Ketogenic Diet in the Treatment of PTSD in Germany: A Single-Arm Feasibility Study

Post-traumatic stress disorder (PTSD) is characterized by intrusive re-experiencing of traumatic events and clinically relevant impairments in mood and functioning. In Germany, PTSD affects a meaningful proportion of the general population and is particularly prevalent in refugee populations. Although trauma-focused psychotherapies are considered first-line treatments, many patients face access barriers and high dropout rates, and currently available pharmacological approaches show limited remission rates.

Emerging evidence suggests that PTSD is associated with trauma-related metabolic dysregulation, including inflammatory processes and mitochondrial impairments. Ketogenic therapy - most commonly implemented via a ketogenic diet (KD) - is a metabolic intervention with documented neuroprotective and anti-inflammatory properties and early evidence of benefit across several psychiatric conditions. Given the overlap between proposed KD mechanisms and PTSD pathophysiology, evaluating KD as a potential intervention for PTSD is a promising and novel research direction. However, prospective feasibility data in German PTSD cohorts are currently lacking, which justifies a human pilot trial under real-world clinical conditions.

This study is a 12-week, single-arm, open-label feasibility trial in six adults with verified PTSD living in Germany. The primary objective is to evaluate feasibility with respect to recruitment, adherence to ketosis, completion of study assessments, and retention. Secondary objectives assess participant-reported feasibility. Exploratory objectives include changes in PTSD symptoms and general mental health, associations between daily capillary β-hydroxybutyrate (BHB) levels and daily symptom severity, identification of barriers and facilitators relevant to future trials, and descriptive changes in metabolic, inflammatory, and mitochondrial markers. Participants will receive a medically supervised, individually tailored KD with structured dietary support. Adherence and symptom trajectories will be monitored via daily BHB measurements and brief daily self-reports.