A revolutionary study published in BJPsych Open has revealed compelling evidence that a ketogenic diet can have a major impact on mental and physical well-being in bipolar disorder patients. The study, conducted by Dr. Iain Campbell, PhD, Baszucki Metabolic Psychiatry Research Fellow at the University of Edinburgh, investigates how a metabolic-based intervention might represent an exciting new strategy for treating this serious mental illness.

The research is the first in Europe to use neuroimaging methods, namely magnetic resonance spectroscopy (MRS), to investigate changes in brain metabolism in people with bipolar disorder after a ketogenic diet. The imaging findings revealed decreases in excitatory neurotransmitters, which are normally increased in bipolar disorder. This indicates that the ketogenic diet can stabilize brain activity, possibly reducing mood swings and other symptoms of the condition.

The trial involved 27 participants diagnosed with bipolar disorder, 20 of whom successfully completed the 6-8 week program. A staggering 91% of these individuals maintained ketosis, the metabolic state where the body primarily burns fat for energy instead of carbohydrates. Those who provided consistent daily ketone and mental health assessments reported notable improvements in mood, energy levels, anxiety, and impulsivity.

Dr. Campbell, who personally adheres to a ketogenic diet himself in order to treat symptoms of bipolar disorder, discussed the importance of these results:

"We saw indicators of diminished excitotoxicity in the brain regions most implicated in bipolar disorder. These findings are consistent with the metabolic overdrive hypothesis that postulates energy dysregulation within the brain as central to the disorder. Treating the dysregulation by means of a ketogenic diet could be a game-changer in treatment-resistant patients.

Aside from the scientific evidence, personal accounts of study participants underscore the life-altering effect of a ketogenic diet.

"Quite literally, for the first time in years, I felt like my brain was finally fueled correctly," explained a participant.

Another participant called the diet "a lifeline, restoring my energy and sense of hope. I felt like I was finally healing my mind, not just coping with my bipolar symptoms."

One of the very vivid accounts described the impact of ketosis in terms of a relaxing mental atmosphere:

"Applying a ketogenic diet is akin to giving my mind a nice warm bath. The edginess disappears. I am more calm, more clear, and my brain function is restored again."

Aside from the psychological benefits of the study, the ketogenic diet was also seen to have beneficial effects on participants' physical health. Nineteen out of the 20 trial completers lost a total of 9.3 pounds (4.2 kg) on average and showed improvements in body mass index (BMI) and blood pressure.

These results are noteworthy in that numerous treatments for bipolar disorder, such as mood stabilizers and antipsychotic medications, have been linked to metabolic side effects of weight gain and risk of cardiovascular disease. In contributing to the reduction of such risks, a ketogenic diet may provide a double dividend for patients with bipolar disorder.

Link Between Metabolism and Bipolar Disorder

Although the ketogenic diet has previously been known largely for its utility in treating epilepsy that is treatment-resistant, it is a somewhat new area to explore in conditions of psychiatry such as in bipolar disorder. It has come to be known that metabolic imbalance is an underlying factor in causing psychiatric disorders as energy production deficiencies have been recognized to contribute towards neural excitability and mood disruption.

One of the important findings of the study is that people with bipolar disorder tend to have sodium levels higher than usual within their cells. Lithium, a standard mood stabilizer, acts partly by reducing these sodium levels. The ketogenic diet seems to do the same thing, offering a metabolic explanation for its beneficial effect on mood stabilization.

What Is a Ketogenic Diet?

The ketogenic diet is a high-fat, low-carb diet that changes the body's main source of energy from glucose to ketones. As carbohydrate consumption is significantly decreased, the liver breaks down fats into ketones, which can be used as a substitute fuel by the brain and body.

First developed in the 1920s as a therapy for epilepsy, the ketogenic diet has been researched for its therapeutic applications in a variety of neurological and psychiatric disorders, including Alzheimer's disease, Parkinson's disease, and most recently, bipolar disorder.

There's a critical need for bigger replication studies and well-designed randomized clinical trials to follow up on these findings," added Dr. Campbell. "Our findings indicate that a ketogenic diet may be a useful adjunctive treatment for bipolar disorder, bringing new promise to patients who have difficulty with standard therapies.

Do you ever feel energetic in the morning only to feel sluggish in the afternoon? Unable to stifle the yawn at meetings or fighting to keep your eyes open in classrooms? And you find yourself inevitably reaching for that cup of coffee? You are not alone! This is called ‘post-prandial somnolence’. Medical jargon aside, let’s decode why it happens and how to beat it.

