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Many people practice the ketogenic diet to lose weight, but some report mental health benefits, such as an improvement in symptoms of anxiety, depression, and bipolar disorder. But clinical research is limited. There are no listings for ‘mental health’ and ‘ketogenic diet’ on clinicaltrials.gov.

However, if ketones impact brain function, why would they not impact mental health? Theravive invited experts to weigh in on the ketogenic diet and potential implications for mental wellbeing.

Cody Steiner, RD is an inpatient dietitian at Aurora St. Luke's Medical Center, working with GI surgical patients. Steiner acknowledges studies that show cognitive improvements with ketogenic diets, yet notes limitations with participants and scope. When compared to balanced diets with normal carbohydrate amounts, he cites "either no significant difference or impaired cognitive function. We need more research in the area and currently I would not recommend the ketogenic diet for weight loss nor cognitive health."

He has a concern with potential side effects on a diet that, in his viewpoint, has no definitive mental health benefits. "Even the somewhat promising research linking ketogenic diets to decreased depression are far from definitive and don’t take into consideration how difficult it is to adhere to such a strict diet. A less strict, balanced plant-based diet can often improve mood and daily functionality without the keto-flu like symptoms and potential health risks of a very low carbohydrate diet."

Caleb Backe, a Certified Personal Trainer and Health & Wellness Expert with Maple Holistics feels differently. Backe believes the keto diet helps with anxiety, referencing our body's increase in production of GABA neurotransmitters when it is in a state of ketosis. "This is the neurotransmitter associated with lowering anxiety levels,” said Backe. "Furthermore, a proper balance of GABA has the potential to increase mental focus and reduce overall stress, which can have a profound effect on your mental health. While glucose might be essential for the brain, research suggests that the ketones formed from a low-carb diet provide an alternative energy source and provide the body with neuroprotective effects.”

While Backe sees benefits to the keto diet, he does not claim it as a cure-all for mental health issues. Yes, there is science supporting its use, but he too is aware of the absence of clinical trials. "While it may provide a way to manage your mental health, there aren’t enough clinical trials to depend on the keto diet despite the basic science providing a solid foundation for promising results." Recognizing the limited clinical research, Ken Berry, MD, still believes a diet change can improve mental health as witnessed with his patients. "I’ve had multiple patients with depression and anxiety be able to decrease or stop the prescriptions they took for these conditions. We would wean down their medications slowly as they ate lower and lower carb diets."

Shani Neomi Bachar RD, LD, the Director of Nutrition with Synchronicity, also sees brain benefits of this diet which is about much more than weight loss. "A true Ketogenic Diet works on a cellular level,” said Bachar. “Eating a very low carbohydrate diet activates BDNF (Brain Derived Neurotrophic Factor), which has a neuroprotective effect as it turns on genes that help the cells survive by reducing inflammation and protecting the mitochondria.  This allows the brain to make new neurons that enhance the mitochondria to generate more energy, reduce fatigue, pain, brain fog, and increased vitality.”

Increased energy and decreased fatigue are clear benefits for people experiencing mental health symptoms, but Molly Bahr, a Licensed Mental Health Counselor who works with eating disorders, anxiety, and depression, is not a proponent of the keto diet. "Keto is another fad," asserts Bahr. "There is not a single diet proven to work long-term (more than 2-5 years) for the vast majority of people.  It's unsustainable and many people develop disordered eating as a result."

Bahr believes the benefits of dieting are short-term and potentially harmful. In her perspective, people feel better while dieting because they tell themselves they are doing something healthy and visualize the superficial improvement of being thin and getting attention.  

The restrictions concern Bahr and she explains it as a pendulum. "The harder we swing to one side (no carbs, no cheats, all whole foods), the harder we tend to swing to the other side (binge/cheat day) due to survival mechanisms. Our bodies are trying to keep us alive. It's incredibly difficult in our culture to avoid carbs without missing out on social events, holidays, and vacations. It's common to develop a binge/restrict cycle of eating, increased anxiety, depression, loneliness, body image distress, and fixation on food and body. It may feel ‘good’ the first 3-6 months, but how do people feel long-term and how much do they have to sacrifice in that time?"

Amanda A. Kostro Miller, RD, LDN, on the advisory board for Smart Healthy Living, offered insight on indirect mental health benefits. The ketogenic diet is often used for patients with epilepsy to reduce seizures, a stressful experience for patients and caregivers. Miller points out that “having a diet that reduces the number of seizures each day is a great tool for improving quality of life and emotional health of the family of someone with epilepsy.” A reduction in negative emotions from experiencing or witnessing a seizure is a positive indirect effect from the direct treatment of epilepsy symptoms through diet.

Not all diets are right for everyone - and many are not even healthy. And more clinical trials are needed. However, changes in eating habits that move away from the SAD (standard American diet) diet are advantageous. It is important for people to consider their motivations and note how they feel as well as the sustainability of any diet changes. Does a diet change leave them starving? Then it will never work long-term. But one that increases energy and reduce anxiety? That’s a change worth exploring.