Various Foods that are Perfect for the Keto Diet

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“It’s very promising and very encouraging that you can take back control of your illness in some way, aside from the usual standard of care,” says Shebani Sethi, MD, an associate professor of psychiatry and behavioral sciences and the first author of the new paper.

Sethi recalls when she first put two and two together. During medical school, when she was working in an obesity clinic, she saw a patient with treatment-resistant schizophrenia whose auditory hallucinations stopped while eating a ketogenic diet. This inspired her to look into the scientific literature, but at the time, there were only a handful of case reports that were decades old about the diet’s link to schizophrenia. However, there were many more documenting keto’s use among epileptic patients, which is the original condition the diet was developed to treat.

“The ketogenic diet has been proven to be effective for treatment-resistant epileptic seizures by reducing the excitability of neurons in the brain,” says Sethi in a university release. “We thought it would be worth exploring this treatment in psychiatric conditions.”

What Is The Keto Diet?

The keto diet, short for the ketogenic diet, is a high-fat, low-carbohydrate eating plan. It involves drastically reducing carbohydrate intake and replacing it with fat. Foods that are part of a typical keto diet include:

  • High-fat proteins like meat like steak, pork, bacon, and chicken.
  • Low-carb leafy greens like spinach, kale, and Swiss chard.
  • Healthy fats like nuts, seeds, avocado, and avocado oil.
  • Dairy products like cheddar cheese, goat cheese, cream cheese, and mozzarella.

A few years later, Sethi popularized the term metabolic psychiatry, a new field that looks at mental health from an energy conversion perspective. During the four-month pilot trial, Sethi’s team followed 21 adult participants diagnosed with schizophrenia or bipolar disorder, taking antipsychotics, and with a metabolic irregularity like insulin resistance or dyslipidemia. The participants were instructed to follow a ketogenic diet, taking in approximately 10 percent of their calories from carbs, 30 percent from protein, and 60 percent from fat. Counting calories was not part of the study.

“The focus of eating is on whole non-processed foods including protein and non-starchy vegetables, and not restricting fats,” says Sethi.

Sethi provided participants with recipes, keto cookbooks, and access to a health coach throughout the trial. The team tracked how well the participants followed the diet by measuring blood ketone levels weekly. Ketones are produced by the body when it breaks down fat for fuel instead of glucose. By the end, 14 patients were noted to have been fully compliant; six were semi-adherent, and one was not. Additionally, the participants underwent various psychiatric and metabolic assessments throughout the trial.

At the beginning, 29 percent of the participants met the criteria for metabolic syndrome, which is defined as having at least three of five conditions: abdominal obesity, elevated triglycerides, low HDL cholesterol, elevated blood pressure, and elevated fasting glucose levels. After four months on a keto diet, none of the participants were dealing with metabolic syndrome. On average, the participants lost 10 percent of their body weight, reduced their waist circumference by 11 percent, and experienced lower blood pressure, body mass index, triglycerides, blood sugar levels, and insulin resistance.

ingredients of a keto diet
A keto diet not only restores metabolic health in patients with mental illness taking medication, but it also improves their psychiatric conditions. (Photo by JJ Jordan from Pexels)

“We’re seeing huge changes,” says Sethi. “Even if you’re on antipsychotic drugs, we can still reverse the obesity, the metabolic syndrome, the insulin resistance. I think that’s very encouraging for patients.”

Moreover, on average, the participants improved by 31 percent on a psychiatrist rating of mental illness known as the clinical global impressions scale, with three-quarters of them showing clinically meaningful improvement.

“The participants reported improvements in their energy, sleep, mood and quality of life,” Sethi explains. “They feel healthier and more hopeful.”

“We saw more benefit with the adherent group compared with the semi-adherent group, indicating a potential dose-response relationship.”

Sethi thinks that in the same way the diet improves metabolism physically, keto also has the same effect on the brain.

“Anything that improves metabolic health in general is probably going to improve brain health anyway,” the study author notes. “But the ketogenic diet can provide ketones as an alternative fuel to glucose for a brain with energy dysfunction.”

Sethi adds that the main goal of the pilot trial is to help researchers pick up on signals that can make for stronger, larger studies to validate the findings.

“Many of my patients suffer from both illnesses, so my desire was to see if metabolic interventions could help them,” she concludes. “They are seeking more help. They are looking to just feel better.”

The findings are published in the journal Psychiatry Research.

A Dietitian’s Take

Epilepsy is a debilitating disease that can affect the quality of life to a severe degree for many people. The same can be said for people with schizophrenia and bipolar disorder.

While there isn’t as much research linking improvements in these conditions with keto, the diet was introduced by modern physicians as an epilepsy treatment in the 1920s. Now that more antiepileptic drugs are surfacing, its use has dropped. However, scientific interest in how diet may continue to play a role in epilepsy and mental health conditions has increased.

Although this study is small, it does open the door for more questions and curiosity about keto’s possible role in schizophrenia, bipolar disorder, and possibly other conditions like depression as well. It’s possible that this diet could be key for helping stabilize the brain in some people, and could be a powerful tool in conjunction with conventional drugs.

About Shyla Cadogan, RD

Shyla Cadogan is a DMV-Based acute care Registered Dietitian. She holds specialized interests in integrative nutrition and communicating nutrition concepts in a nuanced, approachable way.

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