LinkYouTubeFacebookInstagramTwitterLinkedInTikTokLinkLink

Video Presentations on the Brain/Neuroscience and Ketogenic Diet

Neurodegenerative Diseases and the Ketogenic Diet

019: How LOW CARB/KETO Can HELP Your BRAIN! (LOW CARB for NEUROSCIENCE PATIENTS) #ILCAW2023 - Dr. Don Agcopra

International Low Carb Awareness Week 2023

01-07 December 2023

In this presentation, I'll take you on an exciting journey through the fascinating realm of the low carbohydrate ketogenic diet (KD), exploring its medical and therapeutic applications, and its profound impact on patients in the fields of neurology and psychiatry. I will give you a captivating glimpse into the world of Metabolic Syndrome (MetS) and unravel its underlying mechanisms, dissect its potential connection to stroke, and discover how the innovative Therapeutic Carbohydrate Reduction (TCR) or Ketogenic Metabolic Therapy (KMT) serves as a powerful tool in my neurology practice, effectively addressing and preventing associated complications, with a special focus on stroke.

This presentation also tackles the important role of Ketogenic Metabolic Therapy (KMT) for patients with epilepsy, dementia/Alzheimer's disease (AD), Parkinson's disease (PD), Multiple Sclerosis (MS), migraine headache and neuropsychiatric/mental health problems.

"The Ketogenic Diet in Neurology and Psychiatry" - Dr. Chris Palmer

Christopher Palmer, MD received his medical degree from Washington University School of Medicine. He did his internship and psychiatry residency at McLean Hospital, Massachusetts General Hospital, and Harvard Medical School. He is currently the Director of the Department of Postgraduate and Continuing Education at McLean Hospital and an Assistant Professor of Psychiatry at Harvard Medical School. For the past 25 years, he has been an academic physician with administrative, research, educational, and clinical roles.

Dr. Palmer leads McLean Hospital’s Department of Postgraduate and Continuing Education. In this role, he has developed hundreds of educational conferences, workshops, Grand Rounds, and other professional educational activities, most of them under the aegis of Harvard Medical School. He has also held numerous leadership positions in the continuing education field beyond McLean Hospital’s program, including serving on leadership, advisory, and strategic planning committees of Harvard Medical School, Partners Healthcare, the Massachusetts Medical Society, and the Accreditation Council for Continuing Medical Education (ACCME).

Dr. Palmer’s clinical practice has focused on helping people suffering from treatment-resistant mental illnesses, including mood disorders, psychotic disorders, and personality disorders. Most recently, his research interests have turned to the areas of metabolism, metabolic disorders, and their connection to mental disorders. He is focused on combining and understanding epidemiological data, basic science research, and clinical studies in order to better understand what role metabolism plays in mental illness.

Dr. Palmer has been pioneering the use of the ketogenic diet and its applications in psychiatry. He has published case studies, pilot clinical trials, and is actively conducting research in this area. He is also working with researchers from around the world to further explore this treatment in clinical populations as well as pursuing more basic science research.

Brain Glucose and Ketone Metabolism - Dr. Stephen Cunnane, PhD

Filmed at the Emerging Science of Carbohydrate Restriction and Nutritional Ketosis, Scientific Sessions at The Ohio State University

An impressive body of scientific evidence over the last 15 years documents long term benefits of carbohydrate-restricted, especially ketogenic, diets. We now understand molecular mechanisms and why they work. Popular books and articles now challenge the advice ‘carbohydrates are good and fats are bad.’ Circa mid-19th century urinary ketones were identified in diabetics sealing their toxic label for the next 150 years. Despite work four decades ago showing ketones were highly functional metabolites, they are still misidentified as toxic byproducts of fat metabolism. The vilification of fat by regulatory and popular dogma perpetuates this myth. But the nutrition-metabolic landscape is improving dramatically.

