The use of the ketogenic diet in the treatment of psychiatric disorders

Abstract Introduction The ketogenic diet (KD) is a high-fat, low-carbohydrate, and moderate-protein diet that has shown benefit as a treatment in neurologic disorders and may serve as a therapeutic option in individuals with psychiatric disorders. Methods A search was conducted using EBSCOhost and PubMed databases for studies relating to ketogenic or low-carbohydrate diets and psychiatric disorders. Results A total of 32 experimental or observational studies were identified by initial search strategies, 14 of which met the criteria to be included in this analysis. Although specific diet formulations varied somewhat between studies, they all generally examined low-carbohydrate dietary intake with the goal of producing a ketotic state. The studies included in this review indicated the KD was beneficial in reducing symptoms associated with various psychiatric disorders. Discussion This review summarizes the available evidence regarding the efficacy of the ketogenic diet in psychiatric disease states. Data from the studies analyzed demonstrated a positive response in individuals who were able to remain on the diet, regardless of the disease state. However, there is a need for more data to clearly define the specific benefits the KD may provide.

Download Full-text

Why Psychotropic Drugs Don't Cure Mental Illness—But Should They?

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.579566 ◽

2021 ◽

Vol 12 ◽

Author(s):

Iliyan Ivanov ◽

Jeffrey M. Schwartz

Keyword(s):

Mental Illness ◽

Psychiatric Disorders ◽

Symptom Relief ◽

Personal Narratives ◽

Psychiatric Disease ◽

Great Promise ◽

Disease States ◽

Specific Factors ◽

New Treatments

While pharmacological treatments for psychiatric disorders have offered great promise and have provided clinically meaningful symptom relief these treatments have had less effect on altering the course of these disorders. Research has provided many new insights about the effects of different psychotropic agents on the functions of various brain systems as investigators have embraced the “translational research model.” However, this theoretical approach of deconstructing complex behaviors into smaller measurable behavioral units and targeting brain systems that are hypothesized to underlie these discrete behaviors has offered little of practical clinical relevance to significantly improve the treatment of psychiatric disorders in this century. Radical new treatments have not emerged, and available treatments continue to provide symptom relief without resolution of the underlying conditions. Recent publications on the subject have attempted to identify the barriers to progress and have pointed out some of the limitations of the translational approach. It is our position that, given the present limitations of our therapeutic arsenal, both researchers and clinicians would be well-advised to pay closer attention to human specific factors such as the role of language, the creation of personal narratives, and how factors such as these interface with underlying biological diatheses in mental illness. These interactions between pathophysiology and intrapersonal processes may be critical to both the in vivo expression of the underlying biological mechanisms of psychiatric disease states, and to the development of enhancements in therapeutic efficacy. Lastly, we discuss the implications of more coherently integrating neuroscientific research and clinical practice for more effectively addressing the challenges of understanding and treating mental illness.

Download Full-text

A Low-Carbohydrate Ketogenic Diet and Treadmill Training Enhanced Fatty Acid Oxidation Capacity but Did Not Enhance Maximal Exercise Capacity in Mice

Nutrients ◽

10.3390/nu13020611 ◽

2021 ◽

Vol 13 (2) ◽

pp. 611

Author(s):

Sihui Ma ◽

Jiao Yang ◽

Takaki Tominaga ◽

Chunhong Liu ◽

Katsuhiko Suzuki

Keyword(s):

Fatty Acid ◽

Fatty Acid Oxidation ◽

Exercise Capacity ◽

Ketogenic Diet ◽

Maximal Exercise ◽

Treadmill Running ◽

Acid Oxidation ◽

Oxidation Capacity ◽

Low Carbohydrate ◽

Maximal Exercise Capacity

The low-carbohydrate ketogenic diet (LCKD) is a dietary approach characterized by the intake of high amounts of fat, a balanced amount of protein, and low carbohydrates, which is insufficient for metabolic demands. Previous studies have shown that an LCKD alone may contribute to fatty acid oxidation capacity, along with endurance. In the present study, we combined a 10-week LCKD with an 8-week forced treadmill running program to determine whether training in conjunction with LCKD enhanced fatty acid oxidation capacity, as well as whether the maximal exercise capacity would be affected by an LCKD or training in a mice model. We found that the lipid pool and fatty acid oxidation capacity were both enhanced following the 10-week LCKD. Further, key fatty acid oxidation related genes were upregulated. In contrast, the 8-week training regimen had no effect on fatty acid and ketone body oxidation. Key genes involved in carbohydrate utilization were downregulated in the LCKD groups. However, the improved fatty acid oxidation capacity did not translate into an enhanced maximal exercise capacity. In summary, while favoring the fatty acid oxidation system, an LCKD, alone or combined with training, had no beneficial effects in our intensive exercise-evaluation model. Therefore, an LCKD may be promising to improve endurance in low- to moderate-intensity exercise, and may not be an optimal choice for those partaking in high-intensity exercise.

