By Georgia Ede, MD

Nutritional psychiatry, an emerging field that explores the connection between diet and mental health, offers a promising alternative to traditional psychiatric treatments. This approach is particularly relevant for Karl’s situation.

On the night of December 23, 2019, a sudden attack of agitation jolted Karl from a deep sleep. “I felt like a deer in the headlights.” Unable to shake the restlessness with his usual relaxation and breathing techniques, he headed out into the night and walked…for eight miles…but to no avail.

The anxiety persisted for weeks but Karl was dead set against turning to psychiatric medications, again. Years earlier, he had sought help for mood and attention issues from a private specialty clinic where he underwent a psychiatric evaluation, including sophisticated brain imaging.

Thousands of dollars later, he walked out with three psychiatric diagnoses and three prescriptions: Effexor for depression, Klonopin for anxiety, and Adderall for ADHD.

As Karl explained, the low dosages initially helped him feel “superhuman, highly focused, and full of energy,” but before long he became “uncharacteristically arrogant and extroverted.” To help cope with these manic side effects, he added marijuana to the mix, but it only worsened the problem, straining his relationships and nearly leading to divorce.

Karl was diagnosed with bipolar II disorder by a psychiatrist who strongly recommended starting a mood stabilizer. Instead, Karl chose a different path: He gradually tapered off all three of his existing medications and partnered with a new doctor willing to closely monitor his behavior.

Together, they pursued an alternative therapeutic approach that combined cognitive-behavioral techniques with a rigorous physical regimen of cycling one hundred miles per week. Ultimately, this strategy proved effective in managing his mood for over a decade—until that December night.

Evidently, the time had come to fine-tune his regimen and prevent these types of episodes once and for all. While researching online, Karl discovered dietary-based strategies for managing mental health conditions, which led him to contact me in March 2020 to conduct an evalutaion for nutritional psychiatry.

An Unorthodox Remedy

His whole life long, Karl had been eating a standard American diet (SAD) full of highly processed foods—refined carbohydrates (flour, high fructose corn syrup, and processed cereals), sugary beverages, and refined seed oils—all exacerbating his condition.

There was definite room for improvement, so I presented several strategies for him to consider: a paleo diet of meat, seafood, poultry, vegetables, nuts, and seeds; a whole-foods, low-carbohydrate diet; or a plant-free “carnivore” diet, which contains virtually no carbohydrates. Karl chose the carnivore option because he hoped it would bring the fastest relief.

At that point, his score on the PHQ-9—a screening test for depression—was 15 on a scale of 0 to 27 (with 27 being the most severe). His score on the GAD-7—a screening test for anxiety—was 17 on a scale of 0 to 21 (with 21 being the most severe).

Nutritional Psychiatry: Change Your Diet, Change Your Mind

After thirty-nine days on his new diet, both his GAD-7 and PHQ-9 scores had fallen to zero. He messaged me, “Just another awesome week without any symptoms of anxiety, depression, or agitation.”

Psychiatric medications rarely eliminate all symptoms and virtually never produce the empowered joy evident in Karl’s words. After a lifetime of eating SAD, switching to a diet consisting entirely of beef, pork, eggs, and cheese appeared to have helped completely reverse his mood disorder. This remarkable transformation underscores the potential of nutritional psychiatry in addressing mental health issues.

Ironically, the only problem he encountered was that despite eating three to four pounds of fatty animal-based food per day, he couldn’t regain the ten pounds he’d lost during his three month period of agitation. Therefore, to restore healthy weight, support athletic performance, and add variety, I advised him to relax his diet to include about 100 grams per day of carbohydrates from whole foods—which he did by adding in plain yogurt and root vegetables.

After remaining completely well on this plan for over a year, he began broadening his diet to include a greater diversity of whole foods, and for the past year, he has continued to remain well—symptom-free a full three years later.

Whether this remarkable story reflects the unique experience of one man or holds larger lessons that may apply to others, it certainly challenges us to ask new questions about psychiatry, nutrition sciences, and the relationship between the two:

• Could some psychiatric illnesses be partly, largely, or even entirely dietary in origin?

• What is it about the standard American diet that may be contributing to poor mental health?

• How many people might be able to reduce, avoid, or eliminate the need for psychiatric medications using dietary strategies?

