Ketogenic Diet Shows Promise Treating Serious Mental Illness in Stanford Study | Hacker News Reader

Ketogenic Diet Shows Promise Treating Serious Mental Illness in Stanford Study

metabolicmind.org

15 pointsarijo37 comments

The study in question is:

Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial (2024) (PMID 38547601)

Here are the findings from its abstract:

> Results showcased improvements in metabolic health, with no participants meeting metabolic syndrome criteria by study conclusion. Adherent individuals experienced significant reduction in weight (12 %), BMI (12 %), waist circumference (13 %), and visceral adipose tissue (36 %). Observed biomarker enhancements in this population include a 27 % decrease in HOMA–IR, and a 25 % drop in triglyceride levels. In psychiatric measurements, participants with schizophrenia showed a 32 % reduction in Brief Psychiatric Rating Scale scores. Overall Clinical Global Impression (CGI) severity improved by an average of 31 %, and the proportion of participants that started with elevated symptomatology improved at least 1–point on CGI (79 %). Psychiatric outcomes across the cohort encompassed increased life satisfaction (17 %) and enhanced sleep quality (19 %).

This is fine for psychiatric patients, but for everyone else, a real ketogenic diet adds substantial risks as documented in these studies:

1. Ketogenic diets inhibit mitochondrial biogenesis and induce cardiac fibrosis (2021) (PMID 33558457)

2. Ketogenic diet induces p53-dependent cellular senescence in multiple organs (2024) (PMID 38758782)

The problem is that what actually counted as a ketogenic diet in the psychiatric study will get lost in its application, getting misinterpreted as a high-meat high-fat diet, which it wasn't.

Why wouldn’t these substantial risks also apply to psychiatric patients - are there any studies corraborating your assertion?

Firstly, what different studies mean by a ketogenic diet is quite different. For example, it is very possible that a healthy ketogenic diet doesn't carry these risks, whereas an unhealthy high-meat ketogenic diet carries them.

Secondly, even if the risks continue to be present in psychiatric patients, the psychiatirc benefits could still outweigh the risks, and the risks could perhaps be offset in other ways, e.g. using a statin.

If it’s possible that some healthy ketogenic diets don't carry the risks mentioned in those 2 papers then by definition there’s an over generalization implicit in the research results.

If there are issues between different ketogenic diets let’s try to figure out what those are without dropping the baby with the bath water.

I think compared to the average basically toxic US diet, almost any diet that avoids the worst ingredients will help with many diseases. There may be some differences in ourcomes between ketogenic diet, vegan and whatever but the biggest step for health will be eating/drinking cleaner in reasonable amounts.

Contrary to the so called fad diets, ketogenic diet was invented by a medical researcher in the first half of last century with the goal of putting the body in a state of ketosis, which is a known effective treatment for epilepsy.

There have been other studies that show positive heath outcomes for gluten free diets in patients with epilepsy and schizophrenia. So I do not think any cleaner diet will have positive heath outcomes. For example, vegans still eat gluten and if that is the mechanism here then nothing will change.

"The focus of eating is on whole non-processed foods including protein and non-starchy vegetables"

I think the big thing here is not ketosis, it's cutting out a lot of trash from one's diet, which is a side-effect of going keto. A sattvic diet would, I believe, show just the same improvements

The big deal IS ketosis - see my comment below and please watch a few of the videos, they contain interviews with many researchers in the field.

"I think the big thing here is not ketosis"

It is ketosis though, the benefits have proposed mechanisms of action that are directly downstream of the entirely separate ketone-based metabolic pathway.

I would encorage everyone to take a look at the metabolic mind site - https://www.metabolicmind.org/ (youtube channel - https://www.youtube.com/@metabolicmind).

Extensive presentation from Dr. Dom D'Agostino - https://www.youtube.com/watch?v=dxWUGuTV0JY&t=4s

Do not trust opinions on the web, do your own research and approach everything with a critical mind - fact based medicine, not voice of authority matter here.

I have been following the ketogenic diet for about 2 months and I feel significantly better than before starting it - this is not medical advice, each one of us will have to learn about this medical intervention and decide what's best for him or her.

