Bipolar Disorder and Ketogenic Diet A Survey of The Lived Experience of Over 100 Patients

Background:A ketogenic diet, an established treatment for refractory epilepsy, is now being investigated as a potential treatment for bipolar disorder, a condition in which anti-seizure medications are commonly utilized in treatment. This study aims to better understand the lived experience of bipolar disorder patients adhering to a ketogenic diet to identify potential benefits and risks.Methods:A structured online questionnaire was distributed to individuals diagnosed with bipolar disorder who have adhered to a ketogenic diet. The questionnaire collected data on demographics, diet adherence, symptoms and episodes, cognitive function, physical health, and quality of life. Quantitative and qualitative methods were used to analyze the data.Results:A total of 103 participants completed the questionnaire. 67.8% of participants maintained an average ketone level of 1-3 mmol/L. 20.3% maintained an average level above 3 mmol/L and 11.9% maintained an average level below 1 mmol/L. 47% followed a classic ketogenic diet and 28% followed a modified ketogenic diet.The mean number of reported episodes of mania per year decreased by 81% (3.08 to 0.58) when adhering to a ketogenic diet. And the mean number of reported episodes of depression per year decreased 79% (8.24 to 1.7) when adhering to a ketogenic diet.Respondents reported that symptoms of depression (moderate to very severe) decreased by 66.9 percentage points (from 85.5% to 18.6%) after beginning a ketogenic diet. Those reporting no symptoms of depression increased by 40 percentage points (from 5.8% to 46.1%). Hypomania (moderate to very severe) decreased by 42.1 percentage points (from 55.7% to 13.6%). Those reporting no hypomania increased by 35.3 percentage points (from 15.2% to 50.5%). Mania (moderate to very severe): decreased by 20.3 percentage points (from 30.3% to 10%). Those reporting no symptoms of mania increased by 34.7 percentage points (from 47.5% to 82.2%). Thematic analysis of the qualitative data revealed that many participants reported improvements in their quality of life, cognitive function and memory, physical health (including weight loss, and reductions in blood pressure) and social and occupational functioning. Some respondents reported side effects in the transition period into ketosis such as gastro-intestinal issues and fatigue, these were mostly mild and improved when established in ketosis, but were severe in a minority of respondents.Conclusions:Individuals living with bipolar disorder and adhering to a ketogenic diet report substantial benefits to their mental and physical health. These include reductions in occurrence and severity of episodes of depression, mania and hypomania, improved cognitive function, improved energy and weight loss. Most respondents adhered to forms of the diet and ketone ranges consistent with existing epilepsy guidelines. Side effects were reported in the adaptation period to ketosis, but these improved in most cases when in established ketosis. These findings from the lived experience of bipolar patients suggest that a ketogenic diet should be further investigated as a potential treatment for bipolar disorder. Randomized controlled trials are needed to study these effects and explore which patients may benefit from this intervention.