Mental Health Plartform.

Nutrition and supplements for antidepressant withdrawals

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Can I make my antidepressant withdrawal symptoms better with nutrition and supplements?

Planning your titration from antidepressants is important. There are core nutritional supports that include b-complex, amino acids, DHA and EPA, and other micronutrients that should be initiated 1 to 3 months prior to attempting titration. Experienced clinicians recommend titration occur slowly, between 4 months and 1 year, even with the additional nutritional and supplemental supports. In addition to increased nutritional support, many anecdotal reports exist of people finding withdrawals from antidepressants to be less severe while on a ketogenic diet.

Introduction

You do not need to be on a ketogenic diet to help with antidepressant withdrawals, but it sure helps. I am well aware that even people using a ketogenic diet will still get withdrawal symptoms from their medications. And that I have readers who are not on the ketogenic diet to treat their mental health but are struggling with withdrawal symptoms from antidepressants.

There is always the danger when titrating off antidepressants, that medication withdrawal looks and feels like psychiatric dysfunction. People will think the withdrawal effects they are experiencing are who they are and how they are capable of functioning. They will immediately go back on medication. 

“I feel awful, and my mood is so unstable! This must be what I am like when I am not taking my medication!”

Maybe. But more likely, it is that you are going through withdrawals. And you won’t know what your baseline mood and thinking are until you make it through the withdrawal from antidepressants. 

Don’t confuse your antidepressant withdrawal symptoms with who you are or how you function. It can take a long time to get off of antidepressants, with the last few milligrams the hardest to conquer.

Antidepressant Side Effects

As always, I am not your doctor. This blog is not medical advice. I am not advising you about whether or not to take or stay on your medications. That is between you and your prescriber.

That said, there are a lot of people trying to get off their antidepressants. And they started wanting to do so long before they ever encountered me or my blog.

Antidepressant side effects are numerous, unpleasant, and even a little scary. They include anxiety, weight gain, sedation, feeling emotionally flat, and reduced libido.

Side effects from antidepressants that are less talked about but well-documented in the research literature include psychosis, paranoia, violent thoughts and actions, suicidal ideation (thoughts), suicide, and behavioral disinhibition. 

Some antidepressants are harder to titrate down from and discontinue than others. Some are even described as “hellish” to get off of. If you are greatly suffering from antidepressant withdrawal, you are not alone. 

https://www.psychologytoday.com/us/blog/the-bipolar-lens/201312/lets-call-it-what-it-really-is-withdrawal

There are countless stories on Twitter, Reddit, FB, and various forums online of people suffering from antidepressant withdrawals. Many conclude it just cannot be done, even though they believe the medication is no longer providing them any benefit. 

Which means they continue to pay for a prescription for the rest of their life that they don’t feel they still need. They have to worry about times in their life when they may be without health insurance to help pay for the medication or go through terrible withdrawals. They may stay on medication with side effects that may affect the quality of their life for the duration of their lifetime. 

I find this to be ethically unacceptable for patients. 

Let’s begin by empowering you to know the difference between withdrawal reactions and discontinuation syndrome. 

(Spoiler Alert: There isn’t any)

Withdrawal Reactions vs. Discontinuation Syndrome

If you try to stop your antidepressants quickly, you will get a strong withdrawal reaction. It reminds people of benzodiazepine withdrawals. And people are not imagining that it is as difficult as going through benzodiazepine withdrawals; it’s actually been studied. 

Withdrawal reactions to selective serotonin reuptake inhibitors appear to be similar to those for benzodiazepines; referring to these reactions as part of a dependence syndrome in the case of benzodiazepines, but not selective serotonin reuptake inhibitors, does not seem rational.

Massabki, I., & Abi-Jaoude, E. (2021). Selective serotonin reuptake inhibitor ‘discontinuation syndrome’ or withdrawal. The British Journal of Psychiatry218(3), 168-171. https://doi.org/10.1111/j.1360-0443.2011.03686.x

Drug companies call that reaction a “Discontinuation Syndrome.” But there is really no difference.

Clinicians need to add SSRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with benzodiazepines, barbiturates, and other psychotropic drugs. The term’ discontinuation syndrome’ that is currently used minimizes the potential vulnerabilities induced by SSRI and should be replaced by ‘withdrawal syndrome.’

