Obsessive-compulsive disorder can consume hours of a person’s day and reshape life around intrusive thoughts and compulsions that feel impossible to escape.
For Tanner, obsessions and physical and verbal compulsions consumed multiple hours every day. His mind was so rarely quiet that he says he had little experience simply being present.
“My head was always somewhere else,” he recalls.
Valerie Anne Smith remembers checking locks, counting, body checking, and other compulsions beginning when she was young. Over time, OCD became part of a much more complex psychiatric picture that included schizophrenia, anxiety, depression, anorexia, and self-harm.
Both would eventually report profound changes after incorporating ketogenic and other metabolic therapies. So would Genevieve Cook, a child whose OCD occurred alongside bipolar disorder and ADHD, and whose family had spent years searching for ways to help her.
Their experiences belong to Metabolic Mind’s THINK+SMART community, where people share the strategies they’ve used to support their mental health. What makes them especially interesting now is that similar stories are beginning to appear in the scientific literature.
Over the past two years, researchers have published several case reports and a small case series describing substantial improvement and even remission of OCD symptoms during ketogenic therapy. The evidence remains preliminary, but it’s grown enough to make a once largely unexplored question worthy of serious study.
Why OCD Needs More Treatment Options
OCD involves two connected kinds of symptoms. Obsessions are unwanted thoughts or urges, sometimes experienced as vivid mental images, that keep intruding and cause intense distress. Compulsions are the repetitive behaviors or mental rituals a person feels driven to perform in an attempt to ease that distress. For some people, those symptoms can consume hours every day, disrupting school, work, relationships, and the basic routines of daily life[*].
Exposure and response prevention (ERP), a specialized form of cognitive behavioral therapy, and serotonergic antidepressants such as SSRIs are mainstays of evidence-based OCD treatment. While many people benefit substantially from them, treatment resistance remains a serious problem for some people. Research estimates that roughly 40% to 60% of people treated with SSRIs for OCD do not achieve full remission or a clinically meaningful response[*].
Dr. Chris Palmer, a psychiatrist at McLean Hospital and Harvard Medical School, has seen how severe the disorder can become. McLean operates a residential program for people living with serious mental illnesses like OCD, including patients who have spent years or even decades trying medications, ERP, and other treatments.
Some continue to experience severe impairment.
“We desperately need better treatments, new treatments,” Dr. Palmer said in a recent Metabolic Mind interview.
That treatment gap has helped fuel interest in the possibility of whether improving brain metabolism could influence OCD symptoms.
What the Published Reports Shows So Far
So what are these early reports actually finding?
One of the most detailed reports follows a 26-year-old man whose OCD began around age 10 and eventually became dominated by symmetry, order, and perfectionism. His compulsive rituals could consume between three to eight hours a day[*].
He independently began ketogenic therapy shortly before starting work with an ERP therapist. By week three into his new diet, before formal exposure exercises had begun, the amount of time he spent on compulsive behavior had fallen to less than an hour a day and measures of emotional distress had declined substantially.
ERP was introduced in the following weeks, and his symptoms continued to improve. At a 95-week follow-up, those gains had largely persisted.
The patient believed the two therapies helped him in different ways. He credited ERP with teaching him how to stop entrenched behavioral patterns, while describing ketogenic therapy as the “foundation” that allowed him to engage more effectively with the psychological work.
While this is his interpretation of his recovery, rather than evidence that ketogenic therapy makes ERP more effective, the improvement that occurred before exposure work began gave researchers something specific to investigate.
A second 2025 case report followed a 37-year-old woman living with longstanding OCD whose symptoms became especially severe after childbirth. Harm-related obsessions eventually occupied an estimated 75% of her thoughts and interfered significantly with daily life. She continued psychiatric medication and psychotherapy while beginning a personalized, clinician-supervised ketogenic intervention[*].
