On , U.S. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. Stated that adhering to a ketogenic (keto) diet could potentially offer benefits in the management of schizophrenia. This announcement aligns with broader messaging from HHS and the U.S. Department of Agriculture promoting a “real food” approach to diet, following recent revisions to federal dietary guidelines that prioritize protein and fats over carbohydrates.
“We now know that the things that you eat are driving mental illness in this country,” Kennedy said. “There are studies right now that I saw where people lose their bipolar diagnosis by changing their diet.”
Is There Evidence Supporting This Recommendation?
While the claim of a “cure” for schizophrenia through a ketogenic diet has generated considerable discussion, the scientific evidence remains preliminary. Some research suggests a potential link between the keto diet and improvements in psychiatric symptoms, but it’s crucial to understand the limitations of current findings.
A pilot study published in Psychiatry Research in 2024 evaluated the impact of a four-month ketogenic diet intervention on both metabolic biomarkers and psychiatric symptoms in 23 patients diagnosed with either schizophrenia or bipolar disorder. Participants were allowed to continue their standard psychiatric treatment during the trial, with no restrictions on medication adjustments made in consultation with their physicians. The study included individuals aged 18 to 75 who were overweight (BMI ≥ 25 kg/m2) and had experienced weight gain while on psychotropic medications, or who presented with at least one metabolic abnormality, such as insulin resistance or dyslipidemia.
The researchers found that participants with schizophrenia experienced a 32% reduction in scores on the Brief Psychiatric Rating Scale, and an Overall Clinical Global Impression (CGI) severity score improved by an average of 31%, with a significant proportion of participants showing at least a one-point improvement on the CGI scale. The cohort reported increased life satisfaction (17%) and improved sleep quality (19%).
Beyond psychiatric improvements, the study also demonstrated positive changes in metabolic health. By the study’s conclusion, no participants met the criteria for metabolic syndrome. Those who adhered to the keto diet experienced significant reductions in weight (12%), BMI (12%), waist circumference (13%), and visceral adipose tissue (36%). Biomarker enhancements included a 27% decrease in the Homeostasis Model Assessment of Insulin Resistance and a 25% drop in triglyceride levels.
The study authors emphasized that these findings underscore the potential benefits of a ketogenic dietary approach as an adjunct to traditional treatment for serious mental illness. However, they explicitly stated that the keto diet should not be considered a substitute for prescribed medication.
“For the field of psychiatry, these findings open opportunities for further research into the relationship between mental health and metabolic health,” the study authors wrote. “These findings underscore the importance of further exploration of evidence-based approach in neurology to individuals with serious mental illness in psychiatry.” They further noted the interconnectedness of mental and physical health, suggesting that addressing metabolic issues could complement psychiatric treatment to enhance overall well-being.
What Is the Keto Diet and How Can Pharmacists Provide Support to Patients?
The ketogenic diet is a high-fat, very low-carbohydrate nutritional pattern that shifts the body’s primary fuel source from glucose to ketone bodies. This metabolic shift can have implications for individuals with epilepsy, obesity, type 2 diabetes, and certain metabolic disorders. Originally developed as a therapy for refractory epilepsy in children, the keto diet is increasingly being investigated for its potential neurological and endocrine effects.
The diet’s physiological impact involves alterations in mitochondrial function, modulation of neuronal excitability, and changes in gut microbiota. However, implementing and maintaining a keto diet requires careful consideration and monitoring.
Pharmacists play a crucial role in supporting patients who choose to adopt a ketogenic diet, as it can directly affect blood sugar, blood pressure, electrolytes, and kidney function, and potentially interact with medications. They can identify patients at high risk for hypoglycemia, particularly those taking insulin, sulfonylureas, or meglitinides. Monitoring for dehydration and low blood pressure is also important, as these are common early effects of the keto diet due to fluid and sodium losses. Pharmacists can also screen for kidney- and heart-related concerns, exercising caution in patients with pre-existing conditions.
Beyond medication safety, pharmacists can counsel patients on potential nutrient deficiencies, such as low fiber intake and electrolyte imbalances (magnesium, potassium, and sodium), and advise on appropriate supplementation. They can also help patients navigate misinformation, avoid unsafe supplement use, and recognize symptoms that warrant medical attention. Long-term success requires realistic expectations, management of gastrointestinal side effects, and tailoring the dietary approach to individual lifestyles and medical needs. Collaboration with other healthcare professionals is essential for optimal patient care.
