Ketogenic Diets and Mental Health - What Does the Research Say?
Some of the latest research is starting to suggest that replacing carbohydrates in the diet with fat and protein may help treat Alzheimer’s disease, bipolar disorder and schizophrenia. By changing the fuel that the brain runs on from glucose to fat—through a process called ketosis—it may be possible to reverse and heal some of the damage underlying these mental health conditions.
Ketosis is a state where the body is forced to rely on fat rather than carbohydrates for energy production. Think of it as switching to a cleaner fuel, as if you switched from running your car on diesel to natural gas. By running a cleaner fuel through your engine, everything works more efficiently and effectively.
When carbohydrates are in short supply, our bodies produce ketones for energy production from the breakdown of fat. This can occur overnight, when we fast, or when our diet is lacking in sugar and starch. Ketones are a type of alternative fuel for the body that appear to be protective of the brain when glucose is in short supply.
How does this relate to Alzheimer’s disease, bipolar disorder or schizophrenia? As we begin to develop a better understanding of the underlying causes of these conditions, we also start to understand how a ketogenic diet—a diet low in carbohydrates and high in fat—can help to heal these patients. While initially explored for treating epilepsy and seizures, the ketogenic diet is now being studied in an array of different pathologies, from mental health to cancer. While we still need additional clinical trials, several case reports and small preliminary clinical trials show significant improvement in symptoms of patients struggling with schizophrenia, dementia and bipolar disorder (Phelps 2013, Sarnyai 2020, Wlodarek 2021).
Part of the mechanism that engages the healing response from ketosis involves insulin, a crucial compound for our body’s blood sugar balance. Insulin resistance, often thought of only in diabetes, refers to a problem in the ability to utilise insulin to uptake glucose for fuel. Yet more recently, it’s increasingly being recognised as an underlying component in psychiatric and neurodegenerative diseases as well.
Alzheimer’s disease has even been labeled diabetes type three. The causes of insulin resistance and blood sugar problems can stem from any number of sources, including infections, genetics, toxicity, inflammation, lack of exercise, visceral fat and diet.
Regardless of the cause, insulin resistance leads to the same endpoint. As the condition takes hold, the function of insulin for shuttling glucose into cells gets disrupted, typically raising blood sugar levels. And as blood sugar levels rise, the process of glycaetion, a type of tissue damage, ensues.
It’s now thought that insulin resistance, and the damage from elevated blood sugar, looks to be a strong factor in the development of mental illness, including Alzheimer’s disease and cognitive decline.
On average, over half of patients with bipolar disorder have blood sugar issues, typically characterised by insulin resistance. And bipolar patients with blood sugar dysregulation are three times more likely to have a severe, unremitting case (Lojko 2019).
It is also recognised that individuals struggling with schizophrenia commonly have insulin resistance and impaired glucose metabolism, even before treatment with antipsychotics known to affect blood sugar metabolism (Dasgupta 2010).
Research has also started to uncover impressive benefits in switching to a ketogenic diet for such patients. Low-carbohydrate, ketogenic diets regulate energy production, reduce insulin resistance, heal mitochondria and improve symptoms in patients.
In an observational study of 165 online posts on a forum exploring the ketogenic diet and bipolar symptoms, a majority of individuals reported improvements with a ketogenic diet. Just over 12% reported achieving full remission, with another 44.2% reporting significant mood stabilising effects (Campbell 2019). Other diets discussed on the online forum, including a vegetarian diet and a diet high in omega-3 fats did not appear to have the same level of benefits. Because of the findings, the authors have even postulated the underlying mechanisms by which the ketogenic diet may correct certain pathways and relieve oxidative stress (Campbell 2020).
Phelps JR, Siemers SV, El-Mallakh RS. The ketogenic diet for type II bipolar disorder. Neurocase. 2013;19(5):423-426. doi:10.1080/13554794.2012.690421
W?odarek D. Food for thought: the emerging role of a ketogenic diet in Alzheimer’s disease management. Expert Rev Neurother. 2021;21(7):727-730. doi:10.1080/14737175.2021.1951235
Lojko D, Owecki M, Suwalska A. (2019), Impaired glucose metabolism in bipolar patients – the role of psychiatrists in detection and management. Int J Environ Res Public Health. 2019;16(7):1132.
Dasgupta A, Singh OP, Rout JK, Saha T, Mandal S. Insulin resistance and metabolic profile in antipsychotic naïve schizophrenia patients. Prog Neuropsychopharmacol Biol Psychiatry. 2010;34(7):1202-1207. doi:10.1016/j.pnpbp.2010.06.011
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