A growing number of researchers have contributed to what is now a critical mass of science that provides compelling clinical evidence that ketogenic diets uniquely benefit weight loss, pre-diabetes, and type-2 diabetes. In the last five years, basic scientists have discovered that b-hydroxybutyrate (BHB), the primary circulating ketone, is a potent signaling molecule that decreases inflammation and oxidative stress. BHB has been suggested to be a longevity metabolite, with strong support from recently published mouse studies showing decreased midlife mortality and extended longevity and healthspan. Although type-2 diabetes is often described as a chronic progressive disease, emerging evidence indicates that sustained nutritional ketosis can reverses the disease. There is growing interest in studying potential therapeutic effects of ketosis on cardiovascular diseases, cancer, and neurodegenerative diseases including Alzheimer’s and Parkinson’s. There are even reasons certain athletes may benefit from nutritional ketosis and ketone supplements ─ debunking the long-standing dogma that high carbohydrate intake is required to perform optimally.

With the support of the well-established Ohio State Food Innovation Center, this conference will bring together the top experts in these fields to share what has been achieved and what remains to be done to advance this exciting field of scientific discovery.

Keto & Neurological Disorders - Dr. Eric Westman

What we put into our bodies directly affects our health, how we function and how we think. Can nutrition play a role in certain mental and neurological disorders?  

Our resident expert, Dr. Eric Westman, discusses this topic and answers those questions.

Parkinson's Disease and the Ketogenic Diet

Parkinson's and Diet - with Dr Matthew Phillips

Can fasting and keto heal our brains? Dr Phillips is trialling a radical but simple new treatment approach: using metabolic therapies such as fasting and very low carbohydrate Ketogenic diets. The aim is to restore mitochondrial function, which he sees as the foundation for health.

In this webinar Matthew unpacks his research findings and shares how they may help you.

"Parkinson's, Fasting, and Ketogenic Diets" - Dr Matthew Phillips

In this presentation from the 2020 Parkinson's Insight Congress, Dr Matthew Phillips discusses the potential applications of fasting and ketogenic diets to Parkinson's disease, as well as the results of the 2018 Waikato Hospital Parkinson's Dietary Study.

Keto Diet In Human Trials For Mild Cognitive Impairment & Parkinson's - with Dr Mary Newport

In this video Dr Newport talks about some of the trials which are using MCT and ketogenic diets to address mild cognitive impairment and Parkinson's.

Multiple Sclerosis and the Ketogenic Diet

Keto Diet Improves Multiple Sclerosis Symptoms

A new preliminary study reports a ketogenic diet significantly improves quality of life and health scores for people with multiple sclerosis (MS). Given the lack of safe and effective therapies for MS, this is very encouraging to have a lifestyle-based therapy that can make a positive difference in the lives of people with MS.

Psychiatric/Mental Health and the Ketogenic Diet

Keto Diet Improved Mental Illness

A new study reports a ketogenic diet can significantly improve depression, bipolar, and schizoaffective disorders. More evidence continues to accumulate showing the potential use of ketogenic diets in various mental health conditions. It's time to take this seriously. Ongoing research will soon provide even more data to support if keto diets should be a standard treatment option.

Best Practices for Treating Mental Illness with a Keto Diet

If you’re considering starting a ketogenic diet to treat symptoms of psychiatric illness, it is important to find a practitioner who can help guide you through the process. In this video, appropriate for both clinicians and individuals, expert clinicians share their recommendations for getting started with a ketogenic intervention. Featured in this video are Georgia Ede, MD, Chris Palmer, MD, Ignacio Cuaranta, MD, dietician Beth Zupec-Kania, licensed mental health counselor Nicole Laurent, and others. If you are curious about using the ketogenic diet to improve symptoms of psychiatric illness, this is the video for you!

Who Should Use KETO for Mental Illness?

Therapeutic nutritional ketosis can be part of a comprehensive treatment for a broad spectrum of psychiatric illnesses – from anxiety, OCD, PTSD, and mild or moderate depression to Bipolar Disorder, Schizophrenia, Major Depressive Disorder, and everything in between. So, who should consider using therapeutic ketosis to treat mental illness?

