Can a change in diet cure depression, anxiety, or schizophrenia? Some of the latest research suggests the answer is YES!
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A Metabolic Approach to Mental Health
Metabolic psychiatry is a new and growing field exploring the overlap of mental health issues with metabolic dysfunction, including insulin resistance, excess inflammation, metabolic syndrome and obesity. For treatment, metabolic psychiatry focuses on the removal of processed foods and refined carbohydrates, often implementing a ketogenic diet for the metabolic benefits. If dietary approaches are too challenging for patients, they may also include medications to help achieve therapeutic metabolic effects.
Metabolic Psychiatry and the Ketogenic Diet
And the latest research supports the benefits of a metabolic approach to mental health treatment. A recent case analysis of patients admitted to a psychiatric hospital highlights the potential. In the study, 31 patients with severe mental health issues that were poorly responsive to standard treatment were put on a carbohydrate-restricted ketogenic diet (Danan 2022). Of the patients, only three were unable to maintain the dietary regimen. For those that maintained the diet, Hamilton depression rating scores decreased by almost 18 points, a whopping 70%. Considering that antidepressant medications average just a two point reduction on the same depression rating scale highlights the profound potential benefits of a metabolic approach (Volkmann 2020).
Other research also shows promise for low-carbohydrate or ketogenic dietary interventions. An older study exploring optimum carbohydrate intake also found potential benefits (Kunin 1976). To identify optimal carbohydrate intake, a urinary dipstick was utilized to find the daily carbohydrate intake that caused a patient to transition out of ketosis—switching out of the metabolic state which uses fat as a primary energy source. This low carbohydrate level was then recommended for continuing daily consumption. Of the patients following the lower carbohydrate regimens, 82% reported mood and anxiety improvements either from ketosis or from optimal carbohydrate intake.
A more recent, ongoing preliminary trial of a ketogenic diet for bipolar disorder and schizophrenia has also yielded positive results. For the 13 patients prescribed a ketogenic diet, depression symptoms decreased 28%, inflammation—measured as hs-CRP—reduced 28% and triglycerides dropped 21% (Oz 2022). The study highlights both mental health and metabolic improvements from dietary measures, benefits that go beyond improving mental health symptoms. In the study, the induced metabolic changes also likely reduce the long-term risks for heart disease, diabetes, and other chronic illnesses.
How Do Ketogenic Diets Affect Mental Health?
Why do ketogenic diets improve mental health? Because the mind and body are connected! In some respects, it’s kind of exasperating that modern psychiatry and modern medicine have so thoroughly ignored nutrition. Yet what we consume has a profound influence on metabolic function, including brain function. By consuming a ketogenic diet, the brain switches from utilizing glucose for fuel to ketones from fat. Ketones provide a number of different potential benefits for mental health (McDonald 2018). Ketones affect neurotransmitter signaling and inhibit excess brain cell excitability. They also support energy production while reducing the generation of reactive oxygen species or free radicals. Other evidence points to direct anti-inflammatory and neuroprotective effects from ketones.
Additional Metabolic Psychiatry Treatments
And while low-carbohydrate diets are often a focus of metabolic psychiatry, it also includes other innovative approaches. Bipolar disorder is often associated with significant insulin resistance. In fact, a study found that bipolar patients with insulin resistance or diabetes have a three-fold higher risk for a chronic course of their mental-health symptoms (Calkin 2015). As such, one forethinking researcher treated bipolar patients who have insulin resistance with metformin, a drug that sensitizes insulin receptors. In the placebo-controlled trial, patients that fully reversed their insulin resistance with metformin had large, statistically-significant improvements in anxiety, depression and bipolar symptoms (Calkin 2022).
The study is profound in its potential ramifications. First, the authors noted that previous work found that reversing insulin resistance after diabetes has fully developed does not provide similar mental health benefits in bipolar disorder patients. There appears to be a window of opportunity once insulin resistance sets in but before it develops into diabetes. Considering that a number of medications used to treat bipolar disorder can worsen insulin resistance, the data suggests these medications could contribute to a more chronic, treatment-resistant course of the condition.
