People with bipolar disorder are four to six times more likely to die prematurely compared to those without a psychiatric disorder. (In comparison, smokers are two to three times more likely to have a shortened lifespan.) There are several contributing factors, including things like metabolic dysfunction, as well consequences of lifestyle choices influenced by disease burden Science needs to urgently investigate these extremely poor outcomes in search of more effective interventions that will enhance quality of life for people with bipolar disorder. Emerging evidence and clinical experience indicate that ketogenic and metabolic therapies may have a central role in addressing this concerning trend.