In this video, Dr. Bret Scher speaks with Metabolic Psychiatry experts Drs. Georgia Ede and Chris Palmer to help you better understand who may benefit from a ketogenic diet.

Ketogenic Diets for Mental Health - Dr. Georgia Ede

In this private feed episode of The Metabolic Link, psychiatrist Dr. Georgia Ede shares groundbreaking research on using ketogenic diets to treat psychiatric disorders. She makes the case that emerging science shows many psychiatric symptoms may be rooted in treatable metabolic dysfunction.

She takes us through evidence that conditions like schizophrenia, bipolar disorder, and depression share common biochemical imbalances that can be targeted with ketogenic diets.

Many patients in case studies and early clinical trials have shown reduced inflammation, balanced neurotransmitters, enhanced insulin sensitivity, and improved psychiatric symptoms. Thanks to this encouraging preliminary data, the ketogenic diet is being studied clinically, but large human trials are needed to fully understand its safety and efficacy in psychiatric disease.

Treating Mental Illness with Keto - Dr. Georgia Ede

Interventions like ketogenic metabolic therapy (aka ketogenic diet) are being used to treat serious mental illnesses like major depression, bipolar and schizophrenia.  Georgia Ede, MD is a pioneer in Metabolic Psychiatry, and has used a ketogenic diet to help hundreds of patients improve their symptoms of mental illess. 

Dr. Georgia Ede is a Harvard-trained psychiatrist and worldwide expert in nutritional psychiatry. Dr. Ede has over a decade of real-world experience using nutrition as a treatment for mental illness. In her talk, she describes her real-world experience using ketogenic metabolic interventions to restore brain function in psychiatric disorders.

"Change Your Diet, Change Your Mind" by Metabolic Psychiatry Pioneer Dr. Georgia Ede

Is the key to optimizing physical and mental health eating so-called superfoods like dark chocolate, red wine and blueberries? Dr. Georgia Ede, a Harvard-trained psychiatrist and metabolic psychiatry pioneer, shares counter-evidence to mainstream views on the optimal human diet. In this interview, she discusses nourishing the brain by eating the right foods, protecting it by staying away from the wrong foods, and energizing it by cultivating a healthy metabolism. Ede argues that the key to healing, protecting, and enhancing brain function is keeping blood sugar (glucose) and insulin within a healthy range.

Drawing on over a decade of treating patients with a metabolic approach to mental health conditions, Dr. Ede shares the clinical and scientific evidence behind brain food in Change Your Diet, Change Your Mind. It is a practical, comprehensive guide for anyone interested in optimizing brain health If you’re interested in how nutrition can lead to improved mental health.

First Clinical Trial of Ketogenic Diet for Bipolar & Schizophrenia - Shebani Sethi, MD

Early data from the first clinical pilot trial of the ketogenic metabolic intervention for serious mental illness shows promising results that could transform how the field of psychiatry understands and treats serious mental illness. 

“In this pilot study, we taught 22 patients with severe bipolar disorder or schizophrenia how to maintain a ketogenic diet. It was all real-world, meaning we didn’t control food intake in a temporary inpatient setting and we didn’t deliver meals, but instead taught patients how to buy and prepare their own food. Despite the severity of their mental illness, our patients were able to successfully adopt the ketogenic diet as a lifestyle change. However, there is a selection bias, as those who entered the study may have been a more motivated population.

After four months, our preliminary results were very encouraging: They included a 30% reduction in central abdominal fat, an 11% drop in BMI and a 17% drop in cardiac inflammation, as measured by a marker called high-sensitivity C-reactive protein. Perhaps most importantly, we saw a 30% improvement in our patients’ clinical global impression inventory, which is the gold-standard psychiatric assessment we use to evaluate symptoms of mental illness. Additionally, we saw improvements in sleep.”

