- Antipsychotic medications bring with them challenging metabolic side effects, affecting both patients being treated for severe mental health conditions and healthcare professionals.
- A pilot study by Stanford Medicine suggests that combining a ketogenic diet with standard medication can potentially improve psychiatric symptoms and metabolic health in people with severe mental illnesses.
- However, experts insist on the necessity of further comprehensive research, and advise adherence to more sustainable diet patterns.
About 57.8 million or more adults in the United States are affected by mental health conditions, according to the
Antipsychotic medications are vital for managing symptoms but often cause metabolic side effects such as weight gain and insulin resistance. These side effects to lower the quality of life of individuals receiving treatment and sometimes even lead to treatment discontinuation.
This challenge led Stanford Medicine to conduct a pilot study to explore if a ketogenic diet could provide metabolic and psychiatric benefits for individuals with severe mental health conditions.
In previous studies, the ketogenic diet — rich in fats, low in carbohydrates, and with moderate protein levels — has been seen as effective in managing various conditions, such as
In this pilot study, Stanford Medicine found that using a 4-month ketogenic diet intervention alongside standard medication and treatment might significantly enhance symptoms and improve quality of life in individuals suffering from severe mental health issues and metabolic conditions.
This study is published in Psychiatry Research.
21 adults diagnosed with bipolar disorder (76%) or schizophrenia (24%), who were on antipsychotic medication and were overweight or had metabolic disorders, such as insulin resistance, participated in this 4-month study.
Women accounted for the majority of the participants (62%). The participants were predominantly white (76%) with an average age of 43 years.
The participants, as outpatients received instructions to follow a ketogenic diet with specific macronutrient ratios: 10% carbs, 30% protein, 60% fat.
Participants were not required to count calories, but they were asked to take in a minimum of 1,200 calories a day and to limit their net carbs to approximately 20 grams daily.
A 1-hour training session, educational materials, ketogenic cookbooks, recipes and a personal coach were provided to the participants in order to encourage adherence to the diet.
Included in the dietary instructions were recommendations for daily intake of vegetables, salads, and water. The participants were also guided on how to measure blood ketone levels.
Regular medical and psychiatric evaluations were carried out by a psychiatrist, while additional confirmation from their personal psychiatrists was sought when possible. The participants’ dietary compliance was checked weekly using a blood ketone meter during the study. Their usual psychiatric treatments and medications were maintained throughout the study period.
Out of the 21 participants, 14 strictly adhered to the ketogenic diet. The group that adhered strictly had less severe psychiatric symptoms, fewer cases of schizophrenia and a shorter duration of illness compared to the group that was semi-adherent.
The semi-adherent group had higher obesity rates, poorer cholesterol levels and longer durations of illness.
Medical News Today had a conversation with Uma Naidoo, MD who is a nutritional psychiatrist and author, and was not part of this study. According to Naidoo, it might be a challenge for some individuals with these severe disorders to manage the specifics of a ketogenic diet.
This could explain why participants with more severe disorders showed lower adherence to the diet.
Initially, 29% of the participants met metabolic syndrome criteria, and over 85% had multiple medical conditions such as obesity, hyperlipidemia, or prediabetes. At the end of the study, however, no participants met the metabolic syndrome criteria. This points to the ketogenic diet’s positive impact on metabolic health.
The average loss per participant was 10% in body weight, 11% in waist circumference, 17% in fat mass index, and 6% in systolic blood pressure. Participants also showed improvements in metabolic markers such as HbA1c, triglycerides, inflammation, insulin resistance, and visceral fat.
Better metabolic health was associated with higher ketone levels, which indicated greater adherence to the diet.
Psychiatric improvements were also remarkable, with the severity of mental illness decreasing by 31% as measured by the
Out of those participants who showed symptoms at the beginning of the study, 79% displayed a significant improvement in their psychiatric condition, particularly those who adhered strictly to the diet.
Apart from these, there were also improvements in reported life satisfaction, overall functioning and sleep quality. This further demonstrates the diet’s positive effects.
The study results indicate that a ketogenic diet could reduce symptoms of psychiatric disorders and counter the metabolic side effects of antipsychotic medications.
Nonetheless, Naidoo advised exercising caution while interpreting the findings due to the small size of the study and the lack of a control group.
MNT also had a discussion with Jasmine Sawhne, MD who is a board-certified psychiatrist and was not part of the study. She discussed the potential of the ketogenic diet in improving mental health through alterations in the brain’s chemistry and energy metabolism.
