Tyler Black, MD

Sure. Let's do exactly that. The evidence for ketogenic diet is extremely lacking. The highest quality thing in the literature is a RCT of 88 adults with treatment resistant depression using an active control ("phytochemical diet"). Both groups got a lot of support. The 6 week effect was positive (baaarely with a 95% CI of -4.33 to -0.03 on the PHQ-9), and then it was not significant at 12 weeks. There were no between-group differences on secnondary outcomes (remission, anxiety, anhedoina, cognition, quality of life, functino). So sure, its a positive RCT. but it is very very very close to 0 on the 95% ci at 6 weeks, and then insignificant at 12 weeks. If we take out that, we have uncontrolled studies RIFE with expectancy and problems. In fact, when match-controlled, the effect of the intervention drops by almost 75%, and thats a post-hoc matching. The JAMA meta-analysis of keto points exactly the same way as this. Anxiety trials are completely null. The large effect relied on uncontrolled designs. And most of the "depression" effects are on weight-loss trials measuring mood, not depressed patients. We have no evidence for: * severe mental illness (bipolar/schizophrenia) * durability * secondary outcome corroboration * replication * pediatric/adolescent data