Download Full-text

Genetic factors influencing a neurobiological substrate for psychiatric disorders

Translational Psychiatry ◽

10.1038/s41398-021-01317-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Till F. M. Andlauer ◽

Thomas W. Mühleisen ◽

Felix Hoffstaedter ◽

Alexander Teumer ◽

Katharina Wittfeld ◽

...

Keyword(s):

Psychiatric Disorders ◽

Genetic Risk ◽

Meta Analysis ◽

Anterior Cingulate ◽

Psychiatric Disease ◽

Salience Network ◽

Genome Wide Association Studies ◽

Genome Wide ◽

Common Substrate ◽

The Common

AbstractA retrospective meta-analysis of magnetic resonance imaging voxel-based morphometry studies proposed that reduced gray matter volumes in the dorsal anterior cingulate and the left and right anterior insular cortex—areas that constitute hub nodes of the salience network—represent a common substrate for major psychiatric disorders. Here, we investigated the hypothesis that the common substrate serves as an intermediate phenotype to detect genetic risk variants relevant for psychiatric disease. To this end, after a data reduction step, we conducted genome-wide association studies of a combined common substrate measure in four population-based cohorts (n = 2271), followed by meta-analysis and replication in a fifth cohort (n = 865). After correction for covariates, the heritability of the common substrate was estimated at 0.50 (standard error 0.18). The top single-nucleotide polymorphism (SNP) rs17076061 was associated with the common substrate at genome-wide significance and replicated, explaining 1.2% of the common substrate variance. This SNP mapped to a locus on chromosome 5q35.2 harboring genes involved in neuronal development and regeneration. In follow-up analyses, rs17076061 was not robustly associated with psychiatric disease, and no overlap was found between the broader genetic architecture of the common substrate and genetic risk for major depressive disorder, bipolar disorder, or schizophrenia. In conclusion, our study identified that common genetic variation indeed influences the common substrate, but that these variants do not directly translate to increased disease risk. Future studies should investigate gene-by-environment interactions and employ functional imaging to understand how salience network structure translates to psychiatric disorder risk.

Download Full-text

Applications of Ketogenic Diets in Patients with Headache: Clinical Recommendations

Nutrients ◽

10.3390/nu13072307 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2307

Author(s):

Cherubino Di Lorenzo ◽

Giovanna Ballerini ◽

Piero Barbanti ◽

Andrea Bernardini ◽

Giacomo D’Arrigo ◽

...

Keyword(s):

Neurological Disorders ◽

Unmet Needs ◽

Therapeutic Option ◽

Drug Resistant ◽

Pharmacological Treatments ◽

Ketogenic Diets ◽

Neurologic Disorders ◽

Clinical Recommendation ◽

Potential Benefits ◽

Drug Resistant Epilepsy

Headaches are among the most prevalent and disabling neurologic disorders and there are several unmet needs as current pharmacological options are inadequate in treating patients with chronic headache, and a growing interest focuses on nutritional approaches as non-pharmacological treatments. Among these, the largest body of evidence supports the use of the ketogenic diet (KD). Exactly 100 years ago, KD was first used to treat drug-resistant epilepsy, but subsequent applications of this diet also involved other neurological disorders. Evidence of KD effectiveness in migraine emerged in 1928, but in the last several year’s different groups of researchers and clinicians began utilizing this therapeutic option to treat patients with drug-resistant migraine, cluster headache, and/or headache comorbid with metabolic syndrome. Here we describe the existing evidence supporting the potential benefits of KDs in the management of headaches, explore the potential mechanisms of action involved in the efficacy in-depth, and synthesize results of working meetings of an Italian panel of experts on this topic. The aim of the working group was to create a clinical recommendation on indications and optimal clinical practice to treat patients with headaches using KDs. The results we present here are designed to advance the knowledge and application of KDs in the treatment of headaches.

Download Full-text

Effects of a low-carbohydrate ketogenic diet on reported pain, blood biomarkers and quality of life in patients with chronic pain: A pilot randomised clinical trial rationale, study design and protocol.

European Journal of Integrative Medicine ◽

10.1016/j.eujim.2021.101346 ◽

2021 ◽

pp. 101346

Author(s):

Rowena Fielda ◽

Fereshteh Pourkazemi ◽

Kieron Rooney

Keyword(s):

Quality Of Life ◽

Clinical Trial ◽

Chronic Pain ◽

Ketogenic Diet ◽

Study Design ◽

Randomised Clinical Trial ◽

Blood Biomarkers ◽

Low Carbohydrate

Download Full-text

Effects of Two Months of Very Low Carbohydrate Ketogenic Diet on Body Composition, Muscle Strength, Muscle Area, and Blood Parameters in Competitive Natural Body Builders

Nutrients ◽

10.3390/nu13020374 ◽

2021 ◽

Vol 13 (2) ◽

pp. 374

Author(s):

Antonio Paoli ◽

Lorenzo Cenci ◽

PierLuigi Pompei ◽

Nese Sahin ◽

Antonino Bianco ◽

...

