Overview
The investigators aim to examine the effect of the ketogenic diet on brain activity, metabolism, and emotions in adults with Bipolar Disorder (BD).
Description
The investigators hypothesize that a ketogenic diet will enhance levels of the ketone body β-Hydroxybutyrate (beta OHB), resulting in reduced mania/hypomania severity and predisposition to mania/hypomania in individuals with BD. To test this hypothesis in depth, the investigators will use a novel, multidisciplinary mechanistic study using multimodal neuroimaging, peripheral markers of mitochondrial metabolism, and participant-derived induced pluripotent stem cell (iPSC)-derived organoids.
Eligibility
Inclusion Criteria:
All participants:
- 18-40 years of age
- Not following a ketogenic diet
BD hypomanic group (n=30):
- Meeting sex proportion: 50% female
- Meeting diagnosis proportion: 50:50% Bipolar I: Bipolar II (BDI:II) (Diagnostic and Statistical Manual of Mental Disorders 5; DSM-5)
- Score greater than 10 on the Young Mania Rating Scale score(YMRS)
- BD medications will be allowed as in our previous studies: any combination of atypical antipsychotics, lithium, antidepressants, anxiolytics (common in BD)
BD euthymic group (n=30):
- Meeting sex proportion: 50% female
- Meeting diagnosis proportion: 50:50% BDI:II (DSM-5)
- Score less than or equal to 10 on YMRS
- BD medications will be allowed as in our previous studies: any combination of atypical antipsychotics, lithium, antidepressants, anxiolytics (common in BD)
Healthy Control (HC) Group (n=30):
- Sex matched with BD groups
- No psychiatric history
Exclusion Criteria:
All participants:
- Not between 18-40 years of age
- History of head injury, neurological, pervasive developmental disorder (e.g. autism), systemic medical disease and treatment (medical records, participant report)
- Mini-Mental State Examination score (cognitive state) \<24
- Premorbid National Adult Reading Test Intelligent Quotient (NAART IQ) estimate\<85
- Visual disturbance: \<20/40 Snellen visual acuity
- History of alcohol/substance use disorder (SUD; all substances, including nicotine), and/or illicit substance use (except cannabis) over the last 6 months (SCID-5). Note: lifetime/present cannabis use (at non-abuse (\<3 times in the past month) and non SUD levels) will be allowed, given its common usage in BD and young adults. Cannabis SUD over the last 6 months will not be allowed. Urine tests on scan days will exclude current illicit substance use (except cannabis). Salivary alcohol tests on scan days will exclude intoxicated individuals
- MRI exclusion: metallic objects, e.g., surgical implants; claustrophobia; positive pregnancy test for females or self-report pregnancy
- Unable to understand English
- Conditions related to the pancreas, liver, thyroid or gallbladder.
- Taking anticoagulants and/or those with blood dyscrasias (illnesses) who have coagulation disorders (eg, hemophilia) because of the ketomojo finger stick blood tests
- Scoring 3 or higher on positive symptom factor questions on the Positive and Negative Syndrome Scale (PANSS) questionnaire (indicative of psychotic symptoms)
- Currently following a ketogenic diet
- Head circumference larger than 24 inches (62cm) and/or chest circumference larger than 55 inches (139 cm)
BD hypomanic group:
- Must be meeting sex proportions: not 50% female
- Must be meeting diagnosis proportions: not 50:50% BDI:II (DSM-5)
- Diagnosis of BD in a manic or euthymic episode
- Score 10 or lower on the Young Mania Rating Scale score(YMRS)
- Using psychotropic medications other than those allowed in inclusion criteria
- Does not have a smartphone with a) iOS version 12.0 or above, or b) Android version 8 and later to use with the Keto-Mojo app
BD euthymic group:
- Not meeting sex proportion: not 50% female
- Not meeting diagnosis proportion: not 50:50% BDI:II
- Diagnosis of BD in a depressive, hypomanic, or manic episode
- Score greater than 10 on YMRS
- Using psychotropic medications other than those allowed in inclusion criteria
- Does not have a smartphone with a) iOS version 12.0 or above, or b) Android version 8 and later to use with the Keto-Mojo app
Healthy Control (HC) Group
- Not sex-matched with BD groups
- Has psychiatric history