Fava, G. A., Gatti, A., Belaise, C., Guidi, J., & Offidani, E. (2015). Withdrawal symptoms after selective serotonin reuptake inhibitor discontinuation: a systematic review. Psychotherapy and psychosomatics84(2), 72-81. https://doi.org/10.1159/000370338 

Antidepressant withdrawals are the same as discontinuation syndrome—drug companies just like the title better for obvious reasons. 

But don’t get the idea that it is only SSRIs that cause withdrawals. TCAs and MAOIs can also cause really unpleasant side effects for people.  

Antidepressant Withdrawal Symptoms

Below are a list of antidepressant withdrawal symptoms found to be reported by people attempting to go down or discontinue use.

Generalflu-like symptoms, fatigues, weakness, tiredness, headache, tachycardia, dyspnea
Balancegait instability, ataxia, dizziness, light-headedness, vertigo
Sensoryparesthesias, electric shock sensations, myalgias, neuralgias, tennitis, altered taste, pruritus
Visualvisual changes, blurred vision
Neuromotortremor, myoclonus, ataxia, muscle rigidity, jerkiness, muscle aches, facial numbness
Vasomotorsweating, flushing, chills
Sleepinsomnia, vivid dreams, nightmares, hypersomnia, lethargy
Gastrointestinalnausea, vomiting, diarrhea, anorexia, abdominal pain
Affectiveanxiety, agitation, tension, panic, depression, intensification of suicidal ideation, irritability, impulsiveness, aggression, anger, bouts of crying, mood swings, derealization and depersonalization
Psychoticvisual and auditory hallucinations
Cognitiveconfusion, decrease concentration, amnesia
Sexualgenital hypersensitivity, premature ejaculation
Antidepressant withdrawal symptoms. Recreated from James Greenblatt, MD presentation found here: https://www.greatplainslaboratory.com/webinars/2016/5/10/nutritional-support-for-antidepressant-withdrawal

These symptoms can occur after just a few days or can last for weeks. And you can experience these symptoms in any combination. They can last for several months to years following the discontinuation of antidepressant medications. 

How do I use nutritional supports to manage antidepressant withdrawals?

The most important part of this article that I need you to know, is that you need to spend a good amount of time doing the nutritional supports first, BEFORE you begin to titrate down very SLOW. 

You should provide yourself these nutritional supports for a minimum of 1-3 months before you attempt titration. Once your nutritional supports are in place, experienced clinicians recommend titrating over 4 months to even over a year. 

What supplements do I need to minimize withdrawal symptoms from antidepressants?

The following core supplements are useful when trying to diminish withdrawal symptoms experienced when reducing or eliminating antidepressants. These supplements are best taken weeks or months prior to discontinuation attempts. If you are already experiencing difficult withdrawal symptoms, I will encourage you to talk to your prescriber about going back up to the next lowest dose that reduces withdrawal symptoms, and then begin these supplements for a few months and then try again. 

The below links are affiliate links (unless otherwise noted). Please do not feel obligated to use these links.

NAC (N-acetylecysteine) 

What is it and why should you take it? Its an amino acid variant that happens to be a powerful antioxidant and helps your liver detox pathways. It is used to assist with withdrawal from other substances and is well-established in the research literature for this purpose. 

How? Take (1) 600mg capsule with breakfast and dinner

Where can you find it? This supplement can be hard to find but can be ordered online through https://www.pureformulas.com (not an affiliate link) with free standard shipping. Brands that I like for clients include Pure Encapsulations, Thorne, and Integrative Therapeutics.

EPA/DHA

What is it and why you should consider taking it? You are going to need to build neuronal infrastructure as part of healing your brain and recovering from the withdrawals you are experiencing. EPA/DHA are healthy fats that your body uses to insulate nerves. You are going to burn through EPA/DHA rebuilding your brain. It also reduces inflammation improving the environment in which your brain is healing and making neurotransmitters. 

How do you take it? For either of the below brands, take 1 capsule at breakfast and dinner. This will put you at approximately 2g of fish oil a day. You may need more. Do not take if you are on blood thinners without talking to your doctor.

Where can you buy it?

