When people take the time to think about the ketogenic diet, they will likely think about weight loss first. However, not many people realize that neurologists have been treating people with epilepsy with the ketogenic diet for nearly 100 years. The ketogenic diet is a low carbohydrate and high-fat diet that helps people lose weight, but it also has many other health benefits as well. In the Body Reboot book, we outline many of a keto diet’s health benefits. In this article, we reveal how in particular, a low carb diet may also improve mental health. It makes sense that dieting can help improve your self-esteem, help you feel better, and help you make better decisions going forward. In particular, it also improves brain function, which is largely why it has the potential to improve people’s symptoms with depression and mood disorders.
Diet Doctor discusses how one man named Hessen dealt with less bipolar II symptoms after he went on the ketogenic diet. It turns out many other people who have gone on the keto diet have also noticed their symptoms improve.
He was diagnosed in 2014 with bipolar II disorder1 when he was working in Finland and suddenly began rapidly shifting between hypomania2 and depression almost weekly. He feels now that the condition has likely been with him for most of his life. “I have had depressions for as long as I can remember, down to the age of 3 or 4.”
He posts regularly now on ketogenic forums on Reddit, sharing his experience with others who are contemplating doing the diet for mental health reasons.
“I am always really careful not to raise any false expectations. The diet is by no means a cure for the chronic illness that bipolar is. However, the diet is a great tool to help manage it,” he says.
Hessen is not alone. Reddit and other social platforms have comment threads in which people on the LCHF or ketogenic diet report improvements for anxiety, depression, bipolar disorder and even schizophrenia.
Could the ketogenic diet help prevent, reduce or better manage some mental health conditions? While clinical research on real patients to date is slim, a growing body of basic science on ketones’ impact on brain function in animal and human models, and a large number of anecdotes, suggests that it just might.
Diagnosis Diet further discusses the positive impact the keto diet may have on bipolar disorder. Since it has successfully treated epilepsy for years, it’s not far-fetched to say that it can also manage mood orders such as bipolar disorder. With the similar neurotransmitter imbalances, it’s entirely possible that treating depression and related mental disorders with the keto diet is very promising.
Bipolar Disorder and Diet
So, what does all of this have to do with bipolar disorder? It is well-established that epilepsy and bipolar disorder share many biological features, including:
similar neurotransmitter imbalances (serotonin, norepinephrine, GABA, and glutamate)
alterations in sodium and calcium distribution
changes in chemical messenger activity
In fact, it just so happens that many of the mood stabilizing medications we psychiatrists prescribe for bipolar disorder are anticonvulsants that were originally designed to treat seizures—Depakote (Valproate), Lamictal (Lamotrigine) and Trileptal (Oxcarbazepine), to name a few. The fact that epilepsy and bipolar disorder have so much in common begs the question of whether perhaps a low-carb diet could be useful for mood stabilization, as well. Unfortunately, there has yet to be a single scientific study of ketogenic diets in bipolar disorder. I have not yet had a patient in my practice who has been willing to try a strict ketogenic diet, which not only limits carbohydrate, but also limits protein and requires blood monitoring of ketone levels. However, I can tell you that my patients who have been willing to try low carbohydrate “modified Atkins” diets, low carbohydrate “Paleo” diets, or low glycemic index diets for mood problems–from depression to anxiety to eating disorders to bipolar disorders–report significant improvement in their symptoms. It stands to reason that these dietary changes, which have profound effects on other neurological disorders, would have the potential for profound effects on psychiatric disorders, as well.
Psychology Today reveals a few studies that found that the ketogenic diet can reduce anxiety and has the potential to help treat schizophrenia, in particular.
Ketogenic Diets and Schizophrenia
A 3-week mouse study showed that a ketogenic diet normalized pathological behaviors.
1965: A 2-week study of 10 women with treatment-refractory schizophrenia found a significant decrease in symptoms when a ketogenic diet was added to their ongoing standard treatments (medications + ECT). Ketone monitoring was not reported.
