Bipolar disorder is a mental health condition marked by extreme shifts in mood, including highs (often referred to as mania), followed by depressive lows. While bipolar can exist on a spectrum, many people find the ups and downs to be significantly life-disrupting.
Due to the individuality and complexity of the illness, it can be challenging to find effective treatments. Medications that work for one person may not work for another, and misdiagnosis often adds to the confusion.
In recent years, emerging evidence reveals that lifestyle factors like diet play a significant role in managing mental health issues. Studies show that the ketogenic diet, which was originally designed for epilepsy over a century ago, has anti-inflammatory and neuroprotective effects that may support mental well-being.
So the question becomes: could people find relief with ketogenic therapy for bipolar disorder?
In this article, we’ll explore the connection between diet and mental health and highlight the specific ways the ketogenic diet supports neurological health as it relates to bipolar disorder.
Understanding Bipolar Disorder
There are three classifications of bipolar disorder, including bipolar I, bipolar II, and cyclothymic disorder.
The primary difference between bipolar I and bipolar II is the severity of manic and depressive episodes. The diagnosis of bipolar I requires at least one manic episode in a person’s life that isn’t caused by substance use or a medical condition. These manic episodes often show up as euphoria, racing thoughts, and impulsive decisions and may even be accompanied by psychosis.
Bipolar II, on the other hand, is characterized by at least one hypomanic episode and one major depressive episode. Hypomania is a milder form of mania, sometimes even viewed as a positive state, characterized by increased creativity or productivity. Due to its less severe symptoms, hypomania can easily go unnoticed and misdiagnosed[*]. While the mania is less intense, it’s the depressive states that hit the hardest for those with bipolar II.
Cyclothymic disorder is a chronic mood condition characterized by recurring periods of elevated and depressed mood that don’t meet the full criteria for hypomania or major depression, but can still be deeply disruptive to daily life. In adults, these mood fluctuations persist for at least two years (one year in children and adolescents)[*], often leading to significant emotional distress and challenges in relationships, work, and self-esteem.
For the full diagnostic criteria, symptoms, and impairments involved in bipolar disorder, see the DSM-5 definitions.
The most common bipolar treatment options include medications like mood stabilizers or antipsychotics. While some people respond well to the medications, Unfortunately, many people find that they’re unresponsive to medications, and for some that do respond, the side effects like drowsiness, weight gain, and digestive issues can make it hard to feel balanced.
While targeting symptoms with medications may seem like the most direct approach, there’s clearly a missing link. If some people who have bipolar disorder are unable to find relief with medications, it’s time that we look deeper into their physiology.
The Metabolic Link in Bipolar Disorder
Beyond psychological symptoms, there are several physiological markers strongly linked to bipolar disorder, including brain inflammation, mitochondrial dysfunction, and oxidative stress[*].
Furthermore, some research suggests that an estimated 48% of people with bipolar disorder have insulin resistance, pointing to impaired glucose metabolism in the brain[*]. This evidence suggests that bipolar is not simply a disease of the mind but may be rooted in metabolic physiology.
When your brain is unable to adequately utilize glucose for fuel, it’s left hungry for energy. Like any other muscle, tissue, or organ that’s not sufficiently supplied with energy, an insulin-resistant brain won’t be able to function properly. This brain energy deficit, leading to impaired energy use, may also directly impact oxidative stress and inflammation, which could further aggravate neurological processing and activity, much like what we see in bipolar disorder[*].
If this is true, then providing the brain with a steady stream of usable energy should produce positive results in those with bipolar disorder, which is where ketogenic therapy comes in.
What Is Ketogenic Therapy?
Ketogenic therapy is the purposeful use of ketosis to treat a specific medical condition under the guidance of a healthcare professional. While ketogenic therapy includes following a keto diet, the intent and the specifics can vary from a traditional keto diet.
A traditional ketogenic diet refers to any way of eating that shifts the body from using glucose as its primary fuel to burning primarily fat instead. This typically involves significantly reducing carbohydrate intake while increasing healthy dietary fats. While ketogenic diets are often effective for weight loss, some individuals exploring keto for more complex health concerns may find that the standard approach doesn’t fully address their needs or symptoms.
That’s where ketogenic therapy comes in.
Whether you’re addressing a metabolic condition, a mental health challenge, or both, ketogenic therapy offers a structured approach that helps ensure your level of ketosis and the overall quality of your diet are strong enough to make a meaningful impact.
For most people, starting ketogenic therapy begins with a consultation with a healthcare provider. They can run important screening tests, review your current medications, and help design a personalized nutrition and lifestyle plan. As you continue, your provider can monitor medication adjustments, which are often needed, and track your symptoms and lab work to make sure you’re heading in the right direction.
