Ketosis for Type 2 Bipolar – [2 Clinical Cases]

I’ve seen this clinical report mentioned in a couple of places, so I thought it might be worth getting into a few of its details.

It was published in 2013 and it follows two women with type II bipolar disorder who sought to manage their condition with prolonged ketosis. The authors start from the following premise:

“Successful mood stabilizing treatments reduce intracellular sodium in an activity-dependent manner. This can also be achieved with acidification of the blood, as is the case with the ketogenic diet.” [1]

What’s worth mentioning is that the mood stabilizing effect of ketosis surpassed what they had achieved with medication. They mention no adverse effects from the diet and the authors say that this clinical report supports the hypothesis that acidifying plasma may have a beneficial effect on mood – possibly by lowering intracellular sodium and calcium. Let’s look a little bit closer.

Clinical Report – Type II Bipolar Disorder

The first women was a 69-year old who began being symptomatic in her twenties. In her 50s she was given medication such as sertraline and burpropion, which made her feel worse. At 57 a psychiatrist diagnosed her with bipolar disorder and gave her lamotrigene, which improved her condition significantly but not fully. Higher doses were more effective, but lead to confusion.

As of such, she started the ketogenic diet in 2010 and maintained it for, at least, 2 years – until the publication of the report (we don’t know what happened beyond that). She tested urine ketones daily on almost all days:

“Over this period she was able to lower and ultimately stop lamotrigine while maintaining as good or better symptom control. On occasion she would restart lamotrigine at 25 mg daily to augment her diet or when she could not increase her ketone level.” [1]

She also used supplements: aspirin, lutein, astaxanthin, ubiquinol, gingko, vitamin D in the winter, and a multivitamin. Interesting to point out is that she regards 15mg/dL of urine ketones better for symptom control compared to 5mg/dL.

Also worth mentioning is that her lipid profile did not get worse compared to when she ate an omnivorous or a vegetarian diet. Lower triglycerides and higher HDL are markers of a better lipid profile – imho.

Phelps et al. (2013)

Phelps et al. (2013)

The second subject was a 30 year old woman, who began being symptomatic at 13. She was given medication, which worsen her condition.

She was diagnosed at 25 and was given lamotrigene, which helped her sufficiently to maintain a job and a relationship:

“She initially utilized the ketogenic diet to reduce symptoms during flare-ups of irritable bowel syndrome, and noticed its mood stabilizing effects: “My mood felt significantly calmer while in ketosis.”” [1]

Preparing for a child, she decided to stop taking lamotrigene. Recalling her experience with ketosis, she decided to start the ketogenic diet and monitor it with urine strips.

“Within 2 or 3 days of achieving ketosis, her symptoms resolved “and I felt a sense of calm, confidence, and kindness. I feel more comfortable in my own skin than I ever did on Lamictal [lamotrigine], or off meds.”” [1]

She also supplemented with: omega-3s, vitamin D, multi-vitamin, and a probiotic. She maintained ketosis for, at least, 3 years – since 2009 until – at least – the publication of the report. Her diet consisted mainly of fish, coconut milk, olive oil, eggs, fatty meat, butter, nuts, and 1-2 cups of vegetables per day.

In the discussion section the authors mention that omega-3 supplemention in the second subject may have helped with alleviating the symptoms; and they point out to a large study conducted for the purpose. They also discuss the potential negative side effects of ketogenic diets (if they are not well formulated) and ways to mitigate them. They are careful in reminding that the two subjects did not report any negative side effects.

For those interested in all the details, especially the discussion section, I’d recommend reading the complete study. The authors modestly finish by saying:

“At minimum, these patients’ experience suggests that a ketogenic diet, diligently pursued, can act as a mood stabilizer in patients with type II bipolar disorder.” [1]


Given that this is not a randomized blind study, we should not rush into deriving strong conclusion from it, yet we should not dismiss it either. Starting from the hypothesis of mood stabilization with ketosis, there are many venues to be explored scientifically, begging with model organisms to human studies (where/when/if possible).

Ketosis is a metabolic state not easily maintained in the modern environment. A ketogenic diet, if not well formulated, could lead to nutritional deficiencies and could have negative side effects.

There has been a precedent in the research of ketosis for bipolar: a 2002 report where a woman suffering from bipolar disorder was put on a ketogenic diet for a month and showed no improvement in her symptoms. I’d say this report could be easily dismissed since the ketogenic diet was not ketogenic at all, as there were no ketones detected in her urine:

“The patient showed no clinical improvement, no loss of weight, no urinary ketosis, and no changes in liver function during the trial.” [2]

Researchers were however interested in further studying the ketogenic diet for this type of mental condition. Perhaps the successful clinical report of 2012 [1] and the uncounted anecdotal reports of people who try this on their own might ignite the interest in the research field.


  1. Phelps, J. R., Siemers, S. V., & El-Mallakh, R. S. (2013). The ketogenic diet for type II bipolar disorder. Neurocase, 19(5), 423-426.
  2. Yaroslavsky, Y., Stahl, Z., & Belmaker, R. H. (2002). Ketogenic diet in bipolar illness. Bipolar disorders, 4(1), 75-75.

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