Bipolar Disorder and Diet Part II: Low Carbohydrate Diets

Bipolar Disorder and DietCan food stabilize mood?  Is there a diet out there that could prevent mania, mood swings, deep depressions, and uncomfortably anxious and agitated states? Sound far-fetched?  Maybe not. Dietary changes can have very powerful effects on brain chemistry.  Low carbohydrate diets, in particular, are fascinating.



Ketogenic Diets and Epilepsy

When most people think of low-carbohydrate diets, they think of weight loss.  But did you know that neurologists have been successfully treating severe cases of epilepsy with low-carbohydrate (“ketogenic”) diets for nearly 100 years?  Ketogenic diets are specially designed low-carbohydrate diets that typically contain between 60-80% fat, with the remainder consisting of roughly equal amounts of protein and carbohydrate.  In most cases, patients in clinical studies were hospitalized children whose seizures could not be controlled with anticonvulsant medications.  Yet, with diet alone :

  • Nearly all patients achieve more than a 50% reduction in seizures
  • with 33% experiencing a 90% reduction in seizures
  • and 10 to 15% achieving complete remission from seizures

What more powerful evidence could there be for the role of diet in brain chemistry?  Not only is this phenomenon remarkable in its own right, but it also has potentially powerful implications for the treatment of a wide variety of neurological disorders.

Ketogenic Diets Have Magical Healing Properties

All of the following conditions have been shown in animal models or in human studies to improve on a ketogenic diet:

  • Autism
  • Traumatic Brain Injury
  • Alzheimer’s Disease
  • Parkinson’s Disease
  • Brain Cancer
  • Diabetes
  • Prostate Cancer
  • Obesity
  • Chronic Pain/Inflammation
  • Multiple Sclerosis
  • Insomnia/Circadian Rhythm disorders

How Do Ketogenic Diets Work?

Nobody knows.  It is a subject of intense research, and there are many theories.  These diets restrict carbohydrate intake to 10-20 grams per day (the typical American diet contains at least 200 grams per day), and limit protein to just what’s needed, so that the body has no choice but to burn fat for energy.  Fat from the diet or from excess body fat gets broken down into three “ketone bodies” [“ketogenic” means that the diet generates ketones.]   These ketone bodies are:  acetone, acetoacetate, and beta-hydroxybutyrate.   Acetone leaves the body, but the other two compounds circulate in the blood and serve as fuel sources for our cells.

Ketogenic diets are very low in carbohydrate, therefore blood sugar and insulin levels are lower and much more stable than on standard “balanced” diets that are high in carbohydrate.  We do not know whether it is the presence of ketone bodies in the blood, or the stabilization of blood sugar levels, or the reduction in blood sugar and insulin levels, or some combination of these changes that is responsible for the therapeutic effects of the ketogenic diet.

What we do know is that epilepsy and other neurodegenerative diseases are all associated with “mitochondrial dysfunction”. Mitochondria are the miniature generators inside of our cells, so when they are not working properly, energy production is disrupted, and all cell activities can be affected as a result.  Studies consistently find that mitochondria produce more energy (ATP) more efficiently on ketogenic diets than on standard “balanced” diets which force cells to burn glucose (sugar) for energy.  Put simply, most of our cells work best when they burn fat instead of carbohydrate.

We also know that epilepsy and other neurodegenerative diseases are universally associated with inflammation.  Diets rich in sweets and refined starches that cause high, unstable blood sugar and insulin levels are well known for their ability to set the stage for inflammation throughout the body, therefore diets that are low in refined carbohydrates tend to quiet inflammation.

Bipolar Disorder and Diet

So, what does all of this have to do with bipolar disorder?  It is well-established that epilepsy and bipolar disorder share many biological features, including:

  • similar neurotransmitter imbalances (serotonin, norepinephrine, GABA, and glutamate)
  • alterations in sodium and calcium distribution
  • changes in chemical messenger activity

In fact, it just so happens that many of the mood stabilizing medications we psychiatrists prescribe for bipolar disorder are anticonvulsants that were originally designed to treat seizures—Depakote (Valproate), Lamictal (Lamotrigine) and Trileptal (Oxcarbazepine), to name a few.  The fact that epilepsy and bipolar disorder have so much in common begs the question of whether perhaps a low-carb diet could be useful for mood stabilization, as well.  Unfortunately, there has yet to be a single scientific study of ketogenic diets in bipolar disorder.  I have not yet had a patient in my practice who has been willing to try a strict ketogenic diet, which not only limits carbohydrate, but also limits protein and requires blood monitoring of ketone levels. However, I can tell you that my patients who have been willing to try low carbohydrate “modified Atkins” diets, low carbohydrate “Paleo” diets, or low glycemic index diets for mood problems–from depression to anxiety to eating disorders to bipolar disorders–report significant improvement in their symptoms. It stands to reason that these dietary changes, which have profound effects on other neurological disorders, would have the potential for profound effects on psychiatric disorders, as well.

Yet, even if a ketogenic diet worked beautifully for all cases of bipolar disorders of all types, I doubt that most people would choose to commit to a lifetime of eating a ketogenic diet.  These diets are very restrictive and require major lifestyle changes.  Most foods that people are accustomed to eating all day long are off-limits on this diet.  For this reason, neurologists have recently begun to experiment with more relaxed versions of the diet to see how much carbohydrate patients can get away with and still have good seizure control.  Studies of low glycemic index diets and modified Atkins diets (Atkins diets that allow unlimited protein and fat) look very promising but do not seem to work quite as well for seizures as ketogenic diets do.  However, bipolar mood disorders and seizures are different in that seizures are black and white phenomena, whereas mood swings are a matter of degree.  Perhaps people with bipolar mood disorders would be satisfied with less than perfect control over their mood swings in exchange for wider dietary variety?

If You Have a Bipolar Mood Disorder Should You Change Your Diet?

That’s up to you. While there are no scientific studies to support this idea yet, if you wait for the science to properly test the theory, you could be waiting for many years.  You have nothing to lose by doing your own individual experiments, because it is well established that low glycemic index diets, Atkins diets and ketogenic diets are safe.  In fact, it is likely that they are far healthier than the low-fat, high-carb, low-meat diets recommended by public health officials, which are the very same diets that have worsened our collective health over the past four decades. If you do decide to try a dietary change, just keep in mind that it can take 3 to 4 weeks before potential benefits become noticeable.

A few words of caution: 

Dietary changes are difficult to make, and benefits can be slow to take effect, therefore nutritional approaches are not recommended in emergency situations.

If you are currently taking a mood stabilizing medication, please do not make any changes to your medications without discussing it with your clinician.

Very low-carbohydrate diets can alter the way medications are processed by the body, so if you are taking medications of any kind (including blood pressure and diabetes medications), and decide to try a low-carbohydrate diet, please do so with close medical supervision.

*If you are taking Depakote (Valproate), please be aware that there is a case report in the literature of a man who became manic and psychotic after starting a ketogenic diet, despite taking Depakote.  The reason may have been that the diet reduced his Depakote levels (Depakote is a fatty acid, and the ketogenic diet is a fat-burning diet).

How About You?

Have you ever tried a low glycemic index diet or low carbohydrate diet?  If so, did you notice any effects on your mood?

To learn more about about how diet can impact bipolar disorder, read my blog post “Bipolar Disorder and Diet Part I: Omega 3 Fatty Acids.”

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Amann B and Grunze H.  Neurochemical underpinnings in bipolar disorder and epilepsy. Epilepsia 2005; 46 (suppl 4): 26-30.

Brownlee M.  Biochemistry and molecular cell biology of diabetic complications.  Nature 2001; 414: 813-820. 

Cross JH et al.  The ketogenic diet in childhood epilepsy:  where are we now? Arch Dis Child 2010;95:550-553.

El-Mallakh RS and Paskitti ME.  The ketogenic diet may have mood stabilizing properties.  Medical Hypotheses 2001; 57(6); 724-726

Junig JT and Lehrmann JA.  A psychotic episode associated with the Atkins Diet in a patient with bipolar disorder. Bipolar Disorders 2005: 7: 305–306

Keene DL.  A systematic review of the use of the ketogenic diet in childhood epilepsy.  2006 Ped Neurol 35:1-5.

