Mental Disorders
Ketogenic nutrition as a treatment for mental disorders
An estimated 85 million people worldwide suffer from severe psychiatric disorders, and at least 280 million from depression.
Conventional therapies can only partially help. Nineteen percent of patients with depression are considered treatment-resistant, and only 23% of those with schizophrenia respond to antipsychotic medications (neuroleptics). The serious side effects of neuroleptics often significantly impair the quality of life of those affected. These include metabolic disorders, weight gain, diabetes, cardiovascular disease, and lipid disorders. Two-thirds of all patients develop obesity. Because of the many side effects, about 74% of patients try to discontinue their medications, which leads to relapses and further worsens the vicious cycle.
In many cases, medication is essential for treatment, but it does not address the underlying cause of the illness. Especially with psychiatric disorders, approaches that address root causes and sustainably improve symptoms are of great importance.
Current studies show that a ketogenic diet can be meaningfully and successfully integrated into the treatment of even severe psychiatric disorders.
It has long been known that ketogenic nutrition can help with diseases of the brain and nervous system. The ancient Greeks already treated such conditions with fasting, and the Bible describes the treatment of epilepsy through fasting. For certain forms of epilepsy, ketogenic nutrition has long been part of standard therapy.
For pharmacoresistant epilepsy, it is even considered the only effective therapy in some cases. Therefore, these recent study findings make it clear that there is little reason not to explore ketogenic nutrition for other neurological or psychiatric disorders.
The fact that even patients with severe schizophrenia were able to reduce or discontinue their medication, that their metabolic parameters improved significantly, and that long-term patients even recovered completely is highly impressive.
The main effect appears to be that ketogenic nutrition reduces the excitability of nerve cells in the brain.
Current scientific evidence
In a recent study from Stanford University led by Shebani Shanti, 21 participants with schizophrenia or bipolar disorder were examined. All study participants followed a ketogenic diet for four months.
All reported significantly improved sleep.
Overall condition improved by an average of 31%.
Metabolic markers were 29% better than at the start of the diet.
Well-being, concentration, and mood improved in all participants.
In the USA, Dr. Albert Danan implemented a standardized ketogenic diet during inpatient treatment for 31 of his most severe, therapy-resistant cases of schizophrenia, bipolar disorder, and major depression. All patients had been seriously ill for at least ten years, some for more than 30 years, and all had highly abnormal metabolic markers (weight, lipid markers, blood sugar levels, blood pressure, etc.).
Twenty-eight of them followed the keto diet for at least two weeks, with the following results:
43% achieved complete remission of their symptoms.
64% were able to discontinue psychiatric medications.
All showed significant improvement in metabolic parameters.
All reported feeling better after two weeks of ketogenic nutrition than they had in a long time.
Timur Lewinski, head of the Basel Keto Mental Health Study, is currently investigating the effects of ketogenic nutrition on depression. One in ten adults in Europe takes antidepressants. Since these can have serious side effects, he is committed to raising awareness of ketogenic nutrition as an alternative treatment option.
In severe brain disorders, glucose can be poorly utilized as an energy source. This is when ketones come into play as an alternative fuel. It has been proven that ketones improve mood and reduce inflammatory processes in the brain.
Positive effects have also been shown for anxiety disorders through low-carb and ketogenic diets, for example in the study by Daniel M. Dietch.
These are still small studies, and larger ones are needed, but even these early findings encourage the idea that a ketogenic diet—when implemented under professional supervision and never used in a harmful manner—should absolutely be explored for psychiatric conditions, at least as an adjunct to existing medication.
Our own experience shows that even patients with less severe conditions feel noticeable benefits from ketones: a more balanced mood, reduced stress levels, improved concentration, and a sense of inner calm and mental clarity.
Patients with autism spectrum disorders report feeling more connected with themselves and their environment, being able to maintain interpersonal relationships more easily, and managing daily life much better overall.
Our patients with ADHD report that the ketogenic diet helps them stay more focused, wander off less, and work in a clearer and more structured way. Many describe the ketogenic diet as a powerful support for coping with everyday life. Nearly all patients report improved sleep, affecting both the ability to fall asleep and sleep through the night. Perceived stress levels also change positively. Many find certain stressors less burdensome, and their overall stress tolerance increases.
This means that their stress threshold rises. For many people, this newfound sense of inner calm is a valuable benefit that they achieve through the plant-based ketogenic diet.
How exactly do ketones affect our mental health?
