Can Ketogenic Therapy Help with Schizophrenia?
Can Ketogenic Therapy Help with Schizophrenia?
Can Ketogenic Therapy Help with Schizophrenia?
Could a shift in brain metabolism unlock better outcomes for schizophrenia? Discover how ketogenic therapy is reshaping our understanding and treatment of serious mental illness.
Metabolic Mind Team
Dr. Georgia Ede, MD
Schizophrenia is a complex and often debilitating mental disorder that impacts an individual's thoughts, feelings, and actions and is characterized by delusions, hallucinations, disorganized thinking, and more.
Current treatment options for schizophrenia have low success rates and can come with challenging side effects, often leaving those living with schizophrenia with few options when standard approaches fail.
But what if we've been missing a crucial piece of the puzzle?
Emerging research suggests that maybe we have missed the mark in our understanding of the root causes of schizophrenia, opening the door to novel treatments like ketogenic therapy that could improve patient outcomes.
Originally used to treat epilepsy, keto is now gaining serious attention for its potential to treat serious mental illnesses, including schizophrenia.
In this article, we'll explore the limitations of current schizophrenia treatments, how ketogenic therapy might address the underlying causes of schizophrenia, and what research has shown us so far.
Schizophrenia: Where We Are Today
Schizophrenia is estimated to affect approximately 3.7 million people in the United States, and 24 million people worldwide. The dominant theory has been that schizophrenia is a condition rooted in psychological factors and brain chemical imbalances, which has led to medication and psychosocial interventions being the primary treatment options.
The medications most commonly used for schizophrenia are antipsychotics like olanzapine, quetiapine, risperidone, aripiprazole, and clozapine. Anti-psychotic medications target a variety of neurotransmitter systems, but their primary mechanism of action is that they all block dopamine receptors to some extent (excessive dopamine activity is thought to be responsible for many of the symptoms that people with schizophrenia experience).
Reports indicate that only 50% of people treated with anti-psychotic medications get relief from symptoms[*], and the symptoms most likely to improve are hallucinations and disordered thinking (so-called “positive” symptoms), whereas “negative” symptoms such as social withdrawal, learning issues, and attention problems are much less likely to improve.
Unfortunately, blockage of dopamine receptors in the motor system can cause undesirable side effects such as increased blood glucose levels, stiffness, tremors, restlessness, loss of facial expression, and involuntary muscle movements (tardive dyskinesia)[*].
In 2024, a new antipsychotic medication called Cobenfy was approved by the FDA for the treatment of schizophrenia. Cobenfy has generated great interest among prescribing mental health practitioners because it is the first antipsychotic medication that does not block dopamine receptors.
Cobenfy is actually a combination of two medicines–xanomeline (the active ingredient) and trospium (to reduce side effects of xanomeline). Xanomeline stimulates the activity of a neurotransmitter in the brain and body called acetylcholine, which indirectly influences the dopamine system. Since overstimulation of acetylcholine in the body can cause severe gastrointestinal side effects such as vomiting and diarrhea, trospium was added to block acetylcholine receptors in the body and reduce the risk for these side effects.
Small, short-term clinical trials suggest that Cobenfy may reduce some symptoms of schizophrenia in some people, but larger, longer-term trials are needed, and this medication is so new that there is not enough real-world clinical experience yet to understand how it compares to other anti-psychotic medications with respect to both benefits and side effects [*].
To complicate the matter, many patients also experience significant neurological and metabolic side effects from antipsychotic medications that reduce both quality and length of life[*].
Perhaps one of the most significant limitations, however, is that current treatment options focus on disease symptoms but fail to address underlying issues suspected of contributing to the disorder, which include:
Excessive oxidative stress
Brain inflammation
Compromised brain metabolism/mitochondrial dysfunction[*][*].
In fact, many of the existing antipsychotics used to treat schizophrenia worsen these underlying factors [*][*], leading to a vicious cycle that could potentially reduce the effectiveness of current treatment approaches over time.