Masino SA, Rho JM. Mechanisms of ketogenic diet action. In: Noebels JL, Avoli M, Rogawski MA, Olsen RW, Delgado-Escueta AV, editors.  Jasper’s Basic Mechanisms of the Epilepsies. 4th ed. Bethesda (MD): National Center for Biotechnology Information (US); 2012.

Miranda MJ et al.  Alternative diets to the classical ketogenic diet–can we be more liberal?  Epilepsy Research 2012;100(3):278-85.

Neal EG.  The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol 2008; 7:500-506.

Soczynska JK et al.  Mood disorders and obesity:  understanding inflammation as a pathophysiological nexus.  Neuromolecular Med 2011; 13(2): 93-116.

Stafstrom CE and Rho JM.  The ketogenic diet as a treatment paradigm for diverse neurological disorders. Frontiers in Pharmacology 2012; 3(59).


Please note that after 30 days, Dr. Ede may not personally respond to comments, however comments shall remain open to encourage community discussion.
  • Jane

    I have had a lifelong history of dysthymia. Despite various anti-depressants, I could never seem to feel better…until I went on a low-carb diet 2 years ago. Over a period of months, I started to notice I didn’t have that feeling of always having a cloud over me. It nojw feels like the “dark glasses” I had were taken off of me, and life just looks different now, even though not much in terms of life circumstances had changed in the mean time! I started a low-carb diet to improve my GERD but never expected to have less physical pain or depression!

  • Good morning, Jane, and thank you so much for sharing your story–we can all learn so much from one another. Your experience is an excellent example of an individual experiment that shines light on a connection between food and mood in a way that research studies cannot. Keep smiling!

  • Paul

    I am curious as to the effects of low carb diet. I would like to monitor the changes, what type of blood tests or lab tests do I need to take so I have a base line of now and how often do I need to redo test to track changes properly?

    • admin

      Hi Paul

      Great questions—and fabulous gongs!

      Ideally you’d want to have your doctor order some baseline blood tests: Hemoglobin A1C (an estimate of your average blood glucose level over the previous 3 mos), fasting blood glucose, fasting lipid profile (cholesterol & triglycerides), and a C-reactive protein (a marker of inflammation). Then have them all repeated 3 mos after changing your diet to see how they may have changed.

      It can also be very useful to monitor your blood sugar levels at home periodically, using a blood glucose meter (designed for people with diabetes). Many of us have abnormally high fasting (12 hours nothing but water) and “post-prandial” (1 hr after-meal) blood glucose levels due to diets too high in carbohydrate. Ideally, fasting blood glucose should run between the mid-60’s and high 80’s (mg/dl), and 1hr post-prandials should be less than 110—the closer to fasting levels, the better. Post-meal levels vary widely
      depending on your diet and your metabolism.

      There are 3 levels of carbohydrate restriction to choose from, depending on your goals and your preferences:

      1. Low glycemic index diet (please see my low glycemic index diet page). Least restrictive, but also less likely to be effective, especially if you want great results. This diet can smooth out the spikes in blood sugar and insulin but your cells burn mostly carbohydrate on this diet instead of fat.

      2. Low-carb “modified Atkins” diet. 0-50 grams of carb per day spread out over the course of the day. Many need to go below 30 grams to see best results. See also my low-carbohydrate diets page.

      3. Ketogenic Diet, aka Nutritional Ketosis. Theoretically, this is the diet that is most likely to produce the best results. Limits carbs just like modified Atkins, but also limits protein to your individual daily requirements (typically 0.6 to 1.0 grams per pound lean body weight—for more details see my protein page). Purists and those who need to use this diet for important medical reasons monitor their blood ketones in addition to blood glucose. Blood ketone meters are cheap but test strips are very expensive, so most people can’t afford to measure every day. There are meters that measure both ketones and glucose. I use a Precision Xtra® meter and order ketone strips from–the <–the> <–the> least expensive supplier I could find). Unfortunately there is no way yet to measure insulin levels at home.

      There are 2 excellent books about ketogenic diets: The Art and Science of Low Carbohydrate Living (Phinney and Volek) and The Rosedale Diet (Rosedale). There is also a terrific blog written by Jimmy Moore about his own experience with nutritional ketosis (he’s lost 50 pounds in 6 mos on a diet of 80% fat), complete with his daily glucose/ ketone measurements and lots of free information about how the diet works:

      Hope this helps!

    • GeorgiaEde

      Hi Paul

      Great questions—and fabulous gongs!

      Ideally you’d want to have your doctor order some baseline blood tests: Hemoglobin A1C (an estimate of your average blood glucose level over the previous 3 mos), fasting blood glucose, fasting lipid profile (cholesterol & triglycerides), and a C-reactive protein (a marker of inflammation). Then have them all repeated 3 mos after changing your diet to see how they may have changed.

      It can also be very useful to monitor your blood sugar levels at home periodically, using a blood glucose meter (designed for people with diabetes). Many of us have abnormally high fasting (12 hours nothing but water) and “post-prandial” (1 hr after-meal) blood glucose levels due to diets too high in carbohydrate. Ideally, fasting blood glucose should run between the mid-60’s and high 80’s (mg/dl), and 1hr post-prandials should be less than 110—the closer to fasting levels, the better. Post-meal levels vary widely
      depending on your diet and your metabolism.

      There are 3 levels of carbohydrate restriction to choose from, depending on your goals and your preferences:

      1. Low glycemic index diet (please see my low glycemic index diet page). Least restrictive, but also less likely to be effective, especially if you want great results. This diet can smooth out the spikes in blood sugar and insulin but your cells burn mostly carbohydrate on this diet instead of fat.

      2. Low-carb “modified Atkins” diet. 0-50 grams of carb per day spread out over the course of the day. Many need to go below 30 grams to see best results. See also my low-carbohydrate diets page.

      3. Ketogenic Diet, aka Nutritional Ketosis. Theoretically, this is the diet that is most likely to produce the best results. Limits carbs just like modified Atkins, but also limits protein to your individual daily requirements (typically 0.6 to 1.0 grams per pound lean body weight—for more details see my protein page). Purists and those who need to use this diet for important medical reasons monitor their blood ketones in addition to blood glucose. Blood ketone meters are cheap but test strips are very expensive, so most people can’t afford to measure every day. There are meters that measure both ketones and glucose. I use a Precision Xtra® meter and order ketone strips from–the least expensive supplier I could find). Unfortunately there is no way yet to measure insulin levels at home.

      There are 2 excellent books about ketogenic diets: The Art and Science of Low Carbohydrate Living (Phinney and Volek) and The Rosedale Diet (Rosedale). There is also a terrific blog written by Jimmy Moore about his own experience with nutritional ketosis (he’s lost 50 pounds in 6 mos on a diet of 80% fat), complete with his daily glucose/ ketone measurements and lots of free information about how the diet works:

      Hope this helps!

      • Hi Dr. Ede, If it turns out I have normal fasting and post-prandial blood glucose levels (even after eating lots of carbs and sugar for several days, and during the meal just prior) then will eating low-carb still benefit me if I am not in ketosis? I had a fasting level of 70-75 and post-prandial after exceedingly high carb+sugar meals of 80-87. I feel like this isn’t a very significant increase considering HOW much sugar I consumed. Does this mean I have fairly stable blood sugar, and if so, then can I only expect the therapeutic results you mention if I am actually producing ketones? I am confused over why my blood sugar did not spike, especially because I feel like I’m addicted to carbs!

        • Hi Elaine
          First of all, let me say that you are lucky to have such a resilient system. It appears as if you have excellent insulin sensitivity. What these values cannot tell you is what is happening to your insulin, leptin, and ketone levels after eating sugar. Everyone is different when it comes to carbohydrate tolerance. How you can best achieve the results you are looking for will depend on what you notice about your health and well-being when you eat sugar vs when you don’t. However, there is no question that eating sugar and other refined carbs is dangerous to most aspects of health over time. This is one of the very few things around which there is a broad consensus across otherwise opposing camps in the nutrition field.

