The 4th Ketogenic Metabolic Therapies – Future Prevention and Treatment of NCD conference, reconvened on 12th June at the historic Reine Victoria Hotel in St. Moritz, drawing world-leading experts in the field.

Two half-days were focused on ketogenic metabolic therapies in neurology and psychiatry. The event was organised by Josephine Barbarino, Founder and CEO of the Keto Live project and her husband Stephan. Beyond the informative sessions, delegates enjoyed “walk and talk” outings amidst stunning Swiss scenery, evening activities, and sumptuous ketogenic meals and snacks, keeping everyone in ketosis. Exogenous ketones and onsite testing by Keto-Mojo further supported this goal. The conference was generously funded by the Bazouki Group – a foundation inspired by the transformative effects of ketogenic therapy in managing their son’s bipolar disorder.  

Dr Shebani Sethi, a Clinical Associate Professor at Stanford, commenced the conference by discussing the link between metabolic and mental health in patients with diabetes and obesity, which led her to coin the term “metabolic psychiatry” and establish Stanford’s first Metabolic Psychiatry Programme. Noting the prevalence of metabolic syndrome in psychiatric patients – 37% in bipolar disorder and 69% in schizophrenia – and their elevated risk for type 2 diabetes and cardio-metabolic diseases, often exacerbated by anti-psychotic drugs, prompted her to explore the role of insulin resistance, inflammation, and brain glucose dysregulation in these disorders.

She noted further connections of psychiatric disorders and metabolic dysfunction, include mitochondrial DNA alterations in bipolar disorder, impaired glucose metabolism in schizophrenia, and insulin resistance correlation with major depressive disorder. Dr Sethi explained that metabolic psychiatry emphasises that brain and body health are intertwined, advocating for mental health treatment through metabolic therapies. 

Her four-month pilot study [1] with 23 participants on a ketogenic diet showed significant benefits: substantial weight loss, reduced triglycerides, improved insulin sensitivity, and reduced psychiatric medication dependency, and an improvement in their psychiatric assessment. Fully adherent participants experienced better outcomes than semi-adherent, suggesting a dose-response relationship with ketosis. Dr Sethi expressed optimism about the expanding field of metabolic psychiatry, with numerous ongoing trials, including those comparing ketogenic, Mediterranean, and Western diets. 

Dr Iain Campbell from the University of Edinburgh then presented his “metabolic overdrive” hypothesis, capturing our attention by recounting his personal struggle with bipolar disorder and his near-miraculous remission on a ketogenic diet, which inspired his academic pursuit. With support from the Baszucki Group, his pilot study involving 27 participants explored ketogenic therapy for mood regulation in bipolar disorder [2]. Results indicated that increased ketone levels were associated with reductions in anxiety, impulsivity, and depressive and manic symptoms, along with improved metabolic health, again, suggesting a dose-response relationship. Brain imaging revealed significant reductions in glutamate (by 9.2% to 13.13% in key brain regions), which may help stabilise mood, and reduced lactic acid levels, a biomarker linked to bipolar disorder.

Dr Campbell suggested that the ketogenic diet’s capacity to stabilise brain metabolism and reduce excitatory neurotransmitters like glutamate, by supplying ketones as a steady fuel source might help control “overdrive” states, similar to hyper-metabolic conditions seen in epilepsy. He hypothesised [3] that mania might involve excessive metabolic activity in the brain, where overstimulation results in the high energy and impulsivity of manic episodes. He noted that epilepsy, bipolar disorder, and schizophrenia share common anticonvulsant treatments, suggesting a shared modality.

Dr Campbell also introduced the Metabolic Psychiatry Hub, funded by a £4 million grant from the Medical Research Council and Baszucki Group, to research metabolic dysfunction in psychiatry. Future projects include large-scale genetic and biomarker studies and a Wellcome Trust initiative to study circadian rhythms, metabolism, lithium, and insulin sensitisers in bipolar therapy. He concluded with survey findings that the ketogenic diet reduced suicidal thoughts and improved cognition in bipolar patients, but emphasised the importance of medical supervision. 

The 2nd part of the talks was kicked off by Nicole Laurent, a mental health counsellor with 17 years of experience, using ketogenic diets for mental health, particularly for clients unresponsive to conventional treatments. Trained in CBT, DBT, and EMDR, she rebranded her practice as “Mental Health Keto” to concentrate on metabolic psychiatry. Laurent supports clients in adopting and sustaining ketogenic diets tailored for maximum therapeutic benefit. Her dedication earned her the 2022 Metabolic Mind Award from the Baszucki Family Foundation. With an educational blog explaining the science behind ketogenic therapies for mental health, she has established a growing international outreach.

