What if standard of care access is already there waiting for us, thanks to the epilepsy centers who have paved the way worldwide? Could expansion of services in epilepsy centers offering Ketogenic Therapy increase access for children and adults with mental illness wanting to use it as a treatment?

Hear me out, and then tell me your thoughts in the comments.

Introduction

Ketogenic Diet Therapy (KDT) is a high-fat, low-carbohydrate medical nutrition therapy used to treat drug-resistant epilepsy. Originally developed for pediatric epilepsy, it is now offered at specialized epilepsy centers around the world for both children and adults. How many of these centers, already manned by skilled ketogenic dietitians are there, anyways? Buckle up, because I am going to give you an idea of the global availability of KDT that is as of yet untapped for mental health populations.

We are going to use data from hospital directories, epilepsy/neurology societies, and KDT research networks to get an idea of how many current centers there are and to project what this could mean for individuals seeking the ketogenic diet as a treatment for mental illness.

And then we are going to have a real talk conversation about how these already skilled and existing centers might be the key to expanding access if these centers broadly applied their offerings to those with mental illness, given the truly unstoppable emergence of metabolic psychiatry.

Global Ketogenic Diet Therapy (KDT) Centers for Epilepsy

I don’t think you all understand how broad the international adoption of KDT for epilepsy has become over the last two decades, thanks in no small part to the Charlie Foundation and an army of determined and passionate epilepsy dietitians saving lives through their work.

How do I know this? Because I have been hanging with them for a few years when I attend Global Symposiums for Ketogenic Therapies, and because I belong to the International Neurological Ketogenic Society (INKS).

Worldwide Scale Already Exists

As of 2024, there are over 250 hospitals and clinics around the world offering ketogenic therapy for epilepsy. These centers are located in more than 75 countries across all continents. I do not exaggerate when I tell you the ketogenic diet is now available as a therapeutic option in most major epilepsy centers in the United states and in a majority of developed nations.

The National Association of Epilepsy Centers (NAEC) describes the ketogenic diet as a standard non-medication therapy offered at epilepsy centers in the U.S.

Too good to be true? Don’t take my word for it. For current, country-by-country listings of centers, the International League Against Epilepsy (ILAE) maintains an International Ketogenic Diet Centers directory that is regularly updated. You can also visit Charlie Foundation’s worldwide hospital directory.

Global Totals Are Impressive

Aggregating across regions, the current KDT landscape in the Epilepsy World is full of skilled KDT Dietitians waiting to enter the fray of Metabolic Psychiatry. Access to Ketogenic-Trained Dietitians who are relentless patient advocates through Epilepsy Centers has dramatically increased from the roughly 75 centers in 45 countries reported in the mid-2000s. Although we all know there are a multitude of children and adolescents with mental illness who could be helped with access to these centers, utilizing them for adults with mental illness may not even be a difficult accommodation for most. Because while KDT historically focused on pediatric epilepsy, many programs now also treat adults. Roughly one-third of epilepsy centers offering KDT now have an adult diet therapy program as well.

United States

Within the U.S., ketogenic therapy is now standard at comprehensive epilepsy centers. Since the diet’s resurgence in the 1990s (spurred by Johns Hopkins Hospital and the Charlie Foundation), virtually every state has a medical center that can initiate the ketogenic diet. Today many major pediatric neurology programs offer KDT, and many adult epilepsy clinics do as well.

International Distribution

Outside the U.S., KDT has become an option in a majority of countries with developed healthcare systems. In Europe, from the UK and France to Poland and Turkey, ketogenic clinics are widespread. For example, the UK’s National Health Service supports KDT at numerous hospitals (both pediatric and some adult centers). In Asia, countries such as China, South Korea, Japan, and India have established multiple KDT programs, often in large tertiary hospitals. Latin America has seen significant expansion recently! A 2023 Latin American survey found ketogenic therapy centers across Central and South America, totaling 98 centers region-wide. Middle Eastern countries (often categorized in the ILAE “Eastern Mediterranean” region) also participate; for instance, Turkey was among early adopters, and centers now operate in nations like Israel, Saudi Arabia, the UAE, and Iran through neurology departments in children’s hospitals. Australia and New Zealand have KDT programs concentrated in major cities (e.g. Sydney, Melbourne, Auckland). In Africa, uptake has been slower but documented programs do exist in South Africa and a few other countries, but many African nations still lack local ketogenic clinics. Globally, support organizations and networks (e.g. The Charlie Foundation, Matthew’s Friends in Europe, and the International Neurological Ketogenic Society) are helping to train clinicians and connect families with KDT services. This collaborative network has enabled KDT to be accessible in a diverse range of healthcare settings worldwide.

