Keto for Mental Health

While the modern-day Keto diet is one of the most popular nutritional strategies for losing weight and managing food cravings, many people aren’t aware of the historical links between Keto and mental health.

Keto was initially developed as a treatment method for children with epilepsy back in the 1920s and 30s [*], mimicking the effects of fasting and in many cases, helping to stabilize the condition [*].

There was a decline in the medical use of Keto towards the middle of the century following the introduction of antiepileptic drug treatments, but as you’re no doubt aware, it’s since seen a rapid resurgence over the last 30 years with the rise of mainstream diet culture.

The positive cognitive benefits observed in those with epilepsy led to further research into the efficacy of a high-fat, ketogenic diet in supporting various mental health conditions.

With the general state of the world right now, a little extra help with our cognitive well-being wouldn’t go amiss. That’s why in this article, we’re going to explore some of the most interesting findings when it comes to Keto and mental health.

Disclaimer: Diet is just one part of the equation when it comes to both mental and physical health. If you are experiencing symptoms of a mental health condition, seek out professional help. We’ve provided some resources at the end of this article.

Keto and Stress Levels

It’s no secret that stress is a growing problem in our increasingly fast-paced, modern world. In a study from the American Psychological Association, 75% of Americans reported experiencing at least one symptom of stress in the past month [*], which could include irritability, anxiousness, lack of motivation, fatigue, overwhelm, or depression.

There are many factors that influence stress levels and our ability to cope with said stress - diet potentially being one of them. To help understand how our food choices could play a role, let’s recap the basics of the human stress response:

• When we’re faced with a challenging situation, stress hormones like cortisol become elevated. 
• This is a normal and helpful reaction in the face of a short-term, acute stressor, such as being confronted by a wild animal.
• However, if cortisol levels remain elevated over a long time period (as we see with chronic stress) things can start to go awry...  

What about the Keto diet and stress levels?

When you begin restricting carbohydrates, the body can initially interpret this as a form of acute stress, as it appears there may be a food shortage. 

To maintain energy without the presence of glucose, you might experience a rise in cortisol levels. However, this doesn't mean going Keto means you’ll be chronically stressed out.

The human body is incredibly adaptable, and one study noted that after six weeks on a Keto diet, there were no significant changes in cortisol levels (while fat mass significantly decreased) [*]. 

To muddy the waters, in some cases cutting carbs can lead to a reduction in baseline cortisol levels: 

In a 2021 study, obese men in their 50s and 60s saw a significant decrease in their salivary cortisol levels after 8 weeks on a calorie-restricted Keto diet [*].

It’s important to note that this response may depend on age, gender, and various interacting factors that can impact our experience of emotional stress.

Keto and Anxiety & Depression

Alongside chronic stress, we’ve also seen an increase in the prevalence of other mental health disorders in recent years. The Coronavirus pandemic has certainly played a role, with a 6-fold increase in anxiety screens, and an 8-fold increase in instances of depression across the US [*]. 

COVID-19 aside, there are many factors that can influence mental well-being. 

Chronic stress, poor sleep, lack of social support, movement, and genetics all have tie-ins with mental health disorders. Studies have also highlighted how our diets could play an important role.

The Sugar Trap 

We know that the consumption of high-sugar foods generates reward signals in the brain, which can make it more difficult to exert self-control and could eventually lead to obesity and mental health challenges. 

A review study touched on the links between a long-term high-sugar diet, anxiety, and depression, concluding: 

‘The reduction of sugar overconsumption may be capable of significantly reducing the prevalence of negative emotion in a vast number of individuals around the world.’[*]

Moving towards a low-carb or fully Ketogenic diet is an effective way to reduce your sugar intake, instead fueling your body with higher fat foods.

Reducing Oxidative Stress With Keto

Sugar consumption is linked with increased free radical damage and oxidative stress in the body [*], which research suggests may be a risk factor for developing depression [*]. 

A 2015 animal study concluded that a Ketogenic diet may reduce oxidative stress [*]. Although not conclusive, this may be one of the mechanisms behind a low-carb diet supporting mental health.

Increasing GABA Concentrations

Clinical depression [*] and anxiety [*] have also been linked to low levels of the important neurotransmitter Gamma-aminobutyric acid (GABA). 