          • Hi Dr. Ede, okay well I know I FEEL awful after I eat sugar so I should just take that as my cue. Thank you for your time in answering these questions!

  • Kelsey Meyers

    I have been on a low carb paleo/Weston price style diet (not strict) for 5 years and have not had a single depressive episode since adopting this way of life. I used to suffer from depression frequently on my low-fat, processed food diet.

    • Hello, Kelsey

      That’s wonderful! Thank you so much for sharing your story with us. I, too, changed my diet about 5 yrs ago to a low-carb Paleo diet, and my mood, anxiety level, and energy all completely normalized, too. Great minds think alike:) I had changed my diet for other reasons and was pleasantly surprised to see these other positive effects. I wonder if you had also originally changed your diet for some other reason?

  • Des

    Hello again Georgia,

    In your opinion, is the sweet potato the lesser evil when compared to the white potato in terms of sugar spikes? The Kitavans in Papua New Guinea eat more than half their calories from sweet potatoes, sweet fruits and honey and have great skin…:) I’m upset that, even though I’m Paleo, I can’t get away with potatoes skin-wise.

    • Hi Des

      Sweet potatoes and yams have a lower glycemic index (typically between 50 and 70) while white potatoes run between 70 and 110 (Russets are 110). Regarding the Kitavans, my theory about why they are able to tolerate a high carbohydrate diet when so many of us Westerners can’t, is that their carbohydrate processing system functions properly, whereas most of us have a system that has been damaged or completely broken by dietary factors–refined carbs? modern medications? food chemicals? The most important question for you is–if you eat sweet potatoes, do they aggravate acne?

  • Hi Dr. Ede,

    Just wondering if you count total carbs or net carbs? Thanks!

  • Hi Elaine

    It depends. Fiber doesn’t need to be counted, but some people can get into trouble with other carbs that supposedly have zero calories and therefore “have a negligible effect on blood sugar.” The sugar alcohols are one good example–some people experience significant blood sugar spikes after eating certain sugar alcohols. If you want to be on the very safe, conservative side, you would count all carbs except for fiber. If you want to know how various types of “non-carb carbs” affect you, you could test your blood sugar an hour after eating various things to be sure you’re not thwarting your efforts.See also Dr. Andreas Eenfeldt’s site for more information.

    • Interesting. So count the total carbs if you are consuming something with sugar alcohols, but you can do net carbs if you are eating veggies/something with fiber? And thank you for the idea to test out the non-carb carbs….I think I will try that, because I have been wondering which artificial sweeteners I could get away with. I was going to ask you if there were any you found to not be an issue, but I guess it will really be an individual thing and I can just test each one out for myself. Thank you for the website, too!

  • Hi Dr. Ede,

    I have great news. I have been doing a ketogenic
    diet since December 18th and have not had a migraine since! That makes
    it almost a full month 🙂 I have been eating a little bit of starch in
    the form of white rice, but am not eating any fructose at all. I am supplementing with branched chain amino acids and
    NAC, and taking lots of MCT Oil. I am going to experiment with cutting
    out the starch soon, but for now it’s working so I might as well enjoy
    it. Hopefully it will continue to work!

    The bad news is that I am
    still having headaches 2-3x week, so I wonder if it is because I am not
    as “ketogenic” as I could be, or if it is completely unrelated. They seem to occur most frequently towards the end of my work day, so it is probably environmental (strong scents/bright lights) but I would really love to figure out how I can desensitize myself to these headache triggers. I know you are not a headache specialist of course, but any thoughts? I’m really looking forward to being headache free soon! Oh and I have also been doing Julia Ross’s amino acid supplementation (I began it about 2 weeks before starting the ketogenic diet) and within days I was able to stop taking my stimulant regimen of Ritalin/Strattera. Pretty amazing stuff. We will see if these results will be long term, but for now at least I am happy about the combination of these two therapies!

    • Hi Elaine

      That IS wonderful news! I am curious to know if you are measuring ketones and how much carbohydrate you are eating per day, if you are comfortable sharing that? Also, are you getting enough calories? Sometimes headaches can be caused by hunger. I will be writing a blog article about migraines in the near future that will include a review of all of the migraine/food sensitivity literature, but for now: If you eventually experiment with removing the starch and that doesn’t help, you may need to do some vegetable and spice experiments. Nightshades, for example, can be associated with pain for some people. Other common migraine triggers include fermented foods, alcohol, caffeine, and artificial sweeteners. Thank you for keeping us posted about your great progress thus far! You may want to rest on your laurels a while before trying more changes. Also, since you are not getting headaches every day, you may be able to identify potential culprits by keeping a food/headache diary and looking for patterns, if you are not already doing so.

      • Hi Dr. Ede. Sorry for the delayed response. I had the same darn headaches all week (each one developing sometime mid-afternoon) and I finally pinpointed that it must have been a result of the “fat bombs” I was eating every morning and then again in the PM. The first one I ate wasn’t enough to trigger a headache, but the second one was, hence the PM headaches. (Each fat bomb has 1/2T Coconut Oil, 1/2T MCT Oil, 1/2 cup Shredded Coconut, and 1/2 teaspoon Xylitol. Such a tiny amount of Xylitol that I can’t believe that might be the culprit, but it’s either that, the coconut oil, or the coconut.) I had already ruled Coconut out as a trigger but I am revisiting it now! Yesterday I decided not to have a “fat bomb” in the morning, and lo and behold, no headache. I ate one later as a test, and developed a slight headache pretty quickly after, and to be sure I ate part of the next one, and the headache got much worse. I think in a few weeks I will retest each ingredient. The good news is, still no migraines 🙂

        To answer your questions, I am not measuring ketones, but am going by how I feel. The first time I went into ketosis I felt so “different” than usual that it is pretty easy for me to distinguish whether or not I am in it. However I of course don’t know HOW ketogenic I am, so I am going to measure myself soon just to get an idea. For carbs, I just checked my food journal and I am eating between 40-100 carbs a day, probably averaging at 70. And I am averaging about 1500-1600 calories/day. I haven’t had any sugar (including fruit) since the 1st which I am very proud of! Also I have a ton of energy and my sleep schedule is finally normal…I have even dropped the majority of the supplements I had been taking in order to sleep better/have more energy in the day. Anyway, all good updates for now! 🙂

        • Hi Elaine

          Thank you for posting your additional good news–and so interesting. Nuts are on the list of top food sensitivities, but many do not consider coconuts to be nuts. I consider them nuts…because that’s what they are…but so many people with nut allergies and sensitivities report no problems with coconut, that it appears to be a confusing topic. My own personal experience with coconut is that it bothers me in many of the same ways that nuts bother me, but everyone is different.

          Congratulations on your abstinence from sugar, as well! You have so much to be proud of, and most importantly, you are figuring out how to feel your best by doing these experiments, without medications. Very impressive! The only way to be sure it’s the coconut and not the xylitol, of course, is to test them individually, but given the amounts involved, I agree that it’s most likely the coconut. I’m so glad to hear you are feeling better.

          • Hi Dr. Ede, thank you! I have decided it is definitely coconut. I am curious whether you find you can tolerate any coconut products (milk, oil, aminos) or if you avoid all of it? I think I kind of knew coconut was a trigger for me but was in denial, because without it I have such a (even more!) limited diet. Since I can’t have the bars anymore I have been taking MCT oil straight out of the bottle, and this morning it actually made me pretty ill….without food it gives me cramps/diarrhea. Essentially I am currently struggling to get in the high amount of fat needed for this diet. Do you have any tips? As you know it is hard without dairy, seeds, nuts, and now coconuts. I also can’t have avocado. I can’t even have sausage or bacon because they give me headaches! What fat sources do you recommend focusing on? Am I going to have to start eating straight animal fat? 🙂

          • Oh and I forgot, I am curious what you think about this post, if you get a chance to read it :

          • Hi Elaine,

            I just read it over. Without truly studying their book and tracking down their references, I can’t vouch for the information they are presenting. However, I can say that it is not true that eating a zero carbohydrate diet is dangerous or causes lack of mucus secretion. The body has zero requirement for dietary carbohydrate. I really need to explore this MCT/coconut oil fad that is sweeping the ketogenic community. I am not convinced there is any health advantage to eating MCT’s that are simply going to be disposed of…just to raise ketone levels in the blood. Unfortunately I don’t have enough independent information yet to comment intelligently on this topic, but it is on my to-do list!

