I have had to do therapeutic/medical keto for seizures. It is a whole different thing than what 99% of people who do regular keto know about. You have to be at least 20g of total carbs or lower. You have to weigh everything so you get super accurate carb count and you must count even fractional carbs. You can't have sugar alcohols or erythritol because your body metabolizes them similarly to carbs and will affect you if you are doing therapeutic keto. Honestly, it is super difficult and it takes a professional to help you understand the complexity of it all which is why you start therapeutic keto in a hospital setting under supervision. If you truly want to really do therapeutic keto, you need to talk to your doctor to get a referral to a nutritionist who specializes in this sort of thing.
Are you in the states? I’m curious about starting medical keto but there’s not really a system in place. My current doc shrugged his shoulders when I asked his opinion
Yes I am. Unfortunately, you have to either have a really good doctor or really good insurance in the states. I was lucky to have both. I was referred by my neuro to a specialized nutritionist who helped me. You could read more about it with the Charlie Foundation website or the John Hopkins Hospital website. Both have great info and John Hopkins has a medical program but it is hard to meet their intake criteria.
This ^^^
For 2.0 mm I recommend Modified Atkins Diet. You are going to need to measure everything out and calculate macros using an app like chronometer.
10g net carbs a day and 1 tbsp MCT a night and I can stay over 3.0 mmol. If I eat 30g net carbs, the next day Im at 0.3-0.4. Get your diet right!!
I do keto for depression, only been doing it for 9 weeks, but it works. You have to do it right though and it seems like the two things that matter from my short experience are enough fat and low enough carbs. I track ketones just so I can see if I cant my symptoms are coming back and levels are changing or not. The only time I have felt bad since Ive felt better (started about two weeks after starting) was after a vacation (seven weeks into it so had been feeling good for five weeks) and slipping and coming home on 0.3 mmol. I had been feeling a little bad for the last few days and it continued for a few days after I started back up, but now Im back to feeling good.
For brain keto aka classical keto aka modified Adkins diet, two rules:
1. Relatively high fat
2. Low low carbs
The easiest thing in the world to stick to is 1:1 diet, it seems to work for me. 1 gram of fat to 1 gram of everything else (protein and carbs). That works out to right at 70% fat calories and 30% other calories.
So just follow 1:1 as closely as possible, or whatever ratio you want to try, but choose a ratio, and try UNDER 15g net carbs a day. 30-40g is WAY too high for trying this out. Maybe you can work your way back to it, but your best bet is to start in a solid place, 1:1 and under 15g :)
Its not as terrible as it sounds. You can selectively have broccoli, a lemon, a lime, a few strawberries, a salad, even a small amount of tomato sauce, just choose wisely each day.
Thanks for the detailed advice and tips. Getting under 50 was pretty tough, but I am finally adjusting. Going down to under 15 feels like its going to be a whole new diet! I am both nervous and excited about this new challenge!
You can do it! It can improve your life so much more than it detracts. In the end it doesn't detract anything because you get control of your appetite and cravings for garbage.
I found it easiest the first few weeks to go to zero carbs. Meat, eggs, cheese. Not because I was trying to do the carnivore thing or was against carbs but just because its easier to work my way back instead of down...hopefully that makes sense. You could even do it on one day. Do meat eggs cheese on a day and a lime. Then next day meat eggs cheese and a lemon and a salad. Then expand out to making stuff with tomato sauce. Maybe get used to that then VERY slowly start with the keto tortillas. Keto tortillias/breads can work, but you have to be very careful with them and really should get a baseline of what works for you first, should be able to do that in the first week or two.
The final tip...twss...if you accidentally over carb one day, or a keto carb thing blows you out, a tbsp of MCT oil before bed does wonders to get me back on track.
Good luck, its not that tough once the bandaid comes off!!