Limited patient success and lack of root cause treatment options for schizophrenia highlight the need for novel interventions that focus on metabolic health in general and brain metabolism in particular, which is why interest is growing in ketogenic therapy as a hopeful new treatment option for schizophrenia.
How Could A Ketogenic Diet Help?
If you're unfamiliar with keto, this way of eating involves following a high-fat, low-carb, moderate-protein diet that induces a metabolic state known as ketosis. When you are in ketosis, your brain primarily uses ketone bodies (derived from fat metabolism) for energy instead of relying on glucose (derived from dietary carbohydrates or stored sugar).
For brain disorders, ketogenic diets were originally used in the 1920s as effective treatments for pediatric epilepsy[*]. Ketogenic diets are backed by over a century of evidence of efficacy,, including decades of robust research showing support for the diet’s potential to target various neurological and metabolic conditions.
When it comes to schizophrenia and ketogenic therapy, there are a few mechanisms that appear to play a role:
Metabolic Health:
Metabolic syndrome is common in schizophrenia, with 37-57% of individuals living with the disorder displaying signs of poor metabolic health [*]. Metabolic syndrome not only further reduces quality of life and increases the risk of premature death, but also contributes to the psychological symptoms associated with schizophrenia.
It can be argued that people with schizophrenia are at higher risk for metabolic syndrome because symptoms of their illness make it harder to eat healthy and exercise regularly, and because antipsychotic medications can have serious metabolic side effects, which are both valid observations. However, a meta-analysis of 14 case-control studies totaling 1,345 participants with schizophrenia found that a significant percentage of people had high blood glucose levels and insulin resistance at the time of their first schizophrenic episode, suggesting that poor metabolic health may have already been present well before the onset of severe symptoms (and therefore may even have contributed to the development of serious symptoms). Metabolic syndrome can alter brain health in several ways, including contributing to brain inflammation, insulin resistance, hormone imbalances, poor gut health, and altered neurotransmitter function– these are all characteristics commonly seen in schizophrenia.
There is robust evidence demonstrating that a well-formulated ketogenic diet can improve metabolic health markers including cholesterol, insulin, blood glucose, and inflammation [*][*][*]. Even if ketogenic therapy offered no benefits for r schizophrenia symptoms, its many metabolic benefits make it well worth considering as a complementary treatment option.
Ketosis and Brain Energy Metabolism:
Insulin resistance is a key feature of metabolic syndrome and can alter the brain’s ability to metabolize nutrients to create energy. An analysis of brain samples from people with schizophrenia confirms that impaired glucose metabolism and mitochondrial dysfunction are common, preventing the brain from getting enough energy for proper function.
A ketogenic diet can combat low energy in the brain by providing an alternative energy source in the form of ketones. Ketones, little energy molecules produced by the liver from fat, can be taken up by the brain and generate high energy output. Ketones are especially useful because they do not require insulin to enter brain cells, meaning that even an insulin-resistant brain can easily use ketones for energy.
Anti-Inflammatory Effects:
Brain inflammation is another hallmark of schizophrenia, and it is known to compromise brain health in the short term and contribute to brain degeneration over time[*].
Ketogenic therapy has been shown to reduce oxidative stress and specifically reduce inflammation in the brain. Ketones are considered a cleaner source of fuel for the brain that produces less oxidative stress and increases natural antioxidant defenses [*][*].
Influence on Mitochondria:
Another hallmark of schizophrenia is impaired mitochondrial function[*][*][*]. Mitochondria transform fuel molecules like glucose and ketones into energy in the body, including the brain. When mitochondria are damaged, they contribute to the energy crisis found in neurological conditions like schizophrenia.
Ketogenic therapy has been shown to improve mitochondrial function through several mechanisms, giving this therapy another way to target the metabolic component of schizophrenia[*][*].
