How could a ketogenic diet help treat the symptoms of Post-Traumatic Stress Disorder (PTSD)?

Ketogenic diets are able to modify at least four of the pathologies we see in PTSD brains. These pathologies include glucose hypometabolism, neurotransmitter imbalances, inflammation, and oxidative stress. A ketogenic diet is a powerful dietary therapy that has been shown to directly impact these four underlying mechanisms that have been identified to be involved with PTSD symptoms.

Introduction

In this blog post, I am not going to outline the symptoms or prevalence rates of PTSD. This post is not designed to be diagnostic or educational in that way. If you have found this blog post, you know what PTSD is and likely you or someone you love may already be suffering from it.

If you have found this blog post, you are looking for treatment options. You are trying to find ways to feel better and heal.

By the end of this blog post, you will be able to understand some of the underlying mechanisms going wrong in the brains of people suffering from PTSD and how a ketogenic diet can therapeutically treat each of them.

You will come away seeing a ketogenic diet as a possible treatment for your PTSD symptoms or as a complementary modality to use with psychotherapy and/or in place of medications.

It is not medical heresy to write the above statement. Why would we not consider using a ketogenic diet in place of psychopharmacology for PTSD? Psychopharmacology treatment for PTSD has been acknowledged as ineffective and sorely lacking since 2017, by a well-known Consensus Statement of the PTSD Psychopharmacology Working Group. Psychopharmacology as a treatment for PTSD has essentially been a failure.

Despite this high prevalence and costly impact, there seems to be no visible horizon for advancements in medications that treat symptoms or enhance outcomes in persons with a diagnosis of PTSD.

What are the neurobiological changes seen in PTSD? Where are possible pathways of intervention?

This previous post went into detail about how a ketogenic diet can modify symptoms of anxiety.

How do ketogenic diets help anxiety disorders?

How does it do that? By affecting four areas of pathology seen in these disorders.

• Glucose Hypometabolism
• Neurotransmitter Imbalances
• Inflammation
• Oxidative stress.

In PTSD we see these very same pathologies occurring. There are areas of the brain with hypometabolism (not using energy properly) and we see overexcitability in others. There are distinct neurotransmitter imbalances affecting mood and cognition and extreme oxidative stress and inflammation documented as occurring in the PTSD brain. Let’s review each of these.

PTSD and Hypometabolism

Brain hypometabolism means that the brain is not using energy correctly. Areas of the brain that should be active and using energy are not. Brain hypometabolism is indicative of a metabolic disorder in the brain.

Brain imaging studies consistently find areas of reduced energy consumption in the brains of people suffering from PTSD. These areas can include the occipital, temporal, caudate nucleus, posterior cingulate cortex, and parietal and frontal lobes. It is theorized that hypometabolism contributes to the dissociative states reported in PTSD symptomology.

“…only patients with PTSD showed hypoactivation in the dorsal and rostral anterior cingulate cortices and the ventromedial prefrontal cortex—structures linked to the experience and regulation of emotion.”

Etkin, A., & Wager, T. D. (2007). https://doi.org/10.1176/appi.ajp.2007.07030504

How does a ketogenic diet treat hypometabolism in the PTSD brain?

Ketogenic diets are specifically a therapy for brain hypometabolism. So much so that it is used for other neurological disorders such as Alzheimer’s Disease and Traumatic Brain Injury (TBI) for just this exact purpose. Ketogenic diets produce ketones which can be used as an alternative fuel for the brain. Ketones can bypass broken metabolic machinery normally used to utilize glucose for fuel. Brains love ketones. And a ketogenic diet may improve energy expenditure in these important brain structures being affected by PTSD pathology. A brain with fuel will always have improved functioning than one without. And that is why a ketogenic diet may be an excellent therapy for this mechanism of pathology present in the PTSD brain.

PTSD and Neurotransmitter Imbalances

While hypometabolism occurs in some parts of the brain with PTSD, we also see some areas of hyperarousal and excitability. This hyperarousal and excitability are likely occurring due to the types of neurotransmitter imbalances we see in people suffering from PTSD.