The diet has potential in improving outcomes related to cognitive function and mood stabilization by making the brain rely on ketones rather than glucose for energy, she stated.
This metabolic switch may also improve psychiatric symptoms by reducing
According to Eliza Whitaker, MS, RDN, a registered dietitian nutritionist who was not part of the study, the ketogenic diet’s
She added that improvements in insulin sensitivity and blood glucose might also alleviate psychiatric symptoms associated with metabolic issues.
Moreover, the state of ketosis could enhance
Whitaker, however, noted the necessity for more research to fully understand the effect of a ketogenic diet on mental health. She also raised concerns over the possibility of the recurrence of symptoms once the diet is discontinued.
While antipsychotic medications can be effective for managing psychiatric symptoms, they often come with side effects like weight gain, diabetes, and an increased risk of metabolic syndrome. This presents a health conundrum for patients.
According to Sawhne, the substantial improvements seen in both psychiatric and metabolic outcomes in the current study suggest that the ketogenic diet could be an effective supplementary treatment alongside psychiatric medication.
However, she added:
“At this point, the ketogenic diet is not widely advised to be used in conjunction with treatment for schizophrenia and bipolar disorder due to the limited research available. But preliminary results point towards potential benefits. Like all things in the medical field, this is an evolving topic that warrants further investigation.”
Naidoo showed agreement, stating that while the ketogenic diet might be beneficial for some individuals with schizophrenia and bipolar disorder, it doesn’t mean these individuals should discontinue their current medications or change their treatments without the guidance of a physician.
To ensure safety and effectiveness, the blend of dietary approaches and psychiatric treatments must be carefully monitored and adjusted by healthcare professionals.
A significant concern for researchers and healthcare professionals is the long-term sustainability of the ketogenic diet, despite early positive results.
Sawhne cautioned saying:
“The implementation of the ketogenic diet over the long term for the management of psychiatric conditions may lead to potential nutrient deficiencies and alterations in gut microbiomes. Currently, there is limited research available on its efficacy and safety in this context.”
Sanam Hafeez, PsyD, a New York City neuropsychologist and director of Comprehend the Mind, who was not involved in the study, also expressed worries about possible long-term effects of the ketogenic diet. These include nutritional deficiencies, gastrointestinal problems, bone health issues, and the potential for developing disordered eating due to the restrictive nature of the diet.
Hafeez suggested considering sustainable, long-term dietary methods, such as plant-based diets and the Mediterranean diet, mindful eating and personalized nutrition for all-encompassing benefits to health.
Sawhne made similar recommendations for improving mental health through diet. This involved focusing on a balanced diet that is rich in fruits, vegetables, lean proteins, healthy fats, and whole grains, while limiting the intake of processed foods, sugar, and excessive caffeine.
“It may also support mental well-being to incorporate omega-3 fatty acids, foods that are rich in magnesium, and probiotics,” she added.
Whitaker agreed with this, and suggested that the inclusion of fermented foods such as yogurt, sauerkraut, and kimchi may improve mental health since approximately
Whitaker emphasized that it’s essential to eat a diet that is rich in whole foods and to consult with a doctor to check for nutrient deficiencies that could be affecting
This pilot study’s findings on the impact of the ketogenic diet on bipolar disorder and schizophrenia seem promising for the concurrent management of psychiatric symptoms and metabolic health.
However, according to Sawhne, randomized controlled trials that are larger in scale are required to substantiate these initial findings and to understand the long-term implications of a ketogenic diet in psychiatric care.
The lack of a dietary history of the participants in the study means that the noted improvement could be due to an overall increase in the quality of the participants’ diets during the period of monitoring, Whitaker pointed out.
This underlines the significance of understanding the dietary interventions’ context in mental health.
In spite of the study’s limitations, according to Whitaker: “The overall new findings are exciting as they have the potential to greatly improve the lives of people who wrestle with these conditions.”
- 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
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
Now, Stanford Medicine’s pilot study had 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 instructionz 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
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
Eliza Whitaker, MS, RDN, a registered dietitian nutritionist not involved in the study, emphasized the ketogenic diet’s
She noted that improvements in blood glucose and insulin sensitivity might also alleviate psychiatric symptoms connected to metabolic issues.
Additionally, ketosis may enhance
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
It is crucial to eat a diet rich in whole foods and consult with your doctor to check for nutrient deficiencies affecting
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.”