A new study was published in JAMA earlier this month, looking at the ketogenic diet and its effect on mental illness, specifically depression and anxiety. The study authors looked at 50 recently completed studies, including randomized control trials and “quasi-experimental” studies. These studies had covered a total of 41,718 participants. Meta-analysis showed that ketogenic diets were associated with modest improvements in depressive symptoms, with little or no effect on anxiety symptoms.
Our experience with ketogenic, sometimes called “Atkins” diets has been generally positive, with some caveats. The “true” or “classic” ketogenic diet should only be followed under medical supervision, since there are some dangers associated with the state of ketosis that your body reaches when it stops burning carbohydrates for energy, and instead burns fat. Ketosis can interfere with the absorption of some medications, and plays a role in metabolic diseases such as diabetes as well. The heart can also be strained by the bodily changes that the ketogenic diet causes.
People with bipolar also need to be conscious of the possibility of the ketogenic diet “kickstarting” a manic or hypomanic episode, a result that we have seen more than once in our practice. For mental illness, the ketogenic diet has so far only shown positive results with depressive symptoms, although researchers call for further study to get more robust findings.
The studies reviewed by JAMA also showed better results in studies that used ketone monitoring, nonobese participants, and very low-carbohydrate interventions; in other words, carefully monitored diets. The ketogenic diet is not easy!
We have heard some positive comments from our patients on a hand held device that monitors ketones in the breath. Lumen, a small device into which you breathe delivers “metabolic coaching” via the associated app. Measuring ketones tells you if your body is burning fat or carbohydrates from food, which, with regular monitoring, helps you maintain a healthy diet. Notably, the product does not mention using it for reducing depression or any other medical purposes. It is marketed for weight loss. However, coupled with medical oversight, patients have found the device useful.
Reference:
Janssen-Aguilar R, Vije T, Peera M, et al. Ketogenic Diets and Depression and Anxiety: A Systematic Review and Meta-Analysis. JAMA Psychiatry. Published online November 05, 2025. doi:10.1001/jamapsychiatry.2025.3261
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