It’s January, which means there’s still time to curb your existential dread about the passing of time with a few resolutions. Why not try a new diet? You could go Mediterranean, vegan, DASH — or you could just eat bacon and eggs and butter for the rest of the year. Perhaps you’ve heard of this bacon-based weight-loss plan: It’s called the ketogenic diet. And while it’s not without its critics, over the last few years “keto” has attracted throngs of devout followers who bless the diet for its fat-torching properties, claiming immense weight loss while maintaining energy and fullness.
Keto may be getting attention as a weight-loss tool now, but it’s been a huge deal in the medical field for years. Doctors have prescribed the ketogenic diet for epileptic patients since the 1920s, and numerous studies demonstrate it can dramatically reduce seizure activity. And now, a growing body of research suggests the ketogenic diet has potential to treat a wide range of mental-health concerns.
I don’t want to be a buzzkill, but amid the excitement about the ketogenic diet, I think it’s important to point out its drawbacks as a psychiatric tool. And I have some authority to do this, because at one point, I tried keto — and it sucked.
For those of you who may be unfamiliar with the ketogenic diet and are perplexed by the idea that surviving solely on butter and cheesy eggs could help you manage a mental illness, let alone lose weight, here’s how it works, according to Dr. Marcelo Campos, a lecturer at Harvard Medical School: Normally, the body burns mostly carbohydrates for energy. But by starving the body of carbs, a ketogenic diet forces a person into a state of ketosis: Their body burns its own fat, producing ketone bodies. These ketones then travel to the brain and feed the brain, replacing glucose.
This fuel switch is thought to underlie the neurological benefits many doctors have seen in their ketogenic patients. Dr. Emmanuelle Bostock, co-author of a recent review on the use of ketogenic diets in psychiatry, notes that “improvements seen in anxiety, depression and bipolar disorder may be related to changes in neurotransmitters whilst on the diet.” Dr. Georgia Ede, a psychiatrist who studies the relationship between mental health and nutrition, says when refined carbs and sugar serve as the brain’s primary food source, the neural pathways are overwhelmed with free radicals and glucose, depleting our natural internal antioxidants and leading to excess oxidation and inflammation in the brain. When the brain draws its energy from ketones, fewer free radicals are produced, allowing our natural antioxidants to easily neutralize them without becoming depleted. Mitochondria, the “engines” of cells, may function more effectively, and neurotransmitters’ journeys across synapses may be eased.
Campos notes that aside from epilepsy, more evidentiary support is needed before doctors start prescribing ketogenic diets as psychiatric medicine. Yet while few large-scale studies have been conducted, initial research looks promising. At the beginning of last year, Dr. Chris Palmer, a researcher at Harvard Medical School, published a paper on the topic using two of his schizoaffective patients as case studies. These patients, he wrote, initially went “keto” for weight loss. But both noticed dramatic improvements in their psychological symptoms as well; their symptoms measurably diminished as their respective qualities of life went up (and they lost weight while they were at it).
Also early last year, researchers at the University of Tasmania compiled a review on the same subject, titled “The Current Status of the Ketogenic Diet in Psychiatry.” Most of the review was comprised of case studies — but what case studies they were. In one, a 70-year-old woman with schizophrenia saw her hallucinations — which she’d had since age 7 — disappear. Two other studies followed women with bipolar II as they followed a ketogenic diet for two and three years, respectively. Ketosis stabilized the women’s moods, they both reported, more effectively than their meds did. Autistic patients have reported improved social relations, and one autistic child placed on keto saw his IQ increase by 70 points after several years. Of course, these reports are anecdotal, and Ede stresses that a lot more research is needed before ketogenic diets are prescribed the way traditional meds are. But the research seemed promising enough to me. So not long ago, and perhaps against my better judgment, I decided to conduct a case study on myself.
I’ve struggled with depression, anxiety, and ADHD since my early teens, but I’m not on meds because I’ve found their side effects intolerable. When on ADHD medication, I experience panic attacks and rapid weight loss; even something as mild as birth control can render me numb and bedridden. I’ve made do sans medicine, but it’s not always easy.
I know that there are others like me out there, people who aren’t ashamed or afraid to take medications, but who simply haven’t had success with them. A drug that solves one problem might exacerbate another, or work well for this person but fail for that one. And some problems can’t be fixed by medication alone. After his own failed experiment with psychiatric meds, author Johann Hari went on a journey across the world — and found that people using all sorts of nonchemical alternatives to antidepressants, from making new friends to buying a cow. Again, Hari’s argument is not that we should stop prescribing antidepressants; it’s that as a society we’ve come to view them as a universal solution to depression, rather than one tool of many. “At the moment, we offer depressed people a menu with only one option on it,” he writes.
