Keto diet could reduce symptoms of bipolar disorder, schizophrenia

A pilot trial on the effect of a ketogenic diet on people with schizophrenia or bipolar disorder with metabolic abnormalities found significant improvements in both metabolic and psychiatric issues. Led by a researcher at Stanford, it tested the effect of the diet over four months, while patients stayed on their regular psychiatric medications. Researchers found that nearly four-fifths of participants had clinically meaningful improvements in their psychiatric symptoms. The average improvement in the Clinical Global Impressions severity was 31%. Physically, they lost an average of 10% of their weight. While nearly one-third of participants met the criteria for metabolic syndrome at the beginning of the study, none did by the end of the study.They did have side effects, such as headache, fatigue, and constipation, but they didn’t persist past the first three weeks of the diet. Read: Metabolic adverse effects of antipsychoticsThe trialDr. Shebani Sethi, founder and director of the metabolic psychiatry clinic at Stanford Medicine, led the single-arm trial. It recruited five adults who had schizophrenia and 16 with bipolar disorder, all of whom were taking psychotropic medications. The participants also had metabolic issues, with participants falling into one of two groups. Either they were overweight and had gained more than 5% of their overall weight while using psychotropic medicines, or they had one or more metabolic abnormalities, such as insulin resistance.They attended an hour-long session on the ketogenic diet, and the researchers provided access to a health coach, cookbooks, and other resources, such as recipes. Dr. Sethi became interested in what she later coined as metabolic psychiatry after she saw a patient with treatment-resistant schizophrenia have their auditory hallucinations lessen on a ketogenic diet. That led her to research the effect of keto diets on the brain, including case studies about schizophrenia and evidence of its effectiveness for treatment-resistant epileptic seizures. She wondered if it could impact mental health. “Many of my patients suffer from both [obesity or metabolic syndrome and serious mental illness], so my desire was to see if metabolic interventions could help them,” Dr. Sethi said. “They are seeking more help. They are looking to just feel better.”Read: Your body already has a built-in weight loss system that works like Wegovy, Ozempic and Mounjaro—food and your gut microbiomeMental health improvementThroughout the trial, 14 patients were fully adherent, as measured by blood ketone level testing. Six were semi-adherent, and one was non-adherent. The adherent group had higher rates of mental health improvement. According to Clinical Mood Monitoring assessments, 33% of participants were in a recovery state at the beginning of the study, and 75% were by the end. All of those in the adherent group were in the recovered state at the end of the four months. People with schizophrenia had their symptoms improve by an average of 32%, as measured by the the Brief Psychiatric Rating Scale. For people with bipolar disorder, 69% had an improvement of more than one point in Clinical Global Impressions. Meanwhile, 17% of participants had increased life satisfaction, and 19% reported better sleep. The study quoted participants directly on the improvements to their quality of life. "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,” one participant said. Another said, “My opportunity to participate in the [study] transformed my life. I gained knowledge, became able-bodied again, and my mood disorder and eating disorder symptoms lessened dramatically. I became sexually active again after 16 years of celibacy.”Read: A pharmacist’s guide to managing bipolar disorderMetabolic improvementOn average, those who adhered to the diet lost 12% of their weight, 13% of their waist circumference, and 36% of their visceral adipose tissue. They also had a 27% drop in their HOMA–IR and a 25% drop in their triglyceride levels. Insulin resistance and obesity are common side effects of antipsychotic medications, which can cause some patients to stop taking their drugs. People with major mental illness have a higher risk of type 2 diabetes and die prematurely, mainly from cardiovascular disease. And insulin resistance, which has been linked to schizophrenia, can contribute to cognitive impairment. The researchers called for further studies, including randomized controlled trials, on the keto diet and people with serious mental illness, as well as more research into how mental health and metabolic health are connected. “What we are eating does affect the brain,” Dr. Sethi said in a story on the Stanford website. “It affects brainpower. It affects cognition. Mechanistically, we’re trying to better understand why, but this pilot basically tells us that it’s an encouraging intervention that’s helping patients, whether it’s psychiatric outcomes, mental health symptoms, or whether it’s metabolic outcomes.” Read: Obesity drug Wegovy is approved to cut heart attack and stroke risk in overweight patients

Keto diet could reduce symptoms of bipolar disorder, schizophrenia

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