Ever been told your anxiety, depression, or ADHD is due to a “mysterious chemical imbalance?” It’s a phrase we’ve all heard, but it can feel frustratingly vague and disempowering. What if the answer isn’t just about popping a pill to rebalance those “mystery chemicals?” What if there’s a deeper, more fundamental reason why your brain isn’t firing on all cylinders?
What if the key to unlocking better mental well-being is as simple as changing what you eat?
Enter the ketogenic diet. Now, I know what you might be thinking: “Another diet fad? Ugh.” But stick with me. This isn’t about fitting into skinny jeans (though, hey, if that happens, bonus!). This is about potentially rewiring your brain for the better.
A Real-Life Transformation: Carl’s Story
Sometimes, the most compelling evidence comes not from large clinical trials, but from individual stories of transformation. Take the case of Carl, a gentleman in his mid-60s who had experienced lifelong depression and anxiety.
For years, Carl did not seek treatment. However, about 15 years prior, he visited a Psychiatry specialty clinic for brain imaging and extensive evaluation. Following this evaluation, Carl received three diagnoses: depression, anxiety, and ADHD. He was also given three prescriptions, one for each condition.
After starting the medications, his depression improved significantly. However, he developed a new problem: mania, which he had never experienced before. This led to him being uncharacteristically energetic, irritable, and unpleasant, affecting his behavior at work and home.
To cope with the side effects of the medication, Carl turned to marijuana and developed a marijuana addiction, creating another problem for him.
Feeling that the medications were not the right solution, Carl took himself off all medications and decided to manage his mood issues through rigorous exercise. He began cycling over 100 miles a week, which helped to bring his symptoms down to a manageable level for years. Exercise improves metabolic health.
Despite his exercise regimen, Carl was still eating a standard American diet and had never tried any dietary changes.
As he entered his 60s, his depression and anxiety began to increase, and exercise became less effective.
Shortly before exploring dietary interventions, a stressful work event involving a change in his job description caused him to experience sudden bouts of agitation, anxiety, and restlessness. To manage this excess energy, Carl would exercise even more, sometimes cycling on weekends and walking up to 25 miles on weeknights because he couldn’t bike in the dark. He felt he didn’t have enough time to exercise to keep his symptoms under control.
Looking for solutions online, he came across information about carnivore diets and mental health and decided to give it a try.
Carl specifically wanted to try the carnivore diet for his anxiety, hoping for fast relief.
He switched to a diet consisting of 3 to 4 pounds of fatty meat per day, mostly pork and beef, with no dairy or plants. Carl checked his ketones using urine testing and was in mild ketosis every day.
The results were remarkable. He began to improve by week three, and by week six, his score was zero on all his depression and anxiety scales. He had no symptoms at all of depression or anxiety, including the lifelong symptoms that had never fully resolved before.
Carl reported that he had never felt this well in his entire life, highlighting the potential of these strategies to heal underlying problems rather than just reduce symptoms.
Interestingly, during his period of agitation before the carnivore diet, Carl, despite being physically fit and lean, lost 10 pounds that he couldn’t afford to lose. When he started the carnivore diet and was eating four pounds of fatty meat per day, he still couldn’t regain that 10 pounds unless carbohydrate was added back into his diet. This illustrates a subtle point about the potential need for some carbohydrate for athletes, especially during the initial transition.
Carl did not stay on the carnivore diet long-term. After several months, he began adding back some carbohydrate. Carl chose potatoes and plain unsweetened yogurt, consuming up to about 100 grams of carbohydrate per day on exercise days and less on non-exercise days, tailoring it to his energy needs.
Despite these adjustments, Carl has remained well, demonstrating that understanding the fundamental principles of nutrition allows for some dietary flexibility.
Carl’s story is a powerful reminder that diet can play a profound role in mental health, and that even lifelong struggles can potentially be alleviated through targeted dietary interventions.
What is the Ketogenic Diet and How Does it Affect the Brain?
The ketogenic diet (often called “keto”) is a dietary approach that’s very low in carbs, especially low in sugar, and moderate in protein. The main goal? To get your body into a state called ketosis. Think of it as switching your body’s fuel source from sugar-burning to fat-burning. When you drastically reduce your carbohydrate intake, your body starts breaking down fat into molecules called ketones, which then become your primary energy source.
But how does this affect the brain? Well, it all comes down to these tiny powerhouses inside your cells called mitochondria.
