Ketogenic diet as a metabolic therapy for mood disorders
Recent findings and current developments: where do we stand today?

Great "Tl;dr:" figure ->

There is most definitely a multi-level bidirectional relationship between mood disorders and diet/lifestyle habits. Can diet cause or cure mood disorders? Can mood disorders cause you to eat/behave a certain way? Yes, yes, and yes. #Context.

That said, diet interventions present a unique and potentially useful treatment avenue for mood disorders.

Mood disorders are a significant source of mental capital loss with high rates of treatment resistance, in part, because we have no clue about the causes, full influence of their spectrums, or how exactly the effective pharmacotherapies work.The ketogenic diet: why it should be explored ->

  1. Ketogenic diet has profound effects in multiple targets implicated in the pathophysiology of mood disorders, including glutamate/GABA transmission, monoamine levels, mitochondrial quantity and quality, neurotrophism, oxidative stress, insulin signaling, inflammation, etc., etc...
  2. Benign dietary ketosis is a very exclusive diet, immediately cutting out many of the potentially offensive foods.
  3. Malign dietary ketosis, while still technically ketosis, is full of unhealthy n6- and trans fat-rich oils, insufficient protein and fibre, etc. It's basically the bacon-wrapped cheese dog version of keto.

Domains of depressive symptomatology of interest: anhedonia, rumination, suicidality, sleep disruption, appetite dysregulation, among others.

There is a large overlap between body weight and severity of mood disorders. That is, the more excess body weight someone carries, the more symptoms and/or severity of symptoms they are likely to experience.

Disclaimer: there are no strong, high quality studies on this. Evidence level: weak-to-moderate. We're still in the exploratory phase at this point.

"Mood disorders are heterogeneous both in clinical presentation an in underpinning pathophysiology, which may account at least in part for the substantial inter-individual differences in treatment responses." Translation: we have no clue about any of this. Try keto. If it works, it's definitely better than drugs, because we have no clue about them, either.

Treatment of mood disorders (whether by drugs or diet) is important due to the potential for permanent (or at least long-lasting) deleterious neurobiological changes.

DIET DIET DIET. Why? If a patient presents with mood disorders and is overweight, weight loss is increasingly becoming recognized as an important first line therapeutic intervention. The drugs are a guessing game. Keep trying different drugs until you find one that works. Weight loss works. Besides all of the neurological effects of keto, it helps weight loss. Worded another way, obesity and metabolic syndrome are strongly correlated with treatment resistance in mood disorders (Rizvi et al., 2014).

Regarding the neurological effects, keto is already established as a safe & effective intervention in epilepsy, mitochondriopathies, migraine, some cases of autism... and has even demonstrated some pro-cognitive effects.

Epilepsy, cognition, and ketogenic diet (Garcia-Penas et al., 2018) -> reduction of medications, improvement of depressive and anxiety symptoms on keto...

In this context, it may be perfectly legitimate to supplement a low carb diet with exogenous ketones or coconut oil.

Ketogenic diet is a well-known enhancer of glutamate decarboxylase and increased activity of this enzyme stimulates the synthesis of GABA.

Mitochondria are gimped in mood disorders. Cause? Effect? Unknown, although some antidepressants and mood stabilizers revert some of these abnormalities.

Astrocytes convert glucose into lactate for neurons. Or you could, you know, just give 'em ketones.

Another potential mechanism: BDNF BDNF BDNF!

That's all for now!

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