Ketogenic Diet and Mental Health: Could Changing Your Brain's Fuel Improve How You Feel?
- Ruth Etches
- Jun 30
- 21 min read
Key Takeaways:
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Table of Contents
What does the research say about the ketogenic diet and mental health?
Depression
Bipolar disorder
Schizophrenia
Anxiety
Brain fog and cognitive function
What is the ketogenic diet?
If you've been searching for information about the ketogenic diet and mental health, you've probably come across terms like ketosis, ketones and metabolic therapy. Before exploring what the research says, it's helpful to understand what the ketogenic diet actually is and how it works.
The ketogenic diet is a high-fat, moderate-protein and very low-carbohydrate way of eating that changes the body's primary source of energy. Normally, the body relies on glucose, which comes mainly from carbohydrates such as bread, rice, pasta, potatoes and sugary foods. However, when carbohydrate intake is reduced significantly, the body switches to using fat as its main fuel.
As fat is broken down in the liver, it produces molecules called ketones. These ketones can be used by most tissues in the body, including the brain, as an alternative source of energy. This natural metabolic state is known as ketosis.
Although many people now associate the ketogenic diet with weight loss, it was originally developed over 100 years ago as a medical therapy for children with drug-resistant epilepsy. Today, it remains an established treatment for epilepsy and is now being explored by researchers for a growing number of neurological and mental health conditions.
How does ketosis work?
Ketosis occurs when carbohydrate intake is low enough that the body begins producing ketones from stored or dietary fat. Rather than depending primarily on glucose, the body becomes more efficient at using fat for energy.
Importantly, ketosis is a normal physiological process. It is not the same as ketoacidosis, a serious medical condition that can occur in people with uncontrolled diabetes. Nutritional ketosis is a carefully regulated metabolic state that healthy individuals can enter safely under appropriate circumstances.
Is a ketogenic diet the same as a low-carbohydrate diet?
Not necessarily.
While all ketogenic diets are low in carbohydrates, not all low-carbohydrate diets are truly ketogenic.
Many people reduce carbohydrates to support weight loss or improve blood sugar balance without entering nutritional ketosis. A therapeutic ketogenic diet, on the other hand, is designed to produce and maintain ketone levels that can be measured in the blood, breath or urine.
This often requires a lower carbohydrate intake and a higher proportion of healthy fats than a typical low-carbohydrate diet. It also involves paying close attention to food quality, nutrient intake and, in many cases, ongoing monitoring.
For people considering a ketogenic diet to support brain or mental health, the goal is not simply to eat fewer carbohydrates. The aim is to achieve a sustained state of nutritional ketosis, where the brain has access to ketones as an alternative fuel source.
Why is the ketogenic diet being studied for mental health?
For many years, the ketogenic diet was viewed primarily as a treatment for epilepsy and, more recently, as a popular approach to weight loss. Today, however, it is attracting attention for a very different reason.
Researchers around the world are investigating whether changing the brain's fuel source may influence mental health.
This growing field of research, often referred to as metabolic psychiatry, is based on the idea that mental health is influenced by far more than brain chemistry alone. Increasingly, scientists are recognising that factors such as energy production, inflammation, metabolism, immune function and nutrition may all play an important role in how the brain functions.
Rather than asking only "What is happening to brain chemicals?", researchers are also asking "How well are brain cells producing and using energy?"
This shift in thinking is changing the conversation around mental health.
A different way of thinking about mental health
For decades, many mental health conditions have been understood largely through the lens of neurotransmitters such as serotonin and dopamine. While these remain important, they are only part of a much bigger picture.
The brain is the most energy-hungry organ in the body, despite accounting for only around 2% of our body weight. It uses approximately 20% of the body's energy at rest. Every thought, memory, emotion and nerve signal depends on a constant supply of energy.
When the brain struggles to meet these energy demands, it may affect how brain cells communicate and function. Researchers are now exploring whether this may contribute to symptoms seen in some mental health conditions.
What does the research tell us?
Although research is still developing, studies have identified changes in brain energy metabolism in a number of conditions, including depression, bipolar disorder and schizophrenia. Scientists are also investigating ketogenic metabolic therapy in areas such as anxiety, cognitive decline and brain fog.
