The Current Status of the Ketogenic Diet in Psychiatry
Here's when it's important to measure your ketones (Bostock et al., 2017). Actually, this is one of the cooler aspects of keto: you don't need to rely on FFQ's or diet diaries or other unreliable methods to determine adherence. You just measure ketones directly -- if they're there, you're adhering to the diet. And while this isn't really important for body recompositioning purposes, it may matter for neuropsychiatric applications where the ketones themselves may be part of the MOA directly.

Major limitations in the published studies on this: NOT MEASURING KETONES. If keto didn't work and they didn't report ketones, it's hard to know if keto really didn't work or adherence failure.

One more point before diving into the studies: rigid, strict adherence is very important here. One study showed efficacy in mild cognitive impairment, but adherence worsened with disease severity. In other words, the people who potentially stood to benefit the most were the least able to stick to the diet. This is why I'm open to coconut oil or medium chain triglyceride-supplemented low(ish) carb diets or even ketone supplements.

Treatment of Parkinson's disease with diet-induced hyperketonemia: a feasibility study (Vanitallie et al., 2005)

Small sample size (n=7) but pretty good adherence -- 5 were able to successfully maintain ketosis for the full month. Tl;dr: it worked. Improvements in resting tremor, freezing, balance, gait, mood, and energy levels.

The ketogenic diet for type II bipolar disorder (Phelps et al., 2013)

Two long-term case studies (2 and 3 years). Both women reported subjective mood stabilization which exceeded that of medication. No side effects. Three years on keto. No side effects, only improvements. Ketones measured in urine.

Ketogenic diet in bipolar illness (Yaroslavsky et al., 2002)

N=1. Didn't work. Supposedly was the classic 4:1 keto, although urinary ketones weren't detected. Duration: 1 month.

A pilot study of the ketogenic diet in schizophrenia (Pacheco et al., 1965)

10 females, poor prognosis, treatment resistant. Continued pharmacotherapy & electroconvulsive therapies while trying the diet. Statistically significant decrease in symptoms after 2 weeks.

Schizophrenia, gluten, and low-carbohydrate, ketogenic diets (Kraft and Westman, 2009)

N=1 overweight woman with schizophrenia. 12 months. Completely resolved auditory and visual hallucinations. Weight loss. Was in ketosis, but this was more of a hypocaloric protein-sparing modified fast diet consisting of lean protein and non-starchy vege.

That's all for now!

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