The issues

A ketogenic diet is a high-fat, moderate-protein, very low-carbohydrate eating pattern designed to shift the body’s metabolism away from glucose (sugar) and toward fat for fuel. As carbohydrate intake drops, the liver begins to produce ketones, a type of fuel derived from fat, that can be used by the brain and other organs. This induces a metabolic state called nutritional ketosis.

Ketogenic diets are unique among dietary patterns given they can be tracked with measurable biomarkers. Blood levels of beta-hydroxybutyrate (BHB) are often considered to be the gold standard, while breath and urine testing offer additional (though slightly less reliable) options.

For many people, ketogenic diets are used as a tool for weight loss, blood sugar control, or general wellness. The goal is typically to maintain low insulin levels, reduce cravings, and promote fat burning — all of which can be achieved without necessarily measuring blood ketones (although this can be helpful for difficult cases).

In contrast, ketogenic therapy refers to the use of a ketogenic diet (or exogenous ketones) as a targeted medical intervention to manage or improve specific, often serious, chronic, or treatment-resistant health conditions. In these contexts, measuring and sustaining higher ketone levels may be important for therapeutic purposes.

In some health conditions, higher levels of ketones may have therapeutic benefits. This has been studied in conditions such as epilepsy, mental health disorders (including bipolar disorder, schizophrenia, and depression), autoimmune diseases like psoriasis or ulcerative colitis, and neurodegenerative diseases such as Parkinson’s disease or Alzheimer’s disease.

In these situations, maintaining higher ketone levels may help reduce symptoms or slow disease progression for some people. Research is still ongoing, but scientists have proposed several possible biological explanations for why this might occur, including:

• • Mitochondrial support: Improved energy production and reduced oxidative stress
  • Neurotransmitter balance: Favoring calming signals (like GABA) over excitatory ones
  • Anti-inflammatory effects: Suppression of key inflammationpathways
  • Epigenetic regulation: Helping turn genes on or off by adjusting how tightly DNA is wound. 
  • Improved insulin sensitivity: Enhancing blood sugar control and lowering fasting insulin
  • Cancer metabolism: Restricting energyavailability for tumors reliant on sugar

Together, these differences demonstrate an important distinction: while both ketogenic diets and ketogenic therapy share the same underlying biology, the intensity, purpose, and clinical oversight involved may be different.

Patient Spotlights from the Film

The following patient spotlights are featured in the recent documentary The Cholesterol Code, which follows software engineer and cholesterol researcher, Dave Feldman, on his journey to tell the profound stories of those utilizing ketogenic therapy to treat debilitating illnesses but find an alarmingly large increase in their cholesterol blood tests. Many of these individuals exhibit the Lean Mass Hyper-Responder (LMHR) phenotype — a profile marked by very high low-density lipoprotein (LDL)-cholesterol (the ‘bad’ cholesterol) levels but alongside otherwise excellent metabolic health metrics. Using advanced imaging and emerging research, the documentary highlights powerful, real-world examples of people trying to understand the balance of dramatically enhancing their quality of life whilst dealing with the concern of higher cardiovascular risk.

Nick Norwitz (Ulcerative Colitis)
Nick Norwitz, a Harvard medical student with a PhD from Oxford, nearly lost everything to ulcerative colitis—a painful inflammatory bowel disease that left him dangerously thin, hospitalized, and considering dropping out of school. In desperation, he tried a ketogenic diet, and the turnaround was dramatic. “Within a few days I was feeling remarkably better,” he recalls. “My symptoms all improved dramatically.” But while keto gave him his health back, it also sent his LDL cholesterol soaring—eventually peaking in the mid-500s. Searching for answers, Nick stumbled upon the concept of Lean Mass Hyper-Responders: lean, athletic individuals whose LDL spikes on a low-carb diet. “This is me,” he realized. Driven by curiosity, he joined forces with engineer-turned-citizen-scientist, Dave Feldman to investigate further. “When you’re told a question is off limits,” Nick says, “it makes you more hungry to go after it.”

Robyn Dobbins (Bipolar Disorder)
Robyn Dobbins, a wife and mother, spent years trapped in the gray fog of bipolar disorder—barely able to function or connect with her children. “I was basically comatose all day long,” she recalls. After exhausting medications and doctors, she tried a ketogenic diet—not for mental health, but to lose weight and hopefully lower her cholesterol. What happened next shocked her. “I think my mental health is getting better,” she told her husband. Within months, Robyn lost 50 pounds and began feeling joy for the first time in years. Her psychiatrist helped her safely taper off all psychiatric medications, and she’s now been in full remission for seven years. But as her mental health flourished, her cholesterol soared to 360 mg/dL. Attempts to lower it by adding carbs triggered a return of depressive symptoms. “It wasn’t worth it,” she says. For Robyn, keto isn’t a trend—it’s a lifeline, and abandoning it would mean losing the life she fought hard to reclaim.