          • Okay thank you! Yeah the fact that they say “zero carb dangers” made me hesitant to really believe the rest of what they are saying. However I did feel pretty good doing their diet (it stopped my migraines) but I wasn’t losing weight like I wanted so I have cut out the starch for now and maybe I’ll go back to it once I’ve lost weight, if that doesn’t make me gain. I am really trying to not do too many changes at once, but it is so hard as I learn new information!

          • Hi Dr. Ede,
            It’s been 2 weeks since I have cut out starch and my ketone levels are still pretty low (average of 0.4) so I am reducing protein further and playing around with the fat level. I am happy I finally invested in the strips! Apparently I only need a tiny amount of ketones present in order to not have migraines, but I want to be in deeper ketosis for my mood, energy, and focus. Also hopefully it will help me lose weight, which has barely moved so far.

            My only qualm is that I am suddenly having much more difficulty with my sleep. When I was eating that small amount of starch each day, I was sleeping like a baby and was even off of all the supplements I had been taking (Melatonin, L-Tryptophan, Taurine). It felt like my internal clock had been reset, as I found myself getting tired at around 8-9pm and waking up naturally at 6 or 7. Now I am finding that I need the supplements again, not only to fall asleep, but to stay asleep, and circadian rhythm is off again. Any idea why this is, and if it is just a temporary thing?

            Also I am wondering if the bad breath issue will go away eventually? It’s negatively affecting my relationships with those around me 🙂 namely my boyfriend.

            Thanks! Elaine

          • Hi Elaine
            I think you will appreciate this weekend’s new blog post, which should be ready tonight or tomorrow morning–it will be focused on your excellent questions about ketogenic diets…

          • Hi Elaine

            I’m not yet convinced that high fat intake (80%) or MCT oil are necessary for a successful ketogenic diet. I personally have discovered that I need to limit fat in order to remain in ketosis (I’ll be writing more about ketogenic diets in the future). However, eating fat is important, and yes, I can completely identify with your dilemma. I am not able to tolerate any coconut products at all and have to eat a mostly-meat diet myself. I have difficulty with processed meats so eat mostly fresh meats. I just take care to choose fattier cuts, or eat chicken/duck with skin, and make broths that include natural animals fats and I seem to be fine. However, everyone is different. One natural animal food that is very high in fat is pork belly, which is delicious roasted, but does not agree with me, unfortunately. If you can tolerate that, you may enjoy it. For Christmas, my sister made homemade higher-fat sausages for me without the spices that tend to bother me. I cook with duck fat, which I buy at Savenor’s in Cambridge. Can you eat olives? That’s the only other fatty fruit I can think of that is readily available.

          • That is very interesting! And encouraging, because I would really enjoy not having to eat 80% fat. I do make lots of broth at least, and will continue with the fatty cuts of meat. The next food I test is actually going to be pork, because I suspect I have a slight reaction to it (fatigue, head pressure) so maybe when I test it next I will get some pork belly! Thank you so much for the suggestions. I have never actually tried an olive (despite liking olive oil), but that’s not a bad idea to try sometime. And I will check out Savenor’s!

    • lucias

      I understand that a lack of magnesium can cause headaches. Most people in the US are deficient in magnesium. Interestingly, I understand that calcium tightens are muscles while magnesium relaxes them. Hope that helps if you haven’t found help already.

  • Arthur Robey

    How does a ketogenic diet affect endorphin levels? Some people seem to have lost their depressions.

    Once I went for a run and my urine turned brick red and opaque. I had it tested and I was told it was high in ketones.
    This only happened once.

    I had had a bout of Bilharzia so I thought that my kidneys might have been bleeding, but this was not the case.

    • Hello, Arthur

      As far as I know, the antidepressant mechanism behind ketogenic diets is not well understood (I wrote about some aspects of it in my blogpost on bipolar disorder and ketogenic diets here: I just did a quick literature search and was unable to find any articles specifically about ketogenic diets and endorphins. Depression is a complicated condition associated with a number of neurotransmitters, and whether endorphins in particular are involved in the ways that ketogenic diets work, I don’t know. There are plenty of other possible mechanisms that could explain the relationship. What is wonderful is that it’s true–most people I know or about whom I’ve read in studies and anecdotal reports improve significantly improved mood and sense of well-being on low-carb and ketogenic diets.

      As for the red urine, the only possible connection I’m aware of between ketogenic diets and hematuria (blood in urine–I’m assuming that is what was responsible for the red color?) is kidney stones, which some people do develop on ketogenic diets (this is most likely due to the ingredients in the diet–I believe this uncommon side effect is easily avoided by changing the composition of the diet). Bilharzia is also sometimes associated with hematuria. Given that you only had one brief experience of hematuria, it’s hard to say. Were you eating a ketogenic diet at the time or some other special diet at the time?

  • Anne

    I was recently diagnosed with bipolar disorder – I have tried many variations of a low carb diet for over a year- and ketogenic diet- although there were some benifits- weight loss , decrease in cravings, stable mood, there were some definant downfalls – irritability-developing tics, becoming withdrawn, and limited energy to exercise. Also constiPation and lack of joy and happiness – just kind a blah- I probably need fewer carbs but ketogenic was not good for me- also effected my thyroid

    • Hi Anne

      How frustrating–and I share your frustration–if you want to see what happened to me when I tried a (rather extreme) version of a ketogenic diet myself, see blog post entitled “Ketosis Week 4.” I will likely try a more moderate version of the ketogenic diet soon, but for now just want to recover from that experiment. I am very curious about your experience, especially about the effect it had on your thyroid–did you have thyroid tests done that you would feel comfortable sharing? If so, please consider posting them as a comment on the Ketosis Week 4 article, where a number of us are trying to figure out why some people feel so lousy on ketogenic diets, and whether or not they have negative effects on the thyroid. I would also be curious to know what kinds of foods you ate during your diet.

      No worries if you choose not to share more; if not, just know that I understand that this diet is not for everyone, and may require troubleshooting and special modifications for some people in order to make it comfortable and successful.

  • Richard

    My wife has had a bi-polar issue for years, and reports that she feels much better on a low carb, high fat diet. She has told me that when she eats carbs now, in a moment of weakness, her head just spins and she feels very strange. From my perspective I can tell the difference in her behavior too.

    • Hi Richard
      Thank you very much for sharing this information with us here; it’s wonderful that your wife has discovered a diet that helps her! I have heard from a number of people with bipolar type mood disorders that their mood is much more stable on a low carbohydrate diet. While I do not have bipolar disorder, I did used to have some anxiety and occasional depression, and they both go away when I avoid carbohydrates. My mood feels nice and even when I eat this way.

      • Richard

        Well, sad to say, not long after I wrote the above post my wife committed suicide by shooting herself in the head. She had a terrible time with what we might call impulse control, she was bad tempered and emotional and violent. She did do “better” when she controlled her carb consumption, I think, but the other side of that coin is I wonder if people with “bipolar disorder “enjoy” the manic phase of the whole affair, and hate to give that up? Yes, they do not enjoy the depression part very much, and it might be fatal, but how much do they enjoy the “high” and the feelings they have when they are not depressed? It isn’t so much that the low carb approach does not work, but rather the individual’s sense of an objective. Do they want to be normal?

        • Dear Richard
          I just finished up a busy stretch at work and am logging back into my site today after a couple of months away. I’m so sorry to hear this tragic news. It is very common for people with bipolar disorder to enjoy the highs that can come along with the condition. Regardless, I am very sorry for your loss and hope that you have the support and comfort of family and friends at this difficult time.

