Concerns About Ketogenic Diet Claims in Mental Health

Researchers in psychiatry are responding to statements made by health and human services secretary Robert F. Kennedy Jr. regarding claims that a Harvard doctor “cured schizophrenia using keto diets.” While they acknowledge that a well-supervised ketogenic diet might offer potential benefits for certain mental health issues, they emphasize the need for clarity around such statements.

It seems Kennedy Jr. was referring to Dr. Christopher Palmer from Harvard, who clarified that he has never claimed to have cured any mental health conditions, including schizophrenia. He described the ketogenic diet as a strong treatment option that could lead to remission of schizophrenia symptoms.

During a promotional tour for his “new food pyramid,” which encourages increased consumption of red meat and dairy, Kennedy Jr. highlighted the supposed curative properties of the ketogenic diet. However, it’s worth noting that a standard ketogenic diet focuses on a high fat-to-protein and carbohydrate ratio, which isn’t typically centered around red meat. This approach diverges significantly from the “carnivore diet” that Kennedy Jr. personally endorses.

Evidence suggesting that a ketogenic diet may aid in alleviating schizophrenia symptoms comes from two case reports published by Palmer in 2019 in Schizophrenia Research. Palmer was careful to point out that these reports are limited in number and not controlled, which means they don’t provide definitive proof of efficacy. Nevertheless, he believes they’re essential for generating hypotheses about potentially effective treatments, especially given the rarity of symptom remission in schizophrenia.

The reports involved two women, aged 39 and 82, who were on a ketogenic diet for reasons unrelated to their schizophrenia—namely, gastrointestinal issues and weight loss. As they followed the diet, both women reported a noticeable improvement in their schizophrenia symptoms and eventually ceased their medications.

Palmer stressed that discontinuing psychiatric medications should always be done under careful supervision. One of the participants in his case reports properly coordinated with her doctor to taper off her medications, while the other abruptly stopped without guidance, leading to severe psychosis and a two-month hospitalization.

The ketogenic diet has been recognized as beneficial for neurological symptoms for over a century, originally used for treating children with epilepsy in the 1920s. It faded for a time due to the advent of more advanced medications, yet it has regained attention since the 1990s for children with treatment-resistant epilepsy and now in psychiatric research.

Currently, Palmer noted, there are about 20 controlled trials underway exploring the ketogenic diet’s effectiveness for various psychiatric conditions, including schizophrenia and bipolar disorder. Conventional medications for these issues often come with numerous side effects, and preliminary findings suggest that keto might alleviate both symptoms and side effects.

While scientists are still figuring out how exactly the diet might help, Palmer suggested that it could have something to do with mitochondrial function. He pointed out that dysfunction in mitochondria appears to be a common factor across many psychiatric disorders.

Dr. Deanna Kelly, a psychiatry professor at the University of Maryland, explained that the ketogenic diet alters mitochondrial function by changing the type of fuel cells use. Essentially, the diet shifts the body toward burning fat instead of glucose.

Meanwhile, researchers at the University of Edinburgh are employing brain imaging techniques to investigate how keto affects brain function. Dr. Daniel Smith, a professor of psychiatry there, conducted a small feasibility trial regarding keto’s effects on bipolar disorder and observed some correlation between changes in brain glutamate levels and symptom improvement. However, these findings are preliminary, attributed to the small sample size.

As keto gains interest, questions arise about its practicality for patients. Clinical trials usually last only a few weeks or months, raising doubts over the long-term adherence to a diet that severely restricts staples like rice and bread while requiring large fat intake, sometimes in less appealing forms like drinking heavy cream. This diet can also be pricey.

Sydney Murray, a postdoctoral researcher in Kelly’s lab, mentioned we still need to understand if “cheat days” could work on keto. Different individuals may have varying needs regarding fat-to-carb ratios for maintaining ketosis, so a more flexible diet could be viable for some.

Palmer himself expressed a mixture of delight and frustration regarding keto’s visibility in discussions surrounding mental health. He worries that the politicization of the topic might hinder progress in the field.

He said, “If we continue in these polarized camps of ‘Well, that’s a Republican treatment, or keto for schizophrenia is an RFK Jr treatment, therefore I want nothing to do with it,’ … we’re never going to make progress as a field.”