Pilot study of a ketogenic diet in bipolar disorder: a process evaluation
Abstract Background Bipolar disorder is a serious mental illness, which requires new strategies for prevention and management. Recent evidence suggests that a ketogenic diet may be an effective intervention. This research aimed to explore the feasibility and acceptability of a ketogenic diet interve...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12888-025-06479-y |
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| author | Benjamin P. Rigby Nicole Needham Helen Grossi Ivana Kamenska Iain H. Campbell Ben Meadowcroft Frances Creasy Cheryl Fisher Pankaj Bahuguna John Norrie Gerard Thompson Melissa C. Gibbs Maja Mitchell-Grigorjeva Ailsa McLellan Tessa Moses Karl Burgess Rachel Brown Michael J. Thrippleton Harry Campbell Daniel J. Smith Sharon A. Simpson |
| author_facet | Benjamin P. Rigby Nicole Needham Helen Grossi Ivana Kamenska Iain H. Campbell Ben Meadowcroft Frances Creasy Cheryl Fisher Pankaj Bahuguna John Norrie Gerard Thompson Melissa C. Gibbs Maja Mitchell-Grigorjeva Ailsa McLellan Tessa Moses Karl Burgess Rachel Brown Michael J. Thrippleton Harry Campbell Daniel J. Smith Sharon A. Simpson |
| author_sort | Benjamin P. Rigby |
| collection | DOAJ |
| description | Abstract Background Bipolar disorder is a serious mental illness, which requires new strategies for prevention and management. Recent evidence suggests that a ketogenic diet may be an effective intervention. This research aimed to explore the feasibility and acceptability of a ketogenic diet intervention for bipolar disorder, fidelity to its behavioural components and the experiences of the participants and research clinicians involved. Methods A mixed-methods process evaluation was conducted. Semi-structured telephone interviews were carried out with 15 participants 1–2 months after completing a 6–8 week modified ketogenic diet intervention, and 4 research clinicians from the study team following the completion of data collection. Data were thematically analysed. Fidelity checklists completed by research dietitians were analysed using descriptive count and percentage statistics. Findings are reported post-hoc, following the analysis and publication of the main pilot study findings. Reporting was guided by the COREQ checklist. Results Five themes were identified in the qualitative data: (1) ‘Encouraging entry and supporting exit’ (e.g. recognising and managing participants’ varied motives and expectations, including around weight loss and symptom alleviation); (2) ‘Challenging but potentially transformational,’ which reflects that while it can be difficult to initiate and maintain a ketogenic diet day-to-day, many participants perceived physical and psychological benefits (e.g. significant weight loss, mood stability and enhanced ability to focus); (3) ‘Intervention facilitators,’ including a range of behavioural (e.g. goal setting), social (e.g. family and dietitians) and technological (e.g. apps for monitoring) support mechanisms; (4) ‘Intervention barriers’ (e.g. dietary preferences, concerns about the diet and its impact, the testing burden and capacity of the delivery team); and (5) ‘The wider context’ (e.g. the cost of living and sociocultural expectations) was a crucial factor explaining differential experiences. Overall, descriptive analyses indicated moderate-to-good fidelity to the behaviour change components of the study. Conclusion We provide novel insight into the experiences of people living with bipolar disorder initiating and following a ketogenic diet, as well as those of research clinicians who support the intervention. Future trials may benefit from increased clinical research capacity, better-defined entry and exit routes, additional interpersonal support, and greater understanding of how social and societal factors impact participation. Trial registration Study registration number: ISRCTN61613198 (02/03/22). |
| format | Article |
| id | doaj-art-95a6705715c8493ca70f44ee3977a532 |
| institution | Kabale University |
| issn | 1471-244X |
| language | English |
| publishDate | 2025-01-01 |
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| series | BMC Psychiatry |
| spelling | doaj-art-95a6705715c8493ca70f44ee3977a5322025-01-26T12:46:49ZengBMCBMC Psychiatry1471-244X2025-01-0125111810.1186/s12888-025-06479-yPilot study of a ketogenic diet in bipolar disorder: a process evaluationBenjamin P. Rigby0Nicole Needham1Helen Grossi2Ivana Kamenska3Iain H. Campbell4Ben Meadowcroft5Frances Creasy6Cheryl Fisher7Pankaj Bahuguna8John Norrie9Gerard Thompson10Melissa C. Gibbs11Maja Mitchell-Grigorjeva12Ailsa McLellan13Tessa Moses14Karl Burgess15Rachel Brown16Michael J. Thrippleton17Harry Campbell18Daniel J. Smith19Sharon A. Simpson20Population Health Sciences Institute, Newcastle UniversityDivision of Psychiatry, Centre for Clinical Brain Sciences, Royal Infirmary of EdinburghDepartment of Nutrition and Dietetics, Royal Hospital for Children and Young PeopleUsher Institute, University of EdinburghDivision of