The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of 31 Inpatients

Abstract

Background and HypothesisThe robust evidence base supporting the therapeutic benefit of ketogenic diets in epilepsy and other neurological conditions suggests this same metabolic approach may also benefit psychiatric conditions.Study DesignIn this retrospective analysis of clinical care, 31 adults with severe, persistent mental illness (major depressive disorder, bipolar disorder, and schizoaffective disorder) whose symptoms were poorly controlled despite intensive psychiatric management were admitted to a psychiatric hospital and placed on a ketogenic diet restricted to a maximum of 20 grams of carbohydrate per day as an adjunct to conventional inpatient care. The duration of the intervention ranged from 6 to 248 days.Study ResultsThree patients were unable to adhere to the diet for >14 days and were excluded from the final analysis. Among included participants, means and standard deviations (SDs) improved for the Hamilton Depression Rating Scale scores from 25.4 (6.3) to 7.7 (4.2), P < 0.001 and the Montgomery-Åsberg Depression Rating Scale from 29.6 (7.8) to 10.1 (6.5), P < 0.001. Among the 10 patients with schizoaffective illness, mean (SD) of the Positive and Negative Syndrome Scale (PANSS) scores improved from 91.4 (15.3) to 49.3 (6.9), P < 0.001. Significant improvements were also observed in metabolic health measures including weight, blood pressure, blood glucose, and triglycerides.ConclusionsThe administration of a ketogenic diet in this semi-controlled setting to patients with treatment-refractory mental illness was feasible, well-tolerated, and associated with significant and substantial improvements in depression and psychosis symptoms and multiple markers of metabolic health.

Research progress on the effects of ketogenic diet on central nervous system diseases

“…When MPC1 is deficient, it may cause neurological diseases such as epilepsy. High-fat and low-carbohydrate diet can reduce the ratio of NADH/NAD+, promote the production of cytoplasmic aspartate in the cytoplasmic part of MAS, and provide fatty acids and ketone bodies as alternative substrates to replace TCA cycle to bypass the above defects, so as to achieve the role of auxiliary treatment of mitochondrial diseases and protection of nerves [16].…”

Statin therapy is not warranted for a person with high LDL-cholesterol on a low-carbohydrate diet

“…Modest dietary changes can be more effective in the treatment of metabolic syndrome than commonly used antidiabetic drugs in improving CVD risk [163]. Specifically, improvement in the cluster of components of metabolic syndrome is intimately connected with carbohydrate restriction in adults [164–167,168 ▪ ,169 ▪ ,170 ▪ ,171,172 ▪▪ ,173–177,178 ▪▪ ,179–180,181 ▪ ] and in adolescents [182]. LCDs have been shown to improve other CVD risk factors, as well, such as visceral fat, blood pressure, Lp(a) and inflammation [183–189].…”

“…LCDs have been shown to improve other CVD risk factors, as well, such as visceral fat, blood pressure, Lp(a) and inflammation [183–189]. It is therefore highly relevant that LCDs have been studied in numerous RCTs and case reports which show improvement in glucose, lipid and insulin-based CVD risk factors, including an LCD-mediated reduction in the need for hypoglycemic medication [178 ▪▪ ,190,191 ▪ ,192,193 ▪ ,194 ▪ ,195,196 ▪ ,197,198 ▪▪ ,199 ▪ ].…”

A Pilot Study of a Ketogenic Diet in Bipolar Disorder: Clinical, Metabolic and Magnetic Resonance Spectroscopy Findings

“…1, 2 Preliminary data from case reports and retrospective analyses have suggested that a ketogenic diet may also have beneficial effects in bipolar disorder. 3, 4, 5…”