          • Richard

            Thanks. Honestly, the more I deal with this the more complicated it gets. I guess people do enjoy the highs, and who can blame them. They also self-medicate, and apparently, in my wife’s case, with both alcohol and non-prescription (illegal) drugs. My sense is that such illegal drugs, taken as they usually are, are not only addictive, they seem to make people not reason very well, and lead to bad decisions and terrible outcomes.

          • Patrick

            Yes, the highs are great. I did a low carb diet while in high school to get rid of acne (which worked well), but I eventually stopped because life had become boring for me. I enjoyed the highs and lows. Especially once I reasoned that a paleodiet with low GI carbs was good enough, I stayed away from the low carb diet. A few addictions, swings, and bad life decisions late… and I went back on a low carb diet. I think with age (and thus growing self awareness), a change in values, getting used to a slower pace of life, and getting a few tries both ways to compare has allowed me to appreciate a stable mood far more than an exciting life. Afterall, if you’re choosing between two similar fruits at a market, you always look back and forth a few times right?

            Anyways. I’ve now think I’ve found a good medium. I follow a controlled carb diet (around 150g+ on heavy exercise days) so that I can follow my passion for dancing (impossible on low carb). However, when I notice myself slipping (addictions, anxiety, guilt, swings, etc…) I go back on a strict low carb diet for a bit to get a bearing back on my life. During this time I pick back up good habits that sometimes slowly get lost during a carb period (meditation, sleep schedules, etc…), and focus on the more technical aspects of dance. Once the habits start feeling automatic, I slowly reintroduce carbs. In this way, I see low carb as sort of a “reset”.

        • Lainey

          I have bipolar disorder I and YES I enjoy the mania or “highs” that I experience. Sometimes too much of a good thing isnt good, but I ride the “high” as long as I can as I know that the crash is coming.

        • CJP

          I am so sorry for the loss of your wife. 🙁

  • Motionpicture

    I have bipolar disorder and have recently started the paleo diet and plan on doing it for at least 30 days. I read on this page that someone taking depakote went into a manic phase when on a ketogenic diet; i however take lithium. Should I be concerned? I am doing the diet to be more healthy; I don’t want to compromise my health.


    • Hi Motionpicture

      I would not worry about that single case report. It’s true that dietary changes can affect mood, and there is no way to predict what will happen to someone’s mood when they make a major dietary change. However, a dramatic mood change in someone with bipolar disorder who embarks on a Paleo diet is very unlikely. Just pay attention to your mood, work closely with the clinician who prescribes the Lithium for you, and if you notice any significant shifts towards mania, depression, or anxiety, discuss it with your clinician, who may consider adjusting the dosage of Lithium to compensate for any new trends in your mood.

      Dramatic mood changes are more likely on low-carbohydrate diets because the chemical changes within the body on a low-carbohydrate diet are much more profound (and occur more rapidly) than on a Paleo diet–electrolyte and insulin levels can drop quickly, for example, which could affect Lithium levels. Unless you are eating a low-carb Paleo diet, you don’t need to worry about these things. The biggest internal change that I can think of when someone changes from a normal diet to a Paleo diet is the removal of gluten, which can result in improvement in mood in those who are gluten-sensitive. In some cases, people who take a mood stabilizer like Lithium may eventually find that they require a lower dosage, or even eventually be able to discontinue Lithium altogether if their mood disorder happened to be gluten-induced.

      Good luck with the diet and I hope it helps you feel better!

      • Motionpicture

        Thank you, Dr. Ede!

  • Jessica

    Dr. Ede,
    Your blog is fascinating! I’m a psychiatry resident and the first time I encountered ketogenic diets was when I was on an inpatient pediatric neurology rotation as an intern. A few of the epileptic children were on ketogenic diets. We had to make sure their medications had no carbohydrates in their formulations. Often parents would comment that their child had marked reduction in their child’s seizure frequency/severity on the ketogenic diet. It’s interesting to think about if this diet could be translated to help people with bipolar disease.

    • Dear Jessica

      My apologies for the long delay; I am happily returning to full engagement with my nutrition site after a nearly 2-year period of work-related obstacles. I am so pleased to know that there are future psychiatrists out there who are open to thinking about the role of food in brain chemistry. I am hopeful that the next generation of psychiatrists will be better equipped to help people using a variety of approaches, emphasizing care of the whole body. If you have not yet completed your residency, best of luck in the home stretch, and if you have, I wish you well with your clinical endeavors!

  • tanja stark

    Here we go with the Research !

    • Hi Tanja
      Good eye! I became aware of this study some time after I wrote this post and while it’s about bipolar type 2 and not type I, and it is only a couple of case reports, I did include it in my presentation at the Ancestral Health Symposium in August because it is the only evidence I am aware of. Thank you for posting the link for everyone!

  • Ketoman

    Keto is 65% fat 30%protein and 5% carbs. The main idea is no sugar and high GI carbs and low total net carb counts. Protein is for maintenance at .6-1.4 g per lb (depending on activity levels) of “lean” body mass. Fat would then be added to fill the rest of you daily macros requirements for caloric intake.

  • Giovanni Granatin

    Very thought-provoking article, thanks Dr. Ede. I also have Bipolar, type 2 in my case. Are there any contraindications of such diets with Lithium-Lamotrigine-Seroquel combinations or individually? Specifically with Lithium, can such diets cause any disruptions to lithium levels? Thanks in advance, and for a great website.

    • Hello, Giovanni

      Excellent questions, and I’m glad you like the website. I can’t think of any reason why a low-carb diet would be problematic for people who take Lamotrigine (Lamictal) or Quetiapine (Seroquel). However, Seroquel can disrupt normal carbohydrate metabolism, so it may be harder to get rid of carbohydrate cravings or harder to lose weight on a low-carb diet for those taking Seroquel.

      Lithium is another story, because low-carbohydrate diets change the way the body processes water and electolytes (salts), so lithium levels may change on a low-carbohydrate diet because it is a salt, and therefore blood levels should be monitored closely during the transition.

      • Giovanni Granatin

        Hello Dr. Ede,

        Many thanks for you reply!

        There’s a few things in your reply that i thought i’d ask you to clarify.

        Is it possible for Lithium levels to decrease, rather than increase on a low carb diet?

        Also, I’m experiencing some mood destabilisation (dysphoria, insomnia) which is occurring in the evenings when I notice hunger pangs after dinner. Can this be an outcome of not consuming enough carbs? (My only sources are vegetables bar potatoes, corn, sweet potatoes, some oats in the morning and buckwheat in the evenings).

        Much appreciated!

      • joatmops

        I have bipolar 1 and have been following the ketogenic diet rigidly for a month with no change whatsoever on the scales. I exercise daily and have put on 15 kg over the last 2.5yars since diagnosis. I am on a combination of 1000g sodium valproate and 100g sertraline daily and am convinced this is producing a barrier to ketosis. I have had the odd day of feeling g fantastic with boundless energy but distinct from mania, hence determined to get back to this state in an attempt to kick start my weight loss and feel less fatigued. What do you think and any suggestions???? Regards Jo

  • Hi Owen

    Thank you very much for sharing your experience here–sounds like you have made a big difference in your well-being by making these changes in your diet–congratulations!

  • PC

    Hi Dr Ede, I was wondering if you had been tested for SIBO or fructose intolerance? I know both can cause problems with vegetables and other gut problems. I’m beginning to wonder if I have this problem myself as I only seem to feel my best without many vegetables or carbs in my diet.

    • Hi PC

      I have not been tested for either of those things but I definitely feel my best when I avoid plant foods altogether.

      • PC

        Would you consider doing a post on these issues sometime in the future? I love your blog style and it’d be great to read your scientific taken on them 🙂

      • Michelle Abrahmz

        How do you avoid plant food altogether? No veggies at all? What do you do for vitamins?

        • Hello, Michelle

          It is possible to obtain all the vitamins we need from animal foods as long as we are including some organ meat (especially liver). For more information, you may want to see my article about meat nutrients:

  • Hi Lucias

    Yes, grass-fed organ meats are incredibly nutritious! I do eat liver and choose pastured animal liver whenever available.

