These results indicate that the ketogenic diet may be a promising approach to complement the treatment of serious mental illnesses, offering benefits for both metabolic health and psychiatric symptoms. Although more research is needed, this strategy may represent a valuable alternative to improve the lives of people who face these challenges on a daily basis.
Millions of people around the world face serious mental illnesses, such as schizophrenia and bipolar disorder. Although effective treatments are available, many patients face challenges such as drug resistance or severe side effects, which can compromise their quality of life and even lead to treatment discontinuation.
In addition, certain medications used to treat these conditions may increase the risk of premature death, especially in vulnerable populations, such as older adults with dementia.
Studies indicate that, in the long term, antipsychotic medications may be beneficial for schizophrenia, but their metabolic side effects may reduce patients’ life expectancy. The gap in longevity between people with schizophrenia and the general population has been increasing in recent years.
If there were a treatment capable of reducing the negative metabolic effects of these medications without compromising their neuroprotective benefits, the quality of life of these patients could improve significantly.
The ketogenic diet, which is already used to treat drug-resistant epilepsy, may be a promising alternative. This diet reduces carbohydrate intake and causes the body to use fat as its main source of energy, producing molecules called ketone bodies.
These compounds can serve as an alternative fuel for the brain, helping to stabilize neuronal activity. In addition, the ketogenic diet has shown potential to reduce inflammation and improve brain function.
Recent research suggests that diseases such as schizophrenia and bipolar disorder may be linked to metabolic problems in the brain, such as difficulties in using glucose, oxidative stress, and failures in energy production in brain cells.
These factors can impair communication between neurons and increase the instability of brain activity. Because the ketogenic diet alters brain metabolism and reduces inflammation, it may offer benefits for treating these diseases without the side effects of traditional medications.
People with severe mental illnesses are also among the groups most affected by obesity and metabolic problems. Studies show that patients with schizophrenia or bipolar disorder have a significantly higher risk of developing type 2 diabetes and cardiovascular disease.
In addition, psychiatric medications themselves can worsen these metabolic problems, leading to weight gain and insulin resistance. This causes many patients to discontinue treatment, increasing the chances of relapse and hospitalization.
Among U.S. adults with severe mental illness, metabolic syndrome is a highly prevalent condition that has serious consequences, with patients estimated to die on average 10–25 years earlier than the general population, largely from premature cardiovascular disease.
Because the ketogenic diet has been shown to improve metabolic health and reduce cardiovascular risk in people with diabetes and insulin resistance, researchers have begun to investigate its potential benefits for psychiatric patients.
Although still a new field, preliminary studies suggest that this approach may improve psychiatric symptoms and quality of life without the adverse effects of traditional medications.
To test this hypothesis, a pilot study was conducted with 23 patients aged 18–75 who completed the study, 5 of whom were diagnosed with schizophrenia and 16 with bipolar disorder, all of whom had metabolic problems.
For four months, they followed a ketogenic diet and were monitored for changes in metabolic health and psychiatric symptoms.
Participants were not required to count calories, only to monitor their carbohydrate intake (approximately 20 g/day, excluding fiber), consume vegetables and salads daily, and maintain good hydration.
They were instructed to measure blood ketone levels weekly and were classified as adherent (0.5–5 mM ketones in 80–100% of measurements), semi-adherent (50–79%), or non-adherent (<50%).
The results were promising: by the end of the study, none of the participants met the criteria for metabolic syndrome. There was a significant reduction in body weight (12%), body mass index (BMI) (12%), waist circumference (13%) and visceral fat (36%). In addition, metabolic markers such as insulin resistance and triglyceride levels also showed significant improvements.
Metabolic changes over the trial period for adherent and semi-adherent populations. ApoB, Apolipoprotein B; BMI, Body Mass Index; BP, blood pressure; BPRS, Brief Psychiatric Rating Scale; CGI, Clinical Global Impression; CHOL/HDLC, cholesterol/high-density lipoprotein ratio; FMI, Fat Mass Index; GAD–7, 7-item General Anxiety Disorder Scale; GAF, Global Assessment of Functioning; HDL, high-density lipoprotein; HOMA–IR, Homeostatic Model Assessment for Insulin Resistance; hs–CRP, high-sensitivity C-reactive protein; LDL, low-density lipoprotein; MANSA, Short-Form Manchester Quality of Life Assessment; PHQ–9, Patient Health Questionnaire–9; PSQI, Pittsburgh Sleep Quality Index; VAT, Visceral Adipose Tissue; Waist Circumference, Waist Circumference.
From a psychiatric perspective, participants with schizophrenia had a 32% reduction in symptoms, as measured by a physician rating scale.
Overall, symptom severity was reduced by 31%, and 79% of patients who initially had severe symptoms showed significant improvement. In addition, participants reported greater life satisfaction and improved sleep quality.
These results indicate that the ketogenic diet may be a promising approach to complement the treatment of serious mental illnesses, offering benefits for both metabolic health and psychiatric symptoms. Although more research is needed, this strategy may represent a valuable alternative to improve the lives of people who face these challenges on a daily basis.
READ MORE:
Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial
Shebani Sethi, Diane Wakeham, Terence Ketter, Farnaz Hooshmand, Julia Bjornstad, Blair Richards, Eric Westman, Ronald M Krauss, Laura Saslow
Psychiatry Research. Volume 335, May 2024, 115866
Abstract:
The ketogenic diet (KD, also known as metabolic therapy) has been successful in the treatment of obesity, type 2 diabetes, and epilepsy. More recently, this treatment has shown promise in the treatment of psychiatric illness. We conducted a 4–month pilot study to investigate the effects of a KD on individuals with schizophrenia or bipolar disorder with existing metabolic abnormalities. Twenty–three participants were enrolled in a single–arm trial. Results showcased improvements in metabolic health, with no participants meeting metabolic syndrome criteria by study conclusion. Adherent individuals experienced significant reduction in weight (12 %), BMI (12 %), waist circumference (13 %), and visceral adipose tissue (36 %). Observed biomarker enhancements in this population include a 27 % decrease in HOMA–IR, and a 25 % drop in triglyceride levels. In psychiatric measurements, participants with schizophrenia showed a 32 % reduction in Brief Psychiatric Rating Scale scores. Overall Clinical Global Impression (CGI) severity improved by an average of 31 %, and the proportion of participants that started with elevated symptomatology improved at least 1–point on CGI (79 %). Psychiatric outcomes across the cohort encompassed increased life satisfaction (17 %) and enhanced sleep quality (19 %). This pilot trial underscores the potential advantages of adjunctive ketogenic dietary treatment in individuals grappling with serious mental illness.
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