One important part of ketogenic therapy that often gets overlooked in general keto diets is the need to track your ketone levels. When ketosis is used therapeutically, staying in a consistent ketogenic state is essential. If your levels are inconsistent, your provider can help adjust your approach to better support your goals.
This is why when using keto for brain health, particularly when there are neurological or psychological symptoms present, it’s highly recommended that you view it as ketogenic therapy.
For more information and to learn how to get started, check out our Beginners’ Guide to Ketogenic Therapy.
You can also learn more about the difference between standard ketogenic diets and ketogenic therapy in this video with Dr. Bret Scher.
How Keto Can Help with Bipolar Disorder
Stabilizing Brain Energy
One of the most direct and powerful ways that a ketogenic diet can support brain health is through ketones’ ability to stabilize brain energy. As mentioned, bipolar disorder is associated with insulin resistance and impaired glucose metabolism, which can lead to an energy deficit in the brain[*].
Ketones not only offer a source of energy for your hungry brain (which, by the way, accounts for about 20% of your body’s energy demand), but by following a ketogenic diet, you bypass your brain’s struggle to efficiently use glucose.
What happens when your brain can’t efficiently use glucose? It puts a demand on your mitochondria that leads to oxidative stress and can ultimately result in mitochondrial dysfunction.
When ketones are used in place of glucose, you’re offering your brain fuel that can bypass insulin-resistance, delivering your mitochondria a clean fuel source. Furthermore, ketones themselves can enhance mitochondrial function while increasing antioxidant activity and reducing oxidative stress, a perfect trifecta for an inflamed or dysregulated brain[*][*].
In short, ketones can improve brain energy metabolism by supporting mitochondrial function.
Reducing Inflammation and Oxidative Stress
As mentioned, neuroinflammation and oxidative stress are two physiological markers associated with bipolar disorder. Whether they’re causative or the result of impaired neurological health is still up for debate, but what is clear is that when inflammation is present, it can cause changes in the structures of the brain and may contribute to the progression of symptoms[*].
When the brain begins using ketones as its primary fuel source, it triggers several anti-inflammatory responses. One of the first changes happens at the level of energy production itself. While all types of energy metabolism generate some inflammation, ketones create significantly less than glucose. But what really makes ketones stand out, especially when the brain or body is inflamed, is their ability to directly activate anti-inflammatory pathways that help calm and regulate inflammation. At the same time, ketones strengthen the body’s antioxidant defenses, providing not only a steady fuel supply for the brain but also additional protection against oxidative stress, a key contributor to ongoing inflammation[*][*][*].
Interestingly, research also shows that ketones can act as signaling molecules, interacting with cellular DNA to alter the expression of genes related to inflammation[*].
Balancing Neurotransmitters
Imbalanced neurotransmitters play a key role in bipolar disorder, giving way to manic and depressive states. For example, it’s believed that manic episodes are partly driven by excessive levels of the excitatory neurotransmitter glutamate, while uptake of the inhibitory neurotransmitter GABA increases during depressive episodes[*][*].
Serotonin and dopamine also play a role in the mood swings that come with bipolar disorder. Dopamine, which controls reward-seeking behaviors, may instigate mania and feelings of euphoria. Meanwhile, it is believed that serotonin may become underactive during depressive states[*][*][*].
Where does ketogenic therapy fit in?
Research shows that ketones can help to modify and shift the balance of GABA, glutamate, dopamine, and serotonin, producing a more calm and steady mood[*][*].
While the role of neurotransmitters in bipolar symptoms is important to understand, research shows that these imbalances are inconsistent. Therefore, it’s unlikely that the root of bipolar disorder lies in neurotransmitter imbalance, but rather something deeper that is causing imbalances to occur.
Improving Metabolic Health
The ketogenic diet has been widely studied for its positive effects on metabolic health, including improvements in insulin sensitivity, weight loss, lipid profiles, and glucose control[*].
This is particularly relevant for individuals with bipolar disorder, who face a 3.5-fold increased risk of developing metabolic syndrome and a 48% higher likelihood of insulin resistance[*][*].
Impaired glucose metabolism not only worsens metabolic health but also disrupts mitochondrial function, leading to increased inflammation, oxidative stress, and a vicious cycle of impaired neurological function.
To make matters worse, many medications prescribed for bipolar disorder can negatively impact metabolic function, potentially weakening already compromised systems. By using ketogenic therapy alongside these medications, it may help counteract their metabolic consequences and support whole-body health[*].
