Chronic Schizophrenia Put Into Remission Without Medication
New research suggests ketogenic diet may play a role in treating schizophrenia.
Posted Apr 06, 2019
Schizophrenia is usually a chronic, devastating disorder that causes tremendous suffering. It can ruin lives. Even with the best treatments available, symptoms and suffering often continue. An article that two colleagues and I just published April 6, 2019 in the medical journal Schizophrenia Research describes two patients with longstanding schizophrenia who experienced complete remission of symptoms with the ketogenic diet, a well-established, evidence-based treatment for epilepsy. Of particular interest in our research, both patients were able to stop antipsychotic medications and have remained in remission for years now. Though more evidence is certainly needed, this is extraordinarily hopeful news for those with this disorder and for the mental health professionals treating them.
The Psychotic Disorder Challenge
Schizophrenia affects 1 percent of the population. Its close cousin, bipolar disorder, affects 2 to 5 percent of the population. Tens of millions of people suffer. Symptoms include hallucinations, delusions, and disorganized thought and speech patterns. Hallucinations are when people see things or hear things that aren’t there, while delusions are thoughts that aren’t true, such as paranoid beliefs. Many people describe these psychotic symptoms as “being out of touch with reality.” People diagnosed with schizophrenia may also ignore hygiene, avoid being around people, and lack motivation. The illness affects most areas of life and can severely impair people at school, work, and in relationships.
Prevailing treatments revolve around antipsychotic medications. As useful as these are for some, unfortunately, they can yield poor results for others. A three-year study that tracked over 6,000 adults diagnosed with schizophrenia shows just how poor. All patients were treated at academic medical centers and were taking antipsychotic medications. The study tracked three metrics: symptom relief, quality of life, and ability to function in society. Only 4 percent of those patients achieved full relief from the illness on all three measures. Clearly, we need new treatment ideas for schizophrenia.
What Causes Schizophrenia?
No one knows for sure what causes schizophrenia. Most clinicians and researchers think it involves a chemical imbalance. This refers to neurotransmitters in the brain—chemicals that send messages from one brain cell to another. This theory has largely focused on excess activity of a neurotransmitter called dopamine—primarily because all antipsychotic medications block dopamine receptors. While there is a lot of evidence to support the dopamine theory, many current treatments designed around it have come up short. The treatments appear to only affect some of the symptoms, not all of them, and don’t change the course of the illness itself.
Other researchers think of schizophrenia as a neurodegenerative disorder. There is evidence that the brains of people with schizophrenia are different than other people’s brains, and can change over time. Some of the changes observed include shrinking of some brain regions, and changes in the connections between different brain regions.
However, emerging evidence suggests that something else might be behind schizophrenia. Attention has turned to bioenergetics, or energy production in the brain cells. It is well known that people with schizophrenia are three times more likely to develop diabetes. A common debate in the field is whether the antipsychotic medications, which are known to cause weight gain and diabetes, are to blame. Recent research suggests that this is not the entire explanation. Even people newly diagnosed with schizophrenia appear to already have insulin resistance, even though most don’t yet have diabetes. This means that their brains may not be getting enough energy from glucose. Other brain studies have found metabolic abnormalities, such as higher levels of oxidative stress and inflammation as well.
Why Would the Ketogenic Diet Help?
The medical version of the ketogenic diet is a high-fat, low-carbohydrate, moderate-protein diet proven to work for epilepsy. In my article The Ketogenic Diet May Help Stop Seizures, I explain the history and research demonstrating that the ketogenic diet is a powerful intervention in treating epilepsy. While referred to as a “diet,” make no mistake: this is a powerful medical intervention. Studies show that over 50 percent of children with epilepsy who do not respond to medications experience significant reductions in the frequency and severity of their seizures, with some becoming completely seizure-free.
Using epilepsy treatments in psychiatry is nothing new. Anticonvulsant medications are often used to treat psychiatric disorders. Depakote, Lamictal, Tegretol, Neurontin, Topamax, and all of the benzodiazepines (medications like Valium and Ativan, commonly prescribed for anxiety) are all examples of anticonvulsant medications routinely prescribed in the treatment of psychiatric disorders. Therefore, it’s not unreasonable to think that a proven anticonvulsant dietary intervention might also help some people with psychiatric symptoms.
Interestingly, the effects of this diet on the brain have been studied for decades because neurologists have been trying to figure out how it works in epilepsy. This diet is known to produce ketones which are used as a fuel source in place of glucose. This may help to provide fuel to insulin resistant brain cells. This diet is also known to affect a number of neurotransmitters and ion channels in the brain, improve metabolism, and decrease inflammation. So there is existing science to support why this diet might help schizophrenia.
But Does It Work?
An 82-year-old woman with chronic paranoid schizophrenia since age 17
The first patient documented in the Schizophrenia Research article is a woman who spent nearly her whole life suffering chronic, treatment-resistant schizophrenia. For more than 50 years, she endured paranoia, disorganized speech, visual and auditory hallucinations. By the time she was 70, she was suicidal and had been hospitalized repeatedly for psychosis or suicide attempts. She had been treated with over ten different antipsychotic and mood stabilizing medications, including regular antipsychotic injections. None of them helped her symptoms. She was unable to care for herself and had a court-appointed guardian and home health services.
At the age of 70, weighing 330 pounds, she went to a medical weight loss clinic and was started on a ketogenic diet. Within two weeks of starting the diet, she reported a noticeable reduction not only in her weight but also her psychotic symptoms. Within several months, she started to feel so much better that she was able to stop taking her psychiatric medications while remaining on the diet. Over time, her mood stabilized, and her hallucinations and paranoia remitted completely. She was no longer suicidal. Her case was first reported in 2009.
