Keto diet can improve metabolic and mental health symptoms in psychiatric patients

A pilot study by Stanford Medicine researchers suggests a promising new adjunctive treatment for people with serious mental illnesses such as schizophrenia or bipolar disorder who experience metabolic side effects from standard antipsychotic medications. The study, published in Research in Psychiatryreports that a ketogenic diet not only improves metabolic health but also improves psychiatric outcomes in these patients, providing a dual benefit that could encourage better treatment adherence.

The ketogenic diet, commonly known as the “keto diet,” is a high-fat, low-carb eating plan that has been used for decades, primarily to treat epilepsy, especially in children who don’t respond to conventional medications. . By drastically reducing carbohydrate intake and replacing it with fat, the body is forced into a state of ketosis, where it burns fat instead of carbohydrates for energy.

The classic ketogenic diet follows a strict ratio of fat to carbs to protein, often around 4:1 by weight. This means that around 80-90% of the caloric intake comes from fat, with the rest provided by a combination of protein and very limited carbohydrates. Foods such as bread, pasta, cereals and sugary snacks are replaced with fats such as nuts, cream, butter and healthy oils, as well as sufficient sources of protein.

Research into the effect of the ketogenic diet on brain chemistry suggests that the ketone bodies produced during ketosis may provide a more efficient and stable energy source for the brain, potentially stabilizing neuronal activity and reducing inflammation. This has led scientists to explore its benefits beyond epilepsy, including its potential effects on mental health disorders such as depression and anxiety.

Given that metabolic dysfunction could be contributing to the exacerbation of psychiatric symptoms, and knowing the ketogenic diet’s ability to alter metabolic processes, researchers saw an opportunity to explore its use as a complementary treatment. They hypothesized that the ketogenic diet could help mitigate the metabolic side effects of psychiatric medications while potentially enhancing their therapeutic effects on mental health.

“The ketogenic diet has been shown to be effective for treatment-resistant epileptic seizures by reducing the excitability of neurons in the brain. We thought it would be worth exploring this treatment in a psychiatric setting,” said Shebani Sethi, associate professor of psychiatry and behavioral sciences and first author of the new article.

The researchers conducted a four-month single-arm pilot study with 23 participants. Participants were recruited nationwide, with people between the ages of 18 and 75 who had been diagnosed with schizophrenia or bipolar disorder as defined by DSM-V, the Diagnostic and Statistical Manual of Mental Disorders.

Candidates were eligible if they experienced metabolic side effects from their psychiatric medications, such as being overweight or having insulin resistance, among other criteria. All participants were required to continue their psychiatric medications without any changes, unless otherwise indicated by their physician.

Throughout the four-month study, participants’ adherence to the diet was closely monitored using blood ketone meters. Ketone levels were checked at least weekly to ensure participants maintained nutritional ketosis—a key indicator of strict adherence to the ketogenic diet. Adherence was classified into three categories: fully adherent, semi-adherent, and non-adherent, based on the percentage of time participants’ ketone levels were within the target range.

Regular follow-up visits were scheduled for medical monitoring, which included repeated blood tests and assessments of weight, blood pressure, and other metabolic indicators. Psychiatric assessments were also performed at baseline, two months, and at the end of the study, using standardized psychiatric scales to measure symptoms of depression, anxiety, and general psychiatric status.

A subset of the cohort met criteria for metabolic syndrome, a group of conditions that increase the risk of heart disease, stroke and diabetes. At the end of the four-month period, none of the participants continued to meet these criteria, representing a substantial improvement in metabolic health.

On average, participants experienced a 10% reduction in body weight and an 11% decrease in waist circumference. In addition, the researchers observed reductions in blood pressure, body mass index, triglycerides, blood sugar levels and insulin resistance.

In addition, the researchers reported improvements in several metabolic biomarkers. Participants saw improvements in insulin resistance as measured by HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) and a marked decrease in hemoglobin A1c levels, reflecting better blood sugar control.

These changes are critical because they contribute directly to reducing the risk of cardiovascular disease, which is markedly higher in people with severe mental illness due to both their condition and the metabolic side effects of their medications.

He was seeing big changes, Sethi said. Even if you take antipsychotic drugs, we can still reverse obesity, metabolic syndrome, insulin resistance. I think this is very encouraging for patients.

The improvements were not limited to physical health; Significant improvements in psychiatric conditions were also observed. Participants demonstrated reductions in depression, anxiety, and overall severity of mental illness.

Participants reported improvements in their energy, sleep, mood and quality of life, Sethi said. They feel healthier and more hopeful.

Fourteen participants were fully adherent, consistently maintaining ketone levels above 0.5 for more than 80% of the time. Six participants were semi-adherent, with ketone levels above 0.5 for 60–80% of the time, while one participant was nonadherent, maintaining ketone levels above 0.5 less than 50% of the time. time Participants who were fully adherent to the diet showed greater improvements compared to those who were less strict. This finding suggests a possible dose-response relationship between diet adherence and psychiatric relief.

Despite these promising results, the study has several limitations, including its small sample size and lack of a control group, making it difficult to definitively conclude that the observed benefits are due solely to the diet and not to other factors such as increased medical care. The short duration of the studies also leaves open questions about the long-term feasibility and safety of a ketogenic diet in this patient population.

Future research is needed to build on these findings using larger randomized controlled trials that can provide more definitive evidence of the diets’ effectiveness and safety over longer periods. The researchers also suggest exploring the mechanisms through which the ketogenic diet affects both metabolism and psychiatric symptoms, to better understand how this dietary intervention could be optimized and personalized for people with severe mental illness.

“These findings underscore the importance of further exploring the evidence-based approach to neurology for people with severe mental illness in psychiatry,” the researchers concluded. “Mental health and physical health are interconnected, and addressing metabolic issues can complement psychiatric treatment to improve overall well-being. Understanding the mechanisms and potential synergies between psychiatric treatment and metabolic improvements can also inform the development of interventions.” more effective”.

The study, “Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial,” was written by Shebani Sethi, Diane Wakeham, Terence Ketter, Farnaz Hooshmand, Julia Bjornstad, Blair Richards, Eric Westman, Ronald M Krauss, and Laura Saslow.