Chronic Schizophrenia Put Into Remission Without Medication - Psychology Today

10/15/23, 10:51 PM Chronic Schizophrenia Put Into Remission Without Medication | Psychology Today
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Christopher M Palmer M.D.

Avanzando en Psiquiatría
DIETA CETOGÉNICA
Esquizofrenia Crónica
Poner En Remisión Sin
Medicamentos
Una nueva investigación sugiere que la dieta
cetogénica puede desempeñar un papel en el
tratamiento de la esquizofrenia.
Publicado Abril 6, 2019
Reseña escrita por Lybi Ma
Dos mujeres finalmente conquistaron los síntomas de la esquizofrenia con la die‐

ta cetogénica.
Fuente: Shutterstock Image
https://www.psychologytoday.com/us/blog/advancing-psychiatry/201904/chronic-schizophrenia-put-remission-without-medication 1/18
La esquizofrenia suele ser un trastorno crónico y devastador
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que causa un sufrimiento tremendo. Puede arruinar vidas. In‐
cluso con los mejores tratamientos disponibles, los síntomas
y el sufrimiento a menudo continúan. Un artículo que dos co‐
legas y yo acabamos de publicar el 6 de abril de 2019 en la
revista médica Investigación de Esquizofrenia describe a
dos pacientes con esquizofrenia de larga data que experi‐
mentaron remisión completa de los síntomas con el dieta ce‐
togénica, un tratamiento bien establecido y basado en la evi‐
dencia para la epilepsia. De particular interés en nuestra in‐
vestigación, ambos pacientes pudieron detener los medica‐
mentos antipsicóticos y han permanecido en remisión duran‐
te años. Aunque ciertamente se necesita más evidencia, esta
es una noticia extraordinariamente esperanzadora para las
personas con este trastorno y para los profesionales de la sa‐
lud mental que los tratan.
El Desafío del Trastorno Psicótico

La esquizofrenia afecta al 1 por ciento de la población. Su pri‐
mo cercano, trastorno bipolar, afecta del 2 al 5 por ciento de
la población. Decenas de millones de personas sufren. Los
síntomas incluyen alucinaciones, delirios y patrones desorga‐
nizados de pensamiento y habla. Las alucinaciones son cuan‐
do las personas ven cosas o escuchan cosas que no existen,
mientras que los delirios son pensamientos que no son cier‐
tos, como las creencias paranoicas. Muchas personas descri‐
ben estos síntomas psicóticos como “estar fuera de contacto
con reality.” Las personas diagnosticadas con esquizofrenia
también pueden ignorar la higiene, evitar estar cerca de las
personas y carecer de ella motivación. La enfermedad afecta
a la mayoría de las áreas de la vida y puede afectar grave‐
mente a las personas en la escuela, el trabajo y en las
relaciones.
Los tratamientos predominantes giran en torno a los medica‐
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mentos antipsicóticos. Tan útiles como estos son para algu‐
nos, desafortunadamente, pueden producir malos resultados
para otros. Un estudio de tres años que rastreó a más de
6,000 adultos diagnosticados con esquizofrenia muestra
cuán pobre. Todos los pacientes fueron tratados en centros
médicos académicos y estaban tomando medicamentos anti‐
psicóticos. El estudio rastreó tres métricas: alivio de los sínto‐
mas, calidad de vida y capacidad para funcionar en la socie‐
dad. Solo el 4 por ciento de esos pacientes lograron un alivio
total de la enfermedad en las tres medidas. Claramente, ne‐
cesitamos nuevas ideas de tratamiento para la esquizofrenia.
¿Qué causa la Esquizofrenia?