What followed was a gradual change rather than an overnight shift. Her OCD symptoms progressively improved over 12 weeks. Her score on the Florida Obsessive Compulsive Inventory reached zero by week nine, and by week 12 she scored zero on the Yale-Brown Obsessive Compulsive Scale, meeting the case report’s criteria for complete remission. Improvements were also reported in depression, quality of life, and several physical health measures.
Then came three more stories.
In a 2025 case series, Dr. Christopher Palmer and Aaron MacDonald described three adults who had lived with OCD for years before trying ketogenic diets. Each reported that their symptoms eventually receded into remission with ketogenic therapy, with OCD severity falling by more than 90% on average across the three cases.
What caught the researchers’ attention was what happened when the diet changed. Each person reported some return of old OCD symptoms after moving away from the ketogenic diet, and improvement again after returning to it[*].
Dr. Palmer is careful about what those results can tell us.
The participants were identified through the researchers’ professional and personal networks, and their pre-ketogenic symptom scores were reconstructed retrospectively.
Dr. Palmer sees these cases as a reason to conduct controlled trials so researchers can answer the questions that case reports cannot: How often does this work? Who responds? How large is the effect?
There May Be More Than One Timeline for Improvement
The early reports also show considerable variation in how quickly people say they improved.
Two participants in the Palmer and MacDonald’s case series reported dramatic changes within roughly two weeks. But Dr. Palmer has specifically cautioned against turning that into an expected timeline. In his clinical experience, some people notice early changes in mood or functioning while persistent symptoms such as obsessions, compulsions, delusions, or hallucinations can take months to improve.
The THINK+SMART stories reflect that same variability.
Tanner describes a major shift at around six weeks. After years of spending hours inside obsessive thoughts and compulsive behaviors, he says he woke up one day and felt as though “everything had clicked into place.”
“The internal chatter came to a halt,” he says.
His anxiety eased dramatically, and resisting physical and verbal compulsions, something that had previously demanded enormous effort, became much easier. He also noticed something more difficult to capture on a symptom scale: he could finally stay present in his own life.
Valerie’s experience unfolded over many months.
After decades of severe psychiatric illness and extreme anorexia, changing her diet could only happen gradually. In 2017, she began what she describes as “literally one bite at a time,” slowly increasing her intake over several months.
At the three-, six-, and nine-month marks, she began noticing changes. Depression and anxiety eased. The voices she had experienced since childhood grew quieter, eventually feeling as though they were “in another room with the door closed.” As those symptoms receded, Valerie says she also became able to stop compulsive self-harm she had repeatedly tried to resist in the past.
By one year, she reports that her psychiatric symptoms had gone into remission. At the time of her THINK+SMART interview, she said that remission had continued for eight years.
These very different timelines are another reason prospective research matters. If ketogenic therapy ultimately proves useful for some people with OCD, researchers will need to understand how long a therapeutic trial should last and what early signs of response, if any, are meaningful.
Why Might Metabolism Affect OCD?
Researchers are still unsure as to why exactly ketogenic therapy might influence OCD symptoms, and there is unlikely to be one simple explanation.
Dr. Palmer puts it plainly: “Metabolism is ridiculously complicated.”
OCD research has implicated a number of interconnected biological systems, including glucose and insulin regulation, mitochondrial function, oxidative stress, inflammation, and glutamate and GABA neurotransmission. More recent reviews have also examined possible contributions from the gut microbiome and the hypothalamic-pituitary-adrenal, or HPA, stress-response system[*][*].
Mitochondria are one area of particular interest because brain cells require enormous amounts of energy. Researchers are investigating how ketogenic metabolism affects mitochondrial function and the way cells convert fuel into usable energy[*].
Insulin signaling and glucose regulation provide another possible avenue. Insulin has important functions in the brain, and researchers are investigating whether disruptions in metabolic regulation may intersect with pathways involved in obsessive and compulsive behavior[*].