Clinical Evidence: Case Reports and Studies
Case Report:
A 53-year-old woman with Bipolar II had seemingly tried everything: meds, therapy, diet changes, even weekly ketamine infusions, but she couldn’t find anything to beat her depression. With a history of anxiety, migraines, and other chronic conditions, she was ready to try something new, which is when she engaged with a practitioner of ketogenic metabolic therapy (KMT).
She started with virtual support twice a week for three months, and over the first two weeks, she reduced her carbohydrate intake to 30g per day. Mood assessments were conducted at one, four, and five months. At baseline, the patient showed moderate to severe levels of depression, anxiety, and stress. As treatment progressed, all three scores steadily improved, and most notably, depression dropped into the normal range. What’s more, her self-reported mood and quality of life significantly improved as she reported feeling more emotionally balanced, energized, and able to enjoy life again[*].
Case Series:
In a published case series, two women with Bipolar II disorder followed a ketogenic diet and were able to maintain nutritional ketosis for extended periods (two and three years, respectively). While the two women had taken medication for mood stability, they both reported better mood than they’d ever achieved with medication alone. They felt significantly calmer and emotionally steadier, and they consistently linked these improvements to being in a state of ketosis.
Not only did they experience noticeable mental health benefits, but they also tolerated the diet well, with no major side effects reported over the long term[*].
Ketogenic diet in bipolar disorder: clinical, metabolic, and magnetic resonance spectroscopy findings
A recent pilot study published in BJPsych Open and funded by Baszucki Group offers early but exciting evidence that a ketogenic diet might help support both mental and metabolic health in people living with bipolar disorder.
Over the course of 6 to 8 weeks, 27 participants followed a ketogenic diet designed to induce and maintain nutritional ketosis. Twenty participants completed the full intervention, providing a rich set of clinical, metabolic, daily symptom-tracking, and brain-imaging data.
One of the most compelling findings? Mood improvements seemed to track with ketone levels. On days when ketones were higher, participants reported feeling better—more energized, less anxious, and less impulsive. The connection was clear: deeper ketosis led to better mental well-being.
And it didn’t stop at self-reported mood. Brain scans revealed a significant drop in glutamate, a brain chemical often elevated in bipolar disorder and linked to mood instability. This shift occurred in two key regions of the brain involved in emotional regulation, suggesting that the ketogenic diet may help balance brain chemistry in meaningful ways.
Physically, participants also saw benefits. On average, they lost 4.2 kg, reduced their BMI, and improved their blood pressure, with no adverse changes in cholesterol levels.
What makes this study stand out is its combination of clinical outcomes, real-time mood tracking, and brain imaging—all pointing in the same direction. The observed reductions in brain glutamate, alongside day-to-day improvements in mood, anxiety, and impulsivity tied to ketone levels, suggest that ketosis may directly influence core features of bipolar disorder.
While preliminary, these results lend further support to the idea that metabolic interventions may stabilize mood at the neurochemical level. The authors note that larger, controlled trials are now needed to confirm these effects and identify which subgroups within the bipolar population might benefit most.
Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia
In another Baszucki Group–funded study, researchers at Stanford University explored the potential of ketogenic therapy as an adjunct treatment for individuals with bipolar disorder or schizophrenia who also had metabolic abnormalities.
Over a four-month period, 23 participants followed a ketogenic diet while continuing their usual psychiatric treatment. By the end of the study, not a single participant still met the criteria for metabolic syndrome—a significant turnaround for a group that started with clear metabolic challenges. Those who adhered closely to the diet saw the greatest benefits, reporting measurable improvements not just in physical health, but also in mood, energy, and overall mental well-being.
Participants saw an average 12% drop in weight and BMI, a 13% reduction in waist circumference, and a 36% decrease in visceral fat. Markers of insulin resistance and inflammation, like HOMA-IR and triglycerides, also improved significantly.
On the psychiatric side, 69% of participants with bipolar disorder experienced clinically significant improvement in global impression severity ratings. And among those who were adherent to the diet, 100% were classified as “recovered” or “recovering” by the end of the trial.
Beyond symptom scores, participants also reported improvements in life satisfaction and sleep quality. Many shared powerful testimonials about mood stabilization and enhanced daily functioning—one even stated, “It can honestly save a lot of lives. It saved mine.”
The Ketogenic Diet for Refractory Mental Illness
In a pioneering paper from France, psychiatrist Dr. Albert Danan published a retrospective analysis of his practice after introducing a ketogenic diet as part of inpatient treatment for 31 adults living with severe, treatment-resistant mental illnesses, including bipolar disorder, major depression, and schizoaffective disorder. Patients followed a strict ketogenic protocol, limiting carbohydrates to just 20 grams per day.