Global Epilepsy Centers Offering Ketogenic Diet Therapy

Region	Country	Centers
Europe	Portugal, Spain, Sweden, Switzerland, United Kingdom, and MANY more.	25 in Eastern Europe 94 in Western Europe
North America	Canada	11
North America	United States	133 U.S. programs listed across the fifty states plus D.C., on the Charlie Foundation Directory.
Central America & Caribbean	Costa Rica, Cuba, Dominican Republic, El Salvador, Honduras, West Indies, Mexico	12
South America	Argentina, Brazil, Chile, Columbia, Ecuador and Uruguay	Region total from this survey included at least 25 KDT centers
Middle East	United Arab Emirates, Saudi Arabia, Oman, Israel, Iran, Kuwait, and Egypt	15
Africa	Ghana, Kenya, Morocco, and South Africa	6
Asia	China, Hong Kong, India, Indonesia, Japan, Kazakhstan, Malaysia, Philippines, Mongolia, Singapore, South Korea, Sri Lanka, Taiwan, Thailand, and Vietnam.	39
Australasia	Australia, New Zealand	9

_{Please note: Totals in this table include Children’s Epilepsy Centers also, because children also receive mental health diagnoses that may benefit from Ketogenic Diet Therapy access!}

No Need to Reinvent Any Wheels

So why wouldn’t we work to utilize these amazing centers and their staff to bring the treatment to those with mental illness seeking KDT treatment?

When the use of ketogenic therapy in standard of care is broadened beyond epilepsy to include serious mental health conditions (such as depression, bipolar disorder, schizophrenia, etc.), the number of centers and countries offering these therapies would likely expand significantly. It’s not like standard of care needs to reinvent the wheel. It has already been offering ketogenic therapy through these epilepsy centers worldwide.

The research literature supports that many severe mental illnesses share underlying metabolic and neurobiological dysfunctions. This blog is full of that evidence. And there is also a mountain of evidence accumulating that ketogenic therapy can address those sharing metabolic and neurobiological dysfunctions in mental illness. And this is revolutionizing what we think may be possible in psychiatric recovery.

When KDT becomes an accepted standard of care treatment in psychiatry, many new clinics and programs could emerge globally, adding to the existing epilepsy-focused centers. But the early adopting epilepsy centers will already be benefitting from a steady stream of children and adults seeking the treatment. Them paving the way could facilitate adoption by more psychiatric departments, metabolic health clinics, and clinical training opportunities.

Why wouldn’t the projected number of centers double or triple worldwide once epilepsy centers and the ketogenic dieticians lead the way? Given the far larger patient population of metabolic and mood disorders compared to refractory epilepsy, demand could drive an even greater scale-up.

Ketogenic therapy could spread to additional countries that don’t yet have epilepsy diet centers. For example, some lower-resourced countries without epilepsy programs might establish metabolic therapy clinics if motivated by the burden of mental illness and most certainly if international guidelines and training support its adoption.

Dreaming Big? Or just the next most obvious step forward?

Perhaps, in an expanded-use scenario, North America and Europe would lead the way with most academic psychiatry centers in the US, Canada, and Europe. A natural jumping off place from successful utilization of epilepsy centers for metabolic psychiatry expansion.

It’s just a matter of time before Australia/New Zealand are running metabolic therapy programs, possibly directly out of academic centers but even out of epilepsy centers. Trials and organized initiatives are underway (e.g., James Cook University clinical trials).

Asia’s mental health sector (e.g. China, India) could rapidly integrate KDT given existing interest in diabetes/metabolic syndrome management. Plenty of epilepsy centers could integrate KDT for mental illness.

Middle Eastern countries with advanced healthcare (e.g. Israel, Gulf states) will begin fully utilizing their epilepsy centers and likely add KDT clinics through their academic hospitals dedicated to metabolic psychiatry.

Latin America in the field of epilepsy is truly epic. It could leverage the numerous existing 98 epilepsy centers and professionals as a base to service those with mental illness using KDT and introduce psychiatric metabolic therapy in major cities.

Africa could benefit from collaborative efforts (perhaps via NGOs or academic partnerships) and introduce pilot programs in more African countries as the research continues to publish compelling outcomes.

And who will be wildly instrumental in these implementations and therefore leading the charge?

It’s going to be those ketogenic epilepsy dietitians.

