What Is Metabolic Psychiatry?

Metabolic psychiatry is an emerging field that explores the connection between blood-sugar dysregulation and mood disorders, behavioral challenges, mental health challenges and neurodevelopmental challenges. Research shows (see Sources & References, below) that correcting blood-sugar imbalances can greatly improve symptoms of mental health conditions.

Which Psychiatric Conditions Are Affected by Blood-Sugar Dysregulation?

The probable mechanism for most of the symptoms associated with the following psychiatric conditions is that brain cells can become insulin resistant, as can other types of cells in the body. Thus, the brain is deprived of its fuel of choice, glucose. Glucose is not a stable supply of energy, especially when there is a large variation of blood-sugar levels, as typically happens with a processed-food diet. Because glucose burns quickly, it can spike blood-sugar levels too high after sugar consumption then drop to sometimes hypoglycemic levels shortly afterward. This phenomenon is what some refer to as the “blood-sugar rollercoaster.”

Almost all peer-reviewed medical research studies point to the use of the ketogenic diet for controlling symptoms of the pscyhiatric condition in question (see Sources & References, below). Because this diet is low-carbohydrate and high-fat, following it forces the body and brain to run on ketone bodies derived from fat instead of the less-stable glucose. The ketogenic diet has been used for decades to minimize or eliminate seizures and should only be done in coordination with a knowledgeable healthcare professional, especially in the case of children. Incidentally, the ketogenic diet is also being used with some success in reversing symptoms of diabetes and cancer.

Other potential mechanisms of blood-sugar dysregulation leading to symptoms of mental health conditions are inflammation and neurotransmitter imbalances. Chronic inflammation is a hallmark of chronic health condition, and blood-sugar fluctuations can disrupt the balance of neurotransmitters such as serotonin and dopamine, which are necessary for mood regulation. One of the reasons that Julia Ross, author of The Mood Cure, has so much success in treating addictions of all stripes may be due to the elimination of sugar from the diet.

ADHD

Increased blood sugar in the brain can negatively affect the blood flow and function to and within the brain, especially the prefrontal cortex. This action can lead to symptoms such as spaciness, inattention and the inability to focus. These symptoms are typical of an ADHD diagnosis. Daniel Amen MD was one of the first doctors who brought up this notion, and he says that “most people with ADD/ADHD do better on a higher-protein, lower-carbohydrate diet that enhances focus.” This kind of diet, although not the ketogenic diet, can be helpful for stabilizing blood-sugar levels.

One of our documented success stories is of a child with an ADHD diagnosis whose mother also had a child with type 1 diabetes. The family committed to eliminating all sugar (in its “100 forms”), wheat, all grains, rice, potatoes and corn to help the child with type 1 diabetes better control his blood sugar. The surprising side benefit was that another child with ADHD lost his diagnosis after the family made the dietary switch. You can watch John’s success story here.

Depression

Metabolic syndrome affects almost a third of individuals with major depression. Medical research shows that even brain cells can become insulin resistant, thus depriving them of the energy they need to function. Reducing insulin spikes and insulin resistance has been shown to help people lose their diagnosis of depression.

Bipolar Disorder and Schizophrenia

This clinical trial protocol states that “(m)ore recent data from open clinical trials have pointed toward a dramatic reduction in psychotic, affective, and metabolic symptoms in both schizophrenia and bipolar affective disorder” with the use of the ketogenic diet. Children with these challenges may experience heightened mood instability due to irregular blood sugar levels. In addition, elevated blood sugar can exacerbate symptoms, leading to more severe mental health issues.

Anxiety Disorders

Both depression and anxiety are common comorbidities of type 2 diabetes. Anxiety is a common symptom of hypoglycemia, as mentioned above. Irritability, “hangriness”, shaking, tunnel vision, higher pulse, weakness and nausea are also other common symptoms. What’s interesting is that this study found that glucose intolerance induces anxiety-like behaviors independent of insulin resistance. This means that a person doesn’t have to have metabolic dysfunction to have anxiety from eating sugar. Sugar itself may elicit an intolerance, similar to other intolerances to foods such as dairy, gluten, eggs, corn, soy and others.

Autism

About a third of children with autism also have seizures. It is well known that seizures can be significantly decreased with the ketogenic diet because it causes the body and brain to run on ketones rather than glucose. However, even children with autism who don’t have seizures have been shown to respond well to a ketogenic diet, implying once again that the brain prefers ketones as a constant, steady source of fuel rather than the fickle and undependable glucose.

In addition, the hyploglycemic state that often occurs after a blood-sugar spike from consuming too much simple carbohydrates can result in a release of glutamate in the brain, which can cause symptoms of autism. In fact, children with autism whose parents put them on a low-glutamate diet can sometimes reduce or eliminate symptoms of autism, as shown in our twins’ case report and also in this success story.