Good luck.

Any tips for those trying to break the addictive grip of carbs and sweets? I'm sold on the advantages but implementing it has been years of failure.

I had to go cold turkey and did about 4 keto fails. I had to stop saying “I will do keto to drop 20 pounds” (only to eat it all back in a month) and had to start saying “I am not a man who can eat sugar in any form safely.” I have been keto for 2+ years. Dropped 40 pounds, lost the violent hunger pangs, done with the sugar crashes and 3pm mind fog, no more mood swings. My cholesterol spiked at 6 months and then returned to normal at my one year check up. I miss eating for fun. A dozen donuts, here, three bowls of ice cream, there. And then hating myself for the rest of the day. But being in the best mental, physical, and spiritual shape of my life at age 44 is not a bad trade off.

Best of luck to you.

Cook your own meals. Research recipes you'll enjoy.

Don't eat snacks between meals.

Read an article about the benefits before going to the grocery store.

Put a sticker on your credit card as a reminder before you purchase something.

Go through your house and throw out everything that doesn't fit your goals.

Good list, I'd add "eat lightly before heading to the store", you don't want to be hungry when you pass the Snickers aisle.

I would suggest to use an LLM chat to generate ketogenic recipes - works well for me.

A good salad worked wonders for me. Current favorite is

-2 iceberg lettuces

-1 cucumber

-1 red bell pepper

-2 red onions

-some frozen spinach and peas (melted in microwave)

-1 steamed broccoli

-8 hard-boiled eggs

-3 packets of strong feta cheese

-Good bunch of cashew nuts

Seasoning

-a bit of sea-salt (goes a long way with salad)

-black pepper, lemon pepper

-dried basil (pour on tomatoes if you add them)

-quality extra-virgin olive oil (Filos, Memmas Knossos)

-Parmigiano Reggiano (finely grated, chopped doesn't taste as strong. PR is a match made in heaven with practically all salads.)

I usually pair the salad with steak made from minced chicken since it's not red meat and it's low-fat. Seasoned with chicken seasoning, curry, Garam Masala, black and white pepper, garlic powder, a bit of oregano.

I could eat this for the rest of my life. That's the first thing you want: a sustainable habit.

Carbs are not unhealthy, but high-glycemic index foods will make your blood sugar spike and the drop will make you hangry. That's something you'll want to avoid. You'll also want some soluble fiber so a good option is stuff like rye bread and rye porridge. I hear in US it's hard to buy bread that isn't as sweet as pastries are here in Finland. So you might have to learn to bake your own.

As for breaking the addiction, I get accustomed to porridge without sugar in about two weeks. I usually add decreasing amount of frozen blueberries during the "transitioning period". It's bland, but once the sugar dependency eases, it'll start tasting again, but this time in a pleasant, salty-kind of way.

Best of luck with the next attempt!

Fast into a ketogenic diet. It greatly reduces cravings and allows you to reset to healthier foods.

Take a look at this interview with Dr. Georgia Ede MD - she's is an expert on the usage of nutrition for the treatment of mental ilness. In the video (and the book below) she provides a lot of insights about how to start and maintain a medical grade ketogenic diet.

https://www.youtube.com/watch?v=M-iFdXiBObE&t=4s

https://a.co/d/bkDPNT7

Fast. Water, electrolytes, black coffee/plain tea only. That's the best way imho. Prepare for it, make it last at least 3 days (5 is fine), the break it with fruits and fats (avocado are nice).

I started using Claude sonnet to generate a different ketogenic recipe everyday. I lost 15kg in 2 months and basically feel satiated throughout the day. Benefits also on level of energy and focus.

15kg in 2 months is silly levels of loss. I hope you were very very overweight.

1kg of fat is 7,700 kcals. To lose 2kg a week for 8 weeks you need to find a deficit of 2,200 kcals per day the entire time. A large inactive man will have roughly a basal metabolic rate of ~2,200 kcals per day, so you need a deficit of your BMR per day to be losing this level of weight. This is very very hard to do.

Do not try this at home. Do not try this on your own.

