In his 2022 book Brain Energy, Massachusetts psychiatrist Chris Palmer presented the ketogenic diet as a transformative therapeutic, one that could lead to a remission of symptoms and, at times, to a medication-free future. This was true even for some patients diagnosed with schizophrenia and bipolar disorder.

A test of that possibility is now underway at a small clinic in Arlington, Massachusetts. Founded by psychiatrist Matt Bernstein, the Accord clinic, which is located in a two-story house, is treating patients with a ketogenic diet plus support for drug tapering.

This is the first residential ketogenic diet clinic to spring to life in the United States, and unlike the studies of ketogenic diets that have now been published, it will provide an assessment of ketogenic outcomes over the long term when paired with support for drug tapering. The studies now appearing in journals mostly tell of how the ketogenic diet may be a helpful adjunctive treatment to regular psychopharmacology treatments.

“I’m devoting my life to this,” Bernstein said, when I visited the clinic. “And I do think tapering is an important part of this. Almost everyone who really does this will tell you the same thing. If you don’t also taper, you can still get good results. But if you want the really good results, you have got to also taper. And if you exercise, you do even better.”

This conceptual difference—adjunctive therapy versus transformative therapy—is of paramount importance to the possible impact of the keto diet on the future of psychiatry. The first preserves a societal belief in the merits of psychiatric medications and, in essence, a disease model of care, while the latter prods society to conceive of psychiatric drugs as agents that may worsen metabolic health, and to view the keto diet as restorative of a physical well-being that may chase away psychiatric symptoms.

Those two possibilities foretell of two very different futures for psychiatry, and the Accord program will, in essence, be putting the transformative possibility under the research microscope, as it has obtained a $600,000 grant to chart the outcomes of its clients at periodic intervals, up to a final evaluation at 18 months.

A Transformative Possibility

In Brain Energy, Palmer opened his book with an anecdote. First, he told of how a 33-year-old man, Tom, who was diagnosed with schizoaffective disorder, had fared on psychiatric medications:

In order to help Tom lose weight, Palmer suggested that he try a keto diet. Palmer then described his patient’s transformation:

Moreover, by the time Brain Energy was published, Palmer had published two case reports in peer-reviewed journals—one in 2017 and one in 2019—that told of how four patients had recovered with the keto diet. In the 2017 report on two schizoaffective patients, one had successfully withdrawn from all psychiatric drugs, and the other was able to markedly “reduce” her use of such medications. In his 2019 article in Schizophrenia Research, he told of  “two patients with longstanding schizophrenia who experienced complete remission of symptoms with the ketogenic diet . . . of particular interest in our research, both patients were able to stop antipsychotic medications and have remained in remission for years now.”

His work caught the attention of two Silicon Valley philanthropists, David and Jan Baszucki, who soon provided a third public story of the transformational possibilities of a keto diet.

Their son Matt had been hospitalized for a manic episode at age 19. He was diagnosed with bipolar, and as his mother Jan later wrote, he spent the next five years being treated with a cascade of medications. Finally, after being treated by “41 clinicians and prescribed 29 medications,” his psychiatrist pronounced Matt “treatment resistant.”

Then, in 2021 under the guidance of Palmer, Matt started a keto diet. Jan wrote:

David Baszucki had founded Roblox, an online platform and game creation system that is publicly traded, which has provided the Baszucki family with financial resources to back philanthropic projects. They soon launched a non-profit, Metabolic Mind, to fund keto-diet research and promote “metabolic psychiatry” as a therapy that represents a “paradigm shift” in psychiatry.

In addition to Palmer’s two case reports, a handful of other case reports were published that told of bipolar and schizoaffective patients who showed a dramatic improvement after going on a ketogenic diet and markedly decreasing their use of psychiatric drugs.

Palmer’s book also provided an easy-to-understand biological explanation for the therapeutic success of the ketogenic diet. Poor metabolic health is often present in patients diagnosed with major mental disorders (and in other neurological disorders), and the keto diet, which had been used as a treatment for epilepsy since 1921, had been shown in various studies to improve metabolic health and mitochondrial function. The diet was presented as an antidote to the poor metabolic health that was posited as a likely cause of psychiatric symptoms.

