Ketosis as a Mental Health Therapy

The Ketogenic Diet and Ketosis

Changing the foods we eat can have a profound influence on mental health. Recent studies suggest that eating mostly fat and protein, while restricting carbohydrates, may help to treat depression, bipolar disorder and schizophrenia. Removing carbs from the diet and replacing them with fat is the foundation of a ketogenic diet.

While most people think of the ketogenic diet as a low-carb diet for weight loss, it is more appropriate to think of a ketogenic diet as a therapeutic tool to enter the state of ketosis—the state of using fat for energy production. When carbohydrates are unavailable, fat is used for energy in the body through a process called ketosis.

The brain has a strong preference to use sugar for energy. When sugar from carbohydrates is available for fuel, the brain runs on sugar. If sugar is in short supply, the brain is forced to fall back on fat as an energy source. Using fat for energy production deliver beneficial effects that may reverse the underlying damage in the brain that contributes to these mental health conditions.

For energy production in the body, fat is a “cleaner” source of energy than sugar. It’s like switching from running a car on diesel to running on natural gas. By using a cleaner fuel, everything runs more efficiently and there is less damage to the engine. The effects of a ketogenic diet on overall health is often considered a “metabolic approach” to treating mental health conditions.  This metabolic approach has even been given a new name: metabolic psychiatry.

The Benefits of Metabolic Psychiatry

Metabolic psychiatry has been garnering significant interest from some of the most well-known medical institutions in the country. Stanford Medicine opened the first Metabolic Psychiatry clinic in early 2023, with a focus on treating the underlying metabolic problems that contribute to mental illness. Treatments include ketogenic diets, lifestyle changes and medications that help to correct or reverse blood sugar problems, chronic inflammation, and obesity.

At the core of metabolic psychiatry is the management and reversal of insulin resistance. Insulin resistance is a condition associated with diabetes and elevated blood sugar. As a hormone, insulin moves sugar from the bloodstream into the organs and tissues of the body for use in energy production. Insulin resistance is when the tissues begin to lose their normal response to insulin, and blood sugar is not as effectively shuttled into tissues, remaining higher in the bloodstream.

Insulin resistance is strongly associated with weight gain, stress and low-level inflammation, conditions also correlated with mental illness. In fact, research has linked insulin resistance to depression, bipolar disorder and schizophrenia, among other mental health conditions (Leonard 2020, Calkin 2019, Guest 2019). The ketogenic diet is one of the most powerful tools known to reverse insulin resistance. It’s so powerful that research is now suggesting it can reverse type 2 diabetes, something unattainable through standard medication treatment (Hallberg 2018).

The ketogenic diet is one of the most powerful tools known to reverse insulin resistance. It’s so powerful that research is now suggesting it can reverse type 2 diabetes, something unattainable through standard medication treatment.

Ketogenic Diet, Ketosis and Depression

While the clinical trial evidence for treating major depressive disorder with a ketogenic diet is still early, the initial data suggests benefits. Ketogenic diets are known to produce antidepressant effects in animal studies through a number of different mechanisms (Ricci 2020). A case report found that a woman fully reversed both diabetes and major depressive disorder in three months with a ketogenic diet, exercise, and talk therapy (Cox 2019).

A recent case analysis also supports the benefits of a ketogenic diet for severe depression. In the study, 31 hospitalized psychiatric patients struggling with severe mental illness that were poorly responsive to standard therapy were administered a ketogenic diet (Danan 2022). For the twenty-eight patients that maintained the diet, symptoms of depression were decreased by 70%.

Ketogenic Diet, Ketosis, Bipolar Disorder and Schizophrenia

Bipolar disorder and blood sugar problems go hand in hand. Around half of bipolar patients have blood sugar problems and insulin resistance. Even more concerning, for bipolar patients that have blood sugar problems, their bipolar symptoms are significantly more likely to be severe and persistent (Lojko 2019). Similarly, individuals with schizophrenia often have insulin resistance and blood sugar problems, even before treatment with antipsychotics–medications that are well known for their detrimental effects on blood sugar metabolism (Dasgupta 2010).

