Bipolar Disorder and Diet Part II: Low Carbohydrate Diets

Low Carb DietsCan food stabilize mood?  Is there a diet out there that could prevent mania, mood swings, deep depressions, and uncomfortably anxious and agitated states? Sound far-fetched?  Maybe not. Dietary changes can have very powerful effects on brain chemistry.  Low carbohydrate diets, in particular, are fascinating.

 

 

 

KETOGENIC DIETS AND EPILEPSY

When most people think of low-carbohydrate diets, they think of weight loss.  But did you know that neurologists have been successfully treating severe cases of epilepsy with low-carbohydrate (“ketogenic”) diets for nearly 100 years?  Ketogenic diets are specially designed low-carbohydrate diets that typically contain between 60-80% fat, with the remainder consisting of roughly equal amounts of protein and carbohydrate.  In most cases, patients in clinical studies were hospitalized children whose seizures could not be controlled with anticonvulsant medications.  Yet, with diet alone :

  • Nearly all patients achieve more than a 50% reduction in seizures
  • with 33% experiencing a 90% reduction in seizures
  • and 10 to 15% achieving complete remission from seizures

What more powerful evidence could there be for the role of diet in brain chemistry?  Not only is this phenomenon remarkable in its own right, but it also has potentially powerful implications for the treatment of a wide variety of neurological disorders.

KETOGENIC DIETS HAVE MAGICAL HEALING PROPERTIES

All of the following conditions have been shown in animal models or in human studies to improve on a ketogenic diet:

  • Autism
  • Traumatic Brain Injury
  • Alzheimer’s Disease
  • Parkinson’s Disease
  • Brain Cancer
  • Diabetes
  • Prostate Cancer
  • Obesity
  • Chronic Pain/Inflammation
  • Multiple Sclerosis
  • Insomnia/Circadian Rhythm disorders

HOW DO KETOGENIC DIETS WORK?

Nobody knows.  It is a subject of intense research, and there are many theories.  These diets restrict carbohydrate intake to 10-20 grams per day (the typical American diet contains at least 200 grams per day), and limit protein to just what’s needed, so that the body has no choice but to burn fat for energy.  Fat from the diet or from excess body fat gets broken down into three “ketone bodies” [“ketogenic” means that the diet generates ketones.]   These ketone bodies are:  acetone, acetoacetate, and beta-hydroxybutyrate.   Acetone leaves the body, but the other two compounds circulate in the blood and serve as fuel sources for our cells.

Ketogenic diets are very low in carbohydrate, therefore blood sugar and insulin levels are lower and much more stable than on standard “balanced” diets that are high in carbohydrate.  We do not know whether it is the presence of ketone bodies in the blood, or the stabilization of blood sugar levels, or the reduction in blood sugar and insulin levels, or some combination of these changes that is responsible for the therapeutic effects of the ketogenic diet.

What we do know is that epilepsy and other neurodegenerative diseases are all associated with “mitochondrial dysfunction”. Mitochondria are the miniature generators inside of our cells, so when they are not working properly, energy production is disrupted, and all cell activities can be affected as a result.  Studies consistently find that mitochondria produce more energy (ATP) more efficiently on ketogenic diets than on standard “balanced” diets which force cells to burn glucose (sugar) for energy.  Put simply, most of our cells work best when they burn fat instead of carbohydrate.

We also know that epilepsy and other neurodegenerative diseases are universally associated with inflammation.  Diets rich in sweets and refined starches that cause high, unstable blood sugar and insulin levels are well known for their ability to set the stage for inflammation throughout the body, therefore diets that are low in refined carbohydrates tend to quiet inflammation.

KETOGENIC DIETS AND BIPOLAR DISORDER

So, what does all of this have to do with bipolar disorder?  It is well-established that epilepsy and bipolar disorder share many biological features, including:

  • similar neurotransmitter imbalances (serotonin, norepinephrine, GABA, and glutamate)
  • alterations in sodium and calcium distribution
  • changes in chemical messenger activity

In fact, it just so happens that many of the mood stabilizing medications we psychiatrists prescribe for bipolar disorder are anticonvulsants that were originally designed to treat seizures—Depakote (Valproate), Lamictal (Lamotrigine) and Trileptal (Oxcarbazepine), to name a few.  The fact that epilepsy and bipolar disorder have so much in common begs the question of whether perhaps a low-carb diet could be useful for mood stabilization, as well.  Unfortunately, there has yet to be a single scientific study of ketogenic diets in bipolar disorder.  I have not yet had a patient in my practice who has been willing to try a strict ketogenic diet, which not only limits carbohydrate, but also limits protein and requires blood monitoring of ketone levels. However, I can tell you that my patients who have been willing to try low carbohydrate “modified Atkins” diets, low carbohydrate “Paleo” diets, or low glycemic index diets for mood problems–from depression to anxiety to eating disorders to bipolar disorders–report significant improvement in their symptoms. It stands to reason that these dietary changes, which have profound effects on other neurological disorders, would have the potential for profound effects on psychiatric disorders, as well.