Researchers have also documented abnormalities in glutamate and GABA signaling in OCD. Ketogenic therapy can influence these excitatory and inhibitory neurotransmitter systems, giving scientists another plausible mechanism to investigate[*].
And the newer literature widens the picture further. A 2025 review took a broader look at whether metabolically informed dietary changes, including a whole-food ketogenic diet, could plausibly play a role in OCD treatment. The authors examined biological processes already being studied in OCD and asked how nutrition might influence them. Their review highlighted several overlapping areas, including blood sugar regulation, insulin sensitivity, inflammation, the gut microbiome, and the HPA axis, which helps regulate the body’s stress response[*].
While the overlaps here are scientifically interesting, we still don’t have the data to establish that metabolic dysfunction causes OCD, or that ketogenic therapy improves OCD by correcting any one of these pathways.
What Recovery Can Give Back
Symptom scales are necessary for research, but they don’t capture everything people hope to regain.
Genevieve Cook’s family spent years navigating severe psychiatric symptoms, intensive treatment, and periods when keeping her safe dominated family life. On her THINK+SMART profile, Genevieve reports remission from bipolar disorder, as well as ADHD and OCD.
In describing the changes her family experienced, her mother doesn’t reach first for a clinical score. She remembers being able to spend time together at home.
They could cook together. Genevieve’s brother could play guitar. Genevieve could bring out her karaoke machine. The four of them could simply enjoy one another’s company, something her mother says they had never really been able to do before.
“We’re getting to know Genevieve,” she says, “and I think Genevieve is getting to know Genevieve.”
For Tanner, the change eventually altered the direction of his life as well. He is now studying mental health counseling at the University of Texas at San Antonio and seeing clients through the university’s counseling center.
These outcomes are deeply meaningful to the people experiencing them. They also remain lived experiences, which can serve as hope for others while more research is being pursued.
The Research We Still Need
The clinical evidence for ketogenic therapy in OCD currently consists of a handful of published cases. So where do we go from here?
A 2025 review found that there had been no prospective clinical trials testing ketogenic diet interventions for OCD and called for studies evaluating both feasibility and efficacy[*].
Prospective controlled studies could begin answering questions that matter enormously to patients and clinicians: how many people respond, which symptoms improve, how durable those improvements are, how ketogenic therapy interacts with ERP and medication, and whether measurable metabolic changes track with psychiatric outcomes.
Until then, the published cases and THINK+SMART stories should be understood for what they are: early observations compelling enough to warrant much more rigorous study and a conversation with your provider if you are considering trying ketogenic therapy.
Where Ketogenic Therapy Fits Today
ERP and serotonergic medications remain established treatments for OCD, while ketogenic therapy is still an emerging approach with promising case-level evidence and many unanswered questions. For people who want to explore ketogenic therapy, that uncertainty makes clinical support especially important, particularly when medications are involved. Dietary and metabolic changes can affect medication needs, and Dr. Palmer strongly cautions against stopping or tapering psychiatric medications without a qualified prescriber who knows how to manage those changes safely.
While the research is still too early to know how, and for whom, ketogenic therapy may help, the outcomes reported so far are substantial enough to justify putting those questions to the test in larger, controlled studies.
For Tanner, Valerie, Genevieve, and the people described in the published reports, improvement meant getting back pieces of life that OCD and other psychiatric symptoms had taken from them. Research now has to determine if and how other people might experience something similar.
Explore the THINK+SMART Stories
Read Tanner’s THINK+SMART story
Read Valerie Anne Smith’s THINK+SMART story
Read Genevieve Cook’s THINK+SMART story
Want to explore more lived-experience stories and learn about the THINK+SMART metabolic program for mental health? Sign up for the free THINK+SMART Guide.
Disclaimer:
Our website is for informational purposes only. We are not providing individual or group medical or healthcare advice or establishing a provider-patient relationship. Consult your healthcare provider before changing your lifestyle or medications. In addition, it is important to note that people may respond differently to ketosis, and there isn’t one recognized universal response.
