The impact of the ketogenic diet on the course of schizophrenia and bipolar disorder
DOI:
https://doi.org/10.12775/QS.2025.43.61285Keywords
ketogenic diet, schizophrenia, bipolar disorder, ketogenic diet schizophrenia, ketogenic diet bipolar disorderAbstract
Introduction and purpose
Schizophrenia (SZ) and bipolar disorder (BPD) are serious mental disorders that significantly affect the functioning and efficiency of a person. The ketogenic diet (KD) reduces inflammation in the body and improves the efficiency of the nervous system. The aim of this article is to present the impact of the ketogenic diet on the course of these diseases.
Material and methods
The review was conducted based on the analysis of materials collected in the "PubMed" databases. The following keywords were entered when searching for scientific articles: ketogenic diet; bipolar affective disorder; schizophrenia; pathophysiology of schizophrenia; ketogenic diet shizophrenia; ketogenic diet bipolar disease. A total of 32 articles published in 2020-2025 were taken into account for the study and their relevance in the context of the topic of the effect of the ketogenic diet on the course of schizophrenia and bipolar disorder was verified.
Description
The way of eating significantly affects the human body. It provides it with fuel for functioning and soothes the symptoms of many diseases. It is worth focusing on the KD, which has been proven to have a wide range of effects: from anti-inflammatory, through mood stabilization and reduction of productive symptoms, to weight loss and improvement of laboratory test parameters.
Summary
Bipolar disorder and schizophrenia are psychiatric conditions that significantly impair a person's life and functioning. Their treatment most often involves pharmacotherapy, which may be ineffective in controlling symptoms. In such cases, a ketogenic diet can be used to help stabilize mood and alleviate symptoms of a psychological nature. Therefore, expanding research in this direction may be crucial in developing new strategies to support the treatment of BPD and SZ with KD.
References
1. Kurowska A, Ziemichód W, Herbet M, Piątkowska-Chmiel I. The Role of Diet as a Modulator of the Inflammatory Process in the Neurological Diseases. Nutrients. 2023 Mar 16;15(6):1436. PMID: 36986165; PMCID: PMC10057655. https://doi.org/10.3390/nu15061436
2. Choi J, Kang J, Kim T, Nehs CJ. Sleep, mood disorders, and the ketogenic diet: potential therapeutic targets for bipolar disorder and schizophrenia. Front Psychiatry. 2024 Feb 14;15:1358578. PMID: 38419903; PMCID: PMC10899493. https://doi.org/10.3389/fpsyt.2024.1358578
3. Chmiel I. Ketogenic diet in therapy of bipolar affective disorder - case report and literature review. Psychiatr Pol. 2022 Dec 31;56(6):1345-1363. English, Polish. Epub 2022 Dec 31. PMID: 37098202. https://doi.org/10.12740/PP/OnlineFirst/136356
4. Dietch DM, Kerr-Gaffney J, Hockey M, Marx W, Ruusunen A, Young AH, Berk M, Mondelli V. Efficacy of low carbohydrate and ketogenic diets in treating mood and anxiety disorders: systematic review and implications for clinical practice. BJPsych Open. 2023 Apr 17;9(3):e70. PMID: 37066662; PMCID: PMC10134254. https://doi.org/10.1192/bjo.2023.36
