DIME Trial: New study finds a ketogenic diet may help some with severe depression

Megan: 
That was something that came out a lot that people were like, “I had no idea that diet had any impact on my mental health.”

Bret: 
Welcome to the Metabolic Mind Podcast. I’m your host, Dr. Bret Scher. Metabolic Mind is a non-profit initiative of Baszucki Group where we’re providing information about the intersection of metabolic health and mental health and metabolic therapies, such as nutritional ketosis as therapies for mental illness.

Thank you for joining us. Although our podcast is for informational purposes only and we aren’t giving medical advice, we hope you will learn from our content and it will help facilitate discussions with your healthcare providers to see if you could benefit from exploring the connection between metabolic and mental health.

A new study was just published in JAMA Psychiatry looking at a ketogenic diet intervention for individuals with self-reported treatment-resistant depression. And if you’ve seen the social media reports on this study, you may have seen some that say, “This is great. Keto intervention reduced the PHQ-9, showed improvement in depression symptoms. This is wonderful.”

Or you might, for the exact same study, might see someone post, “There was absolutely no difference statistically between keto and the control. So, it shows keto has no added benefits.” So, if you’re an individual wondering if a ketogenic intervention could help you or a loved one, this is probably pretty confusing. And that’s why I’m thrilled to be joined today by Dr. Megan Kirk Chang, who’s a Senior Researcher in Metabolic Psychiatry in the Department of Psychiatry at the University of Oxford.

She has a PhD in Kinesiology and Health Sciences and an Advanced Doctoral Diploma in Health Psychology from York University. She has over two decades of academic and clinical trials experience, and she’s one of the authors on this study.

And I think what you might pick up on is she’s very balanced in her reflection on what did this study show and not show, what did we learn from it, what can be done better, how much can we expect from, an initial randomized control trial with 40 people in each group. And she’s really honest and reflective on a lot of those things.

So, I think if you’re trying to decide for yourself what does this study add to what we know, what could it mean for me or a loved one, I think this might help you with that reflection because it really is harder to say is it good, is it bad? Is it positive or negative? We can’t just boil it down to that. So, with all that as the lead-in, I hope you really enjoy this interview with Dr. Megan Kirk Chang.

Many of the interventions we discuss can have potentially dangerous effects if done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications. In addition, it’s important to note that people may respond differently to ketosis, and there isn’t one recognized universal response.

Dr. Megan Kirk Chang, thank you so much for joining me again here at Metabolic Mind. It’s great to see you again.

Megan: Thank you so much for having me. I’ve been looking forward to our conversation.

Bret: Yeah. So the last time you were on, we were talking about your study as it was getting underway, as you were recruiting.

Megan: That’s right.

Bret: And you talked about the motivation and all this. And now, you’ve got the publication in JAMA Psychiatry about what’s being called the DIME trial. So, let’s just jump into it. So, rewind for a second. Tell us what the study was, what you were looking at, and then we’ll get into a lot of the details, the findings and all that good stuff.

Megan: Absolutely. And I remember our first conversation. I had just newly arrived to the UK and just finding my way and getting settled in. So, it’s such an honor to be back with you. But now, we’ve got this trial wrapped up, and it’s a huge success and the way that it’s been in JAMA Psychiatry. So, as I mentioned in our first session, I had the good fortune of arriving to the UK to work with such an incredible multidisciplinary team.

So, we are a team of nutrition scientists. We are behavioral scientists, psychiatrists, epidemiologists that came together to really look at testing in a randomized control trial the effects of a ketogenic diet, a pretty tightly controlled ketogenic diet compared to a placebo sham arm. So, we set out on a proof of concept pilot trial. So, six weeks duration.

And yeah, I’m just so excited to finally say to you that we’ve wrapped up because when we first talked, I was like, “Oh, there’s so much we have to do between now and getting it launched.”

Bret: Yeah. It is funny to think about how time flies and yet goes slow at the same time, depending on how you look at it.

But it’s great that it’s published in, like you said, JAMA Psychiatry, which is an important psychiatry journal. But a lot to learn from the study. So, depending on how you look at the results and what’s being portrayed in the media or how people are talking about it, there was either, it was either a quote-unquote, “negative trial,” meaning no difference between the control and the keto group.

Or it was a positive trial in that both groups improved, and the keto group improved a little bit more, although not statistically significant. So, it’s being portrayed both ways. So, before we get into the setup and all the details, I’m curious, how do you phrase the results or how do you feel about the results of this study and what it means?

