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What is the Ketogenic Diet?

Ketosis is a state where the body is forced to rely on fat rather than carbohydrates for energy production. Think of it as switching to a cleaner fuel, as if you switched from running your car on diesel to natural gas. By running a cleaner fuel through your engine, everything works more efficiently and effectively.

When carbohydrates are in short supply, our bodies produce ketones for energy production from the breakdown of fat. This can occur overnight, when we fast or when our diet is lacking in sugar and starch. Ketones are a type of alternative fuel for the body that appear to be protective of the brain when glucose is in short supply.

By changing the fuel that the brain runs on from glucose to fat—through a process called ketosis—it may be possible to reverse and heal some of the damage underlying these mental health conditions.

Some of the latest research is starting to suggest that replacing carbohydrates in the diet with fat and protein may help treat Alzheimer’s disease, bipolar disorder and schizophrenia.

The Keto Diet for Alzheimer’s, Bipolar Disorder and Schizophrenia

As we begin to develop a better understanding of the underlying causes of mental illness, we also start to understand how a ketogenic diet—a diet low in carbohydrates and high in fat—can help to heal these patients. While initially explored for treating epilepsy and seizures, the ketogenic diet is now being studied for an array of different pathologies, from mental health to cancer.

While we still need additional clinical trials, a number of case reports and small preliminary clinical trials show significant improvement in symptoms of patients struggling with schizophrenia, dementia and bipolar disorder (Phelps 2013, Sarnyai 2020, Wlodarek 2021).

Part of the mechanism that engages the healing response from ketosis involves insulin, a crucial compound for our body’s blood sugar balance. Insulin resistance, often thought of only in the context of diabetes, refers to a problem in the ability to utilize insulin to uptake glucose for fuel. Yet more recently, it’s increasingly being recognized as an underlying component in psychiatric and neurodegenerative diseases as well.

Alzheimer’s disease has even been labeled diabetes type three. The causes of insulin resistance and blood sugar problems can stem from any number of sources, including infections, genetics, toxicity, inflammation, lack of exercise, visceral fat and diet.

Regardless of the cause, insulin resistance leads to the same endpoint. As the condition takes hold, the function of insulin for shuttling glucose into cells gets disrupted, typically raising blood sugar levels. And as blood sugar levels rise, the process of glycation, a type of tissue damage, ensues.

It’s now thought that insulin resistance, and the damage from elevated blood sugar, looks to be a strong factor in the development of mental illness, including Alzheimer’s disease and cognitive decline.

On average, over half of patients with bipolar disorder have blood sugar problems, typically characterized by insulin resistance. And bipolar patients with blood sugar dysregulation are three times more likely to have a severe, unremitting case (Lojko 2019).

It is also recognized that individuals struggling with schizophrenia commonly have insulin resistance and impaired glucose metabolism, even before treatment with antipsychotics known to affect blood sugar metabolism (Dasgupta 2010).

Research has also started to uncover impressive benefits in switching to a ketogenic diet for such patients. Low-carbohydrate, ketogenic diets regulate energy production, reduce insulin resistance, heal mitochondria and improve symptoms in patients.

In an observational study of 165 online posts on a forum exploring the ketogenic diet and bipolar symptoms, a majority of individuals reported improvements with a ketogenic diet. Just over 12% reported achieving full remission, with another 44.2% reporting significant mood stabilizing effects (Campbell 2019). Other diets discussed on the online forum, including a vegetarian diet and a diet high in omega-3 fats did not appear to have the same level of benefits. Due to the findings, the authors have even postulated the underlying mechanisms by which the ketogenic diet may correct certain pathways and relieve oxidative stress (Campbell 2020).

Animal models of schizophrenia show that ketones bypass problems in energy production in the cell’s energy-producing mitochondria. Researchers have further demonstrated that ketogenic diets in mice rebalanced a key receptor thought to underlie the pathology of psychosis and other mental health conditions. The research found that a ketogenic diet helped to normalize N-methyl-D-aspartate (NMDA) receptor function while reducing the toxicity of the excitatory neurotransmitter glutamate. These effects prevented the development of schizophrenia-like symptoms in treated animals (Kraeuter 2018).

The data on the ketogenic diet and its brain healing effects appears quite promising.

Considering the challenges in treating schizophrenia, bipolar disorder and Alzheimer’s disease, the simplicity of a ketogenic dietary treatment approach stands out as a potential option for patients struggling with these disabling conditions. While it should not be seen as a cure-all, the ketogenic diet and therapeutic ketosis, especially when combined with an overall integrative and functional medicine approaches, can still be a powerful addition to mental health treatment.

This is one of the primary reasons we believe in functional and metabolic medicine training at Psychiatry Redefined. Traditional psychiatry has been slow to adopt nutritional and metabolic medicine, yet educating mental health providers in these whole-body approaches is an absolutely essential part of effective mental health care. Transforming the field of psychiatry begins with providing the latest nutritional data, diet interventions, and metabolic strategies to help practitioners formulate precise, personalized treatment for mental illness.

If you’re ready to join this movement, we encourage you to enroll in our flagship training, the Fellowship in Functional & Integrative Psychiatry. This popular training includes over 300+ hours of research-backed curriculum on how to treat the root causes of mental illness. It’s the best value for busy clinicians who want to enhance their practice with science-backed protocols and deliver real patient wellness, particularly for drug-resistant patients. Our goal is to provide comprehensive training to as many clinicians as possible – and positively transform as many patient lives as possible with whole-person care. Learn more about the Fellowship and book a private discovery phone call with Dr. Greenblatt to learn more today!

Want to learn breakthrough nutritional and metabolic strategies to help your patients? Check out our popular Fellowship program! Book a private phone call with Dr. James Greenblatt to learn more.

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Phelps JR, Siemers SV, El-Mallakh RS. The ketogenic diet for type II bipolar disorder. Neurocase. 2013;19(5):423-426. doi:10.1080/13554794.2012.690421

Włodarek D. Food for thought: the emerging role of a ketogenic diet in Alzheimer’s disease management. Expert Rev Neurother. 2021;21(7):727-730. doi:10.1080/14737175.2021.1951235

Lojko D, Owecki M, Suwalska A. (2019), Impaired glucose metabolism in bipolar patients – the role of psychiatrists in detection and management. Int J Environ Res Public Health. 2019;16(7):1132.

Dasgupta A, Singh OP, Rout JK, Saha T, Mandal S. Insulin resistance and metabolic profile in antipsychotic naïve schizophrenia patients. Prog Neuropsychopharmacol Biol Psychiatry. 2010;34(7):1202-1207. doi:10.1016/j.pnpbp.2010.06.011

Campbell IH, Campbell H. Ketosis and bipolar disorder: controlled analytic study of online reports. BJPsych Open. 2019;5(4):e58. Published 2019 Jul 4. doi:10.1192/bjo.2019.49

Campbell I, Campbell H. Mechanisms of insulin resistance, mitochondrial dysfunction and the action of the ketogenic diet in bipolar disorder. Focus on the PI3K/AKT/HIF1-a pathway. Med Hypotheses. 2020;145:110299. doi:10.1016/j.mehy.2020.110299

Kraeuter AK, van den Buuse M, Sarnyai Z. Ketogenic diet prevents impaired prepulse inhibition of startle in an acute NMDA receptor hypofunction model of schizophrenia. Schizophr Res. 2019;206:244-250. doi:10.1016/j.schres.2018.11.011