The Best Free Mental Health Treatment: Ketogenic Diet

We are facing a mental health crisis. The statistics are alarming:

Rates of major depressive disorder are at all-time highs.
Autism diagnoses in the U.S. have quadrupled in the last 20 years.
ADHD rates have tripled since 2010.
Anxiety, especially in children, has seen a threefold increase in 15 years.
Eating disorders are on the rise.
Bipolar disorder rates have doubled in adults and skyrocketed in children and adolescents.
People with mental illness die significantly earlier, losing years of their lives.
Suicide rates have increased by approximately 30% in the last 20 years.
Deaths of Despair, encompassing suicides, alcohol-related deaths, and drug overdoses, have doubled in the same period.

The dramatic rise in mental illness has often been attributed to factors like increased societal stress, greater awareness and diagnosis, and the lingering effects of trauma and social isolation. Yet, if these were the primary drivers, we would expect treatments developed over the past two decades – specifically targeting neurochemical imbalances with sophisticated medications and refining therapeutic techniques to address trauma and cognitive distortions – would have made significant progress in achieving long-term remission and restoring functional lives. Instead, things have gotten worse.

In the largest study ever done of depression, when people come in for their very first antidepressant treatment, of over 4,000 people treated at the best academic centers in the United States, only about 30% get a remission, meaning 70% still have major depressive disorder. After four levels of treatment, the original published report said that 67% got a remission after four different types of treatment for major depressive disorder. However, other researchers have challenged that 67% figure because half of the people in that study dropped out because it just wasn’t working out for them. Those researchers said if they stuck to their protocol, only about 35% got a remission after four treatment levels, which would mean two-thirds of people after getting four levels of treatment are still clinically depressed. One large study of 6,000 patients with schizophrenia showed that only 4% of the patients got a recovery, meaning that their symptoms were in full and complete remission, they had a decent quality of life, and they were able to function in the world and have a job or go to school. 24 out of 25 people didn’t recover.

Mental disorders are now the leading cause of disease burden and disability worldwide. In March 2024, Canada began allowing people to die by assisted suicide because of treatment resistant mental illness. Our current system has failed us.

What’s Actually Causing This?

We’ve only recently started to understand that our conventional notions about mental disorders might be incomplete. Mental health isn’t solely about the brain; it is intricately linked to the health of the entire body. The first clue came with recognizing the link between obesity, diabetes, and mental illness.

Obesity: A Major Risk Factor for Mental Illness

The rising rates of mental illness mirror the simultaneous surge in metabolic disorders like obesity, overweight, diabetes, and pre-diabetes. It’s not a coincidence. Rates of obesity 50 years ago were far lower than they are today, demonstrating that obesity is not primarily genetic.

Consider these connections:

Autism: Women with obesity and diabetes have quadruple the risk of having an autistic child. Obese men have double the risk.
Bipolar Disorder, Anxiety, and Depression: Obese individuals are 50% more likely to develop bipolar disorder and 25% more likely to develop anxiety or depression.
Puberty and Depression: Weight gain around the time of puberty can lead to a 400% increase in the chance of depression by age 24.
Insulin Resistance and Psychosis: Insulin resistance at age nine can increase the risk of developing a psychotic at-risk mental state (a high risk for developing schizophrenia or bipolar disorder) by 500%.
Metabolic Health Crisis: A staggering 93% of US residents have at least one biomarker of metabolic syndrome, such as pre-diabetes, abnormal lipids, high blood pressure, or excessive abdominal fat.

The statistics are stark:

Approximately 70% of adult Americans are overweight or obese.
About 40% of adult Americans are obese.
Around 40% of children are overweight or obese.

Ultimately, obesity significantly elevates the risk of mental health conditions, with rates ranging from 50% to 350% higher for conditions like schizophrenia and bipolar disorder. Furthermore, children who experience the most weight gain around puberty are four times more likely to develop major depression by the time they reach 24.

