Imagine describing months of poor sleep, low mood, and difficulty getting through the day. There are questions about symptoms and stress, perhaps a discussion about therapy or medication. The appointment ends. And at no point did anyone ask what has been on the dinner table. 

There is no doubt that both therapy and medication are central to mental health care, but lifestyle and, in particular, nutrition, definitely also need a seat at the treatment table.

The many patients sharing their experiences on the Metabolic Mind website certainly think so. One person living with bipolar disorder describes starting a ketogenic diet because of prediabetes, then noticing an unexpected improvement in mental health. Another describes using ketogenic therapy alongside psychiatric care for schizophrenia. The change that mattered was not simply a better score on a questionnaire; it was being able to work, socialise and feel part of life again.

It is tempting to call these stories “just anecdotes”, but an anecdote is an important piece of the puzzle. Each is an n=1: a close account of what changed for one person, and when. The people telling these stories experienced a meaningful shift after changing their diets, and they attribute that shift to the change in food. Their experiences have value in their own right. They can also point researchers towards questions that might otherwise never be asked.

Fortunately, research is giving these stories a wider context. In the SMILES trial (1), adults with major depression who received support to improve their diets had a greater reduction in depressive symptoms over 12 weeks than those who received social support. A review of randomised trials also found that dietary interventions can reduce symptoms of depression (2). Food is clearly relevant to the conversation.

The interest extends beyond depression. In a 2024 pilot study (3), people with bipolar disorder or schizophrenia who adopted a ketogenic diet showed improvements in both metabolic health and psychiatric symptoms over four months. More recently, a study published in Schizophrenia Bulletin (4) reported improvements in metabolic measures among people with schizophrenia spectrum or bipolar I disorder assigned to a ketogenic diet. Participants who continued the diet for four months also showed improvements in psychiatric symptoms and cognition.

The research spans different diagnoses and different approaches to eating, but it is adding weight to what many people have already noticed in their own lives: changing their diet changed how they felt. Their stories helped bring this question into focus, and the findings give mental health professionals more reason to pay attention.

That could begin with asking about food as routinely as they ask about sleep. Has someone noticed a change in mood or symptoms after changing their diet? Are they eating regularly? Do they have a metabolic condition that also needs attention? These are ordinary questions, yet the answers could change the direction of a conversation.

World Mental Health Day’s focus on lived experience is a good reminder that patients often bring valuable observations into the room. Those observations deserve to be heard, explored, and studied. And perhaps the easiest place to start is with a question that should never have been unusual: “Tell me about what you eat.”

References

1. Jacka FN, O’Neil A, Itsiopoulos C, Opie R, Cotton S, Mohebbi M, Castle D, Dash S, Mihalopoulos C, Chatterton ML, Brazionis L, Dean OM, Hodge A, Berk M. The SMILES trial: an important first step. BMC Med. 2018 Dec 28;16(1):237. doi: 10.1186/s12916-018-1228-y. PMID: 30591059; PMCID: PMC6309069. 
2. Firth J, Marx W, Dash S, Carney R, Teasdale SB, Solmi M, Stubbs B, Schuch FB, Carvalho AF, Jacka F, Sarris J. The Effects of Dietary Improvement on Symptoms of Depression and Anxiety: A Meta-Analysis of Randomized Controlled Trials. Psychosom Med. 2019 Apr;81(3):265-280. doi: 10.1097/PSY.0000000000000673. Erratum in: Psychosom Med. 2020 Jun;82(5):536. doi: 10.1097/PSY.0000000000000807. Erratum in: Psychosom Med. 2021 Feb-Mar 01;83(2):196. doi: 10.1097/PSY.0000000000000914. PMID: 30720698; PMCID: PMC6455094. 
3. Sethi S, Wakeham D, Ketter T, Hooshmand F, Bjornstad J, Richards B, Westman E, Krauss RM, Saslow L. Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial. Psychiatry Res. 2024 May;335:115866. doi: 10.1016/j.psychres.2024.115866. Epub 2024 Mar 20. PMID: 38547601. 
4. Abram SV, Kyner JM, Vu A, Naeem Z, Sethi S, Jacob MS, Fryer SL, Mathalon DH, Ford JM. Metabolic Improvements with a Ketogenic Diet Correlate with Symptom Improvement in Psychosis: A Randomized Controlled Trial. Schizophr Bull. 2026 Jul 3;52(4):sbag082. doi: 10.1093/schbul/sbag082. PMID: 42415343; PMCID: PMC13341701.