Can the Keto diet help mental illness? US tech billionaire’s Matt Baszucki found diet helped bipolar

Matt Baszucki is a musician and tech professional living in San Francisco. At just 26, he could be expected to be leading a certain kind of life as befits his age and profession.

Instead, every morning Matt gets up at the same time and goes outside for the morning light to reset his body clock. He spends two hours a day exercising — running in the morning, lifting weights in the afternoon.

He makes sure he gets enough sleep and doesn’t drink or smoke. He also emphatically steers clear of drugs.

But it’s his diet that really sets Matt apart from his peers. He often eats only two meals a day — the first at 1pm or 2pm, the other at 6pm or 7pm — then fasts until lunchtime the next day.

And then there’s what he does, and doesn’t, eat: no bread, pasta, rice or refined carbs, sweets or cola. His meals are instead based on protein and fat — ‘a lot of super-heavy fat foods’, including nut butters and avocados, plus meat, eggs, fish, chicken and ‘a lot of vegetables’.

None of his friends lives like this. ‘This damned diet has turned me into a monk,’ Matt says wryly. ‘It’s lonely.’ But it’s also been the making of him, as he explains: ‘It gave me my life back.’

That he is where he is now is an extraordinary story.

At 19, Matt was hospitalised with severe bipolar disorder, a condition characterised by mood swings, including mania and depression, after he suffered a psychotic breakdown, experiencing delusions.

The next five years were a chaotic blur of recovery, psychotic episodes and mania. At one point Matt was ‘running around barefoot and homeless’ travelling across California (once sleeping behind a skip); at other times, he’d be ‘doing crazy, embarrassing things in front of my friends in public’; or at home, playing the piano for hours and hours, for instance — followed by deep depression.

Matt was in and out of psychiatric wards and treatment centres. In between, he suffered from major anxiety, irritability, brain fog and sleep problems — all the while trying many different medications (with ‘horrific side-effects’) and treatments, and consulting a string of mental health professionals.

Matt describes it as a time of ‘hell’ for him and his family.

And then his parents heard about someone who knew someone who’d used the ketogenic diet to manage his bipolar.

The keto diet is high in fat (such as dairy, nuts and oil) and very low in carbohydrate (typically around 25-30g per day; for context, a slice of white bread provides 6g).

The keto diet is high in fat (such as dairy, nuts and oil) and very low in carbohydrate (typically around 25-30g per day; for context, a slice of white bread provides 6g

While keto has gained notoriety as a fashionable way to lose weight, as a medical therapy it has strong credentials for treating children with epilepsy that doesn’t respond to medication, significantly reducing their seizures (in the UK, the ketogenic diet is a recognised treatment option for drug-resistant epilepsy).

This may be because it provides a fatty acid, decanoic acid, which acts on receptors on the surface of brain cells that cause seizures. Another suggestion is that it offers an alternative source of energy for brain cells — which is where it may play a role in treating mental illness.

There is evidence that bipolar disorder, for instance, is linked to a problem with the mitochondria, the ‘batteries’ in all our cells.

In some people, the mitochondria can’t handle glucose properly. This is the body’s main fuel source, so the cells don’t work efficiently.

In the brain this can affect the communication between cells, in turn affecting brain function and mental health, the theory goes.

With the keto diet the body uses an alternative source of fuel, ketones (which the liver produces when it breaks down fats, a process called ketosis), which effectively stabilises brain function. Medication is a mainstay treatment for bipolar, but this can be a case of trial and error — and by the time Matt’s mother, Jan, told him about the keto diet, he’d already been treated by 41 mental health professionals and prescribed 29 different drugs, including nine antipsychotics.

Matt had also made lifestyle changes, such as taking exercise. But he was still unwell.

He started the diet on January 4, 2021, a date he remembers precisely because it was such a radical shift in his eating habits.

Within just a few weeks he started feeling better: the brain fog lifted, the irritability dissipated.

More significantly for Matt, he ‘was able to get through the equinox on a lower dose of Zyprexa [an antipsychotic] than in previous years — I knew something was changing’. The spring equinox in March is the start of the days becoming longer, and it’s recognised that some people with bipolar (and other disorders) are affected by seasonal changes, though it’s not clear why. With bipolar, it can herald the start of a cycle of not sleeping and mania, followed by deep depression.

‘The equinox would always set my mood off and cause me to become manic,’ says Matt. Significantly, his first manic episode (in 2016) was in March.

‘But in 2021, I was sleeping normally, eight hours a night, and my mood was stable.’

And where previously he’d needed to increase his Zyprexa dose fourfold at that time of year, for the first time he was able to remain on his usual dose. He also didn’t develop depression.

Since then, Matt has been able slowly to reduce the number of his medications to just four — ‘all super-low doses’, he says.

And now? ‘I feel great pretty much all of the time; my mood is stable. I can work all week — two or three years ago I could never have imagined I’d be able to have a job — and I have the energy to work on my music.’

In his own words, Matt has become a ‘functional member of society’ — a significant contrast with the ‘serious impairment’ experienced by 83 per cent of people with bipolar, according to the National Institute of Mental Health in America.

