All protocols

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 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.

Be careful about very high caffeine intake over long periods because it can bias toward anxiety, electrolyte depletion, headaches, irritability, and microvasculature disruption.

If you like exercising fasted, caffeine just prior to exercise can be a fantastic tool.

Ensure adequate calcium intake through diet, supplementation, or both, especially in the context of caffeine use and bone health.

If you are not accustomed to caffeine or are very sensitive to it, do not use it for the first time on the day of an important mental or physical challenge.

Brief bouts of intense exercise ranging from about 10 to 50 minutes after learning can improve memory for information learned beforehand.

He is not a fan of drinking coffee or espresso right before a nap; prefers restricting caffeine to early day and using naps or NSDR without pre-nap caffeine.

Consume caffeine every other day to maximize many positive effects while reducing tolerance and avoiding the misery of longer abstinence periods.

Leverage caffeine's reinforcing effects to increase preference for desired foods or beverages, and avoid pairing caffeine with things you want to stop craving. If trying to reduce sugar cravings, avoid co-ingesting sugar with caffeine, such as chocolate with caffeine or coffee with pastry, because caffeine further enhances sugar reinforcement.

If coffee is not working well for you, herbal tea can be paired with a 125–150 mg caffeine tablet as a way to develop a preference for herbal tea.