Mark my words.

Staunch advocates who believe you deserve to know all the ways you can feel better, just like I do.

They will broaden ketogenic therapy to mental illness in a way that has the potential to greatly increase access, possibly reaching two to three times as many centers and extending into virtually all world regions.

Conclusion

We are not waiting on permission or a brand new system. The scaffold already exists in epilepsy and we have an army of trained ketogenic dietitians, protocols, safety evidence, and real clinical results that is a strong and existing infrastructure. If psychiatry wants metabolic options, the fastest path is to open those same doors for depression, bipolar disorder, schizophrenia, and related conditions. Start with referral pathways into existing epilepsy programs, consider adding adult tracks where they are pediatric only, and run pragmatic clinical evaluations. Individuals and families would get increased access. Clinicians would have increased opportunities for training. Health systems would get outcomes they could be proud of and obviously hospitals with epilepsy centers serving a new population could lead to an expanded source of income. No reinvention required.

This is a call to move it forward. To play it forward. To bring in with open arms the droves of those suffering from mental illness that don’t yet have access. If you run an epilepsy center, widen your intake to include psychiatric referrals and publish your process. If you lead a psychiatry service, partner with your neurology colleagues and create a shared clinic inside their proven workflow. If you are a payer or policymaker, fund rapid pilots inside these established centers and tie reimbursement to measured outcomes. And if you are a patient or caregiver, ask for a referral now. Don’t just ask, bother them. Write letters to the center if they tell you no.

The bridge from epilepsy centers and caring ketogenic trained dietitians to those with need in mental illness was always inevitable. It is just time to talk about how to cross it.

Tell me where you want this to start, and where we should send the first email.

A note about terminology use in this article.

_{Ketogenic Diet Therapy (KDT) is the traditional and internationally recognized name. This is the terminology used in epilepsy treatment guidelines, clinical programs, and by organizations such as the International League Against Epilepsy (ILAE). It emphasizes that the therapy is dietary in nature, derived from food rather than pharmacology. This was an article written in reference to the Epilepsy World, so this term was used.}

_{Ketogenic Metabolic Therapy (KMT) is a more recent expansion of the term, mainly used in oncology, psychiatry, and broader metabolic health fields. Researchers and clinicians who use metabolic instead of diet are emphasizing that ketosis exerts systemic metabolic effects beyond nutrition. The shift in terminology is partly strategic because it keeps the focus on mechanisms (metabolic regulation, mitochondrial function) rather than just food composition.}

_{So when I write in a psychiatry, psychology or general metabolic health context, I use the term Ketogenic Metabolic Therapy because it is increasingly used and accepted. For this article with a neurology or epilepsy context, the standard term is Ketogenic Diet Therapy is used.}

References

Armeno, M., Kossoff, E. H., Guilhoto, L., & Caraballo, R. (2025). Survey of Latin American ketogenic diet centers: Challenges and success for “La Terapia Cetogénica.” Epileptic Disorders, 27(2), 228–234. https://doi.org/10.1002/epd2.20319

European Ketogenic Therapy Centres—Matthews Friends. (n.d.). Retrieved September 22, 2025, from https://www.matthewsfriends.org/medical-section/keto-centres/

Ketogenic diet. (2025). In Wikipedia. https://en.wikipedia.org/w/index.php?title=Ketogenic_diet&oldid=1309473187

Ketogenic Diet Centers in the United States | Epilepsy Foundation. (n.d.). Retrieved September 22, 2025, from https://www.epilepsy.com/stories/ketogenic-diet-centers-united-states

Ketogenic diets in low-resource settings: A snapshot from Zambia // International League Against Epilepsy. (n.d.-a). Retrieved September 22, 2025, from https://www.ilae.org/journals/epigraph/epigraph-vol-22-issue-5-fall-2020/ketogenic-diets-in-low-resource-settings-a-snapshot-from-zambia?

matthew. (n.d.). European Ketogenic Therapy Centres. Matthews Friends. Retrieved September 22, 2025, from https://www.matthewsfriends.org/medical-section/keto-centres/

Palmer, C. M. (2025). The ketogenic diet and metabolic treatments for neuropsychiatric disorders. BJPsych Open, 11(3), e94. https://doi.org/10.1192/bjo.2025.50

What are Epilepsy Centers and How can they Help? (n.d.). National Association of Epilepsy Centers. Retrieved September 22, 2025, from https://naec-epilepsy.org/what-are-epilepsy-centers-and-how-can-they-help