When Higher Ketones Become Therapeutic: What the Science Shows for Mental Health, Gut Disorders, and Autoimmune Disease

Most people step into nutritional ketosis for weight loss, energy, and improved metabolic health. When ketones rise into a healthy nutritional range, usually between 0.5 and 3.0, the body shifts into a cleaner and more efficient way of making energy. In my practice, this shift alone can help stabilize blood sugar, reduce cravings, restore mental clarity, and bring the body back into balance.

There are certain groups, though, who may benefit from pushing ketones higher. I am talking about individuals living with mental health challenges, inflammatory bowel disorders, and autoimmune disease. These conditions often involve deeper issues in the mitochondria, immune system, and gut brain connection. This is where ketones start to act not only as fuel but as a signaling molecule with real biochemical influence.

Let me walk you through exactly why higher ketones matter for these groups, what the research shows, and how to approach this safely and strategically.

1. Mental Health ConditionsSupporting mood, cognition, and brain energy Many people who struggle with depression, anxiety, bipolar disorder, psychosis, or cognitive decline are actually dealing with a brain that has trouble using glucose efficiently. There can be some combination of mitochondrial dysfunction, brain insulin resistance, and chronic neuroinflammation. When this happens, the brain is starving for steady energy even when blood sugar appears normal.

Ketones bypass this bottleneck. They cross into the brain easily, provide a steady flow of ATP, calm inflammation, and rebalance neurotransmitters.

What the research showsClinical studies over the last several years have shown promising improvements in symptoms when individuals with serious mental health conditions maintain stable ketosis.

A 4 month pilot study in adults with schizophrenia or bipolar disorder found that participants who maintained ketosis had significant improvements in depression, psychosis scores, weight, waist circumference, triglycerides, and HbA1c. This was done while they remained on their prescribed psychiatric medications.

A Stanford pilot study in people with serious mental illness found similar results. The ketogenic diet produced greater improvements in psychiatric symptoms, metabolic health, and overall function compared to the standard diet.

A 2025 bipolar disorder pilot study showed that patients experienced better mood, less anxiety, more energy, and measurable improvements on brain imaging when they maintained ketosis.

A 2024 review reported that ketogenic diets produced modest yet meaningful improvements in depression, especially when ketone levels stayed in a measurable range.

A case report published in 2024 documented full remission of major depression and generalized anxiety within 7 to 12 weeks once the patient maintained therapeutic ketosis.

Why this matters - The pattern is clear. When the brain receives a clean and steady fuel source, mood stabilizes, anxiety softens, mental clarity returns, and the brain becomes more resilient. For many of these individuals, higher ketone ranges, usually between 1.5 and 3.0 and sometimes up to 4 or 5 under medical supervision, can create a therapeutic lift.

2. Inflammatory Bowel Disorders. Healing the gut and calming inflammation

Crohn’s. Ulcerative colitis. IBS. Diverticulitis. These conditions create a continuous cycle of inflammation, tissue injury, and immune activation. The gut lining becomes fragile. The microbiome shifts. Digestion becomes unpredictable.

Beta hydroxybutyrate, the primary ketone produced in nutritional ketosis, works directly on inflammatory pathways inside the gut. It quiets the NLRP3 inflammasome, which is one of the major drivers of intestinal inflammation. It also supports mitochondrial health in gut cells and helps strengthen the barrier lining.

What the research showsA 2024 case series followed ten patients with Crohn’s or ulcerative colitis using a carnivore ketogenic approach. Many achieved remission or major symptom improvement, including less pain, less bleeding, improved bowel habits, and better quality of life.

Another case report of a patient with severe Crohn’s showed complete symptom resolution and normalization of inflammatory markers within weeks on a strict paleolithic ketogenic protocol. The patient remained stable without medication.

Several mechanistic studies confirm that beta hydroxybutyrate blocks the NLRP3 inflammasome. This directly lowers inflammatory cytokines that drive intestinal injury.

Why this mattersIn clinical practice, when my clients with chronic GI issues maintain ketones between 1.5 and 3.0, I see the same pattern. Bloating settles. Bowel movements become consistent. Pain drops. The gut becomes quieter and more predictable.

The key is to approach this with a nutrient dense, gentle plan so the gut can heal without being overwhelmed.

3. Autoimmune Conditions - Supporting regulated immunity and lowering inflammatory drive

Autoimmune diseases such as multiple sclerosis, Hashimoto’s, rheumatoid arthritis, psoriasis, and psoriatic arthritis all involve an overactive immune response and chronic inflammation.

Ketones help regulate this response. They calm inflammatory signaling, support mitochondrial health in immune cells, and reduce oxidative stress. They also improve metabolic function, which matters because insulin resistance and visceral fat strongly amplify autoimmune activity.

What the research shows - Multiple sclerosisA six month trial in sixty five patients with relapsing MS showed that a ketogenic style diet significantly improved fatigue, depression, neurological disability scores, and inflammatory markers.

A randomized pilot trial in MS found that both a ketogenic diet and a Paleolithic elimination diet improved quality of life compared with a conventional diet. This shows that dietary interventions can meaningfully influence disease experience.

Animal models of MS have demonstrated that a ketogenic diet reduces microglial inflammation, improves demyelination, preserves neurons, and improves clinical symptoms.

Rheumatoid and psoriatic arthritisA 2023 study used medium chain triglycerides to induce ketosis in rheumatoid arthritis patients. Higher ketone availability reduced disease activity scores.

A very low calorie ketogenic diet in individuals with psoriatic arthritis produced weight loss, lower inflammation, and improved joint symptoms.

Why this matters - Autoimmune conditions respond well when inflammation drops and mitochondrial health improves. For many clients, maintaining ketones between 1.5 and 3.0 is enough to soften pain, improve energy, reduce flare intensity, and restore function.

How to approach higher ketones safelyMost people do well with ketones in the 0.5 to 3.0 range. For individuals with mental health symptoms, gut disorders, or autoimmune disease, a target of 1.5 to 5.0 may be therapeutic. A few things matter here.

Medications People taking SGLT2 inhibitors need careful medical supervision because these medications increase the risk of ketoacidosis.

Individual variabilityAge, metabolism, activity level, gut health, and hormonal status all influence how someone responds to ketosis.

SupervisionAnyone attempting to raise ketones into a therapeutic range should work with a clinician who understands ketogenic therapies, labs, electrolytes, and how to monitor symptoms.

The takeaway - Nutritional ketosis is a powerful tool. For many people, it restores energy, stabilizes hunger, and improves metabolic health. For those navigating mental health challenges, inflammatory bowel disorders, or autoimmune disease, higher ketones can open another level of healing.

It is about giving the brain, gut, and immune system a fuel source that helps them repair and function more clearly.

And if you’re someone who struggles with reactive hypoglycemia or sudden drops in blood sugar, we address that first. Your body can’t repair, calm inflammation, or move into a healing state of ketosis until your glucose is steady and your system feels safe. Once that foundation is in place, therapeutic ketones become a powerful tool for restoring clarity, energy, and long-term metabolic resilience.