I am not eating past 8 pm at night. I have incorporated a 16:8 intermittent fasting routine into the diet. The eating window has shrunk, and I have definitely had a loss of appetite. I don’t eat as much. Also, my sugar cravings have dropped tremendously. I have always had a huge sweet tooth but now I have zero cravings. 


Q: In these past 2 months, did you ever fall off the diet or experience challenges on the diet? Did you have negative thoughts afterward? 

A: Eating out is challenging. I have had no temptation to binge, but I have slipped twice. I had a big piece of cake a month ago, and I baked cookies over the weekend and had a couple of cookies. I use to binge almost daily prior to the intervention and now I had a small binge episode once in the 2 months. I did not have any negative thoughts afterward, because it is not the end of the world. You can recover from this really quickly.


Q: Why do you think you stopped binge-eating?

A: It is a couple of things. The processed foods that I would normally binge on are simply out of the picture with the keto diet. I eat real food. Also, once I get myself motivated and on a diet, I am very good and regimented about it. This diet has established a routine, and I need routine. Plus, I know I am important to this study and I don’t want to fail. I want it to succeed. 


Q: How do you feel mentally now? Has your mood improved? 

A: Mentally, I feel a lot better. I lost 20 pounds and can see it. Looking in the mirror has always been a big challenge for me. So mentally, I am seeing results and that kick starts a lot of things. Also, I have always had a challenge with sleeping. I was a diagnosed insomniac, but now I am getting at least 7 hours a night, which is great! I have a bedtime routine and sleep earlier, which lowers my predisposition to binge. I got this sleep thing under control. Most days around 3 pm, I used to suffer from severe fatigue. That has also gone away at this point! 

The diet has helped my moods considerably. I believe that a lot of that is centered around body image issues that I

have suffered through for quite some time; issues that have been exacerbated over the last two years due to significant weight gain that was a direct emotional response to a very prolonged divorce process. Now that I am "seeing" the results of the diet physically, it's been quite an improvement in mood. Additionally. physically I feel much better, which also seems to have shifted my mood quite a lot.


Q: Last question--if you could tell your former self anything, what would you tell him? 

A: You should have done this sooner. Because I have always been self-aware and knew how to improve, but I just couldn’t do it. Also, you should do a better job at journaling your feelings.


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