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First Peer-Reviewed Expert Consensus on the Use of Ketogenic Therapy for Serious Mental Illness

New publication in Frontiers in Nutrition provides the first expert-driven clinical framework for how to safely implement ketogenic metabolic therapy for schizophrenia, bipolar disorder, and major depressive disorder.

Diagnoses

Schizophrenia, Bipolar Disorder, Major Depressive Disorder

Study Type

Delphi Expert Consensus

Journal

Frontiers in Nutrition

Focus

Clinical framework for implementing ketogenic metabolic therapy (KMT) in serious mental illness

This publication represents the first peer-reviewed expert consensus on the use of ketogenic metabolic therapy (KMT) for people living with serious mental illness (SMI). Created through a modified Delphi process, this document offers practical insights into how to safely integrate KMT, providing clinicians with a structured framework as research in metabolic psychiatry continues to evolve.

Read the Peer-Reviewed Paper
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Ketogenic Therapy in Psychiatry: What the Experts Agree On

How can doctors, psychiatrists, and other health practitioners implement keto for serious mental illnesses like schizophrenia, bipolar disorder, and depression?

Testimonial Image

We’re not saying everyone needs to do this, but I think we’re providing [a framework] for people who want to do this. We help identify the types of people who would most benefit from KMT, along with the most critical things that need to be measured, monitored, and thought about throughout the process.” –Dr. Georgia Ede

I would have loved to have read this six years ago when I was starting to implement these types of practices. It would have given me the confidence to move forward even more quickly and with greater clarity.” –Dr. Matt Bernstein

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Diagram

Expert Consensus on Ketogenic Therapy for Serious Mental Illness

This peer-reviewed consensus paper, published in Frontiers in Nutrition, was created by a multidisciplinary panel of eight experts in psychiatry, psychology, nutrition, and metabolic science. Using a structured Delphi methodology, the group worked independently and iteratively to reach agreement on core principles regarding the implementation of ketogenic metabolic therapy (KMT) in individuals living with serious mental illness.

The panel reached consensus on 33 foundational statements, which are organized into five core topic areas:

• The definition of ketogenic metabolic therapy (KMT) in the context of serious mental illness
• The optimal candidate for KMT
• Monitoring and measurement standards for KMT
• Best practices in employing KMT
• Contraindications to KMT

The statements were then surveyed by a larger group of experienced clinicians to assess the level of broader consensus, resulting in all 33 statements reaching the consensus threshold.

Key Clinical Takeaways

The 33 statements were then used to create a list of recommendations, intended to inform key considerations for clinicians wishing to employ KMT for schizophrenia, bipolar disorder, and major depressive disorder.

Adjunctive Use:

KMT should be considered as an adjunct therapy to first-line treatments for major depressive disorder, bipolar disorder, and schizophrenia.

Who KMT is For:

A trial of KMT is appropriate for most adults living with these conditions, including individuals who cannot access, do not tolerate, or have not sufficiently benefited from first-line treatments.

Signs of Metabolic Dysfunction Not Required:

KMT is appropriate for individuals showing signs of metabolic dysfunction, but the absence of observable signs of metabolic dysfunction should not preclude individuals with schizophrenia, bipolar disorder, or major depressive disorder from a trial of KMT.

Team-Based Care:

Individuals using KMT to treat serious mental illness should be supported by a dietitian/licensed nutritionist or health coach trained in KMT and a prescribing clinician, or a prescribing clinician with training in KMT.

Safety Screening and Baseline Labs:

Prior to consideration of KMT, a thorough medical and psychiatric history should be taken to assess for absolute and relative contraindications (including rare inborn errors of metabolism affecting fatty acid transport/oxidation). Before initiating KMT, a baseline assessment including CBC, CMP, fasting lipid profile, vitamin D, vitamin B12, and a carnitine panel is recommended.

Ketone Targets:

Blood ketone levels should be monitored, especially in the initiation phase. While a BHB concentration of 0.5 mmol/L indicates a state of ketosis, many patients may require levels to be consistently maintained at 1.0 mmol/L or higher for best outcomes.

Trial Duration:

Barring any medical or psychiatric complications, for a trial of KMT to be considered adequate, a state of ketosis should be maintained for at least 3 consecutive months before drawing conclusions about effectiveness (unless earlier discontinuation is necessary).

Why This Consensus Matters

As interest in metabolic psychiatry grows, clinicians need structured frameworks to implement ketogenic therapy responsibly. This paper is the first step in delivering expert guidance to clinicians who may want to add KMT as a tool in their toolbox.

Where to Learn More

→ Read the Full Publication

If you are a clinician, consider sharing this paper with colleagues exploring metabolic approaches in psychiatry.

If you are a patient or family member, consider sharing this interview and the paper with your care team to support an informed discussion about whether metabolic strategies may be appropriate in your individual case.

Clinicians interested in structured training can explore Dr. Georgia Ede’s Ketogenic Metabolic Therapy CME.

General Questions

What is metabolic psychiatry?

Metabolic psychiatry is an emerging field that reexamines mental illness through the lens of brain energy, mitochondrial function, and cellular health.

Rooted in over a century of research on ketogenic therapy for epilepsy, it explores how metabolic interventions might offer new pathways to healing.

Learn more about metabolic psychiatry by reading our blog overview.

What is ketogenic metabolic therapy (KMT)?