From animal research, we know that ketosis can bypass problems with energy production in the brain. Further evidence also shows that ketogenic diets may rebalance receptors thought to underlie the pathology of mental health conditions. Ketogenic diets appear to help restore normal N-methyl-D-aspartate (NMDA) receptor function. At the same time, they reduce glutamate toxicity. In animal models, these effects can prevent the development of schizophrenia symptoms (Kraeuter 2019).

Additionally, research is beginning to show that individuals with bipolar disorder find significant improvements from converting to a ketogenic diet. An observational study of participants from an online forum found that most bipolar patients reported benefits with a ketogenic diet. In the study, 12% said they had achieved complete remission, while an additional 42% said it had a major stabilizing effect on their mood (Campbell 2019).

By way of comparison, there did not seem to be the same amount of benefits from other diets, including a vegetarian diet and a diet high in omega-3 fats. The results have led to speculation about the underlying processes through which the ketogenic diet could potentially correct certain brain pathways and relieve oxidative stress (Campbell 2020).

Positive outcomes have also been seen in a continuing preliminary investigation of a ketogenic diet for schizophrenia and bipolar illness. Thirteen patients who were administered a ketogenic diet saw a 28% decrease in depression symptoms, a 28% decrease in inflammation and a 21% decrease in triglycerides (Oz 2022). As highlighted in the study; the benefits of a ketogenic diet extend beyond just symptom relief. According to the study, the altered metabolism also probably lowers the long-term risks for diabetes, heart disease and other chronic illnesses.

Summary

The research on the ketogenic diet’s ability to repair the brain is encouraging. The simplicity of ketosis as a therapeutic tool for those that can maintain a ketogenic diet, stands out as a potential alternative for people struggling with depression, bipolar disorder and schizophrenia. While it should not be seen as a cure-all, the ketogenic diet and therapeutic ketosis, especially when combined with an overall integrative and functional medicine approaches, can still be a powerful addition to mental health treatment.

This is one of the primary reasons we believe in functional, personalized medicine training at Psychiatry Redefined. Traditional psychiatry has been slow to adopt nutritional and metabolic medicine, yet educating mental health providers in these whole-body approaches is an absolutely essential part of effective mental health care. We believe a transformation in the field of psychiatry begins with providing the latest nutritional data, diet interventions, and metabolic strategies to help our trainees formulate precise, personalized treatment for mental illness.

If you’re ready to join this movement, we encourage you to enroll in our flagship training, the Fellowship in Functional & Integrative Psychiatry. This popular training includes over 300+ hours of research-backed curriculum on how to treat the root causes of mental illness.  It’s the best value for busy clinicians who want to enhance their practice with science-backed protocols to deliver real patient wellness, particularly for drug-resistant patients. Our goal is to provide comprehensive training to as many clinicians as possible – and positively transform as many patient lives as possible with whole-person care. Learn more about the Fellowship and save $500 when you enroll at the early bird rate today!

References

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Cox N, Gibas S, Salisbury M, Gomer J, Gibas K. Ketogenic diets potentially reverse Type II diabetes and ameliorate clinical depression: A case study. Diabetes Metab Syndr. 2019;13(2):1475-1479. doi:10.1016/j.dsx.2019.01.055

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Danan A, Westman EC, Saslow LR, Ede G. The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of 31 Inpatients. Front Psychiatry. 2022;13:951376. Published 2022 Jul 6. doi:10.3389/fpsyt.2022.951376

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Oz R, Wakeham D, Yu B, Hooshmand F, Malhotra A, Ketter T, Saslow L, Sethi S. Impact of a ketogenic diet on metabolic and psychiatric health in patients with bipolar or schizophrenia illness. Poster presented at Metabolic Health Summit; March 18, 2022; Santa Barbara, CA.

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