A 2:1 Ketogenic Diet for Mental Health

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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. Exploring more manageable ratios, like the 2:1 ratio, may offer a sustainable path for those with other mental health conditions.

Different Types of Ketogenic Diets

As explained in a previous article, 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, a 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 is only 60-65% fat, may be useful for reducing symptoms of anxiety, depression, and bipolar disorder without psychosis, where the higher levels of ketones produced by stricter diets may not be required.

The advantages are that this approach is less time-consuming in terms of calculations and design. It also enables individuals to enter ketosis under medical oversight, then decide if improvements are sufficient to maintain the diet as is, or if gradually increasing fat might work better.

A Therapeutic Diet is Not a Standard “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. While they share similarities, a therapeutic ketogenic diet is very different. In a therapeutic version, the amount of protein, carbohydrates, and fat is carefully weighed at each meal to keep ketone levels steady. No weighing of food is typically required in a popularized “keto diet.”

Furthermore, 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

If you are thinking about trying a therapeutic ketogenic diet and you are taking medications for depression, anxiety, or bipolar disorder, the first step is to talk with your doctor. Harvard Psychiatrist Dr. Palmer recommends that patients remain on their medication while trialing a therapeutic ketogenic diet for three months [1]. Changing dosages of medication is not something people should ever do on their own.

Dr. Palmer makes an important point: with the gradual decrease in medications, people become more reliant on the diet to keep symptoms under control. Because the diet is therapeutic, “cheat days” are not an option. It can take several days to get back into ketosis after breaking the diet, during which time symptoms can dramatically reappear [1].

Steps to Getting Started

Learn about me and the types of therapeutic ketogenic diets that I design as adjunct therapy for mental health conditions, and which are implemented under a doctor’s oversight. View my Therapeutic Diet Services page.

If you are thinking of adopting a therapeutic ketogenic diet for improved mental health, discuss it with your doctor first. If your doctor is willing to oversee your health and medications while you adopt the diet, they can complete and return a Request for Medical Supervision Form to our office, available at the link directly above.

To your good health,

Joy

You can follow me on:

Twitter: https://twitter.com/jyerdile
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References

  1. Puder, D. (2022). Episode 163: Dr. Chris Palmer: Ketogenic Diet for Mental Health. Psychiatry & Psychotherapy Podcast. [https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/163-treating-mental-health-disorders-with-a-ketogenic-diet]
  2. Campbell, I. H., & Campbell, H. (2023). Ketogenic diet for bipolar disorder: A pilot study. medRxiv. [https://www.medrxiv.org/content/10.1101/2023.05.28.23290595v1]
  3. Kossoff, E. H., Turner, Z., Cervenka, M. C., & Barron, B. J. (2020). Ketogenic Diet Therapies for Epilepsy and Other Conditions: Seventh Edition. Springer Publishing Company. [https://www.springerpub.com/ketogenic-diet-therapies-for-epilepsy-and-other-conditions-9780826149589.html]
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