Metabolic Ketogenic Diet and Mental Health Conditions
This topic has intrigued me for a couple of years now and recently it has blown up and become intensely polemical and polarized. I think it’s an important topic to address for those recovering from eating disorders because restrictive diets of all kinds are known to hasten relapses and yet the early case evidence on metabolic ketogenic diets is intriguing and merits a deep dive.
Let’s wade in.
The Controversy
At the beginning of February 2026, Robert Francis Kennedy Junior (RFK Jr.) stated that a Harvard doctor had cured schizophrenia using keto diets. [1] The scientific community fell all over itself to rush to clarify the limits of what a ketogenic diet can and cannot do for various psychosis spectrum conditions [I am using this term to bundle up schizophrenia, schizotypal, schizoaffective, borderline and bipolar conditions as all these categories share varying levels in common of breaks with consensus-based reality (i.e. psychosis)].
Because RFK Jr. is the United States Secretary of Health and Human Services, who recently stated he was not afraid of a germ (SARS-CoV-2) and snorted cocaine off of toilet seats back in the day [2], it is understandable that the reaction to blithe statements of the curative powers of keto diets were dismissed outright by anyone with a reasonably intact brain.
All snark aside, it’s important to recognize that a broken clock can still technically be right twice a day and that people with absolutely no clue can still somehow stumble upon ideas that are perhaps a bit off the mark, yet still contain a kernel of truth.
It’s unfortunate that RFK Jr. entered the chat at all. I think that this short video encapsulates where we should land on the topic at this moment in time:
Lauren West Kennedy
I’ve followed this woman (a Canadian too) on YouTube for probably more than five years. I simply happened upon her videos at a time when she was working to educate medical communities, law enforcement and the population at large on the lived experience of schizophrenia. She had been diagnosed with schizoaffective disorder at age 25 and has struggled through several psychotic breaks, involuntary admissions to hospital care and had many challenges with antipsychotic cocktails all while starting a family with her partner in that time as well.
In early 2024 she began a metabolic ketogenesis program, using diet and supplementation and close medical supervision. To be very clear, this is not a keto diet. You wear a blood sugar monitoring patch and you are medically supervised to stably maintain an optimal ketogenic state in your body all while ensuring you are not facing severe deficiencies or any complications.
Ketogenic Diet
“The ketogenic diet is a high-fat, very low-carbohydrate nutritional pattern that promotes a metabolic shift from glucose utilization to ketone production, supporting energy needs during carbohydrate restriction. The diet reduces circulating insulin levels, enhances fat oxidation, and induces ketosis…The diet’s physiologic impact includes alterations in mitochondrial function, modulation of neuronal excitability, and changes in gut microbiota, all of which contribute to its therapeutic potential. Clinicians frequently encounter challenges related to patient selection, monitoring requirements, safety considerations, and long-term adherence, making a structured understanding of its mechanisms and clinical applications essential for optimal patient care.”
What this diet does is manipulates what food is made available so that it preferentially enhances one energy extraction pathway in the body over another. Instead of carbohydrates to generate glucose (mediated by the pancreas and insulin), it becomes fat to generate ketone bodies produced by the liver.
Ketogenic means creating a state of ketosis in the body. Ketosis is a metabolic state where the body is extracting energy from fat, rather than carbohydrates.
Using a high-fat, low-to-almost-no carbohydrate diet is an established treatment for refractory (meaning not responding to drug treatments) epilepsy.[4] As such, we have some decent long-term evidence on the risks of using this diet.
“…reported complications include dyslipidemia, hepatic steatosis, cardiomyopathy, hypercalciuria and kidney stones, reduced bone mineral density, and growth impairment in children. In a study of pediatric patients with intractable epilepsy, the results showed that those treated with the ketogenic diet had lower height, weight, and body mass index after 2 years compared to the control diet group. Chronic use has been associated with deficiencies in multiple micronutrients—including vitamins, minerals, and phytochemicals—as well as hypoproteinemia, all of which may contribute to renal and skeletal complications.”
Translating some of the above terminology for clarity, the complications can be: high levels of bad cholesterol and triglycerides, an enlarged, thickened or rigid heart muscle, the precursor to kidney stones (excreting high levels of calcium in urine), and low protein levels in the blood that can lead to kidney and liver disease, fluid retention and lowered immunity.
As omnivores, humans are designed to use both the carbohydrate and the fat energy extraction pathways to maintain long term energy balance and vitality in our living system.
Now before we get into the grey areas of why this diet might be used in the treatment of serious mental health conditions, let’s talk about how it was even considered as a possible treatment option in the first place.
The Metabolic Rationale
“The dysregulation of systemic glucose metabolism is observed in SZ [schizophrenia], and transcriptomic, proteomic, and metabolomic studies have repeatedly shown the glycolysis pathway as being disturbed in both the brain and cerebrospinal fluid of patients with SZ.”
Brains work on glucose and they need a disproportionate amount of energy to work compared to their proportionate size in the body as a whole. The brain is an energy hog so if the carbohydrate energy extraction system is malfunctioning, the brain is going to feel it.
Glycolysis is the conversion of glucose to adenosine triphosphate (ATP). ATP reverses ion movements that cause postsynaptic responses. [7] ATP facilitates the communication across the gap (synapse) at the end of one neuron over to the beginning of the next neuron. As glycolysis is not functioning well for those with schizophrenia the communication between neurons is dysregulated as well.
The metabolic rationale for using this diet for those with schizophrenia is that given the glucose pathway appears to be malfunctioning and that this may be implicated in why they have the psychotic symptoms that they do, the ketone body pathway has been identified as a reasonable workaround not just for an energy pathway, but for perhaps regulating neural function and alleviating psychotic symptoms.
Part Two April 3
https://cedmohub.eu/rfk-jr-overstates-early-evidence-ketogenic-diet-treats-schizophrenia/
https://www.usatoday.com/story/news/politics/2026/02/12/rfk-jr-cocaine-toilet-seats-theo-von-podcast-substance-abuse-recovery/88650599007/
https://www.ncbi.nlm.nih.gov/books/NBK499830/
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https://pmc.ncbi.nlm.nih.gov/articles/PMC11122005/
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