Yet, even if a ketogenic diet worked beautifully for all cases of bipolar disorders of all types, I doubt that most people would choose to commit to a lifetime of eating a ketogenic diet.  These diets are very restrictive and require major lifestyle changes.  Most foods that people are accustomed to eating all day long are off-limits on this diet.  For this reason, neurologists have recently begun to experiment with more relaxed versions of the diet to see how much carbohydrate patients can get away with and still have good seizure control.  Studies of low glycemic index diets and modified Atkins diets (Atkins diets that allow unlimited protein and fat) look very promising but do not seem to work quite as well for seizures as ketogenic diets do.  However, bipolar mood disorders and seizures are different in that seizures are black and white phenomena, whereas mood swings are a matter of degree.  Perhaps people with bipolar mood disorders would be satisfied with less than perfect control over their mood swings in exchange for wider dietary variety?

IF YOU HAVE A BIPOLAR MOOD DISORDER SHOULD YOU CHANGE YOUR DIET?

That’s up to you. While there are no scientific studies to support this idea yet, if you wait for the science to properly test the theory, you could be waiting for many years.  You have nothing to lose by doing your own individual experiments, because it is well established that low glycemic index diets, Atkins diets and ketogenic diets are safe.  In fact, it is likely that they are far healthier than the low-fat, high-carb, low-meat diets recommended by public health officials, which are the very same diets that have worsened our collective health over the past four decades. If you do decide to try a dietary change, just keep in mind that it can take 3 to 4 weeks before potential benefits become noticeable.

A few words of caution: 

Dietary changes are difficult to make, and benefits can be slow to take effect, therefore nutritional approaches are not recommended in emergency situations.

If you are currently taking a mood stabilizing medication, please do not make any changes to your medications without discussing it with your clinician.

Very low-carbohydrate diets can alter the way medications are processed by the body, so if you are taking medications of any kind (including blood pressure and diabetes medications), and decide to try a low-carbohydrate diet, please do so with close medical supervision.

*If you are taking Depakote (Valproate), please be aware that there is a case report in the literature of a man who became manic and psychotic after starting a ketogenic diet, despite taking Depakote.  The reason may have been that the diet reduced his Depakote levels (Depakote is a fatty acid, and the ketogenic diet is a fat-burning diet).

HOW ABOUT YOU?

Have you ever tried a low glycemic index diet or low carbohydrate diet?  If so, did you notice any effects on your mood?

To read about omega-3 fatty acids and bipolar disorder, click HERE.

REFERENCES

Amann B and Grunze H.  Neurochemical underpinnings in bipolar disorder and epilepsy. Epilepsia 2005; 46 (suppl 4): 26-30.

Brownlee M.  Biochemistry and molecular cell biology of diabetic complications.  Nature 2001; 414: 813-820. 

Cross JH et al.  The ketogenic diet in childhood epilepsy:  where are we now? Arch Dis Child 2010;95:550-553.

El-Mallakh RS and Paskitti ME.  The ketogenic diet may have mood stabilizing properties.  Medical Hypotheses 2001; 57(6); 724-726

Junig JT and Lehrmann JA.  A psychotic episode associated with the Atkins Diet in a patient with bipolar disorder. Bipolar Disorders 2005: 7: 305–306

Keene DL.  A systematic review of the use of the ketogenic diet in childhood epilepsy.  2006 Ped Neurol 35:1-5.

Masino SA, Rho JM. Mechanisms of ketogenic diet action. In: Noebels JL, Avoli M, Rogawski MA, Olsen RW, Delgado-Escueta AV, editors.  Jasper’s Basic Mechanisms of the Epilepsies. 4th ed. Bethesda (MD): National Center for Biotechnology Information (US); 2012.

Miranda MJ et al.  Alternative diets to the classical ketogenic diet–can we be more liberal?  Epilepsy Research 2012;100(3):278-85.

Neal EG.  The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol 2008; 7:500-506.

Soczynska JK et al.  Mood disorders and obesity:  understanding inflammation as a pathophysiological nexus.  Neuromolecular Med 2011; 13(2): 93-116.

Stafstrom CE and Rho JM.  The ketogenic diet as a treatment paradigm for diverse neurological disorders. Frontiers in Pharmacology 2012; 3(59).

 

 

 

 

 

  • Jane

    I have had a lifelong history of dysthymia. Despite various anti-depressants, I could never seem to feel better…until I went on a low-carb diet 2 years ago. Over a period of months, I started to notice I didn’t have that feeling of always having a cloud over me. It nojw feels like the “dark glasses” I had were taken off of me, and life just looks different now, even though not much in terms of life circumstances had changed in the mean time! I started a low-carb diet to improve my GERD but never expected to have less physical pain or depression!

  • http://twitter.com/GeorgiaEdeMD Georgia Ede MD

    Good morning, Jane, and thank you so much for sharing your story–we can all learn so much from one another. Your experience is an excellent example of an individual experiment that shines light on a connection between food and mood in a way that research studies cannot. Keep smiling!

  • Paul

    I am curious as to the effects of low carb diet. I would like to monitor the changes, what type of blood tests or lab tests do I need to take so I have a base line of now and how often do I need to redo test to track changes properly?
    Paul

    • admin

      Hi Paul

      Great questions—and fabulous gongs!

      Ideally you’d want to have your doctor order some baseline blood tests: Hemoglobin A1C (an estimate of your average blood glucose level over the previous 3 mos), fasting blood glucose, fasting lipid profile (cholesterol & triglycerides), and a C-reactive protein (a marker of inflammation). Then have them all repeated 3 mos after changing your diet to see how they may have changed.