5. Chrysafi M, Jacovides C, Papadopoulou SK, Psara E, Vorvolakos T, Antonopoulou M, Dakanalis A, Martin M, Voulgaridou G, Pritsa A, Mentzelou M, Giaginis C. The Potential Effects of the Ketogenic Diet in the Prevention and Co-Treatment of Stress, Anxiety, Depression, Schizophrenia, and Bipolar Disorder: From the Basic Research to the Clinical Practice. Nutrients. 2024 May 21;16(11):1546. PMID: 38892480; PMCID: PMC11174630. https://doi.org/10.3390/nu16111546
6. Zambrano AK, Cadena-Ullauri S, Guevara-Ramírez P, Frias-Toral E, Ruiz-Pozo VA, Paz-Cruz E, Tamayo-Trujillo R, Chapela S, Montalván M, Sarno G, Guerra CV, Simancas-Racines D. The Impact of a Very-Low-Calorie Ketogenic Diet in the Gut Microbiota Composition in Obesity. Nutrients. 2023 Jun 13;15(12):2728. PMID: 37375632; PMCID: PMC10305724. https://doi.org/10.3390/nu15122728
7. Madireddy S, Madireddy S. Therapeutic Interventions to Mitigate Mitochondrial Dysfunction and Oxidative Stress-Induced Damage in Patients with Bipolar Disorder. Int J Mol Sci. 2022 Feb 6;23(3):1844. PMID: 35163764; PMCID: PMC8836876. https://doi.org/10.3390/ijms23031844
8. Scaini G, Valvassori SS, Diaz AP, Lima CN, Benevenuto D, Fries GR, Quevedo J. Neurobiology of bipolar disorders: a review of genetic components, signaling pathways, biochemical changes, and neuroimaging findings. Braz J Psychiatry. 2020 Sep-Oct;42(5):536-551. PMID: 32267339; PMCID: PMC7524405. https://doi.org/10.1590/1516-4446-2019-0732
9. Scott MR, McClung CA. Bipolar Disorder. Curr Opin Neurobiol. 2023 Dec;83:102801. Epub 2023 Oct 27. PMID: 38223491; PMCID: PMC10786345. https://doi.org/10.1016/j.conb.2023.102801
10. O'Connell KS, Coombes BJ. Genetic contributions to bipolar disorder: current status and future directions. Psychol Med. 2021 Oct;51(13):2156-2167. Epub 2021 Apr 21. PMID: 33879273; PMCID: PMC8477227. https://doi.org/10.1017/S0033291721001252
11. Post RM, Grunze H. The Challenges of Children with Bipolar Disorder. Medicina (Kaunas). 2021 Jun 11;57(6):601. PMID: 34207966; PMCID: PMC8230664. https://doi.org/10.3390/medicina57060601
12. Haggarty SJ, Karmacharya R, Perlis RH. Advances toward precision medicine for bipolar disorder: mechanisms & molecules. Mol Psychiatry. 2021 Jan;26(1):168-185. Epub 2020 Jul 7. PMID: 32636474; PMCID: PMC10290523. https://doi.org/10.1038/s41380-020-0831-4
13. Velligan DI, Rao S. Schizophrenia: Salient Symptoms and Pathophysiology. J Clin Psychiatry. 2023 Jan 18;84(1):MS21078COM7. PMID: 36652679. https://doi.org/10.4088/JCP.MS21078COM7
14. Khavari B, Cairns MJ. Epigenomic Dysregulation in Schizophrenia: In Search of Disease Etiology and Biomarkers. Cells. 2020 Aug 5;9(8):1837. PMID: 32764320; PMCID: PMC7463953. https://doi.org/10.3390/cells9081837
15. Hogenaar JTT, van Bokhoven H. Schizophrenia: Complement Cleaning or Killing. Genes (Basel). 2021 Feb 11;12(2):259. PMID: 33670154; PMCID: PMC7916832. https://doi.org/10.3390/genes12020259
16. Prestwood TR, Asgariroozbehani R, Wu S, Agarwal SM, Logan RW, Ballon JS, Hahn MK, Freyberg Z. Roles of inflammation in intrinsic pathophysiology and antipsychotic drug-induced metabolic disturbances of schizophrenia. Behav Brain Res. 2021 Mar 26;402:113101. Epub 2021 Jan 14. PMID: 33453341; PMCID: PMC7882027. https://doi.org/10.1016/j.bbr.2020.113101
17. Park HJ, Choi I, Leem KH. Decreased Brain pH and Pathophysiology in Schizophrenia. Int J Mol Sci. 2021 Aug 4;22(16):8358. PMID: 34445065; PMCID: PMC8395078. https://doi.org/10.3390/ijms22168358
18. McGaugh E, Barthel B. A Review of Ketogenic Diet and Lifestyle. Mo Med. 2022 Jan-Feb;119(1):84-88. PMID: 36033148; PMCID: PMC9312449.