Importantly, this does not mean that all mental health conditions are caused by problems with brain energy, nor does it mean that a ketogenic diet is the right approach for everyone.
Instead, it suggests that for some people, improving the way the brain generates and uses energy may become one part of a broader, personalised treatment approach.
This is an exciting area of research, but it is also one that requires careful interpretation. While some findings are encouraging, larger clinical trials are still underway, and many questions remain about who is most likely to benefit and how ketogenic metabolic therapy should be used alongside conventional care.
In the next section, we'll explore what happens inside the brain during ketosis and why researchers believe this metabolic shift may influence brain health and mental wellbeing.
How does ketosis affect the brain?
One of the reasons researchers are so interested in the ketogenic diet and mental health is that ketosis appears to influence several biological processes involved in healthy brain function.
Rather than acting through a single pathway, ketones may affect the brain in multiple ways. Research suggests they can influence how brain cells produce energy, communicate with one another, respond to inflammation and protect themselves from damage.
This is important because many mental health conditions have been associated with changes in one or more of these processes. While we still have much to learn, understanding these potential mechanisms helps explain why ketogenic metabolic therapy has become such an exciting area of research.
Brain energy and mitochondrial function
Every cell in your body contains tiny structures called mitochondria, often described as the cell's "power stations". Their job is to convert nutrients into the energy needed for every process in the body.
Research suggests that ketones may provide a more efficient fuel source for mitochondria than glucose in some circumstances. They may also encourage the production of new mitochondria and support healthier energy production within brain cells. For this reason, some researchers believe that improving brain energy metabolism could play a role in supporting certain neurological and mental health conditions.
Neurotransmitter balance
The brain relies on chemical messengers called neurotransmitters to allow nerve cells to communicate.
Some neurotransmitters help stimulate brain activity, while others have a calming effect. Healthy brain function depends on maintaining a careful balance between these different signalling systems.
Early research suggests ketosis may influence several neurotransmitters, including GABA, which has calming effects, and glutamate, one of the brain's main excitatory neurotransmitters. Maintaining a healthy balance between these systems may be important for mood, emotional regulation and overall brain function. This is one of several reasons why ketogenic diets are now being investigated across a range of neurological and psychiatric conditions.
Neuroinflammation
Inflammation is a normal and essential part of the immune system. However, when inflammation becomes chronic or poorly regulated, it may affect many parts of the body, including the brain.
An increasing body of research has linked neuroinflammation with conditions such as depression, schizophrenia, Alzheimer's disease and other neurological disorders.
Some compelling research suggest that ketosis may help regulate inflammatory pathways within the brain.
Oxidative stress
Every day, our cells naturally produce unstable molecules known as free radicals. Normally, the body can neutralise these using its own antioxidant defence systems.
When free radicals are produced faster than they can be removed, oxidative stress can occur. Over time, this may contribute to damage within cells, including those in the brain.
Research suggests that ketones may improve the brain's resilience to oxidative stress by supporting cellular energy production and enhancing the body's natural antioxidant systems. This is another area where scientists believe ketogenic metabolic therapy may have potential.
Metabolic health and insulin resistance
The brain and the rest of the body are closely connected.
Poor metabolic health, insulin resistance and unstable blood sugar levels have all been associated with an increased risk of depression, cognitive decline and other mental health conditions. For some people, improving metabolic health through dietary changes may support healthier brain function alongside wider improvements in physical health.
What does the research say about the ketogenic diet and mental health?
The research into ketogenic diets and mental health has expanded rapidly in recent years, making it one of the most exciting developments in nutritional psychiatry and metabolic medicine.
While much of the early work focused on epilepsy, there is now a growing body of evidence suggesting that ketogenic metabolic therapy may have an important role in supporting some people with conditions including depression, bipolar disorder, schizophrenia, anxiety and cognitive impairment.
Although many of the published studies have been relatively small, the findings have been remarkably consistent. Researchers have reported improvements in psychiatric symptoms, mood stability, cognitive function and quality of life in a proportion of participants, often alongside improvements in metabolic health.
Importantly, these findings are supported by an increasingly strong scientific understanding of why ketosis may influence brain function. Rather than targeting a single pathway, ketosis appears to affect multiple biological processes that are increasingly recognised as important in mental health, including brain energy metabolism, mitochondrial function, neuroinflammation and neurotransmitter balance.
