Keto may be getting a lot of attention for being an effective way to lose weight, but it’s been around in the medical field for a long time. This high-fat, low carb diet was prescribed to epileptic patients as early as the 1920s, and many studies show that it can significantly reduce seizures. Also, the Body Reboot book how else the ketogenic diet may help counteract diseases and other health issues. Today growing research suggests the keto diet may also have the potential to treat mental illnesses.

While on the keto diet a body switches over to burning fat instead of glucose. The fuel switch, according to The Cut, may be why some people may experience mental health benefits. See what else they have to say about how the diet can potentially improve symptoms of depression and anxiety.

This fuel switch is thought to underlie the neurological benefits many doctors have seen in their ketogenic patients. Dr. Emmanuelle Bostock, co-author of a recent review on the use of ketogenic diets in psychiatry, notes that “improvements seen in anxiety, depression and bipolar disorder may be related to changes in neurotransmitters whilst on the diet.” Dr. Georgia Ede, a psychiatrist who studies the relationship between mental health and nutrition, says when refined carbs and sugar serve as the brain’s primary food source, the neural pathways are overwhelmed with free radicals and glucose, depleting our natural internal antioxidants and leading to excess oxidation and inflammation in the brain. When the brain draws its energy from ketones, fewer free radicals are produced, allowing our natural antioxidants to easily neutralize them without becoming depleted. Mitochondria, the “engines” of cells, may function more effectively, and neurotransmitters’ journeys across synapses may be eased.

The author on The Cut also goes on to explain a recent study from late 2017 revealed that for many, the keto diet eased their depression and anxiety symptoms.

Also early last year, researchers at the University of Tasmania compiled a review on the same subject, titled “The Current Status of the Ketogenic Diet in Psychiatry.” Most of the review was comprised of case studies — but what case studies they were. In one, a 70-year-old woman with schizophrenia saw her hallucinations — which she’d had since age 7 — disappear. Two other studies followed women with bipolar II as they followed a ketogenic diet for two and three years, respectively. Ketosis stabilized the women’s moods, they both reported, more effectively than their meds did. Autistic patients have reported improved social relations, and one autistic child placed on keto saw his IQ increase by 70 points after several years. Of course, these reports are anecdotal, and Ede stresses that a lot more research is needed before ketogenic diets are prescribed the way traditional meds are.

Writer Lotte Damen on The Noakes Foundation discusses various studies that researched whether the ketogenic diet may help with depression. Since the foundation argues that a diet high in sugar can lead to depression, naturally when anyone consumes less glucose a mood should improve. In addition, studies revealed other interesting findings:

Several studies have shown that depression may be associated with an increased risk of epilepsy (Bostock, Kirkby & Taylor, 2017). The effectiveness of traditional antidepressant therapies is often researched in animal model studies, but there has only been a couple of rat studies so far on the effectiveness of a ketogenic treatment.

To examine if a ketogenic diet can be implemented as an antidepressant therapy, 20 Wistar rats were given this diet and compared to 20 rats that were fed a standard diet. This 7 day study showed that the rats on a ketogenic diet spent less time immobile than the rats in the control group (Murphy, Likhodii, Nylen & Burnham, 2004). This shows some evidence for potential antidepressant effects. During this study, researchers also measured the levels of beta-hydroxybutyrate, a ketone that exert anti-inflammatory effects. Neuro-inflammation plays a critical role in the development of depression (Hashmi, Aftab, Mazhar, Umair & Butt, 2013; Yamanashi, Iwata, Kamiya, et al., 2017). Despite the fact that currently there are little to no reports published indicating that beta-hydroxybutyrate produces antidepressant-like effects, a study showed that adult offspring mice living on a prenatal ketogenic diet were less sensitive to anxiety and depression (Sussman, Germann, Henkelman, 2015). In other rat studies, it has been found that this ketone together with acetoacetate, decreases the death of neurons and prevents negative changes caused by glutamate excitotoxicity (Maalouf, Sullivan, Davis, et al. 2007).

Medium mentions that because the ketogenic diet is known to help with brain healing and improving brain functioning overall, that also means it may help with depression as well.

