G. Ede, M. Bernstein, L. Calabrese, IH. Campbell, N. Laurent, CM. Palmer, S. Sethi, et al. (2026). Awareness and best practices in using ketogenic therapy to treat serious mental illness: a modified Delphi consensus. Frontiers in nutrition, 13, 1749406. https://doi.org/10.3389/fnut.2026.1749406

PubMed 41816235

[Abstract]
BACKGROUND: Metabolic dysfunction is emerging as an important contributor to the pathophysiology of major depressive disorder, bipolar disorder, and schizophrenia, fueling interest in ketogenic metabolic therapy (KMT) as a potentially beneficial intervention for serious mental illness. KMT has been used successfully for decades in treating epilepsy, but evidence for treating mental illness has yet to mature.

AIMS: This study aimed to produce expert-informed guidance for the implementation of KMT in adults with serious mood and psychotic disorders.

METHOD: A modified Delphi methodology was used to examine the opinions of KMT-experienced mental health experts. A steering group of eight such experts convened to develop an online survey comprising 33 statements regarding 1) the definition of KMT in the context of serious mood and psychotic illness; 2) identification of eligible candidates; 3) monitoring and measurement standards; and 4) best practices in employing KMT. This survey was distributed to clinician peers to examine opinions. The threshold for consensus agreement was set a priori at 75%.

RESULT: Consensus was reached for all 33 statements (100%); therefore, the steering group approved the complete series of recommendations.

CONCLUSIONS: This consensus provides expert-informed guidance to support the use of KMT in adults with major depressive disorder, bipolar disorder, and schizophrenia.