Ketosis & Depression

When you're feeling stressed or depressed, it's natural to want to turn to simple sugars for relief, as the substance can reduce cortisol levels in the brain according to a 2015 study published in the Journal of Clinical Endocrinology & Metabolism. But that's not the healthiest way to deal with your stress in the long term. Instead, a diet that helps your body produce ketones for the brain comes with long term benefits that combat depression.

Although ketogenic diets vary, most typically they involve eating less than 20 grams of carbohydrates per day. The goal of the diet is to lower insulin and blood sugar levels in the body, causing it to burn fat from the diet and body stores for energy. The fat breaks down into ketones which can be used by most cells in the body, including the brain.

Morning blood glucose levels of 60 to 85 milligrams per deciliter signal a person is "in ketosis" which sets the ketogenic diet apart from other low-carb eating programs in which higher amounts of protein and carbs don't necessarily create the same effect. When ketones are consistently at this level — usually in about six weeks — a significant number of people begin to see positive mental changes.

Just as a car can't be in drive and reverse at the same time, your body has the option to burn either glucose or ketones to get energy — it doesn't do both at the same time. Although both glucose and ketones can help your brain feel better and ease stress, when your body converts to burning ketones for its energy, it has a steady supply and you don't experience the "bonks" or blood sugar crashes as you do on a glucose-based diet.

Eating the right amount of fats and protein to achieve ketosis means that you're not taking in too many simple sugars like fructose and glucose. These sugars make up a large part of the standard American diet, aptly abbreviated by its initials, SAD, along with refined, high-carb foods. Spiking blood sugar levels lead to a serotonin crash, increasing feelings of depression. High blood sugar also leads to increased risk of diseases of the vital organs, diabetes and obesity. A diet high in ketones comes with none of those risks.

Studies relating depression to a ketogenic diet are few; however, the link between the benefit of ketones and other neurologic disorders such as epilepsy is centuries-old. The anti-inflammatory effects of the ketogenic diet reduced neuroinflammation in studies on rats according to a 2017 study published in Scientific Reports, leaving the animals more active than those on a standard diet. That could translate into more energy and feelings of well-being for humans.

Read more: 8 Warning Signs of Depression You Shouldn't Ignore

Although there isn't hard scientific evidence out there in the way of studies that prove that keto for depression is helpful, there is lots of anecdotal evidence of people on keto diets reporting significant improvements in mood.

Your brain is made up of about 60 percent fat, and healthy fats are necessary to make it function at its best. Eat a diet that is about 75 percent fat, recommends Diet Doctor, focusing on low-carb choices such as butter, mayonnaise, olive or coconut oil, cream cheese and guacamole.

Healthy fats include those found in nuts, seeds, meats, avocados and other whole foods. Unhealthy fats induce inflammation, so avoiding processed fat is critical. Although oils that have been around for centuries, such as olive oil and coconut oil, are great additions to a keto diet, the manufactured oils of the last century contain inflammatory agents that can harm your health. Avoid corn oil, cottonseed oil, sunflower oil, safflower oil and soy oil, for example.

Read more: 10 Habits Keeping You Depressed

When you're feeling stress and want to turn to a quick sugar fix, know that certain types of fat can be converted quickly to ketones by the liver for a nearly instant ketones brain boost. Fats are made of triglycerides that have carbons bound together in chains. The shorter the carbon chain, the more quickly your liver can convert the fat to a ketone.

Short-chain fatty acids are found in small amounts in things like butter and cream (which also have medium-chain fatty acids and saturated fat). If you've ever felt like just sticking a pat of butter in your mouth sans the bread, just go ahead and do it. You're welcome.

Medium-chain fatty acids are also quickly absorbed to provide an energy boost for the body and brain. Coconut oil, butter and MCT oil are ideal sources. Slow-burning saturated fats and long-chain triglycerides will make up most of your diet, though, as these are the fats found in keto-friendly meat, above-ground vegetables, nuts, seeds and eggs.

