The link between bipolar, epilespy, and the ketogenic diet.
In this blog post I will be discussing the similarities between bipolar disorder and epilepsy, and how the ketogenic diet can potentially be used as a treatment for bipolar disorder.
Epilepsy and bipolar disorder seem to both be caused by the same disrupted brain chemistry, as certain drugs for epilepsy are also used to treat bipolar disorder. The only epileptic drugs that work to treat bipolar disorder are drugs that reduce extracellular sodium concentration, which is exactly what happens in a state of ketosis - I believe this is the primary reason why a ketogenic diet would have mood stabilizing effects in bipolar. Because of the similarities between bipolar and epilepsy, I believe that bipolar disorder could actually be a form of epilepsy, and in some cases epilepsy is actually misdiagnosed as bipolar disorder and other forms of mental illness.
As discussed in the article "A dietary treatment for bipolar" by Emily Deans, M.D., lithium is used as a mood stabilizer, which replaces intracellular sodium, decreasing overall levels of sodium (It was also used as a treatment for seizures in the past, but it no longer is as it is very toxic in the high amounts needed to control seizures). Carbamazepine is also used to treat seizures and bipolar disorder. It inhibits voltage sensitive sodium channels. These medications work as insulators in the brain preventing neurons from sending dysfunctional sodium messages that lead to calcium overload, which is neurotoxic and contributes to the development of cognitive disorders such as seizures in epilepsy and this is believed to cause bipolar symptoms as well.
Furthermore, in a state of ketosis, there are extra H+ protons. The extra protons can be used in cells in exchange for sodium, which reduces overall sodium and has a similar effect as lithium. Extra protons outside of cells reduce excitatory neurotransmitters (like glutamate) and the excitability of neurons. This is important as both in high amounts lead to cognitive dysfunction such as seizures and mood disorders, such as bipolar. As previously mentioned, in a state of ketosis, glutamate favors conversion to GABA, which also lowers the seizure threshold, as GABA is inhibitory, which likely also reduces bipolar symptoms as well. Therefore, the ketogenic diet can act as a mood stabilizer for these reasons.
What happens in the brain during a seizure is also what happens to the brain during bipolar manic and depressive episodes, which is shown on CT scans, which further demonstrates that the same impaired brain mechanisms happen in both epilepsy and bipolar disorder.
So, if bipolar disorder, which is theorized to be caused by the same impaired brain function as epilepsy, which both can be improved by lack of carbohydrate in the diet to induce a state of ketosis, this shows there is certainly a link between disrupted brain functioning due to consumption of excessive carbohydrates and mental illness. Which is why I suspect that some cases of depression and other types of mental illness may be caused by the same disruptions in brain chemistry that cause seizures and bipolar symptoms.