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Keto Diet Helps Treat Bipolar and Schizophrenia

The word "keto" spelt in food.
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Cutting out the carbs could lessen the symptoms of bipolar disorder and schizophrenia, according to a new study.

In a small pilot trial of 21 adults (16 with bipolar disorder, 5 with schizophrenia), researchers found that a 4-month-long low-carbohydrate, high-fat diet improved the majority of participants’ mental health scores.

The participants also, on average, lost 10% of their body weight, lowered their blood pressure and improved their sleep and life satisfaction scores.

The findings were published in Psychiatry Research.

Change the food, change the brain

Many current medications for bipolar disorder and schizophrenia come with an increased risk of insulin resistance and obesity.

The ketogenic diet, on the other hand, can help dieters lose weight. It excludes common high-carb foods like bread, pasta, rice and cereals and promotes high-fat foods like cheese. In the world of medicine, it is sometimes recommended for people with epilepsy, as brain neurons fueled by ketones (a by-product of fat) appear to misfire less than neurons fueled by glucose (a by-product of carbohydrates).

Curious as to whether the diet could also benefit patients with bipolar disorder and schizophrenia – and reduce their levels of obesity – researchers at Stanford Medicine recruited 21 adults to try it for 4 months.

“The ketogenic diet has been proven to be effective for treatment-resistant epileptic seizures by reducing the excitability of neurons in the brain,” said Shebani Sethi, an associate professor of psychiatry and behavioral sciences at Stanford Medicine. “We thought it would be worth exploring this treatment in psychiatric conditions.”

All participants had been diagnosed with one of the two mental health disorders and were either overweight or had a metabolic abnormality such as glucose intolerance.

After four months on the low-carb, mild-protein, high-fat diet, the participants were assessed to check their levels of mental health and obesity. A total of 14 participants were considered full-adherents to the diet (on the ketone diet more than 80% of the time), 6 were classified as semi-adherent (on the diet 60-80% of the time) and 1 was non-adherent (on the diet less than 50% of the time).

Initially, 29 % of the cohort met criteria for metabolic syndrome, a group of health problems that put a person at high risk of type 2 diabetes. After the four-month period, none of the participants met the criteria.

“We’re seeing huge changes,” said Sethi. “Even if you’re on antipsychotic drugs, we can still reverse the obesity, the metabolic syndrome, the insulin resistance. I think that’s very encouraging for patients.”

On average, the participants lost 10% of their body weight, reduced their waist circumference by 11% and had lower blood pressure, body mass indexes, levels of triglycerides, blood sugar and insulin resistance.

The benefits to the participants’ mental health scores were even more striking.

On average, the participants improved 31% on a standard psychiatrist rating of mental illness, known as the clinical global impressions scale. Around three-quarters of the group showed clinically meaningful improvement in overall mental health. The cohort also reported better sleep and greater life satisfaction.

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

Some of the testimonies taken from the participants speak for themselves.

“It can honestly save a lot of lives, it saved mine,” said one participant. “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,” said another, “it worked far better than the lamotrigine [a typical bipolar medication] ever did.”

Sethi and her colleagues say the findings of their pilot study should encourage more research into the growing field of “metabolic psychiatry”, given the proportion of mental health patients seeking alternative treatment.

“Many of my patients suffer from both illnesses, so my desire was to see if metabolic interventions could help them,” she said. “They are seeking more help. They are looking to just feel better.”

This article is a rework of a press release issued by Stanford Medicine. Material has been edited for length and content.

Reference: Sethi S, Wakeham D, Ketter T, Hooshmand F et al. Ketogenic diet intervention on metabolic and psychiatric health in bipolar and schizophrenia: A pilot trial. Psy. Res. 2024. doi: 10.1016/j.psychres.2024.115866