Alzheimer’s

Although Alzheimer’s is not a disorder that affects children, it needs to be pointed out that it is what is sometimes referred to as “type 3 diabetes” or “diabetes of the brain”. Poorly controlled blood sugar increases the risk of developing Alzheimer’s, most likely because brain cells can become insulin resistant. This study found that “(r)estoring hippocampal glucose metabolism rescues cognition across Alzheimer’s disease pathologies.” Imagine what correcting blood-sugar dysregulation can do for those without Alzheimer’s. Also, could optimizing blood sugar help prevent the onset of Alzheimer’s? What about other chronic conditions such as Parkinson’s or ALS (Amyotrophic Lateral Sclerosis)?

What Are Ways to Optimize Blood Sugar?

Research listed in the Sources & References section, below, points to the idea that optimizing blood sugar is necessary for improving symptoms of mental health conditions. Here are several strategies to regulate blood sugar more easily:

Eliminating Sugar

Sugar consumption in all of its forms causes glucose spikes that can negatively affect the brain, as discussed above. “Sugar” means not just table sugar but also sweet foods such as honey, dried fruit, tropical fruit, molasses, agave and most other sweeteners. The hard part about quitting sugar is that consuming it causes a quick dopamine hit, much like a dose of cocaine does!

Cutting out Processed Foods

Processed foods often contain sugar as well as other undesirable ingredients. They are typically made with grain flours that have been ground to remove almost all of the fiber, which is one of the factors that prevents blood sugar from spiking quickly. In fact, white bread has roughly the same glycemic load as a candy bar! Beware of foods that say “made with whole grains” because all that means is that the manufacturer started with a whole grain and likely ground out all or most of the fiber. Instead, opt to eat whole, unprocessed grains or, better yet, eliminate grains to see if that helps with blood-sugar regulation.

Adding in Lots of (the Right Kinds of) Fats

Parents may want to ease into dietary changes by initially having their child eat a whole-foods diet (such as the Whole 30 diet), transitioning to a Paleo diet, then ultimately adopting a ketogenic diet (under the supervised care of a knowledgeable professional) if warranted. Not only is the glycemic load lowered by following any of these diets, but adding in more fats can also help to keep insulin and blood sugar from spiking. As the “Glucose Goddess”, Jessie Inchauspe’ notes in her book Glucose Revolution, “put some clothes on your carbs”, meaning add lots of fat when eating carbohydrates. The ketogenic diet would have the most fat in the diet as a percentage, which is what allows for the higher production of ketones and better regulation of blood sugar.

By “the right kinds of fats”, we don’t mean vegetable oils, such as corn oil, canola oil, safflower oil, sunflower oil, soybean oil or other nut or seed oils. Our Scientific Director and Principal Investigator, Chris D’Adamo PhD, co-authored a study about how these seed oils contain high levels of linoleic acid. He noted that, “an excessive intake of LA leads to the formation of oxidized linoleic acid metabolites (OXLAMs), impairments in mitochondrial function through suboptimal cardiolipin composition, and likely contributes to many chronic diseases that became an epidemic in the 20th century, and whose prevalence continues to increase.”

Therefore, “the right kinds of fats” are monounsaturated fats such as olive and avocado oils and saturated fats such as butter (if tolerated), ghee (if tolerated), coconut oil, MCT (Medium Chain Triglycerides) oil, beef tallow, chicken schmaltz, duck fat and other animal fats.

Fasting

Fasting can help with achieving ketosis, although we don’t recommend this option for children unless your child’s healthcare practitioner authorizes it. However, you may be able to swing cutting out snacks (and allowing the gut and immune system to rest) by giving your child more filling meals that always have ample amounts of protein, fat and fiber.

Frequent Monitoring

Regularly checking biomarkers such as blood glucose levels, ketone levels, hemoglobin A1C levels and insulin levels can provide insights into metabolic health and guide dietary adjustments. We recommend purchasing a home-glucose monitoring kit, which can be bought online and in most pharmacies, as can blood ketone monitors. Some people choose to go a step further and get a CGM (Continuous Glucose Monitor), but this requires a doctor’s prescription and a bluethooth connection to a smartphone application.

Physical Activity

Engaging in regular physical activity can help maintain stable blood sugar levels. Any kind of activity is helpful (even doing chores!), but strength training in particular “is more effective than aerobic exercise for improving glycaemic control”.

In Conclusion

Metabolic psychiatry offers a paradigm shift in understanding and treating mental health conditions. By focusing on the role of metabolism, particularly blood-sugar regulation, new pathways for potential symptom reversal for a variety of mental health conditions have opened.