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A paper published recently in Frontiers in Psychiatry highlights the potential effect of ketogenic diets with refractory mental illness. Considering that this very low-carbohydrate nutritional strategy was originally developed a century ago as a dietary therapy for intractable epilepsy, it’s clear that keto has unique salutary effects on the brain and central nervous system. Research is now expanding to see if this way of eating may have efficacy for psychiatric disorders, and results so far are encouraging.
The paper, published in July 2022, is a retrospective analysis of results from 28 individuals in inpatient treatment in a psychiatric hospital for “severe, persistent mental illness (major depressive disorder, bipolar disorder, and schizoaffective disorder) whose symptoms were poorly controlled despite intensive psychiatric management.” Patients were supervised in following a strict ketogenic diet (maximum of 20 grams of carbohydrate per day) as an adjunct to conventional inpatient care. Three protocol-compliant meals per day were provided along with one snack plus select nutritional supplements.
The duration of the diet depended on the length of hospitalization and ranged from a minimum of 14 days up to 248 days. Patients following the diet had substantial improvements in indices of depression and the Clinical Global Impressions Severity Scale. By the end of the intervention, the number and/or dosage of psychotropic medications was reduced in 18 of the 28 subjects (64%), and 5 out of 7 patients also taking non-psychotropic medications had reductions in, or discontinuation of insulin, atorvastatin, ticagrelor, metformin and other diabetes drugs. Patients experienced significant improvements in measures of cardiometabolic health as well, such as blood pressure, fasting glucose, body weight and body mass index (BMI), triglycerides, and in some cases, liver function tests.
Weaknesses of this study are that it was non-randomized and there was no control group. The subjects may have served as their own controls, though: all had previously been hospitalized in the same facility under the care of the same physician (lead author of the paper) or in a similar affiliated facility with “minimal clinical improvement.” Non-dietary interventions had proven ineffective for them in the past and none had ever attempted to follow a low-carbohydrate diet before.
This was a small study, and obviously more research is needed in this area. But this is a notable addition to the growing body of evidence suggesting ketogenic diets may be worth trying for patients living with mental illness.
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