Keto diet may hold key to metabolic & mental health balance

Keto diet may hold key to metabolic & mental health balance
Courtesy: lacaosa / Moment Via Getty Images

According to a recent pilot study conducted by doctors at Stanford Medicine, a ketogenic diet helps mental health in addition to restoring metabolic health. The findings, released in ‘Psychiatry Research’, indicate that nutritional interventions can be quite effective in addressing mental health conditions.

"It's very promising and very encouraging that you can take back control of your illness in some way, aside from the usual standard of care," said Shebani Sethi, MD, associate professor of psychiatry and behavioural sciences and the first author of the new paper.

The senior author of the paper is Laura Saslow, PhD, associate professor of health behaviour and biological sciences at the University of Michigan.

In the four-month pilot trial, the team followed 21 adult participants who were diagnosed with schizophrenia or bipolar disorder, taking antipsychotic medications, and had a metabolic abnormality, such as weight gain, insulin resistance, hypertriglyceridemia, dyslipidemia or impaired glucose tolerance. The participants were instructed to follow a ketogenic diet, with approximately 10 per cent of the calories from carbohydrates, 30 per cent from protein and 60 per cent from fat. They were not told to count calories.

"The focus of eating is on whole non-processed foods including protein and non-starchy vegetables, and not restricting fats," said Sethi, who shared keto-friendly meal ideas with the participants. They were also given keto cookbooks and access to a health coach.

The research team tracked how well the participants followed the diet through weekly measures of blood ketone levels. (Ketones are acids produced when the body breaks down fat – instead of glucose – for energy.) By the end of the trial, 14 patients had been fully adherent, six were semi-adherent and only one was non-adherent.
The participants underwent a variety of psychiatric and metabolic assessments throughout the trial.


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Before the trial, 29 per cent of the participants met the criteria for metabolic syndrome, defined as having at least three of five conditions: abdominal obesity, elevated triglycerides, low HDL cholesterol, elevated blood pressure and elevated fasting glucose levels. After four months on a ketogenic diet, none of the participants had metabolic syndrome.
On average, the participants lost 10 per cent of their body weight; reduced their waist circumference by 11 per cent percent; and had lower blood pressure, body mass index, triglycerides, blood sugar levels and insulin resistance.

"We're seeing huge changes," Sethi said. "Even if you're on antipsychotic drugs, we can still reverse the obesity, the metabolic syndrome, the insulin resistance. I think that's very encouraging for patients."

The psychiatric benefits were also striking. On average, the participants improved 31 per cent on a psychiatrist rating of mental illness known as the clinical global impressions scale, with three-quarters of the group showing clinically meaningful improvement. Overall, the participants also reported better sleep and greater life satisfaction.

"The participants reported improvements in their energy, sleep, mood and quality of life," Sethi said. "They feel healthier and more hopeful."

The researchers were impressed that most of the participants stuck with the diet. "We saw more benefit with the adherent group compared with the semi-adherent group, indicating a potential dose-response relationship," Sethi said.


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There is increasing evidence that psychiatric diseases such as schizophrenia and bipolar disorder stem from metabolic deficits in the brain, which affect the excitability of neurons, Sethi said. The researchers hypothesise that just as a ketogenic diet improves the rest of the body's metabolism, it also improves the brain's metabolism.

"Anything that improves metabolic health in general is probably going to improve brain health anyway," Sethi said. "But the ketogenic diet can provide ketones as an alternative fuel to glucose for a brain with energy dysfunction."


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