All protocols

Recommended as part of the general health practices that support recovery of brain function; he groups healthy metabolic function and healthy body weight together.

He strongly warns that cannabis use in adolescents, teens, and young adults up to age 25 disrupts brain development, accelerates prefrontal cortical thinning, and raises later risk of anxiety, depression, and psychosis.

Avoid cannabis use entirely if possible, especially for adolescents, teens, and people age 25 or younger. If cannabis is used at all, keep both frequency and potency very low to reduce the risk of psychosis.

Foundational prerequisite for mental health, physical health, and performance; also described as part of the general environment of health.

Use a container of ice water or very cold water and place one or both hands in/on it to cool the core; avoid temperatures so cold that they constrict the vasculature.

Use urine ketone strips as a general guide to determine whether ketosis has been achieved; less accurate than blood ketone measurement but still useful as a general guide.

Measure ketones and adjust the diet based on ketosis level and clinical response; Palmer mentions both general ketone measurement and specifically recommending urinary ketosis in Atkins-style ketogenic approaches because clinical benefit often appeared only once patients got into ketosis.

If reducing psychiatric medications, do it safely, cautiously, gradually, and with supervision from a mental health professional or prescriber; do not stop cold turkey because rebound symptoms can be severe or dangerous.

Use frequent contact and education rather than simply prescribing a diet and checking back months later; Palmer describes weekly visits as useful for adherence and adjustment.

Monitor glucose levels alongside ketones during ketogenic interventions.

Avoid junk food and highly processed shelf-stable foods, especially those combining high sugar/carbohydrate with high fat; Palmer describes this combination as especially harmful for metabolic and mental health.

Avoid sleep disruption because Palmer says it impairs mitochondria and mitochondrial function.

Avoid tobacco smoke because Palmer says it impairs mitochondrial function.

Palmer says THC directly impairs mitochondrial function and may harm mental and metabolic health if used chronically.

Do not drink the same amount of alcohol you normally would while on a ketogenic diet, and do not drive after your usual amount, because blood alcohol levels may be much higher and could be dangerous or even deadly.

Support from a health and wellness coach can help people adhere to dietary interventions.

Provide prepared ketogenic meals, such as freezer meals for six months, to make adherence easier and more doable.

During ketogenic dieting, natural sweeteners like stevia or monk fruit can be used as alternatives to sugar.

On ketogenic dieting, Palmer allows ample protein and gives examples including meat, eggs, sardines, and vegan protein sources such as tempeh.

On ketogenic diets, thinner people may need substantial dietary fat to achieve clinical ketosis because they lack large body-fat stores. Palmer mentions avocados, olive oil, butter, heavy cream, nuts, coconut oil, and coconut cream as acceptable fat sources; for obese patients starting keto, he does not push extra fat early.

Work with a dietitian, ideally one experienced in ketogenic therapy, especially for serious mental disorders, to monitor ketosis, nutrient status, and adjust the diet.

Use behavioral sleep measures first when keto triggers sleep disruption or hypomania: get at least six hours of sleep per night, stay in bed and try to fall back asleep if you wake very early, and aim for three nights of decent sleep in a row, which Palmer says often extinguishes hypomania.

For serious mental illness patients on keto who cannot sleep despite behavioral measures and supplements, Palmer uses prescription sleep medication only as a temporary stopgap to get 3-7 days of decent sleep and break hypomania.

Palmer says he would specifically avoid trazodone in this context because it is an antidepressant and the patient is already hypomanic, so he does not want to push that further.

Mentioned among prescription sleep medicines Palmer may use short-term as a stopgap for keto-related hypomania or insomnia.

For selected patients without a history of addiction, short-term Ativan may be used to restore sleep and help break hypomania. Ativan is often preferred because it is shorter-acting.

Palmer says he may use something like Klonopin short-term to restore sleep and break hypomania in selected patients without addiction history.

Use fasted exercise/cardio as a way to stimulate GLP-1 release; presented as a vote in favor of fasted exercise for this purpose.

Figure out your body weight in kilograms and use 1–3 mg/kg as the range to explore for a single caffeine dose.

Look up the caffeine content of your beverages and foods online, especially commercial coffees, sodas, teas, etc., to know how much you are actually ingesting.