Life Extension- Mega EPA/DHA

B-Complex

What is it and why should you take it? Stress depletes the body of B vitamins. Withdrawals are stressful. You are probably B deficient which is part of why you may have ended up on antidepressants in the first place. B vitamins should have been your first line of treatment. Psychiatric medication use also depletes B vitamins as does hormonal birth control. You might need special B vitamins if you have trouble absorbing them due to genetics. This blend is already modified to be the easiest to assimilate.

How? 1 capsule with breakfast and dinner; do NOT take on an empty stomach as it will cause nausea

Where can you get it? Below are affiliate links that you can use to purchase. I have included my favorite brands for clients that I know use good, bioavailable forms in high enough doses.

Inositol

What is it and why do you want it? Myo-Inositol is a carbolytic sugar that used to be called Vitamin B8. It serves an important role in cell membrane formation and supporting neurotransmitter function. It also just happens to be great for anxiety and it is going to help quiet the symptoms of anxiety that you may get as you got through antidepressant withdrawals.

How do you take it? 1/2 tsp with breakfast and dinner. It tastes slightly sweet. Put it in your coffee in the morning if you want or in some tea. Or just pop it in your mouth with some water. It’s not particularly yucky. You can work up to a much higher dose if you feel it is helpful. Many of my clients will take up to 3g (3,000 mg) total a day for specific reasons. Taking too much too soon can cause stomach upset. It also comes in capsules for better convenience.

Where can you get it? Lots of places, but also at the affiliate links below:

Pure Encapsulations – Inositol Powder

Magnesium glycinate

What is it and why do you need it? Magnesium is a mineral that is either required or helpful in about 800 different processes your body needs to carry out. And you are depleted in it. Even if you know enough to supplement it in your diet, you are still likely insufficient because your psychiatric medications depleted your levels even further. Stress also depletes your magnesium. And going through withdrawals is very stressful. It also helps you useother vitamins like Vitamin D and Bs better. Trust me, it’s just a win win sort of supplement.

How is it taken? 1 capsule at breakfast and 2 at dinner

Where can you find it? You can find it online here. I prefer the glycinate form because it’s better utilized by the body. Stay away from Magnesium Oxide and watch out for Magnesium Citrate because it can cause cramping and loose stools.

Pure Encapsulations Magnesium Glycinate (Swanson Vitamins)

Lithium (orotate)

What is it and why should you consider taking it? First of all, don’t freak out. This is not prescription lithium. This is lithium orotate and it is in very small amounts. If you already take prescription Lithium, it would be ok to skip this and check with your doctor. Why? Because you already have really high levels from your prescription and your doctor is working hard to monitor your levels. So don’t mess with them. But if you are not already taking prescription lithium, you will likely benefit greatly from this mineral. It is particularly good for depression and suicidal ideation. And can be very helpful with substance abuse cravings. It also has a lot of neuroprotective qualities that are very helpful to a brain struggling to rewire itself and maintain cognitive function.

How do you take it? 1mg with dinner or before bed, work up to 5mg dose, going up 1mg per week. Some people take small doses during the day. But it enhances sleep so I like to recommend it before bed.

Once you have worked up to a 5mg dose, you may find this formulation more convenient. It’s also less expensive but still high quality.

Swanson Ultra Lithium Orotate, 5mg

Amino Acids

What are they and why do you absolutely need them? A lot of people with mental health issues have serious gut issues. If you are taking anything for acid reflux or gerd, you probably do not have adequate stomach acid to break your protein down into amino acids. This is a huge problem. We have to fix the root digestive problem and get you off those medications. But in the meantime, you need amino acids in order to make important neurotransmitters. This is one of those supplements you probably should have been given before the doctor told you to go on an antidepressant. Amino acids are building blocks for a nervous system under reapir. Which is you if you are working to discontinue your antidepressant medication.

How do you take them? 1 scoop at breakfast and 1 at dinner if using Amino Replete (with food, note this formula has B6 in it and will make you nausous if you take on an empty stomach). If using Hardy’s Naturals use 4 capsules, 2x per day, without food if you want to improve absorption. But don’t over think it. Just get it into your body. Do not use Branch Chain Amino Acid (BCAAs) formulas because they are not complete and can throw your neurotransmitter balance off.

Where can you find them?

Hardy’s Naturals Balanced Free-Form Amino Acid (Not an affiliate link, but you can get 15% off using the discount code: MentalHealthKeto).

What is a minium supplement plan to help reduce withdrawals from antidepressants?