These statistics paint a clear picture: our physical health, particularly our metabolic health, has a profound impact on our mental well-being. Understanding this connection is the first step towards a more holistic and effective approach to mental health care.

Autism, ADHD, and Parental Health: The Generational Connection

While the exact mechanisms underlying the rising rates of neurodevelopmental disorders like autism and ADHD are still being investigated, emerging research points to a critical connection between parental health, particularly metabolic health, and the risk of these conditions in offspring.

It’s important to dispel the notion that mitochondrial dysfunction is solely inherited from the mother. While maternal mitochondrial DNA plays a role, nuclear DNA from both parents is crucial for mitochondrial health and function. “The answer is unequivocally no. That’s not the way it works,” explains one expert. “The beautiful thing about this theory is that it connects all of the risk factors that we already know play a role in mental health but also metabolic health.”

The research is clear: if parents have obesity, their offspring are at a much greater risk of developing neurodevelopmental disorders, including autism, ADHD, and learning disorders.

Maternal Obesity and Autism: A woman with obesity has double the risk of having an autistic child. If she also has diabetes, that risk quadruples.
Paternal Obesity and Autism: An obese man also doubles the risk of his child being autistic.

Several factors may contribute to this increased risk:

Mitochondrial Problems: Parents with obesity may have mitochondrial dysfunction within their cells, which they then pass on to their children. In some cases, this may manifest as a brain condition.
Epigenetic Factors: The environment can influence epigenetic factors, which are inheritable modifications that control gene expression by turning genes on or off. These epigenetic factors can be passed on from parents to their children, potentially predisposing them to certain conditions.
Womb Environment: Children may be born with a predisposition to obesity due to epigenetic factors influenced by the womb environment.
Early Nutrition: The rise of highly processed, ultra-processed baby food or formula with added sugars may be setting children up for a lifetime of metabolic and neurodevelopmental challenges.

Understanding the link between parental metabolic health and the risk of neurodevelopmental disorders opens the door for preventative strategies. Emphasizing healthy eating habits, regular exercise, and metabolic optimization in parents before conception and during pregnancy may significantly reduce the risk of these conditions in their children.

In contrast to the processed foods often fed to babies in the U.S., consider the lower rates of obesity and overweight among Japanese children, who are commonly given real food like broccoli, seaweed, and fish from a young age.

By prioritizing parental metabolic health and providing optimal early nutrition, we can work towards a future where fewer children are affected by neurodevelopmental disorders. This generational connection highlights the far-reaching impact of diet and lifestyle choices on the health and well-being of future generations.

Metabolic Dysfunction: The Root of the Problem?

Obesity and diabetes aren’t isolated conditions; they are symptoms of deeper metabolic derangement in the body and brain. Emerging research suggests that something in our environment impairs mitochondrial function, which in turn disrupts the parts of the brain that regulate metabolism and eating behaviors.

Obesity is a symptom that your metabolism is disrupted. At the same time that it’s causing your fat cells to just get larger and larger, those same processes are affecting the way your brain functions and putting you at risk for depression, anxiety, burnout, psychosis, bipolar symptoms, etc., and those are the labels that will then ruin your life.

This isn’t to say that obesity always comes before mental illness. Sometimes mental illness comes first as a manifestation of metabolic dysfunction. Consider those suffering from a disorder that are not overweight or obese. Still, these people may likely have underlying metabolic dysfunction that is expressed mentally but not physically. Measuring their biomarkers would show evidence of such disregulation.

This perspective highlights the interconnectedness of physical and mental health. When our cells struggle to convert food and oxygen into energy, they malfunction. When this happens in the brain, it can manifest as the symptoms we recognize as mental illness. In essence, disrupted cellular energy production impacts brain function, leading to a wide range of psychological and psychiatric issues.

Supporting this theory, many genes associated with mental illness are related to metabolism and mitochondria. This confirms the vital role of these biological processes in mental health. These genes underscore that the basis of many mental illnesses may be related to impairment of basic biological energy production.

