Integrative Psychiatry

Ketogenic Diet: Indications in Psychiatry and Neurology By Marvin Singh, MD

By August 31, 2020 No Comments

Nowadays the word diet is often used as a term to convey what we are eating instead of it being identified as a lifestyle. We want to make sure that diet is identified as being adaptable, adjustable, and personalized aiming for a variety of fresh organic foods, avoiding processed food and even looking at the type of water we are drinking in which details that filtered water is an important component of nutrition.

Just because it is a ketogenic diet doesn’t mean you have to eliminate vegetables and fruits out of the equation. The Ketogenic Diet is considered as a therapeutic diet serving a specific purpose. Although it has been sensationalized it has been present for almost 100 years and was even used to treat epilepsy in the 1920s.

The key concepts of diet and nutrition focuses on consuming low carb and low sugar fruit and vegetables. Considering doing dirty keto often times includes highly processed foods which is another form of Junk food which impacts the microbiome negatively.

Research have shown that Ketogenic Diet does change the microbiome in a way that a high fat diet alters the setting of the microbiome and that certain shifts can occur in a variety of different conditions which can be therapeutic in particular people.


We only use the word diet because that’s what we humans like to use as a term to convey what you’re eating, what it really is, is a lifestyle. So, we want to make sure that in the long run diet is adaptable, adjustable, and personalized. We want to aim for a variety of foods because it’s the variety that actually makes the microbiome stronger. We want fresh food that’s organic and not genetically modified, preferably avoiding the processed foods, fast foods, junk foods, even looking at the kind of water that you’re drinking. Filtered water actually is an important component of nutrition and we want to have plenty colorful vegetables and fruits. Don’t forget that just because you’re thinking and talking about the ketogenic diet. That doesn’t mean that vegetables and fruits are out of the equation they are still a very important part of the equation.

How does the ketogenic diet fit in all this? We want everybody to keep in mind that the ketogenic diet should be considered a therapeutic diet, a type of diet that serves a specific purpose. The ketogenic diet is not a new thing, it’s become more sensationalized lately, but it’s been around for almost 100 years now. In 1921 Russell Wilder used it to treat epilepsy. Ketogenic diet is where you’re shifting your metabolism from a glycolytic energy production to fatty acid beta oxidation and ketone body production.

The main cycle that we talk about is all about energy production. We’re eating different kinds of foods and the purpose is to create energies to create fuel. Glycolysis will convert sugar to pyruvate and ATP. These are kind of main ingredients in order to enter the Krebs cycle where you get fatty acids, and the Acetyl-CoA converts crosses into the blood brain barrier and goes into the mitochondria and directly goes into Krebs cycle so there’s a lot less steps involved.

What are some examples of keto friendly food? Focus on the low carb vegetables, Arugula, Spinach, your leafy greens, mushrooms, Broccoli, Zucchini, Brussel sprouts, Kale, Cabbage, all these you can still eat. You want to focus on fruits as this is where people get messed up a little bit. You want to focus on the fruits that are really the lowest sugar. So why is dirty keto bad for you? It often includes a lot of highly processed foods and it ends up being just another form of junk food. These can be very high in food additives and toxic chemicals, they often lack essential micronutrients and fiber and they can impact the gut microbiome negatively at the end of the day, we always want to come back to understanding what’s happening in the microbiome.

The ketogenic diet does change the microbiome. Plenty of research shows how the microbiome is altered in the setting of a high fat diet. When you’re thinking about the microbiome, and you’re thinking about how things affect the microbiome, even when you’re thinking about genes and how things affect your epigenetic expression of your genes, the theme is that the ketogenic diet does impact the microbiome and that certain shifts can occur in a variety of different conditions when the ketogenic diet is present and that these can be therapeutic in those particular people.

Remember again, the ketogenic diet is a therapeutic diet. We don’t really know if the ketogenic diet is good for 80 years. There are people that say they’ve been on a ketogenic diet for many years and they’re doing well, and that may be good for them, but that doesn’t mean that as good for you, it’s effects may be modulated by changes in the microbiome. There is certainly evidence in psychiatric and neurologic conditions. We definitely need more studies, particularly with humans as opposed to animals and we need better safety and efficacy, long term use, as mentioned, as well, it may not be for everyone. But it may also have a role as well. Just watch out for some of the withdrawal symptoms, the keto flu symptoms, and know that there are things that we can do to try to manage that accordingly.