Dr. Shebani Sethi is a board-certified physician in psychiatry and obesity medicine, a clinical assistant professor of psychiatry at Stanford University, and the founding director of Stanford's metabolic psychiatry clinic. In this talk, she describes the preliminary findings from her pioneering study on ketogenic diets and mental illness.

Keto Diet Benefits on Depression, Mental & Metabolic Health - Drs. Iain Campbell, Bret Scher & Dominic D’Agostino

The ketogenic diet may help reduce depression and other symptoms in bipolar disorder. The ketogenic diet also helps metabolic health and reduces the risk for cardiometabolic diseases. The risk for cardiometabolic diseases is elevated in people with bipolar disorder when compared to the general population. Dr. Iain Campbell, Dr. Bret Scher, and Dr. Dominic D’Agostino discuss how the state of ketosis has beneficial effects on brain neurotransmitters and how those benefits have been life-changing physically and mentally for Dr. Campbell, who has bipolar disorder.

Ketogenic Diets and Mental Health - with Dr. Chris Palmer

Ketogenic diets may be the most effective lifestyle therapy for mental health disorders. International expert Dr. Chris Palmer and I discuss the state of the field and how he sees keto diets fitting into mental health treatment programs.

Scholarly Articles on the Brain/Neuroscience and the Ketogenic Diet

Sugar and Its Toxic Effects on the Brain

The Impact of Free and Added Sugars on Cognitive Function: A Systematic Review and Meta-AnalysisA relationship between excessive sugar consumption and cognitive function has been described in animal models, but the specific effects of sugars in humans remains unclear. This systematic review and meta-analysis aimed to evaluate the current knowledge, research characteristics, and quality of evidence of studies investigating the impacts of free and added sugars on human cognition in healthy participants. The review identified 77 studies (65 experimental trials, n = 3831; 9 cross-sectional studies, n = 11,456; and 3 cohort studies, n = 2059). All cohort studies and eight of the nine cross-sectional studies found significant positive correlations between added sugar consumption and risk of cognitive impairment. Four studies identified reduced risk of cognitive impairment associated with natural fructose-containing foods. The majority of randomised control trials assessed short-term glucose facilitation effects on cognitive outcomes. The results from these studies suggest the need for a tightly regulated blood glucose level, dependent on individualised physiological factors, for optimal cognitive function. A meta-analysis of a subset of studies that assessed the impact of glucose on recall found improvements in immediate free recall compared to controls (p = 0.002). The findings highlight the potentially detrimental effect of excessive, long-term, or prenatal added sugar consumption on cognitive function. Further research is needed to examine the specific effects of free and added sugars on cognitive function.

