People’s interest in following a ketogenic diet to see if it offers improvements in mental health is continuing to increase, but not everyone is prepared for what is involved in adopting a Modified Ketogenic Diet that contains 75% fat, and little protein. Based on emerging evidence and under the oversight of people’s doctors, I now offer clients the option of an alternative approach.
Different Types of Ketogenic Diets
As outlined in a previous article titled “Use of a Therapeutic Ketogenic Diet in Mental Health,” I outlined what a therapeutic ketogenic diet is, and the 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.
Therapeutic Ketogenic Diets for Mental Health
Since the release of Psychiatrist Dr. Chris Palmer’s book, Brain Energy in November last year, I have had quite a number of people either referred to me by their doctors, or approach me themselves to design a therapeutic ketogenic diet for them. These people knew what the different types of ketogenic diets were, and were quite set on beginning with a Modified Ketogenic Diet (3:1). As a result, they were fully prepared for how much their diet would change and were willing to trial the diet for three months, as is recommended. I have clients that started a therapeutic ketogenic diet at the beginning of the year and who are continuing to eat this way, as their doctors oversee their health and medication adjustments.
Like those who have come to me to design therapeutic ketogenic diets for seizure disorder or as adjunct treatment in glioblastoma (a form of brain cancer), these individuals wanted to do whatever it took to see if they could feel better. Since all of these people were doing this under the oversight of their physicians, my role was simply to design a diet for them to trial, with some food substitutions to keep it interesting.
Another Type of Ketogenic Diet for Mental Health
Recently, I have had people approach me about wanting to adopt a ketogenic diet for mental health, yet feeling apprehensive about the significant change that would be involved with adopting a Modified Ketogenic Diet (3:1). They wanted something that was easier to adopt and something that they would be more likely to be able to sustain, long term.
I had read some 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 .
As a result, I now offer a 2:1 ketogenic diet approach to those working with their doctors who don’t feel they could maintain a 3:1 ketogenic diet (75% fat, with carbohydrate and protein equaling 25% altogether), but who want to try a ketogenic diet to see if they feel better.
This alternative approach is much less time consuming in terms of the amount of calculations and work I need to do, so the benefit to the individual is that it is less costly. It enables people to get into ketosis and see if they feel any better. Then, in consultation with their doctors they can decide if the improvements are sufficient to maintain their diet as it 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 . 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 . 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 ;
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 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.
1. Have your doctor determine if a ketogenic diet might be appropriate for you.
2. If your doctor agrees, then you can ask if they are already working with a Dietitian who is familiar with designing these types of specialized diets, or (if you are in Canada) you can reach out to me.
3. Be aware that you will remain on your medication while trialing a ketogenic diet for several months, and during this time you will be under your doctor’s supervision.
5. If after a period of time your doctor thinks that you might do better adjusting the diet more towards a Modified Ketogenic Diet (3:1), they might recommend that.
6. If you are doing well and your doctor is assured you will remain on the diet without taking breaks, he or she may consider gradually deprescribing some medications.
If you would like more information about having a therapeutic ketogenic diet designed for you, please send me a note using the Contact Me form at the top of this page.
To your good health!
You can follow me on:
- 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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