Such is the transformative possibility that has been presented to the public in the past four years. Case reports told of chronic patients diagnosed with schizophrenia and bipolar disorder becoming symptom free after going on a keto diet, with no ongoing use of psychiatric medications (or minimal use), and that told of patients leaving their diagnoses behind and returning to a robust life.

The Research Literature to Date

However, while the therapeutic logic may be persuasive, case studies do not provide an “evidence base” for a therapy. What is required are larger cohort studies and randomized clinical trials, and while a first wave of such studies is now appearing in the literature, they don’t tell of efforts to reduce use of psychiatric drugs (with one exception). As a result, the ketogenic diet is mostly being tested as an adjunctive therapy to psychopharmacology, research that ultimately doesn’t threaten psychiatry’s drug-centered model of care.

Cohort studies

There are a handful of cohort studies of the keto diet as an adjunctive therapy—in bipolar, schizoaffective, and depressed patients—that have reported an improvement in symptoms.  There are also two published cohort studies that enable a rudimentary comparison of ketogenic therapy outcomes with and without a decrease in the use of psychiatric drugs.

In the first cohort study, 28 patients with “severe mental illness” were treated in a French hospital for an average of two months with a keto diet. All 28, with a mean age of 50, were taking psychiatric drugs at the start of the study (average of 5.3 medications), with 25 of the 28 taking an antipsychotic.

The cohort as a whole showed dramatic improvement on scales that measure psychotic and depression symptoms, and global clinical impression (CGI-S scores). The patients also improved on multiple markers of metabolic health.  By the end of the intervention, 18 of the 28 patients had decreased their use of psychiatric medications, and only one had increased use of such medication.

The second cohort study was led by researchers from Stanford University. Sixteen patients diagnosed with bipolar disorder and five diagnosed with schizophrenia were treated with a ketogenic diet for four months. Their average age was 43; all 21 had a metabolic abnormality at baseline; and they were taking an average of 4 medications at the start of the study.

The Stanford cohort showed significant improvements in their CGI scores, reductions in psychotic symptoms, improved “life satisfaction,” and enhanced “sleep quality.” Their markers of metabolic health improved as well. In terms of their use of psychiatric medication, 48% had no change in their use, 24% increased their use, and 29% decreased their use, such that at the study end they were using an average of 3.9 medications, virtually the same as at baseline.

The researchers concluded that “our results show that a ketogenic diet intervention is a feasible and acceptable supplemental treatment to neuroleptic medications in an outpatient, real-world cohort, showing psychiatric and metabolic improvements in those with bipolar or schizophrenia illness with co-morbid abnormalities.”

Here is the statistical comparison that can be made between the two cohorts: in the Stanford cohort, there was a 31% improvement in CGI-S scores (CGI-S), whereas there was a 60% improvement in CGI-S scores in the French cohort. In other words, symptom improvement was twice as great in a cohort where two-thirds of the patients decreased their use of psychiatric medications.

As can be seen in the graphic below, the patients in the French study were more seriously ill at baseline than those in the Stanford study, and yet scored better on the GCI scale at the end of the study.

Thus, at this point, the cohort literature could be described as providing evidence for the use of the ketogenic diet as an adjunctive therapy, with one such study—the French studyhttps://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2025.1506304/full suggesting that symptom improvement could be further heightened if patients were encouraged to reduce their use of psychiatric drugs.

Randomized clinical trials

The gold standard in research is the randomized clinical trial (RCT), and for the most part, the field is still waiting for the outcomes from a first round of RCTs to be published. These RCTs have been designed to assess the merits of the ketogenic diet as an adjunctive therapy, and while the absence of a drug-tapering protocol may be disappointing, the design serves to isolate the impact of the ketogenic diet.

