Do you have to use a keto diet to improve your symptoms of depression and anxiety?
Often no. There are a lot of different levels of dietary and nutritional intervention that can be tried before implementing a ketogenic diet. If you want relief from symptoms of anxiety and depression but are hesitant to use a ketogenic diet, you can work with a professional to work on fixing nutrient insufficiencies and learn what a healthy brain diet looks like (it is probably not what you think).
So as with most things, the answer is “it depends”. How severe are your symptoms and how long have they been going on? What level of functional impairment exists? In this post, we will explore the varying levels of dietary intervention that I have seen improve symptoms of depression and anxiety in my practice.
There are published case studies of people with some of the most severe and debilitating psychiatric illnesses recovering using a ketogenic diet. But your severity of symptoms may not be to that degree. Does that mean you may not have to go on a ketogenic diet to see improvements in your anxiety and depression? I get it. You may be afraid to contact me because you are worried that I would automatically recommend you use a ketogenic diet to treat your anxiety and depression. I mean, my entire site is kind of devoted to that. And you may in fact need a ketogenic diet to feel better.
But you also may not. You may be able to use supplementation and learn to make better food choices that support your mental health. You may be able to stop using ultra-processed foods as an emotional comfort because you feel terrible and begin to heal and recover from the debilitating symptoms that are a part of anxiety and depression. Professionals don’t implement ketogenic diets just willy-nilly to anybody. Individuals need to be screened and evaluated to determine if a ketogenic diet is appropriate for them.
Sometimes I meet people excited to try the ketogenic diet because they want to know what all those documented brain benefits feel like! But much of the time people contact me wanting to know about less restrictive nutrition and dietary measures. So, let’s talk about some of the ways I help people in my practice with diet and nutrition to treat mental illness. There are varying degrees of nutritional intervention that can be done, and there can be a lot we try before you decide on whether a ketogenic diet is a good option for treating your mental illness.
What are the different ways anxiety and depression can be treated with nutrition?
One of my favorite ways to get started is to do a nutritional analysis of what you have eaten over a few days in a typical week. This can give me a good idea of the quality of your diet and what micronutrients and macronutrients you may be under or overeating. This gives us a jumping-off point to determine what level of nutritional or dietary intervention might be right for you.
Nutritional Supplements to Treat Anxiety and Depression
With the information gathered from your dietary analysis, I may recommend supplementation. How powerful can supplements be? Pretty powerful. The most common nutrients I suggest clients supplement with are magnesium, zinc, B vitamins, vitamin D, and vitamin K2. Sometimes I will supplement with DHA and EPA (brains LOVE these!). I have had people who presented as severely clinically depressed and ready to do intensive therapy but their symptoms went away before we could really get started because we supplemented with the right amount and type of Magnesium. Even though their serum magnesium levels were deemed normal by their doctor during prior visits.
Another option is Broad Spectrum Micronutrient Therapy. People have different genetic differences that make them need more of certain nutrients, even with an already healthy diet (and especially if they do not have a healthy diet because poor diets use up existing nutrients at a faster rate as your body attempts to deal with excess sugar and increased inflammation. There exists a very solid research base for using Broad Spectrum Micronutrient Therapy with a variety of diagnoses and populations, including children and adolescents. These are not the Flintstone Vitamins you took as a kid and they are definitely not those gummy vitamins everyone is giving their children. They are powerful interventions and if you (or your child or adolescent) are already on medications you may need to have them adjusted in the first week because these nutrients are allowing pathways to work better. An example of this effect, known as potentiation, is that prescribers monitoring stimulant medication of ADHD patients implementing Broad-Spectrum Micronutrient Therapy will often have to reduce stimulant dosage in the first week. You can learn more about this specific type of nutrient therapy for mental health at these websites here and here . It is of note that researchers who study the effects of these treatments do not take funding from the companies that create these supplements, other than the companies providing the supplements to participants of the study so they can be studied. There are no “kickbacks” going on that create unwarranted conflicts of interest in evaluating the data. The sites provided will provide case studies, links to the research, and information regarding dosage. But again, if you are already on medications proceed with caution and work with your prescriber.
The point is, people need different levels of these nutrients for their brain to function. We have recommended daily intakes for these vitamins and minerals, but sometimes the research used to determine the amounts was not well done. The levels are set in an attempt to avoid a level of deficiency that would lead to an acute medical disorder. The RDIs are not about our optimal function. I am about your optimal functioning. And so even if you go to your doctor and they test some of your nutrients and they come back normal, it does not automatically rule out that you are not suffering from its insufficiency. Nutrient testing is complicated and often requires specialized functional nutrition tests. And even then to some degree, we are guessing at levels for some of them. So yes, you may just need supplementation.
Your treatment-resistant depression and anxiety really could just be an unidentified nutrient insufficiency. This is a low-risk, zero side effect avenue of exploration for individuals suffering from mental illness.Nicole Laurent, LMHC
On a side note, if you are interested in learning more about nutrition and brain health I highly recommend Chris Masterjohn PhD’s free Vitamins and Minerals Course which you can find here. The lessons are short, easy to understand, and provide high-quality and accurate information.
