Shop
-1.png)
eStoreRx™
Online Supplement Dispensary
eStoreRx™ is an easy direct-to-patient ordering & fulfilment program for lifelong wellness.
Keto diets are perhaps most popular for weight loss, but a growing body of research as well as increasing numbers of patient anecdotes support the use of keto for mental health. The ketogenic diet was originally developed over a century ago as a treatment for intractable epilepsy, so it has long been recognized that this approach has unique effects on the brain and central nervous system. Keto is still used for seizure disorders today, and carbohydrate restriction for mental health concerns has produced quite promising outcomes so far. This new frontier has spurred the creation of a sub-specialty called metabolic psychiatry, with researchers and clinicians at Stanford University and McLean Hospital (Belmont, MA) leading the way. Here, we’ll highlight recent publications on the use of ketogenic diets for a variety of psychiatric conditions.
Schizoaffective disorder
Previous research has shown the efficacy of ketogenic diets (KDs) in leading to significant improvements in psychiatric measures in individuals with bipolar disorder and schizophrenia. A more recent case series published in Frontiers in Nutrition reported on two subjects who experienced remission of psychotic symptoms associated with schizoaffective disorder through following a KD.
The first subject was a 17-year-old girl who “achieved full remission of severe suicidal ideation, hallucinations, and anxiety within 6 weeks, with sustained improvements at a 24-week follow-up.” The second subject was a 32-year-old female who “achieved full remission of chronic psychotic and mood symptoms by 6 months.” At the time of implementing the diet, the first subject was taking olanzapine, buspirone, bupropion, and fluoxetine, “with prior psychotherapy and medications providing little improvement.”
The diet was supplemented with a methylated B-complex, trace minerals, acetyl-L-carnitine and other compounds, and blood glucose and ketones were measured daily to monitor compliance. Within 6 weeks of implementing the diet and supplement protocol, the first subject reported complete resolution of suicidal ideation, depression, anxiety, and hallucinations. By the 24-week follow-up, she had discontinued all medications except fluoxetine, for which she was actively tapering under provider guidance.
The second subject had a similarly remarkable experience, with improvements in self-reported metrics as well as improvements in scores in clinically validated measures of anxiety and depression. As reported in the paper, when asked about her experience using ketogenic metabolic therapy, subject 2 stated:
“It’s hard to think about how my life may have played out differently had I been offered this intervention earlier in the course of navigating my illness. I absolutely wish ketogenic therapy and metabolic therapies would have been shared with me as a viable option as early as possible.”
Major depression
Another recent paper in Frontiers in Nutrition presented the case report of a 47-year-old woman who experienced complete remission of decades-long major depressive disorder (MDD) within 8 weeks of following a supervised KD.
The subject had experienced severe depressive symptoms beginning at age 13. She described herself as “barely functioning”, with debilitating low mood and fatigue, and struggling to initiate daily tasks and maintain basic self-care. She adopted a ketogenic diet after learning from a family member about its potential mental health benefits. Prior to trying this approach, she had followed a vegan diet for 15 years, during which she was diagnosed with iron deficiency anemia. She took prescribed iron supplements but experienced no improvement in her mood or energy levels. Transitioning to a Mediterranean diet also failed to have any impact on her condition. Psychotherapy offered “only limited benefits” and she had discontinued duloxetine owing to unacceptable side-effects.
She implemented a pescatarian ketogenic diet along with virtual support from a psychotherapist and a keto-informed nutrition professional. The diet consisted of fish and shellfish, eggs, dairy foods, and plant-based protein sources such as vegan “steak” and plant “chicken.” Avocados, olive oil, medium chain triglyceride (MCT) oil, heavy cream, nuts and nut butters were the primary fat sources, and the diet also included small amounts of low-carbohydrate vegetables and berries. In addition to the diet, the subject took a host of supplements, including a methylated B-complex, trace minerals, fish oil, and acetyl-L carnitine.
The subject’s Patient Health Questionnaire (PHQ-9) score went from 25 (severe depression) to zero within two months and this was maintained at four months post-intervention. She reported “relief from the pervasive sadness and emotional dysregulation she had experienced in depressive episodes.”
It is worth noting that the subject remained weight-stable throughout the intervention. There was no significant change in her body weight or body mass index (BMI). She self-selected a ketogenic diet with the specific goal of improving her depressive symptoms rather than being motivated by weight loss. Keto is not automatically a weight loss diet. Depending on how it’s implemented, it can be a weight-normalizing diet: for those who are overweight, weight loss can be achieved, weight can be maintained (even while metabolic health improves), and those who are dangerously underweight can gain needed, healthy weight.
