Nick Norwitz:Ketogenic diets may be used to treat mental illness in the future

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Adapted from Ketogenic diet as a metabolic treatment for mental illness by Nicholas Norwitz et al

Wolters Kluwer Health Inc. http://www.co-endocrinology.com 2020

Ketogenic diets have been used to treat drug resistant epilepsy in children for over one hundred years.

Now they are being used for other neurological conditions such as schizophrenia, depression, bipolar disorder and binge eating disorder.

There is strong evidence that common biological pathologies underlie these conditions such as abnormal glucose metabolism, neurotransmitter imbalances, oxidative stress and inflammation. These factors are all improved with a ketogenic diet.

Controlled clinical trials have shown improvement in: Obesity, Type Two Diabetes, Multiple Sclerosis, Epilepsy, Alzheimer’s disease and Autistic Spectrum Disorder.

Uncontrolled clinical trials have shown improvement in: Parkinson’s disease and Schizophrenia.

Case series and animal models have shown improvement in: Cardiovascular Disease, Binge eating disorder, Major Depressive disorder, Bipolar disorder and ADHD.

It is estimated that people who have mental illness live around 7 to 10 years less than those who do not have a mental illness. Sometimes this is due to suicide, but more often it is due to concurrent diabetes, heart disease, respiratory disease, infectious disease and cancer. All of these conditions are raised in people with mental illness. Sometimes this is due to poor health behaviours such as smoking or other lifestyle issues, and drug side effects can also cause problems. But even in people of a healthy weight and who are not on drugs, if they have mental illness, they are also more likely to have physical illness. Could switching the body and brain away from glucose use towards fat and ketone use improve matters?

Cerebral glucose hypometabolism and insulin resistance are features of Alzheimer’s disease, Parkinson’s disease, Schizophrenia, and Epilepsy. In one recent Cochrane review of epilepsy, as many as 55% of patients had complete remission of their fits on a ketogenic diet.

GABA/glutamate imbalance is a feature of Epilepsy and Schizophrenia. Oxidative stress is a feature of Schizophrenia, Bipolar disorder and Major Depressive Disorder. Oxidative stress and inflammation are mutually reinforcing processes. Major Depressive Disorder, Schizophrenia have these issues.

The Virta Health Group has demonstrated that a ketogenic diet is a well tolerated and effective strategy for treating type two diabetes. It reversed the condition in 54% of patients compared to 5% who received standard care. Alzheimer’s patients also improved on a ketogenic diet and also benefitted from medium chain triglyceride supplementation. (MCTs). Parkinson’s disease, Huntington’s disease and Multiple Sclerosis patients also showed improvement in studies. About 50 to 80% of patients with Alzheimer’s disease have cross over symptoms with schizophrenia, Bipolar disorder and major depressive disorder. These conditions all share common metabolic abnormalities.

It is thought that the ketogenic diet affects the gut microbiome and gut issues are thought to influence Autistic Spectrum Disorder. Two clinical trials reported sometimes complete symptom remission in patients with Childhood Autism when treated with a ketogenic diet.

Some case studies involve psychiatric patients who embarked on ketogenic diets for weight loss and gut problems, only to find a massive improvement in their mental conditions as well. Dr Christopher Palmer reported about an elderly woman with over 50 years of schizophrenia who was able to stop all her antipsychotic medication and has been symptom free for over 12 years. Another middle aged woman who had schizophenia and depression went into complete remission and was able to get her degree and a full time job in the last four years. Both remain unmedicated and on their ketogenic diets.

Results with Binge eating disorder have also been impressive. These patients are usually on 20-30g of carbohydrate a day.

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