From severe illness to keto and carnivore

• In February 2024, Sarah was 39, weighed over 100 kg, and had prediabetes, longstanding PCOS, hypertension, sleep apnea, and acne. She initially tried keto for weight loss.
• Her bipolar illness began with depression at 15. An August 2023 third psychiatric hospital admission and second ECT course were followed by maintenance ECT and five psychiatric medications.
• Her psychiatric illness and medication burden contributed to weight gain, alongside a difficult relationship with food. Previous conventional diets and eating less while moving more had not produced lasting success.
• Her initial "dirty keto" included keto wraps, pasta, chocolate, desserts, and packaged products. Weight and general wellbeing improved; she stopped ECT around May 2024 and subsequently connected the mental-health improvement with keto.
• Her husband began carnivore for his own health problems in September 2024, and she joined him. Her experience was an initial improvement on keto followed by further improvements on carnivore.
• Sarah has studied ketogenic metabolic therapies and therapeutic carbohydrate reduction for metabolic syndrome and serious psychiatric illnesses, including bipolar disorder and schizophrenia. This research remains limited but growing, with additional positive personal experiences.

Mental health, medication, exercise, and sleep

• Sarah has experienced no further depressive episode since changing her diet, alongside relief from her longstanding fear of another episode.
• Sarah connects her recovery with diet and other factors: improved energy has enabled weight training, Pilates, greater engagement with family and friends, and more involvement in ongoing psychotherapy.
• Under psychiatric supervision, her medication use has declined from substantial doses of five psychiatric medicines to a small dose of one. She is content to remain on that dose without a plan to discontinue it soon.
• Sleep and energy improved during weight loss. Sarah stopped using CPAP after her husband no longer heard her snore; no repeat sleep study has confirmed resolution of sleep apnea.
• Her earlier psychiatrist referred her to a lifestyle and functional psychiatry specialist, with whom she has worked for about two years. Her history has also been used as a case example at a conference.

Bringing metabolic health into psychiatric care

• Sarah works in public community psychiatry with people who have severe schizophrenia, recurrent bipolar disorder, and sometimes major cognitive impairment. Her own experience has increased her attention to lifestyle within an existing holistic approach.
• Serious mental illness is associated with increased cardiovascular and metabolic disease risk, including in people without psychiatric medication. Medication can add to that risk, while remaining necessary for some people to function; Sarah aims for the lowest effective dose.
• For patients with severe illness, steps include opening curtains and getting outside. Where feasible, she also works with patients on nutrition, exercise, and changes suited to their circumstances.
• Many patients rely on food banks with abundant free bread and pasta. She prioritizes canned tuna, salmon, and affordable eggs where available; one patient with severe diabetes and a fasting insulin level of 50 illustrates the difficulty of even switching regular Coke to Diet Coke.
• Patients capable of sustained dietary changes have sometimes experienced substantial improvements; poverty, disability, and limited access to nutritious food constrain others.

Weight loss, surgery, and recovery

• Sarah lost 35 kg, over one-third of her starting weight, leaving loose skin. Four weeks before the interview, she underwent abdominoplasty and brachioplasty to remove excess abdominal and arm skin.
• Her first postoperative days were difficult, but pain decreased and wound healing progressed better than she expected. She resumed work after four weeks, with swelling, limited reach, and exercise restrictions still in place.
• Sarah attributes her easier-than-expected recovery to prior fitness, consistent exercise, nearly two years of carnivore eating, preoperative preparation, and maintaining her diet after surgery.

Social acceptance, adherence, and research

• Colleagues generally accept Sarah's meat-and-eggs diet. She does not ask them to avoid cakes, and an office farewell for a low-carb colleague included meat, cheese, and other foods compatible with his diet.
• Sarah is completing a master's degree in human nutrition and preparing for research. Her husband was metabolically healthy and a marathon runner before developing chronic fatigue; he experienced fewer changes on carnivore and has followed it less consistently.
• A Low Carb Down Under conference covered difficulties maintaining many dietary patterns, not only keto or carnivore. Greater health improvements, including metabolic, medication, and mobility changes, were linked with greater dietary persistence, consistent with her and her husband's different experiences.
• Sarah intends to strengthen her existing psychiatric practice with research and guidelines, without a separate career plan. She recognizes that her positive experience makes her favor beneficial findings, motivating further formal study.
• A recent trial comparing ketogenic and Mediterranean diets achieved similar weight loss, with stronger metabolic improvements in the ketogenic group over a relatively short period. The ketogenic intervention was not carnivore. [1]

How I eat now

• Sarah mainly eats steak, minced beef or burgers, bacon, eggs, pork, and chicken wings, occasionally with parmesan. Steak costs more, and her husband prefers more variety than she needs.
• Sarah eats little dairy without strictly excluding it; she finds large amounts of cheese easy to overconsume.
• She generally eats lunch and dinner, skipping breakfast as she often did before. Breakfast occurs occasionally with family, including after parkrun.

Making change practical

• A person's motivation and long-term goals shape how they begin. In her clinical practice, Sarah favors a gradual transition with manageable steps.
• Practical steps include serving bolognese with zucchini noodles or roasted cauliflower without spaghetti and garlic bread, and eating bacon and eggs without toast. Each small change can be assessed before making another.
• Sarah shares practical resources with patients, including Ken Berry's free, approximately 60-page Proper Human Diet Guidebook, which includes a meal plan, pantry advice, shopping list, and explanations. [2]
• Minimally processed, nutrient-dense food is her preferred goal within financial limits, including a heuristic based on foods familiar to earlier generations. Food-bank dependence constrains what many patients can obtain.

A wider lifestyle change

• Sarah deleted her social media accounts because of doom-scrolling, does not need them for public-sector psychiatric work, and includes reduced digital stress in her broader mental and metabolic health changes.

References

1. [27:00] Effect of diet macronutrient content on the cardiometabolic response to weight loss: A randomized clinical trial — https://doi.org/10.1016/j.cmet.2026.07.020
2. [33:55] The Proper Human Diet Guidebook — https://drberry.com/pages/guide