The Accidental Nutritionist

Having practiced psychiatry for more than twenty years, I know all too well the shortcomings of medication-oriented care. Even well into the twenty-first century, the practice of prescribing psychiatric medications continues to be a frustrating trial-and-error process fraught with potential complications.

While skilled and thoughtful use of medications absolutely improves quality of life for some people and does prevent some hospitalizations, injuries, and suicides, all too often, the relief from the struggle comes at the expense of side effects such as drowsiness, sexual dysfunction, weight gain, apathy, and high blood sugar.

We can and must do better, and I am convinced that modern nutritional psychiatry is the way forward. This conviction did not come naturally to me. If you had told me twenty-five years ago that I would be practicing nutritional psychiatry, I would have never believed you.

I loved the “hard sciences” of medicine, like biochemistry, physiology, and pharmacology, and believed that the ability to prescribe medication was the hallmark of a “real doctor.” I viewed the work of nutrition specialists and lifestyle-oriented practitioners with great skepticism. I would later come to understand that these arrogant attitudes were rooted in sheer ignorance.

Nutrition courses were not required to earn my bachelor’s degree in biology. In four years of medical school, we received only a few hours of nutrition education, and in four years of psychiatric residency training, nutrition wasn’t mentioned once.

Don’t get me wrong—I was fortunate to have also been taught strong psychotherapy skills from some of the best psychiatrists in the field, so I learned to take thoughtful life histories, explored deeper issues that contribute to emotional distress, and developed meaningful relationships with patients.

I poured my heart and soul into my work and learned invaluable lessons from the hundreds of people I had the privilege of connecting with who came to me for help. As time went by, however, it became painfully obvious that true healing and full recovery were rare.

Looking around at respected colleagues and mentors, some of whom had been in practice for decades, I noticed the same pattern: Everyone’s practices were filling up with people who weren’t getting better. We met with patients to provide support, write prescription refills, and try to instill hope, but most of us had quietly come to view mental illnesses as chronic, mysterious, and incurable.

It had never crossed my mind that food might be important to mental health. Like many women, I viewed my own food choices simply as a means of weight control. I ate a low-fat, high-fiber diet largely comprised of skinless chicken breast, whole grain cereals, soy milk, vegetables, fish, hummus, fat-free yogurt, and Diet Coke. I counted calories and exercised regularly.

Then, in my early forties, I developed a variety of perplexing new symptoms, including migraines, fatigue, body aches, bloating, and stomach pain. Multiple specialists found nothing wrong, and sophisticated test results were all normal. None of the doctors asked me what I ate, so I left their offices with generic printouts advising me to follow a low-fat, high-fiber diet, which I was already doing.

Could any of my symptoms be diet-related? I began a food and symptom journal and looked for patterns. After about six months of trial-and-error changes and incorporating more healthy fats and proteins, I started feeling better. Not only did the bloating, pain, and fatigue disappear, but my mood, concentration, and productivity improved as well.

As a psychiatrist, I became intensely curious about the relationship between food and brain health and began to wonder whether dietary changes might also help some of my patients. I started studying nutrition and completed a graduate course in human nutrition at the Harvard School of Public Health, which laid the foundation for my journey into nutritional psychiatry.

I combed the Harvard Library database for primary research studies, devouring articles not just about nutrition but also about botany, toxicology, animal husbandry, and agriculture. What I discovered was that nearly everything I thought I’d known about nutrition was wrong.

Most of us have been feeding our brains improperly our entire lives; therefore we have no idea how much better we can feel and how much more we can expect of ourselves if we eat right. From what I have learned and observed, many of the emotional and cognitive issues we have come to expect as normal, genetic, or permanent can be eased or even reversed with good nutrition.

If you don’t want to take medication, don’t respond to medication, can’t tolerate medication, or can’t access medication, there are innovative dietary strategies you probably haven’t tried yet that can help medication work better, counteract certain medication side effects (such as weight gain), or in some cases reduce or even eliminate the need for psychiatric medication.

Link Between Mental and Metabolic Health

Between 2007 and 2018, while I was serving as a psychiatrist at Harvard University and then at Smith College, my seasoned colleagues and I observed a most disturbing trend: It was becoming increasingly common for first-year students to arrive on campus already taking one, two, or even three psychiatric medications.

