bowl of salad and small bottle with a dairy drinkShare on Pinterest
Can a keto diet help improve severe mental health symptoms? Image credit: Susan Brooks-Dammann/Stocksy.
  • Severe mental health conditions challenge both patients and healthcare professionals with the metabolic side effects of antipsychotic medications.
  • A Stanford Medicine pilot study suggests that a ketogenic diet, when combined with standard medication, may improve both metabolic health and psychiatric symptoms in people with severe mental illnesses.
  • Despite these encouraging findings, experts emphasize the need for more comprehensive research, and recommend sticking with more sustainable dietary patterns.

Mental health conditions affect an estimated 57.8 million or more adults in the United States. This includes severe conditions, such as bipolar disorder and schizophrenia.

Antipsychotic medications can be essential for symptom management but often lead to metabolic side effects such as weight gain and insulin resistance, negatively impacting individuals’ quality of life and sometimes causing treatment discontinuation.

Addressing these challenges, Stanford Medicine recently explored whether a ketogenic diet could enhance metabolic and psychiatric outcomes for patients with severe mental illness through a pilot study.

The ketogenic diet — high in fats, low in carbohydrates, and moderate in protein — has previously shown effectiveness in managing various conditions, including diabetes, obesity, and mental health disorders.

Now, Stanford Medicine’s pilot study has found that with standard medication and treatment, a 4-month ketogenic diet intervention may significantly improve symptoms and quality of life in people with severe mental illness and metabolic conditions.

The study appears in Psychiatry Research.

This 4-month study involved 21 adults diagnosed with bipolar disorder (76%) or schizophrenia (24%) who were taking antipsychotic medication and were overweight or had a metabolic issue, such as insulin resistance.

Most participants were female (62%) and white (76%), averaging 43 years old.

As outpatients, participants received instructions to follow a ketogenic diet with specific macronutrient ratios: 10% carbs, 30% protein, 60% fat.

Though they did not have to count calories, they were asked to consume a minimum of 1,200 calories daily, and limit their net carbs to about 20 grams per day.

Participants received a 1-hour training session, educational materials, ketogenic cookbooks, recipes, and a personal coach to help with diet adherence.

The diet instruction included daily vegetable, salad, and water intake recommendations, along with guidance on measuring blood ketone levels.

Researchers checked dietary compliance on a weekly basis via a blood ketone meter. The study included regular medical and psychiatric evaluations by a psychiatrist, with additional confirmation from participants’ personal psychiatrists where possible.

Participants maintained their usual psychiatric treatments and medications throughout the study.

Out of 21 participants, 14 strictly followed the ketogenic diet. Those who did showed less severe psychiatric symptoms, with fewer cases of schizophrenia and shorter illness duration compared to the semi-adherent group.

The semi-adherent group had higher obesity rates, worse cholesterol levels, and longer illness durations.

Medical News Today spoke with Uma Naidoo, MD, a nutritional psychiatrist and author, not involved in this research, who shared that “the specifics of the ketogenic diet may be a challenge for some individual[s] with these more serious illnesses to manage.”

This may explain why those with more severe conditions showed lower adherence to the diet.

Initially, 29% of participants had metabolic syndrome criteria, and over 85% had multiple medical conditions like obesity, hyperlipidemia, or prediabetes. By the end of the study, no participants met the criteria for metabolic syndrome, suggesting the ketogenic diet’s positive impact on metabolic health.

On average, participants lost 10% in body weight and body mass index (BMI), 11% in waist circumference, 17% in fat mass index, and 6% in systolic blood pressure, alongside improvements in metabolic markers such as visceral fat, inflammation, HbA1c, triglycerides, and insulin resistance.

Higher ketone levels, suggesting greater diet adherence, correlated with better metabolic health.

Psychiatric improvements were notable, too, with a 31% decrease in mental illness severity, gauged by the Clinical Global Impressions Scale.

Additionally, 79% of participants with symptoms at the start showed meaningful improvement in their psychiatric condition, especially those who strictly adhered to the diet.

Reported life satisfaction, overall functioning, and sleep quality also improved, emphasizing the diet’s wide-ranging positive effects.

The study results suggest the ketogenic diet may reduce psychiatric symptoms and counteract the metabolic side effects of antipsychotic medications.

However, Naidoo advised caution in interpreting the findings due to the study’s small size and the absence of a control group.