We heard a spectacular success story of one of her patients, with schizoaffective disorder, documented on YouTube; she transformed her life, experiencing reduced paranoia and greatly improved life engagement, inspiring others to seek metabolic therapies. Laurent urged for a team approach with trained dietitians, prescribers, and therapists to manage medication adjustments and withdrawal risks effectively. She has developed a certified training programme for therapists, to understand ketogenic therapy’s role in “personality reorganisation” as patients’ experience symptom relief, and offers an online programme with Q&A sessions and personalised dietary support. Concluding, Laurent gave an impassioned plea to the audience to become “ketogenic-informed” enabling transformative care for those with chronic mental health conditions through metabolic psychiatry. 

Finalising the conference, Dr Matthew C.L. Phillips, a metabolic Neurologist, from New Zealand, discussed ketogenic metabolic therapy for neurodegenerative diseases, highlighting the “splitters” and “lumpers” perspectives. “Splitters” view such diseases as Alzheimer’s, Parkinson’s, ALS, and Huntington’s as distinct diseases, while “lumpers” recognise their shared mitochondrial dysfunction. This dysfunction can affect mitochondrial processes like cellular metabolism, biogenesis, mycophagy, and ATP production, impacting both brain and physical health. 

Dr Phillips used the “metabolic iceberg” metaphor, with visible symptoms being the tip of the iceberg, and the majority of disease processes rooted in underlying mitochondrial dysfunction and environmental factors. He stressed the importance of restoring mitochondrial function for effective treatment. We were introduced to mitochondrial hormesis for mental health and neurodegenerative conditions, explaining that mild stressors like intermittent fasting and ketogenic diets strengthen mitochondria, improve energy metabolism, and reduce oxidative stress, but noted that recovery periods are essential for recovery. 

His clinical trials on ketogenic diets for neurodegenerative diseases such as Alzheimer’s [4], Parkinson’s [5], ALS [6], and Huntington’s [7], showed cognitive, mood, and energy improvements, with some patients reducing medications, suggesting mitochondrial hormesis through ketogenic therapy, as a powerful treatment. 

With this annual conference, and the Keto-Live Centre, Josephine Barbarino’s quest to raise awareness on using ketogenic and metabolic therapies in NCD’s, continues, with the imminent establishment of the “Magic Mountain” Metabolic Health Centre in Switzerland, the first, offering education, treatment, research and wellness using ketogenic metabolic therapies.  

References 

  1. Sethi S, Wakeham D, Ketter T, Hooshmand F, Bjornstad J, Richards B, Westman E, Krauss RM, & Saslow L. (2024). Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial. Psychiatry Research. 2024;335:115866. https://doi.org/10.1016/j.psychres.2024.115866. 
  1. Campbell I, Creasy F, Norrie J, McLellan A, Fisher C, Zieliński T, Gaggioni G, Luz S, & Smith DJ. (2023). A Pilot Study of a Ketogenic Diet in Bipolar Disorder: Clinical, Metabolic, and Magnetic Resonance Spectroscopy Findings. medRxiv. https://doi.org/10.1101/2023.10.23.23297391 
  1. Campbell IH, Campbell H. The metabolic overdrive hypothesis: hyperglycolysis and glutaminolysis in bipolar mania. Mol Psychiatry. 2024;29:1521–1527. https://doi.org/10.1038/s41380-024-02431-w  
  1. Phillips MCL, Deprez LM, Mortimer GMN et al. Randomized crossover trial of a modified ketogenic diet in Alzheimer’s disease. Alz Res Therapy. 2021;13:51.  https://doi.org/10.1186/s13195-021-00783-x 
  1. Phillips MCL, Murtagh DKJ, Gilbertson LJ, Asztely FJS, & Lynch CD. (2018). Low-fat versus ketogenic diet in Parkinson’s disease: A pilot randomized controlled trial. Movement Disorders. 2018;33(S2). https://doi.org/10.1002/mds.27448 
  1. Phillips MCL, Murtagh DKJ, Gilbertson LJ, Asztely FJS, & Lynch CDP. Low-fat versus ketogenic diet in amyotrophic lateral sclerosis: A pilot randomized controlled trial. Journal of Neural Transmission 2018;125(3):373–384. https://doi.org/10.1007/s00702-017-1808-9 
  1. Phillips MCL. Time-Restricted Ketogenic Diet in Huntington’s Disease: A Case Study. Neurocase 2020;26(3):171–177. https://doi.org/10.1080/13554794.2020.1786352