# A retrospective evaluation of an online group ketogenic metabolic therapy intervention on mental health outcomes

## TL;DR

An online group program using a ketogenic diet showed significant improvements in depression and anxiety symptoms over 12 weeks.

## Contribution

This study demonstrates the feasibility and effectiveness of a remotely delivered, group-based ketogenic metabolic therapy for mental health.

## Key findings

- Mean PHQ-9 scores decreased by 62% over 12 weeks, with 71% of participants showing clinically meaningful improvement in depression.
- Mean GAD-7 scores decreased by 46%, with 79% of participants showing clinically meaningful improvement in anxiety.
- Participants maintained high adherence to the ketogenic diet, achieving blood ketone levels > 0.5 mmol/L 85% of the time.

## Abstract

Conventional treatments for depression and anxiety, including pharmacotherapy and psychotherapy, often fail to achieve long-term symptom remission and are associated with side effects, limited accessibility, and high attrition. Ketogenic metabolic therapy (KMT) has emerged as a potential adjunctive intervention, with studies showing improvements in metabolic and mental health outcomes. However, research on remotely delivered, group-based KMT remains limited. This study evaluates the feasibility of an online, group-based KMT program integrating psychoeducation, professional guidance, and community support on symptoms of depression and anxiety in adults with varying mental health conditions.

A retrospective evaluation of 19 self-referred participants with baseline PHQ-9 and GAD-7 scores > 4. Participants followed a ketogenic diet tailored to individual macronutrient targets. Depression (PHQ-9) and anxiety (GAD-7) were assessed at baseline, 4, 8, and 12 weeks.

Mean PHQ-9 scores decreased from 13 to 5 over 12 weeks, representing a 62% reduction, with 71% achieving clinically meaningful improvement. Mean GAD-7 scores decreased from 13 to 7, a 46% reduction, with 79% achieving clinically meaningful improvement. Eight participants reached remission for depression and nine for anxiety. Participants achieved blood ketone levels > 0.5 mmol/L 85% of the time, indicating high adherence with mean ketone levels of 1.1 mmol/L. No serious adverse events were reported, and all participants completed the intervention.

This remotely delivered, group-based KMT appears feasible and was associated with clinically meaningful reductions in depression and anxiety over 12 weeks. These findings support the potential of KMT as a scalable, transdiagnostic approach to conventional psychiatric care. Future research should evaluate larger samples and longer-term outcomes.