Yes, however, there can be significant water loss in the initial stages of a ketogenic diet. It’s not all fat that you are initially losing.

Sure, you drop heaps of sodium if you aren't careful and lose 1-3kg of associated water.

It is one of the reasons it hooks people.

Two months of weight loss is a different ballpark.

I think you are making a lot of assumptions here. Eg: It’s common for a ~200 lb male to lose 10 lbs (90 kg male to lose 4.5kg) of water weight in the first week or two. We don’t know anything else about OPs claim of weight loss over two months. We don’t know rate, overall starting point, level of activity, etc. This speaks more to the claim being ill-defined than of being a dangerous quantity.

I’m taking supplements.

I was (still am) very overweight - initial weight aroud 154kg and I’m medium height (180cm)

Eat fats whenever you have sugar/carbs cravings. Even a knob of butter can help satiate.

Also fix sleep: poor sleep messes with hormones and increases carb cravings.

Too much fat can stall progress in a keto diet. It’s better to give yourself a safe option. If you start craving something, ask yourself, “would I eat a hard boiled egg right now?” If the answer is, “no,” then you are probably not actually hungry.

I found that when I did the diet right, the sugar cravings largely went away. It takes some time and effort to get there so once you are, dig in and don’t let people tempt you with sugar. There is free food everywhere and it’s almost all sugar; You get what you pay for.

Interesting to me - no R01 or other NIH money listed on NIH RePORTER for the PI. Either Stanford is moving to boutique private funders a la this Baszucki people or chan-zuckerberg etc etc (with matching overhead?). Or she will be gone to greener pastures in 2 years.

The Baszucki’s personal involvement in the promotion of this type of research is due to one of their kids suffering many years from bipolar psychosis and the extremely positive response he had to medical ketogenic diet - please watch the videos posted here before jumping into uninformed and very unfair conclusions.

yes that's great. rah rah rah. But is their type of funding as transparent as the NIH model? What is their grant review process? And are they willing to sustain the careers of multiple full time faculty/research personnel, clinical trial costs, etc?

Who owns the IP coming out of the research? Stanford or Baszucki?

From what I've seen, Stanford pays docs without NIH backing peanuts, and the faculty environment seems overly hostile. I've lost track of junior faculty that get a nice shiny Stanford Health system job fresh out of training, and 2 years later, they're somewhere else.

Here's your chance to support a research study following all the protocols and procedures that was cancelled unilatery by the state of Maryland - https://x.com/ChrisPalmerMD/status/1807883172454998272

Watch this video for more details on the study - https://www.youtube.com/watch?v=tzPlQ6dJwe8&t=475s

The fishy part is - it is hard for any one organization to "unilaterally" kill a trial if it is legit, irb approved, etc. If it is a political situation at one institution, people often move and take their grant funding with them. Keto diet trials aren't super complicated - if UMD wanted to restructure that unit, it would be easy for the PIs to set up shop either, say, across town at an equivalent psych ward at Johns Hopkins, or even do it privately via a CRO (contract research organization), etc.

Ketogenic diets are hard to get right without really good information. It turns out that a lot of things can send you out of ketosis including just walking by a donut shop and smelling the (delicious) aroma of fresh baked bread. You may even be susceptible to commercials that advertise a burger and fries or pizza.

Foods that are marked as “keto friendly” are not necessarily safe to consume as it is not about eating specific foods as it is about eating the right ratio of protein, fats and carbohydrates. This ratio needs to be tighter for some people to enter and stay in ketosis.

Finally, there are ways to detect whether you are in ketosis via breath … but they only work for so long while your body is getting used to being in ketosis.

All of this is to say that you should be wary of individuals who claim to have followed a ketogenic diet. Maybe they did… but maybe they only thought they did. If they attempted it without feedback, I am suspicious of their claim.

I’m not a doctor but I did spend a lot of time learning about ketosis from one. If you are going to attempt it, consider doing the same.

Please take the time to read the article - this was not just a fluke written by a random individual - this is a research report performed at Stanford by experts in the field.

I did read it. My comment is not about the article but about individuals claims to following a ketogenic diet. Please re-read my comment :)

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