Impact on Brain Chemicals:
Schizophrenia has long been thought of as a brain chemical or neurotransmitter disease. However, the imbalances in neurotransmitters are not consistent among individuals with schizophrenia, which may be why we see different responses to psychiatric medications. And a central question is: what is causing the neurotransmitter irregularities?
Dopamine is the neurotransmitter that gets the most attention when it comes to schizophrenia, and keto has been shown to help maintain appropriate levels of dopamine (and serotonin) to help stabilize mood [*].
GABA and glutamate are two other neurotransmitters of interest. Proper mood and cognitive function depend on these two neurotransmitters remaining balanced [*]. Excess glutamate, an excitatory neurotransmitter, can increase feelings of anxiety and overwhelm and in the case of schizophrenia, can contribute to symptoms of psychosis[*]. Conversely, GABA is an inhibitory neurotransmitter that slows down the messages being transmitted in your brain and induces states of calm and groundedness. Individuals living with schizophrenia typically show altered ratios of these neurotransmitters, which can contribute to symptoms of psychosis[*].
Research shows that ketosis can help regulate the balance between these two important neurotransmitters as well[*].
The Role of Gut Health
We are also now seeing a relationship between digestive and brain health through what is known as the gut-brain axis[*]. This two-way communication network allows the gut to influence the brain and vice versa.
Poor gut health impacts mood and mental health [*] and has been well documented in patients experiencing schizophrenia symptoms [*][*]. While it’s unclear if gut dysfunction is a root cause or a result of lifestyle and treatment side effects, the dysfunction exists, creating another treatment target.
A ketogenic diet has been shown to impact digestive health by increasing the presence of beneficial gut bacteria and decreasing the presence of harmful gut bacteria [*].
What The Research Says About Ketogenic Therapy and Schizophrenia
While the mechanisms supporting the potential for keto in schizophrenia are there, more research is still needed to understand better how ketogenic therapy can help.
Let's take a look at some of the most compelling research supporting the role of ketosis and low-carb diets in the treatment of schizophrenia.
Animal Studies
A growing body of animal research has highlighted how ketones may influence brain function in ways relevant to schizophrenia:
In one study, rats given medium-chain triglycerides (MCTs), which boost ketone production, became noticeably calmer and showed fewer anxiety-like behaviors. This behavioral shift came with a boost in mitochondrial function and improved regulation of glutamate (a neurotransmitter often out of balance in schizophrenia)[*].
Another study found that mice following a low-carb, high-fat ketogenic diet for seven weeks were protected from behavioral abnormalities typically seen in schizophrenia models. Keto appeared to exert an inhibitory effect on NMDA glutamate receptors, which are strongly implicated in the genetic risk for schizophrenia[*].
In this study, researchers looked at sensory gating—the brain's ability to tune out distractions, a function often impaired in schizophrenia. Mice fed a ketogenic diet showed marked improvements in this filtering process, hinting that ketones could help calm the sensory overload commonly seen in the disorder[*].
In another study, mice were given ketone ester (a supplement that induces ketosis) and found that ketone therapy positively impacted genes related to brain inflammation [*].
Evidence for Ketogenic Therapy in Humans
While keto is often considered a novel treatment for schizophrenia, the first keto and schizophrenia exploration actually occurred 60 years ago. In 1965, 10 women hospitalized with schizophrenia were put on a ketogenic diet in a small, open-label, uncontrolled trial. After just two weeks, the researchers reported significant improvements in participants' symptoms[*].
Despite this 60-year-old research, ketogenic therapy for schizophrenia did not receive much attention in the scientific literature again until the 2000s. Since then, and especially in the last few years, we have seen a spike in ketogenic therapy research, and the findings are promising.
To date, there are no major meta-analyses or systematic reviews specifically for ketogenic therapy for schizophrenia. However, there is one meta-analysis looking at keto for serious mental illnesses, which reveals that adherence to keto led to reductions in auditory and visual hallucinations in individuals with schizophrenia, with continued improvement over time[*]. Another study, looking at 31 inpatients with refractory mental illness, including 10 individuals with schizophrenia, found that the ketogenic diet, when added to existing treatments, was well tolerated and improved schizophrenia scores in all 10 participants, reducing average PANSS (Positive and Negative Syndrome Scale) scores from 91.4 to 49.3. [*].