Today, 12 years later, she has lost a total of 150 pounds and remains on the ketogenic diet. She takes no medications and remains symptom-free. She was able to regain her independence, no longer requiring the guardian and the home health care team. When I recently spoke with her, she recalled her decades of suffering and hopelessness, and said that since starting the diet, she has had a "new life," and is happy to be alive.
A 39-year-old woman with schizophrenia for 20 years
The second patient described in the article is a thirty-nine year old woman who suffered from depression, anxiety, anorexia nervosa, hallucinations and paranoia since her teens. As patients sometimes do, she concealed her psychotic symptoms when she was initially treated for depression and anorexia. When she finally reported her psychotic symptoms later in her twenties, she was diagnosed with schizophrenia. For the next ten years, she was treated with 7 different antipsychotic medications—including clozapine (called the “gold standard antipsychotic medication”)—along with antidepressants and anti-anxiety medications. Nevertheless, she continued to have symptoms.
She was having chronic gastrointestinal problems, so she saw a doctor who recommended the ketogenic diet. Noticing some improvement of her symptoms and being frustrated with all of her psychiatric medications, she unwisely stopped taking all 14 of her medications “cold turkey.” This sent her into severe psychosis requiring an extended hospitalization. In the hospital, she was re-medicated with Haldol-decanoate (an injectable medication which had not worked for her previously) and she continued the ketogenic diet. Within a month on both Haldol and the ketogenic diet, she reported complete remission of her psychotic symptoms for the first time since she was 14. Over the following year, she slowly tapered off Haldol, and remained free of psychotic symptoms. Of note, she lost 70 pounds from the diet, which exacerbated her anorexia. She has since regained 30 of those pounds and maintains a healthy weight today. Five years after starting the ketogenic diet, she is off all antipsychotic medications, remains on the diet, and is free of all psychotic symptoms. She has also finished graduate school and now works full time.
More Evidence of the Ketogenic Diet for Schizophrenia
While inspiring, these two case reports aren't the first of their kind. They join a growing body of evidence supporting the use of the ketogenic diet in the treatment of schizophrenia.
Schizophrenia in 1965
In 1965, ten women hospitalized with schizophrenia who were already receiving medications and electroconvulsive therapy (ECT or “shock therapy”) were also placed on the ketogenic diet for a month. The researchers reported that their symptoms improved after two weeks on the diet, but then returned back to their baseline level of symptoms after the diet was stopped.
Schizoaffective disorder in 2017
In 2017, I reported two other cases of schizoaffective disorder improving significantly on the ketogenic diet. Schizoaffective disorder is a diagnosis that includes both a mix of schizophrenia and a mood disorder, often bipolar disorder. One man and one woman, both in their 30’s, had suffered treatment-resistant schizoaffective disorder for years. On the diet, their symptoms were greatly improved, and they both lost significant amounts of weight. Off the diet, their symptoms returned.
Schizophrenia in Ecuador
In 2018, two Ecuadorian twins, one male and one female, diagnosed with schizophrenia since the ages of 14 and 18 were started on a 6-week trial of the ketogenic diet. This study had a psychiatrist rate each twin’s symptoms while being unaware of their diet status. Interestingly, only when the patients were compliant with the diet did their symptoms improve. They also both lost weight. When they stopped the diet at the end of the study, their symptoms returned to their baseline level.
Schizophrenia in mice
In 2015, researchers conducted a study of the effects of the ketogenic diet in a mouse model of schizophrenia. Studies exactly like this are used in the development of new antipsychotic medications. The ketogenic diet was found to normalize the mouse behaviors associated with schizophrenia, indicating an antipsychotic effect.
In 2018, the same researchers published another study of the ketogenic diet normalizing impaired prepulse inhibition in mice—yet another marker commonly associated with schizophrenia. The mice on the ketogenic diet appeared normal on this measure. Interestingly, weight loss was a factor for which they controlled in designing the study. Some of the mice were calorie restricted and others were not. They concluded that weight loss was not required to get the benefit of the ketogenic diet—the diet alone was enough.
The two women described in the Schizophrenia Research article above, who are currently in complete remission from schizophrenia, probably do not care why this diet worked. The proof is in the pudding for them. But we doctors like to know more about how and why things work, and better understand how many more people might respond to this type of treatment. Clearly, more research is needed. However, make no mistake. All of these research findings, from the basic science of schizophrenia to the case reports and studies mentioned here, open up a new field of inquiry—one based on entirely novel mechanisms of action and a whole new way of understanding schizophrenia. I, for one, am hopeful for the millions of people suffering. The sooner we can offer more effective treatments, the better.
Should Someone Try This Diet on Their Own?
If you have schizophrenia or any serious disorder and are considering using the ketogenic diet as a treatment, I strongly recommend that you consult with a healthcare professional before trying this diet. Why? Because mental illnesses are serious disorders and sometimes dangerous. The medical version of the ketogenic diet has risks and side effects. You should have accurate information, help, and medical supervision to implement treatments in a safe and effective way. All of the patients described in all of these studies were treated by physicians while attempting the ketogenic diet.
DISCLAIMER: Nothing in this article is intended as medical advice. Anyone contemplating the ketogenic diet as a treatment for illness of any kind is urged to seek medical help from a competent medical provider trained in treatment of the underlying condition as well as the ketogenic diet therapy before initiating the ketogenic diet. The ketogenic diet induces significant metabolic changes which can impact medication metabolism, among other things. Individuals seeking treatment of any illness using the ketogenic diet will likely require additional support especially during the initial adaptation phase, and thereafter for the duration of treatment which can take years depending on a variety of factors. No doctor-patient relationship is created by this article, or by any responses to comments posted in this forum by Chris Palmer, M.D.