MNT also spoke with Jasmine Sawhne, MD, a board-certified psychiatrist not involved in the study, who elaborated on the ketogenic diet’s potential for improving mental health through altering brain chemistry and energy metabolism.

By shifting the brain’s energy source from glucose to ketones, the diet “can potentially improve mental health outcomes such as mood stabilization and cognitive function,” she explained.

Research suggests that this metabolic shift may also improve psychiatric symptoms by decreasing neuroinflammation and increasing levels of gamma-aminobutyric acid (GABA), a neurotransmitter that helps regulate mood.

Eliza Whitaker, MS, RDN, a registered dietitian nutritionist not involved in the study, emphasized the ketogenic diet’s anti-inflammatory properties, which could be crucial for combating mental health conditions, especially in cases that are resistant to treatment.

She noted that improvements in blood glucose and insulin sensitivity might also alleviate psychiatric symptoms connected to metabolic issues.

Additionally, ketosis may enhance mitochondrial function and reduce oxidative stress, factors implicated in psychiatric disorders.

However, Whitaker cautioned about the need for further research to fully understand the ketogenic diet’s impact on mental health and mentioned the possibility of symptom reemergence upon stopping the diet.

Antipsychotic medications can be effective for managing psychiatric symptoms but often have side effects like weight gain, diabetes, and increased risk of metabolic syndrome, posing a health dilemma for patients.

In the present study, “[t]he significant improvements observed in both psychiatric and metabolic outcomes suggest that [the ketogenic diet] could be a feasible and effective supplemental treatment alongside psychiatric medication,” stated Sawhne.

However, she explained:

“The ketogenic diet is not widely recommended as an adjunctive therapy for schizophrenia and bipolar disorder treatment due to limited research, but preliminary studies suggest it may have potential benefits, so as with anything in the medical field, this is an evolving topic and worth exploring further.”

Naidoo agreed, clarifying that for some with bipolar disorder and schizophrenia, the ketogenic diet helps, but it does not mean stopping medications or altering treatment without a doctor’s guidance.

Healthcare professionals must closely monitor and adjust the combination of dietary approaches to psychiatric treatments to ensure safety and effectiveness.

Despite positive early results, the long-term sustainability of the ketogenic diet remains a significant concern among researchers and health care professionals.

Sawhne cautioned that:

“Long-term use of the ketogenic diet for managing psychiatric conditions may result in potential nutrient deficiencies and alteration of gut microbiomes. There is limited research on its efficacy and safety in this context.”

Sanam Hafeez, PsyD, a New York City neuropsychologist and director of Comprehend the Mind, not involved in the study, also expressed concerns over the ketogenic diet’s potential long-term effects, especially regarding nutritional deficiencies, gastrointestinal issues, bone health, and the risk of developing disordered eating from a restrictive diet.

Hafeez recommended considering sustainable, long-term dietary approaches, such as the Mediterranean and plant-based diets, along with mindful eating and personalized nutrition, for broader health benefits.

Sawhne also advised following “science-backed recommendations for improving mental health through diet includ[ing] focusing on a balanced diet rich in fruits, vegetables, lean proteins, healthy fats, and whole grains, while minimizing processed foods, sugar, and excessive caffeine intake.”

“Incorporating omega-3 fatty acids, magnesium-rich foods, and probiotics may also support mental well-being,” she added.

Whitaker agreed, and suggested that “incorporating fermented foods such as kimchi, sauerkraut, and yogurt may improve mental health as roughly 95% of serotonin is produced in the gut.”

It is crucial to eat a diet rich in whole foods and consult with your doctor to check for nutrient deficiencies affecting brain and nervous system functions, she emphasized.

This pilot study on the ketogenic diet’s impact on schizophrenia and bipolar disorder shows promise for dual metabolic health and psychiatric symptom management.

Still, larger, randomized controlled trials are needed to validate these initial findings and understand the ketogenic diet’s long-term implications in psychiatric care, stated Sawhne.

Furthermore, the study’s lack of participant dietary history means that any improvement could be due to participants’ better overall diet quality during observation, Whitaker noted.

This highlights the importance of understanding the context surrounding dietary interventions in mental health.

Whitaker concluded that despite the study’s limitations, “[o]verall, it’s exciting to see new findings that have the potential to greatly improve the lives of people struggling with these conditions.”