Here’s a deeper look at the available research, looking more specifically at schizophrenia.
Case Reports and Case Series
Several case reports and series have documented the effects of a ketogenic diet in patients with schizophrenia:
Case Report 1:
A 70-year-old woman who had lived with schizophrenia (paranoia, disorganized speech, and hallucinations) since her teens decided to try the ketogenic diet for weight loss. Within eight days of diet, she reported that her hallucinations were gone, and her energy improved[*].
In a 12-year follow-up, at the age of 83, she remained free of hallucinations and had been off all psychotropic medications for 11 years. Furthermore, she no longer required a court-appointed guardian or Program of Assertive Community Treatment (PACT) team. She was thriving on her own.
Case Report 2:
Another case study shows the significant impact that ketosis may have on schizophrenia, with an emphasis on continued compliance. In these case studies, two patients with long-standing, treatment-resistant schizoaffective disorder experienced significant improvement in their psychotic symptoms after only two months on a KD. However, once they stopped the diet, both patients experienced a rapid return of psychotic symptoms.
Upon resuming the diet, their symptoms once again resolved [*].
Case Report 3:
In another case, a 39-year-old woman who had been experiencing treatment-resistant psychotic symptoms for 20 years started a ketogenic diet in an effort to find some relief. After several months following the diet, she reported complete remission of her psychotic symptoms.
Five years later she is still following a ketogenic diet, is free of psychotic symptoms, and is off all of her antipsychotic medications. She completed graduate school and now works full-time [*].
Case Report 4:
Two individuals with treatment-resistant schizoaffective disorder were put on a ketogenic diet with medical oversight. Patient A, a 17-year-old female, achieved full remission of suicidal ideation, hallucinations, and anxiety within 6 weeks and sustained improvements at the 24-week follow-up. Patient B, a 32-year-old female, achieved full remission of chronic psychotic and mood symptoms by 6 months [*].
Landmark Stanford Pilot Study
In a pilot study at Stanford University, ketogenic therapy was examined for its role in psychiatric health, specifically focusing on schizophrenia and bipolar disorder.
This was a four-month trial of a ketogenic diet in 23 participants with poor metabolic health and mental illness, 5 of whom had a diagnosis of schizophrenia. In addition to significantly improved metabolic markers (reduced BMI, weight, waist circumference, and visceral adipose tissue), participants displayed impressive improvements in psychiatric symptoms, with an average of 32% improvement in schizophrenia symptoms, along with improvements in both sleep and quality of life[*].
Active Clinical Trials
The promising outcomes we’re seeing with ketogenic therapy have fueled growing momentum in the field. Currently, their are five clinical trials underway, funded by Baszucki Group, at leading institutions including McLean Hospital, University of California at San Francisco (UCSF), University of Maryland, James Cook University, and Stanford University.
These studies are exploring a range of important questions, such as the impact of ketogenic therapy on first-episode schizophrenia, neural network stability, quality of life, and broader health and functional outcomes. Each trial brings us closer to understanding the full potential of this metabolic intervention in the context of serious mental illnesses like schizophrenia.
To explore these studies in more detail, visit our research page and scroll to the “Active Clinical Trials” section for the latest updates on this exciting work.
Takeaway: A Promising Path Forward
Ketogenic therapy offers a natural, safe alternative or complementary treatment for schizophrenia and may also help combat common co-occurring metabolic dysfunction and insulin resistance.
While early research results and anecdotal evidence are compelling, larger-scale, longer-term, more rigorous studies are needed to better understand the potential of ketogenic therapy as a treatment for schizophrenia. However, the evidence so far makes it clear: this is a path worth exploring.