Mitochondria: The Key to Unlocking Mental Wellness

Mitochondria, often called the “powerhouses of the cell,” are the primary sites where food and oxygen are converted into energy. But their role extends far beyond simple energy production. Emerging research reveals mitochondria as central regulators of cellular function and, potentially, key players in mental health.

In fact, one study revealed that mitochondria are responsible for the expression of approximately 60% of the genes within a cell, highlighting their pervasive influence on cellular processes. Beyond simply being the “power cord” of the cell, mitochondria act as the “motherboard,” directing and allocating resources throughout.

These tiny organelles play a direct role in the production, release, and regulation of crucial neurotransmitters, including serotonin, dopamine, glutamate, and acetylcholine – all vital for mood, cognition, and overall mental well-being.

When mitochondria function optimally, these neurotransmitter systems are balanced and operate effectively. However, mitochondrial dysfunction can disrupt these delicate balances, leading to neurotransmitter imbalances, hormonal dysregulation, increased inflammation, and alterations in the gut microbiome – all factors implicated in the development and progression of mental illness.

Furthermore, the body has a process called “mitophagy,” which involves intentionally or unintentionally “gobbling up” mitochondria, presumably to replace them with newer, healthier versions. Understanding and supporting this process may be crucial for maintaining optimal mitochondrial function.

When you do a deep dive into the science of mitochondria, you can actually begin to understand what’s happening in the brains and bodies of people with mental illness, and you can begin to understand all of these very complicated things, like why would neurotransmitters become imbalanced. By understanding the science of mitochondria, we can begin to connect all the dots in the mental illness puzzle. By supporting mitochondrial health through lifestyle and dietary interventions, we may be able to unlock new avenues for preventing and treating mental health conditions.

Ketogenic Diet: A Better Way to Treat Mental Illness

If mitochondrial dysfunction plays a significant role in mental illness, then therapeutic interventions that target and improve mitochondrial function could offer new hope. One such intervention gaining attention is the ketogenic diet.

The ketogenic diet is a dietary approach characterized by extremely low to zero starch and low carbohydrate intake, especially low sugar intake. The goal is to induce a state of ketosis, mimicking the metabolic effects of fasting. Clinical improvements are often observed only after individuals reach ketosis, indicated by elevated ketone levels in the blood.

How Does it Work?

The ketogenic diet works by stimulating two key processes related to mitochondria:

Mitophagy: The removal of old and defective mitochondria, paving the way for new, healthier ones.
Mitochondrial Biogenesis: The creation of more and healthier mitochondria within cells throughout the body and brain.

By lowering glucose levels, improving insulin signaling, changing the gut microbiome and hormone levels, the ketogenic diet influences neurotransmitter levels, alters calcium channel regulation and calcium levels, changes gene expression, and reduces brain inflammation.

A Century of Use

The ketogenic diet isn’t a new fad. It was developed a century ago, in 1921, by a physician to treat epilepsy. Early results were impressive, with around 50% of patients becoming seizure-free and another 35% experiencing a 50% or greater reduction in seizure frequency. The diet was resurrected in the 1970s at Johns Hopkins for treatment-resistant cases. About one-third of patients become seizure-free, another third get a clinical benefit (50% or greater reduction in seizure frequency), and the other third don’t seem to benefit.

Beyond Epilepsy: Mental Health Benefits

The ketogenic diet has shown promise in significantly improving symptoms for various neurological and psychiatric disorders. Case studies support its use for chronic depression, bipolar disorder, and schizophrenia. In a pilot study of 28 patients with treatment-resistant mental disorders, all experienced some symptom improvement, 46% experienced remission, and 64% were discharged on less medicine.

Furthermore, the ketogenic diet can help reverse insulin resistance and address metabolic syndrome, further supporting overall health. In a randomized controlled trial of Alzheimer’s patients, those in ketosis demonstrated statistically significant improvements in activities of daily living and quality of life.

