Ketogenic diet in bipolar disorder patients may improve mental and metabolic outcomes: Study

A new study published in the British Journal of Psychiatry Open revealed that people with bipolar disorder may benefit metabolically and psychologically from a ketogenic diet.

Based on information from 13 randomized controlled studies (RCTs) and more than a century of clinical usage, a ketogenic diet is recognized as a metabolic treatment for refractory epilepsy. A ketogenic diet may help people with bipolar illness, according to preliminary case reports, observational data, and pilot studies.

With elevated rates of obesity, type 2 diabetes, cardiovascular disease, and shortened life expectancy, bipolar illness bears a significant metabolic cost. Adjunctive therapy approaches are desperately needed to mitigate the cardiometabolic risk that is increased by some of the first-line drugs now used to treat bipolar illness. Thus, to evaluate the effects of a ketogenic diet on clinical, metabolic, and magnetic resonance spectroscopy results in bipolar disorder, this study was carried out.

A modified ketogenic diet was the subject of a 6- to 8-week single-arm open pilot trial, which included 27 euthymic people with bipolar illness. Prior to and during the intervention, clinical, metabolic, and MRS measurements were evaluated. 20 of the 27 people that were recruited finished the ketogenic diet, whereas 26 started it. The mean systolic blood pressure dropped by 7.4 mmHg, the mean body weight decreased by 4.2 kg, and the mean body mass index decreased by 1.5 kg/m2.

With no statistically significant changes in the Affective Lability Scale-18, Beck Depression Inventory, or Young Mania Rating Scale, the euthymic individuals had average baseline and follow-up evaluations that were consistent with their being in the euthymic range. Ketone levels were inversely correlated with both impulsivity and anxiety, and positively correlated with self-rated mood and energy in subjects who provided trustworthy daily ecological momentary assessment data.

The concentration of glutamate and glutamine in the brain dropped by 11.6% in the anterior cingulate cortex and by 13.6% in the posterior cingulate cortex, according to the MRS data. Overall, replication of these results and an RCT are now imperative due to the significant cardiometabolic risk linked to bipolar disorder and the pressing need for novel supplementary (and non-pharmacological) therapy approaches. 

Source:

Campbell, I. H., Needham, N., Grossi, H., Kamenska, I., Luz, S., Sheehan, S., Thompson, G., Thrippleton, M. J., Gibbs, M. C., Leitao, J., Moses, T., Burgess, K., Rigby, B. P., Simpson, S. A., McIntosh, E., Brown, R., Meadowcroft, B., Creasy, F., Mitchell-Grigorjeva, M., … Smith, D. J. (2025). A pilot study of a ketogenic diet in bipolar disorder: clinical, metabolic and magnetic resonance spectroscopy findings. BJPsych Open, 11(2). https://doi.org/10.1192/bjo.2024.841