Introduction
In the last several years, there has been increased interest in the use of a ketogenic diet to support mental health; however, some types of therapeutic ketogenic diets used in mental health conditions, such as bipolar disorder with psychosis, and schizophrenia, can be challenging to follow because they involve eating two to three times more fat than the combined amount of protein and carbohydrates. For example, a Classic Ketogenic Diet (4:1) is 80% fat, and a Modified Ketogenic Diet (3:1) is 75% fat.
Different Types of Ketogenic Diets
As explained in a previous article called “Use of a Therapeutic Ketogenic Diet in Mental Health,” there are three main types of therapeutic ketogenic diets. The Classic Ketogenic Diet uses a 4:1 ratio of fat to protein plus carbohydrates, the Modified Ketogenic Diet uses a 3:1 ratio, and the Modified Atkins Diet uses a 2:1 ratio.
There have been anecdotal reports of individuals doing very well following a Modified Atkins Diet (2:1) under the supervision of their doctors, and recently, (June 3, 2023), a pre-print pilot study tested this diet in people with bipolar disorder and found it to be successful [2].
It is hoped that a Modified Atkins Diet, which has a 2:1 ratio and is only 60-65% fat, may be useful, along with medication, for reducing symptoms of anxiety, depression, and bipolar disorder without psychosis, where higher levels of ketones produced by 4:1 and 3:1 ketogenic diets may not be required.
The advantages are that this approach is less time-consuming in terms of the amount of calculations and work needed to design it. It also enables individuals to get into ketosis under medical oversight, then, in consultation with their doctors, decide if the improvements are sufficient to maintain their diet as is, or if gradually increasing fat and reducing protein might work better.
A 2:1 Therapeutic Diet is Not the Same as a “Keto Diet”
Some people mistakenly believe that a 2:1 therapeutic ketogenic diet is the same as the popular “keto” diet used for weight loss and improved metabolic health. While they have some similarities, a therapeutic ketogenic diet is very different.
In a therapeutic ketogenic diet, the amount of protein, carbohydrates, and fat is carefully weighed at each meal to keep ketone levels steady throughout the day. No weighing of food is required in the popularized “keto diet”.
Secondly, in a regular keto diet, the goal is simply to get into and stay in ketosis; however, in a therapeutic ketogenic diet, there is a need to monitor both glucose and ketone levels so that a specific therapeutic level called the Glucose to Ketone Index (GKI) is achieved.
Working with Your Doctor to Support Mental Health
If you are thinking about trying a therapeutic ketogenic diet to help support mental health and you are taking medications for depression, anxiety, or bipolar disorder, the first step is to talk with your doctor.
As outlined in the previous article, Harvard Psychiatrist Dr. Palmer recommends that doctors have their patients remain on their medication while trialling a therapeutic ketogenic diet for a period of three months, and be evaluated by their doctor during the stages of ketosis to see if there has been any significant change in symptoms [1]. If the doctor finds that the diet is helping, they may begin to gradually discontinue some medications. As stated in previous articles, changing dosages of medication is not something people should ever do on their own.
There is an important point that Dr. Palmer makes that should not be overlooked. With the gradual decrease in medications, people are more reliant on the ketogenic diet to keep symptoms under control. The ketogenic diet is therapeutic; therefore, taking “cheat days” is not an option. Dr. Palmer notes that it takes several days to get back into ketosis after breaking the diet, and during this time, symptoms can dramatically reappear [ [1].
Dr. Palmer recommends the following two steps to doctors who want to use ketogenic diets with their patients [1];
- Find a licensed Dietitian knowledgeable in therapeutic ketogenic diets and partner with them.
- Read the book “Ketogenic Therapies” by Dr. Eric Kossoff.
Dr. Eric Kossoff’s book, Ketogenic Diet Therapies for Epilepsy and Other Conditions, is one that I have referred to often in designing therapeutic ketogenic diets for different physical conditions.
Steps to Getting Started
If you are thinking of adopting a therapeutic ketogenic diet for improved mental health, then the first step is to reach out to your doctor and discuss it.
If your doctor is willing to oversee your health and medications while you adopt the diet, then the next step is to have them complete and return a Request for Medical Supervision Form by fax to our office.
More Info
Under the Services tab, you can learn about the 3:1 and 2:1 therapeutic ketogenic diets that I design, and where you will also find the corresponding Request for Medical Supervision Form.
To your good health!
Joy
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References
- Dr. David Puder, MD, Psychiatry Podcast, Episode 163, Dr. Chris Palmer: Ketogenic Diet for Mental Health, M=November 15, 2022, https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/163-treating-mental-health-disorders-with-a-ketogenic-diet
- Needham Nicole, Campbell Ian, Grossi Helen et al, Pilot Study of a Ketogenic Diet in Bipolar Disorder, June 3, 2023, doi.org/10.1101/2023.05.28.23290595, https://www.medrxiv.org/content/10.1101/2023.05.28.23290595v1
- Kossoff, Eric & Turner, Zahava & Cervenka, Mackenzie & Barron, Bobbie. (2020). Ketogenic Diet Therapies For Epilepsy and Other Conditions. 10.1891/9780826149596.
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