Metabolic Health: Keto Diet in Schizophrenia & Bipolar Disorder

Researchers assessed the impact of a ketogenic diet (KD) on mental and metabolic health in people with schizophrenia or bipolar illness who already had metabolic abnormalities in a recent study that was published in the journal Psychiatry Research.

Context

Severe mental diseases including bipolar disorder (50 million) and schizophrenia (24 million) affect millions of people globally. Treatments now in use frequently result in metabolic adverse effects or resistance, making adherence difficult. Conventional neuroleptics improve long-term mortality in schizophrenia, but they can shorten life expectancy. While these medications are crucial, their impact on metabolic health is a growing concern.

Concerning the study

Twenty-three people between the ages of eighteen and seventy-five who were using psychiatric drugs and fit the description of being overweight or having a metabolic disorder participated in this study. Twenty-one individuals—six with schizophrenia and sixteen with bipolar disorder—completed the trial. Laboratory testing and extensive examinations were used to establish eligibility. Cookbooks, tools, educational materials, and a personal coach were given to the participants.

The recommended KD was 10% fat, 30% protein, and 60% carbs to achieve blood ketone levels of 0.5–5 mM. According to the degree of ketosis, compliance was tracked. Vital signs, body composition, and psychiatric assessments were noted at baseline, two months, and four months, and blood samples were examined for metabolic markers. Remote participants came to nearby facilities for evaluations and self-reported data. Registered with ClinicalTrials.gov (NCT03935854), the study was approved by the Stanford University Institutional Review Board and assessed the possible adverse effects of the KD in comparison to psychiatric drugs. 

Standard Microsoft Excel procedures were used to conduct statistical analyses, and Research Electronic Data Capture (REdCap) was used to record the data. The baseline and end measurements were compared using paired t-tests, and the nominal data was evaluated using Chi-squared analysis and McNemar’s Test. The exploratory character of the study precluded powering for significance, while p-values less than 0.05 were deemed noteworthy. Percent changes in metabolic and psychiatric outcomes were included in the analysis, which shed light on the possible advantages of the KD for people suffering from serious mental diseases.

Study findings

Twenty-three individuals, 16 with bipolar disorder and 5 with schizophrenia made up the data analysis cohort. Of the participants, six were semi-adherent, one was non-adherent, and fourteen were adherent to the KD.

At the beginning, 29% of participants satisfied the metabolic syndrome requirements. By the study’s end, not a single one satisfied these requirements (p < 0.05). Notable metabolic results included a reduction of 10% in average weight (p < 0.001), 11% in waist circumference (p < 0.001), 6.4% in systolic blood pressure (p < 0.005), 17% in fat mass index (p < 0.001), and 10% in body mass index (p < 0.001). Triglycerides dropped by 20% (p < 0.02), small dense low-density lipoprotein (LDL) by 1.3%, high-sensitivity reactive protein (hsCRP) by 23%, and visceral adipose tissue by 27% (p < 0.001). LDL (21%) and high-density lipoprotein (HDL) (2.7%) both showed increases. There was a 3.6% (p < 0.001) drop in hemoglobin A1c (HbA1c) and a 17% (p < 0.05) drop in the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). The 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk score did not significantly decrease for the entire group, although adherent patients did demonstrate an 11% improvement (p < 0.01).

Clinical Global Impressions severity scores showed a 31% improvement in psychiatric outcomes (p < 0.001). By the end of the study, recovery rates had gone from 33% at baseline to 75%, with 100% recovery in the adherent group. 79% of subjects showed a notable improvement in severity (92% adherent, 50% semi-adherent), and overall 43% of patients recovered (50% adherent, 33% semi-adherent). 69% of bipolar individuals showed a severity improvement of at least one point, and recovery rates rose from 38% to 81%. By the end of the research, every adherent bipolar individual was either recovered or in recovery. A 17% rise in life satisfaction (p < 0.002), a 17% improvement in the Global Assessment of Functioning (p < 0.001), and a 19% improvement in sleep quality (p < 0.02) were among the psychiatric improvements. Participants with schizophrenia saw a 32% decrease in their Brief Psychiatric Rating.

Headache, exhaustion, and constipation are common adverse effects of the KD that were first reported but became negligible by the third week. Significant gains in anxiety, mood stabilization, and general life quality were noted in the qualitative responses from participants; some even reported significant personal transformations.

In conclusion

In summary, there were notable improvements in both mental health and metabolism in the trial of patients with bipolar illness and schizophrenia who had a KD in addition to mental medicine. Psychiatric results revealed a 31% reduction in the severity of mental disease, with considerable recovery, especially among followers, experienced by 79% of symptomatic participants. Reductions in weight, waist circumference, systolic blood pressure, visceral adipose tissue, BMI, fat mass index, HbA1c, and triglycerides were among the metabolic results. The typical negative effects of KD subsided after three weeks. These results imply that KD is a workable and beneficial adjunctive treatment that enhances the mental and metabolic well-being of this population. 

For more information: Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial, ScienceDirect, https://doi.org/10.1016/j.psychres.2024.115866