How Your Diet Fuels Your Brain

Metabolic Psychiatry: How Your Diet Fuels Your Brain Your brain is made up of about 60% fat, so it's clearly a hungry fuel-guzzler!

The brain is two percent of your body weight, but it demands twenty percent of your energy; it is incredibly sensitive to variations in its fuel. These simple facts about brain metabolism have been known for decades, but it hasn’t been until the last decade that the evidence is mounting that these facts are crucial for understanding, and perhaps treating, psychiatric disorders such as depression, bipolar, and schizophrenia. Carlat says this is “metabolic psychiatry,” and it is forcing us to radically redefine what we mean by “mental illness.”

Energy metabolism in the brains of some individuals with psychiatric illness may be fundamentally altered. Levels of glucose, the brain’s primary energy source, were found to be abnormal in individuals with bipolar and schizophrenia in early imaging studies, which largely focused on acute illness. Since then, however, findings have emerged that suggest that similar abnormalities in brain energy production also occur in individuals who are stable on medication. Several lines of evidence suggest that brain energy metabolism abnormalities could even play a causative role in illness rather than simply being a consequence of illness or treatment.

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A novel therapeutic target could be the impairment of brain energy metabolism. While attention has focused on neurochemical consequences of disrupted brain energy metabolism, alternative therapeutic approaches might include dietary interventions. A strict diet of high fat and low carbohydrate has been known as a ketogenic diet, which forces the body to utilise fat rather than glucose as its principal energy source; brain energy could be supplied by ketone bodies produced in the liver from fat.

For 100 years, researchers have been studying the effects of the ketogenic diet on brain function. For decades, the diet has been a mainstream treatment for epilepsy and has been particularly successful for children whose seizures have not remitted with medication. In fact, the antiseizure effects of the ketogenic diet were first observed in the 1920s, but back then, very little was known about why it worked so well for some people with epilepsy. For many years, researchers largely left the diet to neurologists who specialized in the treatment of epilepsy, letting them continue to successfully use it to treat children with intractable seizures, even as the mechanisms of action remained largely unknown. But that all changed recently as researchers began to understand that the ketogenic diet stabilizes neuronal electrical activity, reduces neuroinflammation, and alters neurotransmitter balances, and many of these mechanisms have now been implicated in bipolar and schizophrenia as well.

Research into the use of the ketogenic diet in clinical trials for serious mental illness such as bipolar and schizophrenia is still in its early stages, but there have been some compelling results coming across the transom. While there are several case reports, there are also now a number of small clinical trials looking at the diet in bipolar and schizophrenia with some very interesting results. Many patients in these studies experienced a marked reduction in symptoms, and in some cases the results were long lasting with the person experiencing a reduction in the amount of medications they needed to take as well as a reduction in side effects.

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A team of researchers at Stanford University is conducting what they believe is the largest and most comprehensive study to date on the therapeutic potential of a ketogenic diet for the treatment of serious mental illness. Participants in the study, who attended conferences for psychiatrists this week, were losing weight, their blood sugar was coming under control, and they were improving their heart health. The study is timely because the vast majority of people who suffer from serious psychiatric illness, such as bipolar disorder and schizophrenia, also have a serious metabolic illness, such as type 2 diabetes. And for years, the most commonly prescribed medications for serious psychiatric illness have been known to worsen metabolic health.

Diet is one component of metabolic psychiatry, but not the whole story. There is increasing research into the relationship between insulin resistance and mental health. Evidence suggests that the brain can become insulin resistant, similar to type 2 diabetes in the body, preventing neurons from accessing glucose and contributing to depression, cognitive impairments and worsening of psychotic symptoms. Researchers are now investigating antipsychotic efficacy of diabetes medications, particularly the GLP-1 receptor agonist semaglutide. In addition to its effects on brain metabolism, semaglutide may also have anti-inflammatory effects.

In addition to addressing metabolic disorders that are prevalent in many psychiatric illnesses, it is also important to consider the role that the gut plays in psychiatric disease. The gut contains trillions of microorganisms (the gut microbiome) that communicate with the brain through the vagus nerve, the immune system and by providing the precursors to many neurotransmitters. An imbalance in the normal gut microbiome (dysbiosis) has been implicated in many psychiatric diseases, most notably depression and anxiety. By ingesting sufficient dietary fiber, incorporating fermented foods into the diet, and avoiding processed and packaged foods, one can support the attainment of a healthy gut microbiome. Many such dietary interventions have been found to promote psychiatric well-being through this gut to brain communication.

In an exciting new direction for the understanding of mental illness, researchers are applying the insights of metabolic psychiatry to study the role of the body’s metabolic system in psychiatry. Traditionally, the brain has been viewed as a separate organ that produces symptoms of mental illness unrelated to other aspects of health. However, from this new perspective, the brain is viewed as a biological system that requires proper nutrition, metabolic homeostasis, adequate insulin function, reduced systemic inflammation, and a healthy gut microbiota to function properly. In other words, when the body’s metabolic system is in balance, the brain will likely be healthy, and when the body’s metabolic system is out of balance due to nutritional deficiencies, insulin and metabolic problems, inflammation, or an imbalance of the gut microbiota, the brain will likely malfunction and produce symptoms of mental illness. The understanding of the role of the body’s metabolic system in psychiatry is likely to be one of the most significant advances in psychiatry in the next decade, as treatment of mental illness will encompass the entire body’s metabolic system.