Matt’s psychiatrist had previously concluded that his condition was treatment-resistant — and while he supported Matt through this, he’s said to be surprised by the diet’s transformative impact.

This is not just about healthy eating. For as Jan explains, Matt had tried ‘a lot of different diets — Paleo, gluten-free, dairy-free’, she says, listing them off. ‘We knew about diets, but we didn’t know ketosis or a well-managed ketogenic diet could treat mental illness.’

And that’s ‘what changed everything’, she says.

‘It’s been such a miracle to watch it happen and go beyond where Matt was before — his executive function [i.e. ability to plan and focus] and cognitive function are soaring. His calmness is way beyond where he was when he first got sick,’ she adds.

‘None of this happens in bipolar disorder treatment, especially in as serious a case as he had. Yet Matt’s now leading a regular life.’

The Baszuckis are speaking to Good Health to help de-stigmatise mental illness — and, importantly, to support others with bipolar (a condition that affects 1.3 million people in the UK).

To this end, they’ve done more than generously tell their story.

In 2021, Jan, a writer, and her husband, David, the billionaire CEO of Roblox, a video gaming and communications platform, set up the Baszucki Brain Research Fund (BBRF) — a philanthropic foundation that’s donated more than $60 million to mental health research, with the bulk going towards funding work on bipolar disorder.

This includes $2 million for researchers to investigate specifically the keto diet for bipolar, schizophrenia and depression, with five teams given grants, including one at Stanford University in the U.S. and another at the University of Edinburgh.

Jan says this is about providing the scientific evidence to back the grassroots stories, such as Matt’s, showing keto can help with bipolar, and understanding more about why it helps.

‘When people talk about healthy diet being important for mental health, what we really want to get at in our science is that maybe it’s the ketosis that really matters. We were lucky that we had the resources,’ adds Jan, recalling their family’s five-year struggle.

‘That’s part of why we started the foundation. It was so hard for us, we have to make it easier for people to find things that work.’

The first modern drugs for mental illness emerged post World War II — with the first antipsychotic, chlorpromazine, prescribed for schizophrenia and mania.

But if the focus since has been on pharmaceutical solutions, there has been growing disquiet among some researchers and clinicians that medication has proven inadequate for conditions such as mild to moderate depression — or as the sole approach for severe mental health problems including bipolar. Increasingly, experts are looking at the role of diet.

Matt’s meals are based on protein and fat — ‘a lot of super-heavy fat foods’, including nut butters and avocados, plus meat, eggs, fish, chicken and ‘a lot of vegetables’. [File image] 

One of the leading UK figures in this emerging field of nutritional psychiatry is Carmine Pariante, a professor of biological psychiatry at King’s College London, who has been studying the role that inflammation plays in depression.

As Professor Pariante explains: ‘Over time, inflammation feeds back into the brain and changes the function of the neurons [nerve cells].’

He says there is good evidence for the Mediterranean diet, and in particular, a diet rich in fish — specifically, fish oil, which has anti-inflammatory effects — in helping treat depression.

In the landmark SMILES trial in 2017 at Deakin University in Australia, a third of patients with moderate to severe depression put on a modified Mediterranean diet were able to come off their medication after just 12 weeks.

‘With mild depression, it can be worth trying some lifestyle changes first,’ says Professor Pariante.

‘That means exercise and going out in the day — and fish oil, at a dose of at least 1g per day, works as part of that.

‘With moderate or severe depression, in combination with antidepressants, fish oil can help.’

He says that with bipolar ‘the evidence [for nutritional impact] is much more anecdotal, case reports and small studies’.

The need for a scientific evidence base is where the Baszucki Brain Research Fund comes in, sponsoring the work of ground-breaking researchers such as Dr Shebani Sethi, a clinical assistant professor in psychiatry and behavioural sciences at Stanford.

Matt’s psychiatrist had previously concluded that his condition was treatment-resistant — and while he supported Matt through this, he’s said to be surprised by the diet’s transformative impact. [File image] 

In 2015, Dr Sethi coined the term ‘metabolic psychiatry’ to describe an approach to treating mental illness that also involves treating patients’ physical health — including specifically addressing metabolic disorders such as insulin resistance (where the cells don’t respond properly to insulin, leading to raised blood sugar levels) and excess weight.

As Dr Sethi told Good Health, ‘the prevalence of these disorders is greater in patients with psychiatric diseases’, putting them at higher risk of heart disease and stroke. (Research shows that people with severe mental illness die on average ten to 20 years earlier than the general population.)

Excess weight and insulin resistance are recognised side-effects of some psychiatric medicines. But it may be that they precede the mental illness.

Dr Sethi points to findings by Stanford researchers in 2021, showing that if you have insulin resistance, your risk of developing major depression is twice that of someone who doesn’t.

One potential link is inflammation. Dr Sethi describes how insulin resistance can lead to the brain becoming ‘leakier’, allowing more substances to get in, leading to inflammation.

There is ‘significantly more inflammation in the brains of people with mental illness, especially in treatment-resistant patients’, she says.

Another potential link is mitochondrial dysfunction: bipolar disorder is ‘20 times more likely in people with mitochondrial disease’, Dr Sethi told Good Health.