The best-known and likely most effective influences of ketones on our brain are:
Effects on the brain’s energy crisis:
Mental stress creates an energy crisis in the brain. This is where ketones help as efficient energy carriers. It was long believed that our brain relies 100% on glucose. Today we know that up to 70% of the brain’s energy needs can be met by ketones. Ketones can cross the blood-brain barrier and are available directly as an energy source. The brain even prefers ketones over glucose — they burn much cleaner and more efficiently. In the brain, ketones also stimulate the formation of new mitochondria, which act as “power plants” for energy production. This is why, on a ketogenic diet, we often feel more capable, more focused, more concentrated, and clearer in our thinking. Cognitive performance improves both in the short and long term.
On neurotransmitters:
Ketones have a regulatory effect on our neurotransmitters glutamate and GABA. They regulate the excitability of our nerve cells in the brain. This is likely the main effect in mental illnesses. When we have high glutamate levels, our nervous system is in a hyper-regulated and overactive state — we are essentially “overstimulated.”
Ketones lower glutamate levels and raise GABA levels. This means that more calming, balancing messenger substances are produced, which place us in a more stable and even emotional state. As a result, we feel less driven, less overstimulated, and more balanced internally.
On gene expression:
Ketones regulate our genes and therefore exert an epigenetic effect. They influence how easily our genes can be accessed and read, acting through various mechanisms involved in gene regulation. Ketone bodies can cause certain gene segments to be read less frequently, which helps reduce inflammatory responses, for example by preventing a cytokine storm. They can also activate tumor suppressor genes that help prevent the development of malignant cell growth. A key factor in inflammatory processes is NF-κB, a molecule that regulates many genes responsible for immune function. Excessive immune reactions are often the result of NF-κB overactivation. A carbohydrate-rich diet significantly increases NF-κB activity, whereas a ketogenic diet — which is also rich in plant-based phytonutrients — can reduce NF-κB activity and inhibit its harmful inflammatory signaling pathways.
Effects on inflammation:
In psychiatric illnesses, inflammatory processes develop in the brain. Ketones can reduce inflammation and oxidative stress in the brain. This happens in several ways: even during ketone production, fewer free radicals and ROS (reactive oxygen species) are formed. Free radicals trigger inflammatory reactions. Ketones act as antioxidants — meaning they bind free radicals and thereby prevent inflammatory processes. In addition, ketones promote the regeneration of glutathione, a very important endogenous antioxidant produced by the liver. It is the body’s most powerful natural free-radical scavenger. Another important effect is the influence of ketones on the so-called inflammasome. Ketones inhibit this system, which plays a major role in chronic inflammatory diseases.
If long-lasting effects are desired or if medications need to be adjusted or reduced, a ketogenic dietary change — especially for psychological and psychiatric conditions — should always be carried out under the supervision of a qualified physician. Such a transition should never be attempted on one’s own.
Our patients have achieved impressive results with our keto diet.
This is what our patients report:
Do you have psychological symptoms?
We support you in our center for holistic medicine — on-site in Freiburg or through our online consultation.
Your Dr. Brigitte Karner & Dr. Wolfgang Karner
Keto Coaches
Scientific studies on ketogenic nutrition and mental health disorders:
Garner S. (2024): Ketogenic diet has a positive association with mental and emotional well-being in the general population
The Keto Study →
Danan A. (2022): The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of 31 Inpatients
The Keto Study →
– Disorder-specific and transdiagnostic changes in inflammatory activity in mental health disorders
The Keto Study →
– Nutrition, metabolism, brain, and mental health
The Keto Study →
– The ketogenic diet may have mood-stabilising properties
The Keto Study →
– The ketogenic diet for type II bipolar disorder
The Keto Study →
– The ketogenic diet and remission of psychotic symptoms in schizophrenia: Two case studies
The Keto Study →
– A pilot study of the ketogenic diet in schizophrenia
The Keto Study →
– Schizophrenia, gluten, and low-carbohydrate ketogenic diets: a case report and review of the literature
The Keto Study →
– Suppression of oxidative stress by B-hydroxybutyrate, an endogenous histone deacetylase inhibitor
The Keto Study →
– Cytokines sing the blues: inflammation and the pathogenesis of depression
The Keto Study →
– Brain metabolism during fasting
The Keto Study →
– Regulation of GABA level in rat brain synaptosomes: fluxes through enzymes of the GABA shunt and effects of glutamate, calcium, and ketone bodies
The Keto Study →
– The potential use of histone deacetylase inhibitors in the treatment of depression
The Keto Study →
– The antidepressant properties of the ketogenic diet
The Keto Study →
– We eat more carbohydrates than is beneficial
The Keto Study →
– Efficacy of low carbohydrate and ketogenic diets in treating mood and anxiety disorders: systematic review and implications for clinical practice
The Keto Study →