Why Experts Are Exploring Ketogenic Therapy for Mental Health

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Research suggests that metabolic health may play an essential role in mental well-being.

After years of therapies, medications, retreats, and self-exploration, Michael, a former nutrition client of mine, had resigned himself to a familiar low-grade depression and anxiety he’d carried since childhood. He accepted it as part of who he was. However, following Michael’s debilitating autoimmune diagnosis, a friend mentioned that changing her own diet had put her condition into remission. In physical pain on top of his depression, Michael decided to try an elimination diet.

Michael made several key changes to his eating—he cut out processed foods, refined carbs, and sugar, while adding healthy fats, increasing protein, and focusing on whole foods, including vegetables and fruit.

His physical health improved within a few months—and most strikingly, his depression lifted in just one month.

“I felt like life had come back into me. My mind was clear and my apathy gone. I never thought I would feel this happy again.”

For decades, psychiatry has focused on chemical imbalances in the brain. Now, growing research suggests that overall metabolic health—how efficiently the body produces and uses energy—may play an equally important role in mental well-being. That’s why scientists are now exploring therapeutic ketosis, a medically supervised ketogenic diet, as a potential tool for conditions ranging from depression to bipolar disorder.

“Most of the important mechanisms are not about neurotransmitters at all. It’s about ketones bypassing brain insulin resistance and improving mitochondrial health,” Dr. Matthew Bernstein, a board-certified psychiatrist and leading voice in metabolic psychiatry, told The Epoch Times.

“This is moving really fast. Metabolic psychiatry has a good group of people behind it from many disciplines, and therefore, we are pushing ahead with the randomized controlled trials,” Erin Louise Bellamy, a metabolic psychiatry clinician and researcher, and expert in ketogenic therapy for depression, told The Epoch Times.

The overarching theory of therapeutic ketosis is that it improves metabolism by reducing inflammation, stabilizing blood sugar, and countering insulin resistance, while improving mitochondrial health—the “batteries” that make us tick and work.

“We are fixing that [mitochondria], or at least giving it some time out away from all the blood sugar spikes, to get healthy again,” Bellamy said.

Unlike popular keto diets marketed for weight loss and convenience foods, therapeutic ketosis uses precise macronutrient ratios, monitors ketone levels, and requires medical supervision. A neurologist works with a registered dietitian to prescribe a diet to a patient.

“It will be carefully calculated to change their metabolic physiology,” Dominic D’Agostino, associate professor of molecular pharmacology and physiology at the University of South Florida Morsani College of Medicine, told The Epoch Times.

Bellamy noted that fat-to-carb-plus-protein ratios can be adjusted individually, often being roughly two parts fat to one part carbs, plus protein.

A day’s diet following such a ratio might include eggs with bacon cooked in cream and butter for breakfast, a leafy green salad with chicken, avocado, and plenty of olive oil for lunch, salmon with roasted asparagus, drizzled with butter and olive oil for dinner, and a small handful of macadamia nuts or a piece of full-fat cheese if needed to maintain the ratio.

The popular keto diet carries a lot of baggage—meaning it’s often overhyped and sensationalized. People tend to focus on extreme versions, packaged treats, celebrity anecdotes, or short-term results, which can give the wrong impression of how therapeutic keto actually works, D'Agostino said.

“If you elevate circulating ketones, they rapidly cross the blood-brain barrier and restore normal cerebral metabolic activity,” noted D’Agostino.

A ketogenic diet often works like a form of calorie restriction because it’s less palatable and naturally helps you feel full, so you don’t overeat like on a standard American diet, he said.

Ketones directly calm inflammatory pathways linked to psychiatric disorders. In the brain, they provide an alternative energy source when glucose is low and boost GABA, a calming neurotransmitter, acting somewhat like a mild anti-anxiety medication.

Gut inflammation may also play a role in the mechanisms of therapeutic keto.

She recommends returning to foods our grandparents would recognize to help stabilize blood sugar, including prioritizing animal protein, cooking with butter or coconut oil, a variety of vegetables, especially leafy greens, and choosing fattier cuts of meat.

A common question Bernstein grapples with in clinical practice is whether people can see mental health benefits from lowering inflammation through diet—cutting processed foods or eating low-carb—without committing to full therapeutic ketosis. He suggested easing in by reducing ultra-processed foods,  added sugar, refined flour, and industrial refined oils, while emphasizing whole foods and vegetables. Then, consider a lower-carb or low-glycemic diet next. Habits such as regular exercise, quality sleep, circadian rhythm alignment, and mind-body practices can further support many of the same metabolic processes targeted by a ketogenic diet.

Bernstein suggested a mindset shift around eating fat: “Initially it’s about not fearing fat … That’s a whole psychological shift people need to make. There really is no good evidence that saturated fat is bad for us.”

Small interventions, such as time-restricted eating or adding MCT oil in the morning, can also help, he said.

Even a simple low-carb diet—around 100 grams of fibrous carbs from vegetables and fruits while avoiding processed grains—can deliver many of keto’s benefits, D’Agostino said.

Michael’s elimination diet was one example—he cut carbs drastically but didn’t enter ketosis, removed inflammatory foods, and increased healthy fats like coconut oil, duck fat, and tallow.

“You, as an individual, have the ability to choose how you eat and the nutrition you have day to day… all of that is within your grasp right now, and you don’t have to wait,” Bellamy said.

Always check in with your physician before making major dietary changes—including trying a ketogenic diet—especially if you take medication to manage a mental health condition.

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