Neurodegenerative Diseases and the Ketogenic Diet

Modulation of Cellular Biochemistry, Epigenetics and Metabolomics by Ketone Bodies. Implications of the Ketogenic Diet in the Physiology of the Organism and Pathological StatesKetone bodies (KBs), comprising β-hydroxybutyrate, acetoacetate and acetone, are a set of fuel molecules serving as an alternative energy source to glucose. KBs are mainly produced by the liver from fatty acids during periods of fasting, and prolonged or intense physical activity. In diabetes, mainly type-1, ketoacidosis is the pathological response to glucose malabsorption. Endogenous production of ketone bodies is promoted by consumption of a ketogenic diet (KD), a diet virtually devoid of carbohydrates. Despite its recently widespread use, the systemic impact of KD is only partially understood, and ranges from physiologically beneficial outcomes in particular circumstances to potentially harmful effects. Here, we firstly review ketone body metabolism and molecular signaling, to then link the understanding of ketone bodies’ biochemistry to controversies regarding their putative or proven medical benefits. We overview the physiological consequences of ketone bodies’ consumption, focusing on (i) KB-induced histone post-translational modifications, particularly β-hydroxybutyrylation and acetylation, which appears to be the core epigenetic mechanisms of activity of β-hydroxybutyrate to modulate inflammation; (ii) inflammatory responses to a KD; (iii) proven benefits of the KD in the context of neuronal disease and cancer; and (iv) consequences of the KD’s application on cardiovascular health and on physical performance.
Neurodegenerative disorders, metabolic icebergs, and mitohormesis - Translational NeurodegenerationNeurodegenerative disorders are typically “split” based on their hallmark clinical, anatomical, and pathological features, but they can also be “lumped” by a shared feature of impaired mitochondrial biology. This leads us to present a scientific framework that conceptualizes Alzheimer’s disease (AD), Parkinson’s disease (PD), amyotrophic lateral sclerosis (ALS), and Huntington’s disease (HD) as “metabolic icebergs” comprised of a tip, a bulk, and a base. The visible tip conveys the hallmark neurological symptoms, neurodegenerative regions, and neuronal protein aggregates for each disorder. The hidden bulk depicts impaired mitochondrial biology throughout the body, which is multifaceted and may be subdivided into impaired cellular metabolism, cell-specific mitotypes, and mitochondrial behaviours, functions, activities, and features. The underlying base encompasses environmental factors, especially modern industrial toxins, dietary lifestyles, and cognitive, physical, and psychosocial behaviours, but also accommodates genetic factors specific to familial forms of AD, PD, and ALS, as well as HD. Over years or decades, chronic exposure to a particular suite of environmental and genetic factors at the base elicits a trajectory of impaired mitochondrial biology that maximally impacts particular subsets of mitotypes in the bulk, which eventually surfaces as the hallmark features of a particular neurodegenerative disorder at the tip. We propose that impaired mitochondrial biology can be repaired and recalibrated by activating “mitohormesis”, which is optimally achieved using strategies that facilitate a balanced oscillation between mitochondrial stressor and recovery phases. Sustainably harnessing mitohormesis may constitute a potent preventative and therapeutic measure for people at risk of, or suffering with, neurodegenerative disorders.
Neuroprotection by the Ketogenic Diet: Evidence and ControversiesThe ketogenic diet (KD) is a high-fat low-carbohydrate diet that has been used for decades as a non-pharmacologic approach to treat metabolic disorders and refractory pediatric epilepsy. In recent years, enthusiasm for the KD has increased in the scientific community due to evidence that the diet reduces pathology and improves various outcome measures in animal models of neurodegenerative disorders, including multiple sclerosis, stroke, glaucoma, spinal cord injury, retinal degenerations, Parkinson's disease and Alzheimer's disease. Clinical trials also suggest that the KD improved quality of life in patients with multiple sclerosis and Alzheimer's disease. Furthermore, the major ketone bodies BHB and ACA have potential neuroprotective properties