Round 4: Nutritional Ketosis
Part One
Brain Metabolism and Mental Health
There are many ways to wellbeing.
And nutritional ketosis is one of them.
Our wellbeing, sense of self, the thoughts we think, and the emotions we experience are in fact closely related to the foods that we eat. That is the bold hypothesis from the emerging field of metabolic psychiatry. In some sense that is obvious and unsurprising, but good science is now supporting and confirming this position, mainly at the cellular level. One way to achieve good results for brain and mental health, according to the research, is nutritional ketosis.
Nutritional ketosis is something that for around 7 months I have personally been experimenting with and experiencing positive results. What does it do? I believe that it helps me sleep well, feel more balanced emotionally, and have more consistent energy levels throughout the day. This series of posts will explore and explain what nutritional ketosis is, who and what it’s good for, and what risks it carries.
Note that the biggest risk is that the state of nutritional ketosis can sometimes make mental health conditions worse, usually in the short term, and especially if a person is already using psychiatric medication. That’s why researchers advise individuals to try ketosis only in collaboration with a medical professional.
A medical treatment, not a fad diet
Nutritional ketosis refers to the ketogenic diet, sometimes called keto. In short, the key idea is that by eating certain foods and avoiding others, we can have positive effects on our cells, our brains, and thus our mental health. Originally developed in the 1920s as a medical treatment for epilepsy, the diet is designed to mimic fasting. Why fasting? Because it has long been known that fasting - simply not eating food - deprives the brain and body of energy, and does in fact reduce the rate and severity of seizures, which are the essence of epilepsy. Obviously, however, people need to eat - and thus fasting for people living with epilepsy is only a temporary solution. Which is where the ketogenic diet comes in; it was specifically designed by the medical profession to reduce epileptic seizures by allowing people to regularly eat food, but while maintaining the benefits of fasting, and so also reducing seizures over the long-term. Indeed, in many people, though not in all, it helps to reduce both the frequency and severity of seizures, making it a serious option for people living with epilepsy.
What’s important to know is that the ketogenic diet has applications beyond epilepsy. Essentially, that’s because neuronal patterns found in epilepsy have many similarities to those patterns found in other mental health conditions. In fact, there is research to suggest that following a ketogenic diet has improved many varied psychological conditions, such as autism, alcoholism, ADHD, bipolar disorder, schizophrenia, and Alzheimer’s disease. It is believed that the widespread positive effects emerge because of a common pathway: which is the metabolic health of our brains. By improving the metabolism of our brain at the cellular level, we can improve a host of seemingly separate conditions.
How does this work? Think of the common pathway idea like this. The brain is a garden. And if the garden is diseased in some manner, many different plants will grow, all with slight variations and differences. These plants are our varied mental health conditions; they are epilepsy, autism, alcoholism, schizophrenia, and the like. Therefore, treatments that work on the whole garden, rather than separately on the plants alone, are likely to benefit not just one condition but many at the same time. The idea is not just two birds with one stone, but many birds with one stone. That is what nutritional ketosis, report researchers, does. The rest of this post is dedicated to explaining how and why this happens, through the mechanisms of metabolism. But before moving on, let’s hedge this. Note that nutritional ketosis is not a magical and miracle cure; instead, this is a treatment that works for some people and not others, and is rightly undergoing an empirical renaissance - reader, see the references for papers, videos, podcasts, doctors, and researchers all discussing it’s pro’s and con’s.
Some mechanisms of brain metabolism
An important place to begin is the difference between how fats and carbohydrates are metabolised in the brain and body. Start with the fats. When adhering to a ketogenic diet, we are both minimising our carbohydrate intake and significantly increasing our fat intake. This high fat/low carb combination has positive effects on brain energy. For one thing, carbohydrates tend to spike our blood sugar, which, like a rollercoaster, comes back down, and then dips below what our baseline level was before we ate. This spike and subsequent drop in blood glucose (sugar) contributes to why we feel physically tired and emotionally down. Fats, on the other hand, don’t spike our blood sugar anywhere near as much, and are a slower release energy for the body and brain.
It is worth remembering that the brain is fundamentally a physical organ: an entity of nature that requires fuel and blood flow in order to work. It really should not be surprising that the fuel we choose to power our brains with directly influences how we think and how we feel about the world and ourselves. This is true because much evidence points to that fact that the mind (thoughts, emotions) is what the brain does (physical processes). This point about fuel can be demonstrated well by analogy. I want you to imagine two cars.
