I was reluctant to write this article, because I’m not a doctor, and I have never tried a ketogenic diet myself, neither I have a mental disorder that I know of. The depression I had accumulated in the past 10 years because of IBS-D ruining my life, is already gone with the plain, less-restrictive Paleo/Primal diet.
As it happens, in the last week I kept researching about ketogenic diets as a way to lose more weight. But what I ended up finding instead, is a whole new way of fixing (== making asymptomatic) disorders that until very recently I’d thought to be “unfixable”. I always thought of mental disorders as this whole other thing, medically. It’s not like a broken arm, where you put it in a cast, and it gets fixed in a month or so. Or even like with my own problem, IBS-D, where you remove certain foods, while adding others, to fix this GI issue. Mental disorders are shrouded in this mystique of the unknown, which I always found fascinating, and scary as hell at the same time.
So while researching (some links: 1, 2, 3, 4, 5, 6, 7), I found that the known ketogenic diet for epileptics, actually has magical effects also to autistic/aspergers, bipolar, depressed, anxious, and even schizophrenic people. Other positive benefits of a very low-carb, high-fat diet was found during the treatment of Parkinson’s, Alzheimer’s, Lou Gehrig’s disease, and even brain cancer patients! Unfortunately, no research was ever done for adults to study the alleviating of these illnesses’ symptoms with a keto diet. The epileptic keto diet is mostly tested on children, who are not allowed to eat more than 10 grams of carbs daily. A number of children who have followed the diet, generally saw a reducing of the number of seizures within a few weeks, and in some cases, they got a complete loss of seizures within a few months. There are also a lot of autistic kids who got their ability to connect with others, and even speak, or go to normal school, just by following the similar to Paleo & Keto diets: the GAPS and SCD diets. A bipolar woman got so much better that she even managed to stop her medication within 6 months time of following a strict ketogenic diet (with the agreement of her doctor, one of the few doctors who suggests diet as a prescription). There are these who claim that most mental disorders are nothing but metabolic disorders. A completely “physical” problem that is.
A ketogenic diet is a diet that removes most sugars and starches from the diet. Adult patients are not allowed to eat more than 30 grams of carbs a day, or about 10-20 grams for children. After 2-3 weeks, the body stops burning glucose as its fuel, and instead runs on fat! There are sticks you can buy where you pee on them in the morning, and you can see for sure if your body has gotten into a ketosis mode or not (also, bad breath, and stinky unine are other ways to know). While in this mode, the brain then will produce a byproduct called ketones. The body can also run on protein, but it prefers sugar or ketones/fat. By changing the fuel that floods the brain, the seizures get minimized or stop, because the whole dynamic of the brain changes. Your mood will stabilize, you will focus better, and a whole new world will open up for you (hopefully — as with other illnesses, “only” about 90% of the cases usually respond to diet changes).
So, to start, follow the Paleo diet (including bone broths, offal, lactose-free probiotic yoghurt), plus this additional protocol here (except for the suggested honey). Never put grains in your mouth again, not even in the form of a beer. In addition of what you can’t eat while on the plain Paleo diet (that is, all grains/corn/rice, sugar, legumes/soy, and white potatoes), you must also remove the following to go Ketogenic: parsnips, sunchokes, sweet potatoes, tapioca, taro, yams, honey, maple syrup, lactose, and the big one, most fruits. Rutabaga, carrots and beets must be eaten in small quantities, while turnip tubers/greens, beet greens, and celeriac are safer, since they have fewer sugars/starches. The rest of the veggies are OK, but you’d have to always measure how much of it you eat (no more than 10-15 gr of carbs per meal that is). If you can tolerate dairy, you can make your own home-made probiotic lactose-free goat yoghurt, and also eat goat hard cheeses. For milk, you go for unsweetened almond or coconut milk. For fruits, you can chop two small strawberries in your yoghurt, or 4-5 of the smaller berries per day (that’s overall about 3-5 grams of carbs). The rest of the fruits are pretty much out, unless you’re ok eating very small pieces of fruits, pieces that overall don’t have more than 5 grams of carbs (e.g. 1/4 of a small peach).
The kinds of plants allowed or not in a keto diet. When after a year you will move out of ketosis and you start adding the more carb-y veggies, still, never eat anything again from the “avoid” category (except sweet potatoes, parsnips and raw honey which are “safer” health-wise)
A tip: While you’re calculating carbs, you can remove the fiber from the calculation, so that gives you some more vegetables to eat. For example, if a veggie has 10 grams of carbs for 100 grams of its weight, but 4 of these grams are fiber, then in reality that’s 6 grams of carbs. So add more than 100gr of the vegetable in your plate! Yum, more to eat! Also, the suggested vitamins here will be beneficial (supplementation for loss of vitamins), while the krill oil stabilizes the mood. For people specifically on a keto diet, it’s important to also supplement with L-Carnitine (at least in the beginning) at no more than 50-100 mg/day, a substance that helps the body metabolize fat into fuel. Also, make absolutely sure that you cook mostly with pure coconut oil (MCT oils are imperative for mental health). Make sure your salt has added iodine in it, and that you do eat salt. Also try sea-vegetables for their iodine. Beet greens and swiss chard can keep a good level of potassium too. A few times a week you might want to take some fiber too (psyllium). Here’s a diet plan I put together, with additional info about Paleo-keto towards the end of the article.