      It can also be very useful to monitor your blood sugar levels at home periodically, using a blood glucose meter (designed for people with diabetes). Many of us have abnormally high fasting (12 hours nothing but water) and “post-prandial” (1 hr after-meal) blood glucose levels due to diets too high in carbohydrate. Ideally, fasting blood glucose should run between the mid-60’s and high 80’s (mg/dl), and 1hr post-prandials should be less than 110—the closer to fasting levels, the better. Post-meal levels vary widely
      depending on your diet and your metabolism.

      There are 3 levels of carbohydrate restriction to choose from, depending on your goals and your preferences:

      1. Low glycemic index diet (please see my low glycemic index diet page). Least restrictive, but also less likely to be effective, especially if you want great results. This diet can smooth out the spikes in blood sugar and insulin but your cells burn mostly carbohydrate on this diet instead of fat.

      2. Low-carb “modified Atkins” diet. 0-50 grams of carb per day spread out over the course of the day. Many need to go below 30 grams to see best results. See also my low-carbohydrate diets page.

      3. Ketogenic Diet, aka Nutritional Ketosis. Theoretically, this is the diet that is most likely to produce the best results. Limits carbs just like modified Atkins, but also limits protein to your individual daily requirements (typically 0.6 to 1.0 grams per pound lean body weight—for more details see my protein page). Purists and those who need to use this diet for important medical reasons monitor their blood ketones in addition to blood glucose. Blood ketone meters are cheap but test strips are very expensive, so most people can’t afford to measure every day. There are meters that measure both ketones and glucose. I use a Precision Xtra® meter and order ketone strips from http://www.UniversalDrugstore.com–the < http://www.UniversalDrugstore.com–the> < http://www.UniversalDrugstore.com–the> least expensive supplier I could find). Unfortunately there is no way yet to measure insulin levels at home.

      There are 2 excellent books about ketogenic diets: The Art and Science of Low Carbohydrate Living (Phinney and Volek) and The Rosedale Diet (Rosedale). There is also a terrific blog written by Jimmy Moore about his own experience with nutritional ketosis (he’s lost 50 pounds in 6 mos on a diet of 80% fat), complete with his daily glucose/ ketone measurements and lots of free information about how the diet works: http://www.livinlavidalowcarb.com/blog/

      Hope this helps!

    • GeorgiaEde

      Hi Paul

      Great questions—and fabulous gongs!

      Ideally you’d want to have your doctor order some baseline blood tests: Hemoglobin A1C (an estimate of your average blood glucose level over the previous 3 mos), fasting blood glucose, fasting lipid profile (cholesterol & triglycerides), and a C-reactive protein (a marker of inflammation). Then have them all repeated 3 mos after changing your diet to see how they may have changed.

      It can also be very useful to monitor your blood sugar levels at home periodically, using a blood glucose meter (designed for people with diabetes). Many of us have abnormally high fasting (12 hours nothing but water) and “post-prandial” (1 hr after-meal) blood glucose levels due to diets too high in carbohydrate. Ideally, fasting blood glucose should run between the mid-60’s and high 80’s (mg/dl), and 1hr post-prandials should be less than 110—the closer to fasting levels, the better. Post-meal levels vary widely
      depending on your diet and your metabolism.

      There are 3 levels of carbohydrate restriction to choose from, depending on your goals and your preferences:

      1. Low glycemic index diet (please see my low glycemic index diet page). Least restrictive, but also less likely to be effective, especially if you want great results. This diet can smooth out the spikes in blood sugar and insulin but your cells burn mostly carbohydrate on this diet instead of fat.

      2. Low-carb “modified Atkins” diet. 0-50 grams of carb per day spread out over the course of the day. Many need to go below 30 grams to see best results. See also my low-carbohydrate diets page.

      3. Ketogenic Diet, aka Nutritional Ketosis. Theoretically, this is the diet that is most likely to produce the best results. Limits carbs just like modified Atkins, but also limits protein to your individual daily requirements (typically 0.6 to 1.0 grams per pound lean body weight—for more details see my protein page). Purists and those who need to use this diet for important medical reasons monitor their blood ketones in addition to blood glucose. Blood ketone meters are cheap but test strips are very expensive, so most people can’t afford to measure every day. There are meters that measure both ketones and glucose. I use a Precision Xtra® meter and order ketone strips from http://www.UniversalDrugstore.com–the least expensive supplier I could find). Unfortunately there is no way yet to measure insulin levels at home.

      There are 2 excellent books about ketogenic diets: The Art and Science of Low Carbohydrate Living (Phinney and Volek) and The Rosedale Diet (Rosedale). There is also a terrific blog written by Jimmy Moore about his own experience with nutritional ketosis (he’s lost 50 pounds in 6 mos on a diet of 80% fat), complete with his daily glucose/ ketone measurements and lots of free information about how the diet works: http://www.livinlavidalowcarb.com/blog/

      Hope this helps!

      • http://www.facebook.com/snooptaco Elaine Shields

        Hi Dr. Ede, If it turns out I have normal fasting and post-prandial blood glucose levels (even after eating lots of carbs and sugar for several days, and during the meal just prior) then will eating low-carb still benefit me if I am not in ketosis? I had a fasting level of 70-75 and post-prandial after exceedingly high carb+sugar meals of 80-87. I feel like this isn’t a very significant increase considering HOW much sugar I consumed. Does this mean I have fairly stable blood sugar, and if so, then can I only expect the therapeutic results you mention if I am actually producing ketones? I am confused over why my blood sugar did not spike, especially because I feel like I’m addicted to carbs!