Clearly, the two cars will differ in how they perform depending on the kind of fuel that each has been given. And the same should be true of brains, which many scientists consider a natural machine, one that nature has, over mind-bending stretches of time, evolved. Moreover, the unique selling point of keto is that when we consume enough fat and low amounts of carbs, the brain switches its fuel source, from glycogen to ketones. The body and brain are not supplied with carbohydrates and instead mostly with fats, which means it has to burn the fat. A nice side effect of the diet is weight loss, which we will discuss below. This is similar to a car switching from petrol to diesel, for example.
When this happens, ketones often produce a stabilising effect in a person's brain, especially in people with severe mental illness. This is partly because fats, as opposed to foods rich in carbohydrates, are much slower release. Carbohydrates release energy very quickly and spike a person's blood sugar, and therefore brain energy. All thoughts and feelings we have about ourselves or indeed about anything are preceded by physical events in the brain, which is why stabilising the brain's fuel source can stabilise both thoughts and feelings in some people.
Moreover, strict high fat/low carb diets, by producing ketones, regrow our mitochondria, which results in system-wide positive effects on the human being. Why? Mighty mitochondria are important because of their powerful influence. Mitochondria are miniature and deeply ancient organs found within our cells throughout our brain and body. Much research has confirmed that in people with mental disorders of many kinds (autism, ADHD, schizophrenia, etc), there is usually dysfunctional mitochondria present. This means that if there are effective and accurate ways to target mitochondria, there is potential to improve brain metabolism and therefore overall mental health across the board. This is why some researchers are suggesting that mental health conditions - autism, ADHD, schizophrenia, and so on - are not only disorders of the brain generally (which is already an accepted view), but are metabolic disorders of the brain in particular. The mitochondria are, in other words, the metabolic garden of our brains.
What mighty mitochondria do
Mitochondria are very important in our mental life because they have so many important functions relating to it. They have lots and lots of important functions, which I will list below:
They are widely known as the powerhouse of the cell. Many people are taught that mitochondria are like little batteries in each of our cells that convert the food we eat into energy the brain and body can use, adenosine triphosphate (ATP). This is true, but they do much more than this.
They are involved in the production and release of neurotransmitters. This is very important because the release of neurotransmitters are exactly what many mental health medications target, and mitochondria are directly involved in the very production of this fundamental neurochemical process.
They are involved in producing and releasing hormones; again, these play a very important role in how we feel and think.
They are involved in overall metabolism, which is where our body converts food into energy and is involved in things like weight gain and weight loss. But more fundamentally, metabolism is about how each of our cells in our body and brain work. Metabolism is about much more than burning calories and instead relates directly to our brain and therefore mental health.
They are involved in calcium regulation, which plays a role in brain cells and how they work (which relates to thoughts and feelings).
They are involved in gene expression, which means dysregulated mitochondria may make it more likely that genes associated with mental distress may become active; healthier mitochondria may prevent genes associated with mental distress from being turned on in the first place.
They are involved in the gut microbiome, which also has links to our mental health, and much research exists on the gut-brain axis. In essence, they improve gut and therefore brain health.
They are involved in reducing inflammation inside our cells. Inflammation is a common marker in much severe mental illness, and reducing it is usually helpful.
Now, if a person wants to engage with mitochondria in a positive way and thereby improve brain metabolism and overall mental health, a ketogenic diet is one way to do this (other things like stress management, sleep, exercise, light, fasting, and cold water exposure are other metabolic treatment options). Getting even more specific, when a person eats keto, the mechanisms of action that make all this mitochondrial change happen are many.
In essence, when you eat a ketogenic diet, the research suggests that you will benefit in the following ways:
Enhanced mitochondrial efficiency, which means the brain gets ATP in a more calculated and balanced way (this stabilises neurotransmitter release and enhances electrical neuronal signalling, which is how neurons communicate with each other).
Reduced reactive oxygen species (ROS) production; too many ROS are associated with damaged mitochondria. In other words, keto improves this.
Enhanced mitophagy. This process - mitophagy - is what allows the body and brain to get rid of dysfunctional mitochondria, and contributes to the formation of new and healthy mitochondria.
Enhanced autophagy. This process - autophagy - is what allows the body and brain to remove damaged and dysfunctional cells and stimulates the production of new and healthy cells. This can also be achieved through fasting. Because the keto diet mimics fasting, it also stimulates autophagy.
Altered respiratory chain function, which may make oxidative phosphorylation more efficient, a process of metabolism that is implicated in brain health.
In summary, the ketogenic diet - what is here called nutritional ketosis - can stabilise mental health because it provides the body and brain with a much more balanced fuel source. This new fuel source, ketones instead of glycogen, has many, many positive effects on mitochondria. And because mitochondria are at the foundation of our of metabolic brain health, they are also at the foundation of our overall feeling of sound mental health. From autism to bipolar disorder, and from alcoholism to Alzheimer's disease, the ketogenic diet seems to improve metabolic brain health across the board, helping individuals regain their sense of wellbeing.
