Front Nutr. 2026 Feb 24;13:1749406. doi: 10.3389/fnut.2026.1749406. eCollection 2026.

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.

PMID:41816235 | PMC:PMC12971900 | DOI:10.3389/fnut.2026.1749406

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