A pilot study of a ketogenic diet in bipolar disorder: clinical, metabolic and magnetic resonance spectroscopy findings.
Level 4 - case-series / case-control
Single-arm open pilot study without a control group
PubMed 39995103 · doi:10.1192/bjo.2024.841
What was done
Euthymic individuals with bipolar disorder (N = 27) were enrolled in a 6- to 8-week single-arm open pilot study of a modified ketogenic diet. Investigators evaluated metabolic parameters (body weight, BMI, blood pressure), standard psychiatric rating scales (Affective Lability Scale-18, Beck Depression Inventory, Young Mania Rating Scale), daily ecological momentary assessment (EMA) data paired with ketone measurements, and magnetic resonance spectroscopy (MRS) measures of brain metabolites before and after the dietary intervention.
What was found
Of 27 recruited participants, 26 started and 20 completed the ketogenic diet. In completers, mean body weight decreased by 4.2 kg (P < 0.001), mean BMI decreased by 1.5 kg/m2 (P < 0.001), and mean systolic blood pressure fell by 7.4 mmHg (P = 0.041). Psychiatric scale scores (ALS-18, BDI, YMRS) remained in the euthymic range without statistically significant changes. Among 14 participants providing reliable daily EMA data, daily ketone levels positively correlated with self-rated mood (r = 0.21, P < 0.001) and energy (r = 0.19, P < 0.001), and negatively correlated with impulsivity (r = -0.30, P < 0.001) and anxiety (r = -0.19, P < 0.001). MRS demonstrated that brain glutamate plus glutamine concentrations decreased by 11.6% in the anterior cingulate cortex (P = 0.025) and by 13.6% in the posterior cingulate cortex (P < 0.001).
Why it matters
This pilot study provides preliminary human evidence that a ketogenic diet is feasible in bipolar disorder, alters neurometabolites linked to glutamatergic signaling, and correlates with daily emotional state.
Limits
The trial lacked a control group and was unblinded. The sample size was small (N = 27 recruited, 20 completers, 14 with reliable EMA data) and the intervention duration was short (6–8 weeks). Participants were euthymic at baseline, limiting applicability to active manic or depressive episodes.
Cited by
- context Jan Baszucki's son with bipolar disorder experienced mood stabilization, cessation of mania and depression cycling, and improved sleep within weeks of adopting a ketogenic diet.