19. Masood W, Annamaraju P, Khan Suheb MZ, Uppaluri KR. Ketogenic Diet. StatPearls https://www.ncbi.nlm.nih.gov/books/NBK499830/ (access: 2025.03.28)
20. Baylie T, Ayelgn T, Tiruneh M, Tesfa KH. Effect of Ketogenic Diet on Obesity and Other Metabolic Disorders: Narrative Review. Diabetes Metab Syndr Obes. 2024 Mar 21;17:1391-1401. PMID: 38529169; PMCID: PMC10962461. https://doi.org/10.2147/DMSO.S447659
21. Dyńka D, Kowalcze K, Paziewska A. The Role of Ketogenic Diet in the Treatment of Neurological Diseases. Nutrients. 2022 Nov 24;14(23):5003. PMID: 36501033; PMCID: PMC9739023. https://doi.org/10.3390/nu14235003
22. Martin-McGill KJ, Bresnahan R, Levy RG, Cooper PN. Ketogenic diets for drug-resistant epilepsy. Cochrane Database Syst Rev. 2020 Jun 24;6(6):CD001903. PMID: 32588435; PMCID: PMC7387249 https://doi.org/10.1002/14651858.CD001903.pub5
23. Stocker RK, Reber Aubry E, Bally L, Nuoffer JM, Stanga Z. Ketogene Diät: evidenzbasierte therapeutische Anwendung bei endokrinologischen Erkrankungen [Ketogenic Diet and its Evidence-Based Therapeutic Implementation in Endocrine Diseases]. Praxis (Bern 1994). 2019 Jun;108(8):541-553. German. PMID: 31185843. https://doi.org/10.1024/1661-8157/a003246
24. Jing T, Zhang S, Bai M, Chen Z, Gao S, Li S, Zhang J. Effect of Dietary Approaches on Glycemic Control in Patients with Type 2 Diabetes: A Systematic Review with Network Meta-Analysis of Randomized Trials. Nutrients. 2023 Jul 15;15(14):3156. PMID: 37513574; PMCID: PMC10384204. https://doi.org/10.3390/nu15143156
25. Sethi S, Wakeham D, Ketter T, Hooshmand F, Bjornstad J, Richards B, Westman E, Krauss RM, Saslow L. Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial. Psychiatry Res. 2024 May;335:115866. Epub 2024 Mar 20. PMID: 38547601. https://doi.org/10.1016/j.psychres.2024.115866
26. Bohnen JLB, Wigstrom TP, Griggs AM, Roytman S, Paalanen N, Andrews HA, Bohnen NI, Franklin JJH, McInnis MG. Ketogenic-Mimicking Diet as a Therapeutic Modality for Bipolar Disorder: Biomechanistic Rationale and Protocol for a Pilot Clinical Trial. Nutrients. 2023 Jul 7;15(13):3068. PMID: 37447394; PMCID: PMC10346691. https://doi.org/10.3390/nu15133068
27. Danan A, Westman EC, Saslow LR, Ede G. The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of 31 Inpatients. Front Psychiatry. 2022 Jul 6;13:951376. PMID: 35873236; PMCID: PMC9299263. https://doi.org/10.3389/fpsyt.2022.951376
28. Campbell IH, Needham N, Grossi H, Kamenska I, Luz S, Sheehan S, Thompson G, Thrippleton MJ, Gibbs MC, Leitao J, Moses T, Burgess K, Rigby BP, Simpson SA, McIntosh E, Brown R, Meadowcroft B, Creasy F, Mitchell-Grigorjeva M, Norrie J, McLellan A, Fisher C, Zieliński T, Gaggioni G, Campbell H, Smith DJ. A pilot study of a ketogenic diet in bipolar disorder: clinical, metabolic and magnetic resonance spectroscopy findings. BJPsych Open. 2025 Feb 25;11(2):e34. PMID: 39995103. https://doi.org/10.1192/bjo.2024.841
29. Laurent N. Retrospective case study: ketogenic metabolic therapy in the effective management of treatment-resistant depressive symptoms in bipolar disorder. Front Nutr. 2024 Aug 12;11:1394679. PMID: 39188977; PMCID: PMC11346312. https://doi.org/10.3389/fnut.2024.1394679
30. Rarinca V, Vasile A, Visternicu M, Burlui V, Halitchi G, Ciobica A, Singeap AM, Dobrin R, Burlui E, Maftei L, Trifan A. Relevance of diet in schizophrenia: a review focusing on prenatal nutritional deficiency, obesity, oxidative stress and inflammation. Front Nutr. 2024 Dec 13;11:1497569. PMID: 39734678; PMCID: PMC11673491. https://doi.org/10.3389/fnut.2024.1497569
31. Garner S, Barkus E, Kraeuter AK. Positive and negative schizotypy personality traits are lower in individuals on ketogenic diet in a non-clinical sample. Schizophr Res. 2024 Aug;270:423-432. Epub 2024 Jul 10. PMID: 38991418. https://doi.org/10.1016/j.schres.2024.07.010
32. Omori NE, Malys MK, Woo G, Mansor L. Exploring the role of ketone bodies in the diagnosis and treatment of psychiatric disorders. Front Psychiatry. 2023 Apr 17;14:1142682. PMID: 37139329; PMCID: PMC10149735. https://doi.org/10.3389/fpsyt.2023.1142682
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Klaudia Klimczak, Agnieszka Protasiuk, Agata Żak-Gontarz, Rafał Sierzpowski, Patrycja Tymoszuk, Bartosz Kasperek, Katarzyna Augustowska, Kamila Budzyńska, Laura Loryś
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 10
Number of citations: 0