        • http://diagnosisdiet.com/ Dr. Ede

          Hi Elaine
          First of all, let me say that you are lucky to have such a resilient system. It appears as if you have excellent insulin sensitivity. What these values cannot tell you is what is happening to your insulin, leptin, and ketone levels after eating sugar. Everyone is different when it comes to carbohydrate tolerance. How you can best achieve the results you are looking for will depend on what you notice about your health and well-being when you eat sugar vs when you don’t. However, there is no question that eating sugar and other refined carbs is dangerous to most aspects of health over time. This is one of the very few things around which there is a broad consensus across otherwise opposing camps in the nutrition field.

          • http://www.facebook.com/snooptaco Elaine Shields

            Hi Dr. Ede, okay well I know I FEEL awful after I eat sugar so I should just take that as my cue. Thank you for your time in answering these questions!

  • Kelsey Meyers

    I have been on a low carb paleo/Weston price style diet (not strict) for 5 years and have not had a single depressive episode since adopting this way of life. I used to suffer from depression frequently on my low-fat, processed food diet.

    • http://twitter.com/GeorgiaEdeMD Georgia Ede MD

      Hello, Kelsey

      That’s wonderful! Thank you so much for sharing your story with us. I, too, changed my diet about 5 yrs ago to a low-carb Paleo diet, and my mood, anxiety level, and energy all completely normalized, too. Great minds think alike:) I had changed my diet for other reasons and was pleasantly surprised to see these other positive effects. I wonder if you had also originally changed your diet for some other reason?

  • Des

    Hello again Georgia,

    In your opinion, is the sweet potato the lesser evil when compared to the white potato in terms of sugar spikes? The Kitavans in Papua New Guinea eat more than half their calories from sweet potatoes, sweet fruits and honey and have great skin…:) I’m upset that, even though I’m Paleo, I can’t get away with potatoes skin-wise.

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Des

      Sweet potatoes and yams have a lower glycemic index (typically between 50 and 70) while white potatoes run between 70 and 110 (Russets are 110). Regarding the Kitavans, my theory about why they are able to tolerate a high carbohydrate diet when so many of us Westerners can’t, is that their carbohydrate processing system functions properly, whereas most of us have a system that has been damaged or completely broken by dietary factors–refined carbs? modern medications? food chemicals? The most important question for you is–if you eat sweet potatoes, do they aggravate acne?

  • http://www.facebook.com/snooptaco Elaine Shields

    Hi Dr. Ede,

    Just wondering if you count total carbs or net carbs? Thanks!

  • http://diagnosisdiet.com/ Dr. Ede

    Hi Elaine

    It depends. Fiber doesn’t need to be counted, but some people can get into trouble with other carbs that supposedly have zero calories and therefore “have a negligible effect on blood sugar.” The sugar alcohols are one good example–some people experience significant blood sugar spikes after eating certain sugar alcohols. If you want to be on the very safe, conservative side, you would count all carbs except for fiber. If you want to know how various types of “non-carb carbs” affect you, you could test your blood sugar an hour after eating various things to be sure you’re not thwarting your efforts.See also Dr. Andreas Eenfeldt’s site http://www.dietdoctor.com for more information.

    • http://www.facebook.com/snooptaco Elaine Shields

      Interesting. So count the total carbs if you are consuming something with sugar alcohols, but you can do net carbs if you are eating veggies/something with fiber? And thank you for the idea to test out the non-carb carbs….I think I will try that, because I have been wondering which artificial sweeteners I could get away with. I was going to ask you if there were any you found to not be an issue, but I guess it will really be an individual thing and I can just test each one out for myself. Thank you for the website, too!

  • http://www.facebook.com/snooptaco Elaine Shields

    Hi Dr. Ede,

    I have great news. I have been doing a ketogenic
    diet since December 18th and have not had a migraine since! That makes
    it almost a full month :) I have been eating a little bit of starch in
    the form of white rice, but am not eating any fructose at all. I am supplementing with branched chain amino acids and
    NAC, and taking lots of MCT Oil. I am going to experiment with cutting
    out the starch soon, but for now it’s working so I might as well enjoy
    it. Hopefully it will continue to work!

    The bad news is that I am
    still having headaches 2-3x week, so I wonder if it is because I am not
    as “ketogenic” as I could be, or if it is completely unrelated. They seem to occur most frequently towards the end of my work day, so it is probably environmental (strong scents/bright lights) but I would really love to figure out how I can desensitize myself to these headache triggers. I know you are not a headache specialist of course, but any thoughts? I’m really looking forward to being headache free soon! Oh and I have also been doing Julia Ross’s amino acid supplementation (I began it about 2 weeks before starting the ketogenic diet) and within days I was able to stop taking my stimulant regimen of Ritalin/Strattera. Pretty amazing stuff. We will see if these results will be long term, but for now at least I am happy about the combination of these two therapies!

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Elaine

      That IS wonderful news! I am curious to know if you are measuring ketones and how much carbohydrate you are eating per day, if you are comfortable sharing that? Also, are you getting enough calories? Sometimes headaches can be caused by hunger. I will be writing a blog article about migraines in the near future that will include a review of all of the migraine/food sensitivity literature, but for now: If you eventually experiment with removing the starch and that doesn’t help, you may need to do some vegetable and spice experiments. Nightshades, for example, can be associated with pain for some people. Other common migraine triggers include fermented foods, alcohol, caffeine, and artificial sweeteners. Thank you for keeping us posted about your great progress thus far! You may want to rest on your laurels a while before trying more changes. Also, since you are not getting headaches every day, you may be able to identify potential culprits by keeping a food/headache diary and looking for patterns, if you are not already doing so.