2009: A 12-month case study details the experience of a 70-year old overweight woman with chronic schizophrenia who was prescribed a diet limited to 20 grams of carbohydrate per day. She noted significant improvement in severe symptoms beginning only eight days after starting the diet, which consisted of “beef, poultry, ham, fish, green beans, tomatoes, diet drinks, and water.” [ Kraft and Westman 2009 Nutrition & Metabolism 6:10.] She reported complete resolution of auditory and visual hallucinations–with which she’d suffered since age seven. Ketone levels were not monitored.
Ketogenic Diets and Anxiety
A rat study found that adding ketone supplements to a standard high-carbohydrate diet reduced anxious behavior.
As we’ve mentioned throughout this article, there haven’t a lot of studies done on the keto diet treating mood disorders. However, the Front Pharmacol. did a study in 2012 on rats, and they did show an improvement in their depressive state. Researchers should concentrate on doing more studies on how the keto diet may improve mental disorders. If they do, it’s exciting to think about the positive effects the keto diet may have on people who are struggling.
Dietary and metabolic therapies have been attempted in a wide variety of neurological diseases, including epilepsy, headache, neurotrauma, Alzheimer disease, Parkinson disease, sleep disorders, brain cancer, autism, pain, and multiple sclerosis. The impetus for using various diets to treat – or at least ameliorate symptoms of – these disorders stems from both a lack of effectiveness of pharmacological therapies, and also the intrinsic appeal of implementing a more “natural” treatment. The enormous spectrum of pathophysiological mechanisms underlying the aforementioned diseases would suggest a degree of complexity that cannot be impacted universally by any single dietary treatment. Yet, it is conceivable that alterations in certain dietary constituents could affect the course and impact the outcome of these brain disorders. Further, it is possible that a final common neurometabolic pathway might be influenced by a variety of dietary interventions. The most notable example of a dietary treatment with proven efficacy against a neurological condition is the high-fat, low-carbohydrate ketogenic diet (KD) used in patients with medically intractable epilepsy. While the mechanisms through which the KD works remain unclear, there is now compelling evidence that its efficacy is likely related to the normalization of aberrant energy metabolism. The concept that many neurological conditions are linked pathophysiologically to energy dysregulation could well provide a common research and experimental therapeutics platform, from which the course of several neurological diseases could be favorably influenced by dietary means. Here we provide an overview of studies using the KD in a wide panoply of neurologic disorders in which neuroprotection is an essential component.
Ketogenic Diets and Depression
A rat study found that a ketogenic diet reduced depressive behaviors.
A mouse study found that feeding pregnant animals a ketogenic diet reduced offspring susceptibility to depressed (and anxious) behaviors.
Despite the relative lack of clinical data, there is an emerging literature supporting the broad use of the KD (and its variants) against a variety of neurological conditions. These preliminary studies are largely based on the fundamental idea that metabolic shifts may lead to neuroprotective actions (Gasior et al., 2006; Maalouf et al., 2009). How can a simple dietary change lead to improvement in disorders with such a huge span of pathophysiological mechanisms? Alterations in energy metabolism appear to be a common theme. So while the mechanisms through which the KD exerts such effects are likely diverse (Maalouf et al., 2009; Rho and Stafstrom, 2011), there may indeed be one or more common final pathways that are mechanistically shared. Ultimately, the details of how that altered metabolism reduces neuronal excitability, abrogates ongoing neurodegeneration, or mitigates functional disability remain unknown. Herein lay rich opportunities for further investigation, in both the laboratory and the clinic, in the broad realm of translational neurosciences.
Mood stabilizing properties of the KD have been hypothesized (El-Mallakh and Paskitti, 2001), but no clinical studies have been conducted as of this writing. The potential role of the KD in depression has been studied in the forced choice model of depression in rats, which led to a beneficial effect similar to that afforded by conventional antidepressants (Murphy et al., 2004; Murphy and Burnham, 2006).
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