Nadie sabe con certeza qué causa la esquizofrenia. La mayo‐
ría de los médicos e investigadores piensan que implica un
desequilibrio químico. Esto se refiere a los neurotransmiso‐
res en el cerebro — químicos que envían mensajes de una
célula cerebral a otra. Esta teoría se ha centrado en gran me‐
dida en el exceso de actividad de un neurotransmisor llama‐
do dopamina— principalmente porque todos los medicamen‐
tos antipsicóticos bloquean los receptores de dopamina. Si
bien hay mucha evidencia para apoyar la teoría de la dopami‐
na, muchos tratamientos actuales diseñados a su alrededor
se han quedado cortos. Los tratamientos parecen afectar
solo algunos de los síntomas, no todos, y no cambian el cur‐
so de la enfermedad en sí.
Other researchers think of schizophrenia as a neurodegene‐

rative 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 in‐
clude shrinking of some brain regions, and changes in the
connections between different brain regions.
However, emerging evidence suggests that something else
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might be behind schizophrenia. Attention has turned to bio‐
energetics, 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 re‐
search suggests that this is not the entire explanation. Even
people newly diagnosed with schizophrenia appear to al‐
ready have insulin resistance, even though most don’t yet
have diabetes. This means that their brains may not be get‐
ting enough energy from glucose. Other brain studies have
found metabolic abnormalities, such as higher levels of oxi‐
dative 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 epi‐
lepsy. In my article The Ketogenic Diet May Help Stop Seizu‐
res, 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 po‐
werful medical intervention. Studies show that over 50 per‐
cent of children with epilepsy who do not respond to medi‐
cations experience significant reductions in the frequency
and severity of their seizures, with some becoming comple‐
tely seizure-free.
Using epilepsy treatments in psychiatry is nothing new. Anti‐

convulsant medications are often used to treat psychiatric di‐
sorders. 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 treat‐
ment of psychiatric disorders. Therefore, it’s not unreasona‐
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ble 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 neu‐
rotransmitters and ion channels in the brain, improve metabo‐
lism, and decrease inflammation. So there is existing science
to support why this diet might help schizophrenia.
KETOGENIC DIET ESSENTIAL READS
New Study: Serious Mental Illness Improves

on Ketogenic Diet
The Benefits and Risks of a Ketogenic Diet
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 diffe‐
rent antipsychotic and mood stabilizing medications, inclu‐
ding regular antipsychotic injections. None of them helped
her symptoms. She was unable to care for herself and had a
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court-appointed guardian and home health services.
At the age of 70, weighing 330 pounds, she went to a medi‐

cal weight loss clinic and was started on a ketogenic diet.
Within two weeks of starting the diet, she reported a noticea‐
ble 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 com‐
pletely. She was no longer suicidal. Her case was first repor‐
ted 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 indepen‐
dence, 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 39-year-old

woman who suffered from depression, anxiety, anorexia ner‐
vosa, 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 twen‐
ties, she was diagnosed with schizophrenia. For the next ten
years, she was treated with 7 different antipsychotic medica‐
tions—including clozapine (called the “gold standard antipsy‐
chotic medication”)—along with antidepressants and anti-an‐
xiety medications. Nevertheless, she continued to have
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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 pre‐
viously) and she continued the ketogenic diet. Within a month
on both Haldol and the ketogenic diet, she reported comple‐
te remission of her psychotic symptoms for the first time sin‐
ce 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, re‐
mains 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 ke‐
togenic diet for a month. The researchers reported that their
symptoms improved after two weeks on the diet, but then
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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 disor‐

