Schizophrenia can be helped by Keto. Is Bobby Jr. crazy to suggest? This past week, Robert Kennedy Jr made an announcement that keto can help with schizophrenia. How true or untrue is this? In my practice as a CNS, and even before that, I've helped patients with schizophrenia to come up with diet and meal plans to manage their symptoms. When I've been at the helm, episodes haven't been present. Other practitioners such as Daniel Amen have helped people with schizophrenia by using diet, herbs, and neural feedback. Bobby Jr. was referring to similar case studies where other practitioners have been able to help manage schizophrenia symptoms with diet. So how true is it that keto diet can help? There are a few ways to look at the underlying science. The first is to look at common underlying mechanisms that are happening. With keto diets, and the other diets that are recommended, there is low to no blood sugar spiking. If you've ever had brain fog after eating too much sugar, it's not a far leap to understand that blood sugar spikes have an impact on mental health. Blood sugar can have a huge impact and make people out of control of general faculties. Ketogenic diets stabalize the ups and downs of the brain and help help the patients to have greater clarity from day to day. Most people get onto keto diets to reduce BMI, and BMI is also more highly correlated with specific subtypes of schizophrenia [8] Keto diets tend to be anti-inflammatory in a variety of ways. Schizophrenia is associated with elevated blood levels of C-reactive protein (CRP) and pro-inflammatory cytokines, including IL-6, IL-12, IL-1beta and TNF-alpha. The last two of these, at higher levels, are more associated with social withdrawal, lack of motivation and cognitive decline. One kind of inflammation, CRP, found in blood work, when high is correlated with people who are statistically more likely to develop schizophrenia. Keto often reduces these levels. IL-6 and TNF-alpha interfere with dopamine and glutamate When there is too much dopamine, the brain will hyper focus on things that are not important such as random sounds and internal thoughts which can lead to hallucinations. When there is low dopamine, it can be hard to be motivated to do anything. In a healthy brain glutamate makes the production of dopamine stop If glutamate receptors are weak or fail, the dopamine system can go into overdrive leading to a dopamine storm and psychosis. Keto enhances the conversion of glutamate to glutamine and then to GABA, increasing the GABA/glutamate ratio, and suppressing excessive glutamate release, creating a more stable brain environment, causing keto diets to influence dopamine by increasing the inhibitory neurotransmitter GABA, which modulates dopamine. There is one kind of inflammation, microglial activation, found in post‐mortem brains of schizophrenia patients. When these are activated chronically, more cytokines and free radicals that may lead to excessive "synaptic pruning" which can destroy neurological connections. This can lead to a reduced reduction in brain volume. Beyond this, we all need different nutrients for signals for neurogenesis and synaptic pruning. Keto diets etnd to have less processed foods and foods that are higher in micronutrients. - Schizophrenia is related to zinc levels (Bitanihirwe and Cunning- ham., 2009) - Excessive B6 is related to schizophrenia - Magnesium helps to maintain neuroplasticity - deficiency in omega-3 PUFAs is found in both first-episode psychosis and chronic schizophrenia patients. Keto diets are not necessarily high in these but are likely higher in these than a standard American diet. Some herbs have been shown to be helpful such as rhodiola which improves blood flow to the prefrontal cortex but ginkgo biloba can have adverse impacts especially when using a drug that is metabolized by the CYP450 enzyme system.