All this may speak to Matt Baszucki’s experience. In the lead-up to his illness, he’d recently started on a demanding degree course at the prestigious University of California, Berkeley, eating a lot of sugar and burning the candle at both ends leading the lifestyle of a fraternity member.

He describes his bipolar as ‘a brain energy imbalance: the brain is not getting the right fuel. It’s nothing to do with personality.’

Metabolic psychiatry is about more than simply using nutrition as ‘an add-on’ to medication that might improve diabetes, for instance, says Dr Sethi — it’s about ‘targeting’ metabolic dysfunction.

‘It’s about the understanding that a metabolic therapy [a drug or dietary intervention] could alter the structure and the way the brain functions,’ she explains.

This lies at the core of the work at the Metabolic Psychiatry Clinic that Dr Sethi has set up — ‘the world’s first’ speciality clinic to treat patients struggling with both mental illness and metabolic disorder.

Research is in its early days, but in a recent pilot study she led, with 24 patients with bipolar disorder or schizophrenia, after four months on a ketogenic diet (20/30g carbohydrates a day, along with moderate amounts of protein, cheese, eggs, salad and non-starchy veg, e.g. broccoli), they lost on average almost 11 per cent of their body weight.

Their visceral fat (the dangerous type around the organs that pumps out toxic chemicals) dropped by 31 per cent, and their blood fats, cholesterol, blood pressure and inflammation levels — markers for metabolic disease — all improved.

Significantly, the patients were sleeping better and experienced a vast improvement in their psychiatric symptoms such as mood. A few were also able to reduce their need for psychiatric medicines.

In another small study, published last year, 64 per cent of patients were able to reduce their psychiatric medication (with improvements in their symptoms, as well as markers for metabolic conditions).

In this study, led by Dr Albert Danaan, a psychiatrist at the University of Toulouse in France, 28 hospital patients with bipolar, schizophrenia, or severe depression whose condition was poorly controlled with medication, followed a ketogenic diet for between two weeks to up to nearly nine months (there was no control group of patients for comparison).

Separately, Dr Iain Campbell, a researcher at the Centre for Clinical Brain Sciences at the University of Edinburgh, is conducting a pilot trial with 25 patients with bipolar, looking at keto’s impact on mood, metabolic markers and brain scans (as with all these studies, patients continue taking their medication).

The significance of being able to add other options to the current treatments cannot be underestimated. Dr Campbell says that ‘even with widely available access to modern medications, the attempted suicide rate for bipolar disorder is 25 to 60 per cent’.

Dr Campbell, who last December was announced as the BBRF’s Metabolic Psychiatry Research Fellow, has a unique perspective on keto, having experienced substantial reduction in his own bipolar symptoms with the diet over the past seven years.

He came across it serendipitously, wanting to lose weight. Then, three days into a very low-carb diet, it was like a light was switched on in his brain. ‘For the first time in my life’, he says. ‘I thought: “This is what normal people feel like.” ’

The question is how much of a role diet plays ultimately.

‘People think “Maybe the diet accounts for 15-20 per cent of his recovery”, but this is it,’ says Matt emphatically.

He believes it’s ‘totally possible’ he will no longer need medication within two to five years, ‘though there’s no rush, it’s a slow process, the side-effects are pretty manageable’.

But he also acknowledges that

medications saved his life — and he is certainly not suggesting people don’t take them. But keto is what gave him his mind back, he says.

Professor Pariante is emphatic that, with bipolar, ‘because it can quickly go one way or the other — unlike depression, which takes weeks to appear — patients really should be on medication.

‘Of course diet could be helpful, especially if patients don’t respond to medication or even if just to counter some side-effects of medication such as weight gain.’

‘But my main message is that people can’t cure any mental illness with diet: it’s part of the package, but shouldn’t be the only resource.’

Dr Campbell explains that the ketogenic diet is not a ‘cure’ but suggests that for those for whom it works, it could be a long-term therapy in combination with medication — should the evidence prove the theory.

And the ketogenic diet is not for everyone, says Dr Sethi.

Furthermore, all those involved in this area cannot stress enough the importance of it being undertaken only under the proper supervision of both a psychiatrist and a dietitian, and not coming off medication without medical advice.

And if it has been transformative for Matt, there is no doubt this lifestyle is challenging.

‘I did enough drinking for a lifetime from the ages of 16 to 21 and enough staying up late, but it is difficult to feel left out.’

Has he cheated?

‘I’ve had tiny things, like two M&Ms that wouldn’t throw me out. But for me, food is just fuel and I don’t cheat; I don’t want to go back.

‘My whole life is trying not to fall prey to the temptations of the world, and then, as a result, I get everything else: my brain fog lessens, my mood is stable and my temperament is balanced, and that solves issues in my relationships and issues with work and productivity,’ Matt says.

‘It means I don’t have to worry about the rest of my life — it takes care of itself as long as I just keep doing those basic things: good sleep, sun in the morning, exercise in the morning, keto diet, don’t smoke or drink or do drugs. The energy, the productivity . . . it’s worth it.’