A 2:1 Ketogenic Diet for Mental Health

People’s interest in following a ketogenic diet for improved mental health has significantly increased over the past year. Emerging evidence suggests that this diet may be helpful as an adjunct treatment, along with medication, for improving mental health symptoms of anxiety, depression, and some types of bipolar disorder. However, not everyone is prepared for the demands of adopting a diet that contains twice (2:1) or three times (3:1) the amount of fat compared to protein and carbohydrates combined.

Some people assume that a 2:1 therapeutic ketogenic diet is the same as the popularized “keto” diet used for weight loss and improved metabolic health. While there are similarities, the 2:1 diet is therapeutic in its design, and the popularized “keto diet” is used therapeutically to improve weight and metabolic health. You can read more about his here.

In a 2:1 therapeutic ketogenic diet, the amount of protein, carbs and fat are regulated at each meal so that ketone levels are consistent through the day. In the popularized “keto diet” the goal is to be in ketosis with little to no regard to the level of ketosis, or the relationship between glucose levels and ketone levels.

Different Types of Ketogenic Diets

As outlined in a previous article titled “Use of a Therapeutic Ketogenic Diet in Mental Health,” there are three basic types of therapeutic ketogenic diets; a Classic Ketogenic Diet that uses a 4:1 ratio of fat to protein plus carbs, a Modified Ketogenic Diet that uses a 3:1 ratio, and a Modified Atkins Diet that uses a 3:1 ratio.

There are anecdotal reports of individuals doing very well following a Modified Atkins Diet (2:1) under the supervision of their doctors, and very recently (June 3, 2023) a pre-print pilot study came out where this approach was successfully trialed in people with bipolar disorder [2].

This alternative approach is much less time consuming in terms of the amount of calculations and work need to design, so the benefit to the individual is that it is less costly. It enables people to get into ketosis under medical oversight to see if they feel, then in consultation with their doctors can decide if the improvements are sufficient to maintain their diet as is, or whether it may be worth seeing if a gradual increase in fat, and decrease in protein may work better.

Working with Your Doctor to Support Mental Health

As mentioned in the previous article, Dr. Palmer recommends that Psychiatrists first determine if trialing a ketogenic diet is appropriate for a specific patient. For people considering using a ketogenic diet as an adjunct treatment for mental health, the first place to start is by having this discussion with your doctor — especially if taking any medications for depression, anxiety disorder, or bipolar disorder or for metabolic conditions such as high blood pressure or to control blood sugar.

Dr. Palmer also recommends that doctors have their patients remain on their medication while trialing the diet for a period of three months, during which they are evaluated 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 deprescribe some medications. As I’ve said in many other articles, changing dosages of medication is not something people should 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 must realize that they are more reliant on the ketogenic diet to keep symptoms under control. Since the diet is therapeutic, taking “cheat days” may result in it taking several days to get back into ketosis — during which symptoms can dramatically reappear [1]. I do not recommend “cheat days” when following a ketogenic diet for therapeutic purposes.  While a 2:1 diet is much easier to maintain long term than a 3:1, consistently maintaining the correct ratio of fat to protein and carbohydrate is essential.

Dr. Palmer recommends the following two steps to doctors that want to use ketogenic diets with their patients [1]; 

  1. Find a licensed Dietitian knowledgeable in therapeutic ketogenic diets and partner with them. 

  2. Read the book “Ketogenic Therapies” by Dr. Eric Kossoff [3]

Dr. Eric Kossoff’s book, Ketogenic Diet Therapies for Epilepsy and Other Conditions is one that have referred to often over the last 5 years of designing therapeutic ketogenic diets for other conditions.

Steps to Getting Started

If you are thinking of adopting a ketogenic for improved mental health, then the first step is to reach out to your doctor.  To assist you in having this type of discussion, please feel free to download this letter

If your have already discussed this and your doctor is willing to oversee your health and medications while you adopt the diet, I can provide you with a Request for Medical Supervision Form. 

More Info

If you would like more information about having a therapeutic ketogenic diet designed for you, please visit the Services tab and scroll down to Therapeutic Diets. 

To your good health!



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  1. 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
  2. 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
  3. Kossoff, Eric & Turner, Zahava & Cervenka, Mackenzie & Barron, Bobbie. (2020). Ketogenic Diet Therapies For Epilepsy and Other Conditions. 10.1891/9780826149596.



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