      • http://www.facebook.com/snooptaco Elaine Shields

        Hi Dr. Ede. Sorry for the delayed response. I had the same darn headaches all week (each one developing sometime mid-afternoon) and I finally pinpointed that it must have been a result of the “fat bombs” I was eating every morning and then again in the PM. The first one I ate wasn’t enough to trigger a headache, but the second one was, hence the PM headaches. (Each fat bomb has 1/2T Coconut Oil, 1/2T MCT Oil, 1/2 cup Shredded Coconut, and 1/2 teaspoon Xylitol. Such a tiny amount of Xylitol that I can’t believe that might be the culprit, but it’s either that, the coconut oil, or the coconut.) I had already ruled Coconut out as a trigger but I am revisiting it now! Yesterday I decided not to have a “fat bomb” in the morning, and lo and behold, no headache. I ate one later as a test, and developed a slight headache pretty quickly after, and to be sure I ate part of the next one, and the headache got much worse. I think in a few weeks I will retest each ingredient. The good news is, still no migraines :)

        To answer your questions, I am not measuring ketones, but am going by how I feel. The first time I went into ketosis I felt so “different” than usual that it is pretty easy for me to distinguish whether or not I am in it. However I of course don’t know HOW ketogenic I am, so I am going to measure myself soon just to get an idea. For carbs, I just checked my food journal and I am eating between 40-100 carbs a day, probably averaging at 70. And I am averaging about 1500-1600 calories/day. I haven’t had any sugar (including fruit) since the 1st which I am very proud of! Also I have a ton of energy and my sleep schedule is finally normal…I have even dropped the majority of the supplements I had been taking in order to sleep better/have more energy in the day. Anyway, all good updates for now! :)

        • http://diagnosisdiet.com/ Dr. Ede

          Hi Elaine

          Thank you for posting your additional good news–and so interesting. Nuts are on the list of top food sensitivities, but many do not consider coconuts to be nuts. I consider them nuts…because that’s what they are…but so many people with nut allergies and sensitivities report no problems with coconut, that it appears to be a confusing topic. My own personal experience with coconut is that it bothers me in many of the same ways that nuts bother me, but everyone is different.

          Congratulations on your abstinence from sugar, as well! You have so much to be proud of, and most importantly, you are figuring out how to feel your best by doing these experiments, without medications. Very impressive! The only way to be sure it’s the coconut and not the xylitol, of course, is to test them individually, but given the amounts involved, I agree that it’s most likely the coconut. I’m so glad to hear you are feeling better.

          • http://www.facebook.com/snooptaco Elaine Shields

            Hi Dr. Ede, thank you! I have decided it is definitely coconut. I am curious whether you find you can tolerate any coconut products (milk, oil, aminos) or if you avoid all of it? I think I kind of knew coconut was a trigger for me but was in denial, because without it I have such a (even more!) limited diet. Since I can’t have the bars anymore I have been taking MCT oil straight out of the bottle, and this morning it actually made me pretty ill….without food it gives me cramps/diarrhea. Essentially I am currently struggling to get in the high amount of fat needed for this diet. Do you have any tips? As you know it is hard without dairy, seeds, nuts, and now coconuts. I also can’t have avocado. I can’t even have sausage or bacon because they give me headaches! What fat sources do you recommend focusing on? Am I going to have to start eating straight animal fat? :)

          • http://www.facebook.com/snooptaco Elaine Shields

            Oh and I forgot, I am curious what you think about this post, if you get a chance to read it : http://perfecthealthdiet.com/2011/02/ketogenic-diets-i-ways-to-make-a-diet-ketogenic/

          • http://diagnosisdiet.com/ Dr. Ede

            Hi Elaine,

            I just read it over. Without truly studying their book and tracking down their references, I can’t vouch for the information they are presenting. However, I can say that it is not true that eating a zero carbohydrate diet is dangerous or causes lack of mucus secretion. The body has zero requirement for dietary carbohydrate. I really need to explore this MCT/coconut oil fad that is sweeping the ketogenic community. I am not convinced there is any health advantage to eating MCT’s that are simply going to be disposed of…just to raise ketone levels in the blood. Unfortunately I don’t have enough independent information yet to comment intelligently on this topic, but it is on my to-do list!

          • http://www.facebook.com/snooptaco Elaine Shields

            Okay thank you! Yeah the fact that they say “zero carb dangers” made me hesitant to really believe the rest of what they are saying. However I did feel pretty good doing their diet (it stopped my migraines) but I wasn’t losing weight like I wanted so I have cut out the starch for now and maybe I’ll go back to it once I’ve lost weight, if that doesn’t make me gain. I am really trying to not do too many changes at once, but it is so hard as I learn new information!

          • http://www.facebook.com/snooptaco Elaine Shields

            Hi Dr. Ede,
            It’s been 2 weeks since I have cut out starch and my ketone levels are still pretty low (average of 0.4) so I am reducing protein further and playing around with the fat level. I am happy I finally invested in the strips! Apparently I only need a tiny amount of ketones present in order to not have migraines, but I want to be in deeper ketosis for my mood, energy, and focus. Also hopefully it will help me lose weight, which has barely moved so far.