This doesn't mean that a ketogenic diet is the right approach for everyone, nor should it replace appropriate medical care. However, the growing evidence means it is no longer reasonable to dismiss ketogenic metabolic therapy as simply another dietary trend. It is now being actively researched by leading universities and psychiatric centres around the world as a potential therapeutic option for selected individuals.
Who might benefit from a ketogenic diet?
A ketogenic diet is not appropriate for everyone, and it is certainly not a one-size-fits-all approach. However, research suggests that some people may benefit more than others, particularly where there is evidence of metabolic dysfunction or altered brain energy metabolism.
Current evidence and clinical experience suggest ketogenic metabolic therapy may be worth exploring in people with:
Bipolar disorder
This is currently one of the most promising areas of research. Several studies have reported improvements in mood stability, symptom severity and quality of life in some people following a well-formulated ketogenic diet. Larger clinical trials are underway, but the early findings are encouraging.
Schizophrenia
Growing evidence suggests ketogenic metabolic therapy may support some people living with schizophrenia, particularly when used alongside conventional psychiatric care. Researchers are investigating its effects on symptoms, cognition and overall functioning.
Depression
Some people with depression, particularly those who also have insulin resistance, metabolic syndrome or blood sugar dysregulation, may benefit from improving metabolic health. While more research is needed, early studies suggest ketogenic diets may improve mood and wellbeing in some individuals.
Brain fog and cognitive difficulties
People experiencing persistent brain fog, poor concentration, mental fatigue or memory problems may benefit from a thorough assessment to understand the underlying causes. Where impaired brain energy metabolism or metabolic dysfunction is suspected, ketogenic metabolic therapy may be one option to consider as part of a wider personalised approach.
Mild cognitive impairment and Alzheimer's disease
Researchers are increasingly interested in whether ketones can provide an alternative fuel source for ageing brains that are becoming less efficient at using glucose. While research is ongoing, several studies have reported encouraging findings relating to memory and cognitive function in some individuals.
Long COVID
Many people living with Long COVID experience persistent symptoms such as brain fog, fatigue, poor concentration and memory difficulties, even months or years after the initial infection.
Researchers are investigating whether impaired brain energy metabolism, mitochondrial dysfunction, neuroinflammation and ongoing metabolic changes may contribute to these symptoms. As ketones provide an alternative fuel source for the brain, ketogenic metabolic therapy is attracting increasing interest as a potential strategy to support recovery in some individuals.
Although research is still in its early stages, emerging studies and clinical experience are encouraging. For people with Long COVID, however, a ketogenic diet is unlikely to be the whole answer. It is important to identify and address other potential contributing factors, such as nutritional deficiencies, gut health, immune dysregulation, hormone imbalances and disrupted sleep, as part of a personalised treatment plan.
One size fits one
A diagnosis alone is never enough to determine whether a ketogenic diet is appropriate.
At Re:Health Clinic, we look at the bigger picture. Alongside your symptoms and medical history, we consider factors such as blood sugar regulation, nutritional status, gut health, inflammation, hormone balance, sleep, lifestyle and current medications.
For some people, ketogenic metabolic therapy can be a valuable part of their personalised plan. For others, a different nutritional or Functional Medicine approach may be more appropriate.
Our goal is always the same: to identify the underlying factors contributing to your symptoms and recommend the strategy that best fits your individual needs, rather than applying the same approach to everyone.
Is a ketogenic diet suitable for everyone?
Although the research into ketogenic diets and mental health is exciting, ketogenic metabolic therapy is not the right approach for everyone.
Like any therapeutic intervention, it works best when it is carefully planned, tailored to the individual and supervised appropriately. Factors such as your medical history, current medications, nutritional status and health goals all influence whether it is likely to be a suitable option.
Contraindications to a ketogenic diet include those who:
Take medication for diabetes
Are pregnant or breastfeeding.
Have a history of an eating disorder or disordered eating.
Have significant kidney, liver or pancreatic disease.
Are underweight or at risk of malnutrition.
Are supporting a child or teenager, where specialist guidance is particularly important.
