Therapeutic
After resolution of bipolar 2, without symptoms to manage, I began a slow journey of tapering medications. This took three years. If you are able to do this with the support of your psychiatrist/doctor/clinician, then this is optimal. The work of Mark Horowitz was enormously useful to me – this article (pubmed.ncbi.nlm.nih.gov/33754644/), published in 2021 in peer reviewed journal was fantastic at explaining the general principles of hyperbolic tapering. Horowitz and Taylor published the Maudsley Deprescribing Guidelines last year (2024) which are clinical guidelines. The Maudsley Prescribing Guidelines have long been used by clinicians, now de-prescribing guidelines are also available on Amazon. My adoption of the ketogenic diet and my tapering of medications were under the oversight of a doctor, but without their support. By this I mean that I still had a treating psychiatrist but they did not support my decision to use a ketogenic diet, and they did not support my choice to taper medications.
Integration
I take no medications or supplements. I do regular bloodwork to check for any dietary deficiencies. My LDL cholesterol has more than doubled, but I followed up with LDL sub-fraction testing and a CT scan for coronary calcium. I am in the lowest risk category for heart attack - I eat up to 80% fat in my diet. I am a "lean mass hyper responder" to a low carb diet. I am comfortable with this. For more info on understanding a cholesterol panel I recommend this learning from Dr. Paul Mason at Low Carb Down Under (www.youtube.com/watch?v=rdgS3PuSuyg).
Nutritional
I always eat less than 20g carbs per day - often much less. I aim for no less than 90g protein (up to approx 130g) and keep fat roughly between 70-80% of energy intake. I eat when I am hungry and then I eat a full meal. I do not snack (the work of Dr. Jason Fung is a great resource if one is interested in understanding meal timing/snacking etc). It took a while to get used to, but now, I do not need to measure or think about macros unless I get curious. (Sometimes I get curious, try some new experiments, and measure macros etc). Mostly I just eat delicious food with enough fat and without/very low carbohydrates. Twice a year I do a 3-5 day fast (unrelated to ketogenic therapy - but possibly good for me)!
Ketosis
I test sometimes, or not at all. However, in the first year I tested regularly each day - a couple of hours after waking. This was important - I needed to know if I was in ketosis. I needed to know what kicked me out of ketosis. And I liked to know roughly how deep I was in ketosis. I used the cheap urine-stick testing and this was adequate in the first year to establish that I was in ketosis. As I advanced, I bought myself a blood monitor (which I really like), but it is not needed to begin this therapy. These days I test when I am curious. But I can feel whether I am in or out of ketosis, so this is more for curiosity that for need. I feel best between 1.5 and 3 mmol. I get edgy and uncomfortable if ketones stay too high for too long (above 4). And I do not feel as good under 1 mmol. I sometimes test glucose but have never been pre-diabetic so this is driven by curiosity. I sometimes calculate GKI. I spend very little time testing/monitoring these things now - but in my first year I measured much more frequently as I got to know how my body and symptoms responded to dietary intake.