Obsessive-compulsive disorder
Two papers published recently demonstrate the efficacy of ketogenic diets for obsessive-compulsive disorder (OCD). The first, published in Frontiers in Psychiatry, covers the care report of a 37-year-old woman who sought treatment at a specialized metabolic psychiatry clinic. Specifically, she was seeking to reduce persistent OCD (with a 25-year history), anxiety and depression, as well as to lose weight. Her mental health issues had persisted despite use of sertraline, bupropion, and cognitive behavioral therapy (CBT). She also had psoriasis, Hashimoto’s disease, atopic dermatitis, and a 5-year history of moderately severe ulcerative colitis (UC), confirmed via histopathology.
The subject’s major depression remitted within 9 weeks of implementing a KD and her OCD was in complete remission within 12 weeks. Over the course of 12 weeks of ketogenic treatment, she lost over 9 percent of her body weight (21 pounds) and her body fat percentage decreased by 3 percent. Notably, the subject had not been expecting an improvement in her psoriasis or UC, but within only 3 weeks, her psoriatic plaques cleared and the UC was in clinical remission: “All cramping and bloody diarrhea ceased, and stool frequency/form normalized to one stool per day.” (She had previously reported spending two hours in the bathroom every morning, with cramping and five episodes of bloody diarrhea daily.)
The paper includes this perspective in this subject’s own words, from early and later on in the study:
Early: “I’m surprised that this is not harder, and that I’ve lost so much weight so easily where I couldn’t ever before. […] Mid to late: “I am so much better overall. When I got a GI bug, [my gut] was OK after two days, and that never would have happened before—I’d be symptomatic for weeks–this is so different it’s incredible.”
The second paper on keto for OCD, published in Frontiers in Nutrition, presents a case series of three patients (one male, two female, ages 22-47), all of whom experienced complete remission of OCD using a ketogenic diet. Histories ranged from nearly lifelong symptoms to symptoms developing with post-partum depression at age 28, a subject needing to leave college owing to thoughts of harming others, and a subject’s child being temporarily relocated with a family member due to the subject’s thoughts of harming the child. Average Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores decreased by 21 points, or 90 percent. All three patients had tried either CBT or multiple medications, with only limited relief. In all three cases, deviation from the KD resulted in a return of symptoms, with subsequent relief upon re-adherence.
In their own words:
“The ketogenic diet was transformative for resolving my OCD, mood disorders, and focus issues. Without making the changes to my diet that I did, I would not have had the mental wherewithal to perform well enough in high school to get into Harvard, much less college.” (Patient 1, a 22-year-old male.)
“I used to tell myself in the depths of OCD, ‘The only way out is death,’ as a kind of mantra to put things into perspective. I’m happy to say I found another way. It would make me really happy if others knew about ketosis as a way to end their suffering.” (Patient 2, a 35-year-old female.)
“Before eliminating sugars and grains from my diet, the best way to describe me was hollow, a shell of a person who could not fully engage in life. I feel like I missed the best part of my children’s young lives, sedated and overwhelmed by my thoughts. Now, I enjoy the person I am today—alive, active, and determined not to miss another second.” (Patient 3, a 47-year-old female.)
These results demonstrate the power of ketogenic diets to facilitate dramatic improvements in quality of life among those who have spent decades debilitated by compromised mental health.
(See this 2024 review for a detailed overview of the etiology of OCD, its overlap with metabolic syndrome and mitochondrial dysfunction, and the mechanisms by which ketogenic and metabolic therapies may be exerting their beneficial effects.)
Treatment resistance
These remarkable case studies are even more impressive when we consider that each of the subjects had already tried multiple medications and/or other therapies for their conditions, with lackluster results. Ketogenic metabolic therapy appears to be effective for patients even when years of other interventions have failed or had only minimal benefit.
More than one “keto diet”
It’s important to note that there isn’t just one “keto diet.” Different approaches can be used to achieve the metabolic and mental health effects of nutritional ketosis. Ketosis is a physiological state that can be induced via very low carbohydrate intake, moderate protein, and high fat. Heavy inclusion of animal proteins and fats is not required. It is not necessary to avoid animal foods for health reasons, but for those who prefer to do so, ketogenic diets can be pescatarian or even vegetarian or vegan. However, vegetarian sources of protein—such as beans, nuts, and seeds—may be too high in carbohydrate or fat, respectively, to support a therapeutic level of ketosis or to facilitate fat loss (if fat loss is desired).
Ketogenic diets are not a “fad”
It is time to end the stigma surrounding ketogenic diets as being a dangerous fad. It’s unfortunate that such a powerful therapeutic option has so much “baggage” and so many misunderstandings attached to it that may prevent medical professionals from learning more about it and adding it to their treatment repertoire. For this reason, researchers and clinicians are increasingly using the terms “ketogenic metabolic therapy” and “therapeutic carbohydrate restriction” to distinguish the safe, powerful, and efficacious application of this very-low-carbohydrate way of eating as a treatment strategy, as opposed to the hyperbolic and potentially dangerous ways “keto” is portrayed in social media.
Submit your comment