A Ketogenic Diet For OCD and Severe Mental Illness

Psychiatry may be on the cusp of a paradigm shift. Mounting evidence—including a case series of a keto diet for OCD—suggests we may finally be targeting the root cause of severe mental illnesses

“I used to tell myself in the depths of OCD, ‘The only way out is death,’ as a kind of mantra to put things into perspective. I’m happy to say I found another way. It would make me really happy if others knew about ketosis as a way to end their suffering.”

This dramatic quote, drawn from a new medical case series by Dr Aaron MacDonald and Dr Chris Palmer, describes one patient’s experience whereby they completely resolved their symptoms of debilitating obsessive-compulsive disorder (OCD) with a ketogenic diet.

Now, because I know we’ve all heard a friend or acquaintance say something like, “Oh, I’m so OCD,” let me beg of you to compensate for any desensitization you might have to the term: There’s a big difference between a casual remark to explain a preference for organization and serious mental illness. It’s akin to the difference between an uncomfortably firm handshake and placing your brain in a literal trash compactor.

People with OCD can suffer terribly, sometimes to the point that death may appear a reasonable therapeutic, as was the case with this patient.

Now, let’s discuss the case series at hand and why you should care, whether or not you or a loved one suffer with OCD. This is important for everyone to hear.

We’ll explore in seven parts:

1. Patient 1: Early Onset, Harvard Student

2. Patient 2: Trauma-Triggered OCD

3. Patient 3: Complex Case with Bipolar Disorder

4. Quantifying the Patients’ Improvements

5. A Paradigm Shift in Psychiatry

6. A Private Conversation with Patient 3

7. Additional Resources on the Metabolism-Mental Health Connection

Patient 1: Early Onset, Harvard Student

Patient 1 was a 22-year-old student at Harvard College, who first started exhibiting symptoms of OCD at 18 months. What began as consistent object alignment evolved into cleaning his friends’ toys, excessive handwashing, balanced twirling (if he spun twice clockwise, he’d need to spin twice counterclockwise to “balance things out”), balanced hugging and kissing, and exclusively symmetrical works of art. He was formally diagnosed with OCD at age 4.

The path that led this young boy to a ketogenic diet, like many others, was unexpected. Noting concerns about his weight, his parents supported him in removing grains from his diet, “unexpectedly noticing a dramatic reduction in his OCD symptoms.”

Intensifying his dietary regimen towards a ketogenic diet at age 15 resulted in a “complete cessation of ritualistic behaviors” within two weeks.

Also, of note—and a key element in any ‘case experiment’—reintroduction of the independent variable (dietary carbohydrates sufficient to knock him out of ketosis) results in a change in the dependent variable (OCD symptoms). Indeed, excursions from the ketogenic diet consistently result in a return of symptoms for this patient (and for the others, as we will see). For instance, once while on vacation he indulged in a carbohydrate-rich meal. Shortly thereafter, he was found in his hotel room, late at night, organizing shampoo and conditioner bottles into neat rows.

Patient Perspective:

“The ketogenic diet was transformative for resolving my OCD, mood disorders, and focus issues. Without making the changes to my diet that I did, I would not have had the mental wherewithal to perform well enough in high school to get into Harvard, much less college.”

Patient 2: Trauma-Triggered OCD

The second patient in this case series was a 35-year-old woman who developed symptoms of OCD at age 16 following a mass shooting near her school. The trauma triggered the development of overwhelming intrusive thoughts characterized by fear of loss. The obsessions were so severe she began to isolate herself from friends and family, ran away from home, and tried to harm her own head in a desperate attempt to alleviate the intrusive thoughts. She was formally diagnosed with OCD at age 20.

Again, the patient adopted a ketogenic diet serendipitously. Again, the patient noted massive symptom improvements within two weeks. Again, “[r]eintroducing high-carbohydrate foods triggers symptom recurrence, which she describes as feeling like ‘swimming in a lake as a thunderstorm approaches.’”

Patient Perspective:

“I used to tell myself in the depths of OCD, ‘The only way out is death,’ as a kind of mantra to put things into perspective. I’m happy to say I found another way. It would make me really happy if others knew about ketosis as a way to end their suffering.”

Patient 3: Complex Case with Bipolar Disorder

The third patient’s story in many ways follows the pattern of the other two; however, it was more medically complex. Now a 47-year-old woman, she was diagnosed with OCD at age 35 and carries additional diagnoses of bipolar disorder. She’s also a mother. In addition to an obsession with orderliness and cleaning that was so severe as to rob her of sleep—she’d often stay up cleaning until 4:00 am—she developed intrusive thoughts of harming her son. For a time, she lost her child to her mental illness as the patient and her husband agreed it was not safe for him to stay in the home, and he was sent to live with her sister.

Over the course of years, the patient tried a pharmacy of medications (Prozac, Seroquel, Viibryd, Remeron, Xanax). She, too, discovered the ketogenic diet by chance and experienced “complete cessation of her compulsive urges.”

With the support of her doctor, she was eventually able to come off all her medications and is now symptom-free and medication-free, living happily with her children and husband.

And, once again, reintroduction of carbohydrate—even ¼ sweet potato—triggers symptom relapses.

Patient Perspective:

“Before eliminating sugars and grains from my diet, the best way to describe me was hollow, a shell of a person who could not fully engage in life. I feel like I missed the best part of my children’s young lives, sedated and overwhelmed by my thoughts. Now, I enjoy the person I am today—alive, active, and determined not to miss another second.”

These three stories are stunning. But anecdotal evidence only goes so far. How dramatic were these improvements quantitatively? And what does the pioneering Harvard psychiatrist behind this research believe it means for the future of treating mental illness?

For premium subscribers, we now go deeper to answer those exact questions.

In the rest of the letter, we:

• Quantify these patients’ improvements using the official Yale-Brown Obsessive Compulsive Scale.

• Share an Exclusive Except from the author discussing a Paradigm Shift in Psychiatry.

• Share a Private Text Exchange with Patient 3 (with the patient’s consent) — And, I must say, it’s heart-wrenching!

• Provide links to Additional Resources on metabolism-mental health connection with respect to Anxiety, Depression, and neurodegenerative diseases.