The ketogenic diet has been the talk of an area of something called metabolic psychiatry over the last few years. There are those who think that medical keto might be able to treat and maybe even “cure” (remit) bipolar disorder. Personally, I’ve been hearing about keto for bipolar disorder for more than a decade. I want to address the current state of keto in bipolar treatment right now and talk about whether trying a ketogenic diet might be right for you.
Jump to . . .
- What Is a Ketogenic Diet for Bipolar Disorder?
- Why Are People Researching Keto for BIpolar Disorder?
- The Best Bipolar-Specific Keto Study So Far
- More Bipolar Keto Evidence
- What Is the Keto for Bipolar Protocol?
- What Are the Dangers of Keto in Bipolar Disorder?
- The Big Problem with the Keto Diet
- Who Shouldn’t Try Keto for Bipolar Disorder?
- Should You Try the Keto Diet to Treat Bipolar Disorder?
- The Bottom Line on Keto and Bipolar Disorder
What Is a Ketogenic Diet for Bipolar Disorder?
The ketogenic diet (usually just referred to as “keto”) was not specifically designed for bipolar disorder. It is a very low-carbohydrate, high-fat diet. The goal of the diet is to shift the body into ketosis, where it produces ketones and uses them as an alternative energy source to glucose. In other words, instead of burning sugar, your body burns fat. However, getting your body to change its preferred fuel source is no small matter.
Although keto is often discussed today as a weight-loss diet, it was not originally developed for weight loss or overall wellness. The ketogenic diet was developed in the early 1920s as a medical treatment for epilepsy. Dr. Russell Wilder at the Mayo Clinic proposed the diet in 1921 as a way to mimic some of the seizure-reducing effects of fasting, while later Mayo Clinic work helped turn it into a structured clinical diet for people with epilepsy. People still use it to this day to control seizures in some people.
Why Are People Researching Keto for BIpolar Disorder?
Metabolic psychiatry is currently looking into this for bipolar disorder because bipolar disorder has been linked in some studies to problems involving energy metabolism, insulin resistance, inflammation, and brain signaling. It may be the case that keytones provide a more stable energy source than glucose for the brain.
It’s worth remembering that many anticonvulsants like lamotrigine (Lamictal) and valproic acid (Depakote) — the primary treatment for those with seizures — are also a treatment for bipolar disorder. This may mean there are common antecedents between the two disorders. So, if keto successfully treats epilepsy, them maybe it will successfully treat bipolar disorder as well.
The Best Bipolar-Specific Keto Study So Far
The strongest bipolar-specific evidence so far comes from a 2025 BJPsych Open pilot study of a modified ketogenic diet in people with bipolar disorder. The study recruited 27 euthymic participants, meaning they were not in an acute depressive, manic, or hypomanic episode at the time. Twenty-six began the diet, and 20 completed the six-to-eight-week intervention.
TL;DR In the study, those with a normal mood did not experience a new mood episode, lost weight, and lowered their blood pressure. (Click for details.)
The details: Among those who completed the diet, average body weight dropped by 4.2 kg, body mass index (BMI) dropped by 1.5 kg/m², and systolic blood pressure dropped by 7.4 mmHg. The study did not find significant changes in standard depression, mania, or mood switching scales, likely because participants were already euthymic at baseline. In the subgroup with reliable daily data, higher ketone levels were associated with better self-rated mood and energy, and lower impulsivity and anxiety. Brain magnetic resonance spectroscopy also showed reductions in glutamate-plus-glutamine concentrations in the anterior and posterior cingulate cortex.
This is important, but it must be interpreted carefully. The study was tiny, open-label, and had no control group. That means researchers cannot yet say whether the improvements were caused by ketosis itself, weight loss, expectancy effects, increased clinical attention, changes in sleep or routine, or some combination of factors. The authors themselves concluded that randomized controlled trials are now needed.
More Bipolar Keto Evidence
There is an additional small study on those with bipolar disorder and schizophrenia that found health and small psychiatric benefits to the keto diet. Additional case and online reports suggest that a few people with bipolar disorder have been helped with the keto diet, both with regard to mood and metabolic health.
These initial data points have motivated bigger trials, which are underway.
What Is the Keto for Bipolar Protocol?
In the small number of available studies, medically supervised, dietitian-led ketogenic interventions were used as adjuncts to standard psychiatric care. In other words, no one is suggesting that keto can replace medication treatment.
A medically supervised keto diet may have 60-75% of calories from fat, 5-7% from carbohydrates, and the rest from protein. This is supervised by an experienced ketogenic dietician, as it is not easy to achieve and can be dangerous if you’re not getting the right nutrition within those ratios.
As the goal is to get your body into and stay in ketosis, daily monitoring is also important. This means daily blood ketone measures, blood glucose measures, and assessment of symptoms.
All of this is very important to ensure you are getting what you need from the diet and not harming your body in the process.
