Bipolar disorder symptoms could be improved by diet

Eating a high fat, low carbohydrate diet could help to manage symptoms in patients with bipolar disorder, a study suggests.

Keto diet food products displayed on a white wooden table. Salmon, olive oil, avocado, eggs, nuts and vegetables.

Maintaining a ketogenic diet over six weeks or more was linked with improvements in mood, energy and anxiety, researchers discovered.

The findings point to an important new direction for research into treatment options for those living with the condition, experts say.

The research team highlights further studies are needed to explore any potential effects in a larger group of patients.

Energy source

The ketogenic diet involves significantly reducing intake of carbohydrates, like bread and rice. These are replaced by large amounts of fats, found in foods like butter and avocado.

Without carbohydrates the body begins to break down fat to produce chemicals called ketones which can be used for fuel, in a process called ketosis.

The ketogenic diet has been used in the treatment of epilepsy for more than a century and its benefits are now being studied across a range of psychiatric and neurological conditions.

Symptom improvement

The study involved 27 patients with a bipolar disorder diagnosis who followed a ketogenic diet for six to eight weeks. 

Some 20 participants completed the study, demonstrating that the intervention was safe and tolerable in this population, experts say. Most patients reached and maintained ketosis during the study, with 91 per cent of their readings testing positive for blood ketones.

Among participants who provided reliable daily ketone and mental health assessments, increased ketone level was correlated with improvements in mood, energy, impulsivity, and anxiety.

Brain imaging also revealed reductions in excitatory neurotransmitters – chemical messengers in the brain – in two key brain areas implicated in bipolar disorder, suggesting a potential mechanism behind a ketogenic diet's effectiveness.

Metabolic benefits

Participants’ metabolic function also improved. Some 19 participants lost an average of 4.2kg (9.3lbs) and saw improvements in body mass index (BMI) and blood pressure. 

The findings suggest that a ketogenic diet may help to mitigate common metabolic health risks associated with bipolar disorder, such as diabetes and heart disease, which can lead to shortened life spans, experts say.

These results add to a small but growing body of evidence suggesting that a ketogenic diet may be a safe and effective intervention for bipolar disorder, alongside existing medications. There is an urgent need for larger replication studies and carefully designed randomised clinical trials to build on these findings.

Poor metabolic health is a significant problem for people with bipolar disorder, so the study of metabolic treatment approaches is very much welcomed by the patient community.

The idea that a severe mental illness such as bipolar disorder may respond to a metabolic treatment such as the keto diet is challenging and exciting. We are looking forward to carefully exploring links between metabolism and mental illness over the next few years, as part of the work within the new UKRI Hub for Metabolic Psychiatry in Edinburgh.

The study, funded by the Baszucki Group, is published in the journal BJPsych Open.

Related links

Read the study

UKRI Hub for Metabolic Psychiatry

Image credit: Nadiia Borovenko via Getty Images

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2025
Future of Health and Care
Research