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November 30, 2020
Diet has a direct impact on how well our bodies function, from digestion and sleep to feeling tired or having the ability to focus.
There have been plenty of fad diets over the decades as well as popular ones that get a lot of fanfare. Some have been shown to work, while others are simply marketing gimmicks aimed at selling commercial products with little evidence to point to their effectiveness.
Two diets that have resurfaced in popularity, intermittent fasting and the ketogenic diet, can be impactful on your physical health—and your mental health too. As research around these two diets has grown, their potential benefits to our mental health are more obvious now than ever before.
Over the years, we’ve been advised on different ways to eat—three square meals, the food pyramid, snack every 90 minutes, and so on. While different eating habits benefit different people, varying advice has led to health epidemics: obesity, diabetes, and other metabolic conditions.
In addition, overeating—or eating too frequently—can raise glucose and insulin levels. Over time, this can lead to insulin resistance, which may cause higher levels of inflammation—something that has been found in many people with psychiatric disorders.
So how do we reshape our diets to work for our bodies—and our minds?
“Fasting is tapping into our fuel stores that we’ve saved for a rainy day,” explained Christopher M. Palmer, MD, director of the Department of Postgraduate and Continuing Education at McLean Hospital, and pioneer of the use of the ketogenic diet in psychiatry.
“When we go into a fasting state, not only do we tap into some of these stores and reserves … our body actually uses that opportunity to look for old or damaged cells and recycles them.” Our cells then use the recycled parts of old or damaged cells as energy sources. “When you eat again,” Palmer shared, “you get new ones again.”
Fasting and intermittent fasting are obvious ways to reduce the number of calories eaten. But fasting can also reduce glucose, insulin levels, and inflammation.
“The challenge with fasting,” Palmer explained, “is that you have to find the right balance.” And while there are clinics that host supervised fasts for a week or even up to a month, this extreme fasting can backfire. “When we talk about fasting, we’re talking about skipping one meal, maybe two meals, or having one large meal and a snack,” Palmer said. “If you’re looking to become more athletic, fasting can take a toll on your metabolism, your muscle mass, and your athletic performance.”
It’s encouraged to seek clinical advice before starting a fasting regimen, Palmer shared. “There are always risks in trying or doing it. You have to do it in the right amount for your body and your medical condition.”
The ketogenic diet has a lot of fans—and a lot of naysayers. Some argue it works very well, delivering on its promises and providing expected results. Others argue the diet can result in health risks, especially from a cardiac perspective. This polar spectrum of support and opposition has made keto more controversial than other diets that have come and gone.
“There is a tremendous amount of information—and misinformation—out there on the keto diet,” Palmer said.
“We’ve been using the ketogenic diet since the early 1900s to treat seizures,” Palmer said. In psychiatry, the use of seizure treatment is common, so “it’s not farfetched to be thinking about an effective, evidence-based seizure treatment alongside the treatment of psychiatric disorders,” Palmer explained.
Dr. Russell Wilder officially named this newer approach the ketogenic diet or “keto,” which Palmer explained “is the original fasting-mimicking diet, developed to imitate the benefits of a fasting state.” R.T. Woodyatt confirmed that ketones caused by fasting could be triggered by a high-fat, low-carb diet. By using fats as fuel instead of carbohydrates, the body creates ketones and doesn’t need to fast to achieve the same result.
A lot of research has been conducted on the ketogenic diet and how ketone levels affect the body. What they discovered was that many patients respond well to the ketogenic diet in terms of reduced seizure frequency—and the results weren’t a fluke. The outcomes were significant. Dietary management could and did have a positive effect on controlling epilepsy. It provided patients with an effective, alternative treatment for those with drug-resistant epilepsy.
Dr. Chris Palmer talks about supporting your mental health through diet and sleep
It’s likely that the keto diet has a widespread benefit on more than just epilepsy, as the diet has been used in practice and is applied by doctors to treat various health problems. There have been well-documented aspects of shared commonalities between multiple mental health conditions. Epilepsy treatment may have been the origin of the diet, but keto has helped introduce how mental health can be improved by simply changing the way we eat.
“It’s surprising to most people to learn that we actually have a lot of scientific evidence of the effects of the ketogenic diet on the brain,” said Palmer.
As researchers have been studying keto, they have learned the diet has also balanced neurotransmitters, decreased inflammation, improved insulin resistance, and corrected metabolic problems in many.
“The ketogenic diet has been found to have profound effects on the gut microbiome, which appears to play a role in mental illness in some people,” said Palmer.
An increase in studies published in medical literature has documented the effectiveness of the diet in treating bipolar disorder and schizophrenia. As a result, there are now a number of controlled studies underway looking at this treatment for mental illnesses, including schizophrenia, treatment-resistant depression, alcoholism, and opioid use disorder.
One common concern is the safety of this diet. As it becomes more popular, skepticism around high-fat diets has begun to reemerge.
“Research has started to examine the safety of the ketogenic diet in people at high risk of heart attack and stroke,” said Palmer. “Although levels of ‘bad’ cholesterol (LDL) do sometimes increase, overall cardiac risk improves dramatically in most people due to improvements in blood pressure, levels of ‘good’ cholesterol (HDL), triglycerides, and inflammation.”
So much research has emerged on the safety and effectiveness of this diet that the American Diabetes Association now lists low-carb and ketogenic diets among recommended dietary patterns for people with diabetes.
Anyone considering either diet should always start first by talking to their physician. The most popular version of the keto diet being used now, Palmer explained, is more focused on weight loss. This version of the diet has not been studied for effectiveness in mental health treatment, “as it creates different levels of ketone bodies,” Palmer said. If you’re considering using the keto diet for mental health treatment, you may need different dietary guidelines.
A quick Internet search will lead you to keto-related recipes, lifestyle changes, and communities. It’s easy to find details about ratios, measurements, and ingredients to follow the diet you want to pursue. But beware: There is a lot of misinformation within these resources.
“There are a lot of different versions of the keto diet, and it’s normal to feel confused and skeptical,” Palmer advised. “Working with a licensed ketogenic dietitian can be helpful if your physician isn’t familiar with the diet.”
That said, a clinically guided approach to diet could be a practical answer for mental wellness that’s been under our noses—and on our plates—for centuries.
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