Could a ketogenic diet eventually become part of treatment for conditions such as schizophrenia, bipolar disorder or depression? Researchers are increasingly studying the possibility, but the evidence isn't settled yet.
That's important context for a new University of Maryland School of Medicine study examining ketogenic diets in mental health care. Despite growing interest in their potential psychiatric benefits, this study did not test whether keto improves mental illness. Instead, researchers wanted to know whether specialized training could help health care professionals feel better prepared to discuss the diet with patients.
Ketogenic diets already have an established medical role in treating some forms of epilepsy, which is one reason researchers are interested in their possible effects on the brain and mental health. Early studies have explored their use for schizophrenia, bipolar disorder and depression, but researchers say more rigorous, longer-term trials are still needed to determine whether they improve psychiatric symptoms.
For the new study published in Frontiers in Psychiatry, 40 health care professionals from across the U.S., including physicians, pharmacists, psychologists and therapists, completed a training program on using ketogenic diets in mental health care. The course covered the basics of the diet, nutrition, monitoring and possible side effects.
Participants were then invited to try the diet themselves for four weeks. Twenty-five started that part of the study and 21 completed it. They received nutrition guidance and support while following the diet.
After completing the educational course, participants reported feeling much more prepared to discuss and potentially use ketogenic diets with patients. Those who also tried the diet reported additional gains in confidence.
Following the diet themselves also gave the health care professionals a better understanding of the challenges patients might face. Participants became more aware of how difficult the diet can be to follow and the importance of setting realistic expectations and involving registered dietitians when appropriate.
The experience wasn't easy for everyone. Two of the 25 participants who started the diet withdrew because of moderate side effects that researchers believed were related to it. One experienced muscle soreness and another had heart palpitations. More detailed findings about side effects and other health measures are expected in a separate paper.
There are also important limitations to what this study can tell us. It was small, had no comparison group and primarily measured how confident and capable participants felt after the training. It did not test whether they became better at providing ketogenic therapy in clinical practice or whether their patients benefited.
There was also potential for bias. Trying the diet was optional, so the people who chose to participate may have been particularly interested in ketogenic therapy. Several members of the research team participated in the study themselves, a limitation the researchers acknowledged.
Most importantly, no patients with mental illness were treated as part of this study. The researchers did not measure changes in depression, schizophrenia, bipolar disorder or any other psychiatric condition.
That doesn't mean the idea of using ketogenic diets in mental health care is unsupported. Early clinical research has produced enough encouraging results to prompt further study. But even some of the more promising research has important limitations, and researchers say longer randomized controlled trials are still needed to determine whether ketogenic diets can reliably improve psychiatric symptoms.
The study was funded by the Baszucki Foundation, which supports research into metabolic approaches to mental health. Ketone meters and test strips were purchased at a research discount from Keto-Mojo.
Several researchers disclosed professional or financial connections related to ketogenic therapy. One receives royalties from a book about metabolic approaches to mental health and owns a health care practice that incorporates ketogenic therapies. Another owns a ketogenic therapy business and co-owns a ketogenic training company, among other related roles. Four study authors also participated in the education and diet portions of the research.