and are now known to have direct effects on specific inflammatory proteins, transcription factors, reactive oxygen species, mitochondria, epigenetic modifications and the composition of the gut microbiome. Neuroprotective benefits of the KD are likely due to a combination of these cellular processes and other potential mechanisms that are yet to be confirmed experimentally. This review provides a comprehensive summary of current evidence for the effectiveness of the KD in humans and preclinical models of various neurological disorders, describes molecular mechanisms that may contribute to its beneficial effects, and highlights key controversies and current gaps in knowledge.
The Role of Ketogenic Diet in the Treatment of Neurological DiseasesOver a hundred years of study on the favourable effect of ketogenic diets in the treatment of epilepsy have contributed to a long-lasting discussion on its potential influence on other neurological diseases. A significant increase in the number of scientific studies in that field has been currently observed. The aim of this paper is a widespread, thorough analysis of the available scientific evidence in respect of the role of the ketogenic diet in the therapy of neurological diseases such as: epilepsy, Alzheimer’s disease (AD), Parkinson’s disease (PD), multiple sclerosis (MS) and migraine. A wide range of the mechanisms of action of the ketogenic diet has been demonstrated in neurological diseases, including, among other effects, its influence on the reduction in inflammatory conditions and the amount of reactive oxygen species (ROS), the restoration of the myelin sheath of the neurons, the formation and regeneration of mitochondria, neuronal metabolism, the provision of an alternative source of energy for neurons (ketone bodies), the reduction in glucose and insulin concentrations, the reduction in amyloid plaques, the induction of autophagy, the alleviation of microglia activation, the reduction in excessive neuronal activation, the modulation of intestinal microbiota, the expression of genes, dopamine production and the increase in glutamine conversion into GABA. The studies discussed (including randomised controlled studies), conducted in neurological patients, have stressed the effectiveness of the ketogenic diet in the treatment of epilepsy and have demonstrated its promising therapeutic potential in Alzheimer’s disease (AD), Parkinson’s disease (PD), multiple sclerosis (MS) and migraine. A frequent advantage of the diet was demonstrated over non-ketogenic diets (in the control groups) in the therapy of neurological diseases, with simultaneous safety and feasibility when conducting the nutritional model.
The Role of Ketogenic Metabolic Therapy on the Brain in Serious Mental Illness: A ReviewIn search of interventions targeting brain dysfunction and underlying cognitive impairment in schizophrenia, we look at the brain and beyond to the potential role of dysfunctional systemic metabolism on neural network instability and insulin resistance in serious mental illness. We note that disrupted insulin and cerebral glucose metabolism are seen even in medication-naïve first-episode schizophrenia, suggesting that people with schizophrenia are at risk for Type 2 diabetes and cardiovascular disease, resulting in a shortened life span. Although glucose is the brain’s default fuel, ketones are a more efficient fuel for the brain. We highlight evidence that a ketogenic diet can improve both the metabolic and neural stability profiles. Specifically, a ketogenic diet improves mitochondrial metabolism, neurotransmitter function, oxidative stress/inflammation, while also increasing neural network stability and cognitive function. To reverse the neurodegenerative process, increasing the brain’s access to ketone bodies may be needed. We describe evidence that metabolic, neuroprotective, and neurochemical benefits of a ketogenic diet potentially provide symptomatic relief to people with schizophrenia while also improving their cardiovascular or metabolic health. We review evidence for KD side effects and note that although high in fat it improves various cardiovascular and metabolic risk markers in overweight/obese individuals. We conclude by calling for controlled clinical trials to confirm or refute the findings from anecdotal and case reports to address the potential beneficial effects of the ketogenic diet in people with serious mental illness.