PTSD patients have been found to have increased levels of dopamine and norepinephrine which are thought to be responsible for symptoms seen such as higher resting pulse rates, blood pressure readings, and startle response. Decreased levels of serotonin affect communication pathways between the amygdala and hippocampus, reducing the ability of the PTSD brain to modulate anxiety. These decreased levels of serotonin are thought to contribute to the increased hypervigilance, impulsivity, and intrusive memories experienced as symptoms.

Additionally, several studies have found decreased levels of the neurotransmitter GABA. GABA is a neurotransmitter that is crucial in helping a person deal with stress and anxiety. But not only is there a decrease in GABA but there is a large increase in the excitatory neurotransmitter glutamate and norepinephrine. These neurotransmitter imbalances are thought to help explain symptoms of increased startle responses and even disassociation.

How does a ketogenic diet treat neurotransmitter imbalances in the PTSD brain?

Ketogenic diets improve neurotransmitter imbalances by improving the metabolic environment of the brain as it is making neurotransmitters. The neurotransmitter balancing effects of a ketogenic diet are well known. Perhaps the best example of this is its assistance in the making of more GABA and its ability to reduce neurotoxic levels of glutamate. This same pathway that is beneficially influenced by the ketogenic diet can increase levels of serotonin and reduce an overabundance of dopamine. Each of these changes is relevant to the treatment of PTSD symptomatology. A well-formulated ketogenic diet is also nutrient-dense, providing multiple important cofactors to not just produce neurotransmitters but improve their ability to function in the brain. Ketones do this with improved cell membrane function, which improves communication between neurons. So not only do you get balanced levels of neurotransmitters, you get better functioning neurons ready to use them well.

PTSD and Oxidative Stress

Oxidative stress is a significant area of pathophysiology in the PTSD brain. There are decreased levels of important enzymes that help internal antioxidants, like glutathione, do the job of reducing oxidative stress. Oxidative stress that is chronic in nature, as we see with PTSD, has real neurobiological consequences that include accelerated cellular aging and the progression of neurological illnesses seen in aging brains. The powerhouses of our cells, known as mitochondria, cannot function in a brain that cannot manage its level of oxidative stress.

What do mitochondria do?

The very machinery and function of the cells are impaired and under great duress.

Currently, the role of oxidative stress and associated neuroinflammation in … PTSD is well established. Increased production of free radicals and/or reduced antioxidant defenses under challenged conditions result in excessive levels of free radicals in the brain, leading to mitochondrial dysregulation, microglia activation, and neuronal death. These mechanisms are suggested to play a key role in helplessness, anxiety, and inappropriate retention of aversive memories.

https://doi.org/10.3389/fnut.2021.661455

If you want to understand better the difference between oxidative stress and neuroinflammation, check out this article below:

If Your Brain Were a City: Understanding Oxidative Stress and Neuroinflammation

How does a ketogenic diet treat oxidative stress in the PTSD brain?

The ketogenic diet treats oxidative stress in at least three ways.

The first is by reducing inflammation in the brain by interfering with pathways that produce a lot of inflammation (see the section on inflammation in this blog post below).

Ketogenic diets improve brain energy by providing an alternative fuel for brain cells that improves mitochondrial functioning (how much energy your brain has to burn) and this improved functioning allows the neurons to do a better job of fighting inflammation and maintaining neuronal health.

And finally, ketogenic diets upregulate (helps your body make more of) the most powerful antioxidant known as glutathione. You can take glutathione and precursors to glutathione as supplements, but you will never absorb and utilize the levels that your internal machinery can provide with the right dietary and nutritional environment. Which is what a well formulated ketogenic diet is and provides.