Megan: Yeah, and I have really appreciated seeing such a mix of comments in social media and online, and I think that really is a sign of critical thinking about the research. So, one of the things we set out to do right away was to add in a control arm because a lot of the previous research on ketogenic diet trials were looking at single-arm experimental.

So, we wanted to build upon the great work, a great trial coming out of Stanford, a great trial coming out of Edinburgh. We wanted to build upon that work and add in what we felt were additional strengths. Now, one of the things that I’ll say is we had limited budget and limited time. So, a six-week trial is not very long in the grand scheme of things for a dietary intervention.

But proof of concept and pilot work, I think what a lot of people need to realize is that we’re actually just testing for “is there a signal here?” So, that we can go after larger pots of money to do more robust, more robust research. So, it’s been really quite interesting to see the mix of comments out there about the study.

And for myself, when I kind of overall reflect on the findings, I think we really had a positive trial. One of the things that I like to emphasize is that both groups in our trial saw statistically significant reductions in the clinically meaningful range in PHQ-9. So, both groups saw dramatic reductions.

That’s making a difference in people’s lives. We didn’t see the threshold that we set out to between the groups at the end of the six weeks. So, the difference between the keto arm and the phyto arm, while it was modestly significant in favor of the ketogenic diet, it didn’t meet that minimal clinically important difference of a five-point reduction in PHQ-9 that we were hoping for.

Does that mean that there was no improvement? I personally don’t think so. I think we saw a lot of benefits for the patients we worked with. I think we saw a signal that the ketogenic diet, there’s something happening with the ketogenic diet that’s showing a greater reduction in those six weeks.

But then we look at, and what I’m really interested in, is what happened after the protocol, the six-week protocol stopped? We saw a dramatic reduction in people dropping off the ketogenic diet compared to the phyto diet. And so, I’ve been reflecting a lot on why so many people are dropped out. What could we do differently next time to keep people engaged for longer?

Bret: Yeah. So, I really like how you summarized those findings with the PHQ-9 being the depression scale, and clinically significant improvement in both groups. So, just to rewind, these were individuals, who self-reported as having treatment-resistant depression, correct? And how many were in each group?

Megan: Yes. So, the requirement was that they had to have self-reported treatment-resistant depression, which we based on the UK NICE guidelines, which were the use of two, at least two, antidepressant medications for a period of four weeks over the last two months. We did a sample size calculation based on the minimal clinically important difference that we wanted to find.

So, we set out to recruit 100 people, but we saw great recruitment efforts. And we ended up with 88 participants in the trial, 44 randomized to each arm. 

Bret: Great. And then, you said there was a control diet. So, there was a ketogenic diet and a control diet, but the control diet wasn’t just eat whatever you want.

It was, they were encouraged to increase the amount of fruits and vegetables and to decrease saturated fat and were also given a stipend to help with their grocery shopping. So, are you surprised that group did better, too? That they saw improved results, too? 

Megan: Yeah, we set out to make the participants feel like they were part of an intervention, regardless of what arm they were assigned to.

So, I give really big credit to our research assistants and our dietician that did the coaching, for making sure participants believed that they were actually engaging in an intervention regardless of what arm they were in. And so, with the phyto diet, just to add a few details to that. So, we based it on this idea of consuming phytonutrients, and this idea of consuming the color wheel of vegetables.

So, we did a lot of work to understand what color of vegetables participants most predominantly ate. So, say for example, it was green. Then, we said, “Okay, opposite on the color wheel of green is red. So, this week we want you to really amp up red fruits and vegetables. However much and however you want to do, that’s up to you, but we want red to be the focus.”

Both of the groups were matched in dietetic support. So, every week they had on average 10 to 15-minute calls with our dieticians, longer if they needed to. But on average, it was about the 15-minute mark. So, they were matched in dietetic support, but definitely had different protocols in terms of what to eat.

And I was a bit surprised because, in the research that we’ve done leading up to this trial, there’s been such positive, dramatic effect size reductions in people’s mental health symptoms with the ketogenic diet. But with the phyto diet, as I reflect back, one of the things that I think was really meaningful was that it was very easy to implement.

And with our lived experience panel that we worked very closely with, they mentioned a lot that with treatment-resistant depression, like the cognitive fatigue, the cognitive burden that can happen, I think there’s something there when we make things really easy to adopt and easy to follow.

They just had to focus on one different color of a fruit and vegetable. And I think indirectly, that saw some benefit. 