If you take medication for bipolar disorder, schizophrenia or other mental health conditions then it is vital that the diet is supervise and medications adjsuted as necessary. Any dietary changes should be discussed with your prescribing clinician, and medications should never be reduced or stopped without medical supervision.
It is also worth remembering that there is no single version of a ketogenic diet. Many recipes and meal plans found online are designed for weight loss rather than therapeutic ketosis and may rely heavily on processed foods or fail to provide adequate vitamins, minerals and fibre. A well-formulated ketogenic diet should be based on real, nutrient-dense foods and carefully planned to meet your nutritional needs.
Why professional guidance matters
When ketogenic metabolic therapy is used to support brain or mental health, the goal is not simply to reduce carbohydrates. The aim is to create a sustainable nutritional approach that supports both physical and mental wellbeing while minimising potential side effects.
Professional support can help you:
Decide whether a ketogenic diet is appropriate for your individual circumstances.
Adapt the approach around your medical history and medications.
Ensure your diet remains nutritionally balanced.
Monitor ketone levels where appropriate.
Reduce the risk of common problems such as constipation, electrolyte imbalances and the so-called "keto flu".
Review your progress and make adjustments as your health changes.
At Re:Health Clinic, we view ketogenic metabolic therapy as one evidence-informed tool within a much broader personalised approach to brain and mental health. Before recommending any intervention, we take time to understand the bigger picture, looking at factors such as nutrition, gut health, sleep, hormone balance, inflammation, metabolic health and lifestyle. Our aim is always to identify the combination of strategies that is most likely to help you achieve long-term improvements in your health and wellbeing.
How to get started safely
If you're considering a ketogenic diet to support your brain or mental health, it's important to remember that therapeutic ketogenic metabolic therapy is very different from simply following a low-carbohydrate diet for weight loss.
Success depends on much more than cutting out bread, pasta and sugar. A well-formulated ketogenic diet requires careful planning to ensure it provides adequate protein, healthy fats, fibre, vitamins and minerals while achieving nutritional ketosis.
Consider a gradual transition
One of the biggest misconceptions about the ketogenic diet is that you have to change everything overnight.
While some people prefer to make an immediate switch, many find it easier and more sustainable to transition gradually. This allows your body time to adapt to using fat as its primary fuel source and makes the dietary changes feel much less overwhelming.
For many of our clients, we recommend taking a stepped approach. This might begin by moving towards a whole-food, anti-inflammatory diet, such as a Paleo-style approach, before progressively reducing carbohydrate intake over several weeks.
For example, you might start by:
Removing ultra-processed foods, sugary drinks and refined carbohydrates.
Prioritising good-quality protein at every meal.
Replacing processed foods with colourful vegetables, healthy fats and nutrient-dense whole foods.
Including more healthy fats such as extra virgin olive oil, avocado, nuts, seeds and oily fish.
Gradually reducing foods such as bread, pasta, rice, cereals and potatoes as your confidence grows.
Becoming comfortable preparing simple, nourishing meals before aiming for nutritional ketosis.
This gradual approach often helps people develop sustainable habits, build confidence and identify practical challenges before progressing to a therapeutic ketogenic diet.
Focus on food quality
A ketogenic diet should be based on real, nutrient-dense foods rather than processed "keto" products. While packaged keto snacks and desserts can occasionally have a place, they should not form the foundation of your diet.
Instead, focus on quality sources of protein, healthy fats, plenty of non-starchy vegetables, herbs, spices, nuts, seeds and minimally processed foods.
Don't neglect protein
One of the biggest misconceptions about ketogenic diets is that they are extremely high in fat and very low in protein.
In reality, therapeutic ketogenic diets contain adequate protein to support muscle mass, immune function, hormone production and overall health. Protein requirements vary between individuals and should be tailored according to factors such as age, activity levels and health goals.
Pay attention to electrolytes
During the first few weeks of a ketogenic diet, the body loses more water and sodium than usual. This can contribute to headaches, fatigue, dizziness, muscle cramps and the collection of symptoms often referred to as the "keto flu".
Ensuring adequate sodium, potassium and magnesium intake, alongside good hydration, can help minimise these symptoms and make the transition much more comfortable.
