Prospects of the keto diet in treating mental disorders

The essence of ketogenic therapy is that the diet is structured roughly as follows: about 75 % of calories come from fats, approximately 20 % from proteins, and usually less than 10 % from carbohydrates. Because of this ratio, the body stops relying on glucose as the main source of energy and switches to ketones. Psychiatrists and neurobiologists suggest that such a shift in metabolism can alleviate certain neurological and psychiatric symptoms.

For children with epilepsy whose seizures cannot be controlled with medication, the ketogenic diet is already considered the standard of care, as recommended by the Epilepsy Foundation. Currently, studies are emerging that examine it as an additional treatment for schizophrenia, bipolar disorder, and depression in patients who do not respond well to traditional therapy.

The University of Maryland (USA) conducted a study to understand how best to train doctors to work with this method. The team at the Maryland Center for Psychiatric Research developed a two‑stage training program called “Live It ~ Launch It”. Forty specialists from across the country — psychiatrists, clinical pharmacists, psychologists, psychotherapists, and others — took part in the pilot project.

First, all participants completed a four‑hour online course: they studied the basics of ketogenic metabolic therapy, diet options, issues related to nutrition, monitoring of their condition, and possible side effects. Then they were asked to try the ketogenic diet themselves for four weeks under the supervision of dietitians and clinical nutrition specialists. Twenty‑five people chose this format.

It turned out that the combination of theory and personal involvement significantly strengthens doctors’ confidence. They were better at explaining the benefits and risks of therapy to patients, discussed joint decision‑making more freely, and were more willing to involve dietitians in the work. Personal experience turned out to be especially important: it provided a deep understanding of the everyday and psychological challenges that a person faces on such a diet. As Sidney Murray, the lead author of the study, noted, science alone is not enough — when a doctor follows the diet themselves, they have a much better sense of the practical barriers a patient faces.

The study also examines an important nuance. Many people with schizophrenia have associated metabolic problems — weight gain, insulin resistance, and increased cardiovascular risk — which are often exacerbated by antipsychotic medications. If a ketogenic approach can simultaneously support mental health and improve metabolic health, this will be a significant step forward for patients and their families.

The conclusions are still preliminary. More data is needed to understand whether such an approach actually changes real‑world clinical practice. Furthermore, despite the rapid growth in the number of publications, reliable recommendations require randomized controlled trials and long‑term observations to clearly determine under which conditions and in which circumstances the ketogenic diet is safe and effective.

The team is currently preparing a companion publication that will present data on the physical and mental well‑being of the doctors themselves, as well as their nutritional and metabolic indicators over four weeks of the diet. Such information will help refine training programs and plan larger‑scale studies that will show whether ketogenic metabolic therapy can be safely and effectively implemented in routine psychiatric care.