“The practical reason (for such design) is that academic researchers cannot easily design studies that include medication tapering as a protocol element,” Bernstein said. “The liability exposure is significant, IRB approval becomes complicated, and tapering would confound the metabolic outcomes they’re trying to measure.”

The largest RCT with published results is a UK study of 88 patients with treatment-resistant depressant who were randomized either to a ketogenic diet or to a phytochemical diet. A phytochemical diet focuses on maximizing intake of plant-based compounds (phytonutrients), and typically involves eating colorful fruits, vegetables, nuts, seeds, and healthy oils. Thus, in this instance, the ketogenic diet wasn’t being compared to placebo, but to another diet designed to improve health.

At baseline, 93% of the patients were taking a single antidepressant, and the remaining 7% two or three drugs. Their average age was 42, and at the end of a six-week treatment period, depressive symptoms had decreased slightly more in the keto group than in the phyto group. While the difference was small, improvement in depressive symptoms on the PQ9 scale in both groups was quite good.

However, after active support for the two diets ended, there was no further improvement in either group on any domain of outcomes over the next six weeks. Only 20% in the keto group adhered to that diet at least 50% of the time during the follow-up, whereas nearly half in the phyto group retained that degree of adherence, suggesting that the phyto diet was a more sustainable intervention.  There was no significant difference in depressive symptoms between the two groups at 12 weeks, or on anxiety, cognition, functional and quality of life measurements.

However, in their conclusion, the researchers put the focus on the six-week outcomes, writing that “this RCT found small improvements in depression in people with treatment resistant depression when a ketogenic diet was used as an adjunct to pharmaceuticals.”

There have been a small number of other RCTs of the keto diet in depressed and anxious patients, and the authors of a “metanalysis” of RCTs concluded ketogenic  “interventions were associated with small to moderate improvements in depressive symptoms in RCTs but with no significant changes in anxiety.”

A First Step in Research

Such is the “evidence base” beginning to emerge from RCTs of the ketogenic diet as an adjunct therapy to pharmaceuticals. There are reports of significant improvements in target symptoms for patients adhering to the keto diet for a short period of time, and significant improvements in markers of metabolic health.

This research led Palmer, Bernstein, and six other proponents of metabolic psychiatry to conclude, in a recently published “consensus statement,” that “ketogenic metabolic therapy should be considered as adjunct therapy to first-line treatments for major depressive disorder, bipolar disorders, and schizophrenia.”

While that conclusion did fit with the available evidence, Bernstein acknowledged that there is also a political reason why proponents of metabolic psychiatry do not want to publicly push the tapering aspect of ketogenic interventions.

“Metabolic psychiatry is fighting for acceptance within a specialty committed to the pharmacological model. Recommending tapering in print—even where the mechanistic logic demands it—would invite attacks that could threaten the field’s credibility before it has established a sufficient evidence base,” Bernstein said.

This is where the Accord program comes in. With its $600,000 research grant in hand, it will provide evidence of longer-term outcomes with care that combines a ketogenic diet with drug tapering. What will be particularly interesting is to see how many of its clients, at the end of 18 months, are doing well and either off psychiatric medications altogether, or down to a low dose of just one or two such drugs. Those outcomes will tell whether the ketogenic diet plus drug tapering could be a transformative therapy for a significant percentage of patients.

An Open Mind

Psychiatry likes to tout that its practices are evidence-based, and as such, it is worthwhile to recount the “evidence-based” path, step by step, that led Bernstein to open the Accord program.

Bernstein is the medical director at Ellenhorn, a “treatment without walls” program in the Boston area that emphasizes a holistic approach, with a particular focus on the importance of social connections as a path to recovery. While Bernstein had always been interested in helping Ellenhorn clients taper from certain classes of psychiatric medications, this interest grew, he said, after he read Anatomy of an Epidemic, which presented evidence that antipsychotics and other classes of psychiatric drugs worsen long term outcomes.

“Your book taught me quite a bit about psychopharmacology that I never learned in residency that helped me along in my process of being bold enough to taper people off antipsychotics,” he said.