To learn more about ketogenic therapy for schizophrenia, check out our Schizophrenia Resource Hub to see all of the keto and schizophrenia research, our best content on the topic, and real stories from people who have achieved success implementing ketogenic therapy for schizophrenia.
Schizophrenia is a complex and often debilitating mental disorder that impacts an individual's thoughts, feelings, and actions and is characterized by delusions, hallucinations, disorganized thinking, and more.
Current treatment options for schizophrenia have low success rates and can come with challenging side effects, often leaving those living with schizophrenia with few options when standard approaches fail.
But what if we've been missing a crucial piece of the puzzle?
Emerging research suggests that maybe we have missed the mark in our understanding of the root causes of schizophrenia, opening the door to novel treatments like ketogenic therapy that could improve patient outcomes.
Originally used to treat epilepsy, keto is now gaining serious attention for its potential to treat serious mental illnesses, including schizophrenia.
In this article, we'll explore the limitations of current schizophrenia treatments, how ketogenic therapy might address the underlying causes of schizophrenia, and what research has shown us so far.
Schizophrenia: Where We Are Today
Schizophrenia is estimated to affect approximately 3.7 million people in the United States, and 24 million people worldwide. The dominant theory has been that schizophrenia is a condition rooted in psychological factors and brain chemical imbalances, which has led to medication and psychosocial interventions being the primary treatment options.
The medications most commonly used for schizophrenia are antipsychotics like olanzapine, quetiapine, risperidone, aripiprazole, and clozapine. Anti-psychotic medications target a variety of neurotransmitter systems, but their primary mechanism of action is that they all block dopamine receptors to some extent (excessive dopamine activity is thought to be responsible for many of the symptoms that people with schizophrenia experience).
Reports indicate that only 50% of people treated with anti-psychotic medications get relief from symptoms[*], and the symptoms most likely to improve are hallucinations and disordered thinking (so-called “positive” symptoms), whereas “negative” symptoms such as social withdrawal, learning issues, and attention problems are much less likely to improve.
Unfortunately, blockage of dopamine receptors in the motor system can cause undesirable side effects such as increased blood glucose levels, stiffness, tremors, restlessness, loss of facial expression, and involuntary muscle movements (tardive dyskinesia)[*].
In 2024, a new antipsychotic medication called Cobenfy was approved by the FDA for the treatment of schizophrenia. Cobenfy has generated great interest among prescribing mental health practitioners because it is the first antipsychotic medication that does not block dopamine receptors.
Cobenfy is actually a combination of two medicines–xanomeline (the active ingredient) and trospium (to reduce side effects of xanomeline). Xanomeline stimulates the activity of a neurotransmitter in the brain and body called acetylcholine, which indirectly influences the dopamine system. Since overstimulation of acetylcholine in the body can cause severe gastrointestinal side effects such as vomiting and diarrhea, trospium was added to block acetylcholine receptors in the body and reduce the risk for these side effects.
Small, short-term clinical trials suggest that Cobenfy may reduce some symptoms of schizophrenia in some people, but larger, longer-term trials are needed, and this medication is so new that there is not enough real-world clinical experience yet to understand how it compares to other anti-psychotic medications with respect to both benefits and side effects [*].
To complicate the matter, many patients also experience significant neurological and metabolic side effects from antipsychotic medications that reduce both quality and length of life[*].
Perhaps one of the most significant limitations, however, is that current treatment options focus on disease symptoms but fail to address underlying issues suspected of contributing to the disorder, which include:
Excessive oxidative stress
Brain inflammation
Compromised brain metabolism/mitochondrial dysfunction[*][*].
In fact, many of the existing antipsychotics used to treat schizophrenia worsen these underlying factors [*][*], leading to a vicious cycle that could potentially reduce the effectiveness of current treatment approaches over time.
Limited patient success and lack of root cause treatment options for schizophrenia highlight the need for novel interventions that focus on metabolic health in general and brain metabolism in particular, which is why interest is growing in ketogenic therapy as a hopeful new treatment option for schizophrenia.