In a pilot study of 31 patients admitted to a French hospital, 28 patients were able to adhere to the ketogenic diet. Of those 28, 100% had at least some improvement in symptoms, 46% had remission of illness, and 64% were discharged on less medication than they were admitted with.

Real-Life Examples: Case Studies of Transformation

Doris and Schizophrenia: Doris experienced a difficult childhood marked by abuse and trauma. By age 17, she began experiencing daily hallucinations and delusions, eventually leading to a diagnosis of schizophrenia. For decades, Doris tried various medications, but none effectively stopped her symptoms. By age 70, she weighed 330 pounds and had attempted suicide six times. At 70 years old, she was advised to lose weight and began following a ketogenic diet. Within two weeks, she experienced a significant reduction in her hallucinations and delusions. Within months, all of her symptoms of schizophrenia were in full and complete remission. Doris tapered off all medications and lived for another 15 years without symptoms, remaining out of psychiatric hospitals and ceasing suicide attempts. She lost 150 pounds and maintained the weight loss until her death at age 85.
Schizoaffective Disorder and Weight Loss: One 33-year-old man, diagnosed with schizoaffective disorder for eight years, experienced daily auditory hallucinations and paranoid delusions that tormented him and ruined his life. He had tried 17 different medications without success and had gained significant weight. After beginning a ketogenic diet, he experienced an antidepressant effect within two weeks, becoming more engaged and communicative. After six to eight weeks, his auditory hallucinations began to subside, and he started to question his paranoid delusions. Over time, he lost 160 pounds, completed a certificate program, was able to go out in public without paranoia, and performed improv in front of a live audience. He also moved out of his father’s home and lived independently. While he remained on medication, the improvements in his quality of life were remarkable.

Implementation and Ketone Levels

Implementing the ketogenic diet requires careful attention to detail. For obese patients, the focus is on carbohydrate restriction (less than 20 grams of carbs a day). Thin individuals may need to consume high amounts of healthy fats, such as avocados, olive oil, butter, and heavy cream. Measuring ketone levels is essential to ensure ketosis is achieved.

The desired ketone levels depend on the individual and the condition being treated. For depression, a level greater than 0.8 mmol/L is often desired, while for psychotic and bipolar disorders, the goal is often greater than 1.5 mmol/L.

The ketogenic diet represents a promising avenue for exploring metabolic therapies for mental health, primarily because it removes sugar entirely from the diet. By improving mitochondrial function, decreasing brain inflammation, and altering neurotransmitter systems, the ketogenic diet offers a potential pathway towards restoring balance and improving mental well-being.

Conclusion: A New Paradigm for Mental Health

The alarming rise in mental illness demands a new perspective, one that recognizes the profound interconnectedness of the body and mind. Current treatments often fall short, highlighting the need to explore alternative approaches that address the root causes of mental distress.

As we’ve seen, metabolic dysfunction, particularly mitochondrial dysfunction, appears to play a significant role in the development of mental illness, ranging from depression and anxiety to schizophrenia, bipolar disorder, autism, and ADHD. Obesity and related metabolic disorders aren’t merely correlated with mental illness; they may be contributing factors. Furthermore, these metabolic imbalances can have generational consequences, impacting the neurodevelopmental health of offspring.

The ketogenic diet, by targeting mitochondrial function, reducing inflammation, and influencing neurotransmitter systems, offers a promising metabolic therapy for a range of mental health conditions. The case studies of Doris and the schizoaffective patient underscore the transformative potential of this dietary approach.

It’s time to shift our focus from solely targeting neurochemical imbalances to addressing the underlying metabolic factors that contribute to mental illness. Prioritizing parental metabolic health and exploring the ketogenic diet as a therapeutic intervention may pave the way for a brighter, healthier future for ourselves and generations to come.

Interested in learning more about the ketogenic diet and its benefits? Check out our other articles on keto for beginners, keto recipes, and more!