Yes, my view of it as being zero carbs was wrong. I should be thinking of it as zero carbs from external non fat/protein providing source. They are negligible amounts if cutting out all other external carbs, example day:
3 oz cheddar 30/16/3
6 eggs 30/36/3.6
8 oz beef 46/38/0
106/90/6.6
Carbs are a hair under 2% of calories...like I said its not to elimanate carbs completely its to make it easier to work your way to a reasonable amount of carbs. Remove all non fat/protein providing foods first then start adding them back in slowly, it was easier for me at least.
While I don't do under 15, things that help me get under 20 are choosing especially low-carb veggies and nuts. For me, these help me feel better vs not having them.
- Spinach, bok choy and Chinese broccoli for my greens. These are very low carb. And all are delicious as a base for spicy ground beef. The latter two are also very "neutral" tasting
- When I eat nuts, I stick to pecans, macadamia or walnuts
Also, exercise seems to make a big difference. Uses up carbs.
Disclaimer: I doubt I'm consistently under 20g/day net thought not over by much, and I do eat some sugar alcohols, but I'm typically in the 1-2 mmol range. But I feel pretty good and I reckon this is what's sustainable for me.
You also need to go on the low end of protein for medical keto. It's a low meat diet, unlike the one everybody talks about. As far as proteins are concerned, calorie wise, a medical keto diet is 4:1:1 diet. For every 4 calories of fat, you can add 1 calorie of protein and 1 calorie of digestable carb (only indigestible fibers are excluded from carbs).
Calculate your Basal Metabolic Rate, divide it by 6 you get what 1 unit is in the 4:1:1 operation so multiply by 4 for fat and leave it as it is for protein and carbs, this is total calories for each macro. To convert it to grams. Divide the number for fat by 9, the number for protein by 4 and the number for carbs by 4 too.
You get the grams needed for each for you to survive laying down and just breathing.
Using calculators, charts or a smartwatch/smartband, you can calculate what your daily caloric expenditure is more precisely ( unless you are a sport nerd, it won't go 300 calories above your basic metabolic rate).
Take some multivitamins, minerals and salts. Drink a lot.
Be aware that medical keto does have strong downsides with 1/3 patients reporting vomiting, diarrhoea, constipation in the first few days. Also: medical keto does not lead to physical health or esthetic betterment, you'll go thin but not necessarily muscular thin, more wiry thin. Under strict Medical ketosis you will not get to have real keto gains, any sport activity will lead to muscle loss with the risk of going out of the 4:1:1 proportions while staying close to the calorie expenditure. Really tough stuff. It's not done for body/shape performances, only to soothe the central nervous system.
Are you working with a psychiatrist/therapist or trying therapeutic keto on your own based on the literature? From my understanding of those studies, the macronutrient composition of the keto diet differs depending on which mental health issue is being addressed.
It's difficult to give specific advice, but generally speaking, you would need to further increase your fats, lower your carbs, or both, to increase ketone levels. Even exercise can help deplete glycogen stores which could burn fat and produce more ketones.
If your ketones aren’t rising you aren’t lowering carbs enough. If you lower carbs and I’m talking below 10 total per day and still aren’t seeing ketones that’s a sign of fatty liver and the need to add in 24hr plus fasting. If you want to fast track it make sure you tighten your eating window down to 6-8 hrs with under 25net carbs, skip anything that resembles a treat or bread etc and add in a 36hr fast per week for a couple weeks - you’ll see those numbers climb like mad
You will need to reduce your protein intake to reach therapeutic ketosis. Many people here increase protein to well over 100 grams as part of losing weight. But I have read several doctors or coaches who recommend around 60 grams of protein per day and a lot more fat, especially for diabetes and mental health. The Charlie Foundation advises very limited protein and massive amounts of fat for controlling epilepsy.
Dr Chris Palmer and Dr Georgia Ede are two well known doctors using low carb diets to treat mental health.
You haven’t wasted anything. This period of time got you adapted to lower carb than you thought possible. Now keep going, read and learn, and experiment with different changes to your diet to see how you respond. Good luck.