Elimination of Ultra-Processed Foods to Treat Anxiety and Depression
If your dietary analysis has come back and I see your quality of diet is not good we may discuss what percentage of your diet is highly processed foods. I often provide nutrition and psychoeducation around what highly processed food is, and how it hijacks your neurotransmitters and hunger cues. Clients are often very surprised to learn how the neurotransmitter system and the dopamine neurotransmitter balance specifically is influenced by these “foods” (actually they are more like psychoactive substances than food).
Are you depressed and having a hard time finding joy in anything? Is the only thing you look forward to a particularly tasty ultra-processed food tasting sweet or salty? Believe it or not, these “foods” impair our neurotransmitter activity to such a degree that normally pleasant activities, such as going for a walk or visiting with a friend become less joyful. There is an entire medical textbook written about the neurobiological and treatment implications of processed food addictions (see Joan Ifland’s textbook here). And it is being taught now in medical schools. So this is not a fringe idea. This is science. Processed foods are not benign and directly influence your symptoms of anxiety and depression. And we can talk about this and potentially use this knowledge even if you currently have or have had a previous diagnosis of Binge Eating Disorder or Bulimia Nervosa. But don’t worry. Because I am a licensed mental health counselor, we would be doing psychotherapy to help you successfully make these and any other changes you might need to reduce or eliminate your symptoms of depression and anxiety.
Paleo Diets to Treat Depression and Anxiety
Often times I and other professionals that practice nutritional psychiatry will transition people to what is known as a paleo diet. The paleo diet as a treatment for mental health is often effective because it eliminates some problematic foods that block absorption of very important brain nutrients. Paleo diets also tip the diet toward more bioavailable and nutrient-dense foods. I have seen first-hand many clients not only see significant symptom reduction in their anxiety and depression but begin to thrive using just a paleo diet. There is a wonderful blog post about paleo diets for mental health by nutritional psychiatrist Georgie Ede, MD that I would recommend you read here if you are curious.
Elimination Diets to Treat Depression and Anxiety
Sometimes with clients, the best course of action is an elimination diet. These are not fun, and the only clients I have ever seen be excited about them are those that were very excited at the possibility of feeling better! These types of diets restrict down to a few highly nutrient-dense foods that generally have a lower risk of reactivity. Then we watch to see if symptoms improve. One great way to measure this is using assessment tools that measure levels of self-reported and observed symptoms of anxiety and depression. Elimination diets are not forever, because people carefully and methodically add one whole food back at a time, paying attention to how they feel. Common elimination diets work with excluding grains, legumes, dairy, nightshades, and/or sugar/fruits (fructose). But can also include foods that we would normally consider quite healthy like vegetables. Essentially, we are looking for autoimmune responses or whether the elimination of certain anti-nutrients found in some foods reduces symptoms of anxiety and depression for clients.
And of course there is the very powerful ketogenic diet!
The ketogenic diet targets several different pathways considered causal or associational in the development and progression of depression and anxiety. But you can read about those in my blog posts here, here, and here and learn about other people’s outcomes from my Case Studies and from other nutritional psychiatry practitioners and researchers by following the links on my resource page. (I highly recommend the podcasts!)
Where do I begin if I am wanting to use nutrition or dietary therapy to help treat my symptoms of depression and anxiety?
If you are on any medications at all you should let your doctor know if you are planning to take supplements or make a significant dietary change. Even sometimes what we would consider benign supplements like fish oil or vitamin K2 can influence medications. If you are on psychiatric medications or any medications used to treat metabolic issues (e.g., hypertension, Type I or II diabetes, diuretics) you really need to have the support of a prescriber to work with you on adjusting medications during your diet change.
Especially if the diet change involves any type of therapeutic carbohydrate restriction as would be the case with a low-carb or ketogenic diet. Your current prescriber may not have experience with dietary therapies so you may benefit from finding a psychiatrist or prescriber that does. Or you can have someone experienced on your treatment team. For example, when I coordinate care with prescribers, we discuss what medications may need adjustments as you progress with your dietary and nutritional therapy for depression and anxiety. You deserve a treatment team that works together for your health whenever and however possible. It is worth the time to develop your treatment team from the very beginning.
There are some useful drug interaction checkers online here and here. But this does not replace the care of a doctor or prescriber evaluating your medications and being an active participant on your treatment team.
Dietary therapies for mental health symptoms like we see in depression and anxiety are powerful interventions. There is a strong evidence base in the literature, going back decades, showing the effects of nutritional deficiencies and insufficiencies in mental health disorders. Including clinically significant anxiety and depression. Ketogenic diets have been used for over a century to treat epilepsy and there are now case studies and some RCTs looking at its use in other brain disorders classified as neurological disorders and mental illness. Evidence-based treatments such as CBT, DBT, Behavioral Therapy, and EMDR for depression and anxiety are powerful. Imagine a treatment plan in which you have access to and are implementing both. This is what I get to do with people every day and I get to see how powerful this combination can be. And that is why I am excited about the possibility of you reducing your symptoms of anxiety and depression.
Feel free to learn about me and what I do. Contact me and ask questions. I will do my best to become a resource on your treatment team or I am happy to help you find resources on your journey towards wellness.
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What level of nutritional or dietary therapy would YOU be willing to try to reduce symptoms of anxiety and depression?