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THINK+SMART is a community-driven resource that supports a metabolic approach to mental health. It provides a flexible framework designed to help you improve mental and physical well-being by integrating ketogenic and other metabolic strategies into your lifestyle. 

THINK stands for Therapeutic Integration of Nutritional Ketosis and describes any medical keto protocol used to treat psychiatric illness. SMART stands for Sleep, Move, Avoid, Rebuild, and Track, and describes additional lifestyle practices and therapies our community members have found useful in their recoveries.

No, THINK+SMART is designed to be descriptive, not prescriptive. There are many ways to integrate metabolic therapies into your life, and different things work for different people. We developed THINK + SMART to document and share different approaches that have worked for our community members, so you can design a program that works for you.

No, THINK+SMART is a framework that collects different strategies and tactics that have worked for others in a systematic way so that you can pick and choose from many options and find one that works for you.

Yes. It’s critical to consult your physician before beginning a therapeutic diet, especially if you are on prescription medications. Adjustments to medications may be necessary, and you will need to have a prescriber on board to help you. Frequent, ongoing monitoring of both metabolic and psychiatric medications during ketogenic therapy is recommended, especially for conditions like diabetes, obesity, high blood pressure, bipolar disorder, schizophrenia and others. 

In addition, anyone with high blood pressure, low blood pressure, diabetes, heart disease, thyroid problems, gallbladder disease, gout, cancer, liver disease, poor kidney function, kidney stones, pancreatic disease, anorexia, or a history of weight loss surgery, or other medical condition, should work with their healthcare provider as they would for any new treatment.

We know how hard it can be to find a clinician trained in metabolic psychiatry, but most of the people we hear from who are successful using ketogenic and metabolic therapies to treat a mental disorder report that it has been critical to assemble a care team of some kind. This might include a combination of a prescribing family physician, a psychiatrist, a nurse practitioner, a keto coach, a dietitian, a therapist, etc.

Different people have different aims with regard to psychiatric medications, and different experiences. Watch our community videos to hear many approaches and experiences with tapering meds. Some people find that on keto, their meds work better with fewer side effects. Some are able to reduce the number or dose of medications. Others find that over time, with careful medical supervision, they can taper off all medications and remain in remission from psychiatric symptoms for the long term. 

Most people will not change their psychiatric medications at all for several weeks or months on a ketogenic diet, although there are exceptions. It’s critical to have your provider on board to monitor changes in symptoms and side effects as you begin ketogenic therapy.

In addition, some may experience potentiation, or increased side effects, from certain medications, particularly those that are lipophilic (literally means “fat loving,” and includes olanzapine, clozapine, valproic acid, and others). A high fat diet can increase the absorption of these medications, thus increasing both the targeted effects and adverse effects. You can learn more about this in this published article. However, it is another example of why it is crucial for someone taking psychiatric medications to work closely with a prescribing clinician.   

While ketosis is safe for most people even with pre-existing medical conditions like heart disease, it’s important to work with a healthcare provider to monitor for any changes in your health.

You can learn more in our video about ketosis and heart disease, and read an educational guide about ketosis with pre-existing medical condistions.

There are very rare conditions that would make ketosis unsafe, such as inborn inability to digest fat. Otherwise, following a ketogenic diet and being in ketosis is safe for most people. However, if someone has a serious medical condition, like advanced liver or kidney failure, or is on metabolic or psychiatric medications, they should consult a trained healthcare provider. Ketosis can still be safe with chronic medical conditions but may need more monitoring.

You can reference our video on what labs to follow and read about starting ketosis with pre-existing medical conditions.

Absolutely. But some medications, for example, blood pressure medications, SGLT2 inhibitors, insulin, and other blood sugar medications may need to be adjusted rapidly. It’s essential to work with your prescribing clinician to ensure safe adoption of nutritional ketosis and to monitor interactions with your medications.

In addition, as detailed above, some individuals will experience increased side effects from certain medications as a result of something called potentiation. It is important to work with your prescribing clinicians. For further reference, please see this published article.

Ketogenic therapy is a safe and effective treatment for brain-based disorders, backed by more than 100 years of evidence in the field of neurology, specifically with seizure disorders. In addition, the emerging field of metabolic psychiatry has begun to generate evidence for ketogenic metabolic therapies as a safe and effective treatment for dementia, depression, anxiety, anorexia, bipolar disorder, schizophrenia and other conditions. Learn more about the scientific rationale and the evidence base on Metabolic Mind’s research section and our YouTube channel. 

Nutritional ketosis is a metabolic state where the body burns fat for fuel instead of carbohydrates, typically achieved through a low-carb ketogenic diet, fasting, and/or intensive exercise.

Nutritional ketosis is the metabolic state achieved by a ketogenic diet; keto refers to the dietary strategy used to reach that state. We use the term THINK– Therapeutic Integration of Nutritional Ketosis–to describe any nutritional strategy that puts the body in a state of ketosis on a long-term basis.

Results vary by individual, but many people see improvements in mood, energy, and cognition within weeks to months. Most clinicians we hear from recommend committing to at least three to four months to see significant benefit. Many individuals report continuing to see improvements over months and years after adopting ketogenic and metabolic therapies.

No, you can start with individual components and personalize the framework. But full adoption of a THINK diet may lead to more significant benefits than focusing on SMART strategies alone.

Costs can vary, but many people find that a ketogenic diet is easily made affordable by focusing on whole, unprocessed foods like meat, eggs, and vegetables, and eliminating expensive processed foods and snacks. Clinicians have even been able to help people on SNAP reverse disease using ketogenic diets. 

Resources that may be helpful for understanding the costs associated with adopting ketogenic diets include Lauren Kennedy’s video and this article by DietDoctor.

No, while devices like ketone meters, glucose monitors, and sleep trackers can be helpful, they are certainly not essential. Ketones can be tested with inexpensive urine strips if a blood meter is cost-prohibitive. 

As you will learn from individuals who have shared their stories and strategies, there is no “correct” way to use ketogenic and metabolic therapies. The idea with THINK+SMART is to show you many different approaches that have worked, and to encourage you to work with your care team to experiment and to adjust your program over time. 

Most people we hear from are using therapeutic ketogenic nutrition as a cornerstone of their metabolic framework for mental health. But many started out using other low carbohydrate dietary strategies, then eased into keto over time. Still, others began with other smart metabolic strategies focusing on sleep or movement, then later worked toward changing nutrition. Not everyone is in a position to radically change their diet, and that’s okay. THINK+SMART was designed to collect strategies in many different categories so that you can decide what you are ready to take on. Even small steps can make a big difference in wellness.

Absolutely! THINK diets can include many different animal and plant foods and can accommodate carnivore, omnivore, vegetarian, and, with the right supplementation, even vegan nutrition. Consult our Metabolic Mind content along with your care team to learn more about customizing your low-carb ketogenic nutritional approach to your specific dietary preferences.

You can explore the THINK+SMART website or visit Metabolic Mind for more information on metabolic psychiatry, including links to partners, clinicians, scientific evidence, personal stories and more.

The THINK+SMART website and worksheet offer specific links to help you explore SMART strategies for mental wellness that have been shared by our community members.

To inspire others in our community, we invite you to submit your personal journey using the “Share Your Strategies” button on the THINK+SMART website. By sharing your experiences, you can help us build a collective knowledge base that will help others.

The THINK+SMART website is intended to be used in conjunction with our Metabolic Mind content, including on MetabolicMind.org and our YouTube channel. You will find many resources that will help you assemble a care team, find community, and use ketogenic and metabolic therapies to improve your mental health.