Of the 28 participants who maintained the diet for at least two weeks, every one experienced meaningful clinical improvements. Depression scores dropped by about 70%, symptoms of psychosis were cut nearly in half, and almost half of the group reached clinical remission. Additionally, 64% were able to reduce their psychiatric medications.
And the benefits weren’t limited to mental health. Participants also experienced significant improvements in physical health, including weight loss, lower blood pressure, and improved key metabolic markers such as blood glucose and triglycerides.
Effects of a Ketogenic Diet on Cardiometabolic Health in Patients with Bipolar Disorder
A recent case series out of Germany explored how a well-formulated ketogenic diet might improve cardiometabolic health in people with bipolar disorder—something that’s especially important, given the high rates of metabolic issues in this population.
Over the course of 12 weeks, seven adults with bipolar disorder and existing lipid imbalances followed a medically supervised ketogenic program as part of a broader metabolic therapy approach. By the end of the program, participants saw measurable improvements in nearly every major cardiometabolic marker. Triglycerides dropped by 30%, apolipoprotein B decreased by 10%, and lipoprotein(a) fell by 21%. Markers of inflammation, like hsCRP, were cut nearly in half. Oxidative stress levels also declined, and most participants experienced weight loss and reductions in visceral fat, pointing to meaningful shifts in overall metabolic health.
Perhaps most notably, while LDL cholesterol increased slightly on average, apolipoprotein B, which is now widely recognized as a better predictor of cardiovascular risk, decreased. This suggests that the type of LDL may have shifted toward a less harmful pattern, even if the overall cholesterol number increased. In other words, the lipid picture may be more nuanced than we once thought.
That said, there were a few red flags: homocysteine and advanced glycation end products (AGEs) increased in most participants, pointing to the importance of proper micronutrient support and individualized dietary planning. But rather than signaling danger, these findings reinforce the need for well-formulated ketogenic diets, especially in clinical settings.
Considerations and Precautions
The ketogenic diet can be a powerful tool for improving metabolic and psychological health, but like any intervention, it may not be the right fit for everyone.
It’s important to understand the distinction between a ketogenic diet and ketogenic therapy. While both use the same nutritional foundation, ketogenic therapy is typically pursued as a medical intervention, often to target specific health conditions such as epilepsy or serious mental illness. In these cases, it’s essential to work closely with a healthcare professional trained in ketogenic therapy, especially if you’re taking psychiatric or metabolic medications. Ketosis can significantly shift your physiology, and adjustments to medications may be necessary to maintain safety and effectiveness.
There are some rare medical conditions that are contraindications to the ketogenic diet, and others that require special caution or medication monitoring. These are explained in more detail in this video.
How to Get Started with Keto for Mental Health
If you’re using the ketogenic diet for mental health, you’ll want to take a therapeutic approach and work closely with your healthcare provider. Before beginning the diet, they may want you to take certain tests and prepare you for the transition into ketosis.
Some tips for starting ketogenic therapy safely include:
- Work with your doctor, or nutritionist for an individualized plan
- Become familiar with keto-friendly foods and recipes
- Prepare go-to meals and snacks to have on hand
- Invest in a ketone meter so you can track your level of ketosis
- Transition meals slowly and mindfully
- Plan for keto-flu (the transition into ketosis) by staying hydrated with water and electrolytes
- Track your mood and symptoms along the way
If you’re interested in learning more about how ketogenic therapy may support bipolar disorder, we’ve put together a Bipolar Topic Page that offers a timeline of research, patient success stories, podcasts, news, and more.
And for more details on how to embark on your keto journey, read our The Beginner’s Guide to Starting Ketogenic Therapy.
Conclusion: A Promising Path Forward
While the ketogenic diet is not necessarily a cure for bipolar disorder, emerging research suggests it may offer real relief for some individuals by targeting underlying metabolic and mitochondrial dysfunction. With its potential to improve insulin sensitivity, reduce inflammation, and stabilize energy production in the brain, ketogenic therapy could serve as a powerful adjunct to traditional treatment.
That said, ketosis isn’t a one-size-fits-all solution, which is why working with a healthcare professional is crucial, especially if you’re taking prescribed medications. The best outcomes with ketogenic therapy often come from a comprehensive, personalized approach.
Metabolic Mind is here to offer the latest news, resources, and real stories from the people who have lived
Talk to your doctor, stay informed of emerging research, and consider keto as one potential tool in a broader mental health care strategy.