PTSD and Inflammation

In a recent (2020) meta-analysis, they reviewed 50 original articles examining inflammation in the PTSD brain. They found elevated levels of serum proinflammatory cytokines (inflammation) in individuals suffering from PTSD. The type of trauma did not matter. All had this pathological level of inflammation occurring and the level was much higher than those not suffering from PTSD. They also found through neuroimaging that this increased inflammation was associated with changes in brain structures and how those structures functioned. These changes were in brain regions responsible for our ability to regulate stress and emotion.

Inflammatory cytokines disrupt brain function in all kinds of ways, but one of those ways is our neurotransmitter balance. They trigger the activation of an enzyme that degrades serotonin and the amino acid precursor tryptophan. These types of complicated mechanisms are involved between inflammation and the neurotransmitter imbalances seen in depression/anxiety disorders.

Finding ways to reduce this level of inflammation in the brain is already being conceptualized as a target of intervention, through the use of antioxidants and psychopharmacology. Albeit unsuccessfully.

How does a ketogenic diet treat inflammation in the brain?

The ketogenic diet is amazing at reducing inflammation. While the exact mechanisms are not yet known, the data coming in consistently show that for a variety of populations the ketogenic diet significantly and dramatically reduces inflammation. We do know that ketones act as signaling bodies that inhibit the expression of inflammatory gene expression. Ketogenic diets are so anti-inflammatory that they are often used for chronic pain syndromes. One mechanism in which ketogenic dietary therapy provides symptoms relief is thought to be ketones’ ability to block the activation of inflammatory pathways as a signaling molecule, turning some genes on and other genes off.

Ketones also help us make more of a very powerful internal antioxidant. That’s right. You don’t ingest this antioxidant. You make it on your own, under the right conditions, in your own amazing body. It is called glutathione. This increase in glutathione provided by ketones may be a very important modulator of inflammation in the PTSD brain, improving the other pathological factors involved such as hypometabolism, oxidative stress, and neurotransmitter imbalances.

Conclusion

Ketogenic diets are shown to modulate disease at least four of the pathological mechanisms observed in Post Traumatic Stress Disorder (PTSD) symptomatology. Using the ketogenic diet as a primary or complementary treatment with psychotherapy is based on the mechanisms seen in the scientific literature regarding this disease. The use of this dietary therapy is based on the science of neurobiology and pathophysiology.

RCTs using the ketogenic diet for PTSD would be nice, and I really hope we get them. I think we eventually will. But I see no reason to deprive you of this knowledge in the meantime. I see no reason to allow unnecessary suffering when such a treatment might do wonders for your symptoms. The ketogenic diet for mental illness, and PTSD specifically, is not a fad, quackery, or mumbo-jumbo. It is based on an understanding of real biological mechanisms in mental illness and the conditions required in order to heal.

The real question is why wouldn’t you consider a ketogenic diet as a treatment for PTSD in you or someone you loved?

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I am a mental health counselor that works with dietary and nutritional therapies to treat mental illness and neurological issues. You can learn more about me here. You have a potential online option to work with me via the Brain Fog Recovery Program. You can learn more about it below:

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References

Bhatt, S., Hillmer, A.T., Girgenti, M.J. et al. PTSD is associated with neuroimmune suppression: evidence from PET imaging and postmortem transcriptomic studies. Nat Commun 11, 2360 (2020). https://doi.org/10.1038/s41467-020-15930-5

de Munter, J., Pavlov, D., Gorlova, A., Nedorubov, A., Morozov, S., Umriukhin, A., Lesch, K. P., Strekalova, T., & Schroeter, C. A. (2021). Increased Oxidative Stress in the Prefrontal Cortex as a Shared Feature of Depressive- and PTSD-Like Syndromes: Effects of a Standardized Herbal Antioxidant. Frontiers in nutrition, 8, 661455. https://doi.org/10.3389/fnut.2021.661455

Elias, A., et al. (2020) ‘Amyloid-β, Tau, and ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography in Posttraumatic Stress Disorder. Journal of Alzheimer’s Disease. https://doi.org/10.3233/JAD-190913