Bret: Yeah. That’s an interesting take-home in and of itself, for sure. And then the keto group, it sounds like they were actually given three meals a day. So, not preparing their own meals, not. You could say on the one hand, super convenient that they didn’t have to. But on the other hand, also they didn’t learn those skills and those techniques and make it like a personal engaged thing either. So, it’s goes both ways. What are your thoughts on that? 

Megan: Absolutely. I feel like I couldn’t have said it any better.

And again, we worked very closely with our lived experience panel, in partnership with the McPin Foundation in the UK. So, an amazing charitable organization that brings lived experience expertise to research projects. And one of the resounding pieces of feedback we heard over and over again was this idea with treatment-resistant depression, the cognitive fatigue and the cognitive burden that we have, it would be really nice to have prepared meals because the ketogenic diet is such a deviation from our typical diet that we eat. That it would be really nice to have those meals provided.

So, we went to town. We found a great supplier. We also found a great snack supplier. So, we wanted to make the ketogenic diet as easy as possible. Now, indirectly, I think as I reflect on that, we may have unintentionally taken away people’s autonomy and some of their cultural preferences. So, for example, different spices, flavorings, lots of different things in the qualitative interviews came up where we were like, “Okay, we made a decision. We went with it, and how could we make this better next time?”

And six weeks, we felt supplying those meals was no problem for six weeks. But if we were to do it again and for a longer period, what are some of the ways that we could build somebody’s confidence and self-efficacy in cooking the meals, preparing them for themselves? How do we make this something that they can maintain and sustain in real-life settings?

Bret: Yeah. That’s a really important point. if you’re going through this, and as you’re doing it, you’re thinking, “I’m never going to do this on my own.” How does that change sort of your engagement? I don’t know. But I also like how you brought up the cultural part, and that’s super important to reflect on because a ketogenic diet isn’t one thing.

It can be carnivore. It can be vegan. It can be vegetarian. It can be Mediterranean. It can be Italian. It can be Mexican. It can be Indian. And all those span the spectrum of what is, quote-unquote, “a ketogenic diet.” So, I think that’s a really good point that you mentioned there about the meal deliveries.

Megan: Yeah, I was just going to say, too, like sometimes you’re at the limitation of your suppliers, right? Like we had an excellent supplier that made ketogenic-friendly meals, and did an excellent job. But they can’t meet all the needs. They didn’t have halal options, for example. And that was something that was asked by participants.

So, where we could, the dietician would step in and offer suggestions. Or if people didn’t want to do the meals, which wasn’t very many overall, but if they didn’t want to do the meals, there was the opportunity to have a grocery voucher to go purchase some foods and try to make some of the ketogenic diet meals on their own.

You learn, and I think that’s the thing with research. And sometimes, I think we can be so quick to criticize research studies when it’s it’s a step. It’s a step, and what can we do to build upon it to make it even better next time? That’s how research really works. So, yeah. 

Bret: But we’re just impatient, aren’t we?

Megan: I know. 

Bret: We want one study to answer all our questions and tell us everything we need to know. 

Megan: It’s true. 

Bret: But it doesn’t work that way. 

Megan: But I have to say, in the two and a half years since we, I think it was two and a half years ago that we had our first podcast together, if you can believe that much time’s gone by.

The community that I have met in the ketogenic diet space for mental illness has, I didn’t know this community prior to arriving to the UK. So, even now, the connections I’ve made, the colleagues across the globe that are doing some incredible work. That’s one of the things that has been the most meaningful for me is now after meeting people, going to conferences, sharing ideas, having conversations. I know that there’s so much more we could do next time to make this even better.

So, it’s been a really wonderful experience. Just a huge learning curve as well for the entire team. 

Bret: Yeah. And I think that’s what I’m going to pat ourselves on the back here at Baszucki Group, but really it’s patting Dr. Julie Milder on the back because she leads the Baszucki Group effort to bring this research community together.

So, the psychiatry researchers are talking to the experienced keto researchers so that you can have one trial that has the best of both worlds because a lot of psychiatrists don’t know about ketogenic interventions, and a lot of ketogenic researchers don’t know about the psychiatry interventions.

And so putting the two together, which Julie has done such a great job of fostering that community, which actually leads me to the next topic about how ketones were measured. Because traditionally, a lot of these studies are using daily capillary finger stick, ketone measurements, which gives you an accurate ketone level.

And since it’s daily, you know what’s going on day to day. Even better, will eventually be the continuous ketone monitors. But in your study, it was at least twice weekly urine ketones, and it looked like some people were doing as infrequently as once weekly. The urine ketones, which is very different.