If all of the above supplements just feel like too much for you to handle right now, I have also successfully helped people with withdrawal symptoms using just two supplements. The amino acids and a broad spectrum micronutrient from Hardy Nutritionals. You can find a link to the amino acid supplement above (under Amino Acids) and a link to the broad spectrum micronutrient here. Again, not an affiliate link, but you can get 15% off using the discount code: MentalHealthKeto

Conclusion

If you have tried unsuccessfully in the past to titrate down from or discontinue your antidepressants, do not lose hope. You may have been missing the important piece of nutrient support to help your process.

If you have sufficient nutritional support, as you go through your antidepressant withdrawals, you will have an easier time reducing and/or eliminating your antidepressant medication (hopefully). 

Your brain will also get the support needed to heal, and you will have a better chance of figuring out how well your brain actually truly works or is capable of working.

Will all these nutritional supports fix your brain so you don’t have to be on antidepressants? Maybe. There are a lot of other factors that probably need to be fixed. 

  • Your diet
  • Your digestive health 
  • Eliminating factors causing neuroinflammation

All of these play a role. You really do deserve a full functional and nutritional psychiatry sort of workup, with all the support that that includes. But you can definitely start here! You can definitely start by giving your brain what it needs to help it adjust to antidepressant withdrawals.

I help people explore medication-free options for their mental health using research and evidence-based nutritional and functional psychiatry so that people can get their lives back without side effects or dependence on big pharma. You can learn more about me or contact me for a consultation.

If you want to be alerted to different learning and coaching opportunities around ketogenic diets, mental health, supplements, and psychotherapy, you can sign up for these announcements here.

Because you have the right to know all of the ways that you can feel better.


References

Fava, G. A., Gatti, A., Belaise, C., Guidi, J., & Offidani, E. (2015). Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review. Psychotherapy and Psychosomatics, 84(2), 72–81. https://doi.org/10.1159/000370338

Harvey, B. H., Brink, C. B., Seedat, S., & Stein, D. J. (2002). Defining the neuromolecular action of myo-inositol: Application to obsessive–compulsive disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 26(1), 21–32. https://doi.org/10.1016/S0278-5846(01)00244-5

Let’s Call It What It Really Is: Withdrawal | Psychology Today. (n.d.). Retrieved February 20, 2022, from https://www.psychologytoday.com/us/blog/the-bipolar-lens/201312/lets-call-it-what-it-really-is-withdrawal

New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal—Abstract—Psychotherapy and Psychosomatics 2015, Vol. 84, No. 2—Karger Publishers. (n.d.). Retrieved February 20, 2022, from https://www.karger.com/Article/Abstract/371865

Nielsen, M., Hansen, E. H., & Gøtzsche, P. C. (2012). What is the difference between dependence and withdrawal reactions? A comparison of benzodiazepines and selective serotonin re-uptake inhibitors. Addiction, 107(5), 900–908. https://doi.org/10.1111/j.1360-0443.2011.03686.x

Nutritional Support for Antidepressant Withdrawal. (n.d.). Great Plains Laboratory. Retrieved February 20, 2022, from https://www.greatplainslaboratory.com/webinars/2016/5/10/nutritional-support-for-antidepressant-withdrawal

Supplements for Happiness & Health: Lithium Webinar | PR. (n.d.). Psychiatry Redefined. Retrieved February 20, 2022, from https://www.psychiatryredefined.org/lithium-supplement-for-happiness-and-health-webinar/

Tomko, R. L., Jones, J. L., Gilmore, A. K., Brady, K. T., Back, S. E., & Gray, K. M. (2018). N-acetylcysteine: A potential treatment for substance use disorders. Current Psychiatry, 17(6), 30.

von Schacky, C. (2021). Importance of EPA and DHA Blood Levels in Brain Structure and Function. Nutrients, 13(4), 1074. https://doi.org/10.3390/nu13041074

Post-Traumatic Stress Disorder(PTSD)

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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?

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

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. 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 one based on the mechanisms seen in the scientific literature regarding this disease. The use of this dietary therapy is one 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?


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. Feel free to contact me on your journey to mental health.

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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 nutrition8, 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 Psychiatry164(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 psychiatry82(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.
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3 Reasons you may need a therapist helping you use the Ketogenic Diet for Mental Health

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For many people, hiring one of the many “Keto Coaches” or low-carbohydrate informed Dieticians out there is going to be life-changing and all they need to lose weight, feel better, and improve their mental health. These professionals can help answer a lot of important questions.