The next step came when he read a study by Lex Wunderink in the Netherlands. In this study, first-episode psychotic patients, after a period of initial stabilization on antipsychotics, were randomized either to treatment as usual or to a tapering protocol. At the end of two years, the relapse rate was higher in the tapering group, although such relapses were usually managed without rehospitalization. However, at the end of seven years, the recovery rate was twice as high in the tapering group, and the percentage of patients who had experienced a relapse was the same in both cohorts.

“I’ve handed the study out to everybody, and no-one knows about it, which is incredible because it’s probably the most important paper, in my view, that’s been published the last 20 years in psychopharmacology,” Bernstein said. “And after that paper, it really felt like there’s evidence on our side that tapering is going to lead to better outcomes, and it’s not just patients asking for it, but it’s actually evidence-based, especially if you look out long enough.”

The third step for Bernstein was born from clinical experience. As he incorporated tapering from antipsychotics into his clinical practice, he found that at Ellenhorn, with its team-based care, they could usually handle any temporary spike in symptoms “without having  to go up on the dose, or sometimes we go up on the dose temporarily, and then we can resume the taper,” he said. “There’s enough support for the person, and for the family, to not let it lead into a crisis.”

Thus, his first years of tapering antipsychotics led to a measure of therapeutic success. Many patients were able to get down to lower doses, and a few patients got all the way off their psychiatric medications, including antipsychotics. However, at the same time, he found that his patients would often “hit a point” where they couldn’t go down any lower on their antipsychotic medication. “We’d also hit limits in terms of people’s functional outcomes. And they would still have gained a bunch of weight and be metabolically sick from being on the medications for long periods of time.  And even on lower doses, that wouldn’t go away,” he said.

The next step in the evolution of his thinking came when he attended a Grand Rounds presentation at McLean Hospital by Chris Palmer, who had recently published his paper about two patients with psychotic disorders “fully recovering, with clozapine-resistant psychosis melting away from ketogenic diets.” He was, he recalled, perhaps the “only one in the audience who believed Chris.”

At this point, Bernstein dove into the scientific literature regarding the merits of a ketogenic diet. The research literature, he noted, provided a compelling physiological rationale for why a ketogenic diet could be an effective treatment for psychiatric symptoms.

Our modern diets rely on carbohydrates to produce glucose, which circulates in our blood. Insulin moves glucose into the cells, where the mitochondria convert it into adenosine triphosphates, which is the energy molecule that powers cellular function. Potatoes, refined grains, certain fruits, sweets, sugary beverage, and processed foods are all high in carbohydrates, a diet linked to an increased risk for insulin resistance, obesity, type 2 diabetes, fatty liver, and cardiac events.

A ketogenic diet switches on a second method—burning fat—for fueling the mitochondria.  This dual-energy system, Bernstein, served an obvious purpose as humans evolved. In times when high-carbohydrate foods are not available, the liver converts fat stored in the body into ketones, which become the energy source for the cells.

“It allowed us to survive as a species,” Bernstein said. “It’s brain fuel when you have no food, and it makes your brain work even better. It allowed us to hunt and gather and get food when we were three or four days into not having food. That’s why ketones exist.”

Three days of fasting can put the body into ketosis—e.g. producing ketones to power the cells. A ketogenic diet turns this alternative energy system on by basically starving the body of the carbohydrates needed by the body to run on glucose. A ketogenic diet will typically consist of eating four grams of fat for every gram of protein and carbohydrates, with total daily consumption of carbohydrates between 20 and 50 grams. This requires eating a diet composed of healthy oils, fatty fish, meat (beef, pork, chicken, turkey), eggs, nuts, seeds, cheese, whole milk yogurt, and leafy vegetables—broccoli, cauliflower, spinach and kale.

Research has shown that a ketogenic diet reduces oxidative stress, has anti-inflammatory properties, and may regulate neurotransmitter activity in the brain. People lose weight on the diet, and it immediately provides a remedy for insulin resistance, since ketones are now fueling the mitochondria and they do not require insulin to enter the cell.

