Keto diet leads to health benefits in bipolar patients

With over 100 years of evidence of efficacy in epilepsy, a ketogenic diet is now being studied around the world for a variety of psychiatric and neurological conditions. A new European study has now demonstrated that such a diet may improve brain metabolism in individuals with a bipolar disorder diagnosis, with the results published in BJPsych Open.

The study, supported by Baszucki Group and co-led by The University of Edinburgh, saw 27 participants with bipolar disorder enrolled into a 6–8 week pilot trial of a typical high-fat, low-carbohydrate ketogenic diet. 20 participants completed the study, demonstrating that the intervention was safe and tolerable in this population. Most reached and maintained ketosis, with 91% of readings positive for blood ketones. Among participants who provided reliable daily ketone and mental health data assessments, increased ketone level was correlated with improvements in mood, energy, impulsivity and anxiety, with some describing the intervention as life-changing.

“Using a ketogenic diet is like giving my mind a warm bath,” said one participant. “The edginess is gone. I feel calmer, clearer, and my brain is working again.”

Advanced brain imaging techniques, including magnetic resonance spectroscopy (MRS), were used to measure changes in brain metabolism. The imaging revealed reductions in excitatory neurotransmitters typically elevated in bipolar disorder, suggesting a potential mechanism behind a ketogenic diet’s effectiveness. Markers of metabolic function also improved; 19 of 20 participants lost an average of 4.2 kg and saw improvements in body mass index (BMI) and blood pressure. These findings suggest that a ketogenic diet may help mitigate common metabolic health risks associated with bipolar disorder and its pharmacological treatments, which can lead to shortened lifespans.

“We observed markers of reduced excitotoxicity in two key brain areas: the anterior cingulate cortex and posterior cingulate cortex — both implicated in bipolar disorder,” said Edinburgh scientist Dr Iain Campbell, who lives with the disorder and follows a ketogenic diet to alleviate his symptoms. “We also observed effects on a marker which has been associated with lithium and insulin signalling in the posterior cingulate cortex.

“These results add to a small but growing body of evidence suggesting that a ketogenic diet may be an effective adjunctive metabolic intervention for bipolar disorder,” Campbell continued. Indeed, the changes observed align with the metabolic overdrive hypothesis, a theory that Campbell has proposed, which posits that energy dysregulation is central to the mechanism of bipolar disorder and that addressing this dysregulation may be key to the success of ketogenic diet therapy.

The study is the second recently published pilot trial to demonstrate the safety and potential efficacy of ketogenic therapy in improving both metabolic and mental health markers in serious mental illness. The first trial, also funded by Baszucki Group, was conducted at Stanford University and suggested that systemic metabolic changes from a ketogenic diet may help stabilise the brain in serious mental illness. This second study has paved the way for a broader initiative at The University of Edinburgh to explore the potential of ketogenic therapy and other metabolic interventions for treating severe mental illnesses.

“There is an urgent need for larger replication studies and carefully designed randomised clinical trials to build on these findings,” Campbell said.

Image credit: iStock.com/Nadiia Borovenko