            My only qualm is that I am suddenly having much more difficulty with my sleep. When I was eating that small amount of starch each day, I was sleeping like a baby and was even off of all the supplements I had been taking (Melatonin, L-Tryptophan, Taurine). It felt like my internal clock had been reset, as I found myself getting tired at around 8-9pm and waking up naturally at 6 or 7. Now I am finding that I need the supplements again, not only to fall asleep, but to stay asleep, and circadian rhythm is off again. Any idea why this is, and if it is just a temporary thing?

            Also I am wondering if the bad breath issue will go away eventually? It’s negatively affecting my relationships with those around me :) namely my boyfriend.

            Thanks! Elaine

          • http://diagnosisdiet.com/ Dr. Ede

            Hi Elaine
            I think you will appreciate this weekend’s new blog post, which should be ready tonight or tomorrow morning–it will be focused on your excellent questions about ketogenic diets…

          • http://diagnosisdiet.com/ Dr. Ede

            Hi Elaine

            I’m not yet convinced that high fat intake (80%) or MCT oil are necessary for a successful ketogenic diet. I personally have discovered that I need to limit fat in order to remain in ketosis (I’ll be writing more about ketogenic diets in the future). However, eating fat is important, and yes, I can completely identify with your dilemma. I am not able to tolerate any coconut products at all and have to eat a mostly-meat diet myself. I have difficulty with processed meats so eat mostly fresh meats. I just take care to choose fattier cuts, or eat chicken/duck with skin, and make broths that include natural animals fats and I seem to be fine. However, everyone is different. One natural animal food that is very high in fat is pork belly, which is delicious roasted, but does not agree with me, unfortunately. If you can tolerate that, you may enjoy it. For Christmas, my sister made homemade higher-fat sausages for me without the spices that tend to bother me. I cook with duck fat, which I buy at Savenor’s in Cambridge. Can you eat olives? That’s the only other fatty fruit I can think of that is readily available.

          • http://www.facebook.com/snooptaco Elaine Shields

            That is very interesting! And encouraging, because I would really enjoy not having to eat 80% fat. I do make lots of broth at least, and will continue with the fatty cuts of meat. The next food I test is actually going to be pork, because I suspect I have a slight reaction to it (fatigue, head pressure) so maybe when I test it next I will get some pork belly! Thank you so much for the suggestions. I have never actually tried an olive (despite liking olive oil), but that’s not a bad idea to try sometime. And I will check out Savenor’s!

    • lucias

      I understand that a lack of magnesium can cause headaches. Most people in the US are deficient in magnesium. Interestingly, I understand that calcium tightens are muscles while magnesium relaxes them. Hope that helps if you haven’t found help already.

  • Arthur Robey

    How does a ketogenic diet affect endorphin levels? Some people seem to have lost their depressions.

    Once I went for a run and my urine turned brick red and opaque. I had it tested and I was told it was high in ketones.
    This only happened once.

    I had had a bout of Bilharzia so I thought that my kidneys might have been bleeding, but this was not the case.

    • http://diagnosisdiet.com/ Dr. Ede

      Hello, Arthur

      As far as I know, the antidepressant mechanism behind ketogenic diets is not well understood (I wrote about some aspects of it in my blogpost on bipolar disorder and ketogenic diets here: http://diagnosisdiet.com/bipolar-disorder-and-low-carb-diets/. I just did a quick literature search and was unable to find any articles specifically about ketogenic diets and endorphins. Depression is a complicated condition associated with a number of neurotransmitters, and whether endorphins in particular are involved in the ways that ketogenic diets work, I don’t know. There are plenty of other possible mechanisms that could explain the relationship. What is wonderful is that it’s true–most people I know or about whom I’ve read in studies and anecdotal reports improve significantly improved mood and sense of well-being on low-carb and ketogenic diets.

      As for the red urine, the only possible connection I’m aware of between ketogenic diets and hematuria (blood in urine–I’m assuming that is what was responsible for the red color?) is kidney stones, which some people do develop on ketogenic diets (this is most likely due to the ingredients in the diet–I believe this uncommon side effect is easily avoided by changing the composition of the diet). Bilharzia is also sometimes associated with hematuria. Given that you only had one brief experience of hematuria, it’s hard to say. Were you eating a ketogenic diet at the time or some other special diet at the time?

  • Anne

    I was recently diagnosed with bipolar disorder – I have tried many variations of a low carb diet for over a year- and ketogenic diet- although there were some benifits- weight loss , decrease in cravings, stable mood, there were some definant downfalls – irritability-developing tics, becoming withdrawn, and limited energy to exercise. Also constiPation and lack of joy and happiness – just kind a blah- I probably need fewer carbs but ketogenic was not good for me- also effected my thyroid

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Anne

      How frustrating–and I share your frustration–if you want to see what happened to me when I tried a (rather extreme) version of a ketogenic diet myself, see blog post entitled “Ketosis Week 4.” I will likely try a more moderate version of the ketogenic diet soon, but for now just want to recover from that experiment. I am very curious about your experience, especially about the effect it had on your thyroid–did you have thyroid tests done that you would feel comfortable sharing? If so, please consider posting them as a comment on the Ketosis Week 4 article, where a number of us are trying to figure out why some people feel so lousy on ketogenic diets, and whether or not they have negative effects on the thyroid. I would also be curious to know what kinds of foods you ate during your diet.

