Should the Keto Diet Be in Your Schizophrenia Treatment Plan?

While medication for schizophrenia remains the gold standard for treatment, there’s an emerging field known as metabolic psychiatry that may hold some promise as a complement to that approach. The field explores the effects that nutrition and metabolism — the way your body processes food for fuel — have on your mental health.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290e744f03-bf4f-402b-bb9e-f5a06a9f0ded According to Stanford Medicine, mental and metabolic illnesses often occur together. As many as 40 percent of people with conditions such as schizophrenia and bipolar disorder also have metabolic syndrome, which can include increased waist size plus high blood pressure, cholesterol, and blood sugar.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292efa8398-3bf1-4f66-b1a7-3456fa219855e60dc2a1-f33c-4a05-9b50-8e3e8e597629d90e08ff-647b-4d32-8788-43068fa78f4f Metabolic psychiatry uses interventions, including dietary changes, to address metabolic factors that might underlie mental illness. An example is the ketogenic diet, which could offer benefits for brain health. More research on the keto diet and mental health is needed, but there’s a possibility that this could be added to medication therapy for some people with schizophrenia and other disorders, says Khendra Peay, MD , a psychiatrist and the founder of Capital Area Child and Adolescent Psychiatry in Washington, DC. “If more clinical trials support this as a potential complementary intervention with current treatment, this could not only reduce the severity of the metabolic illnesses associated with schizophrenia, but could also potentially help to change the trajectory of the illness itself,” Dr. Peay says. Here’s a look at why this way of eating might be helpful, along with suggestions from a dietitian on how to implement the keto diet for those looking to give it a try.
Schizophrenia as a Metabolic Disorder Schizophrenia and Metabolism Schizophrenia is increasingly recognized as a metabolic disorder, not just a disease affecting the brain only.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294f1e1879-10c3-42c9-9db1-85595b34fb24 “Metabolic health and brain health are deeply intertwined, and targeting metabolic effects may help manage and treat schizophrenia while still relying on medications,” says Adiana Castro, RDN , a metabolic dietitian specializing in chronic conditions, and owner of Compass Nutrition in New York City. The connection between schizophrenia and metabolism has several aspects. Brain energy: Studies have found problems with the way brain cells both receive fuel and generate energy in people with schizophrenia, which has a direct impact on brain function.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c4742a0f-11c8-4c3d-b7db-c4e32d2b9078 Insulin resistance: Considered the primary driver of metabolic syndrome, insulin resistance happens when cells lose their sensitivity to insulin, which is necessary for taking in glucose for fuel. This increases blood sugar levels.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295bb13e11-7fc7-4001-9c69-11c98741c672 Medication side effects: “Pharmaceutical treatment of schizophrenia does help with brain chemistry; but it also has side effects that impact insulin resistance and obesity,” Castro explains. Specifically, antipsychotics like clozapine and olanzapine can increase metabolic effects.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292b207e8c-7ba9-4ef0-94e5-c2249cfda028 These factors have pointed researchers toward the ketogenic diet, because it can have significant effects on how your metabolism functions, and it has been shown to help regulate brain activity in epilepsy.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290cf06b56-ab84-414b-9e19-a46653182cd0
Role of the Ketogenic Diet How the Keto Diet Works The ketogenic diet is a high-fat, low-carbohydrate eating method that forces your body to burn fat. Without carbs to convert to glucose, your body gets its energy from ketones, which are acids produced from breaking down fat. While there are many different versions of a keto diet, the macronutrients usually break down to no more than 10 percent of calories coming from carbohydrates, about 30 percent from protein and at least 60 percent from fat.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b18aad6a-a3b2-4908-9ef7-87b3142d712b “Using ketones for energy can aid in weight loss, reducing waist circumference, lowering blood pressure, blood sugar levels, and insulin resistance,” says Castro. “All of these positive health outcomes help reduce inflammation in the body, while also increasing levels of GABA — the calming hormone — and improve mitochondrial and metabolic health.”
What the Research Says Study Results At this point, research is not extensive around schizophrenia and the ketogenic diet, but what’s been done so far is promising, says Castro. For example, a four-month pilot trial led by researchers in Stanford Medicine’s metabolic psychiatry program found that people with schizophrenia who followed a keto diet had, on average, a more than 30 percent improvement in symptoms. They also improved metabolic syndrome factors, including weight, waist circumference, blood sugar, blood pressure, and triglyceride levels.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297c513560-1085-4d1d-9e81-1ca9d6c18e96 And a research review that assessed use of the keto diet as an adjunctive treatment for schizophrenia in case reports and small trials found that this type of therapy may improve symptoms as well as cognitive performance and metabolic function. Researchers noted that ketogenic therapy holds potential for people who haven’t been helped by conventional treatment, and who’ve experienced metabolic side effects from their medication.e60dc2a1-f33c-4a05-9b50-8e3e8e59762934f3ea33-0657-448c-96d4-b4f9f595222c “It’s important to emphasize that the research is limited, and more randomized controlled studies are needed,” says Peay. “Before keto diets can be a recommendation as a course of treatment, studies can help to determine a safety range for use and that the benefits outweigh the concerns. This is separate from short-term or long-term efficacy.”
How to Implement Ketogenic Metabolic Therapy (KMT) Tips for Trying It Sometimes called ketogenic metabolic therapy, the keto diet can feel restrictive if you try to make a sudden overhaul to what you’re eating, says Castro. Here are her suggestions for implementing this approach in a way that feels less overwhelming. Work with your doctor, since keto can change how the body processes medication in some circumstances. Keep a food diary along with a symptom tracker, to see if dietary changes are causing noticeable shifts in your mood, cognitive function, or energy levels. Calculate your daily macros, so you’re burning fat for fuel instead of carbs; there are macro-tracking apps that make this easier. Eat more healthy fat, such as olive oil, nuts, fatty fish, and avocados. Emphasize nonstarchy vegetables since they’re lower in carbs and have plenty of fiber and nutrients; examples include spinach, broccoli, lettuce, and kale. “In order to check for symptom improvement, I would recommend starting with a time limited trial of three months on the keto diet, closely monitoring bloodwork and side effects,” suggests Castro. “Of course, I would continue psychiatric meds alongside following the keto diet.” Following a keto diet also has some risks, including nutrient deficiencies, constipation, kidney stones, and high cholesterol, along with flu-like symptoms that are common when people start it.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c68236b7-b382-451b-86ae-35f30a547b9f A dietitian can help you come up with an eating plan that’s safe and meets your goals.
The Takeaway Increasingly, schizophrenia is being recognized as a metabolic disorder, not just a disease affecting the brain only. There’s been some promising research connecting use of the ketogenic diet to schizophrenia symptom relief, since this way of eating can support metabolic health. The keto diet is considered an adjunct to your regular therapy, including medications, rather than a replacement for them; be sure to work with your doctor if you’re interested in trying a keto diet for your schizophrenia.
Resources We Trust Mayo Clinic: How to make the keto diet healthyCleveland Clinic: Living With SchizophreniaStanford Medicine: What Is Metabolic Psychiatry?Metabolic Mind: The Science of Metabolic PsychiatryNorthwestern Medicine: Pros and Cons of the Keto Diet