Revolutionary breakthrough in understanding mental health—and improving treatment for anxiety, mania depression, OCD, PTSD, and more

Ketogenic and low-carb diet offer hope

— Harvard psychiatrist Dr. Christopher M. Palmer lays a framework for rethinking mental illness in his new book, Brain Energy.

The 320-page book, published in 2022, says many psychiatric conditions, including mania in bipolar disorder, are not isolated diagnoses but share a common root in metabolic dysfunction of the brain.

He recommends ketogenic or low-carbohydrate diets, intermittent fasting, and exercise as an effective solution for many mental health conditions.

Palmer says that classifying mental disorders as separate conditions is misleading. Instead of individual illnesses, he says they are different manifestations of the same metabolic problem. He says that disrupted cellular energy in our mitochondria is the issue.

The book shows the connections between psychiatric illness and other metabolic diseases. Diabetes, heart attacks, strokes, obesity, Alzheimer’s disease, epilepsy, and chronic pain disorders all share pathways with mental illness. 

Because the brain is the most energy-demanding organ, it is especially vulnerable when metabolism falters. This helps explain why mental health and physical health often decline together, he says

Palmer’s book discusses mania’s extreme energy and impulsivity. In bipolar disorder, he says, metabolic systems in the brain become dysregulated. Circuits that normally regulate mood and control behavior are underpowered, while energy increases in reward pathways drive racing thoughts, sleeplessness, and risky choices. The result is a brain in metabolic overdrive and unable to balance its own energy.

He  links metabolism to genetics, inflammation, hormones, neurotransmitters, sleep, stress, and trauma. Rather than competing explanations, these are interconnected through the body’s energy systems, he says.

For instance, trauma raises stress hormones that disrupt mitochondrial function; poor sleep strains the same metabolic pathways; and genes influence how effectively cells produce energy.

The book describes treatments available today that may promote long-term healing by restoring metabolic health. 

These include ketogenic or low-carbohydrate diets, intermittent fasting, exercise, improved sleep hygiene, nutrient optimization, and stress-reduction practices. 

A low-carb diet limits foods high in carbohydrates, such as bread, pasta and sugary snacks, focusing instead on protein, healthy fats and nonstarchy vegetables. It recommends between 20-100 grams of carbohydrates per day.

The ketogenic diet is a very low-carb, high-fat eating plan that shifts the body into ketosis, where fat becomes the primary fuel. Carbs are restricted to about 20–50 grams per day. Supporters say it aids weight loss and blood sugar control, in addition to the benefits described in the book.

Some existing therapies fit Palmer’s framework: Medications and psychotherapies, he says, likely work by improving brain metabolism. Antidepressants, mood stabilizers, and antipsychotics may change mitochondrial efficiency or glucose use. Cognitive-behavioral therapy may reduce stress responses that drain cellular energy. 

The strength of Brain Energy is that it integrates cutting-edge science with actionable advice. Palmer combines clinical cases, emerging research, and plain-language explanations to give readers both hope and tools. 

Here is an interview with Dr. Palmer:

A reader comments: I enjoyed this article and the new science from Dr. Palmer. As someone who has Bipolar 1, I agree that I have metabolic issues. My weight has fluctuated all of my life from as early as I can remember. I’m either losing or gaining with no in between. Most of my life I have been obese or overweight. There have been periods of healthier weight, even for more than a 1/4 of the time. I’ve realized the only way to lose or maintain my weight is carb restriction. I’ve counted carbs and kept them below 50 grams per day to lose weight, and around 100 grams per day to stay the same. Unfortunately, my greatest period of mania came while my carbohydrate restriction was below 100g, which doesn’t seem to add up. Overall, I do think that my mood is associated with my weight – But isn’t that true of most people? When I am losing weight I am in a good mood, and maybe hypomanic sometimes. When I am gaining weight, I am down on myself and a little depressed, though I can’t remember a major depressive episode until recently.

See related story: Researchers testing ‘ketogenic-mimicking’ plan for treatment of mania and depression