What Drives the Post-meal Drowsiness?

The body has a natural clock, called the Circadian rhythm, which drives sleep – wake cycles. This clock brings about a slight dip in alertness in the early afternoon, between 1PM to 4PM and hence the afternoon sleepiness.

But circadian rhythm isn’t the only one driving this slump. The status of digestive power and food plays an important role.

A weak digestive capacity or a weak Agni, as Ayurveda puts it, makes one sluggish after a meal. Also, the quantity and quality of the meal, that is, Matra and Guna of food, help make the distinction between being active or feeling sluggish in the afternoons. A diet rich in refined carbohydrates and fats like maida parotta, Poori, curd, buns/ breads, desserts, etc in large quantities drives this slump. These foods increase Kapha in the body, which makes a person sleepy.

Hydration plays an equally important role. Poor hydration, poor nighttime sleep, and a sedentary lifestyle can worsen the phenomenon.

How Do We Overcome It?

The trick to overcome this slump is to combine food wisely, rather than skipping food. Instead of a large bowl of polished rice with rasam and papad, one can go with a moderate amount of brown rice, a bowl of sambar, vegetable fry, sprouts, or nuts. Maida-based rotis can be replaced with barley-based chapathis with a bowl of moong dal, chana, green leafy vegetables, etc. One can also opt for millet-based khichdi, millet rotis for the same. Foods that are not heavy for digestion and in the right quantity help avoid mid- day sleepiness.

Maintaining hydration by adequate water intake is recommended. One can also opt for fresh fruit juices, water-rich fruits like melons, or water-rich vegetables. Buttermilk is another healthy option for the same.

Physical activity, or Vyayama as Ayurveda describes, is another important aspect to keep in mind. Prolonged sitting often leads to an increase in Kapha in the body, which results in sluggishness. It is especially true after meals. A short walk of 100 steps after lunch helps beat the sluggishness. Light shoulder and neck stretches in between work too shall keep one active.

However, persistent or excessive daytime sleepiness could be because of underlying medical conditions like thyroid disorders, diabetes mellitus, etc. Hence, it is important to consult the physician if one feels excessive sleepiness or an energy slump during the day.

One need not let the post–meal drowsiness define the rest of the day. A combination of the right food, hydration, and exercise can go a long way in restoring energy without the caffeine!

(By Dr Meghana K A, Assistant Professor, SDM College of Ayurveda, Hospital & Research Center, Udupi)

In today’s times, the consumers are becoming more health conscious and whenever they buy a new product, they tend to check the nutrition labels that helps them in making a better choice between multiple brands. However, making that choice can be a huge task since there is a surge in nutrition and health claims such as high protein, no added sugar, low fat, multigrain, etc., which usually confuse and often mislead them.

So now the question is: how do they make the right choice? The answer is by understanding how to read food labels. This understanding will help them in making informed decisions and choosing what is better suited for their health and needs. All packaged foods have a nutrition information label either at the back of the package or on the side.

Now let us look at a sample label and understand how to read it effectively.

1. Start with the serving size information:

While looking at the nutrition label, the first thing to notice should be the total number of servings in the package and the recommended serving size. The serving size equates to the quantity people usually consume, not how much should be consumed. So, all the nutrients that are shown on the label refer to the serving size. If we consider this label,

1 serving = 25 grams, so if 50 grams of supplement is consumed, the calorie and other nutrient values will also double.

2. Calories:

Calories refer to the amount of energy that is yielded from 1 serving of that particular product. So, in this scenario, there are 90 kcal in 1 serving of the supplement. If the entire container is consumed, it would equate to 10 servings or 361 kcal. So, one important point to remember is that the number of servings will determine the number of calories consumed. It is always advised to be mindful of the portion size to avoid excess calorie consumption.

3. Nutrients

The next thing to focus on is the list of nutrients. This list can be used to understand what would be suitable for individual dietary needs. The choice can be made based on which nutrients are required in larger quantities and the nutrients that have to be limited. Ideally, the nutrients that should be limited or consumed in lesser quantities should be saturated fats, sodium, and added sugars. These nutrients are associated with adverse health effects such as increased cholesterol, obesity, and high blood pressure.

One very common confusion is what is the difference between added sugars and total sugars? Total sugars refer to the sugars naturally present in many foods, such as milk and fruits, along with any added sugars present in the product. On the other hand, added sugars refer to the sugars that have been added during food processing, such as dextrose, sucrose, sweeteners like table sugar, etc. So, in this product, the total sugar is 10 grams per serving, and added sugar is 7.6 grams per serving.