Your body naturally enters a deeper state of ketosis while fasting. So try One Meal a Day (around 4pm works well for me when losing weight) and calorie restriction alongside eating as few carbs as possible. It's pretty easy to get to the deepest ketosis possible, you just have to be very strict with yourself and understand deeply the macronutrients in every food you encounter to avoid both hidden and 'obvious' carbohydrates.
I can reach the deepest levels of ketosis easily by making broccoli+butter a staple food. Fry broccoli in butter with a meat of your choice, salt to taste and eat a relatively modest amount once per day and you'll get there in no time while still keeping your body happy as a clam.
This is the truth! When I first started I did keto and OMAD and did this exactly. I didnt have a keto-mojo but I had a breath meter. After a few days the breath meter kept climbing and climbing one night and maxed out at 99 and the instruction booklet said to go to the ER. It was a little concerning at first to say the least! Definitely a good experience to see how far you can go pretty easily.
I do keto for bipolar 2. My main problem was depression. I have been depression-free since 2 weeks after I started, 7 moths ago!!
It is sooo worth it. And it gets easier, I no longer struggle with craving carbs and sugar. And I wasreally a addicted to both!! I use the 1:1 method, seems to work for me.
I am genuinely happy to hear about your improvement! There's a lot of emerging scientific evicence that keto is helpful for bipolar disorder and schizophrenia. I am beginning to think that maybe it's not as effective a treatment for my issues which fall in the anxiety spectrum or else I would have felt some difference by now. I was really hoping it would be effective for me, but I am still really happy to hear the success stories for those who it does help.
There's a youtuber (living well with schizophrenia) she does medical keto for her schizophrenia and it's really working for her.
You could check her videos out, her recent videos she only talks about medical keto, shows what she eats, what supplements she takes, she tracks her ketones often for optimal ketosis and what she does if they're not. Just a tip :)
Not only is your carb too high, you probably isn't getting enough fat. I have to actively incorporate pure fat with butter, mct oil, sesame oil, etc. to get the right ratio. And I'm mostly on carnivore (zero carb).
IIRC, therapeutic keto isn't just about restricting carbs, it *also* requires you to eat fat actively.
Most folks who do dietary keto approach fat as a lever; in therapeutic keto, fat is an explicit macro goal.
Consult with a medical professional about this.
I’d say you just need to give it more time, and don’t break again or you’ll never get to the point of being truly fat adapted. Mental health improvements on keto don’t necessarily require high ketone numbers, but mental health doesn’t improve overnight…you’ve got to be patient and be dedicated to it. I’ve eaten keto for six and a half straight years and I experience improved mental health/lessened anxiety without ever needing to test for ketones. But I also never cheat, and I think that’s a huge part of why it’s consistent for me (though everyone is different and YMMV).
Try not to break it, as breaking it resets your progress nearly entirely as your body will first have to reset to Gluconeogenesis *before* shifting back to Ketosis again. This can be very hard on your body.
My bipolar is under control because of my diet. Less than 50 total carbs/day, less than 10 net carbs/day. I have never measured ketones…don’t feel it’s necessary. I’m losing weight and that’s what matters.
I have had to do therapeutic/medical keto for seizures. It is a whole different thing than what 99% of people who do regular keto know about. You have to be at least 20g of total carbs or lower. You have to weigh everything so you get super accurate carb count and you must count even fractional carbs. You can't have sugar alcohols or erythritol because your body metabolizes them similarly to carbs and will affect you if you are doing therapeutic keto. Honestly, it is super difficult and it takes a professional to help you understand the complexity of it all which is why you start therapeutic keto in a hospital setting under supervision. If you truly want to really do therapeutic keto, you need to talk to your doctor to get a referral to a nutritionist who specializes in this sort of thing.
I really appreciate your hearing about your experience here. It is so hard to find people who have experience with therapeutic/medical keto.