In addition to providing the mitochondria with a different fuel source, a ketogenic diet helps the mitochondria function more efficiently. It promotes mitochondria reproduction, the removal of damaged or dysfunctional mitochondria (a self-cleaning process called (mitophagy), and the production of brain derived neurotropic factor (BDNF.)

“The brain needs to have BDNF to be flexible in our behavior and our thinking,” Bernstein said. “It’s a perfect correlate to mental health. It’s what allows the neurons to make more connections with more neurons. Exercise also increases BDNF, and it does so by increasing ketones.”

The other part of the “evidence base” for his shift in thinking came from his review of research that documents how antipsychotics, and to a lesser extent, antidepressants and mood stabilizer, can be harmful to metabolic well-being, which he also regularly witnessed in his patients. “It’s insane,” he said.” We’re prescribing things that cause people to gain 80 pounds and become diabetic and die 15 to 20 years early.”

After reviewing the science and trying out a ketogenic diet himself, Bernstein began encouraging his patients at Ellenhorn to try it. These were patients with a variety of diagnoses—”bipolar, schizophrenia, OCD, treatment resistant depression, the gamut” he said. “I was blown away by the results that people are getting. Universally, when people start making some ketones, they come back and say to me, ‘I’ve got more energy. My brain is coming is coming back online.’”

The diet, he discovered, also enabled tapering efforts. Whereas before patients would reach a point where they would get stuck, with the ketogenic therapy the patients could “keep going.” In addition, a number of his patients, once they got stable on a keto diet, now saw an “opportunity” to start tapering from their medication.

Such was the “evidence-based” path that unfurled over the course of 12 years for Bernstein, with one step leading to another. With that experience in mind, he and two others from Ellenhorn opened Accord in July of 2024, with the Baszucki group providing some initial funding.

The Program at Accord

The Accord house in Arlington can accommodate seven in-residence patients at a time, who come for one to three months, at a monthly cost of $36,000. Accord also operates a day program, which costs $26,000 a month.  While Accord may provide scholarship support to some clients, insurance companies do not provide coverage for such care, which sharply limits who can access this program.

The daily program consists of a finely tuned ketogenic diet, cooking lessons, an appointment with a personal trainer at a nearby gym, and afternoon walks with program director Sophie Kwass.

“The walks are stabilizing glucose levels, they’re getting you sunlight, fresh air, a break from being inside,” said Kwass, who is a licensed social worker.  “And I find that some of my best therapeutic conversations have happened outside of the therapy office. There’s not the pressure of the therapy, and so a lot of our clients open up more when we’re walking and talking, and things are more casual.”

The staff nutritionist, Meghan Stein, previously worked for a company that certified that food labels were accurate, a work experience that enables her to make precise calculations about the mix of fat, protein, and carbohydrates in the daily meals. When she worked as a nutrition analyst, Stein recalled that she considered the keto diet a fad, as it inverts the traditional food pyramid, which places carbohydrates as the base and fat at the top. “That’s what I was taught. It was like 40% to 60% of your diet should be carbohydrates, and that you should sharply limit your fat.”

She is now a believer in the keto-diet pyramid, which puts fat at the base and carbohydrates at the top. “I typically see a boost of energy first [in the patients], then I see better concentration and a better ability to learn. I see improved laboratory markers for insulin resistance and cholesterol panels, and over a longer period of time, I see improvements in psychiatric symptoms.”

The chef at Accord, Katrina Vazquez, started preparing keto meals while working at Ellenhorn. However, she has also had her own lived experience with depression, PTSD, and celiac disease, and once she personally began eating “keto,” she lost weight, her rosacea cleared up, and she suddenly had energy to work out.

While she prepares the same meal for everyone, she and Stein prepare “individual client sheets to make sure they are measuring out their food properly.” The different food groups—carbohydrates, protein, and fat—are measured to the gram, which helps their clients get into ketosis quickly. “If they’re 100% compliant, they can get into ketosis in 48 hours,” Vazquez said.

