One of the most talked-about frontiers in keto research is the brain, and specifically serious mental illness. The idea has a logic to it: conditions like bipolar disorder may involve problems with how brain cells produce and use energy, and ketones offer the brain an alternative, steady fuel. A 2024 pilot study from Stanford put that idea to a careful first test.
The study
Shebani Sethi and colleagues at Stanford Medicine, publishing in Psychiatry Research, ran a pilot trial in 21 adults who had either bipolar disorder or schizophrenia and were already taking antipsychotic medication, all of whom also had signs of metabolic trouble such as weight gain or raised blood sugar, which these medications commonly cause. Participants followed a ketogenic diet, roughly 10 per cent of calories from carbohydrate, 30 per cent protein and 60 per cent fat, for four months, while continuing their psychiatric medication. They were not asked to count calories, and adherence was tracked through weekly blood ketone readings.
What happened to mental health
The psychiatric results were striking for so short a study. On a standard clinical scale used to judge overall severity, about three-quarters of participants showed a clinically meaningful improvement, with an average improvement of around 31 per cent. People also reported better energy, sleep, mood and general satisfaction with life. These are the everyday markers that matter to someone living with a serious mental illness, not just numbers on a chart.
What happened to physical health
The metabolic results were arguably just as important. At the start, nearly a third of participants met the criteria for metabolic syndrome, the cluster of high blood pressure, blood sugar and unhealthy blood fats that raises the risk of heart disease and diabetes. By the end, none did. Participants lost around a tenth of their body weight, trimmed their waists, and improved blood pressure, blood sugar and insulin resistance. This double benefit is unusual, because many psychiatric medications improve the mind at the cost of the body, and here both moved in a good direction at once.
Why this is only a beginning
The enthusiasm has to be matched by caution, and the researchers were the first to say so. This was a small pilot of 21 people with no control group, designed to see whether the effect is worth chasing with a bigger, more rigorous trial, not to prove that keto treats mental illness. With no comparison group, some of the improvement could reflect the attention and structure of being in a study, or the effects of weight loss and better metabolic health feeding back into mood, rather than a direct effect of ketones on the illness. It is a strong signal pointing towards larger trials, several of which are now under way, not a finished answer.
What it means in practice
For now the sensible reading is that this is a promising and active area of research, not an established treatment. The single most important point is that everyone in the study stayed on their psychiatric medication throughout. Nobody used the diet to come off their drugs, and nobody should: stopping medication for bipolar disorder or schizophrenia can be dangerous, and any role for diet here is as a supervised addition, explored with a psychiatrist, not a substitute. If the idea interests you or someone you support, that conversation with the treating clinician is the place to start.
The bottom line
A 2024 Stanford pilot found that a ketogenic diet, added to ongoing medication, improved both psychiatric symptoms and metabolic health in adults with bipolar disorder or schizophrenia. It is small and preliminary, the kind of early result that justifies bigger trials rather than firm conclusions, but it is one of the more intriguing things happening in keto research right now.
This is general information, not medical advice. Serious mental illness requires professional treatment. Never stop or change psychiatric medication, and do not start a restrictive diet for a mental health condition, without the guidance of your doctor or psychiatrist.
Source: Sethi S, et al. Pilot study of a ketogenic diet in serious mental illness. Psychiatry Research. 2024. Stanford Medicine summary.