So, I’m curious your thoughts on that as you reflect back on it. 

Megan: Yeah, for sure. And again, as a researcher, you come up against constantly navigating patient-centered feedback with rigor and methodology. And you know, if I were to make the decision every day of the week, I would always focus on putting patients first.

I don’t know if everyone would agree with that. But one of the things that we felt sensitive to was not making participants feel like we were over-monitoring. Or with treatment-resistant depression, when people lapsed on the diet or made a mistake, there was a tremendous amount of guilt expressed.

That came out in the qualitative interviews that lapses led to shame and guilt and feeling like this all or nothing thinking. And so, when we were thinking about monitoring, there was a couple things at play. One, limited budget, limited time. There’s certain regulations in the UK around continuous ketone monitors that we can’t rush or get around.

And approval processes and regulations and ethics can be bureaucratic and take a lot of time. And we’re under a bit of time pressure to prove to our funders that we’ve got a signal with the work that we want to proceed on a translational pipeline. But then with the so, we went with the urinalysis sticks, which we know aren’t the gold standard of measuring ketones.

But we wanted to give patients something to help with monitoring, and the minimum criteria we asked was for two days a week. Now, looking at the supplementary files in, if people want to go through those many pages in the JAMA Psychiatry, only about twelve percent of folks didn’t monitor their ketone levels.

So, about five participants out of the forty-four, which it’s notable. But it’s not a lot in the grand scheme of things. And I wrote it down here, sixty-nine percent of folks monitored their urinalysis seven days a week on average. So, people did find it helpful, and we also gave them a written tracking to let the dietician know each week what the ketones were over the seven days. But you never know with that kind of reporting.

You never know if there’s social desirability bias or people forget. There’s lots of limitations to that. So, if I were to do it again, goodness, I would love to have a dual continuous glucose and continuous ketone monitor. They’re not currently available. The ones that we want to use aren’t currently available in the UK. But hopefully, that will change in the near future.

But absolutely, I personally think if we were to monitor across a 24-hour period and then coincide that with potentially daily tracking of mood, we could actually see if there were folks at risk of reducing their mental health, and we could intervene earlier if we had that momentary assessment.

So, that’s some of the things I’m thinking about in the future. Yeah. 

Bret: Yeah, and interestingly, you mentioned Dr. Campbell and his colleagues at University of Edinburgh, which did suggest a correlation between the degree of ketosis and symptom improvement in bipolar disorder. And then there was another, a meta-analysis published in JAMA Psychiatry, suggesting the lower the carbohydrates went and monitoring blood ketones correlated with better mood symptoms.

But none of this was published when you started your enrollment, and when you designed your study, right? So, you didn’t have that signal. But it seems like now that would be a really important signal to monitor the degree of ketosis with the most accurate measurement we have to make sure people are getting the right benefit.

But this is, like you’re saying, this is how research progresses. You didn’t have that when you started. So, when you reiterate on it now with taking all the evidence as a whole, maybe you would do things differently? So, I think we have to be gracious to that, and appreciate that things evolve over time, right?

Megan: It’s true. And I think even the blood, the plasma continuous ketone monitors or the Keto-Mojo, for example, are looking at levels of beta-hydroxybutyrate in the blood, but the urinalysis is looking at acetoacetate. And I think, for me at least, there’s still a question around is that 1.0 millimoles per liter of acetoacetate equivalent to a 1.0 beta-hydroxybutyrate level?

Are those one and the same? I don’t necessarily know the question to that. And then there’s breath monitors coming out and being developed as well. So, I think there’s a really big opportunity to continue to evaluate what is the optimal threshold. We didn’t see in our patients any significant difference based on the minimum thresholds of ketosis, that 0.5 mark right up to 4.0.

We didn’t. We analyzed for that. So, it makes me wonder, was that maybe not the best way to measure ketone levels, or was there something else driving the reductions in depression, like the dietetic support, for example? So again, more questions, which I think is a good thing, but more questions come out of your findings.

Bret: Now, a couple times you’ve referred to some of the qualitative data that you collected. So what else s- stood out for you with the qualitative data? 

Megan: Yeah. I think right away one of the biggest things that stood out for me was how many people spoke about carb as comfort. So, their comfort foods of cakes, sweets, breads, pastas, those cravings and temptations were really magnified over the six weeks.

And that leads me to think maybe six weeks isn’t long enough to really get people into the state of ketosis that’s actually yielding that mental clarity or that energy or that feel-good feeling that we were hoping for? Because cravings and temptations were reported a lot. And then, not in a lot of people, but in a small subgroup of folks at the end of the six weeks, it’s almost like people rewarded themselves by returning to some of their cravings.

