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Can Ketogenic Therapy Revolutionise Treatment for Severe Mental Illness?

Updated: Apr 12

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In 1965, a study was published titled ‘A pilot study of the ketogenic diet in schizophrenia’ by authors Pacheco, Easterling, and Pryer. In 2014, I stumbled upon this paper and it was the findings of this paper that inspired me to complete my PhD in Psychology looking specifically at the ketogenic diet for depression and psychological well-being (Bellamy et al., in publication), more on that later. 


Here is a closer look at the study. In a trial conducted on ten female patients diagnosed with chronic schizophrenia, all of whom were considered 'treatment resistant' due to their lack of response to multiple previous interventions, the ketogenic diet was administered alongside their standard care and mental health treatment.


The findings of the study indicated a statistically significant reduction in schizophrenia symptoms after just two weeks of adherence to the diet. However, upon discontinuation of the diet and a return to their regular dietary habits after one week, symptoms of schizophrenia increased once again. This suggests a potential link between carbohydrate metabolism and schizophrenia pathology, indicating that individuals with schizophrenia may benefit from low or no carbohydrate dietary interventions. Further research was warranted. 


Following the publication of this study, there was a lack of further research exploring the therapeutic potential of dietary interventions for severe mental illness. The focus of research in this area shifted towards pharmacological treatments, leading to a hiatus in dietary intervention studies, until now.


In 2015, Dr. Shebani Sethi of Stanford Medicine introduced the concept of 'Metabolic Psychiatry,' which investigates the intersection of metabolic processes and mental health disorders. Dr. Sethi and her research team initiated the first pilot trial since 1965, titled 'Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial,' aiming to explore the potential benefits of the ketogenic diet on both metabolic and psychiatric outcomes in individuals with bipolar disorder and schizophrenia.


What did they do?

The trial recruited 21 adults diagnosed with either schizophrenia or bipolar disorder, all of whom were on antipsychotic medication and exhibited symptoms of metabolic syndrome such as obesity, insulin resistance, and impaired glucose tolerance. These participants were administered ketogenic metabolic therapy, which involved the implementation of a ketogenic diet with a specific macronutrient composition for four months. Remarkably, 96% of participants successfully achieved ketosis.


What did they find?


Ketogenic metabolic therapy, which involves following a variation of the ketogenic diet, improves severe mental illness. 


This four month pilot trial showed improvements in both psychiatric and metabolic health in those with bipolar disorder and schizophrenia


  • The ketogenic diet they used for this intervention is both feasible and safe

  • Keto flu side effects diminished by week three of the intervention

  • 79% of participants experienced a clinically meaningful psychiatric improvement

  • Improvements were seen in quality of life, sleep, insulin sensitivity, and across all other psychiatric measures

  • Participants lost on average, 10% of their body weight

  • 100% of participants eliminated their metabolic syndrome 

  • Paranoia and delusions in schizophrenia improved

Dr. Sethi said: "I had patients that told me that their voices, the number or frequency of the voices per day...was reducing...And I think that's a huge change for quality of life in an individual... It gives them hope."


Here are some quotes from participants in the trial:


“Since being on the diet, I haven’t noticed any significant anxiety level or attacks. And I’ve been able to work through basically everything I’ve come across.”


"It can honestly save a lot of lives, it saved mine. I would not be here today if it wasn’t for Keto. It’s helped a lot with my mood Stabilization.”


“I can tell you that I have never felt better than I have since using ketosis, it worked far better than the lamotrigine ever did.”


Ketogenic Therapy for Mental Illness - What does this mean?

This pilot trial contributes to the increasing evidence supporting the use of ketogenic therapy alongside standard care for individuals with severe mental illness. When implemented correctly, this therapy not only helps manage and alleviate the negative metabolic effects associated with psychiatric medications but also enhances mental health outcomes, quality of life, and overall psychological well-being. However, additional research is required, and randomised clinical trials are currently in progress to further explore its effectiveness.


Do you want to trial Ketogenic Therapy for your mental health condition?

If you're seeking guidance from an experienced clinician to explore ketogenic therapy for a mental health condition, we are here to assist. Our personalised 12-week program is designed to help you integrate ketogenic metabolic therapy into your existing mental health treatment safely and effectively. Whether you require regular or occasional support, we're available to help you navigate this journey. Please reach out to us today to learn more.


What Next?

Check out our program here: Metabolic Mental Health Program

If you haven't seen it, watch Erin discuss Ketogenic Diets for Depression on the Metabolic Mind Podcast


References 

Pacheco, A., Easterling, W. S., and Pryer, M.W. (1965). A Pilot study of the ketogenic diet in schizophrenia. American Journal of Psychiatry, 121(11), 1110–1111. https://doi.org/10.1176/ajp.121.11.1110


Sethi, S., Wakeham, D., Ketter, T., Hooshmand, F., Bjornstad, J., Richards, B., … & Saslow, L. (2024). Ketogenic diet intervention on metabolic and psychiatric health in bipolar and schizophrenia: a pilot trial. Psychiatry Research, 335, 115866. https://doi.org/10.1016/j.psychres.2024.115866

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