How Could A Ketogenic Diet Help?
If you're unfamiliar with keto, this way of eating involves following a high-fat, low-carb, moderate-protein diet that induces a metabolic state known as ketosis. When you are in ketosis, your brain primarily uses ketone bodies (derived from fat metabolism) for energy instead of relying on glucose (derived from dietary carbohydrates or stored sugar).
For brain disorders, ketogenic diets were originally used in the 1920s as effective treatments for pediatric epilepsy[*]. Ketogenic diets are backed by over a century of evidence of efficacy,, including decades of robust research showing support for the diet’s potential to target various neurological and metabolic conditions.
When it comes to schizophrenia and ketogenic therapy, there are a few mechanisms that appear to play a role:
Metabolic Health:
Metabolic syndrome is common in schizophrenia, with 37-57% of individuals living with the disorder displaying signs of poor metabolic health [*]. Metabolic syndrome not only further reduces quality of life and increases the risk of premature death, but also contributes to the psychological symptoms associated with schizophrenia.
It can be argued that people with schizophrenia are at higher risk for metabolic syndrome because symptoms of their illness make it harder to eat healthy and exercise regularly, and because antipsychotic medications can have serious metabolic side effects, which are both valid observations. However, a meta-analysis of 14 case-control studies totaling 1,345 participants with schizophrenia found that a significant percentage of people had high blood glucose levels and insulin resistance at the time of their first schizophrenic episode, suggesting that poor metabolic health may have already been present well before the onset of severe symptoms (and therefore may even have contributed to the development of serious symptoms). Metabolic syndrome can alter brain health in several ways, including contributing to brain inflammation, insulin resistance, hormone imbalances, poor gut health, and altered neurotransmitter function– these are all characteristics commonly seen in schizophrenia.
There is robust evidence demonstrating that a well-formulated ketogenic diet can improve metabolic health markers including cholesterol, insulin, blood glucose, and inflammation [*][*][*]. Even if ketogenic therapy offered no benefits for r schizophrenia symptoms, its many metabolic benefits make it well worth considering as a complementary treatment option.
Ketosis and Brain Energy Metabolism:
Insulin resistance is a key feature of metabolic syndrome and can alter the brain’s ability to metabolize nutrients to create energy. An analysis of brain samples from people with schizophrenia confirms that impaired glucose metabolism and mitochondrial dysfunction are common, preventing the brain from getting enough energy for proper function.
A ketogenic diet can combat low energy in the brain by providing an alternative energy source in the form of ketones. Ketones, little energy molecules produced by the liver from fat, can be taken up by the brain and generate high energy output. Ketones are especially useful because they do not require insulin to enter brain cells, meaning that even an insulin-resistant brain can easily use ketones for energy.
Anti-Inflammatory Effects:
Brain inflammation is another hallmark of schizophrenia, and it is known to compromise brain health in the short term and contribute to brain degeneration over time[*].
Ketogenic therapy has been shown to reduce oxidative stress and specifically reduce inflammation in the brain. Ketones are considered a cleaner source of fuel for the brain that produces less oxidative stress and increases natural antioxidant defenses [*][*].
Influence on Mitochondria:
Another hallmark of schizophrenia is impaired mitochondrial function[*][*][*]. Mitochondria transform fuel molecules like glucose and ketones into energy in the body, including the brain. When mitochondria are damaged, they contribute to the energy crisis found in neurological conditions like schizophrenia.
Ketogenic therapy has been shown to improve mitochondrial function through several mechanisms, giving this therapy another way to target the metabolic component of schizophrenia[*][*].
Impact on Brain Chemicals:
Schizophrenia has long been thought of as a brain chemical or neurotransmitter disease. However, the imbalances in neurotransmitters are not consistent among individuals with schizophrenia, which may be why we see different responses to psychiatric medications. And a central question is: what is causing the neurotransmitter irregularities?
