Keto diet shows early promise for serious mental illness

keto diet – After decades of studying how ketosis changes the brain, several small trials are now suggesting ketogenic diets may ease symptoms in conditions including treatment-resistant depression, bipolar disorder, schizophrenia and anorexia nervosa. The findings are pr

The brain is an engine that rarely shuts off. Even though it makes up just 2 percent of the body’s mass. it consumes about 20 percent of its energy—usually by running on glucose produced from carbohydrates. But when glucose is scarce, the brain can switch to fat-derived compounds called ketone bodies.

That metabolic switch is ketosis. It’s what happens on a ketogenic, or keto, diet—an eating regimen high in fat and low in carbs. Scientists have been circling the connection between ketosis and the brain since the early 1920s. when the diet was introduced as a therapy for treatment-resistant epilepsy in children. Some studies have also suggested it could help with symptoms of Alzheimer’s disease.

Now. results from several small trials are adding momentum to a harder question: could keto also help treat mental health conditions that include depression. bipolar disorder. schizophrenia and anorexia nervosa?. The results are preliminary. Randomized controlled trials are underway to better evaluate who might be helped by the diet and how much it might benefit them. Still. together. the findings support a theory that some mental illnesses may be metabolic disorders—conditions in which the brain’s ability to derive energy from its preferred sources becomes compromised.

For Chris Palmer, a psychiatrist who studies metabolism at Harvard Medical School, the implications go beyond dietary trends. “It’s really forced me to rethink how I understand mental illness,” he says.

A metabolism link already has a track record in psychiatry. Isaac Marin-Valencia. a neurologist studying metabolic diseases at the Icahn School of Medicine at Mount Sinai. puts it bluntly: “Metabolism is basically the backbone of physiology.” Without it. “life wouldn’t be possible. ” he adds. making it less surprising that “pretty much any human disease [has] some metabolic component.”.

People with psychiatric conditions such as depression. bipolar disorder and schizophrenia are known to be at higher risk of metabolic diseases including diabetes. obesity and polyendocrine metabolic ovarian syndrome—PMOS. formerly polycystic ovary syndrome or PCOS. The reverse is also true: people with metabolic disorders are more likely to have psychiatric illnesses. In serious mental illnesses, disruptions to glucose metabolism in the brain are often part of the picture. In bipolar disorder. for example. people whose brains were inefficient at turning glucose into energy showed earlier and more frequent symptoms.

That background is part of the reason ketosis attracts attention. A ketogenic diet bypasses glucose by providing an alternate fuel source, and early studies suggest it may help.

In February. a randomized controlled trial with 88 participants reported that people with treatment-resistant depression who followed a strict keto diet experienced a small improvement in symptoms compared with a control group. Smaller pilot trials have also found improvements in bipolar disorder and schizophrenia symptoms. Importantly, participants in those studies remained on their medications to treat their conditions. At least five randomized controlled trials are currently underway to test the effects of the diet more rigorously.

Shebani Sethi, a metabolic psychiatrist at Stanford University, is careful with the language. “These research results are early; they’re preliminary. But it definitely gives us a signal that we should explore further.”

What’s doing the work in the body and brain isn’t likely to be one single mechanism. Palmer says the effect is probably driven by multiple factors beyond simply changing the brain’s fuel. Ketosis may shift the balance of two essential neurotransmitters: glutamate and gamma-aminobutyric acid. known as GABA. which respectively excite and inhibit neuronal firing. This kind of regulatory influence helps explain why the diet can treat epilepsy. and it could play a role in other conditions as well. Ketosis also supports the overall function of mitochondria—the powerhouses of cells that create the molecules brain cells use as energy. And the diet appears to reduce inflammation throughout the body. a factor intertwined with many mental illnesses; easing inflammation may indirectly improve symptoms.

All of this arrives with a second, more personal set of stakes—especially for anorexia nervosa, a diagnosis where food and weight are often at the center of daily life.

This month. a small study found that the keto diet improved eating disorder symptoms in people with anorexia nervosa who were either mildly underweight or had managed to get back to a healthy weight. The idea of using a highly restrictive diet to treat a highly restrictive eating disorder can feel paradoxical. “It’s kind of paradoxical,” says the study’s lead author Guido Frank of the University of California, San Diego.

But the paradox comes with nuance. The keto diet limits the food groups that people can eat, but it doesn’t necessarily restrict calories. In the trial, participants didn’t experience clinically significant weight loss while on the diet.

One co-author. Caroline Beckwith. a wellness coach who acted as a counselor for participants. describes the change in her own recovery story. She had recovered from anorexia nervosa after being treated with the keto diet. Before following it, “I was so scared of eating fat. That was a whole food group I didn’t eat,” Beckwith says. When she didn’t gain weight on keto, she felt encouraged to keep it up.

Within weeks, she says, there was a moment that stuck: the first day in many years in which she wasn’t preoccupied with food restriction and exercise. “I realized, at the end of the day, that was hours and hours of not having any anorexic thoughts,” Beckwith adds.

Even if those accounts are compelling. both Palmer and Sethi stress that anyone considering a ketogenic diet for mental illness must speak with a doctor first. The diet can interact with psychiatric medications in unpredictable ways. and it can trigger episodes of mania—including in people with no psychiatric history. For Palmer, the warning is direct: “Please don’t attempt to do this on your own.”.

The temptation to see one treatment stretching across multiple diagnoses is understandable. Alzheimer’s and depression often occur together, which suggests some shared biological mechanisms could underlie both. Other conditions also show overlapping relationships: bipolar disorder and schizophrenia. for example. may fit within a broader spectrum of conditions than today’s diagnostic categories reflect.

More broadly, metabolism is increasingly being linked to a range of health problems. That has fueled interest in metabolic treatments—whether diets. drugs or exercise regimens—as possible tools that reach far beyond one symptom. GLP-1 medications. for example. primarily target metabolism and weight. but they also affect the brain. helping reduce the risk of substance use and some eating disorders.

“Metabolism affects every cell, tissue and organ in your body,” Palmer says. A therapy aimed at metabolic dysfunction, he adds, “can end up being a powerful treatment.”

For now, the evidence is still small and incomplete. The promise is real, the risks are real, and the next answers will come from larger randomized controlled trials—especially as clinicians work to determine who might benefit, and how to do it safely.

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