So, whether that was returning to smoking, which was interesting, or returning to rewarding themselves for finishing the ketogenic diet with a piece of cake. I think there’s something to be said around impulse control and cravings that is worth looking at, and also looking at the influence of the ketogenic diet on cognitive processes.

So, that’s something I’m really interested in as we’ve wrapped up this trial is looking more into mindset, cognitive processes related to cravings and temptations regulation. Those are things that I think came out a lot. But one of the things to say is a lot of people reduced their medication prescription.

Some people even came off medication. So, there was a lot of really positive things. We didn’t interview the phyto arm like the control arm. So, can’t really draw any comparisons there. But we did see a lot of people really benefit from being on the ketogenic diet and implement smaller strategies beyond.

So, someone bought a spiralizer, for example, to have zucchini noodles because they really liked using that as a replacement. Folks really talked about wanting to reduce their carb load. But again, I think the six weeks was a short time period. And perhaps we’d see more sustained effects if we had a longer trial, which is being planned currently. 

Bret: Yeah, and it’s important to reflect on why this is so important to do? Like why this research is so important? These were people, like you said, who had been on two antidepressants for at least four weeks who are not benefiting, and that’s standard of care treatment. And these people want to get their lives back. So, it’s so important to try and help them find ways.

So, I’m so thankful that you are doing this research, and that you’re so passionate about this. And that you’re reflecting and learning from this study to design other trials. So, you just referenced the one that’s in plan. So, what is planned for next? Tell us more. 

Megan: Before I do that, the one thing as you were saying about treatment-resistant depression, and just if I may for a minute because I want to make sure I give voice to the incredible group of participants we worked with.

A lot of people had assumptions about what the ketogenic diet was prior to starting. So, we elicited that in the qualitative interviews. A lot of people felt like it was your typical bacon and cheese, or a lot of people said, “I had no idea of the link between diet and mental health.” And so, I think there’s a really big missed opportunity across the globe around how you fuel internally.

What you put into your body is going to be reflected in your mental well-being and state of mind. And so that was something that came out. A lot that people were like, “I had no idea that diet had any impact on my mental health.” And so, many of the people that came through were sick and tired of being on a concoction of medications.

I’d say the majority of folks in our trial resoundingly said they don’t want to be on medications for life. That’s not what they want to do. They want to look for an alternative. And I think we really showed that the ketogenic diet could potentially be an alternative approach. Not to replace medication, but as something that could potentially support.

So, I just wanted to give voice to the participants because they shared a lot about where they were at and what made this easy and what made it difficult. 

Bret: And just to expand upon the medication thing for a second. We see that a lot in the type 2 diabetes literature that you can compare to control, and the hemoglobin A1c is better in the keto group than the type 2 diabetes group or than the control diet group.

But they’re also like half the people came off their medications or on their half the amount of medicine. So, to do better with fewer medicines is much more powerful than simply doing better. So, that would be interesting to see in future studies as well. I, again, one study’s not going to answer every question, but just wanted to throw that out there.

Megan: Yeah, and that’s so interesting because I’m also interested in like responders versus non-responders, and what’s the marker that makes somebody really respond well to a ketogenic approach and what makes people not respond? So again, way more questions than I have answers to at the end of this, but I think that’s a sign of good research. And now there’s so many areas that we can go.

So, you’d asked about about a study and so a couple of things. The PI, Dr. Min Gao, who did an excellent job on this trial, is now continuing on to explore a longer intervention period with a different patient population. So, clinically high-risk psychosis, and I hope you get the opportunity to chat with her about that. And I think it’s going to be a fantastic study coming out.

And then I’ve put in a few different grant bids. I won’t hear for a few more weeks, but a few different grant bids to look at focusing and targeting in on midlife. And I’m really interested in this idea of chronic mental illness across the life course and subsequent risk of dementia or cognitive decline in later life.

And I really feel like we can’t wait until cognitive impairment is diagnosed. We need to really hit people at that midlife stage before the cognitive decline becomes irreversible. So, I’ve put in a few grants to look at exploring the ketogenic diet with cognitive endpoints, like memory and learning, and things like that because that was something that we didn’t do in the DIME trial, but certainly am very interested in.

And then, the other piece that has been really exciting is I was awarded an NIHR Innovation Fellowship last year to work with an industry partner. And I’m currently working with a fantastic company in Toronto, Canada, that is exploring the development of AI-assisted meal analysis for ketogenic diet adherence.