In a similar vein, glucagon-like peptide-1 (GLP-1) receptor agonists, semaglutide and liraglutide among others, may also exert similar metabolic benefits. GLP-1 agonists were originally developed for the treatment of diabetes. They work through increasing insulin production while inhibiting glucagon, a hormone from the pancreas that raises blood sugar levels. The metabolic benefits of GLP-1 agonists appear to extend beyond improving diabetes to include weight loss and mental health improvements. And recent media reports have only added to the hype around GLP-1 agonists for weight loss.
A review of over 10,000 patients taking GLP-1 agonists found significantly lower rates of depression and anxiety. In the study, GLP-1 agonists reduced the incidence of depression and anxiety by 20%. The effects were strongest for anxiety in women, reducing anxiety disorders by almost 60% (Tsai 2022).
Metabolic Psychiatry and Psychiatry Redefined
While it is exciting to see metabolic psychiatry making inroads as an accepted treatment approach, we’ve been teaching and utilizing metabolic treatments since the beginning of Psychiatry Redefined foundation. In fact, we have courses and events currently available that were dedicated to the potential of low-carbohydrate, ketogenic diets for mental health treatment. Our courses include experts in the field and their clinical experience in its application.
As an industry-leading resource for training in the latest research-based, functional and integrative medicine approaches, Psychiatry Redefined is dedicated to changing the paradigm of effective mental-health care. Metabolic psychiatry is one piece in a much larger puzzle that acknowledges and evaluates a patient’s biochemical individuality. By taking a more comprehensive approach, through the evaluation of metabolic issues, nutrient deficits, hormonal dysregulation, toxicities, chronic infections, inflammation, and genetics, we can treat the root causes of mental health problems. Using a comprehensive approach yields better outcomes with the potential for symptom resolution, unlike the standard approach which typically focuses on long-term medication management.
Join Our Training Fellowship to Learn Metabolic Psychiatry and More!
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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
Volkmann C, Volkmann A, Müller CA. On the treatment effect heterogeneity of antidepressants in major depression: A Bayesian meta-analysis and simulation study. PLoS One. 2020;15(11):e0241497. Published 2020 Nov 11. doi:10.1371/journal.pone.0241497
Kunin, RA. Ketosis and the optimal carbohydrate diet: a basic factor in orthomolecular psychiatry. Orthomolecular Psychiatry 1976; 5: 203–11.
Oz R, Wakeham D, Letter T, Letter T, Hooshmand F, Letter T, et al. Impact of a Ketogenic Diet on Metabolic and Psychiatric Health in Patients with Bipolar or Schizophrenia Illness, Pilot Trial Preliminary Analysis. In Proceedings of 5th Annual Metabolic Health Summit. 2022 May 5–8; Santa Barba, CA, USA. Metabolic Health Summit. 2022.
McDonald TJW, Cervenka MC. Ketogenic Diets for Adult Neurological Disorders. Neurotherapeutics. 2018;15(4):1018-1031. doi:10.1007/s13311-018-0666-8
Calkin CV, Ruzickova M, Uher R, et al. Insulin resistance and outcome in bipolar disorder. Br J Psychiatry. 2015;206(1):52-57. doi:10.1192/bjp.bp.114.152850
Calkin CV, Chengappa KNR, Cairns K, et al. Treating Insulin Resistance With Metformin as a Strategy to Improve Clinical Outcomes in Treatment-Resistant Bipolar Depression (the TRIO-BD Study): A Randomized, Quadruple-Masked, Placebo-Controlled Clinical Trial. J Clin Psychiatry. 2022;83(2):21m14022. Published 2022 Feb 1. doi:10.4088/JCP.21m14022
Tsai WH, Sung FC, Chiu LT, Shih YH, Tsai MC, Wu SI. Decreased Risk of Anxiety in Diabetic Patients Receiving Glucagon-like Peptide-1 Receptor Agonist: A Nationwide, Population-Based Cohort Study [published correction appears in Front Pharmacol. 2022 Mar 22;13:886343]. Front Pharmacol. 2022;13:765446. Published 2022 Feb 23. doi:10.3389/fphar.2022.765446