  • How do you track macros and decide how many carbohydrates to eat?
  • What low-carb foods can you pack with you while traveling or on a busy day?
  • How do you make your low-carb meals delicious?

However, for many people, difficulty adhering to the ketogenic diet is about deeply engrained emotional and thinking patterns. Some people have lifelong difficulties implementing self-care and self-love strategies. Being able to say no and have boundaries for one’s own emotional and in this case, physical well-being can feel insurmountable. There is a lot of psychotherapy, sometimes subtle and sometimes blatant, that goes on in the successful and enduring implementation of dietary therapy for mental health. And in our very processed food and carbohydrate-rich world, even more so for a ketogenic diet.

What people may need more support in adopting a ketogenic diet?

People who don’t know the answers to the following questions or who suspect they will have difficulty figuring those answers out, and then following them up with behavior change, will be the people who need and DESERVE additional support from a therapist in adopting a ketogenic diet.

What will you do when they have cravings and how will you manage them?

The managing of cravings is something mental health professionals who work with addiction often encounter. However, not surprisingly, there is in fact a large body of empirical evidence to support the condition of processed food addiction as its own disorder. Knowing how to manage cravings is also an important consideration in some eating disorders like Binge Eating Disorder and Bulimia. Or even in just anyone who has problems effectively managing their emotions. There are countless mental health conditions where a major symptom is problems with Emotion Regulation. Just telling them to “not give in to cravings” is not a sufficient intervention for these individuals. This is where you need a mental health counselor to help them increase their coping and emotion regulation skills, so they are up for the challenge!

What are you going to do when you are encouraged (or even feel bullied) into eating carbs at social situations, holidays, and family gatherings?

If someone struggles with boundaries this can be a very difficult situation to manage and continue to be successful with. The person on a low-carbohydrate or ketogenic diet may be concerned they will hurt someone’s feelings if they say no to a sweet someone has baked. They may be fearful of being made fun of or being ostracized in future social situations. They know that some people will take their food choices personally and decide they are being judged by the low-carb adherent.

Sometimes there are social or family dynamics in which the entire system is threatened by someone making a healthy decision for themselves because it goes against unspoken norms. These people need support and help in identifying their enmeshment with these systems. They need skills in how to assert themselves while staying emotionally open and loving to the people around them. Sometimes they need psychotherapy in order to learn to build a sense of identity that is both connected to the group and still individual. This is no small task. And requires a level of support that one can not often find in Keto Coach or a Registered Dietician.

How will you assert yourself with wait staff or while ordering at a restaurant?

Again, many people struggle with “being a bother” or with what I like to call “taking up space”. They feel like the wait staff sees them as a problem or a difficult customer. They feel shy or have crippling social anxiety they are dealing with and need evidence-based treatments such as CBT in order to combat a certain level of social anxiety before they can successfully ask questions about ingredients and make choices that will support what they are doing for their mental and long-term health.

What will you do when you encounter unsupportive medical or academic authority figures who may not be aware of the research literature of a ketogenic diet for mental health as a possible intervention?

This is an important issue when working with other medical professionals (e.g., Dieticians, Doctors, etc.) that want you to try different treatments or want you to stop something that you are finding is helpful. Does the client have the developed sense of self and assertiveness skills to determine what is best for them in the presence of someone with medical authority that has an alternative opinion? Many of us do, and many of us do not. And this is another area in which it may be helpful or even necessary to work with a mental health professional to not only facilitate your treatment but to help you handle the feelings that come up when you disagree with or do not feel heard by authorities, whether institutional (e.g., National Dietary Guidelines) or individual (e.g., your doctor).

Conclusion

There are a lot of psychological factors that go into making big lifestyle changes. Big lifestyle changes are influenced by how we think, what we feel, and our current behavioral habits. These all feed into our sense of self, our relationships, and even how we interact in society. Sometimes evaluating these factors with a mental health professional can increase our chances of success when wanting to use a dietary therapy like the ketogenic diet as a treatment for our mental health.

If you found this blog post helpful you may also find the following to be useful in your mental health journey.

You may also want to hear other people’s experiences: Ketogenic Diet Case Studies

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