Coming to fats, the different types of fats that are mentioned on the package are total fat, trans fat, unsaturated fat, and saturated fat. Out of these, trans and saturated fats increase the risk of cardiovascular diseases. On the other hand, unsaturated fats reduce the risk of heart diseases and are healthier. Ideally, foods with total fat less than 5 grams, saturated fats less than 2 grams, and trans fats at 0 grams should be chosen. Another way to understand the trans fat content is to check the ingredient list and see if ‘partially hydrogenated oils’ is mentioned.

Sodium is another important nutrient whose content must be definitely checked. The daily limit of sodium intake for an adult is limited to 2000 mg/day. Per serving, the amount of sodium may be categorised as:

· Low sodium: <140 mg

· Very low sodium: <35 mg

· No sodium foods: <5 mg

Another nutrient that can usually be misleading is protein. A lot of foods claim to be ‘high protein,’ but the reality can be otherwise. Look for foods that have at least 10-30 grams of protein per serving.

In conclusion, it is important to learn and understand how to spot marketing gimmicks such as low fat, low sodium, natural, etc., and read the labels properly to see whether the health claim is actually right or wrong. Ensure to read these on the label to make an informed purchase: the serving size, ingredients, sugar, fat and sodium content, calories per serve.

Remember: don’t let the label confuse you; let it inform you.

(By Asmita Jotshi, Nutritionist at Cloudnine Group of Hospitals, Pune)

If you are considering switching from dairy to plant-based alternatives such as oat and almond milk, a new study warns that the move could increase the risk of nutrient deficiencies, particularly among women and children.

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Published in The Lancet Planetary Health, the study found that replacing dairy products with unfortified plant-based alternatives could reduce the intake of essential vitamins and minerals.

“With the growing need to address environmental sustainability, many dietary recommendations are focused on plant-based diets and the reduced intake of animal products,” said Dr Katie Nicol, co-author of the study and Research Fellow at the University of Surrey, UK.

Dr Nicol explained that plant-based alternatives may not provide the same micronutrients as dairy products, putting vulnerable groups such as young children and adolescent females at greater risk of deficiencies that could affect their overall health.

Which Nutrients Could Be Lost When Replacing Dairy?

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The study warned that replacing dairy products, even partially, with unfortified plant-based alternatives could reduce the intake of four essential micronutrients:

• iodine
• calcium
• riboflavin
• vitamin B12.

In the study, the researchers examined the impact of replacing milk, yoghurt and cheese with commercially available plant-based alternatives on micronutrient intake.

They analysed data from more than 3,500 individuals aged between 18 months and 100 years from the National Diet and Nutrition Survey. Using a modelling technique, they assessed how different levels of dairy replacement affected the intake of these four nutrients.

The findings showed that even modest replacements led to marked declines in all four micronutrients, with iodine intake being particularly affected.

Replacing just 20% to 35% of dairy products with plant-based alternatives, under current market fortification levels, increased iodine inadequacy among adolescent females from 54% to 65%. Among women aged 19–49, it rose from 32% to 42%.

With complete replacement, iodine inadequacy increased to 80% among adolescent females and 72% among adolescent males.

Why Is Iodine Particularly Important?

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Iodine is essential for producing thyroid hormones, which regulate metabolism and support healthy growth and brain development.

“People may also be unaware of the importance of iodine, which is needed to make thyroid hormones to regulate our metabolism, support healthy growth and brain development,” said lead author Dr Sarah Bath, Associate Professor at the University of Surrey.

She added that iodine is particularly important during pregnancy, when requirements increase, but adequate stores are also needed before pregnancy.

Dairy products are a major source of iodine, while unfortified plant-based alternatives contain very little of the mineral.

Can Fortification Prevent Nutrient Deficiencies?

The researchers also assessed whether mandatory fortification of plant-based dairy alternatives could help prevent nutrient deficiencies.

They found that fortifying these alternatives with essential micronutrients prevented declines in their intake when dairy products were replaced. However, iodine inadequacy remained high, affecting 59% of adolescent females.

The study also found that iodine-fortified bread could further improve iodine intake, reducing inadequacy among adolescent females to 37%.

The findings suggest that combining mandatory fortification of plant-based dairy alternatives with iodine-fortified bread could be the most effective strategy to reduce iodine inadequacy.