Abstract
Members of online bipolar disorder forums often report experiences of mood-stabilisation on the ketogenic diet, which has traditionally been used in the treatment of epilepsy. We examined the nature and extent of such reports. To investigate associations between a ketogenic diet and mood stabilisation among individuals with bipolar disorder. We undertook an observational analytic study of free-text comments in online forums about mood effects of dietary interventions (ketogenic, omega-3 enriched or vegetarian) classified by a priori categories of change in mood stabilisation in 274 people with bipolar disorder. There were 141 (85.5%) free-text comments on ketogenic diets that reported a positive impact on mood stabilisation. Reports of significant mood stabilisation or remission of symptoms over a period were substantially higher for a ketogenic diet than for other diets (93/165, 56.4%, 95% CI 48.4-64.1) v. 14/94, 14.9%, 95% CI 8.4-23.7), odds ratio 7.4, 95% CI 3.8-14.1, P < 0.0001), many with detailed reports of the improvements experienced and several lasting for extended periods (months to years). Other reported associations included fewer episodes of depression (in 41.2%, 95% CI 30.6-52.4 of individuals); improved clarity of thought and speech (28.2%, 95% CI 19.0-39.0); increased energy (25.9, 95% CI 17.0-36.5); and weight loss (25.9%, 95% CI 17.0-36.5). Despite the inherent limitations of the observational data based on self-reports posted online, the association strength and reports of sustained benefit support a hypothesis of a ketogenic diet being associated with beneficial effects on mood stabilisation. Caution should be exercised in interpreting this data until a controlled trial can be carried out to examine this hypothesis. These preliminary observations are generally consistent with a mitochondrial dysfunction component to bipolar disorder aetiology with ketones bypassing a block between glycolysis and the tricarboxylic acid cycle. None.
Highlights
Members of online bipolar disorder forums often report experiences of mood-stabilisation on the ketogenic diet, which has traditionally been used in the treatment of epilepsy
There were 141 (85.5%) free-text comments on ketogenic diets that reported a positive impact on mood stabilisation
Reports of significant mood stabilisation or remission of symptoms over a period were substantially higher for a ketogenic diet than for other diets (93/165, 56.4%, 95% CI 48.4–64.1) v. 14/94, 14.9%, 95% CI 8.4–23.7), odds ratio 7.4, 95% CI 3.8–14.1, P < 0.0001), many with detailed reports of the improvements experienced and several lasting for extended periods
Summary
We undertook an observational analytic study of free-text comments in online forums about mood effects of dietary interventions (ketogenic, omega-3 enriched or vegetarian) classified by a priori categories of change in mood stabilisation in 274 people with bipolar disorder. Since there are several websites with large followings that are dedicated to bipolar disorder we decided to employ text mining to investigate reports of mood stabilisation associated with adoption of a ketogenic diet. To account for reporting biases in online forums we adopted an observational analytic study design with a ‘control’ group by comparing reports of ketogenic diet with similar reports for other ‘control’ dietary interventions (omega-3 enriched or vegetarian) that have. 2019.49) and we conducted parallel independent scoring that was partially masked to diet category (the first reviewer prepared edited versions of online posts for the second reviewer with dietary details redacted to the extent that this was possible). To control for ‘herd’ effects in specific online forums we sought independent replication of findings in different online resources: in a large bipolar disorder online forum (study 1) and by data mining other online bipolar disorder forums (study 2)
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