  • Jolie

    Dr. Ede,
    I have Bipolar disorder and was stable on Lithium and Effexor for 6 years. I did a Very Low Calorie Diet thru the Center for Medical Weight Loss and experienced a Manic Episode. The diet was successful in helping me lose weight, but the mania resulted in a hospitalization and a change in my medication to Depakote and Seroquel. Also, the Lithium had shutdown my thyroid, and my thyroid began functioning again when the Lithium was discontinued. Until I figured this out, my thyroid medication caused a manic type reaction. I don’t know for sure if the VLCD caused my mania. But it does seem to be the only significant change to my lifestyle. The mania occurred after a bout with low potassium caused after 3 or 4 weeks on the diet. But before that, I enjoyed the diet and the weight loss. Now, about a year later, I am overweight again and would like to see the fast results again, but I am too scared to try it for it might be destabilizing.

  • Randy Oles

    I’ve been bipolar since they called it manic depressive. In fact I was
    so bad they prescribed me lithium and then haldol with varying results.
    Went mostly ketogenic about a year ago to lose weight and lo and behold,
    almost no mood swings at all any more, as well as no more heartburn,
    anxiety, insomnia, high blood pressure, etc. And yes I lost 40 lbs as
    well. I can testify that this works, and I for one will be mostly
    ketogenic for life. 🙂

    • Dave Tweed

      Hi Randy, which medications do you use?

      • Randy Oles

        None anymore. For me carb free means drug free. 🙂

    • Dear Randy

      My apologies for the long delay in responding to you. How wonderful to hear that you were able to find a diet that improved your mood as well as your overall health! I hope you are still doing well and I really appreciate your sharing your experience here so that others can benefit.

    • Helana Bosch Vd Walt

      Hi Randy, could you share at all how you tapered off your meds and when you found that you felt comfortable to do so, i.e. how long into keto?

      • Randy Oles

        Due to no medical insurance I went of my meds long before I went keto. Pretty much just self medicated with lots of alcohol. I can tell you that it was only a few weeks into going no carb that I noticed the lack of mood swings and anger outbursts. 2 Years in and still doing great. and I don’t drink much anymore either. 🙂

        • Dear Randy,

          Thank you so much for sharing your experience here. I wish more people would try low-carbohydrate diets to stabilize mood, even for a few weeks as an experiment, to see whether carbohydrates are driving their mood swings. Congratulations on your recovery and your commitment to eating a low-carbohydrate diet!

          • Evelyn Mackintosh

            Hi dr Ede
            I currently take 1500mg depakote and 10 mg cipralex per day. I have cut out sugar since 12th july 2015. I’ve been experiencing balance problems for over seven days. I have lost approx 15lbs since 12th july. Blood sugar and blood pressure have been checked by pharmacist and all is normal.

            I actually feel giddy and a bit like im on a boat most of the time. It’s not like vertigo (I’ve had labyrinthitis before and this is different)

            Im wondering whether an adjustment to the depakote dose would be beneficial but im fearful of relapse as I’ve experienced two psychotic episodes in the paast.

            I read your warning about depakote and the ketogenic diet. Im not following a strict ketoenic diet im eating low carb atkins diet.

            Could it be that i have too much depakote in my blood?

            Could it be a lack of magnesium or another mineral or salt?

          • Evelyn Mackintosh

            Ps i was diagnosed with bipolar disorder and started depakote 16 years ago age 20. I’m overweight but exercise regularly. Devided to lose weight because i was concerned about my increaee in weight over past four years and worried anout type 2 diabetes.

          • Dear Evelyn

            Great question. While I can’t diagnose the problem for you over the internet or give you official medical advice, what I can say is that it is very possible that the dizzy sensations you are experiencing are a sign that your Depakote dose may need to be reduced, just as you suspect.

            Vertigo and balance problems are very common when the dose is too high. Given that you have lost weight and that you have cut out sugar, your body composition, your metabolism, and your fluid/salt balance are now very different. Since you’ve been on Depakote a long time, I’m hoping that you have some previous Depakote levels on file with your doctor. Please make an appointment to see whomever prescribes the Depakote for you and request a new blood level. If the level is higher than it had been, your clinician will probably readily agree to a dose reduction.

            The tricky part is that, even if there’s been no change in the level, it may still be a good idea to lower the dose a little bit to see if the sensations improve, because your chemistry may simply require a lower dose now that your body has changed. With the supervision of your prescriber, perhaps a very slow decrease in the dose (no more than 250 mg reduction the first week) would be a good idea. It would be very unlikely for you to have a relapse with that small of a dose reduction, and it could give you valuable information. If the dizziness is due to excess Depakote, it should start to improve within about 5 days of reducing the dosage.

            Hope that helps!

  • Dawn

    I have bipolar and I take lamictal & Yaz. Yaz is a birth control pill. It is a progesterone blocker. These two have changed my life. I recently cut my carbs to below 50 a day. My fiance said its makes me act weird. Lol. I really like how I feel with the carbs gone. Just mellow. I can read a book, clean, listen. I don’t really mind cooking one meal for me and something different for my family. They feel kinda bad for me but I don’t feel bad for me. If I slip up, I feel gross. And I easily get back on the wagon bc I know it makes me feel clean and not hyper. I HATE HYPO anything!!! I DO NOT enjoy the “high”. To me if feels like I drank 5 pots of coffee and haven’t slept in 48hrs. Hope this helps.

    • Dear Dawn,

      My apologies for the long delay in responding to you. Thank you for sharing your story here–it’s a great example of how diet can have such powerful effects on brain chemistry. I can relate to your experience; many people in my life feel bad for me because of my food restrictions, but to me they are worth it, because I know how good I feel when I eat my special way. And like you, when I stray from my plan, I am reminded of why I am better off when I eat properly. Another point your story drives home is that some people do best with a combination of medication plus dietary changes–diet alone doesn’t work for everyone, and Lamictal is a medication I find very useful in my own clinical practice.

  • Jo Miller

    Your article on low carb high protein diet effect on Bipolar Disorder and depression is very interesting. I was diagnosed with bipolar disorder, type 2, two years ago after a first time manic episode at age 42. For the past two years I had constant problems with anxiety, and depression, especially early mornings. About two weeks ago I have started a low carb high protein diet and for about a week now I can feel a huge difference in my mental state. I do not feel anxious at all, very calm and focused. I sleep much better, I have much more energy during the day, do not experience tiredness etc, etc.

    • Dear Jo

      My apologies for the long delay in responding to you. Thank you for sharing your story here–it sounds like you had a wonderful start! I wonder how things have gone for you in the meantime.

      • Sean1978

        I felt the same way as Jo when I started and for a few months was getting really high and had a ton of energy, then the mood swings came in about a few months in and I hit very low. I would get terrible mood swings and the depression at times was just horrible on the very low carb diet.. It would be interesting to hear some follow ups on this because honestly days to a few weeks or even months is not enough indication long term as to which the diet will lead you. Sometimes you get a placebo effect because it is new and then a crash later because your body is lacking something. I know my Moods would get very very low after a few months on very low carb, never went Keto because I ate too much protein IMO but the very low carbs over time are a no no. I don’t handle carbs very well in high doses but I need some I found out, sweet potatoes or carrot Juice etc., just need some carbs to pep me up over time or I will get too low and get confusion etc.

        I would love to hear some follow ups though of people on the diet for days and think it works well, if they hit the crash I did etc. I know mine sucked and I still get depression if I go too low or eat the wrong things, my body is very tricky with food sensitivities etc.

        • Traci St Claire Johnson

          I know this post is very old but you said you never went Keto which is kinda the point here and if you had, it might have made all the difference in your moods.

          • Sean1978

            I was definitely keto and this post is very old so I tried it for a while after the post and it never worked for me. Everyone is different on diets, Keto or Zero carb did not work for me at all and I got indications from the body on end, enough to give it up finally and move on and do other things that worked for me personally. I said I ate too much protein which later on was bunk I discovered so I was zero carb and very much keto for a while and never did any better on that diet personally. It might work for you or someone else like charm but for me personally it does not. I was actually keto adapted for a while too, that diet makes me a wreck for some odd reason and I will have to pass and try different avenues. Good luck!