A person is said to get into ketosis when their blood levels of beta hydroxy ketone reach .5 millimoles, but for therapeutic purposes, the goal is often to reach 1 to 3 millimoles.

On its website, Accord has posted “outcomes” for its first wave of resident clients. This first group ranged in age from 20 to 67 years old and on average spent two months at Accord. The charts tell of a drop in weight, body fat, blood sugar levels, and triglycerides, all signs of improved metabolic health. Clinical measurements tell of reductions in symptoms, and improvements in functional capacities and quality of life. Their CGI-S scores dropped from an average of 3.6 to 2.8 on the seven-point scale.

Patient Accounts: An N of 2

When I visited Accord last November, they set me up to speak with two of their clients who had been in the program in the spring of 2025, and thus at the time of our interview, had been on a ketogenic diet for longer than six months. As such, they might be described as “case studies” that Accord wanted to present to the public (and who agreed to speak to me for the purpose of a public story). 

Jack Grady and Family

As any family can attest, when a loved one suffers a manic episode or psychotic break and then falls down the rabbit hole of polypharmacy, it can be a long journey to climb back out of that hole. And so, when Jack’s mother, Mary Alice Grady, speaks about the journey that her family and her son Jack have been on, she describes the pre-Accord times as “eight years of hell.”

In high school, Jack was friends with a popular group of kids, got good grades and played sports, a bright future seemingly ahead of him,” she said. However, in the fall of his sophomore year at college he had a manic break, which his parents believe was triggered by his use of marijuana. Jack was put on Risperdal, with the thought that perhaps he had just suffered a brief bout of marijuana-induced psychosis. However, a month or so later he wandered around lost after going to a basketball game, wading into traffic, and this time he was diagnosed with bipolar 1 and put on lithium and Invega. While he got stable on that combination, “he was a zombie,” his mother said. “And we’re like, ‘Is this going to be our new kid?’”

For a time, after a stint in a transitional living facility, Jack fared pretty well. He stopped using marijuana and tapered off most of his psychiatric medications, and for the next three years he lived independently, with a community of friends and working at a restaurant. In 2022, he enrolled in the University of Colorado in Denver, with the goal of becoming a video editor. However, in this new environment, soon he was drinking again and using Vyvanse to study and marijuana to relax, which led to another psychotic break.

“He was completely in another world,” his mother said. “He was hearing voices . . . you could see there was a snap that happened.”

After that, there were multiple hospitalizations, stints in various residential treatment centers, and a slew of medications—Risperdal, Invega, Abilify, the injectable Aristada, lithium, Lamictal, and finally a high dose of clozapine, the  drug for “treatment-resistant” psychosis. “He kept getting worse and worse,” his mother said, constantly going on and off the drugs because he hated how they made him feel, and “finally he looked at us and said, ‘Mom, did you ever think that the hospital and the treatments centers are making me worse?’”

For Jack,  those years were a torment. “I am talking to the voices in my head all the time,” he recalled in our interview. “They are like the voice of God, of Jesus, Kobe Bryant . . . a lot of hospitalizations, a lot of crazy things happening. I was screaming, I was hitting my head on the group, it was a religious penance.”

Moreover, on a cocktail of drugs that included clozapine, “I was like a different person,” he said. “I was sedated, not motivated, not really happy. I just always wanted to sleep. I had no motivation for music, for anything.”

Jack was in a treatment program in New York when his parents, who had learned of the keto diet from an appearance by the Baszucki family on The Today Show, asked Jack if he would consider going to Accord. What convinced him to do so, his mother said, was that Kwass asked him what his goals were, something nobody had asked him before. Jack told her that his goals were “to get healthy again, to start working out, and to get off meds,” his mother said.

In early 2025, Jack spent two months in residence at Accord. He arrived on a high dose of clozapine (450 mg), a second antipsychotic (Vraylar), an SSRI (fluvoxamine), lithium and a mood stabilizer (Lamictal). The tapering process began, with a focus in particular on reducing clozapine, yet during his time at Accord, there was no significant diminishment of his psychiatric symptoms. He continued to hear voices, “but my energy got better,” he recalled.  “My mood improved. Like happier, or less sad. I started exercising, working with a personal trainer. I was going out for walks. I felt more optimistic.”