Parkinson's Disease and the Ketogenic Diet

Multiple Sclerosis and the Ketogenic Diet

Exploring the impact of ketogenic diet on multiple sclerosis: obesity, anxiety, depression, and the glutamate systemBackgroundMultiple sclerosis (MS) is a neurodegenerative disorder. Individuals with MS frequently present symptoms such as functional disability, obesity, and anxiety and depression. Axonal demyelination can be observed and implies alterations in mitochondrial activity and increased inflammation associated with disruptions in glutamate neurotransmitter activity. In this context, the ketogenic diet (KD), which promotes the production of ketone bodies in the blood [mainly β-hydroxybutyrate (βHB)], is a non-pharmacological therapeutic alternative that has shown promising results in peripheral obesity reduction and central inflammation reduction. However, the association of this type of diet with emotional symptoms through the modulation of glutamate activity in MS individuals remains unknown.AimTo provide an update on the topic and discuss the potential impact of KD on anxiety and depression through the modulation of glutamate activity in subjects with MS.DiscussionThe main findings suggest that the KD, as a source of ketone bodies in the blood, improves glutamate activity by reducing obesity, which is associated with insulin resistance and dyslipidemia, promoting central inflammation (particularly through an increase in interleukins IL-1β, IL-6, and IL-17). This improvement would imply a decrease in extrasynaptic glutamate activity, which has been linked to functional disability and the presence of emotional disorders such as anxiety and depression.
Phase II study of ketogenic diets in relapsing multiple sclerosis: safety, tolerability and potential clinical benefitsBackground Dietary changes impact human physiology and immune function and have potential as therapeutic strategies. Objective Assess the tolerability of a ketogenic diet (KD) in patients with relapsing multiple sclerosis (MS) and define the impact on laboratory and clinical outcome metrics. Methods Sixty-five subjects with relapsing MS enrolled into a 6-month prospective, intention-to-treat KD intervention. Adherence was monitored with daily urine ketone testing. At baseline, fatigue, depression and quality of life (QoL) scores were obtained in addition to fasting adipokines and MS-related clinical outcome metrics. Baseline metrics were repeated at 3 and/or 6 months on-diet. Results Eighty-three percent of participants adhered to the KD for the study duration. Subjects exhibited significant reductions in fat mass and showed a nearly 50% decline in self-reported fatigue and depression scores. MS QoL physical health (67±16 vs 79±12, p<0.001) and mental health (71±17 vs 82±11, p<0.001) composite scores increased on-diet. Significant improvements were noted in Expanded Disability Status Scale scores (2.3±0.9 vs 1.9±1.1, p<0.001), 6-minute walk (1631±302 vs 1733±330 ft, p<0.001) and Nine-Hole Peg Test (21.5±3.6 vs 20.3±3.7 s, p<0.001). Serum leptin was lower (25.5±15.7 vs 14.0±11.7 ng/mL, p<0.001) and adiponectin was higher (11.4±7.8 vs 13.5±8.4 µg/mL, p=0.002) on the KD. Conclusion KDs are safe and tolerable over a 6-month study period and yield improvements in body composition, fatigue, depression, QoL, neurological disability and adipose-related inflammation in persons living with relapsing MS. Trial registration information Registered on ClinicalTrials.gov under registration number [NCT03718247][1], posted on 24 October 2018. First patient enrolment date: 1 November 2018. Link: <https://clinicaltrials.gov/ct2/show/NCT03718247?term=NCT03718247&draw=2&rank=1>. Data are available upon reasonable request. Any data not published within the article are available, and the anonymised data will be shared by request from any qualified investigator. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03718247&atom=%2Fjnnp%2F93%2F6%2F637.atom

Psychiatric/Mental Health and the Ketogenic Diet

The Role of Ketogenic Metabolic Therapy on the Brain in Serious Mental Illness: A ReviewIn search of interventions targeting brain dysfunction and underlying cognitive impairment in schizophrenia, we look at the brain and beyond to the potential role of dysfunctional systemic metabolism on neural network instability and insulin resistance in serious mental illness. We note that disrupted insulin and cerebral glucose metabolism are seen even in medication-naïve first-episode schizophrenia, suggesting that people with schizophrenia are at risk for Type 2 diabetes and cardiovascular disease, resulting in a shortened life span. Although glucose is the brain’s default fuel, ketones are a more efficient fuel for the brain. We highlight evidence that a ketogenic diet can improve both the metabolic and neural stability profiles. Specifically, a ketogenic diet improves mitochondrial metabolism, neurotransmitter function, oxidative stress/inflammation, while also increasing neural network stability and cognitive function. To reverse the neurodegenerative process, increasing the brain’s access to ketone bodies may be needed. We describe evidence that metabolic, neuroprotective, and neurochemical benefits of a ketogenic diet potentially provide symptomatic relief to people with schizophrenia while also improving their cardiovascular or metabolic health. We review evidence for KD side effects and note that although high in fat it improves various cardiovascular and metabolic risk markers in overweight/obese individuals. We conclude by calling for controlled clinical trials to confirm or refute the findings from anecdotal and case reports to address the potential beneficial effects of the ketogenic diet in people with serious mental illness.
The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of 31 InpatientsBackground and HypothesisThe robust evidence base supporting the therapeutic benefit of ketogenic diets in epilepsy and other neurological conditions suggests this same metabolic approach may also benefit psychiatric conditions.Study DesignIn this retrospective analysis of clinical care, 31 adults with severe, persistent mental illness (major depressive disorder, bipolar disorder, and schizoaffective disorder) whose symptoms were poorly controlled despite intensive psychiatric management were admitted to a psychiatric hospital and placed on a ketogenic diet restricted to a maximum of 20 grams of carbohydrate per day as an adjunct to conventional inpatient care. The duration of the intervention ranged from 6 to 248 days.Study ResultsThree patients were unable to adhere to the diet for >14 days and were excluded from the final analysis. Among included participants, means and standard deviations (SDs) improved for the Hamilton Depression Rating Scale scores from 25.4 (6.3) to 7.7 (4.2), P < 0.001 and the Montgomery-Åsberg Depression Rating Scale from 29.6 (7.8) to 10.1 (6.5), P < 0.001. Among the 10 patients with schizoaffective illness, mean (SD) of the Positive and Negative Syndrome Scale (PANSS) scores improved from 91.4 (15.3) to 49.3 (6.9), P < 0.001. Significant improvements were also observed in metabolic health measures including weight, blood pressure, blood glucose, and triglycerides.ConclusionsThe administration of a ketogenic diet in this semi-controlled setting t...