  • Aubrey

    Found this article because I am a vegetarian who decided to try a low carb (but still vegetarian) diet in the last week and noticed that my constant irritability I’ve had since forever has vanished. I am following a 20-30 grams of carbs a day diet using vegan protein powder, some eggs and cheese, coconut milk, nuts, seeds, leafy greens an green veggies,avocados and vegan low carb “meats”. Feel better than I have with the low fat high carb diet I felt miserable on.. my moods feel incredibly stable as well as my energy levels. Hope this lasts 🙂

  • Michelle

    Thank you for our article. I am wondering if anyone can shed some light on an interesting phenomenon I’ve noticed with my own experience attempting a very low carb diet. My depression (which had been in remission) reared its ugly head after about the sixth week on the diet. As soon as I began eating sources of carbs such as potatoes again, it again went into remission. I have duplicated this numerous times. I’ve recently done a little investigating into MCT oil, and I’m wondering if it might have the potential of allowing me to try eating low carb again without the ill effects on my mood. It would be nice if that were true, as I have a very difficult time losing weight in general, but it’s much easier for me to lose weight at a reasonable pace on a low carb regimen.

    • Dear Michelle

      My apologies for the delay in responding to you. It’s difficult to provide specific feedback without knowing a lot more about the composition of your low-carb diet–ketogenic, whole foods LCHF, Atkins, how many carbs, supplements, etc, but I am glad to know you figured out a way to make your depression go away! Even if you were to provide lots of detail about your diet before and after, I might not be able to explain why you feel better with carbs than without carbs. We are each a little different in how our bodies and brains metabolize nutrients so you may be someone whose system prefers a diet that contains some starch. I am not personally able to tolerate MCT oil so can’t provide you with information about it from my own experience, but I have read that some people on ketogenic diets feel more physically energetic on MCT oil. I think of MCT oil as a “fast fat”–the way sugar is a fast carb. If you do try it it would be interesting to hear how it goes for you.

  • Stefan

    First of all apologizes for my probably bad english,hope I can be understood.

    So I’ve never talked about this with any professional or person in general because they would probably think that i’m talking bullshit and even if they didnt think that,they wouldnt be able to help me,but maybe here I can find answers so here I go:

    Some time ago I did a PSMF diet (protein sparing modified fast) wich is a ketogenic diet in wich you only eat the bare minimum protein that you need and some vegetables+some supplements (please lets not discuss if its healthy or not,its a very well structured diet and I felt very good doing it).

    Everything was just fine,I was happy with my progress.Then it happened.

    There is a stage in this diet where you do a carb load/refeed wich consist in consuming large amounts of carbs,while eating little fat and your usual protein on the diet.This is done to counter some of the negative effects of dieting and to promote a better future weight loss.It can last from 5hours to days.Mine was a 5h refeed .

    So I did the refeed after 1 week of dieting.At first I felt absolutely euphoric.I did it at night and I even wasnt able to sleep.The next day I woke up the same,even more motivated and euphoric,I felt like nothing could go wrong and nothing could stop me.It was really amazing.

    The interesting part comes now.Through the day I started to feel bad and depressed and this feeling increased over time to such a point that I even cryied at night.

    I felt really depressed for the next days/week.So I just stopped doing the diet but now I started again and something even worse happened.

    Yesterday I did my first refeed,brutal amount of carbs.I had one of the biggest depressions that I can remember(I was pretty depressive when I went through puberty).I did my refeed and after an hour or so I felt empty,surrounded my darkness,alone.I really wanted to die.It was horrible.That hadnt happened to me in years.I also felt very very very nervous and anxious.

    Something happened inside me,I knew it wasnt normal to have such an insane mood swing and I already experienced something similar last time so it wasnt a casual thing.Carbs were related with all this.I know that it has to do with my chemistry because the depression faded pretty fast and Ibgot more stable after a couple of hours

    I’m not sure about how old this article is but I hope someone read this.

    • Helana Bosch Vd Walt

      If you’re able, have a look on YouTube a lady called “Stephanie Keto Person”. There are other keto-people on YouTube as well, but she advocates NO refeeds at all while on keto. She’s been in ketosis for more than 4 yrs and it is very possible and probably advisable not to refeed on a ketotic diet. I hope this helps.

      • Dear Stefan

        I’m sorry to hear about your difficulties. I agree with Halana that it is probably the cycle of refeeding that is causing problems, especially since it sounds as if you were doing very well on a ketogenic diet until you tried refeeding. I am personally eating a ketogenic diet now, but I do not fast, and I do not refeed. I feel perfectly fine on this diet without fasting or refeeding and am convinced that it is quite safe. as long as you are eating enough protein and plenty of fat.

  • cathy

    I started lo carb dieting 3 days ago. I am bipolar. I immediately started to feel really down and missed two days of work for depression. I don’t think this diet is for me. I do not take Depakote, but I do take Prozac and Seroquel.

    • Hi Cathy

      There is definitely an adjustment period that can last for several days to a couple of weeks, depending on the person. The adjustment period can be thought of as a kind of “withdrawal” from carbohydrates; it can be rocky, but it usually passes. I can’t guarantee you that you’d feel better if you waited it out, but most people do. Of course it is very important to do what feels best for your personal situation.

  • Dylan Moritz

    Former bipolar type 1 with two admissions to the closed ward. Medicated with lithium after release. Been symptom and drug free for 8 months and sleeping steadier the anyone I know. Keto Works for me.

  • Sonia

    I have been diagnosed with Bipolar disease and manage to control it without medication by eating (mostly) Atkins and taking 3 Tablespoons of Omega 3 and 1/2 cup melted coconut oil and scoop of Ultra Clear Renew and 1 banana in smoothie every day. Almost 6 months without any medication. No depression or loss of energy – feel better every day!

    • Hi Sonia

      Thank you for sharing your experience here for others to read; so glad that you are doing well!

  • Ela

    I’m bipolar 1, also anorexia/purge type, also celiac. Messed around with cyclic keto for a bit, which was crazy since any cycling=bad for me and precipitated binging and digestive distress. But for the past six weeks or so have been strictly ketogenic. Still taking meds (lithium 450/lamicatal 100).
    Binge/purge is completely removed. summer solstice is v hard time for me, so i haven’t been perfect, but I think doing waaay better than if I were eating any other way.

    • Dear Ela

      Thank you for sharing your experience here–so glad you are starting to feel better!

  • Susan

    Hi there, I am starting a new regime of Latuda and Lamotrogine, I have been on lamotroging for years with Abilify and am considered morbidly obese (286 lbs – 5’3) .. I also have a hypothyroidism and am on medication for that as well, I have also experienced being depressed since I have been on these meds. …. I am eager to be on a ketogenic diet, but I am concerned as to how the meds will be affected on this diet. I am going to try living this way and will report any problems I am having. I really need to lose this weight and latuda is supposed to be weight neutral. I would love to hear if anyone else has taken latuda/lamotrogine combo and what their experiences are. I cannot afford to go manic at this time in my life. I am bipolar 1. Also would you suggest I get regular blood tests to stay on top of this? Please advise.

    • Hello, Susan

      I am so glad to hear that you are ready to try changing your diet to improve your health! Great questions. Of course I can’t provide medical advice to anyone over the internet, but I can comment generally:

      I am not aware of specific interactions between ketogenic diets and Lamotrigine or Latuda. However, because low-carb and ketogenic diets change the way fluids and salts are handled by the body, people tend to lose some water weight, which can affect blood levels of medications of all kinds, so careful monitoring (frequent visits with your doctor/therapist) and checking in about how you’re doing with family and friends is very important.

      Since you’ve been taking Lamotrigine for a long time, it would be a good idea to ask your doctor to check a Lamotrigine blood level before you change your diet, and then if you notice a change in your mood or new possible side effects of Lamotrigine that you didn’t have before (dizziness, headaches, rashes, etc) you could have the blood level rechecked to see how it compared to the pre-diet level to guide any necessary dosage adjustments.

