Doctors always recommend a healthy diet but the truth is I don’t even think anyone knows what that means anymore including most doctors themselves. The standard American diet is pretty much a disaster for the human body and mind. The other problem is that even if there was a consensus on what constitutes a healthy diet getting people motivated or inspired to adhere to it is very challenging.
When I’ve suggested to someone to cut out sugar for a month, I’m pleasantly surprised upon their return a month later telling me that they did it and their mild depression is much better. However, there was a young woman who presented to me with severe depressive symptoms: hopelessness, lack of enjoyment, poor concentration and memory, worthlessness, feeling unable to do her job, passive suicidal thoughts, always tired and needing between 12-18 of sleep per night. It was also clear medications were only temporarily helpful and even dietary changes revealed no consistent pattern until she hit upon a modified ketogenic diet. Suddenly, for the first time in her life, she only needed 5-6 hours sleep/night, no daytime fatigue, concentration was normal and her memory was 90% better, and her mood was consistently upbeat. She no longer required medication and she was motivated to stick with the diet and not even feel the need to cheat given how desperate she had been for many years and how wonderful she was feeling.
What is a modified ketogenic diet? It is a low carbohydrate diet (20-50 gm/day) with unlimited leafy green vegetables. What it all comes down to is cutting out all forms of sugar and grains (which are converted to sugar) so that your blood sugar is steady and you rely more on a diet rich in fats and some proteins. The discovery of this diet in 1921 at the Mayo Clinic was a way to trick the body into thinking it is maintaining a fasting state in order to control epilepsy. It worked but the problem is the original ketogenic diet is not a healthy diet by itself and requires taking dietary supplements or supplemental vegetables. There’s no more cereal, bagels, toast or oatmeal in the morning but eggs, vegetables, and meat or fish to replace it. Lunch and dinner can include giant salads (kale, microgreens, avocado, tomatoes, coconut oil, Himalayan salt). You can add a few pecans/macadamia nuts for fat and eggs, fish, or meat for protein. You are also allowed some berries and dairy (if you can tolerate it). Clearly, this diet is a tough sell for the average American but I do suggest cutting out the grains and sugar as much as possible and start with small tweaks: eggs and vegetables for breakfast and more vegetables with lunch and less bread. Even if you start with just changing your breakfast, you may notice feeling better that same day.
The other possible role for the ketogenic diet is the one popularized in recent years—weight loss. People do lose weight on this diet and this is possible by the restriction of carbohydrates and once you are in a ketogenic state, it’s really hard to overeat because you are no longer hungry between meals. On the down side, some studies have shown there is a slight increase in cholesterol levels and you will still require additional vitamins and minerals. There are already some case studies around the world showing how patients on certain psychotropic medications that cause significant weight gain were able to lose all the extra weight on the ketogenic diet and their mental status improved as well with regard to mood, anxiety, and cognition. However, this diet is not right for everyone and for some people it can even worsen their mood or anxiety. Clearly, more studies need to be done for better evidence that the ketogenic diet offers consistent long term benefits in improving mental health for a subset of people. The young woman I mentioned above continues to do consistently well a year later in all areas of her life and that had never happened before even when she was on psychotropic medication so there is something there that could benefit others as well.