Experiential Training Program Builds Health Care Professionals’ Readiness to Implement Ketogenic Metabolic Therapy in Mental Health Care

Specialized high-fat, low carbohydrate diets, known as ketogenic metabolic therapy, are showing promising therapeutic benefits for certain mental illnesses in emerging research. Now, a new study from researchers at the University of Maryland School of Medicine’s Maryland Psychiatric Research Center (MPRC) shows that an immersive training program can improve health care provider confidence in using a ketogenic dietary treatment plan for their patients.

The study was published in the journal Frontiers in Psychiatry.

Ketogenic metabolic therapy incorporates about 75 percent of calories from dietary fats, about 20 percent from protein, and usually less than 10 percent of calories from carbohydrates to shift the body’s metabolism from relying on glucose to ketones, which psychiatric researchers think have a beneficial effect on alleviating certain neurological and psychiatric symptoms that don’t respond well to prescription medications.

For example, the ketogenic diet is currently recommended as the standard of care for children with epilepsy whose seizures have not responded to traditional seizure medications, according to the Epilepsy Foundation. Several new studies suggest it has potential role as a complementary treatment for psychiatric conditions, including schizophrenia, bipolar disorder, and depression in patients who are not responding to traditional therapies.

“We launched this study because the science around ketogenic metabolic therapy in mental health is advancing rapidly, and we wanted health care professionals to be prepared to add it to their treatment options,” said study lead investigator Deanna L. Kelly, PharmD, BCPP, the Dr. William and Carol Carpenter Professor in Psychiatry for Mental Illness Research in the School of Medicine and the director of the Maryland Psychiatric Research Center. “Clinicians considering this approach with their patients should understand both the potential benefits and the practical challenges as new data continues to emerge.”

The forthcoming study evaluates Live It ~ Launch It , a two-part training program by the University of Maryland School of Medicine team that was funded by Baszucki Group, a private advocacy organization advancing metabolic therapies.

The pilot study enrolled 40 health care professionals from across the United States, including psychiatrists, psychiatric pharmacists, psychologists and therapists, as well as other health professionals. Participants first completed a four-hour online educational course covering the foundations of ketogenic metabolic therapy, as well as different approaches to ketogenic diets, nutrition, monitoring, and potential adverse effects when implementing ketogenic diets in clinical care.

They were then offered the opportunity to try the ketogenic diet themselves during a four-week “lived experience” phase; 25 participants opted in, receiving guidance from registered dietitians and physician nutrition specialists as part of a group cohort.

Dr. Kelly and her colleagues found that giving clinicians guided education, combined with firsthand experience using the ketogenic diet, substantially increased their confidence in explaining benefits and the risks of the therapy to patients with difficult-to-treat mental health disorders. They had firsthand experience in understanding the potentials challenges to adherence to the diet and substantially greater confidence in their ability to engage patients in shared decision-making about the therapy, including greater comfort in partnering with nutritionists when needed.

“Many people living with schizophrenia struggle also with weight gain, insulin resistance, and other metabolic problems that may be worsened by antipsychotic medications and contribute to cardiovascular risk,” said Dr. Kelly. “An approach that could improve metabolic health while also helping psychiatric symptoms would represent a very meaningful advance for patients and families.”

The researchers emphasize that the findings should be considered preliminary. Future research will need to examine whether training translates into changes in clinical practice.

The UMSOM researchers also noted that while data is quickly emerging, additional randomized controlled trials and longer-term studies are needed to establish the efficacy and appropriate clinical use of ketogenic diets in mental health care overall.

“What stood out in this study was how much clinicians gained from going beyond traditional education and actually experiencing ketogenic metabolic therapy themselves,” said Sidney Murray, PhD, MS, a postdoctoral fellow at the Maryland Psychiatric Research Center and lead author of the study. “Learning the science is important, but following the diet firsthand gave participants a much deeper understanding of the practical challenges their patients may face.”

The research team is preparing to publish a companion paper that measures the health care professionals’ physical health, mental health, nutrition, and metabolic measures during the four-week ketogenic diet phase.

The researchers say the findings will help inform development of future ketogenic metabolic training education and larger studies designed to determine whether the approach can be implemented safely and effectively in routine mental health care.