The ketogenic diet is showing to be a useful tool in brain healing, having an anti-inflammatory effect in the brain, and potentially having long term effects in brain anatomy and function.

This is GREAT news for anyone suffering with depression.

Using the ketogenic diet, we can improve brain function (and therefore better moods and behaviours) by using the benefits of a ketogenic diet to alter the downstream neurochemical effects of depression.

These studies are demonstrating that there is another important tool — the ketogenic diet — to help improve the symptoms of depression.

To dive into more specific mental disorders, let’s see what Georgia Ede MD on Psychology Today has to say about how the keto diet may help people who suffer from schizophrenia based on a few studies:  

A 3-week mouse study showed that a ketogenic diet normalized pathological behaviors.

1965: A 2-week study of 10 women with treatment-refractory schizophrenia found a significant decrease in symptoms when a ketogenic diet was added to their ongoing standard treatments (medications + ECT). Ketone monitoring was not reported.

2009: A 12-month case study details the experience of a 70-year old overweight woman with chronic schizophrenia who was prescribed a diet limited to 20 grams of carbohydrate per day. She noted significant improvement in severe symptoms beginning only eight days after starting the diet, which consisted of “beef, poultry, ham, fish, green beans, tomatoes, diet drinks, and water.” [ Kraft and Westman 2009 Nutrition & Metabolism 6:10.] She reported complete resolution of auditory and visual hallucinations–with which she’d suffered since age seven. Ketone levels were not monitored.

However, despite the hopeful results of the 2017 study, the researchers concluded that a lot more research must take place before we can say with certainty that the keto diet can combat depression and other mental illnesses.

The search yielded 15 studies that related the use of KD in mental disorders including anxiety, depression, bipolar disorder, schizophrenia, autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD). These studies comprised nine animal models, four case studies, and two open-label studies in humans. In anxiety, exogenous ketone supplementation reduced anxiety-related behaviors in a rat model. In depression, KD significantly reduced depression-like behaviors in rat and mice models in two controlled studies. In bipolar disorder, one case study reported a reduction in symptomatology, while a second case study reported no improvement. In schizophrenia, an open-label study in female patients (n = 10) reported reduced symptoms after 2 weeks of KD, a single case study reported no improvement. In a brief report, 3 weeks of KD in a mouse model normalized pathological behaviors. In ASD, an open-label study in children (n = 30) reported no significant improvement; one case study reported a pronounced and sustained response to KD. In ASD, in four controlled animal studies, KD significantly reduced ASD-related behaviors in mice and rats. In ADHD, in one controlled trial of KD in dogs with comorbid epilepsy, both conditions significantly improved.

Despite its long history in neurology, the role of KD in mental disorders is unclear. Half of the published studies are based on animal models of mental disorders with limited generalizability to the analog conditions in humans. The review lists some major limitations including the lack of measuring ketone levels in four studies and the issue of compliance to the rigid diet in humans. Currently, there is insufficient evidence for the use of KD in mental disorders, and it is not a recommended treatment option. Future research should include long-term, prospective, randomized, placebo-controlled crossover dietary trials to examine the effect of KD in various mental disorders.

Despite not being certain as to whether the keto diet does help with depression, one thing is for sure: It can help many people rethink their relationship with food. Perhaps by implementing a better diet, some may form a better relationship with the food they’re eating and learn to reach for healthier items as opposed to food full of sugar and other unhealthy ingredients. Emily Laurence went on the keto diet and documented how she felt and surprisingly realized why the keto diet had mental benefits for her in particular:

That’s when I realize that, as terrible as the detox was, it did have some mental benefits—it broke diet habits that were so ritualistic I did them without thinking. “Part of the reason for the detox is getting you to rethink your relationship with food,” Dr. Passler says. “Sometimes, you don’t have access to the outward things that make you happy, like that latte in the morning. It’s important to have inner happiness so you don’t need outward things to make you happy.” I hate to admit it, but the man has a point.

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Sources: The Cut, Medium, The Noakes Foundation, Psychology Today, Front Psychiatry. 2017 NCBI, Well+Good