Mitochondria: The Key to Unlocking Mental Wellness
Mitochondria are often called the “powerhouses of the cell,” and for good reason! They’re 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.
Think of them as the brain’s little helpers, directly influencing the production, release, and regulation of crucial neurotransmitters like serotonin, dopamine, glutamate, and acetylcholine. These neurotransmitters are vital for mood, cognition, and overall mental well-being.
When your mitochondria are firing on all cylinders, these neurotransmitter systems are balanced and operate effectively. But, when mitochondrial function goes south, it can disrupt these delicate balances, leading to neurotransmitter imbalances, hormonal dysregulation, increased inflammation, and even changes in your gut microbiome. All of these factors are heavily implicated in the development and progression of mental illness. See the connection?
What’s more, your body has a built-in “clean-up crew” called “mitophagy.” This involves intentionally or unintentionally “gobbling up” old or damaged mitochondria, presumably to replace them with newer, healthier versions. Like upgrading your brain’s hardware!
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
Okay, so mitochondria are important. Got it. But what does this have to do with keto?
Well, 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.
Here’s how keto might be beneficial for mental well-being:
- Mitophagy Boost: The keto diet encourages the removal of old and defective mitochondria, making room for the new and improved models. Think of it as a spring cleaning for your cells.
- Mitochondrial Biogenesis: Keto stimulates the creation of more – and healthier – mitochondria throughout your body and brain. More power = more better!
But the benefits go deeper than just mitochondria. Emerging research is pointing to three major drivers of mental health conditions: inflammation in the brain, oxidative stress, and insulin resistance. Guess what? The ketogenic diet can potentially tackle all three.
-
Inflammation Reduction: Here’s the thing: many people have brain inflammation without even knowing it! The brain doesn’t have pain receptors, so it’s not like you’ll feel a throbbing headache. But this “silent” inflammation is considered a major culprit in depression and other brain-related conditions. And, instead of adding more anti-inflammatory foods, a more important strategy is to subtract the foods that cause the inflammation in the first place. The ketogenic diet can help reduce overall inflammation in the body, including that sneaky brain inflammation.
-
Oxidative Stress Management: Think of oxidative stress as rust accumulating in your brain. We’re often told to eat more antioxidants to combat it. But instead of just adding more antioxidants, it’s important to know what is causing all that oxidative stress in the first place, and remove those things. Again, keto may play a role in reducing the root causes of oxidative stress.
-
Insulin Resistance Reversal: Insulin resistance, where your cells become less responsive to insulin, isn’t just a pre-diabetes problem; it’s now estimated to affect over 90% of Americans! And it messes with your brain. A ketogenic diet shifts your brain’s energy source from glucose to ketones, effectively bypassing the insulin resistance issue. It helps stabilize appetite hormones because cells are getting energized in between meals without the glucose spikes and crashes that cause fluctuations in insulin and other hormones. Getting glucose and insulin levels into a healthy range is crucial for the brain to energize itself in the most clean, efficient, and reliable way possible
In fact, a ketogenic diet is any diet that lowers insulin levels to the fat-burning point. You can lower insulin levels through various methods like fasting, intermittent fasting, exercise, and calorie restriction, but the ketogenic diet is the only way to safely and sustainably maintain a state of ketosis long-term, which requires lower insulin.
Insulin is a master metabolic hormone that regulates the activity of every cell in the body and controls many other hormones, including stress hormones, reproductive hormones, satiety hormones, and hunger hormones. Being on a glucose and insulin roller coaster can lead to instability within the body. If your insulin levels are too high, you cannot burn fat. A ketogenic diet, by producing ketones, indicates that you are burning fat because ketones cannot be produced unless insulin is low enough. Ketone levels are essentially a mirror image of insulin levels, indicating whether fat is being burned.
Basically, 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, reduces oxidative stress, and reduces insulin resistance.
Groundbreaking Study: Keto Diet and Clinical Remission in Mental Illness
Okay, okay, so the science sounds promising. But you’re probably thinking, “Has anyone actually tried this for mental health conditions?” The answer is yes! And the results are pretty darn interesting.
Psychiatrist Dr. Alber Dena, who practiced in Tulo, France for over 35 years was inspired to conduct a study after observing a young family member with autism and seizures improve within weeks of starting a ketogenic diet.