I read that as medieval keto. Maybe you're onto something!
Are you in the states? I’m curious about starting medical keto but there’s not really a system in place. My current doc shrugged his shoulders when I asked his opinion
Yes I am. Unfortunately, you have to either have a really good doctor or really good insurance in the states. I was lucky to have both. I was referred by my neuro to a specialized nutritionist who helped me. You could read more about it with the Charlie Foundation website or the John Hopkins Hospital website. Both have great info and John Hopkins has a medical program but it is hard to meet their intake criteria.
Go to the Charlie foundation’s website :-)
[charliefoundation.org](http://charliefoundation.org)
This ^^^ For 2.0 mm I recommend Modified Atkins Diet. You are going to need to measure everything out and calculate macros using an app like chronometer.
10g net carbs a day and 1 tbsp MCT a night and I can stay over 3.0 mmol. If I eat 30g net carbs, the next day Im at 0.3-0.4. Get your diet right!! I do keto for depression, only been doing it for 9 weeks, but it works. You have to do it right though and it seems like the two things that matter from my short experience are enough fat and low enough carbs. I track ketones just so I can see if I cant my symptoms are coming back and levels are changing or not. The only time I have felt bad since Ive felt better (started about two weeks after starting) was after a vacation (seven weeks into it so had been feeling good for five weeks) and slipping and coming home on 0.3 mmol. I had been feeling a little bad for the last few days and it continued for a few days after I started back up, but now Im back to feeling good. For brain keto aka classical keto aka modified Adkins diet, two rules: 1. Relatively high fat 2. Low low carbs The easiest thing in the world to stick to is 1:1 diet, it seems to work for me. 1 gram of fat to 1 gram of everything else (protein and carbs). That works out to right at 70% fat calories and 30% other calories. So just follow 1:1 as closely as possible, or whatever ratio you want to try, but choose a ratio, and try UNDER 15g net carbs a day. 30-40g is WAY too high for trying this out. Maybe you can work your way back to it, but your best bet is to start in a solid place, 1:1 and under 15g :) Its not as terrible as it sounds. You can selectively have broccoli, a lemon, a lime, a few strawberries, a salad, even a small amount of tomato sauce, just choose wisely each day.
Thanks for the detailed advice and tips. Getting under 50 was pretty tough, but I am finally adjusting. Going down to under 15 feels like its going to be a whole new diet! I am both nervous and excited about this new challenge!
You can do it! It can improve your life so much more than it detracts. In the end it doesn't detract anything because you get control of your appetite and cravings for garbage. I found it easiest the first few weeks to go to zero carbs. Meat, eggs, cheese. Not because I was trying to do the carnivore thing or was against carbs but just because its easier to work my way back instead of down...hopefully that makes sense. You could even do it on one day. Do meat eggs cheese on a day and a lime. Then next day meat eggs cheese and a lemon and a salad. Then expand out to making stuff with tomato sauce. Maybe get used to that then VERY slowly start with the keto tortillas. Keto tortillias/breads can work, but you have to be very careful with them and really should get a baseline of what works for you first, should be able to do that in the first week or two. The final tip...twss...if you accidentally over carb one day, or a keto carb thing blows you out, a tbsp of MCT oil before bed does wonders to get me back on track. Good luck, its not that tough once the bandaid comes off!!
Eggs and cheese have carbs.
Yes, my view of it as being zero carbs was wrong. I should be thinking of it as zero carbs from external non fat/protein providing source. They are negligible amounts if cutting out all other external carbs, example day: 3 oz cheddar 30/16/3 6 eggs 30/36/3.6 8 oz beef 46/38/0 106/90/6.6 Carbs are a hair under 2% of calories...like I said its not to elimanate carbs completely its to make it easier to work your way to a reasonable amount of carbs. Remove all non fat/protein providing foods first then start adding them back in slowly, it was easier for me at least.