Track your ketones
If your goal is therapeutic ketogenic metabolic therapy rather than simply reducing carbohydrate intake, it's important to measure whether you have actually reached nutritional ketosis.
There are three main ways to measure ketones:
Urine ketone strips are inexpensive and easy to use, making them a helpful starting point when first transitioning to a ketogenic diet. However, they become less reliable over time as the body becomes more efficient at using ketones for energy.
Blood ketone meters measure beta-hydroxybutyrate (BHB) and are widely regarded as the most accurate way of measuring nutritional ketosis. For therapeutic ketogenic diets used to support brain or mental health, blood ketone monitoring is generally recommended.
Breath ketone meters are also available and can be useful for some people, although their accuracy can vary between devices.
Tracking your ketone levels helps confirm that you are achieving nutritional ketosis rather than simply eating a lower-carbohydrate diet. It also allows dietary adjustments to be made if needed and provides valuable feedback on how different foods, meals and lifestyle factors affect your metabolism.
Be patient
Many people begin producing ketones within a few days of significantly reducing carbohydrates. However, becoming fully adapted to using ketones efficiently as a primary fuel source often takes several weeks.
During this time, it's normal for energy levels to fluctuate as your metabolism adjusts. Giving your body time to adapt is an important part of the process.
Work with an experienced practitioner
If you're considering ketogenic metabolic therapy to support depression, bipolar disorder, schizophrenia, anxiety, brain fog or another neurological or mental health condition, professional guidance is strongly recommended.
A practitioner experienced in ketogenic metabolic therapy can help determine whether this approach is appropriate for you, tailor the diet to your individual needs, monitor your progress, interpret your ketone levels and ensure it is safely integrated with any existing medications or treatments.
Remember: ketogenic metabolic therapy is one piece of the puzzle
At Re:Health Clinic, we see ketogenic metabolic therapy as one evidence-informed tool within a broader personalised approach to brain and mental health.
Alongside nutrition, we also consider factors such as sleep, gut health, nutrient deficiencies, inflammation, metabolic health, hormone balance, movement, stress, genetics and lifestyle. These factors can all influence how the brain functions and how you feel.
Our goal isn't simply to help you achieve ketosis. It's to understand the underlying drivers of your symptoms and develop a personalised plan that gives your brain the best possible opportunity to thrive.
Is ketogenic metabolic therapy right for you?
The ketogenic diet is one of the most exciting areas of research in brain health and mental health today. As our understanding of metabolic psychiatry continues to evolve, we are learning that nutrition may influence the brain in ways that extend far beyond simply providing fuel.
While ketogenic metabolic therapy is not the right approach for everyone, the growing body of research suggests it may offer real benefits for some people, particularly when used as part of a personalised, evidence-informed treatment plan.
At Re:Health Clinic, we don't believe in one-size-fits-all solutions.
Ketogenic metabolic therapy is one of many tools in our clinical toolkit. Before recommending any intervention, we take time to understand your unique health story, looking at factors such as nutrition, metabolic health, gut function, inflammation, nutrient status, hormones, sleep, genetics and lifestyle. This allows us to build a personalised plan that addresses the underlying drivers of your symptoms, rather than simply focusing on a diagnosis.
For some people, ketogenic metabolic therapy becomes an important part of that plan. For others, a different nutritional or Functional Medicine approach may be more appropriate. Our goal is always to help you find the strategy that is most likely to support your long-term brain and mental wellbeing.
Work with Re:Health Clinic
If you're interested in exploring whether ketogenic metabolic therapy could be right for you, we offer both personalised one-to-one support and a structured group programme.
Our clinicians have extensive experience supporting people with complex brain and mental health conditions, using Functional Medicine, Nutritional Psychiatry and the latest research in metabolic health to develop personalised care plans.
Whether you're living with depression, bipolar disorder, schizophrenia, anxiety, brain fog, cognitive decline or Long COVID, we'll help you understand whether ketogenic metabolic therapy could play a role in your wider health journey.
Join our Ketogenic Metabolic Therapy Group Programme
If you'd like expert guidance alongside the encouragement of a supportive community, our Ketogenic Metabolic Therapy Group Programme begins in September 2026.