Dr. Dena invited 31 of his most treatment-resistant patients with bipolar disorder, major depression, or schizophrenia to voluntarily try a very mildly ketogenic Whole Foods diet in the hospital under his supervision. These were adults who had been ill for an average of 10 years, with some having been ill for as long as 30 years. At the beginning of the study, these patients were taking an average of five psychiatric medications, which is not unusual for people with chronic mental illness. All of the participants had one or more markers of poor metabolic health, such as obesity, high blood pressure, and high blood sugar.
Here’s the kicker: 43% of these patients achieved clinical remission from their chronic mental illness!
Think about that for a second. These were individuals who had been struggling for years, often on multiple medications, and nearly half of them found significant relief through a ketogenic diet.
But wait, there’s more! 64% of the patients in the study left with less psychiatric medication. Less medication. That’s a huge deal.
Here are some key takeaways from Dr. Dena’s study:
- Of the 31 people, 28 were able to stay on the ketogenic diet for more than two weeks, which is the time needed to start seeing benefits.
- Every single one of the 28 patients who stayed on the diet improved.
- All of the patients who remained on the diet also improved metabolically.
Importantly, these kinds of results are not typically seen in conventional psychiatric care. These patients were eager to try this intervention because nothing else had helped them.
The study’s setting within a hospital provided a significant advantage: the diet was carefully supervised six days a week, offering participants tremendous support and comprehensive medical and psychiatric supervision. This level of oversight is especially beneficial when transitioning from a standard high-carbohydrate diet to a low-carbohydrate diet, ensuring patient safety and well-being during this period of significant metabolic change.
And the evidence continues to grow! A 2024 pilot study conducted by Stanford Medicine also investigated the effects of a ketogenic diet on participants with schizophrenia and bipolar disorder. Participants in that study reported improvements in energy, sleep, mood, and quality of life, suggesting that the ketogenic diet may stabilize brain functions in serious mental illnesses as well. This separate study corroborates the findings of Dr. Dena’s work.
Keto and Anxiety: A Calm in the Chaos?
If you’re living with anxiety, you know how relentless and overwhelming it can be. Constant worry, racing thoughts, physical tension… it’s exhausting. Could the ketogenic diet offer a respite from this inner turmoil?
Emerging evidence suggests that many individuals experience significant reductions in anxiety within a relatively short period – from a few days to a few weeks – after starting a ketogenic diet. It’s worth noting that a diet “backwards from what we’re told is healthy” can potentially offer significant benefit. This may indicate that people unknowingly walk around with suboptimal mental health, experiencing “more anxiety than was necessary,” and that feeding the brain properly can lead to significant improvement.
Reduced anxiety may be one of the most predictable benefits of a ketogenic diet, often seen alongside mental clarity. Anecdotal accounts exist of individuals with lifelong anxiety disorders experiencing complete resolution of their symptoms after adopting a very low-carbohydrate or carnivore diet.
So, how does it work? Well, remember those drivers of mental health conditions we talked about earlier – inflammation of the brain, oxidative stress, and insulin resistance? Anxiety, like depression and other brain conditions, can be exacerbated by these issues. And, just as life stress can unbalance brain chemistry, so too can diet, particularly through the roller coaster of glucose and insulin levels, which can affect stress hormones and contribute to anxiety. The ketogenic diet aims to stabilize these factors.
While research is still emerging, a 2023 systemic review that examined the efficacy of low-carbohydrate ketogenic diets in treating mood and anxiety disorders highlighted potential benefits, but also emphasized the necessity for randomized controlled trials to establish definitive conclusions.
Keto and ADHD: Could it Help Focus the Mind?
ADHD, or Attention-Deficit/Hyperactivity Disorder, is often thought of as a childhood condition, but it affects millions of adults as well. Difficulty focusing, impulsivity, and hyperactivity can make daily life a challenge. While medication is often the go-to treatment, could diet play a role?
There are anecdotal reports of individuals with ADHD experiencing significant improvements in their symptoms after adopting very low-carbohydrate diets.
Interestingly, studies from the 1980s, 1990s, and early 2000s in Europe where children with ADHD, some with severe cases, were placed on a “few foods diet” (oligo antigenic diet), typically consisting of chicken, lamb, fruits, and vegetables. These studies showed 62 to 82% response rates and, in some cases, a 70% cure rate within weeks, suggesting a significant impact of food on ADHD symptoms. This indicates that dietary changes can lead to improvement to the point where children no longer qualified for an ADHD diagnosis.
