Okay...well...hmm...
Keto diets might be effective for modulating a lot of things, and they might not. Is this theory totally "revolutionary?"
No.
There is a lot of suggestive research indicating a lot of "maybe" stuff when it comes to these diets, and various MDs write non academic books for public consumption that weave a very convincing narrative for whatever specific diet they're promoting. But we in the medical world take these books worth a grain of salt.
This research exists in all of our worlds, it's not like it's being ignored. Plenty of medical courses are now teaching that keto and intermittent fasting are reasonable recommendations for various conditions and as the clinical success add up, so will the recommendations. However, overstatements from MDs trying to sell books tend to actually slow the dissemination of these approaches.
These MDs get skewered by actual scientists for overstating what the research actually says for the sake of a more convincing narrative. The narrative is NEVER that convincing in reality, unfortunately. The science is more like a lot of "well maybe" and "needs further study."
The thing with diet is that it's impossible to study properly. We can't design studies that reliably control people's eating for extended lengths of time. That's why when it comes to how diet affects the body, it's mostly just a shrug and a "maybe?"
Plus the vast majority of nutrition science is commissioned and paid for by industry, so what's out there mostly just very expensive advertising dressed up as science. I'm not saying that's the science this dude based his conclusions on, I'm just saying that's why there isn't better science for him to cite.
The world of medicine and nutrition and how they interact has always been a "fucked if we know" hand waving kind of trial and error mess where myths frequently get mistaken for facts, and entire policies get based on them. It's unfortunate.
Is a keto or intermittent fasting diet worth trying if you have a complex health condition? Yep.
A complex mental health condition? Yep
Can we say much beyond that?? Not really, not with any degree of certainty, and certainly not with a legitimate, highly convincing narrative that's actually scientifically defensible without endless hedging language like "may have an impact" and "could be causal" and "is still unknown" and "requires more research."
But we clinicians often get a little bolder in what we've come to understand and believe based on our extensive clinical knowledge, which is legitimate. If these doctors just said "I read some cool shit, thought it might work, and then it did!" I would be like "cool, me too, isn't it fun when you find shit that works?"
That's how medicine works. We don't actually have solid science behind a lot of our treatments. We have clinical experience. It's totally legitimate to promote a treatment approach based on clinical experience without claiming your approach is scientific, because most of the time it isn't.
That's what drives a lot of us batty. Especially folks like me who have done research AND clinical work.
It's like Dr. Jason Fung. I don't doubt for a second that he gets great clinical results with intermittent fasting for his patients. That's cool. But then he goes and writes these ridiculous, very convincing for lay people, books that overstate the research instead of just resting on his clinical laurels of "I tried this and it worked!"
I don't doubt for a second that diet is a major contributor to mental health. I think pretty much everyone has known this to some degree for many, many years.
Exactly the relationship? Impossible to say at the current level of scientific knowledge. Can I believe that a psychiatrist would get much better results putting everyone on a keto diet? No doubt! That's very easy for me to believe.
Do I buy his complex, highly convincing narrative as to *why* any of this happens? Eh...not so much.
It's not like he has special access to science that the world of experts doesn't.
At best, he has a theory, he has clinical knowledge (highly valuable), and he has a good understanding that the existing science doesn't contradict his theory.
That's pretty impressive. It just doesn't sell books to lay people.
Are we looking at a future where mental health is eradicated by keto diets? Lol, I fucking doubt it. But in the distant future, we could be looking at a future where genes are analyzed and eating profiles are generated for each individual to stave off various health issues.
My point is, everyone is affected by their diet. But we're nowhere near a point of understanding exactly how, or what that means for individuals.
However, IF and Keto are much more harmless interventions than most drugs, so it's totally reasonable to recommend it as an intervention for patients with substantial mental health issues.
If this very convincing book helps with patient compliance, then there's some value there I suppose. But does it offset the damage of lowering the credibility of the keto/IF for medicine approach?
Not sure.
My entire last few years of my career were centered on a scientifically unproven treatment that was clinically known to work well for most patients with a particularly hard to treat condition.
It exploded into popularity and the "scientific" claims of its inventor were right in line with the medical trends of the era, but they were a huge overstatement, just like most associated with this trend were.
As the overstatement was debunked, many of the associated treatments were thrown out. As was this particular one. The tragic part was that the reason it worked had nothing to do with the trend. The inventor's explanation for why it worked was flat out wrong. As were his explanations for the cases where it didn't work.
Years later some clinicians figured out how the treatment actually worked and also figured out how to make it much more effective.
Unfortunately by that point, the damage of the theory having been debunked was already done. The treatment was almost universally denounced as "quackery" and no one was willing to pay thousands of dollars to learn how to do it anymore, and anyone who said it actually works was seen as falling for quackery.
This is the main risk I see in overstatement of scientific explanations that don't really exist.
Do I think diets should play a much bigger role in mental health management? Absolutely. As someone who is a former neuroscience researcher, a former clinical medical professional, and currently training as a mental health professional, I will absolutely be keeping my eye on what comes along in terms of "best practices" for recommending diets to clients.
However, I worry that the over eager, profit driven, overstatement of theories in books for lay consumption could cause the same kind of reputational damage that happened in my previous area of expertise.
It's the same way that the book "Wheat Belly" made diet recommendations that helped millions of people, but once the author was proven to be ridiculously overstating the science, that's it, his books stopped being able to help anyone.
If these doctors just stuck to the discourse that they KNOW is medically and scientifically valid, they wouldn't run this risk of having their own area of expertise tarnished with the "quack" label.
But that wouldn't make them as much money :(
