The keto or ketogenic diet is characterized by a high fat content, moderate protein content and very low carbohydrate content, and its main objective is to induce the body to enter a state of ketosis, a metabolic process in which the body burns fat to get energy instead of glucose, which is mainly derived from carbohydrates. By promoting the burning of body fat, it facilitates weight loss and that is why it has become popular among the general population, while scientists analyze its advantages and disadvantages.
A pilot study by Stanford Medicine researchers has now found that the metabolic effects of the keto diet provide significant psychiatric benefits. On average, participants showed a 31% improvement on a psychiatric rating scale for mental illness known as the Clinical Global Impressions Scale, with three-quarters of participants experiencing clinically significant improvement. Overall, participants also reported better sleep and greater life satisfaction.
For people living with serious mental illnesses such as schizophrenia or bipolar disorder, standard treatment with antipsychotic medications can be beneficial, but also problematic. Although these drugs help regulate brain chemistry, they often cause metabolic side effects such as insulin resistance and obesity, worrying enough that many patients stop taking them.
The new study has found that a ketogenic diet not only restores metabolic health in these patients while they continue taking their medications, but also improves their psychiatric conditions, suggesting that a dietary intervention may be a significant help in the treatment of mental illness. . The results have been published in Psychiatry Research where the authors explain their main findings, which were:
- Ketogenic diet therapy resulted in reversal of metabolic syndrome in this severe mental illness cohort.
- Participants with schizophrenia showed an average improvement of 32% based on the Brief Psychiatric Rating Scale.
- The percentage of participants with bipolar disorder who showed >1 point improvement in clinical global impression was 69%.
- Greater biomarker benefits were observed with adherence to the ketogenic diet.
Improve metabolic health to improve brain health
Dr. Shebani Sethi, associate professor of psychiatry and behavioral sciences and first author of the study, remembers when she first noticed the connection. As a medical student working in an obesity clinic she saw a patient with treatment-resistant schizophrenia whose auditory hallucinations calmed on a ketogenic diet. This led her to research the medical literature and, although she only found a few old reports on the use of the ketogenic diet to treat schizophrenia, she discovered a long history of success in using ketogenic diets to treat epileptic seizures.
“The ketogenic diet has been shown to be effective for treatment-resistant epileptic seizures by reducing the excitability of neurons in the brain,” Sethi said. “We thought it would be worth exploring this treatment in psychiatric conditions.” A few years later, Sethi coined the term metabolic psychiatry, a new field that approaches mental health from an energy conversion perspective.
During the four-month pilot trial, Sethi’s team followed 21 adult participants diagnosed with schizophrenia or bipolar disorder, who were taking antipsychotic medications and had a metabolic abnormality, such as weight gain, insulin resistance, hypertriglyceridemia, dyslipidemia, or insulin intolerance. glucose. Participants were instructed to follow a ketogenic diet, with approximately 10% of calories from carbohydrates, 30% from protein, and 60% from fat. They were not instructed to count calories and were also provided keto cookbooks and access to a health coach.
“Anything that improves overall metabolic health is probably going to improve brain health, but the ketogenic diet can provide ketones as an alternative fuel to glucose for an energy-disfunctioning brain.”
The research team monitored participants’ dietary adherence through weekly measurements of blood ketone levels. At the end of the trial, 14 patients were completely adherent, six were semiadherent, and only one was nonadherent. Participants underwent a variety of psychiatric and metabolic evaluations throughout the trial.
Before the trial, 29% of participants met criteria for metabolic syndrome, defined as having at least three of five conditions: abdominal obesity, high triglycerides, low HDL cholesterol, high blood pressure and high fasting glucose levels. After four months on a ketogenic diet, none of the participants had metabolic syndrome.
On average, participants lost 10% of their body weight; reduced their waist circumference by 11%; and had lower blood pressure, body mass index, triglycerides, blood sugar levels and insulin resistance.
“We are seeing huge changes,” Sethi said. “Even if you are taking antipsychotic medications, we can still reverse obesity, metabolic syndrome, and insulin resistance. “I think that’s very encouraging for patients.” “Participants noticed improvements in their energy, sleep, mood and quality of life,” Sethi highlighted, adding: “They feel healthier and more hopeful.”
The researchers were impressed by the high level of adherence to the diet by the majority of the participants. “We observed greater benefits in the group that fully adhered to the diet compared to the semi-adherent group, indicating a possible dose-response relationship,” Sethi explained.
There is growing evidence that psychiatric diseases such as schizophrenia and bipolar disorder originate from metabolic deficits in the brain, which affect the excitability of neurons, Sethi said. Therefore, researchers hypothesize that, just as a ketogenic diet improves the metabolism of the rest of the body, it also improves brain metabolism.
“Anything that improves overall metabolic health is probably going to improve brain health anyway,” Sethi said. “But the ketogenic diet can provide ketones as an alternative fuel to glucose for an energy-deficient brain.” There are likely multiple mechanisms at play, she added, and the main purpose of this small pilot trial is to help researchers detect signals that will guide the design of larger, more robust studies.
