Investigating the Role of Ketogenic Diets in Mental Health
In the realm of psychiatric research, a contentious debate has arisen surrounding claims made by Health and Human Services Secretary Robert F. Kennedy Jr. He suggested that a Harvard doctor had “cured schizophrenia using keto diets.” However, many researchers emphasize a more nuanced perspective, recognizing that, while a well-supervised ketogenic diet may show potential for various mental health conditions, the assertion of a complete cure remains unsubstantiated.
Kennedy Jr. likely referenced Dr. Christopher Palmer, a psychiatrist at Harvard. Dr. Palmer clarified, “I have never once used the word ‘cure’ in my work. I have never claimed to have cured any mental illness, including schizophrenia.” He did, however, acknowledge the ketogenic diet as a powerful treatment, capable of inducing symptom remission in some cases.
During a promotional tour for his “new food pyramid,” which advocates increased consumption of red meat and dairy, Kennedy Jr. touted the supposed curative effects of the ketogenic diet. This diet, characterized by a high-fat-to-carbohydrate and protein ratio, differs significantly from the emphasis on red meat found in the “carnivore diet” that Kennedy Jr. personally follows. Additionally, traditional ketogenic diets do not typically stress the inclusion of red meat.
The evidence linking ketogenic diets to the remission of schizophrenia symptoms stems from two case reports published by Dr. Palmer in 2019 in the journal *Schizophrenia Research*. He was quick to point out, “Yes, it’s only two,” expressing the limitations of case reports, which lack control and are often biased. Nonetheless, he believes that they can serve as valuable starting points for hypothesizing effective treatments, particularly since remission in schizophrenia cases is quite rare.
The case reports detailed the experiences of two women, ages 39 and 82, both suffering from long-term schizophrenia and initially adopting the ketogenic diet for reasons unrelated to their mental health—specifically, gastrointestinal issues and weight loss. Over time, both women reported noticeable improvements in their schizophrenia symptoms and eventually discontinued their psychiatric medications.
Dr. Palmer advised strong caution, stating that no one should cease taking psychiatric medications without appropriate supervision. While one patient collaborated with her healthcare provider to taper her medications cautiously, the other abruptly stopped them on her own, leading to severe psychotic episodes that necessitated hospitalization for over two months. Following her discharge, she continued her diet but had to resume medication before safely tapering off.
The ketogenic diet has shown promise for managing neurological symptoms for over a century. Initially developed in the 1920s as a treatment for children with epilepsy, interest waned as newer treatments were developed. However, since the 1990s, pediatricians have rekindled interest, prescribing the ketogenic diet for children with treatment-resistant epilepsy, and it has recently attracted attention from psychiatric researchers.
Dr. Palmer reported that approximately 20 controlled trials are currently underway, exploring the ketogenic diet’s efficacy for various psychiatric disorders, including schizophrenia and bipolar disorder. Traditional medications for these conditions often come with significant side effects, and initial evidence suggests that the ketogenic diet may mitigate both the disorders and their associated side effects.
While research is ongoing to better understand the mechanisms behind this potential benefit, Palmer posited that mitochondrial function—considered the “powerhouse” of the cell—might be a contributing factor. “Mitochondrial dysfunction has been found to play a role in almost all psychiatric disorders,” he said.
Dr. Deanna Kelly, a psychiatry professor at the University of Maryland School of Medicine focusing on keto and mental health, explained how the ketogenic diet alters mitochondrial function by changing the primary fuel source. When the body enters a state of ketosis, it begins to burn fat instead of glucose, which is the goal of the diet.
Researchers at the University of Edinburgh are leveraging brain imaging to uncover how a ketogenic diet might alter brain function. Dr. Daniel Smith has led a feasibility trial investigating the diet as a treatment for a limited number of patients with bipolar disorder. He noted that while “changes in brain glutamate levels were correlated with symptomatic improvement,” the evidence remains weak due to the small sample size. He is now embarking on a larger, controlled study.
While interest in the ketogenic diet is rising, concerns persist about its practicality for patients. Most clinical trials last only a few weeks to months, yet it remains uncertain whether many individuals can adhere to a diet that largely excludes staples like rice and bread, and that often requires consuming significant amounts of fat in less palatable forms, such as heavy cream served as a side dish. Furthermore, ketogenic diets can also be quite costly.
Sydney Murray, a postdoctoral researcher in Kelly’s lab, pointed out that while we are still unsure about the feasibility of “cheat days” on the ketogenic diet, different individuals may require varying fat-to-carb ratios to maintain ketosis, which could allow for a more flexible approach for some.
Dr. Palmer expressed his enthusiasm for the increased visibility of the ketogenic diet in medical discussions but lamented that his research has become politicized. He cautioned against allowing political affiliations to influence perceptions of the diet’s potential: “If we continue in these polarized camps… we’re never going to make progress as a field.”
Conclusion
As research into the ketogenic diet unfolds, it holds promise as a therapeutic avenue for individuals grappling with psychiatric disorders. However, significant challenges remain regarding its practicality and the need for further investigation. Balancing dietary interventions with clinical care will be crucial in the ongoing exploration of keto’s role in mental health.