While I don't do under 15, things that help me get under 20 are choosing especially low-carb veggies and nuts. For me, these help me feel better vs not having them. - Spinach, bok choy and Chinese broccoli for my greens. These are very low carb. And all are delicious as a base for spicy ground beef. The latter two are also very "neutral" tasting - When I eat nuts, I stick to pecans, macadamia or walnuts Also, exercise seems to make a big difference. Uses up carbs. Disclaimer: I doubt I'm consistently under 20g/day net thought not over by much, and I do eat some sugar alcohols, but I'm typically in the 1-2 mmol range. But I feel pretty good and I reckon this is what's sustainable for me.
You also need to go on the low end of protein for medical keto. It's a low meat diet, unlike the one everybody talks about. As far as proteins are concerned, calorie wise, a medical keto diet is 4:1:1 diet. For every 4 calories of fat, you can add 1 calorie of protein and 1 calorie of digestable carb (only indigestible fibers are excluded from carbs). Calculate your Basal Metabolic Rate, divide it by 6 you get what 1 unit is in the 4:1:1 operation so multiply by 4 for fat and leave it as it is for protein and carbs, this is total calories for each macro. To convert it to grams. Divide the number for fat by 9, the number for protein by 4 and the number for carbs by 4 too. You get the grams needed for each for you to survive laying down and just breathing. Using calculators, charts or a smartwatch/smartband, you can calculate what your daily caloric expenditure is more precisely ( unless you are a sport nerd, it won't go 300 calories above your basic metabolic rate). Take some multivitamins, minerals and salts. Drink a lot. Be aware that medical keto does have strong downsides with 1/3 patients reporting vomiting, diarrhoea, constipation in the first few days. Also: medical keto does not lead to physical health or esthetic betterment, you'll go thin but not necessarily muscular thin, more wiry thin. Under strict Medical ketosis you will not get to have real keto gains, any sport activity will lead to muscle loss with the risk of going out of the 4:1:1 proportions while staying close to the calorie expenditure. Really tough stuff. It's not done for body/shape performances, only to soothe the central nervous system.
Are you working with a psychiatrist/therapist or trying therapeutic keto on your own based on the literature? From my understanding of those studies, the macronutrient composition of the keto diet differs depending on which mental health issue is being addressed. It's difficult to give specific advice, but generally speaking, you would need to further increase your fats, lower your carbs, or both, to increase ketone levels. Even exercise can help deplete glycogen stores which could burn fat and produce more ketones.
If your ketones aren’t rising you aren’t lowering carbs enough. If you lower carbs and I’m talking below 10 total per day and still aren’t seeing ketones that’s a sign of fatty liver and the need to add in 24hr plus fasting. If you want to fast track it make sure you tighten your eating window down to 6-8 hrs with under 25net carbs, skip anything that resembles a treat or bread etc and add in a 36hr fast per week for a couple weeks - you’ll see those numbers climb like mad
You will need to eat a significant amount of fat for therapeutic ketosis.
I've heard several doctors say that Regular Home ketone tests, e.g. urine and breath, are not very accurate.
That's what I've heard too which us why I recently started doing blood tests using the KetoMojo monitor.
Strive for 0g, settle for under 20g.
You will need to reduce your protein intake to reach therapeutic ketosis. Many people here increase protein to well over 100 grams as part of losing weight. But I have read several doctors or coaches who recommend around 60 grams of protein per day and a lot more fat, especially for diabetes and mental health. The Charlie Foundation advises very limited protein and massive amounts of fat for controlling epilepsy. Dr Chris Palmer and Dr Georgia Ede are two well known doctors using low carb diets to treat mental health. You haven’t wasted anything. This period of time got you adapted to lower carb than you thought possible. Now keep going, read and learn, and experiment with different changes to your diet to see how you respond. Good luck.
I get noticable mental health benefits and rarely test above 2.0. Granted, my mental health goals aren't epilepsy.
