Keto Diet May Alleviate Depressive Symptoms, Researchers Say

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Mental illnesses such as depression or anxiety disorders are widespread. In recent years, research has increasingly focused on the role of nutrition. A specific diet form—the ketogenic diet—is suspected of positively influencing mood. A new analysis of 50 studies now examines whether this diet can actually help.

What Was Studied and Why?

The ketogenic diet was originally developed to treat epilepsy. It is based on a diet very high in fats and proteins and very low in carbohydrates. The body switches to using so-called ketone bodies as an alternative energy source, a state known as “ketosis.”

Researchers are now also interested in the potential effects of this diet on mental health. Many mental illnesses, such as depression or bipolar disorders, are associated with inflammation, metabolic disturbances, and an imbalance of neurotransmitters in the brain.¹ Ketone bodies could potentially regulate these issues.

The aim of the current investigation was to scientifically determine whether a ketogenic diet affects mental symptoms such as depressive moods or anxiety, and if so, under what conditions. The result: In controlled studies, a clear connection was found with depression—but not with anxiety.

How the Study Tested Whether Ketogenic Diet Affects Mental Health

The evaluation is a systematic review with a subsequent meta-analysis. It was conducted according to recognized scientific standards and registered in advance.²

A total of 50 studies with more than 41,000 adult participants from 15 countries were included. These included both randomized controlled trials (RCTs), which are considered particularly robust, and so-called quasi-experimental studies (QSEs), which did not have a direct comparison group.

Only studies where participants received a clearly defined ketogenic diet—very low in carbohydrates—and where changes in mental symptoms were measured using standardized questionnaires were included.

Additionally, researchers examined whether certain factors, such as evidence of ketosis or body weight, influenced the effect.

Studies Show Effect on Depression—Evidence Lacking for Anxiety

In controlled studies, it was found that a ketogenic diet was associated with a small to moderate reduction in depressive symptoms. The effect was particularly strong when participants had demonstrably reached the state of ketosis. Even individuals without significant overweight benefited more. Studies with comparison diets high in carbohydrates, however, showed no significant effects.

For anxiety disorders, the picture is different: In nine controlled studies with a total of 672 people, no statistically significant connection between a ketogenic diet and an improvement in anxiety symptoms was found.

More pronounced effects were observed in the so-called quasi-experimental studies. There, noticeable improvements were seen in both depression and anxiety symptoms. However, these studies lacked a comparison group—a second group that did not receive a ketogenic diet. Therefore, it remains unclear whether the positive changes were actually due to the diet. It is also conceivable that other factors, such as personal motivation, belief in the effect, or accompanying lifestyle changes, played a role. Such influences can only be reliably excluded in strictly controlled studies.

What Do These Results Mean?

The analysis suggests that a ketogenic diet can alleviate depressive symptoms under certain conditions, especially when the diet is strictly followed and the state of ketosis is achieved. The effect was particularly pronounced in non-obese individuals.

For anxiety symptoms, however, the study situation remains contradictory. Some open studies report positive changes, but strictly controlled investigations have not yet been able to replicate these effects.

Biologically, the effect also seems plausible: Ketone bodies could reduce inflammation in the brain, improve energy supply, and positively influence the balance of neurotransmitters such as GABA and glutamate.

Nevertheless, caution is advised: The diet is not suitable for everyone. Possible side effects include fatigue, digestive problems, or headaches. In rare cases, especially when taking certain medications such as SGLT2 inhibitors, a dangerous metabolic imbalance can occur.

Where Are the Weaknesses of the Analysis?

Despite the large amount of data, the study has some limitations. The studies were very differently structured—for example, in terms of duration, composition of the diet, participant support, or type of control. A central problem was the unreliable evidence of ketosis. Many studies did not consistently check whether participants actually reached the desired metabolic state, although this appears to be closely linked to the effect.

Additionally, many studies were only conducted over a few weeks. Whether the observed effects are sustained long-term or how practical a ketogenic diet is in everyday life remains open. It is also important: The results should not be understood as a general recommendation. The studies provide indications of possible effects—but they do not prove that a ketogenic diet fundamentally helps with mental illnesses or replaces other therapies. The role the diet can play in the long term must be clarified through further research.

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