What Are the Dangers of Keto in Bipolar Disorder?
Even if it turns out that keto is useful for bipolar mood (which we don’t know yet), it is not without risk.
The key risks of the ketogenic diet for bipolar disorder treatment (or any other reason):
- Keto may trigger hypomania or mania in some. A 2026 case series reported eight cases of hypomania and one case of mania that emerged within two months of starting a ketogenic diet. Seven of the nine people had no prior bipolar-spectrum diagnosis. That’s scary stuff.
- Keto can cause blood sugar problems. In one small study, 9% of daily glucose readings showed mild hypoglycemia; sometimes, this was persistent even after dietary changes were made.
- Keto can affect cholesterol and triglycerides. Some studies have shown increased total cholesterol, LDL cholesterol, or triglycerides. This matters especially in bipolar disorder because many people already have elevated cardiometabolic risk, including medication-related weight gain, insulin resistance, and cardiovascular risk factors.
- Keto can harm your kidneys. A 2021 meta-analysis found a 7.9% rate of kidney stones in those on a ketogenic diet.
- Keto can cause physical side effects. Some side effects, including fatigue, constipation, drowsiness, and hunger, are noted during studies. However, these can sometimes be addressed with additional dietary changes.
- Keto may be dangerous with some diabetes medications. The most serious adverse event in the bipolar feasibility study was euglycemic ketoacidosis in a participant with type 2 diabetes who was taking the SGLT2 inhibitor empagliflozin. The participant required hospital treatment with intravenous insulin and glucose.
Additional risks may include bone density concerns and pancreatitis in rare cases.
This is why you absolutely should not undertake a keto diet without medical supervision. You want to make sure you’re doing it right to get its benefits and not actually making your overall health worse.
The Big Problem with the Keto Diet
The big problems with the keto diet for bipolar disorder are how strict it needs to be and how you absolutely cannot cheat. If the goal is to maintain ketosis, then eating a single doughnut can knock you out of that. In other words, it’s not like your average diet, where a small lapse doesn’t really matter. A small lapse in this diet can make it useless and possibly result in mood destabilization. (We don’t have the data right now to say exactly what lapses will do.)
And the thing is, people with bipolar disorder have notoriously unhealthy diets anyway.
Unhealthy dietary habits observed in this population include high intake of ultra-processed foods, sugary drinks, and saturated fats, as well as irregular meal patterns, emotional eating, and high rates of eating disorders, are particularly concerning.
So, thinking that the average person with bipolar disorder is going to maintain something so strict in the long term just isn’t reasonable — even if it did work on mood (which it very well may not).
I am one of the most conscientious bipolars you’ll ever meet. I never miss a medication. I go to all my appointments. I use coping skills all day. I have modified my sleep for bipolar. My every day considers this illness. And I don’t think I could maintain such a strict diet. This doesn’t mean you couldn’t; I’m just saying.
Who Shouldn’t Try Keto for Bipolar Disorder?
Because of all the known risks of the keto diet, many people are not candidates to even try this diet. A 2024 randomized clinical trial protocol for keto in schizophrenia and bipolar disorder excluded people pregnant or breastfeeding, with active substance misuse, recent psychiatric hospitalization, uncompensated cardiovascular disease, severe hyperlipidemia, type 1 diabetes, a history of eating disorder, a BMI under 18.5, medications that can cause ketosis, active liver or kidney disease, and an inability to access cooking facilities and ingredients.
If you fall into any of the above groups, you just probably can’t even try it. If you do, it should be under very strict medical care.
Should You Try the Keto Diet to Treat Bipolar Disorder?
That, of course, is a decision you should make with careful consultation with your doctor and maybe a dietitian.
The best candidate is probably someone who:
- Is not in acute crisis
- Doesn’t mind controlling every aspect of their diet constantly
- Has a supportive doctor
- Has access to keto-experienced professionals like dieticians
- Has access to the right kinds of foods and cooking equipment (and doesn’t mind cooking)
- Doesn’t mind daily health monitoring
- Can make all their healthcare appointments
- Is in a safe medical group (see above)
Be careful out there. We don’t know what we don’t know.
The Bottom Line on Keto and Bipolar Disorder
Keto and bipolar disorder research is no longer just anecdote. There are now bipolar-specific pilot data, process-evaluation data, serious-mental-illness pilot trials, case reports, and registered randomized trials. The direction is interesting enough to take seriously.
But “interesting” is not the same as proven. Right now, keto is best described as a developing area of metabolic psychiatry — one with real potential, real limitations, and a real need for careful medical supervision. For people with bipolar disorder, the safest message is this: keto may eventually become a useful tool for some, but it is not yet an evidence-based replacement, or even add-on for most people, for standard bipolar treatment. And no, keto will never cure bipolar disorder.
If you’re looking for a more reasonable diet to help with bipolar disorder, try the MIND diet.
Other Posts You Might Enjoy