Ketogenic metabolic therapy (KMT) is a therapeutic dietary intervention designed to shift the body’s primary fuel source from glucose to ketones through a state called nutritional ketosis. This metabolic state is typically achieved through a very-low-carbohydrate, adequate-protein, higher-fat diet.

Ketogenic therapy has been used for more than 100 years as a treatment for epilepsy and is now being studied as a potential metabolic intervention for certain serious mental illnesses.

What mental illnesses does this consensus study focus on?

This expert consensus focuses on the use of ketogenic metabolic therapy in adults with three serious mental illnesses:

  • Schizophrenia
  • Bipolar disorder
  • Major depressive disorder

These conditions were selected because emerging research and clinical experience suggest metabolic dysfunction may contribute to their underlying biology, and ketogenic therapy is showing promising results.

Does this study prove that ketogenic therapy treats mental illness?

No. This publication is not a clinical trial and does not prove effectiveness.

Instead, it provides expert-informed guidance on how ketogenic metabolic therapy may be implemented safely while the scientific evidence continues to develop. The recommendations are based on a combination of available research and real-world clinical experience from clinicians using ketogenic therapy in psychiatric settings.

To learn more about the available evidence for ketogenic therapy, visit our Science Overview page.

Who should try ketogenic metabolic therapy?

According to the consensus, a trial of ketogenic metabolic therapy may be considered for many adults with schizophrenia, bipolar disorder, or major depressive disorder, particularly those who:

  • Have not experienced sufficient benefit from standard treatments
  • Cannot tolerate medication side effects
  • Prefer to explore metabolic or lifestyle approaches
  • Have signs of metabolic dysfunction, such as insulin resistance or metabolic syndrome

However, we recommend discussing ketogenic therapy with your care team to help determine if this therapy is right for you.

Is ketogenic therapy safe for people with serious mental illness?

When used therapeutically, ketogenic metabolic therapy should be implemented under medical supervision, especially for individuals with serious mental illness.

The consensus recommends:

  • Careful screening for contraindications
  • Baseline laboratory testing
  • Ongoing monitoring of metabolic markers and ketone levels
  • Coordination between nutrition professionals and prescribing clinicians

Learn more about absolute and relative contraindications for ketogenic therapy:

How long should someone try ketogenic therapy before evaluating whether it’s helping?

The expert panel recommends maintaining nutritional ketosis for at least three consecutive months before determining whether ketogenic metabolic therapy is effective, unless medical or psychiatric complications require earlier discontinuation.

What are the optimal ketone levels?

Nutritional ketosis generally begins when blood ketone levels reach 0.5 mmol/L of beta-hydroxybutyrate (BHB).

Some individuals may experience greater improvements when ketone levels are maintained around 1.0 mmol/L or higher, though this can vary between individuals.

Who should supervise ketogenic therapy for mental illness?

The consensus recommends a team-based approach that ideally includes:

  • A prescribing clinician (such as a psychiatrist or physician)
  • A dietitian, nutrition professional, or trained health coach experienced in ketogenic metabolic therapy

Additional professionals such as therapists, nurses, or care coordinators may also be involved, depending on the patient’s needs.

Is ketogenic therapy meant to replace psychiatric medications?

No.

The consensus recommends that ketogenic metabolic therapy be considered as an adjunct to standard treatments rather than a replacement for them.

However, some individuals may wish to taper medications or adjust dosing due to symptom improvement, medication side effects, or reduced efficacy.

Medication decisions should always be made with a qualified prescribing clinician. Learn more on our Keto & Psych Meds Topic Page.

Is there research on the ketogenic diet for bipolar disorder?

Yes. A growing body of research, including case reports, pilot trials, and clinical observations, suggests ketogenic metabolic therapy may benefit some individuals with bipolar disorder. However, more large clinical trials are still needed.

Learn more about the available evidence by visiting our Keto for Bipolar Disorder Topic Page.

Is there research on the ketogenic diet for schizophrenia?

Yes, early evidence and clinical observations suggest ketogenic therapy may be a promising intervention for individuals living with schizophrenia and schizoeffective disorder. However, more large clinical trials are still needed.

Learn more about the available evidence by visiting our Keto for Schizophrenia Topic Page.

Is there research on the ketogenic diet for depression?

Yes. Researchers are investigating ketogenic metabolic therapy as a potential intervention for major depressive disorder, particularly in individuals with treatment-resistant depression. However, more large clinical trials are still needed.

Learn more about the available evidence by visiting our Keto for Depression Topic Page.

How can I talk to my doctor about ketogenic therapy for serious mental illness?

This expert consensus paper was written to help clinicians understand how ketogenic therapy can be implemented safely and responsibly in psychiatric care.

If you or someone you care about is interested in metabolic approaches to mental health, the best place to start is a conversation with your healthcare provider.

Because ketogenic therapy can affect metabolism, medications, and overall health, it should always be implemented under medical supervision, particularly for individuals living with serious mental illness.

→ Download and Share the Paper With Your Doctor

As a clinician, where can I go to receive more training on ketogenic therapy for serious mental illness? 

We have a suite of free CME offerings that examine the emerging evidence, safety considerations, and appropriate clinical implementation of ketogenic therapy for serious mental illnesses like bipolar disorder, schizophrenia, major depressive disorder, and more.

Visit our Trainings and Education page to learn more about our free CME offerings.

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