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Pilot study of a ketogenic diet in bipolar disorder

Lookup NU author(s): Dr Benjamin RigbyORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


BackgroundRecent evidence from case reports suggests that a ketogenic diet may be effective for bipolar disorder. However, no clinical trials have been conducted to date.AimsTo assess the recruitment and feasibility of a ketogenic diet intervention in bipolar disorder.MethodEuthymic individuals with bipolar disorder were recruited to a 6–8 week trial of a modified ketogenic diet, and a range of clinical, economic and functional outcome measures were assessed. Study registration number: ISRCTN61613198.ResultsOf 27 recruited participants, 26 commenced and 20 completed the modified ketogenic diet for 6–8 weeks. The outcomes data-set was 95% complete for daily ketone measures, 95% complete for daily glucose measures and 95% complete for daily ecological momentary assessment of symptoms during the intervention period. Mean daily blood ketone readings were 1.3 mmol/L (s.d. = 0.77, median = 1.1) during the intervention period, and 91% of all readings indicated ketosis, suggesting a high degree of adherence to the diet. Over 91% of daily blood glucose readings were within normal range, with 9% indicating mild hypoglycaemia. Eleven minor adverse events were recorded, including fatigue, constipation, drowsiness and hunger. One serious adverse event was reported (euglycemic ketoacidosis in a participant taking SGLT2-inhibitor medication).ConclusionsThe recruitment and retention of euthymic individuals with bipolar disorder to a 6–8 week ketogenic diet intervention was feasible, with high completion rates for outcome measures. The majority of participants reached and maintained ketosis, and adverse events were generally mild and modifiable. A future randomised controlled trial is now warranted.

Publication metadata

Author(s): Needham N, Campbell IH, Grossi H, Kamenska I, Rigby BP, Simpson SA, McIntosh E, Bahuguna P, Madowcroft B, Creasy F, Mitchell-Grigorjeva M, Norrie J, Thompson G, Gibbs MC, McLellan A, Fisher C, Moses T, Burgess K, Brown R, Thrippleton MJ, Campbell H, Smith DJ

Publication type: Article

Publication status: Published

Journal: BJPsych OPen

Year: 2023

Volume: 9

Issue: 6

Print publication date: 01/11/2023

Online publication date: 10/10/2023

Acceptance date: 22/08/2023

Date deposited: 09/11/2023

ISSN (electronic): 2056-4724

Publisher: Cambridge University Press


DOI: 10.1192/bjo.2023.568


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Funder referenceFunder name
Baszucki Brain Research Fund