Requests for specialized support for learning and emotional disabilities were rising so fast that it was difficult to accommodate everyone’s needs. More and more students were showing up at campus mental health clinics in crisis, requiring emergency psychiatric hospitalizations, leaves of absence, or academic withdrawals.

Just as our mental health has been spiraling downward in recent decades, so, too, has our physical health. In the United States, cases of heart disease nearly doubled between 1990 and 2019, and the percentage of Americans with obesity has nearly tripled since the 1960s.

People with these chronic conditions are also more likely to have psychiatric comorbidities, such as depression and bipolar disorder—and this is no coincidence. Metabolic and mental health conditions commonly co-occur and share many of the same underlying abnormalities—the most important being inflammation, oxidative stress, and insulin resistance.

It just so happens that the industrially ultra-processed SAD is a powerful promoter of inflammation, oxidative stress, and insulin resistance—all of which are just as dangerous for the brain as they are for the rest of the body.

We readily accept that diet plays a major role in the health of the rest of the body—why should the brain be any different? The foods we eat provide the construction materials we need to build healthy, resilient brain cells and the fuel we need to energize them. If we don’t eat the right foods, none of our cells will develop or function properly, and any number of things can and will go wrong—including many things medication cannot address.

Medications can and do change brain chemistry, and they have their place, but I’m convinced that the most powerful way to change brain chemistry is through food because that’s where brain chemicals come from in the first place.

Neurotransmitters are made from food, the brain cells that pass them back and forth to communicate with each other are made from food, and even the salty fluid that surrounds them is made from food. Optimal mental health requires that your whole brain be made of the right stuff. So, if you have a mental (or metabolic) health problem of any kind, the first place to look isn’t your medicine cabinet; it’s your pantry.

The Promise of Nutritional Psychiatry in Mental Health Treatment

Reimagining mental health disorders as metabolic disorders has opened the door to exciting new therapeutic interventions, most notably the ketogenic diet. This approach is at the core of nutritional psychiatry, which seeks to address mental health issues through dietary interventions.

Ketogenic diets are very low-carbohydrate, moderate-protein, high-fat diets that stimulate your body’s ability to burn fat—and to turn some of those fats into ketones, which are compounds your brain can burn for energy.

Some people think of the ketogenic diet as a weight loss diet—and yes, it can help burn excess body fat. Some people think of the ketogenic diet as a diet for type 2 diabetes—and yes, it is a very effective way to treat type 2 diabetes because it reliably lowers blood glucose levels, reduces or eliminates the need for diabetes medications, and can even put type 2 diabetes into sustained remission.

But did you know that the original intended purpose of the ketogenic diet was to stabilize brain chemistry?

In 1921, long before anticonvulsant medications were available, the ketogenic diet was invented to treat children with epilepsy. More than a dozen quality clinical trials have since demonstrated that ketogenic diets are safe and effective in both children and adults with epilepsy, cutting seizure activity by more than half in greater than fifty percent of cases, and completely eliminating seizures in ten percent or more.

The ketogenic diet has shown promise in many other neurological conditions as well, including multiple sclerosis, Parkinson’s disease, and migraine headaches. This strong evidence base in neurology is good news for psychiatry because, as I see it, the line between neurology and psychiatry is imaginary.

The brain isn’t divided into neurology cells and psychiatry cells—it is one organ. It stands to reason that if a particular treatment benefits neurological brain disorders, it should also benefit psychiatric brain disorders. Emerging evidence looks very promising, and scientific interest in this area is suddenly exploding.

Case in Point: Dr. Danan’s Diet Protocol

Several years ago, a young man with epilepsy and autism behavior adopted a ketogenic diet and experienced substantial improvements in both conditions within only a few weeks, ultimately becoming seizure-free.

It just so happened that this young man was a relative of my friend and colleague, Albert Danan, MD, who has been practicing psychiatry in Toulouse, France, for more than thirty-five years. Having witnessed this remarkable transformation in brain health in a member of his own family, Dr. Danan became curious about whether this same diet might be able to help some of his own patients.

The population Dr. Danan serves is comprised primarily of people of French and North African descent with severe mental illnesses, most of whom he has been working closely with for many years or even decades.