While these studies are promising, it’s important to note that, as of 2019, major health organizations do not recommend dietary modifications as standard treatment for ADHD due to insufficient evidence. A 2014 review found only minor benefits in a subset of children with food sensitivities or allergies.
Direct research on the ketogenic diet and ADHD is still in its early stages. However, the rationale for exploring the ketogenic diet for ADHD is supported by the observation that there are clues to poor metabolic health in individuals with ADHD. For example, children with obesity are twice as likely to have ADHD (obesity being a marker for insulin resistance), and adults with type 2 diabetes are also twice as likely to have ADHD (type 2 diabetes representing severe end-stage insulin resistance). Given that the ketogenic diet is the most effective way to address insulin resistance, this provides a biological plausibility for its potential benefit in ADHD.
Some experts advocate for considering the risk-benefit analysis of all treatment options, including lifestyle changes, and state that lifestyle changes, playing to individual strengths, can be a powerful intervention for ADHD.
The bottom line? While direct research on the ketogenic diet and ADHD is still in its early stages, the connection to metabolic health and the potential for improved focus and brain function make it an area worth exploring.
The Brain-Healthy Diet Blueprint: Nourish, Protect, Energize
So, how do you put all this information into practice? What does a truly brain-healthy diet look like? It comes down to three fundamental principles: Nourish, Protect, and Energize. Remember, a brain-healthy diet is one that supports the health of all the cells in your body, not just the brain.
1. Nourish: Fueling Your Brain’s Foundation
The first fundamental principle is to nourish. This means that a brain-healthy diet must contain and be able to safely deliver all essential nutrients to your cells. You need to know where those nutrients are! Following Whole Food principles and not including supplements or specially fortified processed foods, it is difficult to meet the goal of providing all essential nutrients without including some animal foods in your diet. This is presented as a truth of human biology.
Think of it as providing the building blocks for a strong, resilient brain.
2. Protect: Shielding Your Brain from Damage
The second fundamental principle is to protect the brain from damaging ingredients. Protection isn’t about adding things (like supplements); it’s about subtracting them. You need to subtract the foods from your diet that cause inflammation and oxidative stress.
Brain inflammation is a main driver of depression and other brain conditions, and many people have it without realizing it. Regarding oxidative stress, we are often told to eat more antioxidants, but what we really need to be told is what’s causing all that oxidative stress in the first place and remove those things. The antioxidant strategy alone may not be enough.
The signature ingredients of the standard American or Western diet – refined carbohydrates and vegetable oils – should be limited or excluded to protect the brain.
3. Energize: Providing a Steady Stream of Clean Fuel
The third fundamental principle is to energize. The brain is a very high-energy electrical organ that needs a constant supply of high-quality, clean-burning energy. If you’re eating the wrong way, your brain will gradually lose its ability over time to generate energy.
This principle is primarily about getting your glucose and insulin levels into a healthy range. You need to look beyond just glucose levels to what is happening with insulin underneath. Getting your glucose and insulin levels down will allow your brain to energize itself in the most clean, efficient, and reliable way possible.
Personalization begins at the “energized” piece. If someone has excellent metabolic health, they may not need a ketogenic diet to control glucose and insulin levels and thoroughly energize their brain cells. However, if someone has significant metabolic damage, is sedentary, older, or has pre-diabetes or type 2 diabetes, they may need to reduce the amount of carbohydrate in their diet, even from Whole Foods, and potentially go to a ketogenic level to achieve healthy glucose and insulin levels.
Understanding where you stand on the insulin resistance spectrum and getting your glucose and insulin levels into a healthy range gives you tremendous power over your emotional, intellectual, and physical health future, as it is the number one risk factor for almost all chronic diseases.
Conclusion
So, what’s the takeaway? The ketogenic diet, with its focus on metabolic health, mitochondrial function, and the principles of Nourish, Protect, and Energize, offers a promising avenue for exploring the management of anxiety, depression, and ADHD. The growing body of evidence, including compelling case studies like Carl’s, suggests that dietary changes can have a profound impact on mental well-being.
While more research is certainly needed, the potential benefits are undeniable. By understanding the interplay between diet, brain function, and mental health, we can move beyond the simplistic notion of “chemical imbalances” and empower ourselves to take a more proactive role in our own well-being.
Ready to dive deeper into the world of the ketogenic diet? Be sure to check out our other posts on keto for weight loss, improved energy, and overall health!