      If you’re changing from Abilify to Latuda because Abilify has been causing weight gain, keep in mind that Latuda does have a lower risk of weight gain than some other medicines in this mood stabilizer family, but the risk of weight gain is not zero. 3% of people gained weight on Latuda after only 6 weeks on the medicine according to the manufacturer’s studies (and the percentage may have been higher if the studies had been done for a longer period of time). I don’t want you to get discouraged if you gain weight on Latuda!

      Also, I wouldn’t recommend changing your diet at the same time that you change one of your medications, because that can be very confusing. If you felt worse or better, you wouldn’t know whether it was because of the new diet or because of the new medication, and it would be difficult to know what to do next. I usually recommend that people separate diet and medicine changes by at least 6 weeks.

      If you’ve never tried a plain old LCHF diet (low-carb, high-fat) before, you may want to start there, since it’s a lot easier (you don’t have to count protein grams), and you’re likely to see some wonderful changes pretty quickly! Then maybe transition to the stricter ketogenic diet as step two later on, depending on how things go. If you go this route, I highly recommend Dr. Andreas Eenfeldt’s site:

      I hope this feedback is useful, Susan; feel free to keep us posted and I wish you well on your new path!

      • Susan

        Thank you so much for your in depth answer! I will check out that site as well as the plan is to switch up the meds… stabilize then look at the diet …. thanks for your input! 🙂 I will keep you posted 🙂

  • Ed Turnbull

    By taking the following steps – discovered after many years of trial and error – I am able to mostly control my bipolar 2 rapid cycling symptoms:

    – low carb diet – high protein and high healthy fats
    – gluten free
    – dairy free
    – 220 mg of magnesium every night in the form of mg glycinate – key to eliminating anxiety and improving my sleep quality

    I’ve literally tried dozens of things over the years and these are the foundation of good health for me. Hope this may be helpful to someone else. Bipolar 2 is pure misery when not under control and the side effects of the drugs can be almost as bad.

    • Dear Ed,

      Thank you so much for sharing your valuable experience here. How wonderful that you’ve found a healthy nutrition plan that works so well!

  • Susan

    HI Dr. Ede!

    This is Susan, the one who wrote about Lamactil and Latuda? Anyway you suggested I try the LCHF way of eating and I have combed through the diet doctor web site… I did get stabilized on Latuda and Lamotrogine and because my depression was still bothersome the doctor added Wellbutrin. I am finally feeling better and have been doing the LCHF diet since the middle of January. So far I have lost 28 lbs! I am very happy with this way of eating and know that if I ever go back to carbs then I will gain it all back. I see this as a permanent solution and have embraced the lifestyle.

    Now I am reading about MCT oil and am considering taking that too. I just wonder if that has any effect on the medications I am on? I am always leery about anything that affects my brain. I realize that it’s not common for people with Bipolar 1 to take an antidepressant but it’s the only thing that makes me feel normal.

    I would talk with my doctor about it but she is very ingrained in the food pyramid with carbs being the staple. That only lead me to gain over 50 lbs. It’s hard to find LCHF friendly doctors in my area.

    Thank you!

  • Kim

    I am bipolar and went low carb to lose 31 kg, successfully. I was however, MANIC the entire time. I lost the weight but also lost family and friends. I couldn’t even see how manic I had become. I destroyed my life with a low carb diet and would not recommend anyone with bipolar to attempt this. No carbs = No relaxation, no reasoning, very little sleep, no appetite. A bipolar recipe for disaster and madness.

    • unlikelyepiphany

      Like all therapeutic tools than can have an impact, they need monitoring. Ketosis isn’t a replacement for therapeutic supervision.

  • Lee Bravo

    I have been using Keto and intermittent fasting since the first of 2017 specifically to manage my Bipolar disorder. My mental health team, God bless them, are not completely on board but are monitoring me. I have gone 46 days without an episode of mania, depression, anxiety, anger, or impatience. That is a record for me. I thought it was interesting that epilepsy and bipolar disorder are linked. My brother, as a child and teenager, suffered from epilepsy. To date I have lost over 50 pounds and I am not going back. I love being “level” day in, day out. Keto with breathing exercises from Wilm Hoff…brighter days ahead….

  • Ginger Smith

    Dr. Ede, I have just been introduced to your work today by my sister in-law. I have been diagnosed as bi-polar for many years, though now just discovering through an MRI that I also have marked thinning of the corpus callosum. I am in CT and in the midst of seeing specialists in all realms. I am also an endurance racer, retired Ironman athlete, now ultra-marathoner who has a strong passion for nutrition and considered it my 4th discipline in Ironman. I believe your diet could help change the course of how things unfold for me. I am medicine-free for the first time in 27 years while we continue doing neurological testing. I would like to try the Keto diet in its truest deliver and hopefully be helpful to your studying. I have signed up with Cal Tech to be part of social-emotional studies for cc thinning, and as an MSW feel strongly that I help contribute how I can to helping further science. You can reach me at Happy to help and learn and heal simultaneously. Best, Ginger

  • Judy Dixon

    I am bipolar and I have been doing LCHF/keto diet since March 8 2017 and have lost 38 lbs so far. I count total carbs not net and stay between 20-30 a day getting my carbs from vegetables mostly and limited amounts of nuts. I felt awful first 2 weeks but then started feeling great. I stalled on weight loss and started adjust fats. When I have around 130 grams of fat a day my moods tend to be more manic when I lowered fats to 80 grams a day my moods tend to be more depressive and the past few weeks have been extremely depressive. I can not totally pin it on the lower fats because there is some extreme health worries for 2 family members waiting for test results of possible cancer diagnosis’s. So I am very stressed and worried and stress has always been a trigger for me. I am also type 2 diabetic and this ketogenic type diet has greatly improved my glucose numbers. Going from fasting numbers between 180-225 down to between 70-90. My insulin has been greatly reduced (Humulin R used to be 6-8 units after meals and sometimes booster injections to get numbers below 200. Levemir insulin before was 60 units once of morning and again at night and is now only 60 units at night.)

    • Judy Dixon

      I have not required Humulin R insulin since 3rd day of this diet.

      • unlikelyepiphany

        How are you doing now ? Congrats on your Ketogenic Diet – hope all is well !!!

  • Eugenia

    Dear Dr. Ede,
    I was misdiagnosed as bipolar depressive for about 16 years and subsequently was on lamictal, ability, celexa, and benzos for all of those years. I now have discovered after a suicide attempt and having to detox from all of those drugs that I think the doctors mistook my hyper anxiousness as me being manic-like. I have suffered with depression since I was a child. I am currently taking effexor and zyprexa for the anxiety and sleep as a result of taking benzos for so long. I also am being treated for hypothyroidism with 100 mcg of levothyroxine and just started taking about 5 mcg of cytomel because my most recent labs showed that my t3 was elevated.
    I started on the keto diet a month ago and I have felt so incredibly fatigued. One day I ate 4 ounces of cheese and my stomach bloated up horribly, so two weeks into the keto diet, I gave up all dairy including eggs and butter. After reading your posts on vegetables and hypothyroidism, and a post in one of them where you wrote that you wished you had started on a plain meat only diet to begin with, I started on one myself a couple of days ago. I read in one of your posts that you supplement your mostly meat diet with organ meat to insure you get all the nutrients you need. I do not relish the idea of eating organ meats and would like to know what is the bare minimum I would need to eat to feel better? I am still struggling with fatigue and anxiousness and was wondering how long I should give this diet a good go of it? In addition, my stomach has been incredibly sensitive and hurting me so badIy in the same way it did when I was first detoxing from the benzos. I would like to put it out there that in order to follow all these dietary changes I have had to accept that the changes will not happen overnight and that I will probably feel pretty badly for a while. Also, I have relatively low blood pressure (90/60) and I drink 2 teaspoons of salt and tons of water and that seems to help the postural hypotension I started getting when I first started the keto diet.
    I realize that you cannot give me medical advice; however, I desperately would like to know more about how to properly carry out this diet as my naturopath doctor has never heard of it. If you or anyone else could suggest other sources of how to properly carry out a meat only diet, I would so greatly appreciate it. Most importantly, thank you so much for what all you have researched and then turned around and shared. It has been an incredible eye opener for me.