Anxiety disorders in modern society

Ketogenic Diets benefits for mood and mind disorders:

The overwhelming prevalence of anxiety disorders in modern society, medications and psychotherapy often fail to achieve complete symptom resolution. A complementary approach to medicating symptoms is to address the underlying metabolic pathologies associated with mental illnesses and anxiety. This may be achieved through nutritional interventions.

Ketogenic diets—high-fat, low-carbohydrate diets that induce the body to produce ketones, a fuel source for the brain—are gaining traction as a metabolic treatment for a wide range of chronic metabolic diseases. Ketogenic diets have been used for a century to treat drug-resistant pediatric epilepsy, are still widely used for epilepsy and are gaining in popularity for the treatment of neurodegenerative conditions, such as Parkinson's disease and Alzheimer's disease. For reviews specifically on the topic of ketogenic diets for neurological diseases and mental illnesses, we recommend the following recent reviews, both published this year, which cover the literature supporting the therapeutic implementation of ketogenic diets for a wide range of conditions including attention deficit hyperactivity disorder (ADHD), bipolar disorder, schizophrenia, autism spectrum disorder, major depressive disorder, and binge eating disorder.

Ketogenic diets help to address many of the biopathological foundations of chronic neurological diseases and mental illnesses, including glucose hypometabolism, neurotransmitter imbalances, oxidative stress, and inflammation. Ketones produced by the liver during carbohydrate restriction are not only a more efficient fuel substrate for the brain, but are also signaling molecules that bind their own G-protein coupled receptors, inhibit HDACs, directly modify histones, shift the gut microbiome and improve gut barrier function, and reduce oxidative stress and inflammation.

Preclinical models offer promise. Rats orally administered exogenous ketone supplements to achieve ketone levels comparable to those achieved by patients on ketogenic diets (~0.8 mmol/L) exhibited significant decreases in anxiety. Another rat study found that ketosis induced anti-anxiolytic changes in brain metabolism in association with a reduction of anxiety-like behaviors. There is also evidence that intermittent fasting, an intervention that induces ketosis, induces neurological adaptations overtime (including an upregulation of the mitochondrial sirtuin, SIRT3, and GABAergic activity) that and neuroprotective and reduce anxiety. No clinical trials assessing the efficacy of ketogenic diets for anxiety have yet been conducted. We include ketogenic diets as a potentially promising future option and to provide clinicians with a perspective on the emerging research on nutrition and mental health.

Nutrition regulates anxiety disorders by influencing the microbiome and inflammation. The gut microbiome and inflammation are interrelated and influence anxiety. By acting on the gut microbial ecosystem, regulating inflammation, as well as through other pathways mentioned in the text, particular nutritional strategies have been suggested to either harm or help disorders of anxiety. Sugar, processed vegetable oils rich in inflammatory omega-6 fatty acids, artificial sweeteners, and gluten have a negative effect on anxiety, whereas omega-3 fatty acids, turmeric (curcumin), vitamin D3 -K2, and ketogenic diets are thought to have a therapeutic effect.

References:

Norwitz Nicholas G., Naidoo Uma; Nutrition as Metabolic Treatment for Anxiety; Frontiers in Psychiatry. Vol.12, 2021.

Norwitz NG, Sethi SD, Palmer CM. Ketogenic diet as a metabolic treatment for mental illness. Curr Opin Endocrinol Diabetes Obes. (2020) 27:269–74. doi: 10.1097/MED.0000000000000564

Armstrong DJ, Meenagh GK, Bickle I, Lee AS, Curran ES, Finch MB. Vitamin D deficiency is associated with anxiety and depression in fibromyalgia. Clin Rheumatol. (2007) 26:551–4. doi: 10.1007/s10067-006-0348-5

Cunnane SC, Courchesne-Loyer A, Vandenberghe C, St-Pierre V, Fortier M, Hennebelle M, et al. Can ketones help rescue brain fuel supply in later life? Implications for cognitive health during aging and the treatment of Alzheimer's disease. Front Mol Neurosci. (2016) 9:53. doi: 10.3389/fnmol.2016.00053

Fortier M, Castellano CA, Croteau E, Langlois F, Bocti C, St-Pierre V, et al. A ketogenic drink improves brain energy and some measures of cognition in mild cognitive impairment. Alzheimers Dement. (2019) 15:625–34. doi: 10.1016/j.jalz.2018.12.017

Hyde PN, Sapper TN, Crabtree CD, LaFountain RA, Bowling ML, Buga A, et al. Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss. JCI Insight. (2019) 4:e128308. doi: 10.1172/jci.insight.128308