Psychiatry, Centre for Clinical Brain Sciences, Royal Infirmary of EdinburghPsychiatry, NHS LothianPsychiatry, NHS LothianDepartment of Nutrition and Dietetics, Royal Hospital for Children and Young PeopleHealth Economics and Health Technology Assessment, University of GlasgowUsher Institute, University of EdinburghCentre for Clinical Brain Sciences, University of EdinburghNuffield Department of Clinical Neuroscience, University of OxfordBipolar ScotlandDepartment of Paediatric Neurology, Royal Hospital for Children and Young PeopleEdinOmics Research Facility (RRID: SCR_021838), University of EdinburghCentre for Engineering Biology, University of EdinburghCentre for Engineering Biology, University of EdinburghCentre for Clinical Brain Sciences, University of EdinburghUsher Institute, University of EdinburghDivision of Psychiatry, Centre for Clinical Brain Sciences, Royal Infirmary of EdinburghMRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of GlasgowAbstract Background Bipolar disorder is a serious mental illness, which requires new strategies for prevention and management. Recent evidence suggests that a ketogenic diet may be an effective intervention. This research aimed to explore the feasibility and acceptability of a ketogenic diet intervention for bipolar disorder, fidelity to its behavioural components and the experiences of the participants and research clinicians involved. Methods A mixed-methods process evaluation was conducted. Semi-structured telephone interviews were carried out with 15 participants 1–2 months after completing a 6–8 week modified ketogenic diet intervention, and 4 research clinicians from the study team following the completion of data collection. Data were thematically analysed. Fidelity checklists completed by research dietitians were analysed using descriptive count and percentage statistics. Findings are reported post-hoc, following the analysis and publication of the main pilot study findings. Reporting was guided by the COREQ checklist. Results Five themes were identified in the qualitative data: (1) ‘Encouraging entry and supporting exit’ (e.g. recognising and managing participants’ varied motives and expectations, including around weight loss and symptom alleviation); (2) ‘Challenging but potentially transformational,’ which reflects that while it can be difficult to initiate and maintain a ketogenic diet day-to-day, many participants perceived physical and psychological benefits (e.g. significant weight loss, mood stability and enhanced ability to focus); (3) ‘Intervention facilitators,’ including a range of behavioural (e.g. goal setting), social (e.g. family and dietitians) and technological (e.g. apps for monitoring) support mechanisms; (4) ‘Intervention barriers’ (e.g. dietary preferences, concerns about the diet and its impact, the testing burden and capacity of the delivery team); and (5) ‘The wider context’ (e.g. the cost of living and sociocultural expectations) was a crucial factor explaining differential experiences. Overall, descriptive analyses indicated moderate-to-good fidelity to the behaviour change components of the study. Conclusion We provide novel insight into the experiences of people living with bipolar disorder initiating and following a ketogenic diet, as well as those of research clinicians who support the intervention. Future trials may benefit from increased clinical research capacity, better-defined entry and exit routes, additional interpersonal support, and greater understanding of how social and societal factors impact participation. Trial registration Study registration number: ISRCTN61613198 (02/03/22).https://doi.org/10.1186/s12888-025-06479-yBipolar type I or II disordersProcess evaluationNeurophysiologyMetabolic psychiatry |
| spellingShingle | Benjamin P. Rigby Nicole Needham Helen Grossi Ivana Kamenska Iain H. Campbell Ben Meadowcroft Frances Creasy Cheryl Fisher Pankaj Bahuguna John Norrie Gerard Thompson Melissa C. Gibbs Maja Mitchell-Grigorjeva Ailsa McLellan Tessa Moses Karl Burgess Rachel Brown Michael J. Thrippleton Harry Campbell Daniel J. Smith Sharon A. Simpson Pilot study of a ketogenic diet in bipolar disorder: a process evaluation BMC Psychiatry Bipolar type I or II disorders Process evaluation Neurophysiology Metabolic psychiatry |
| title | Pilot study of a ketogenic diet in bipolar disorder: a process evaluation |
| title_full | Pilot study of a ketogenic diet in bipolar disorder: a process evaluation |
| title_fullStr | Pilot study of a ketogenic diet in bipolar disorder: a process evaluation |
| title_full_unstemmed | Pilot study of a ketogenic diet in bipolar disorder: a process evaluation |
| title_short | Pilot study of a ketogenic diet in bipolar disorder: a process evaluation |
| title_sort | pilot study of a ketogenic diet in bipolar disorder a process evaluation |
| topic | Bipolar type I or II disorders Process evaluation Neurophysiology Metabolic psychiatry |
| url | https://doi.org/10.1186/s12888-025-06479-y |
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