Once they were back home in St. Louis, his efforts to taper from clozapine and the other drugs continued and his family kept to a keto diet. Then, about two months later, it was “like a light switch changed,” his mother recalled.

“The voices in my head are almost gone,” Jack said in November, when he came back to Accord for a short visit with Bernstein. “And even when they come back, I just sort of shut them down, which I couldn’t really do before, and didn’t really want to do before.”

With his symptoms lessening, Jack began working again, bussing at a restaurant in an art museum. He built a music studio in his garage, and began writing lyrics and making music, “just singing and rapping and getting like the beats and instrumentals from YouTube for now.”

“Jack is so much better,” his mother said. “He’s starting to function. The social part hasn’t come back, but I’m hopeful. He’s healthier, and he’s working out on his own. His self-directed behavior is back.”

Meredith Marks

Having lived with a bipolar diagnosis for 27 years, Meredith Marks recounts a life history that is common to many so diagnosed. She tells of having been horribly bullied in school; years of abusing alcohol as a teenager; a suicide attempt that led to a diagnosis of borderline personality disorder at age 21; and then a second diagnosis of bipolar at age 24. A drug cocktail marked her life from that point forward, such that when she first entered the day program at Accord in March of 2025, she was on a regimen of seven such drugs.

“I’ve  had quite the road. I was hospitalized probably five times from my mid-20s to my mid-30s, and I’ve had 36 sessions of electric shock therapy,” she said.

Despite her psychiatric struggles, during her twenties she graduated from Suffolk University in Boston with a degree in sociology (cum laude and in two national honor societies). However, with her psychiatric history, “the first job I took after getting out of school was picking up doc feces at a doggy daycare,” she said. “That tells you where my head was at, what I could and could not handle.”

The ups and downs in her life—mixed in with hospitalizations—continued. She gained a lot of  weight on the drugs, got married and divorced, and then in her early 30s, earned a master’s degree in mental health counseling. That degree finally provided an anchor in her life, as she has worked as counselor for DCS Mental Health, which provides treatment to those with serious mental disorders, for the past 12 or 13 years. However, during this time, she regularly cycled through episodes of depression and mania, which would require her to take leave from her job.

“I’ve been good on [the drug cocktail], I’ve been bad on it, I’ve been indifferent on it. It’s kept me stable for the most part, but it doesn’t mean that it is immune to the episodes,” she said.

Moreover, outside of work, there was little joy in her life. She spent her time “hiding, literally hiding from the world,” she said, showing how she combed her hair so that it covered her eyes. “And I spent the best years of my life overweight.”

Bernstein first tried to get her to try to try the ketogenic diet when she was an Ellenhorn client, but she refused. “I like my sugar; I like my carbs.”  But after Accord opened and he pitched the day program to her, she took stock of her life and decided she had to change. “It finally came to a point that I was so heavy, so miserable, and I would sleep all the time. I was not fun for my family. I was not a good friend.”

On her first day at Accord, she recalled, “we went out on a walk, and I could hardly do it. I was out of breath.”

Within a month on the keto diet, she said, “I felt ridiculously better. Energetic. Our walks got longer and longer after the meals here. I felt more at ease with myself. I felt that I was heard and understood, it was a whole dynamic. It was so many pieces to the puzzle. It’s not just the diet.

She remained in the day program for two months, and with ongoing support from the Accord staff, she has kept up the ketogenic diet while doing her own cooking for nearly a year.  Tapering has gone slow, although she has decreased her drug cocktail from seven drugs to five and decreased the dosage of some of her other drugs. She hasn’t had any manic or depressive episodes during the past year and has been able to work regularly.

Most of all, she speaks of a newfound zest for life, and a change in personality. “My social life has expanded. And my life is so much fuller now. I’m just out and about more, and I’m an active member of my family. I have a brother and a sister, both younger, and they say it’s so nice to have you around now.”