Migraine and the Ketogenic Diet

Very-low-calorie ketogenic diet vs hypocaloric balanced diet in the prevention of high-frequency episodic migraine: the EMIKETO randomized, controlled trial - Journal of Translational MedicineBackground Migraine is the second world’s cause of disability. Among non-pharmacological treatments, nutritional intervention, particularly ketogenic diet, represents one of the most promising approaches. Methods This a prospective, single center, randomized, controlled study aimed at evaluating the efficacy of a very low-calorie ketogenic diet (VLCKD) compared to a hypocaloric balanced diet (HBD) in migraine prophylaxis in patients affected by high-frequency episodic migraine (HFEM) with a Body Mass Index (BMI) > 27 kg/m2. Fifty-seven patients were randomly assigned to a VLCKD (group 1) or HBD (group 2). Group 1 patients followed a VLCKD for 8 weeks, followed by a low calorie diet (LCD, weeks 9–12), and a HBD (weeks 13–24), whereas group 2 patients followed a HBD from week 0 to 24. Anthropometric indexes, urine and blood chemistry were assessed at enrollment, baseline, weeks 4, 8, 12, and 24. Migraine characteristics were evaluated at baseline, weeks 8, 12 and 24. Change in monthly migraine days (MMDs) at weeks 5–8 compared to baseline was the primary endpoint. Secondary endpoints encompassed changes in visual analogue scale (VAS), Headache Impact Test-6 (HIT-6) and Short Form Health Survey-36 (SF-36) scores. We also studied effects on circulating lymphocytes and markers of inflammation, changes in plasma aldosterone and renin levels before and after VLCKD or HBD treatment. Results Reduction from baseline in MMDs was greater in VLCKD compared to HBD group at week 8 (p = 0.008), at week 12 (p = 0.007), when ketosis had been interrupted by carbohydrates reintroduction, and at week 24 (p = 0.042), when all patients were following the same dietary regimen. Quality of life scores (SF-36) were improved in VLCKD group at week 8 and 12, and were also improved in HBD group, but only at week 12. Weight-loss was significantly higher in VLCKD group at week 8 (p = 0.002) and week 12 (p = 0.020). At the end of the study weight loss was maintained in VLCKD group whereas a slight weight regain was observed in HBD group. Inflammatory indexes, namely C reactive protein (CRP), neutrophil to lymphocyte ratio (NLR) and total white blood cell count (WBC) were significantly reduced (p < 0.05) in VLCKD group at week 12. Aldosterone plasma level were significantly increased in both groups at week 8, particularly in VLCKD group. However, electrolytes and renin plasma levels were never altered throughout the study in both groups. Conclusions VLCKD is more effective than HBD in reducing MMD in patients with HFEM and represents an effective prophylaxis in patients with overweight/obesity. Trial registration ClinicalTrials.gov identifier: NCT04360148.