Diets come and diets go with amazing predictability. The standard American diet has shortcomings, so people are frequently eager for an approach to nutrition that will be healthful. A ketogenic diet has been an option for at least a hundred years. A recent pilot study suggests yet another possible application, this time in psychiatry.
History of the Ketogenic Diet:
In the early 20th century, when there were few effective drugs to treat epilepsy, doctors prescribed starvation or a very low-carbohydrate high-fat diet (Epilepsia, Nov. 4, 2008). Such a regimen forced the body to burn fat rather than carbohydrates for energy and resulted in the formation of ketones (explaining the term ketogenic diet).
This dietary approach frequently reduced the number of seizures epileptic children suffered. Parents learned how to manage the diet, which was considered the standard treatment for seizures for several decades.
When phenytoin (Dilantin) was introduced in 1938, doctors lost interest in the ketogenic diet to treat epilepsy. Patients found taking pills much easier than following such a restrictive eating pattern. Medications worked well enough for many individuals with epilepsy.
After decades of neglect, however, the ketogenic diet is returning to popularity. Some individuals don’t respond well to anti-seizure drugs. As a consequence, neurologists have once again begun to treat youngsters with refractory epilepsy by prescribing a low-carb high-fat ketogenic diet (Current Pharmaceutical Design, online Aug. 9, 2017).
Other Possible Uses for a Ketogenic Diet:
We recently received this question from a reader who made no reference to epilepsy: “Can you enlighten us about the ketogenic diet, which I suspect I need?” In recent years, physicians have adopted a carbohydrate-restricted diet to treat metabolic syndrome, type 2 diabetes and cardiovascular disease. The most recent research suggests that people with major mental health challenges such as schizophrenia or bipolar disorder may also benefit.
Psychiatric Conditions:
Doctors usually rely on psychotropic drugs to treat people with bipolar disorder or schizophrenia. Such drugs can be helpful, but they come with a number of potential side effects. A study published in Psychiatry Research suggests that a ketogenic diet might be surprisingly helpful (Psychiatry Research, March 20, 2024).
The pilot study included just 23 individuals with schizophrenia or bipolar disorder along with metabolic abnormalities. There was no control group. After four months, people who stuck with the diet had lost weight and belly fat. Most importantly, their mental health had improved as measured by standardized rating scales. They also reported better sleep and increased life satisfaction.
Such a pilot study is inadequate on its own, but it suggests further trials should be done to explore diet as an additional means for treating mental illness. The scientists are recommending that the diet be tested as an ” adjunct” to rather than replacement for standard antipsychotic medications.
Diabetes:
Researchers have found that cutting carbohydrate intake dramatically reliably lowers blood sugar in people with type 2 diabetes (Nutrition, Jan. 2015). A year-long study of 115 overweight people with diabetes compared the effects of low-carb and high-carb diets (American Journal of Clinical Nutrition, Oct. 2015). The patients following a low-carb diet high in unsaturated fat were able to reduce their medications for blood glucose control. Their blood sugar was less variable, and their lipid profiles, especially HDL and triglycerides, were more favorable. Both groups lost weight and reduced their HbA1c (a measure of blood sugar control over time).
Weight Loss:
Studies in humans and experimental animals show that a very low-carb high-fat diet can help with weight loss (Nutrients, May 2017). In one study, the weight loss drug orlistat (Xenical or Alli) combined with a low-fat diet was compared to a low-carbohydrate ketogenic diet ( Archives of Internal Medicine, Jan. 25, 2010). Over the course of almost a year, both groups lost weight. Those following the ketogenic diet conscientiously improved their blood pressure, blood glucose and insulin levels more effectively.
Athletic Recovery:
Could a very low-carbohydrate diet improve athletic performance? That hypothesis was tested in a case study of five New Zealand endurance athletes (Journal of the International Society of Sports Nutrition, July 12, 2017). After ten weeks on the diet, their performance actually dropped somewhat. However, they reported feeling better, with improvements in recovery time, skin conditions and other inflammatory complaints.
In summary, a low-carbohydrate high-fat diet with adequate protein appears to be a reasonable approach for people who are attempting to lose weight, control their blood sugar and improve their fat metabolism. You’ll find information on how to follow such a diet in the book KetoClarity by Jimmy Moore and Dr. Eric Westman. Be sure to ask your doctor if this regimen is safe for you.
