Table 5.

A practical guide to implementing the ketogenic diet in psychiatric disorders [156].

Potential Risk	Risk Group	Advice
Dyslipidemia	Patients treated with atypical antipsychotic medication. Overweight or obese individuals.	Replace foods with high SFA and trans unsaturated fatty acid with sources of PUFA and MUFA. Less: meat with high-fat content, lard, butter, eggs, coconut/palm oil More: olive oil, rapeseed oil, flax oil, avocado, fatty fish, allowed amounts of nuts and seeds Supplementation of omega-3 fatty acids (>1 g EPA or EPA/DHA ratio 1:1) could be helpful
Constipation	Patients treated with medication with anticholinergic effects (clozapine, olanzapine, phenothiazine derivatives, TCA72).	Choose vegetables, nuts, and seeds with more fiber and less carbohydrate content; the examples of the ratio of fiber to carbohydrate in some foods are presented below: Spinach 1:1.15 Sesame 1:1.27 Desiccated coconut 1:1.28 Mushrooms 1:1.3 Chives 1:1.56 Celery tuber 1:1.57 Almonds 1:1.59 Kale 1:1.6 Brussels sprout 1:1.6 Hazelnut 1:1.67 Chinese cabbage 1:1.68 Horseradish 1:1.76 Green beans 1:1.95 Lettuce 1:2.07 Broccoli 1:2.08 Cauliflower 1:2.08 Parsley, root 1:2.14 Peanuts 1:2.63 Red cabbage 1:2.68 Walnuts 1:2.77 Tomatoes 1:3 Zucchini 1:3.2 Red pepper 1:3.3 Cucumber, pickled 1:3.8 Onion 1:4.05 Cucumber 1:5.8 *
Calcium deficiency, osteoporosis risk	Patients treated with SSRI, valproic acid and with high prolactin levels after pharmacotherapy.	Supplementation of vitamin D according to guidelines. Monitoring vitamin D status. Intake of foods rich in Ca allowed on KD, such as: cheese (hard cheese, feta, mozzarella), Greek yoghurt, cream, or vegetables with a high ratio of Ca to P. The ratio of Ca to P in some foods is presented below; 1:1 or higher Ca is recommended. Kale 1:0.36 Parsley, leaves 1:0.44 Cabbage, white 1:0.49 Cheese, Emmentaler 1:0.5 Sauerkraut 1:0.5 Chives 1:0.54 Onion 1:0.56 Brussels, sprout 1:0.58 Cheese, parmesan 1:0.59 Cheese, brie 1:0.63 Pumpkin 1:0.65 Cabbage, red 1:0.67 Cheese, camembert 1:0.8 Cabbage, Chinese 1:0.82 Broccoli 1:1.38 Cucumber, pickled 1:1.5 Cucumber 1:1.53 Almonds 1:1.9 Cauliflower 1:2.15 Walnuts 1:3.82 Sunflower seeds 1:5.98 Peanuts 1:6.64 Egg, white 1:8.5 Cod 1:92 Roast beef 1:95.5 Chicken, leg 1:98 Egg 1:102 Breast, chicken 1:120 Salmon 1:133 Egg, yolk 1:293 **

TCA—tricyclic antidepressants; SSRI—selective serotonin reuptake inhibitor; SFA—saturated fatty acid PUFA—polyunsaturated fatty acids; MUFA—monounsaturated fatty acids; EPA—eicosapentaenoic acid; DHA—docosahexaenoic acid; Ca—calcium; P—phosphorus; KD—ketogenic diet; * fiber to carbohydrate ratio; ** Ca to P ratio.