One particularly rocky month in late 2016, I visited my therapist in tears. She asked me some questions, and at the end of our meeting, told me that I met criteria for bipolar II.
Reluctant to start medication again, I scoured the internet. Eventually I came across a message board exploring the ketogenic diet’s potential to alleviate symptoms of depression and bipolar disorder. Why not try? I thought.
The first day or two were fine: I ate a lot of bacon and Brussels sprouts, and avoided ketchup to the best of my abilities. But after two days of eating fewer than 30 grams of carbs, it hit — a period of low energy and weakness that keto experts call “the low-carb flu.”
I woke up achy and sluggish, confused and depressed. Every time I passed one of those muffin carts in lower Manhattan, pangs of longing possessed me. By Thursday, I noticed blearily that my anxiety was gone — I was simply too tired to be nervous about anything. But my depression had deepened, sending me into a dull blue fog.
This hits on a complication with the ketogenic diet as a treatment for mental illness. Bostock notes that many people with certain mental disorders find it especially difficult to maintain thanks to the very symptoms they’re looking to manage. For instance, the impulsivity that accompanies a manic episode would make sticking to a salad-dressing-and-sausages diet difficult when there’s cake around. The apathy that’s a mainstay of depression makes it difficult to care enough to maintain such a difficult diet for long periods of time.
This was certainly my case; I battled depression and physical fatigue for ten days straight, and still, my “flu” raged on. The following Monday, I poured a ribbon of sugary one-percent milk all over a bowl of carb-stuffed Cheerios and went to town. I’d lasted ten days, each of them torturous. The transgression alone flooded me with euphoria, not to mention the instant rush of energy — sweet energy — that snaked through my veins. The coup was complete. The short-lived ketone dynasty had been toppled.
Ede says that it make take up to a few weeks of “low-carb flu” before getting adjusted to a ketogenic diet. The body and mind are so used to burning carbohydrates that they usually need some time to transition to fat, a slower-burning, more efficient energy source. But once your brain takes to its new, more efficient and de-inflammatory fuel, something miraculous happens, she and other keto-devotees argue. Your mind clears. You’re calmer, more productive, and less anxious.
Still, Ede notes, a handful of patients experience difficulties with keto for far longer than a few weeks, usually due to mineral deficiencies or processed food high in other inflammatory molecules like unnatural fats. “The simpler it is, the better,” she says. “Meat, seafood, poultry, vegetables, don’t make it too complicated.” When it comes to her highly volatile patients, Ede says she usually waits until their brains are relatively stable before suggesting any kind of diet change. Often, they first require some stabilizing kind of medication. (And it’s also worth noting that you should consult your doctor before making any drastic change in your diet.)
Would I be typing this, happily symptom-free, had I stuck with the ketogenic diet for a few more weeks until my low-carb symptoms abated? Perhaps. But I found another way to manage my symptoms: I left New York. Soon after that meeting with my therapist, I moved out of the city that had taken so much from me, the trees and quiet, my space and time. Now I’m in graduate school and I live in Oakland, and I go on hikes sometimes and I live in a way bigger room for a lot less. I have not had to go back on meds. My mood swings have all but disappeared.
When I tell people about my short-lived foray into keto, their initial responses usually sound like “What the hell?” To them, the diet sounds like dangerous, artery-hardening nonsense. Ede and others say such fears are likely unfounded — studies have found the diet to be generally safe.
“The criticism I get on social media [goes like this]: These diets, how dare you recommend them, they’re untested and dangerous!’” Ede says. “Nothing could be further from the truth — in fact, the standard American diet is the most dangerous diet I can think of.” Simply shifting away from that diet, with its heavy emphasis on refined carbohydrates, can ease inflammation and provide some of keto’s benefits, though not all.
I may try keto again someday, if my mental health destabilizes. For now, I’m exploring my new town’s food. I delight in its mole burritos and samosas. I inhale its jasmine rice. The other day I stopped by King Pin Donut on Durant Avenue and purchased a chunky, frosted cake doughnut with chocolate chips. It tasted like transgression: sweet and sinful. And for a brief, miraculous moment, my mind went calm.