der improving significantly on the ketogenic diet. Schizoaffec‐
tive disorder is a diagnosis that includes both a mix of schi‐
zophrenia and a mood disorder, often bipolar disorder. One
man and one woman, both in their 30’s, had suffered treat‐
ment-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 antipsy‐
chotic medications. The ketogenic diet was found to normali‐
ze the mouse behaviors associated with schizophrenia, indi‐
cating an antipsychotic effect.
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In 2018, the same researchers published another study of
the ketogenic diet normalizing impaired prepulse inhibition in
mice—yet another marker commonly associated with schi‐
zophrenia. 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 con‐
cluded that weight loss was not required to get the benefit of
the ketogenic diet—the diet alone was enough.
Implications
The two women described in the Schizophrenia Research ar‐
ticle 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 un‐
derstand 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 ba‐
sic 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 ef‐
fective 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 se‐
rious disorders and sometimes dangerous. The medical ver‐
sion of the ketogenic diet has risks and side effects. You
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should have accurate information, help, and medical supervi‐
sion 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 treat‐
ment 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 indu‐
ces significant metabolic changes which can impact medica‐
tion metabolism, among other things. Individuals seeking
treatment of any illness using the ketogenic diet will likely re‐
quire additional support especially during the initial adapta‐
tion 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 res‐
ponses to comments posted in this forum by Chris Palmer,
M.D.
Sobre el Autor
Christopher M. Palmer, M.D., es un psiquiatra

e investigador de Harvard que trabaja en la
interfaz del metabolismo y la salud mental. Es
director del Departamento de Postgrado y
Educación Continua del Hospital McLean y
Profesor Asistente de Psiquiatría de la
Escuela de Medicina de Harvard.
En línea: Chris Palmer, MD, Facebook, Instagram,

LinkedIn, Twitter
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10/15/23, 10:51 PM Chronic Schizophrenia Put Into Remission Without Medication | Psychology Today

Encuentra un Terapeuta (Ciudad o Cremallera)

Christopher M Palmer M.D.

Dos mujeres finalmente conquistaron los síntomas de la esquizofrenia con la die‐

Fuente: Shutterstock Image

El Desafío del Trastorno Psicótico

¿Qué causa la Esquizofrenia?

Other researchers think of schizophrenia as a neurodegene‐

Why Would the Ketogenic Diet Help?

Using epilepsy treatments in psychiatry is nothing new. Anti‐

Interestingly, the effects of this diet on the brain have been

KETOGENIC DIET ESSENTIAL READS

New Study: Serious Mental Illness Improves

The Benefits and Risks of a Ketogenic Diet

But Does It Work?

The first patient documented in the Schizophrenia Research

At the age of 70, weighing 330 pounds, she went to a medi‐

A 39-year-old woman with schizophrenia for 20 years

The second patient described in the article is a 39-year-old

She was having chronic gastrointestinal problems, so she

More Evidence of the Ketogenic Diet for

In 1965, ten women hospitalized with schizophrenia who

Schizoaffective disorder in 2017

In 2017, I reported two other cases of schizoaffective disor‐

In 2018, two Ecuadorian twins, one male and one female,

In 2015, researchers conducted a study of the effects of the

Should Someone Try This Diet on Their

DISCLAIMER: Nothing in this article is intended as medical

Christopher M. Palmer, M.D., es un psiquiatra

En línea: Chris Palmer, MD, Facebook, Instagram,

More from Christopher M Palmer M.D. NOSOTROS

HEALTH 3 MIN READ

Brain Energy: The Metabolic Theory of

SLEEP 2 MIN READ

Craving Sweets? You Might Need

More from Psychology Today NOSOTROS

GHOSTING 5 MIN READ

8 Common Experiences of Ghosters

FANTASIES 3 MIN READ

6 Signs of Being Stuck in a Fantasy of

RELATIONSHIPS 4 MIN READ

3 Red Flags of the Most Manipulative

CHILD DEVELOPMENT 2 MIN READ

Study: Fathers Significantly Influence

GASLIGHTING 4 MIN READ

A 5-Step Gaslighting Safety Plan

LEADERSHIP 2 MIN READ

You Have the Power to Change

PARENTING 2 MIN READ

1 Sure Way to Improve Relationships

RELATIONSHIPS 4 MIN READ

3 Steps to Letting Go of a Parasocial

San Francisco, CA Tucson, AZ

¿Eres terapeuta? Obtenga listados hoy

About Editorial Process Privacy Terms Accessibility

Psychology Today © 2023 Sussex Publishers, LLC

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