Linking To And Excerpting From Psychiatric Research’s “Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial”

Today, I review, link to, and excerpt from Psychiatric Research’s Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. Psychiatry Res. 2024 May:335:115866. doi: 10.1016/j.psychres.2024.115866. Epub 2024 Mar 20.

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Outline

1. Highlights
2. Abstract
3. Keywords
4. 1. Introduction
5. 2. Methods
6. 3. Results
7. 4. Discussion
8. CRediT authorship contribution statement
9. Declaration of competing interest
10. Acknowledgements
11. Funding Disclosure
12. Appendix. Supplementary materials
13. References

Highlights

• Ketogenic diet therapy resulted in metabolic syndrome reversal in this cohort of serious mental illness.
• Participants with schizophrenia showed an average of 32 % improvement according to the brief psychiatric rating scale.
• The percentage of participants with bipolar who showed >1 point improvement in clinical global impression was 69 %.
• Greater biomarker benefits observed with ketogenic dietary adherence.
• Pilot trial suggests dual metabolic–psychiatric benefits from ketogenic therapy.

Abstract

The ketogenic diet (KD, also known as metabolic therapy) has been successful in the treatment of obesity, type 2 diabetes, and epilepsy. More recently, this treatment has shown promise in the treatment of psychiatric illness. We conducted a 4–month pilot study to investigate the effects of a KD on individuals with schizophrenia or bipolar disorder with existing metabolic abnormalities. Twenty–three participants were enrolled in a single–arm trial. Results showcased improvements in metabolic health, with no participants meeting metabolic syndrome criteria by study conclusion. Adherent individuals experienced significant reduction in weight (12 %), BMI (12 %), waist circumference (13 %), and visceral adipose tissue (36 %). Observed biomarker enhancements in this population include a 27 % decrease in HOMA–IR, and a 25 % drop in triglyceride levels. In psychiatric measurements, participants with schizophrenia showed a 32 % reduction in Brief Psychiatric Rating Scale scores. Overall Clinical Global Impression (CGI) severity improved by an average of 31 %, and the proportion of participants that started with elevated symptomatology improved at least 1–point on CGI (79 %). Psychiatric outcomes across the cohort encompassed increased life satisfaction (17 %) and enhanced sleep quality (19 %). This pilot trial underscores the potential advantages of adjunctive ketogenic dietary treatment in individuals grappling with serious mental illness.

Keywords

Bipolar illness

Schizoaffective disorder

Ketogenic diet metabolic therapy

Insulin resistance

Obesity

Metabolic psychiatry

Metabolic syndrome

Psychiatric disease

Clinical trial

Mental health

1. Introduction

Globally, a significant number of people suffer from severe mental illnesses, including schizophrenia (24 million) and bipolar disorder (50 million) (GBD 2019 Mental Disorders Collaborators., 2022). Although there are currently life–saving evidence–based standard therapeutic options for care, many individuals can experience treatment resistance, or major metabolic side effects, which can result in nonadherence of prescribed treatments (Pillinger et al., 2020). Furthermore, traditional neuroleptic medications can increase acute mortality and reduce life expectancy in vulnerable populations, such as those with dementia (Schneider–Thoma et al., 2018). Meta–analyses do show a beneficial effect on long–term mortality in schizophrenia with neuroleptics, however they may have a negative impact on life expectancy due to metabolic effects. The life expectancy gap between schizophrenia and the general population is growing (Jia et al., 2022). If treatment existed that would alleviate the undesirable metabolic effects of the medication, but kept the beneficial neuroprotective effect of neuroleptics through myelination and brain–derived neurotrophic factor (BDNF) (Bartzokis et al., 2002), that would lead to an improved situation for those afflicted with serious mental illness. For these reasons, it is crucial to explore novel treatment approaches to mental illnesses, with the goal of reducing the burden of side effects including metabolic dysfunction.