Finally, cut off completely on cigarettes, recreational drugs, alcohol (you could still have a bit of dry wine every now and then), and definitely get off caffeine. Caffeine has some good effects itself, but it can send some people with mental disorders into a manic state. Herbal tea (e.g. chamomile) and decaf kombucha green tea should be in your future. If you’re an alcoholic, you must cut off alcohol slowly, so you don’t get ketoacidosis. If you have to cut down all these substances, then it makes sense to go for the plain Paleo diet in the first month, and only after you’re free from addiction to go for the Paleo-keto version of the diet.
Having said all that, be careful with such a diet, and always ask the permission of your doctor. Of course, most doctors don’t believe that a diet works for mental illnesses, because there are only anecdotal testimonials about it so far, no backing research (except for epileptic children). If your eyes are starting to get dry, add a few more carbs. There is also the danger of ketoacidosis, kidney stones (make sure you drink enough water), and constipation (follow the protocol here). Also note, that most people who got out of the diet had their symptoms eventually returned. A Paleo diet is not a panacea, but it’s a way to manage your problems, and eventually & hopefully (with your doctor’s approval), to stop taking these drugs that usually have so horrible side-effects, and most often than not, they just don’t work. But no matter what, always keep your doctor(s) in the loop!
Here’s how a sample menu looks like in a Paleo-ketogenic diet:
* Breakfast: 2 eggs, 2 sausage links, 2 bacon strips, cooked in coconut oil. Serve with a dollop of lactose-free cream, and drink a cup of bone broth, along water or unsweetened coconut milk. That’s almost 0 net carbs for breakfast. It’s best to eat within 30-40 minutes of waking up.
* Lunch: A small cup of a vegetable+bone_broth+sour-cream soup. 1 beef steak or 1 pork chop, fried in coconut oil. Serve with a big dollop of unrefined coconut oil, and a cup of steamed greens, or 1/2 cup fried mushrooms or other greens. Have some goat hard cheese with it. Overall, that’s 10 net carbs.
* Dinner: Green salad with olive oil and French vinaigrette. Two-three roasted chicken drumsticks served with cream or a big white fish fried in coconut oil. Serve with 1/2 cup of mashed cauliflower or a cup of other greens, bathed in cream or butter. Have 1/2 cup of your home-made probiotic lactose-free yoghurt, served with 4-5 small berries, and nuts & seeds from the allowed list, chopped. That’s overall another 15 grams of carbs.
Overall for the day, rounding up on error, that’s about 25-35 grams of carbs, which is low enough to keep most adults under ketosis, and high-enough to not be completely unmanageable. A considerable amount of fat is consumed, since that’s what’s running the body now. Don’t be afraid about cholesterol, as with the Paleo diet, the diet itself will balance everything out as of magic. There are a lot of myths about cholesterol out there, but there’s also rebuttal (1, 2, 3). Finally, you will feel headaches, brain fog, cramps, moodiness, and fatigue in the first 30 days of the diet, this is normal and to be expected. Do not eat more carbs to combat all this, your body will adjust to the new fuel eventually.
The most difficult part of this diet is of course to keep it up. Most people can’t keep it up for long. But if you can keep it up for 2-3 months, and then you see the benefits of the diet in both your body & mind, it’s up to you if you want to continue getting drugs for the rest of your life (drugs that very rarely work), or get with the program and find your inner peace. Maybe after 6 months on a ~30gr-of-carbs-per-day Paleo-keto diet, after you stabilize and heal, you could increase carb-intake every three months by 10gr or so, and see how you do (although it would probably help to not exceed 100gr of carbs daily in your lifetime). By adding more carbs, after a year you would be essentially doing normal Paleo, not Paleo-ketogenic, which is a great way to do maintenance for the condition. Think about it, and do your own research online. As importantly, start a blog about it, and share your progress while on such a diet! Spread the word!
Update Dec 20 2011: A new article, at NPR, about dieting and mental health.
Update Jan 6 2012: Coconut oil fixes Alzheimer’s.
Update Jan 20 2012: Positive effects of the ketogenic diet on behavior and cognition.
Update Mar 8 2012: Results from my own experiment with the Paleo-ketogenic diet.
Update Apr 26 2012: More Clues to Systemic Inflammation in Mood Disorders