Dopamine is the neurotransmitter that gets the most attention when it comes to schizophrenia, and keto has been shown to help maintain appropriate levels of dopamine (and serotonin) to help stabilize mood [*].
GABA and glutamate are two other neurotransmitters of interest. Proper mood and cognitive function depend on these two neurotransmitters remaining balanced [*]. Excess glutamate, an excitatory neurotransmitter, can increase feelings of anxiety and overwhelm and in the case of schizophrenia, can contribute to symptoms of psychosis[*]. Conversely, GABA is an inhibitory neurotransmitter that slows down the messages being transmitted in your brain and induces states of calm and groundedness. Individuals living with schizophrenia typically show altered ratios of these neurotransmitters, which can contribute to symptoms of psychosis[*].
Research shows that ketosis can help regulate the balance between these two important neurotransmitters as well[*].
The Role of Gut Health
We are also now seeing a relationship between digestive and brain health through what is known as the gut-brain axis[*]. This two-way communication network allows the gut to influence the brain and vice versa.
Poor gut health impacts mood and mental health [*] and has been well documented in patients experiencing schizophrenia symptoms [*][*]. While it’s unclear if gut dysfunction is a root cause or a result of lifestyle and treatment side effects, the dysfunction exists, creating another treatment target.
A ketogenic diet has been shown to impact digestive health by increasing the presence of beneficial gut bacteria and decreasing the presence of harmful gut bacteria [*].
What The Research Says About Ketogenic Therapy and Schizophrenia
While the mechanisms supporting the potential for keto in schizophrenia are there, more research is still needed to understand better how ketogenic therapy can help.
Let's take a look at some of the most compelling research supporting the role of ketosis and low-carb diets in the treatment of schizophrenia.
Animal Studies
A growing body of animal research has highlighted how ketones may influence brain function in ways relevant to schizophrenia:
In one study, rats given medium-chain triglycerides (MCTs), which boost ketone production, became noticeably calmer and showed fewer anxiety-like behaviors. This behavioral shift came with a boost in mitochondrial function and improved regulation of glutamate (a neurotransmitter often out of balance in schizophrenia)[*].
Another study found that mice following a low-carb, high-fat ketogenic diet for seven weeks were protected from behavioral abnormalities typically seen in schizophrenia models. Keto appeared to exert an inhibitory effect on NMDA glutamate receptors, which are strongly implicated in the genetic risk for schizophrenia[*].
In this study, researchers looked at sensory gating—the brain's ability to tune out distractions, a function often impaired in schizophrenia. Mice fed a ketogenic diet showed marked improvements in this filtering process, hinting that ketones could help calm the sensory overload commonly seen in the disorder[*].
In another study, mice were given ketone ester (a supplement that induces ketosis) and found that ketone therapy positively impacted genes related to brain inflammation [*].
Evidence for Ketogenic Therapy in Humans
While keto is often considered a novel treatment for schizophrenia, the first keto and schizophrenia exploration actually occurred 60 years ago. In 1965, 10 women hospitalized with schizophrenia were put on a ketogenic diet in a small, open-label, uncontrolled trial. After just two weeks, the researchers reported significant improvements in participants' symptoms[*].
Despite this 60-year-old research, ketogenic therapy for schizophrenia did not receive much attention in the scientific literature again until the 2000s. Since then, and especially in the last few years, we have seen a spike in ketogenic therapy research, and the findings are promising.
To date, there are no major meta-analyses or systematic reviews specifically for ketogenic therapy for schizophrenia. However, there is one meta-analysis looking at keto for serious mental illnesses, which reveals that adherence to keto led to reductions in auditory and visual hallucinations in individuals with schizophrenia, with continued improvement over time[*]. Another study, looking at 31 inpatients with refractory mental illness, including 10 individuals with schizophrenia, found that the ketogenic diet, when added to existing treatments, was well tolerated and improved schizophrenia scores in all 10 participants, reducing average PANSS (Positive and Negative Syndrome Scale) scores from 91.4 to 49.3. [*].