Researchers suggest that a Ketogenic diet may help increase levels of this brain chemical by facilitating a more efficient conversion of glutamine to GABA [*]. 

Supporting Mitochondrial Function

Studies have drawn similar conclusions when it comes to ATP and mitochondrial function. 

Mitochondria play a role in the production of ATP [*] - the energy currency of our body. Low levels of ATP and mitochondrial dysfunction have both been linked with depression[*][*]. 

The good news? Research suggests that Ketosis activates mitochondrial metabolism [*] potentially resulting in an improvement in mitochondrial function [*], which may make it easier to synthesize ATP. In theory, this may have a positive knock-on effect on mental wellbeing.

Keto and Stress Resilience

When it comes to stress resilience, Brain-Derived Neurotrophic Factor (BDNF) may hold the key. This protein can be depleted by chronic stress, and decreased levels are linked with depression [*]. 

The good news is that a diet low in carbohydrates, particularly when supported by an exercise regime, could raise BDNF levels [*]. This is promising news, suggesting that Keto may positively impact our ability to manage the obstacles life throws our way.

Mental Health Considerations on Keto

While evidence suggests that a Ketogenic diet can potentially have a positive impact on mental health, there are some considerations to take into account before jumping into the low-carb way of life.

Keto Flu and Low Mood

During the transition to using fat and ketones as fuel, the body may experience a number of side effects, often dubbed the ‘Keto Flu’. Low mood can be one of these [*], sometimes accompanied by brain fog and fatigue. 

The side effects of Keto flu typically occur within the first 4 weeks of beginning a Keto diet and often pass after a few weeks. Others have reported that their Keto flu symptoms improved in response to increased hydration and electrolyte intake [*].

Keto and Social Implications

The food we eat is more than simply fuel to keep us going through the day. We share food as a form of social bonding and we eat in response to certain emotions. It’s perhaps no surprise then that any form of dietary restriction could come with mental health challenges. 

Compared to the standard western diet, Keto could be considered extremely restrictive as it cuts out many common staples - bread, pasta, rice, desserts... 

Although there are workarounds available and more and more Keto-friendly options, going strictly low-carb may make it harder to attend some social gatherings with friends and family, potentially resulting in feelings of isolation. 

If you're looking for support and a sense of community, you're always welcome in the Carb Manager forums.

Keto and Thyroid Function in Women

Although there are potentially a number of positive benefits of a low-carb diet, it’s also important to consider that there’s not necessarily a one-size-fits-all solution when it comes to nutrition. 

In some females, for example, Keto can lead to irregular menstrual patterns and amenorrhea, particularly in teenage girls[*]. 

Changes in thyroid function have also been observed in people with epilepsy on a high-fat diet, including a reduction in levels of the thyroid hormone T3 while on modified Atkins [*]. In a 2017 study, hypothyroidism was shown to occur in 20 of 120 subjects with epilepsy [*]. Changes like these in thyroid function have been linked with depression [*].

Conversely, in a 2020 study observing the effects of a Ketogenic diet on quality of life and health biomarkers in cancer patients, no difference in thyroid function was observed between those on Keto and the control group [*] - an important reminder that the effects of a particular diet can vary from person to person.

Keto and Mental Health Challenges: Steps to Take

If you are experiencing mental health challenges on Keto, here are some steps to explore:

1. Seek Professional Help

Contact your medical provider and consider reaching out to the following resources: 

• Mental Health America
• Mental Health USA
• American Foundation for Suicide Prevention
• CDC Mental Health Resources 

2. Build Your Foundation with High-Quality Foods

Staying hydrated and eating a wide range of whole foods will help supply your body with the essential nutrients, giving you the best chance of functioning to your potential and managing daily stressors.

3. Consider Increasing Your Carb Intake

If you feel that a Keto diet is contributing to your mental health challenges, consider increasing your carbohydrate intake with cyclical Keto, traditional low-carb, or a balanced wholefood diet. 

The Keto diet can be a powerful tool in your health and wellness journey. The key to its success is in creating balance and finding what works for you as an individual. Be mindful of your symptoms both physically and mentally, adjust your program, or seek additional support if needed.