Finally, a reminder on the risks. The diet sometimes makes these complex conditions worse, not better, usually at first. And that’s why many people advise trying keto in collaboration with a medical professional, especially if the person not only has a mental health condition but also is taking medication for these.
References and Further Reading
Reviewing the findings and clinical implications for using ketogenic diet in patients with schizophrenia, published in Current Opinion in Psychiatry https://journals.lww.com/co-psychiatry/Abstract/2019/09000/Ketogenic_diet_for_schizophrenia__clinical.6.aspx
The Effects of Ketogenic Diets on Psychiatric Disorders Involving Mitochondrial Dysfunction: A Literature Review of the Influence of Dieting on Autism, Depression, Anxiety, and Schizophrenia, published in HAPS Educator https://files.eric.ed.gov/fulltext/EJ1233662.pdf
Chronic schizophrenia put into remission without medication, published in Schizophrenia Research https://www.sciencedirect.com/science/article/abs/pii/S0920996419301136?via%3Dihub
Ketogenic diet as a metabolic treatment for mental illness, published in Current Opinion in Endocrinology, Diabetes, and Obesity https://journals.lww.com/co-endocrinology/Abstract/2020/10000/Ketogenic_diet_as_a_metabolic_treatment_for_mental.5.aspx.
Ketogenic therapy in serious mental illness: emerging evidence, published in International Journal of Neuropsychopharmacology https://academic.oup.com/ijnp/article/23/7/434/5861311?guestAccessKey=58ac5bc1-6503-42ea-b9e5-0929513f4f61&login=false
Induced ketosis as a treatment for neuroprogressive disorders: food for thought? Published in International Journal of Neuropsychopharmacology https://academic.oup.com/ijnp/article/23/6/366/5731399
Diets and disorders: can foods or fasting be considered psychopharmacologic therapies? Published in Journal of Clinical Psychiatry https://pubmed.ncbi.nlm.nih.gov/31294934/
The effects of the ketogenic diet on psychiatric symptomatology, weight and metabolic dysfunction in schizophrenia patients, published in Clinical Nutrition and Metabolism https://www.oatext.com/pdf/CNM-1-105.pdf
Harvard researcher and psychiatrist Dr Palmer's Metabolic Thesis is presented in a new book, Brain Energy: A Revolutionary Breakthrough in Understanding Mental Health - and Improving Treatment for Anxiety, Depression, OCD, PTSD, and more, published by Dr Chris Palmer, accessed and more information available at: https://brainenergy.com/#about-the-book
Article written by Dr Palmer on how and why the ketogenic diet can help people who experience mental and auditory hallucinations https://www.psychologytoday.com/us/blog/advancing-psychiatry/201904/chronic-schizophrenia-put-remission-without-medication
Dr Palmers metabolic theory of mental health is presented in a worthwhile book, Brain Energy: A Revolutionary Breakthrough in Understanding Mental Health - and Improving Treatment for Anxiety, Depression, OCD, PTSD, and more, published by Dr Chris Palmer, accessed and more information is available at: https://brainenergy.com/#about-the-book
Free article discussing how the ketogenic diet can help with diverse things like autism, depression, anxiety, and schizophrenia, The Effects of Ketogenic Diets on Psychiatric Disorders Involving Mitochondrial Dysfunction: A Literature Review of the Influence of Dieting on Autism, Depression, Anxiety, and Schizophrenia, published in HAPS Educator https://files.eric.ed.gov/fulltext/EJ1233662.pdf
Three hour podcast where Dr Palmer discusses his research with another well known neuroscientist, Dr Andrew Huberman. This can be listened to and is technical at times, but both are good communicators and try to explain in a way that anyone could understand https://www.youtube.com/watch?v=xjEFo3a1AnI&ab_channel=AndrewHuberman
Another two hour discussion with Dr Palmer about his research with the author Tim Ferris, who is a person that has lived experience with severe mental illness. Again, a bit technical, but both are good communicators https://www.youtube.com/watch?v=JVl1X0fb1uA&t=17s&ab_channel=TimFerriss
A short 3 minute video clip of Dr Palmer describing his most impressive results using the ketogenic diet to treat mental disorders. Her symptoms are similar to Jacks https://www.youtube.com/watch?v=CSGXYg9_fZ4&ab_channel=TimFerriss
20 minute interview with Dr Palmer about his theory of Brain Energy https://www.youtube.com/watch?v=IQpPSYM6Bc8&ab_channel=OneMind