Her confidence during our interview was quite noticeable, and I couldn’t help but comment how healthy she looked. And then she pointed to how her hair no longer covered her eyes.

“I feel so much better about myself. I feel like I used to try to not be who I really am. Now I am really genuinely, authentically me. Like, I’m not nice and sweet. But I am kind and honest.”

Is it Sustainable? 

Given that the keto diet has been used as a treatment for epilepsy since 1921, there is ample evidence in the scientific literature that a keto diet can improve markers of metabolic health, and by substituting ketones for glucose as a fuel for the cellular mitochondria, provide a boost in energy. There can be a period of the “keto flu”—headaches, fatigue, irritability, and nausea—during the shift into ketogenesis, but over the long-term, the diet has been found to be associated with a significant decrease in all-cause mortality.

However, it is clear that it can be difficult for patients to sustain the diet once active clinical support ends, and if the diet is used as an adjunctive therapy to psychiatric drugs, and after a short period patients don’t continue with the diet, then they will end up in the same place they were before, on a drug regimen that was so problematic.

The possibility that so stirred  the public imagination came from the case reports that told of a remission of symptoms in patients with a serious mental disorder who, after going on a ketogenic diet, were able to stop their medication and remain well. The Accord program starts patients down that path, but tapering is a long, slow, and complicated process, and so an essential aspect of its research will be to assess what happens to their clients in the 18 months after they finish their residential stay (or the day program.)

Last September, Accord hired Donika Hristova, who trained as a “health coach” in metabolic psychiatry, to provide online support to psychiatric patients seeking to start or maintain a ketogenic diet, and many Accord clients, after completing the residence or day program, tap into this online service.

Hristova’s personal story fits into the “transformative” narrative that Palmer presented to the public. About ten years ago, she was diagnosed with bipolar 2 disorder and put on a mood stabilizer, and while the medication did help her successfully manage her symptoms for six years, it “was not something that was helping me live the life thaat I wanted to live.” She then tried the ketogenic diet, without any outside support, and started tapering from her mood stabilizer as well, and within six months was off the medication and doing well.

 

“My cognition really improved, my mood stabilized, and my energy increased like never before. That mental fog just went away,” she said.

She stayed on a ketogenic diet for two more years, and then switched to a whole food diet, low in carbs but not one that would put her into ketosis. She has remained well, without any need for medication. She follows what she describes as a  “lifestyle medication,” which is also what Accord preaches. “it’s not just the diet but it’s the exercise, the stress management, the social connections and just the whole holistic approach.”

With one exception, the Accord patients she has provided on-line support to in the past eight months have been able to sustain a ketogenic diet. “What i see is people starting to feel better and being equipped with the knowledge of how to stay well, and so with support and proper guidance they are able to incorporate that knowledge into a way of life that suits them pretty well, and they find it easier to live that life than to go back to where they were before.”

While here are a number of RCTs of ketogenic therapies that will report their results in the coming months and next couple of years, those studies will provide limited insight into  long-term outcomes with a ketogenic diet. However, the Accord study will tell of how a cohort of patients, diagnosed with major mental disorders and typically coming to Accord on a slew of medications, are faring at the end of 18 months following initial treatment with a ketogenic diet plus drug tapering support. Their findings should report on how many were able to sustain the diet, the extent of the diminishment in their use of psychiatric medications, and whether some were able to get off all medication and stay well.

Those findings will help inform an “evidence base” for ketogenic therapy that, at the moment, is in its infancy, and largely telling of its possible short-term efficacy when used as an adjunctive therapy. The potential with the Accord protocol is that it will show whether “metabolic psychiatry” can be a transformative therapeutic, one that leads to a robust recovery that minimizes the ongoing use of psychiatric drugs.

 

The post The Keto Diet + Drug Tapering: What Are the Possibilities? appeared first on Mad In America.

 

IPAK-EDU is grateful to Mad In America as this piece was originally published there and is included in this news feed with mutual agreement. Read More