Should the Keto Diet Be in Your Schizophrenia Treatment Plan?

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.

"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.

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• 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.

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• 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.

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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.

"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."

At this point, research is not extensive around schizophrenia and the ketogenic diet, but what's been done so far is promising, says Castro.

"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."

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."

• 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.