      No worries if you choose not to share more; if not, just know that I understand that this diet is not for everyone, and may require troubleshooting and special modifications for some people in order to make it comfortable and successful.

  • Richard

    My wife has had a bi-polar issue for years, and reports that she feels much better on a low carb, high fat diet. She has told me that when she eats carbs now, in a moment of weakness, her head just spins and she feels very strange. From my perspective I can tell the difference in her behavior too.

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Richard
      Thank you very much for sharing this information with us here; it’s wonderful that your wife has discovered a diet that helps her! I have heard from a number of people with bipolar type mood disorders that their mood is much more stable on a low carbohydrate diet. While I do not have bipolar disorder, I did used to have some anxiety and occasional depression, and they both go away when I avoid carbohydrates. My mood feels nice and even when I eat this way.

      • Richard

        Well, sad to say, not long after I wrote the above post my wife committed suicide by shooting herself in the head. She had a terrible time with what we might call impulse control, she was bad tempered and emotional and violent. She did do “better” when she controlled her carb consumption, I think, but the other side of that coin is I wonder if people with “bipolar disorder “enjoy” the manic phase of the whole affair, and hate to give that up? Yes, they do not enjoy the depression part very much, and it might be fatal, but how much do they enjoy the “high” and the feelings they have when they are not depressed? It isn’t so much that the low carb approach does not work, but rather the individual’s sense of an objective. Do they want to be normal?

        • http://diagnosisdiet.com/ Dr. Ede

          Dear Richard
          I just finished up a busy stretch at work and am logging back into my site today after a couple of months away. I’m so sorry to hear this tragic news. It is very common for people with bipolar disorder to enjoy the highs that can come along with the condition. Regardless, I am very sorry for your loss and hope that you have the support and comfort of family and friends at this difficult time.

          • Richard

            Thanks. Honestly, the more I deal with this the more complicated it gets. I guess people do enjoy the highs, and who can blame them. They also self-medicate, and apparently, in my wife’s case, with both alcohol and non-prescription (illegal) drugs. My sense is that such illegal drugs, taken as they usually are, are not only addictive, they seem to make people not reason very well, and lead to bad decisions and terrible outcomes.

        • Lainey

          I have bipolar disorder I and YES I enjoy the mania or “highs” that I experience. Sometimes too much of a good thing isnt good, but I ride the “high” as long as I can as I know that the crash is coming.

  • Motionpicture

    I have bipolar disorder and have recently started the paleo diet and plan on doing it for at least 30 days. I read on this page that someone taking depakote went into a manic phase when on a ketogenic diet; i however take lithium. Should I be concerned? I am doing the diet to be more healthy; I don’t want to compromise my health.

    Thanks.

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Motionpicture

      I would not worry about that single case report. It’s true that dietary changes can affect mood, and there is no way to predict what will happen to someone’s mood when they make a major dietary change. However, a dramatic mood change in someone with bipolar disorder who embarks on a Paleo diet is very unlikely. Just pay attention to your mood, work closely with the clinician who prescribes the Lithium for you, and if you notice any significant shifts towards mania, depression, or anxiety, discuss it with your clinician, who may consider adjusting the dosage of Lithium to compensate for any new trends in your mood.

      Dramatic mood changes are more likely on low-carbohydrate diets because the chemical changes within the body on a low-carbohydrate diet are much more profound (and occur more rapidly) than on a Paleo diet–electrolyte and insulin levels can drop quickly, for example, which could affect Lithium levels. Unless you are eating a low-carb Paleo diet, you don’t need to worry about these things. The biggest internal change that I can think of when someone changes from a normal diet to a Paleo diet is the removal of gluten, which can result in improvement in mood in those who are gluten-sensitive. In some cases, people who take a mood stabilizer like Lithium may eventually find that they require a lower dosage, or even eventually be able to discontinue Lithium altogether if their mood disorder happened to be gluten-induced.

      Good luck with the diet and I hope it helps you feel better!

      • Motionpicture

        Thank you, Dr. Ede!

  • Jessica

    Dr. Ede,
    Your blog is fascinating! I’m a psychiatry resident and the first time I encountered ketogenic diets was when I was on an inpatient pediatric neurology rotation as an intern. A few of the epileptic children were on ketogenic diets. We had to make sure their medications had no carbohydrates in their formulations. Often parents would comment that their child had marked reduction in their child’s seizure frequency/severity on the ketogenic diet. It’s interesting to think about if this diet could be translated to help people with bipolar disease.

  • tanja stark

    Here we go with the Research ! http://www.ncbi.nlm.nih.gov/pubmed/23030231

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Tanja
      Good eye! I became aware of this study some time after I wrote this post and while it’s about bipolar type 2 and not type I, and it is only a couple of case reports, I did include it in my presentation at the Ancestral Health Symposium in August because it is the only evidence I am aware of. Thank you for posting the link for everyone!

  • Ketoman

    Keto is 65% fat 30%protein and 5% carbs. The main idea is no sugar and high GI carbs and low total net carb counts. Protein is for maintenance at .6-1.4 g per lb (depending on activity levels) of “lean” body mass. Fat would then be added to fill the rest of you daily macros requirements for caloric intake.

