Ketogenic Diet for Schizophrenia: Clinical Implication

Zoltán Sarnyai; Ann-Katrin Kraeuter; Christopher M. Palmer


Curr Opin Psychiatry. 2019;32(5):394-401. 

In This Article

Future Directions

Recent preclinical results and promising case studies provide rationale for further research. It is important to understand the mechanism of action by which ketogenic diet exerts its beneficial effects in schizophrenia. This requires converging evidence from mechanistically diverse animal models and from in-vitro systems, such as inducible pluripotent stem cells from individuals with schizophrenia. Such mechanistic understanding can lead to the identification of molecular targets for future drug development resulting in precise metabolic targeting. As compliance with ketogenic diet can be problematic, like in the case of any other restrictive diets, alternative approaches to reach metabolic ketosis through ketogenic dietary supplements, such as exogenous ketones, on the background of standard diet should be actively researched in this context. Controlled clinical trials with objective verification of the presence or absence of ketosis are warranted to assess efficacy on psychiatric symptoms as well as on the metabolic side effects of antipsychotics. This latter approach is critical as the weight loss, decreased blood glucose and increased insulin sensitivity induced by the ketogenic diet can be critical in overcoming the drug-induced metabolic side effects. The recent case studies reviewed here give reason for some optimism. However, it is possible that a certain subgroup of patients benefit from ketogenic diet more than others and certain patients will tolerate this diet subjectively and from a metabolic point of view better than others. Therefore, when research on this field continues such individualized medicine strategies should be kept in sight. Importantly, more evidence is needed about the long-term tolerability and safety of the ketogenic diet to counteract the reluctance driven by the long-held, likely erroneous, view that fat consumptions needs to be curtailed in order to avoid adverse metabolic and cardiovascular consequences.[65]