Can a ketogenic diet help improve mental health symptoms? Researchers have found that this dietary intervention brings significant metabolic and psychiatric improvements in patients with serious mental illnesses such as schizophrenia and bipolar disorder.

Treatment with antipsychotic medications can be beneficial for individuals with serious mental illnesses. However, these medications can also cause metabolic side effects such as insulin resistance and obesity, which may lead many patients to stop taking the medication.

As per the results of a pilot study published in Psychiatry Research, adopting a ketogenic diet — low in carbs and high in fat — while continuing medication restores metabolic health and improves psychiatric conditions.

"It's very promising and very encouraging that you can take back control of your illness in some way, aside from the usual standard of care," said Dr. Shebani Sethi, the first author of the study from Stanford Medicine.

"The ketogenic diet has been proven 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 psychiatric conditions," Sethi said.

During the four-month pilot trial, 21 adult participants with schizophrenia or bipolar disorder were asked to follow a ketogenic diet. This diet plan comprised roughly 10% of calories from carbohydrates, 30% from protein, and 60% from fat. The participants were on antipsychotic medications and had metabolic disorders such as weight gain, insulin resistance, hypertriglyceridemia, dyslipidemia, or impaired glucose tolerance.

Throughout the trial, the participants underwent various psychiatric and metabolic assessments. "On average, the participants lost 10% of their body weight; reduced their waist circumference by 11% percent; and had lower blood pressure, body mass index, triglycerides, blood sugar levels, and insulin resistance," the researchers wrote in the study.

The team also noted striking psychiatric benefits, including better sleep and greater life satisfaction in the participants. "On average, the participants improved 31% on a psychiatrist rating of mental illness known as the clinical global impressions scale, with three-quarters of the group showing clinically meaningful improvement," they added.

At the end of the trial, researchers examined how well the participants adhered to the prescribed diet by measuring blood ketone levels. The results showed that 14 patients were fully adherent, six were semi-adherent and one was non-adherent.

"We saw more benefit with the adherent group compared with the semi-adherent group, indicating a potential dose-response relationship," Sethi said.

Studies have shown that mental illnesses like schizophrenia and bipolar disorder might originate from metabolic deficits in the brain, affecting how brain cells function. The researchers believe that a ketogenic diet, which helps improve overall body metabolism, can also improve brain metabolism.

"Anything that improves metabolic health in general is probably going to improve brain health anyway. But the ketogenic diet can provide ketones as an alternative fuel to glucose for a brain with energy dysfunction," Sethi explained.