So, participants can take a photo of their meal. They don’t have to search up every ingredient or weigh it out. They can take a photo. It will populate the macronutrient content. So, your protein in grams versus your fats versus your carbs. And then it will, through positive psychology and motivational interviewing, it will generate personalized insights on how to improve or enhance that meal to be more ketogenic the next time.

And so, that’s been an amazing opportunity to see the academic industry partnership and then look at things like user-experience and user-interface. And how do we make this for folks that really, like how do we get people to stick to taking photos of their meals and staying on their diet program?

So, more to come with that, but that’s been a couple of different things that I’ve been up to since this study. Really to try to improve adherence and to really get people to engage in the diet for the period that we set out to get the maximum return on investment hopefully. 

Bret: That sounds like a fantastic venture.

When you have a prototype or when it’s working, let me know. I want to try it. No, I definitely want to try it. 

Megan: Oh, I am. I am their guinea pig right now. And I will tell you, since I attended the Metabolic Psychiatry Retreat in November in Washington, I have been following the ketogenic diet myself, and I have lost 12 kilograms, and I feel fantastic.

And I think it’s really been great because I want to be a researcher that never asks my participants to do something I wouldn’t try. So, it’s been really great to be on the ketogenic diet. 

Bret: Oh, that’s fantastic. You, need to talk to Dr. Deanna Kelly and, her Livit launch it. So they live, th- they get into ketosis themselves so they can learn about it, and then they launch it in their practice to help others do it.

So similar. 

Megan: Okay. 

Bret: So to get clinicians doing it themselves to learn about it. Yeah. 

Megan: Yeah. Deanna’s a bit of a celebrity status for me, but maybe after this I’ll reach out to her. 

So, yeah. 

Bret: She’s wonderful. Yeah, great. So this has been an incredible interview. I really appreciate your reflections and your learnings from the trial, and your honesty about what it did and didn’t show and all the questions it raises.

I think that’s such an important way to analyze research, and sounds like you have a lot of exciting projects. 

Megan: And I think I attribute, I do want to attribute that to the DIME research team that was involved in this because I think what we really set out to do in the manuscript was to think critically about the limitations of the study, and really represent those limitations well.

So, I think we saw a lot of success. We tried something different. We added to the field by bringing in a control arm that hasn’t been done before. We did a lot of things really well, but there was a lot of learnings and a lot of things that now we’re going to take forward and continue to advance on. And to me, that’s good research. You can’t do all the things in one study, as you said. I would love to. 

Bret: Eventually, eventually. Great. 

Megan: Yeah. 

Bret: I can’t wait to hear more from you. And if people want to hear more from you and learn more from you, where can we direct them to go? 

Megan: Absolutely. So, I will post my email in the podcast, but people can reach out to me directly at meghan.kirkchang, all one word, at psych.ox.ac.uk.

People can email me. They can find me on LinkedIn. And I’m always happy to engage in respectful critical thinking of the research. 

Bret: Great. Thank you so much for joining me. I really appreciate it. 

Megan: Always great to see you. Thanks so much. 

Bret: I’ve got to say, I think that was one of my favorite sort of post-study interviews.

I loved how Dr. Kirk Chang was really so balanced in her analysis, and it brings up how it’s really hard to say was it a positive study? Was it a negative study? Was keto good? Was it bad, right? It’s not so cut and dried. And really the analysis of the strengths and the weaknesses and being honest about your own study, of course.

If you put your blood, sweat, and tears in this study, you want it to be perfect. But no study’s perfect. And like we said, no study’s going to answer every question, and you have to do with what you have at the time and build upon it. So, I really liked her reflections on the study, and what she can and is doing differently for future studies.

But to really bring it back to the core, for this group who self-reported as having treatment-resistant depression, they all improved, with the ketogenic group improving a little bit more. And even with all the pluses and minuses of the study, the point is everybody got better, and that’s pretty remarkable for any nutrition intervention.

And so with all these different changes, will a ketogenic diet show even more improvements for a longer study with more intensive ketosis monitoring, et cetera, et cetera? We’ll find out. Those studies are being done. But this definitely goes into the group of ketogenic interventions for mental health.

It goes into that group of research so that we can all learn from it and build for the future. So, I’m really thankful that, Dr. Kirk Chang took the time to join with us today and talk about all these details. Hope you enjoyed it, too, and you learned from it. And we’ll see you here next time at Metabolic Mind.

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