Here’s a deeper look at the available research, looking more specifically at schizophrenia.
Case Reports and Case Series
Several case reports and series have documented the effects of a ketogenic diet in patients with schizophrenia:
Case Report 1:
A 70-year-old woman who had lived with schizophrenia (paranoia, disorganized speech, and hallucinations) since her teens decided to try the ketogenic diet for weight loss. Within eight days of diet, she reported that her hallucinations were gone, and her energy improved[*].
In a 12-year follow-up, at the age of 83, she remained free of hallucinations and had been off all psychotropic medications for 11 years. Furthermore, she no longer required a court-appointed guardian or Program of Assertive Community Treatment (PACT) team. She was thriving on her own.
Case Report 2:
Another case study shows the significant impact that ketosis may have on schizophrenia, with an emphasis on continued compliance. In these case studies, two patients with long-standing, treatment-resistant schizoaffective disorder experienced significant improvement in their psychotic symptoms after only two months on a KD. However, once they stopped the diet, both patients experienced a rapid return of psychotic symptoms.
Upon resuming the diet, their symptoms once again resolved [*].
Case Report 3:
In another case, a 39-year-old woman who had been experiencing treatment-resistant psychotic symptoms for 20 years started a ketogenic diet in an effort to find some relief. After several months following the diet, she reported complete remission of her psychotic symptoms.
Five years later she is still following a ketogenic diet, is free of psychotic symptoms, and is off all of her antipsychotic medications. She completed graduate school and now works full-time [*].
Case Report 4:
Two individuals with treatment-resistant schizoaffective disorder were put on a ketogenic diet with medical oversight. Patient A, a 17-year-old female, achieved full remission of suicidal ideation, hallucinations, and anxiety within 6 weeks and sustained improvements at the 24-week follow-up. Patient B, a 32-year-old female, achieved full remission of chronic psychotic and mood symptoms by 6 months [*].
Landmark Stanford Pilot Study
In a pilot study at Stanford University, ketogenic therapy was examined for its role in psychiatric health, specifically focusing on schizophrenia and bipolar disorder.
This was a four-month trial of a ketogenic diet in 23 participants with poor metabolic health and mental illness, 5 of whom had a diagnosis of schizophrenia. In addition to significantly improved metabolic markers (reduced BMI, weight, waist circumference, and visceral adipose tissue), participants displayed impressive improvements in psychiatric symptoms, with an average of 32% improvement in schizophrenia symptoms, along with improvements in both sleep and quality of life[*].
Active Clinical Trials
The promising outcomes we’re seeing with ketogenic therapy have fueled growing momentum in the field. Currently, their are five clinical trials underway, funded by Baszucki Group, at leading institutions including McLean Hospital, University of California at San Francisco (UCSF), University of Maryland, James Cook University, and Stanford University.
These studies are exploring a range of important questions, such as the impact of ketogenic therapy on first-episode schizophrenia, neural network stability, quality of life, and broader health and functional outcomes. Each trial brings us closer to understanding the full potential of this metabolic intervention in the context of serious mental illnesses like schizophrenia.
To explore these studies in more detail, visit our research page and scroll to the “Active Clinical Trials” section for the latest updates on this exciting work.
Takeaway: A Promising Path Forward
Ketogenic therapy offers a natural, safe alternative or complementary treatment for schizophrenia and may also help combat common co-occurring metabolic dysfunction and insulin resistance.
While early research results and anecdotal evidence are compelling, larger-scale, longer-term, more rigorous studies are needed to better understand the potential of ketogenic therapy as a treatment for schizophrenia. However, the evidence so far makes it clear: this is a path worth exploring.
To learn more about ketogenic therapy for schizophrenia, check out our Schizophrenia Resource Hub to see all of the keto and schizophrenia research, our best content on the topic, and real stories from people who have achieved success implementing ketogenic therapy for schizophrenia.
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