The Metabolic Link to Mental Health
Thank you to Metabolic Health Summit for this article!
We are facing a mental health crisis. In 2019, the WHO estimated that nearly 1 billion people globally were living with a mental disorder, a figure that is expected to have risen substantially following the pandemic. Anxiety and depressive disorders were the most common, affecting a total of nearly 600 million people, including over 70 million children. Other disorders include bipolar disorder, PTSD, schizophrenia and eating disorders.
Current treatments, including medication and psychological therapies, have variable success and there is an urgent requirement for more effective standalone and adjunctive approaches.
One treatment area that is gaining traction is the use of metabolic therapies, in particular the ketogenic diet. This has arisen from multiple strands of evidence:
Biological plausibility for a beneficial and stabilizing influence of ketones on the brain;
Anecdotal evidence of mood improvements in people who have undergone a ketogenic diet;
Observational evidence that risk factors for metabolic conditions are also risk factors for mental disorders; and
Clinical evidence for the effectiveness of the ketogenic diet in treating other neurological conditions, most notably epilepsy.
Building upon these early lines of evidence, we are now seeing an explosion in research related to the ketogenic diet and mental health. Last month, a systematic review was published that explored efficacy of low carbohydrate and ketogenic diets in treating mood and anxiety disorders. It identified 12 studies (nine case reports, two cohort studies and one observational study) involving a total of 389 patients.
The studies showed some evidence of efficacy in bipolar disorder, schizoaffective disorder, and possibly unipolar depression/anxiety. Reported therapeutic effects included mood stability, increased energy and concentration, and reductions in symptoms of anxiety, depression, and psychosis. However, the review didn’t find any randomized controlled trials (RCTs), which are the gold standard for establishing causality, and the authors conclude that – unsurprisingly – more robust studies are needed.
Excitingly, this is exactly what seems to be happening. A search for clinical trials on clinicaltrials.gov revealed 12 clinical trials that are currently recruiting participants. These are investigating the effects of a ketogenic diet on a whole range of mental health disorders, including psychosis, PTSD, schizophrenia, depression, alcoholism, bipolar, and Alzheimer’s. Hopefully, this research will answer many questions, including which patient groups may benefit, what mechanisms are driving the reported effects, what level of ketosis is required for therapeutic success, and many more.