This summer, I was fortunate to participate in the groundbreaking International Society for Nutritional Psychiatry Research (ISNPR) conference held in Bethesda, Maryland. The meeting was truly inspiring and exciting to those of us who believe that nutritional approaches are the way forward in the treatment of mental health disorders. While the majority of the presentations at this conference were focused on omega-3 fatty acids, microbiome research, micronutrients, and the Mediterranean diet, there were a few small breakout sessions exploring the potential benefits of ketogenic diets. Ketogenic diets are special low-carbohydrate diets that have been used to treat epilepsy for almost 100 years and show great promise in the management of a wide variety of other brain disorders.
One of the presentations I attended was by Dr. Chris Palmer, a psychiatrist from Harvard’s McLean Hospital in Belmont, Massachusetts. In a small room packed with curious doctors, scientists and nutritionists from around the world, Dr. Palmer described the experiences of two adults in his practice with schizoaffective disorder who had tried a ketogenic diet. Whereas schizophrenia is characterized primarily by psychotic symptoms, people with schizoaffective disorder have to cope not only with psychosis but also with overlapping periods of severe mood symptoms. Signs of psychosis include paranoia, auditory hallucinations, visual hallucinations, intrusive thoughts/images, and/or disorganized thinking. Mood episodes may include depression, euphoria, irritability, rage, suicidal thoughts, and/or mood swings. As a practicing psychiatrist for more than 15 years, I can tell you that schizoaffective disorder is a particularly challenging diagnosis for people to live with and for psychiatrists to treat. Even the most potent antipsychotic and mood stabilizing medications available often don’t bring sufficient relief, and those medications come with a significant risk of side effects.
Below I’ve summarized the cases Dr. Palmer presented. More details of each story, along with Dr. Palmer’s commentary are published in the journal Schizophrenia Research.
The first story is of a 31-year-old woman who was diagnosed with schizoaffective disorder eight years ago. Trials of TWELVE different medications, including Clozapine, a powerful antipsychotic agent considered by many psychiatrists to be the medication of last resort due to its risk of serious side effects, were unsatisfactory. She had also undergone 23 rounds of electroconvulsive therapy (ECT or what used to be called “electric shock treatments”), yet remained troubled by serious symptoms. She decided to try a ketogenic diet with the hope of losing some weight. After four weeks on the diet, her delusions had resolved and she’d lost ten pounds. At four months’ time, she’d lost 30 pounds and her score on a clinical questionnaire called the PANSS (Positive and Negative Symptom Scale), which ranks symptoms on a scale from 30 (best) to 210 (worst), had come down from 107 to 70.
The second story is of a 33-year-old single man diagnosed with schizoaffective disorder fourteen years ago. Over the years he had tried SEVENTEEN different psychiatric medications with limited success, including Clozapine. Weighing 322 pounds, he decided to embark on a ketogenic diet for weight loss.
Within three weeks, he reported “dramatic” reduction in auditory hallucinations and delusions, as well as better mood, energy, and concentration. Over the course of a year, he lost a total of 104 pounds. When in ketosis, his PANSS scores improved significantly—falling from 98 to only 49. His daily function and quality of life also improved dramatically; he moved out of his father’s home, began dating, and started taking college courses.
Interestingly, in both cases, each time either of these individuals went off of the ketogenic diet, their symptoms worsened, and when they went back on the diet, their symptoms improved again, suggesting it was the diet and not some other factor that was responsible.
These outcomes are truly remarkable: improvement by dozens of points on the PANSS, significant weight loss, and better quality of life. There simply is no psychiatric medication available with the power to accomplish those results. I have certainly seen antipsychotic medications help people with bipolar and psychotic symptoms, and sometimes help dramatically. However, all antipsychotic medications, unfortunately, come with a substantial risk of side effects that can worsen quality of life, not the least of which is weight GAIN.
All antipsychotic medications (Abilify, Zyprexa, Risperdal, Seroquel, Clozapine, etc.) can contribute to high insulin levels and insulin resistance —a hormonal shift in metabolism that makes it harder for the body to process carbohydrates. Over time, insulin resistance can lead to weight gain, type 2 diabetes, heart disease, and even Alzheimer’s disease. In stark contrast, ketogenic diets have many positive side effects; they lower insulin levels and improve insulin sensitivity, reversing signs of insulin resistance and associated conditions.
A ketogenic diet is an ultra-low-carbohydrate diet (maximum 20 grams of carbohydrate per day) that is typically much higher in fat than other diets. This diet is designed to lower and stabilize insulin levels, allowing the body to burn fat more easily, and rely less on glucose (blood sugar) for energy. Fat is broken down into ketones, which most cells in the brain can use for energy instead of glucose. Ketones burn more cleanly and efficiently than glucose, resulting in less inflammation and oxidation throughout the brain and body.
There are many theories as to why ketogenic diets seem to be so healing and stabilizing for brain cells, some of which you can read about in this article about bipolar disorder and ketogenic diets. I have studied, written about and personally followed a ketogenic diet for the better part of the past five years, and recommend it to my patients as an alternative and/or add-on option to medication. At the ISNPR conference, I presented a poster summarizing exciting nutritional approaches to Alzheimer’s disease prevention and treatment, including ketogenic diets.
Earlier this summer, I wrote an article for Psychology Today entitled Ketogenic Diets for Psychiatric Disorders summarizing studies and case reports of how low-carbohydrate and ketogenic diets affect people with psychiatric disorders including bipolar disorder, autism, and schizophrenia. That review includes the remarkable account of a woman who had suffered with psychotic symptoms for 63 years before finally experiencing relief on a low-carbohydrate diet.
Although we only have a handful of published examples so far, the information within them is full of promise for people who have been suffering from life-altering psychiatric disorders and health-compromising medications.
Most people don't realize that options beyond medication exist. It is critical that we spread awareness of these potentially powerful dietary strategies to everyone who may benefit. If you know of someone who is coping with mental illness, please share these inspiring stories with them.
If you yourself are struggling with symptoms of a mood or thought disorder, I encourage you to learn more about ketogenic diets and other nutritional approaches. Yes, medications can play a very important role in your care, but I believe that the most powerful way to change your brain chemistry is through food—because that's where brain chemicals come from in the first place! Feeding your brain properly has the potential to get to the actual root of the problem, which may allow you to reduce the amount of medication you need to feel well and function at your best. In some cases, a ketogenic diet can even completely replace medications.
Nutritional psychiatry can empower you to take more control of your symptoms, your overall health, and the course of your future.
*Note: low-carbohydrate diets cause significant changes in body chemistry very quickly. If you take any medications or have any health problems, please do not start this diet without first consulting with your health care provider, as medication dosages may need to be closely monitored as you transition to a new way of eating. Please see this short post about the safety of ketogenic diets for more information.