Matt Baszucki (Bipolar Disorder)
Matt Baszucki battled severe, treatment-resistant bipolar disorder that left him homeless and wandering the streets of Los Angeles. Out of desperation, he tried a ketogenic diet—and everything changed. “Not only did my mood stabilize,” he says, “but everything just fell into place.” He regained the ability to work, exercise, and think clearly. For the first time in years, he felt joy, energy, and purpose. The transformation was so profound that Matt now advocates for metabolic therapies in mental health. “It’s almost like a different existence,” he reflects. For Matt, keto didn’t just improve symptoms—it gave him his life back.

Lauren Kennedy West (Schizoaffective Disorder)
Lauren Kennedy struggled with schizo-affective disorder—a debilitating blend of schizophrenia and bipolar disorder—for more than a decade. After countless medications and setbacks, she began medically supervised ketogenic therapy and saw her symptoms vanish. “I’m kind of blown away… it has been shockingly effective at eradicating my symptoms,” she said. Today, she shares her journey openly, changing the name of her YouTube channel from Living Well with Schizophrenia to Living Well After Schizophrenia. Now off all psychiatric medications, Lauren says she no longer experiences symptoms. Her story stands as a powerful beacon of hope for those facing similar mental health challenges.

Eric Rodgers (Severe Depression)
Eric Rodgers endured severe depression and suicidal thoughts for years. When he adopted a ketogenic diet to address pre-diabetes, something unexpected happened—his mental health began to improve. “I felt it initially fairly quickly,” he recalls, “but it’s just been a continual gradual improvement… the last seven years—no mood issues at all.” For Eric, keto did more than normalize his blood sugar; it lifted a lifelong burden of emotional darkness. His story highlights the growing body of evidence connecting metabolic health and mental well-being and raises important questions about the role of nutrition in treating psychiatric conditions previously thought untouchable.

Highlighted Communities Using Ketogenic Therapy

• Type 1 Diabetes: May improve blood sugar stability and reduce insulin requirements with medical oversight.
• Type 2 Diabetes: Often leads to improved insulin sensitivity, lower A1c, and often reversal/remission.
• Mental Health Disorders: Shows potential in bipolar disorder, depression, schizophrenia, anxiety among others.
• Eating Disorders: Early reports suggest possible benefit in severe anorexia nervosa under careful supervision.
• Digestive Disorders: Some patients with ulcerative colitis and IBS report symptom improvement.
• Autoimmune Conditions: Preliminary evidence shows potential benefits in conditions like psoriasis and psoriatic arthritis.

Scientific Support and Areas for Research

While much of the data is still preliminary or based on case reports, interest in ketogenic therapy is rapidly expanding in the medical world. A few key examples include:

•         Danan A et al. Front Psychiatry, 2022 — Retrospective study of 31 psychiatric inpatients showed ketogenic diets were associated with improved symptoms in refractory mental illness.
•         Norwitz NG et al. Curr Opin Endocrinol Diabetes Obes, 2020 — Review article summarizing mechanistic rationale for ketogenic diets in mental illness.
•         Sethi S et al. Psychiatry Res, 2024 — Pilot trial showed metabolic and psychiatric improvements in patients with bipolar disorder and schizophrenia following ketogenic diet.
•         Norwitz NG et al. J Insulin Resist, 2023 — Case series reported sustained remission of severe anorexia nervosa using an animal-based ketogenic diet.
•         Phillips MCL et al. Alzheimers Res Ther, 2021 — Randomized crossover trial found cognitive and functional improvements in Alzheimer’s patients on a modified ketogenic diet.
•         Vanitallie TB et al. Neurology, 2006 — Feasibility study showed diet-induced ketosis was well tolerated and potentially beneficial in Parkinson’s disease.
•         Cukoski S et al. Cell Rep Med, 2023 — Randomized controlled trial demonstrated ketogenic diets were feasible and improved metabolic markers in polycystic kidney disease.
•         Norwitz NG & Soto-Mota A. Front Nutr, 2024 — Case series of 10 patients with inflammatory bowel disease showed symptom remission on a carnivore-ketogenic diet.
•         Ciaffi J et al. Front Med (Lausanne), 2021 — Mini review suggested ketogenic diets may reduce systemic inflammation and improve cardiovascular markers in rheumatic disease.
•         Lambadiari V et al. Int J Mol Sci, 2024 — Randomized crossover trial found ketogenic diet reduced inflammatory markers more than Mediterranean diet in psoriatic arthritis and obesity.

Call to Action for Researchers
Larger, controlled trials are needed. The signals from existing data are compelling, and the patient stories are powerful — but rigorous science will help the medical community clarify where, how, and for whom ketogenic therapy can work its magic.