Etkin, A., & Wager, T. D. (2007). Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. American Journal of Psychiatry, 164(10), 1476-1488. https://doi.org/10.1176/appi.ajp.2007.07030504

Grigolon. R. B., Fernando, G., Alice C. Schöffel, A. C., Hawken, E. R., Gill, H., Vazquez, G. H., Mansur, R. B., McIntyre, R. S., and Brietzke, E. (2020)
Mental, emotional, and behavioral effects of ketogenic diet for non-epileptic neuropsychiatric conditions. Progress in Neuro-Psychopharmacology and Biological Psychiatry. https://doi.org/10.1016/j.pnpbp.2020.109947.
(https://www.sciencedirect.com/science/article/pii/S0278584620302633)

Kim TD, Lee S, Yoon S. (2020). Inflammation in Post-Traumatic Stress Disorder (PTSD): A Review of Potential Correlates of PTSD with a Neurological Perspective. Antioxidants. 9(2):107. https://doi.org/10.3390/antiox9020107

Krystal, J. H., Davis, L. L., Neylan, T. C., A Raskind, M., Schnurr, P. P., Stein, M. B., Vessicchio, J., Shiner, B., Gleason, T. C., & Huang, G. D. (2017). It Is Time to Address the Crisis in the Pharmacotherapy of Posttraumatic Stress Disorder: A Consensus Statement of the PTSD Psychopharmacology Working Group. Biological psychiatry, 82(7), e51–e59. https://doi.org/10.1016/j.biopsych.2017.03.007

Malikowska-Racia, N., and Salat, K., (2019) Recent advances in the neurobiology of posttraumatic stress disorder: A review of possible mechanisms underlying an effective pharmacotherapy. Pharmacological Research, v.142, p.30-49. https://doi.org/10.1016/j.phrs.2019.02.001.
(https://www.sciencedirect.com/science/article/pii/S1043661818311721)

Miller, M. W., Lin, A. P., Wolf, E. J., & Miller, D. R. (2018). Oxidative Stress, Inflammation, and Neuroprogression in Chronic PTSD. Harvard review of psychiatry, 26(2), 57–69. https://doi.org/10.1097/HRP.0000000000000167

Sartory G, Cwik J, Knuppertz H, Schürholt B, Lebens M, Seitz RJ, et al. (2013) In Search of the Trauma Memory: A Meta-Analysis of Functional Neuroimaging Studies of Symptom Provocation in Posttraumatic Stress Disorder (PTSD). PLoS ONE 8(3): e58150. https://doi.org/10.1371/journal.pone.0058150

Scientific discoveries: projects, strategies and development: Collection of scientific papers «ΛΌГOΣ» with Proceedings of the International Scientific and Practical Conference (Vol. 2), October 25, 2019. Edinburgh, UK: European Scientific Platform. (Viewed “NEUROBIOLOGY OF POSTTRAUMATIC STRESS DISORDER” DOI: DOI 10.36074/25.10.2019.v2.13)

Stevanovic, D., Brajkovic, L., Srivastava, M. K., Krgovic, I., & Jancic, J. (2018). Widespread cortical PET abnormalities in an adolescent related to a PNES dissociative state, PTSD, ADHD, and domestic violence exposure. Scandinavian journal of child and adolescent psychiatry and psychology, 6(2), 98–106. https://doi.org/10.21307/sjcapp-2018-011

Yang, X.; Cheng, B. Neuroprotective and anti-inflammatory activities of ketogenic diet on MPTP-induced
neurotoxicity. J. Mol. Neurosci. 2010, 42, 145–153.

Zandieh, S., Bernt, R., Knoll, P., Wenzel, T., Hittmair, K., Haller, J., Hergan, K., & Mirzaei, S. (2016). Analysis of the Metabolic and Structural Brain Changes in Patients With Torture-Related Post-Traumatic Stress Disorder (TR-PTSD) Using ¹⁸F-FDG PET and MRI. Medicine, 95(15), e3387. https://doi.org/10.1097/MD.0000000000003387