Growing research suggests that ketogenic diets can be helpful for psychiatric conditions, including depression, anxiety, bipolar disorder, and schizophrenia. However, there are important safety concerns that must be considered before starting this nutritional approach. This article covers potential benefits, safety precautions, practical tips, and resources for following a ketogenic diet for mental health disorders.
Potential Benefits of the Ketogenic Diet in People with Mental Health Disorders
Why might a high-fat, very-low-carb ketogenic diet be beneficial for mental health? This approach, also known as ketogenic metabolic therapy (KMT), shifts the body’s primary energy source from glucose to fat and ketones, which may benefit people with psychiatric conditions in several ways:
- Improvement in brain energy metabolism: Emerging research suggests that ketones may improve mitochondrial function and promote mood stability in people with schizophrenia, bipolar disorder, and major depression.
- Neuroprotection: Ketones provide a steady energy source for the brain that can help protect nerves and reduce brain inflammation.
- Reduced oxidative stress: In studies, KMT has been shown to reduce oxidative stress—an imbalance between free radicals and antioxidants—which is thought to be a key factor in the onset and progression of psychiatric disorders.
- Better metabolic health: There is growing awareness of the connection between mental health disorders and poor metabolic health, as evidenced by the emerging field of metabolic psychiatry. Ketogenic diets have been shown to increase insulin sensitivity, improve blood glucose control, lower triglyceride levels, and improve other markers of metabolic health.
Research Supporting KMT for Psychiatric Conditions
Although research is still in its early stages, several small studies suggest that ketogenic diets may lead to promising outcomes in several mental health disorders.
Depression and anxiety:
- A 2023 systematic review of case reports and observational studies concluded that ketogenic diets may provide benefits for individuals with mood and anxiety disorders, although further study is needed.
- In a case series, three patients with major depression and generalized anxiety disorder who followed an animal-based ketogenic diet for 7 to 12 weeks experienced complete remission from their condition, along with improvements in quality of life, body composition, and metabolic health markers. In addition, the two patients with binge-eating disorder reported that they no longer binged or felt the urge to binge within days of starting ketogenic metabolic therapy.
Bipolar disorder and schizophrenia:
- Researchers conducted a 6-8 week pilot study of a ketogenic diet in 26 euthymic individuals with bipolar disorder. Among the 20 participants who completed the trial, 91% of blood ketone (beta-hydroxybutyrate) measurements fell within the nutritional ketosis range, and the diet was generally well-tolerated with minimal side effects. Daily beta-hydroxybutyrate levels were positively correlated with self-rated mood and energy levels and inversely associated with impulsivity and anxiety. In addition, participants lost an average of 9.2 lbs (4.2 kg).
- A retrospective analysis explored the effects of a ketogenic diet in 28 inpatient adults with treatment-resistant severe mental illnesses, including schizophrenia and bipolar disorder. All patients experienced improvement in symptoms, with nearly half achieving remission, and 64% were able to reduce or discontinue their psychotropic medications.
- In a pilot study, 23 individuals with schizophrenia or bipolar disorder and metabolic abnormalities followed a ketogenic diet for four months. Schizophrenia patients saw a 32% reduction in symptoms, and 69% of those with bipolar disorder showed significant clinical improvement. Additionally, none of the participants met the criteria for metabolic syndrome by the end of the study, with adherent individuals experiencing significant reductions in waist circumference, insulin resistance, and triglyceride levels.
Currently, several trials exploring the impact of KMT on mental health disorders are recruiting or already in progress.
Safety Precautions
High-quality research has established that ketogenic diets can be safe and effective for managing epilepsy––which has a bidirectional relationship with mood disorders –– in children and adults who have not responded to conventional anti-seizure medications. Indeed, this approach has been successfully used to treat epilepsy for more than 100 years.
While KMT can be beneficial, it requires extra precautions for individuals with mental health disorders.
- Medical supervision: It’s important that people with mental health conditions follow a ketogenic diet under the guidance of a psychiatrist or other medical provider. KMT can affect mood, blood sugar and medication levels, requiring careful monitoring.
- Managing keto flu symptoms: The transition to ketosis can cause temporary symptoms like fatigue, headaches, and other changes that may affect mood. It’s important to increase water intake and ensure adequate intake of sodium, potassium and magnesium in the initial stages of a ketogenic diet. It’s best to work with a dietitian or nutritionist who is knowledgeable in KMT for mental health disorders.
- Sleep challenges: Sometimes people experience sleep disturbances, like difficulty falling asleep or frequently waking, as the body adjusts to being in ketosis. Since restorative sleep is crucial for well-being, it’s important to take steps to minimize sleep disturbances. Avoiding caffeine after noon, finishing the last meal several hours before going to bed, and practicing meditation or deep breathing exercises can promote better sleep.
Resources:
Websites:
Metabolic Mind: Extensive Information about KMT for mental health, including articles and videos detailing the science of this approach and the lived experiences of people who follow a ketogenic lifestyle.
Dr. Georgia Ede’s Ketogenic Diets for Mental Health Clinician Directory: A list of doctors, dietitians, nutritional therapists, health coaches, and other professionals with expertise in KMT
Books:
Brain Energy by Christopher Palmer, MD
Change Your Diet, Change Your Mind by Georgia Ede, MD
Videos:
Christopher Palmer, MD: The Ketogenic Diet in Neurology and Psychiatry
Metabolic Mind YouTube Channel
Take-Home Message
Ketogenic metabolic therapy shows promise for offering neuroprotection, reducing inflammation, improving symptoms, and enhancing metabolic health in people with mental health conditions. However, this powerful dietary approach should be followed with caution and under the guidance of a knowledgeable healthcare professional to ensure safety and maximize benefits.