The programme has been designed for people who want to learn how to implement a therapeutic ketogenic diet safely and effectively, with expert education, practical resources and ongoing support throughout the process.
You can find out more here:
Or, if you'd prefer a personalised 1:1 approach, we'd be delighted to discuss how we may be able to support you through a one-to-one consultation.
The field of metabolic psychiatry is developing rapidly, and we're excited to see where the research leads over the coming years. We hope this article has helped you better understand why the ketogenic diet is attracting so much interest and how changing the brain's fuel source may open up new possibilities for supporting brain and mental health.
Frequently Asked Questions
Can a ketogenic diet improve mental health?
A growing body of compelling research suggests that a ketogenic diet may support some people with certain mental health conditions, particularly bipolar disorder, treatment resistent depression and schizophrenia, where some of the strongest evidence is emerging. Scientists believe this may be due to improvements in brain energy metabolism, mitochondrial function and neuroinflammation.
Does the ketogenic diet help depression?
Early research suggests that some people with depression experience improvements in mood and wellbeing when following a well-formulated ketogenic diet. Researchers are investigating whether improved brain energy metabolism, more stable blood sugar levels and reduced inflammation may contribute to these benefits. More large-scale clinical trials are still needed, but the findings so far are encouraging.
Is there evidence that keto can help bipolar disorder?
Yes. Bipolar disorder is currently one of the most promising areas of ketogenic metabolic therapy research. Several pilot studies, case reports and observational studies have demonstrated improvements in mood stability, symptom severity and quality of life in some individuals. Larger clinical trials are now underway to build on these encouraging findings.
Can a ketogenic diet help schizophrenia?
There is growing evidence that ketogenic metabolic therapy may benefit some people living with schizophrenia, particularly when used alongside conventional psychiatric care. Researchers are investigating its effects on symptoms, cognition and overall functioning. Although the evidence continues to grow, ketogenic therapy should only be undertaken with appropriate clinical supervision.
How long does it take to get into ketosis?
Most people enter nutritional ketosis within two to seven days of significantly reducing carbohydrate intake, although this varies depending on factors such as metabolism, activity levels and previous diet. Becoming fully adapted to using ketones efficiently as a primary fuel source can take several weeks.
Is a ketogenic diet safe?
For many people, a well-formulated ketogenic diet can be a safe and nutritious way of eating. However, it is not suitable for everyone. If you have diabetes, take medication, are pregnant or breastfeeding, have a history of an eating disorder or have certain medical conditions, it is important to seek professional advice before making significant dietary changes.
Do I need to stay on a ketogenic diet forever?
Not necessarily. The duration depends on your health goals, your response to the diet and the condition being addressed. Some people follow a ketogenic diet for months or years, while others transition to a less restrictive whole-food, lower-carbohydrate approach once they have achieved their goals. This should always be individualised.
Can I follow a vegetarian ketogenic diet?
Yes, although it can be more challenging to meet protein and nutrient requirements. Careful planning is important to ensure adequate intake of essential nutrients while maintaining nutritional ketosis. Some people may also benefit from targeted supplementation.
Should I try a ketogenic diet on my own?
If you are considering ketogenic metabolic therapy for a mental health condition, it is advisable to seek guidance from a practitioner experienced in this area. Professional support can help ensure the diet is nutritionally balanced, appropriate for your medical history and safely integrated with any existing treatments.
About the Author
Ruth Etches, Nutritional Therapist & Functional Medicine Practitioner
Ruth is a leading practitioner in brain and mental health, with advanced training in Integrative and Nutritional Psychiatry. She is also a certified Bredesen practitioner, offering the ReCode and PreCode protocols for Alzheimer's prevention and cognitive optimisation.
With many years of clinical experience, Ruth specialises in uncovering the triggers and drivers of complex conditions such as anxiety, depression, ADHD, bipolar disorder, OCD, schizophrenia, cognitive decline, and mould-related illness. She uses advanced functional testing - including genetics, organic acids, hormone panels, immune markers, and gut analysis - to create highly personalised nutrition and lifestyle strategies.
Ruth is the founder of Re:Health Clinic, where she and her team provide compassionate, evidence-based support to clients across the UK and internationally. Her approach blends cutting-edge science with a deeply personalised, holistic philosophy: no stone unturned.
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