Best Diet for Mental Health: Keto or Mediterranean? with Dr. Bret Scher

Bret: 
At Metabolic Mind, we often discuss the benefits of ketogenic therapy for treating mental health disorders. But what about the Mediterranean diet? Isn’t that good for treating depression, and isn’t it regarded as the healthiest diet? if so, what’s better for mental health? A Mediterranean diet or a keto diet?

Let’s find out.

Welcome to the Metabolic Mind Podcast. I’m your host, Dr. Bret Scher. Metabolic Mind is a nonprofit initiative of Baszucki Group where we’re providing information about the intersection of metabolic health and mental health and metabolic therapies, such as nutritional ketosis as therapies for mental illness.

Thank you for joining us. Although our podcast is for informational purposes only and we aren’t giving medical advice, we hope you will learn from our content and it will help facilitate discussions with your healthcare providers to see if you could benefit from exploring the connection between metabolic and mental health.

First, I want to acknowledge that any discussion about how what we eat impacts our mental health is amazing. I feel it’s a discussion we need much more of. But as I highlighted in a prior video, sometimes the advice we get about the best food or the best diet for mental health can be misleading, right?

Like eating beans and whole grains and dark chocolate to improve bipolar disorder. We did a video how the data really doesn’t support these specific foods as being beneficial. But it seems clear that just improving diet quality can impact mental health, right? Alright, but before we go further, please remember our channels for informational purposes only.

We’re not providing individual or group medical or healthcare advice or establishing a provider patient relationship. Many of the interventions we discuss can have potentially dangerous effects of done without proper supervision. So, consult your healthcare provider before changing your lifestyle or medications.

In addition, please recognize that people may respond differently to ketosis, and there isn’t one recognized universal response. Alright, so eating better may help. So, let’s start with the evidence in favor of a Mediterranean diet. There actually are four interventional studies that have demonstrated improved depression symptom scores with a Mediterranean diet compared to diet as usual.

And there are many more observational studies. But to be honest, we should discount the nutritional epidemiology studies as their very low-quality evidence, especially when higher quality intervention studies exist, as is the case here. Now, a Mediterranean diet can have many different definitions. But for the most part, these trials defined it as focusing on fresh vegetables and fruit and fish and lean meats and nuts and olive oil, low fat, unsweetened dairy, whole grains, red wine, and even allowed some eggs, and limiting sugar, refined grain, processed meats, and ultra-processed foods.

So, when compared to diet as usual, the individuals following a Mediterranean diet tend to have improved depression symptom scores, and really that shouldn’t be a surprise. Any improvement to the standard industrialized diet will likely provide metabolic and mental health benefits. But the question that these studies don’t answer is if this dietary pattern is the most helpful or the best for treating symptoms of mental illness.

Another dietary intervention we discuss often here at Metabolic Mind is a ketogenic diet as part of ketogenic therapy. Now, two recently published non-randomized studies by Dr. Danan and Dr. Sethi have shown significant benefits from a ketogenic dietary intervention for individuals with either major depressive disorder, bipolar disorder or schizophrenia.

And scores of anecdotal reports suggests the potential for complete remission of serious mental illnesses with ketogenic therapy. Now, a ketogenic diet is a very low carbohydrate diet, usually around 30 grams per day with moderate protein, 20 to 30% of calories, and the remainder of the calories from fat.

So, it, too, eliminates sugar, refined grains and processed foods like the Mediterranean diet. And here’s an important point though. A keto diet is not one diet, right? People can follow a Mediterranean keto diet or a vegan, vegetarian, omnivore, carnivore, or other keto diet. It’s not just one diet. But it’s safe to say that, in general, a keto Mediterranean diet will contain more fat and fewer carbs than the average Mediterranean diet.

And one more important concept is that ketosis is a dietary intervention that changes our body and brain’s fuel source. It can also alter brain neurotransmitter balance, reduce neuroinflammation, and even improve the number and function of mitochondria in our cells. This doesn’t prove it’s more effective, but it’s certainly suggestive that it’s, I guess you can say, more powerful or more impactful intervention than simply eating better.

Which is better? A keto diet or a non keto Mediterranean diet? There’s never been a head-to-head comparison of a Mediterranean diet versus a keto diet. So, we aren’t able to say which is better. Studies are ongoing that may eventually help us answer this question with more certainty, but for now, that evidence doesn’t exist.

So, in the absence of head-to-head trials, what should we do? How should an individual wanting to improve their mental health eat? What should a clinician wanting to help their patients recommend? I think we can approach this really in two ways. One way is to recommend a whole foods Mediterranean diet first and see how that works.

There likely will be some metabolic and mental health improvements. And then, over time, if the improvements aren’t as dramatic as hoped for, one could consider a ketogenic intervention to see if the improvements are even greater. The other approach, of course, is just start with a ketogenic therapy, ketogenic diet, monitor for improvements, and then decide in the future if someone wants to experiment with a more flexible Mediterranean diet.

You can see in our video about the differences between a keto diet and ketogenic therapy to learn more about using ketosis as a medical intervention, but here’s a difficult question. Is a Mediterranean diet working in the real world? A Mediterranean diet has likely been the go-to dietary recommendation, at least since 2017, since the SMILES trial was published.

And there’s no secret that people should be eating less processed junk food and more real food. People know that, right? But as they say, how’s that been working for you? I’m not sure we’ve seen a significant improvement in dietary treatment for mental health disorders. Perhaps it’s because a Mediterranean diet isn’t enough, or simply eating better isn’t enough?

Or perhaps it’s because dietary compliance across the board just tends to be poor? But it clearly seems like we need something different, something better than what we’ve been doing. Is a Mediterranean ketogenic therapy what we need? Perhaps. We know for many individuals, ketosis has been life changing, but will that hold up to a scalable population basis?

That remains to be seen, but here’s another way to look at it. If ketogenic therapy has the potential to put serious mental illness into remission, why wouldn’t someone try it? Maybe that’s the question we should be asking? To help answer that, you can watch some of our other videos about the efficacy and safety of ketogenic therapy for mental health disorders.

Perhaps this time we approach nutritional psychiatry through a different lens? And instead see it as metabolic, nutritional psychiatry centered around ketogenic therapy. Thanks for listening to the Metabolic Mind Podcast. If you found this episode helpful, please leave a rating and comment as we’d love to hear from you.

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Thanks again for listening, and we’ll see you here next time at The Metabolic Mind Podcast.