He invited thirty-one of his most treatment-resistant patients with major depression, bipolar disorder, or schizoaffective disorder (a form of schizophrenia that also affects mood) to try a ketogenic diet under his close supervision in the Clinique du Castelviel, a local psychiatric hospital.

As is so often the case in people with chronic mental illness, all of these volunteers also had markers of poor metabolic health, such as high blood glucose, high blood pressure, high triglycerides, and obesity. Many were unable to work due to psychiatric disability.

All of them were taking multiple psychiatric medications, and all of them had been hospitalized before by Dr. Danan one or more times at either the Clinique du Castelviel or at a similar sister hospital nearby. Having exhausted all other treatment options, they agreed to participate. What happened was extraordinary.

By week three, every one of the volunteers who stuck with the plan (twenty-eight of the original thirty-one) began improving—both metabolically and psychiatrically. All twenty-three people with depression symptoms experienced substantial improvements in mood, and all ten people with schizoaffective disorder experienced substantial reductions in psychosis symptoms.

Twelve people (44 percent) achieved full clinical remission, and eighteen people were discharged from the hospital on fewer psychiatric medications than they were taking at the time of admission.

The dietary intervention used in this study was adapted from the protocol that one of our colleagues, Eric Westman, MD, MHS, an internist specializing in obesity medicine, has used in his weight-loss research at Duke University for many years.

The plan consisted almost exclusively of meat, seafood, poultry, eggs, vegetables, nuts, and cheese; it was low in carbohydrates (20 grams per day maximum) and moderate in protein (up to 20 percent of calories), with the remainder of daily calorie requirements coming from fat. The diet was well tolerated, and no medical or psychiatric safety issues arose.

So, how does the ketogenic diet improve brain health? It may surprise you to hear that we know more about how ketogenic diets affect the brain than we know about psychiatric medications because scientists and clinicians have been using and studying the ketogenic diet since 1921— decades before any psychiatric medication had been developed.

Unlike medication, which targets just one or maybe a few brain chemistry problems at most (such as the activity of a particular neurotransmitter), the ketogenic diet is a multi-purpose tool that addresses numerous underlying problems simultaneously, including the following:

• Supports neuroplasticity (creation of new brain circuits)

• Resolves sensory gating deficits that cause hallucinations

• Rebalances glutamate, GABA, and other neurotransmitter systems

• Stabilizes brain cell networks

• Lowers sodium levels inside neurons, making them less reactive

• Bolsters antioxidant defenses

• Repairs and replenishes mitochondria

Keep in mind, while the ketogenic dietary intervention supports and stabilizes brain metabolism with ketones— allowing the brain to operate more cleanly, smoothly, and efficiently—optimal mental health is about more than just ketones.

The nutritional quality of your diet matters, too. If it’s optimal brain health you seek, you’ll need to do more than just energize your brain; you’ll need to nourish and protect it as well, and this is where minimally processed, nutrient-dense, clean food choices come into play—no matter whether you’re keto, plant-based, carnivore, or paleo.

As I tell my clients, when it comes to mental health, you can’t change the genes you were born with or the childhood you experienced, and there’s only so much you can do to reduce your exposure to stress, but you can change your diet—and changing your diet can change your mind.

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Georgia Ede, MD, is a Havard-trained psychiatrist specializing in nutrition science, brain metabolism, and mental health. Her twenty-five years of clinical experience include twelve years at Smith College and Harvard University Health Services, where she was the first to offer nutrional psychiatry as an alternative to psychiatric medications.

Dr. Ede speaks internationally about dietary approaches to psychiatric disorders, nutrition science, and nutrition policy reform. She is also the creator and director of the first medically accredited course in ketogenic diets for mental health practitioners. In 2022, she coauthored the first inpatient study of the ketogenic diet for serious mental illnesses and was honored to be a recipient of the Baszucki Brain Research Fund’s Metabolic Mind Award.

Well Being Journal adapted the above excerpt from Change Your Diet, Change Your Mind: A Powerful Plan to Improve Mood, Overcome Anxiety, and Protect Memory for a Lifetime of Optimal Mental Health, by Georgia Ede, MD, and reprinted with permission from Balance Publishing.