  • Giovanni Granatin

    Very thought-provoking article, thanks Dr. Ede. I also have Bipolar, type 2 in my case. Are there any contraindications of such diets with Lithium-Lamotrigine-Seroquel combinations or individually? Specifically with Lithium, can such diets cause any disruptions to lithium levels? Thanks in advance, and for a great website.

    • http://diagnosisdiet.com/ Dr. Ede

      Hello, Giovanni

      Excellent questions, and I’m glad you like the website. I can’t think of any reason why a low-carb diet would be problematic for people who take Lamotrigine (Lamictal) or Quetiapine (Seroquel). However, Seroquel can disrupt normal carbohydrate metabolism, so it may be harder to get rid of carbohydrate cravings or harder to lose weight on a low-carb diet for those taking Seroquel.

      Lithium is another story, because low-carbohydrate diets change the way the body processes water and electolytes (salts), so lithium levels may change on a low-carbohydrate diet because it is a salt, and therefore blood levels should be monitored closely during the transition.

      • Giovanni Granatin

        Hello Dr. Ede,

        Many thanks for you reply!

        There’s a few things in your reply that i thought i’d ask you to clarify.

        Is it possible for Lithium levels to decrease, rather than increase on a low carb diet?

        Also, I’m experiencing some mood destabilisation (dysphoria, insomnia) which is occurring in the evenings when I notice hunger pangs after dinner. Can this be an outcome of not consuming enough carbs? (My only sources are vegetables bar potatoes, corn, sweet potatoes, some oats in the morning and buckwheat in the evenings).

        Much appreciated!

  • http://diagnosisdiet.com/ Dr. Ede

    Hi Owen

    Thank you very much for sharing your experience here–sounds like you have made a big difference in your well-being by making these changes in your diet–congratulations!

  • PC

    Hi Dr Ede, I was wondering if you had been tested for SIBO or fructose intolerance? I know both can cause problems with vegetables and other gut problems. I’m beginning to wonder if I have this problem myself as I only seem to feel my best without many vegetables or carbs in my diet.

    • http://diagnosisdiet.com/ Dr. Ede

      Hi PC

      I have not been tested for either of those things but I definitely feel my best when I avoid plant foods altogether.

      • PC

        Would you consider doing a post on these issues sometime in the future? I love your blog style and it’d be great to read your scientific taken on them :)

  • http://diagnosisdiet.com/ Dr. Ede

    Hi Lucias

    Yes, grass-fed organ meats are incredibly nutritious! I do eat liver and choose pastured animal liver whenever available.

  • Jolie

    Dr. Ede,
    I have Bipolar disorder and was stable on Lithium and Effexor for 6 years. I did a Very Low Calorie Diet thru the Center for Medical Weight Loss and experienced a Manic Episode. The diet was successful in helping me lose weight, but the mania resulted in a hospitalization and a change in my medication to Depakote and Seroquel. Also, the Lithium had shutdown my thyroid, and my thyroid began functioning again when the Lithium was discontinued. Until I figured this out, my thyroid medication caused a manic type reaction. I don’t know for sure if the VLCD caused my mania. But it does seem to be the only significant change to my lifestyle. The mania occurred after a bout with low potassium caused after 3 or 4 weeks on the diet. But before that, I enjoyed the diet and the weight loss. Now, about a year later, I am overweight again and would like to see the fast results again, but I am too scared to try it for it might be destabilizing.

  • Randy Oles

    I’ve been bipolar since they called it manic depressive. In fact I was
    so bad they prescribed me lithium and then haldol with varying results.
    Went mostly ketogenic about a year ago to lose weight and lo and behold,
    almost no mood swings at all any more, as well as no more heartburn,
    anxiety, insomnia, high blood pressure, etc. And yes I lost 40 lbs as
    well. I can testify that this works, and I for one will be mostly
    ketogenic for life. :)

  • Dawn

    I have bipolar and I take lamictal & Yaz. Yaz is a birth control pill. It is a progesterone blocker. These two have changed my life. I recently cut my carbs to below 50 a day. My fiance said its makes me act weird. Lol. I really like how I feel with the carbs gone. Just mellow. I can read a book, clean, listen. I don’t really mind cooking one meal for me and something different for my family. They feel kinda bad for me but I don’t feel bad for me. If I slip up, I feel gross. And I easily get back on the wagon bc I know it makes me feel clean and not hyper. I HATE HYPO anything!!! I DO NOT enjoy the “high”. To me if feels like I drank 5 pots of coffee and haven’t slept in 48hrs. Hope this helps.

  • Jo Miller

    Your article on low carb high protein diet effect on Bipolar Disorder and depression is very interesting. I was diagnosed with bipolar disorder, type 2, two years ago after a first time manic episode at age 42. For the past two years I had constant problems with anxiety, and depression, especially early mornings. About two weeks ago I have started a low carb high protein diet and for about a week now I can feel a huge difference in my mental state. I do not feel anxious at all, very calm and focused. I sleep much better, I have much more energy during the day, do not experience tiredness etc, etc.

  • Aubrey

    Found this article because I am a vegetarian who decided to try a low carb (but still vegetarian) diet in the last week and noticed that my constant irritability I’ve had since forever has vanished. I am following a 20-30 grams of carbs a day diet using vegan protein powder, some eggs and cheese, coconut milk, nuts, seeds, leafy greens an green veggies,avocados and vegan low carb “meats”. Feel better than I have with the low fat high carb diet I felt miserable on.. my moods feel incredibly stable as well as my energy levels. Hope this lasts :)