Get medical tests before starting keto and at regular intervals along the way. Knowing how the diet is affecting your body will give you peace of mind and help your doctor head off any problems that might present in your individual chemistry. Make sure to do the first blood test before you make any dietary changes.

Psychology Today recommends the following lab tests for those pursuing keto for better mental health:

• Fasting Total Insulin Level
  
• Fasting Comprehensive Metabolic Panel to track your levels of electrolytes and glucose as well as your kidney and liver function, and acid-base balance
• Fasting Lipid Panel to determine your HDL cholesterol and triglycerides
• Any relevant blood levels of substances from your medications such as lithium and Depakote
  

Although the dramatic shifts in brain and body chemistry brought on by the keto diet are nearly always positive, understand that the diet can potentially change the way your medications affect you.

Visit your prescribing physician and make known your intent to go keto. Hopefully, your doctor is already versed in the diet or willing to learn; however, you might need to see if he's willing to work in partnership with a nutritionist or, if not, find a medical team who can give you the support you need as you transition onto the diet the first few months.

Although you'll start to feel mentally better in all likelihood, don't just quit your medication cold turkey. It's essential to plan a safe tapering schedule with your medical expert and get regular checkups along the way. Some medications can have life-threatening withdrawal effects if you come off of them too quickly.

Resign yourself to the fact that it's going to take a while to get completely off of your medications if you are taking more than one. Don't start any taper until you've been on the keto diet for at least six weeks to three months, as this is how long it takes your body to adapt to the diet fully.

Consult with your physician to see which medication is best to taper off first. Tapering schedules should be gradual to avoid unpleasant side effects.

After you've successfully tapered off of the first med, wait another six weeks before backing down on the next one. Meds such as Zoloft take that long to get completely out of your system. You won't know if you feel worse from the absence of the first med or the second one if you start the taper immediately.

Read more: 12 Foods That Can Improve Your Mood

Most psychiatric drugs don't pose any problems for going keto. However, if you're on the certain types of meds, watch out for increased risks.

Anticonvulsant mood stabilizers: Originally prescribed for treating epilepsy, anticonvulsants are often prescribed as mood stabilizers. Some can bring on unexpected side effects when you embark on a keto diet. Some of those that have known side effects include:

• Depakote: Also known as valproate or valproic acid, this med is a fatty acid itself and can get used by your body as fuel. A keto diet that trains your body to burn fat can reduce the levels of Depakote in your bloodstream, and you won't feel like it's working as well. Have your doctor run a blood test and prescribe increased dosage if necessary until you're adjusted to keto.
  

• Topamax (topiramate) and Zonegran (zonisamide) affect the way your kidneys process electrolytes and can put you at an increased risk for kidney stones when you go keto. Drink plenty of water and get regular checkups when you're on these or other anticonvulsants.
  

Antipsychotics: Medicines such as Seroquel, Abilify and Risperdal are increasingly prescribed for non-psychotic disorders such as anxiety and depression. The drugs can up your insulin resistance, meaning your body will have a harder time converting fat to ketones. These and other antipsychotic drugs might need to be reduced or even stopped — under a doctor's care — before you can realize the full benefits of the ketogenic diet.

Blood pressure medicine: If you're on medication to lower your blood pressure, going on a keto diet could make it even lower, as your body rids itself of extra fluid in the early stages. Meds like Clonidine, Prazosin, and Propranolol are sometimes prescribed for anxiety, insomnia, nightmares or ADHD, even if your blood pressure is normal.

Lithium: Water loss during the early days of the ketogenic diet can increase lithium levels in your bloodstream, leading to unpleasant side effects like excessive thirst, difficulty with coordination and concentration, tremors and feeling sluggish. Make sure to get enough salt, magnesium, potassium and other electrolytes in the early weeks of the diet. Monitoring your blood levels is especially important so your doctor can adjust your dosage downward if needed.