Keyword(s):

Body Composition ◽

Muscle Strength ◽

Ketogenic Diet ◽

Inflammatory Cytokines ◽

Blood Parameters ◽

Maximal Strength ◽

Muscle Area ◽

Low Carbohydrate ◽

Before And After ◽

Adequate Quantity

Background: Ketogenic diet (KD) is a nutritional approach that restricts daily carbohydrates, replacing most of the reduced energy with fat, while maintaining an adequate quantity of protein. Despite the widespread use of KD in weight loss in athletes, there are still many concerns about its use in sports requiring muscle mass accrual. Thus, the present study sought to investigate the influence of a KD in competitive natural body builders. Methods: Nineteen volunteers (27.4 ± 10.5 years) were randomly assigned to ketogenic diet (KD) or to a western diet (WD). Body composition, muscle strength and basal metabolic rate were measured before and after two months of intervention. Standard blood biochemistry, testosterone, IGF-1, brain-derived neurotrophic factor (BDNF) and inflammatory cytokines (IL6, IL1β, TNFα) were also measured. Results: Body fat significantly decreased in KD (p = 0.030); whilst lean mass increased significantly only in WD (p < 0.001). Maximal strength increased similarly in both groups. KD showed a significant decrease of blood triglycerides (p < 0.001), glucose (p = 0.001), insulin (p < 0.001) and inflammatory cytokines compared to WD whilst BDNF increased in both groups with significant greater changes in KD (p < 0.001). Conclusions: KD may be used during body building preparation for health and leaning purposes but with the caution that hypertrophic muscle response could be blunted.

Download Full-text

Effects of low-carbohydrate diet and ketogenic diet on glucose and lipid metabolism in type 2 diabetic mice

Nutrition ◽

10.1016/j.nut.2021.111230 ◽

2021 ◽

pp. 111230

Author(s):

Zi Yang ◽

Jingyi Mi ◽

Yu Wang ◽

Lamei Xue ◽

Jinxin Liu ◽

...

Keyword(s):

Lipid Metabolism ◽

Ketogenic Diet ◽

Diabetic Mice ◽

Carbohydrate Diet ◽

Low Carbohydrate Diet ◽

Glucose And Lipid Metabolism ◽

Low Carbohydrate ◽

Type 2 Diabetic

Download Full-text

Incidence and Characteristics of Kidney Stones in Patients on Ketogenic Diet: A Systematic Review and Meta-Analysis

Diseases ◽

10.3390/diseases9020039 ◽

2021 ◽

Vol 9 (2) ◽

pp. 39

Author(s):

Prakrati Acharya ◽

Chirag Acharya ◽

Charat Thongprayoon ◽

Panupong Hansrivijit ◽

Swetha R. Kanduri ◽

...

Keyword(s):

Uric Acid ◽

Kidney Stones ◽

Observational Studies ◽

Meta Analysis ◽

Random Effects Model ◽

Ketogenic Diets ◽

Cochrane Database ◽

Uric Acid Stones ◽

Low Carbohydrate

Very-low-carbohydrate diets or ketogenic diets are frequently used for weight loss in adults and as a therapy for epilepsy in children. The incidence and characteristics of kidney stones in patients on ketogenic diets are not well studied. Methods: A systematic literature search was performed, using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from the databases’ inception through April 2020. Observational studies or clinical trials that provide data on the incidence and/or types of kidney stones in patients on ketogenic diets were included. We applied a random-effects model to estimate the incidence of kidney stones. Results: A total of 36 studies with 2795 patients on ketogenic diets were enrolled. The estimated pooled incidence of kidney stones was 5.9% (95% CI, 4.6–7.6%, I2 = 47%) in patients on ketogenic diets at a mean follow-up time of 3.7 +/− 2.9 years. Subgroup analyses demonstrated the estimated pooled incidence of kidney stones of 5.8% (95% CI, 4.4–7.5%, I2 = 49%) in children and 7.9% (95% CI, 2.8–20.1%, I2 = 29%) in adults, respectively. Within reported studies, 48.7% (95% CI, 33.2–64.6%) of kidney stones were uric stones, 36.5% (95% CI, 10.6–73.6%) were calcium-based (CaOx/CaP) stones, and 27.8% (95% CI, 12.1–51.9%) were mixed uric acid and calcium-based stones, respectively. Conclusions: The estimated incidence of kidney stones in patients on ketogenic diets is 5.9%. Its incidence is approximately 5.8% in children and 7.9% in adults. Uric acid stones are the most prevalent kidney stones in patients on ketogenic diets followed by calcium-based stones. These findings may impact the prevention and clinical management of kidney stones in patients on ketogenic diets.

Download Full-text