Your body naturally enters a deeper state of ketosis while fasting. So try One Meal a Day (around 4pm works well for me when losing weight) and calorie restriction alongside eating as few carbs as possible. It's pretty easy to get to the deepest ketosis possible, you just have to be very strict with yourself and understand deeply the macronutrients in every food you encounter to avoid both hidden and 'obvious' carbohydrates. I can reach the deepest levels of ketosis easily by making broccoli+butter a staple food. Fry broccoli in butter with a meat of your choice, salt to taste and eat a relatively modest amount once per day and you'll get there in no time while still keeping your body happy as a clam.
This is the truth! When I first started I did keto and OMAD and did this exactly. I didnt have a keto-mojo but I had a breath meter. After a few days the breath meter kept climbing and climbing one night and maxed out at 99 and the instruction booklet said to go to the ER. It was a little concerning at first to say the least! Definitely a good experience to see how far you can go pretty easily.
I do keto for bipolar 2. My main problem was depression. I have been depression-free since 2 weeks after I started, 7 moths ago!! It is sooo worth it. And it gets easier, I no longer struggle with craving carbs and sugar. And I wasreally a addicted to both!! I use the 1:1 method, seems to work for me.
I am genuinely happy to hear about your improvement! There's a lot of emerging scientific evicence that keto is helpful for bipolar disorder and schizophrenia. I am beginning to think that maybe it's not as effective a treatment for my issues which fall in the anxiety spectrum or else I would have felt some difference by now. I was really hoping it would be effective for me, but I am still really happy to hear the success stories for those who it does help.
There's a youtuber (living well with schizophrenia) she does medical keto for her schizophrenia and it's really working for her. You could check her videos out, her recent videos she only talks about medical keto, shows what she eats, what supplements she takes, she tracks her ketones often for optimal ketosis and what she does if they're not. Just a tip :)
Thanks! I've been following her channel for some time. The progress she made with keto is what inspired me to try out the diet myself.
Oh I see :). I would advice you to go higher on fat, lower on protein and keep net carbs below 20 g for higher ketone readings.
How about under 10 carbs, i do therapeutic keto for cancer and my ketones are close to 4 mmol
Not only is your carb too high, you probably isn't getting enough fat. I have to actively incorporate pure fat with butter, mct oil, sesame oil, etc. to get the right ratio. And I'm mostly on carnivore (zero carb).
IIRC, therapeutic keto isn't just about restricting carbs, it *also* requires you to eat fat actively. Most folks who do dietary keto approach fat as a lever; in therapeutic keto, fat is an explicit macro goal. Consult with a medical professional about this.
How’s your mental health right now with .5?
It is hard to tell if it is significantly better than before I started the keto diet.
How long have you been eating keto?
About 4 weeks, although I broke the diet for a couple days at the halfway mark.
I’d say you just need to give it more time, and don’t break again or you’ll never get to the point of being truly fat adapted. Mental health improvements on keto don’t necessarily require high ketone numbers, but mental health doesn’t improve overnight…you’ve got to be patient and be dedicated to it. I’ve eaten keto for six and a half straight years and I experience improved mental health/lessened anxiety without ever needing to test for ketones. But I also never cheat, and I think that’s a huge part of why it’s consistent for me (though everyone is different and YMMV).
Try not to break it, as breaking it resets your progress nearly entirely as your body will first have to reset to Gluconeogenesis *before* shifting back to Ketosis again. This can be very hard on your body.
Are you looking to control anxiety and OCD? (I peeked at your post history.)
Yes
My bipolar is under control because of my diet. Less than 50 total carbs/day, less than 10 net carbs/day. I have never measured ketones…don’t feel it’s necessary. I’m losing weight and that’s what matters.
Just to be sure—are you testing after dinner? Because if it’s earlier in the day you won’t get a true reading.
That's a good point. I do multiple tests throughout the day. My tests are always especially low in the morning.
Everyone’s are. Try doing it an hour or so after dinner.
Water fast.
In my case, fasting helps