Comment by jdietrich | Hacker News Reader

Comment by jdietrich | Hacker News Reader

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>I can't help but think "finally" and "told ya so" regarding this news.

I don't want to dismiss your personal experiences, but I think that's the wrong conclusion to draw.

Common mental illnesses - particularly depression and anxiety - have incredibly high placebo response rates. Everything looks like a promising treatment for depression in an uncontrolled trial. You can pick practically any intervention - including literal sugar pills - and get ~40% remission rates in an open-label pilot study. Many thousands of potential treatments supported by plausible theories, anecdotal accounts, case reports and small uncontrolled trials have fallen flat as soon as they were tested rigorously. The base rate suggests that the chance of a keto diet (or any other intervention with this level of evidence) being an effective treatment for depression is on the order of 0.1%.

If keto works for you then you should stick with it. The problem is that it's overwhelmingly likely to be no more effective for other people than a low-fat diet or a low-GI diet or sugar pills or faith healing. Articles like this one do a huge disservice to patients, because they completely neglect the base rate and perpetuate a cycle of hype and disappointment that can ultimately lead to distrust and despair.

https://pubmed.ncbi.nlm.nih.gov/7945737/

Jeez, chill out.

You have zero proof & did zero research on this person, yet trying to put someone who down sees profound benefit with the good old: "it's just placebo".

Just because there is no direct studies backing it up yet doesn't mean there isn't real effect. Could be keto, could be lack of certain starches or other foods, could be the focus & rhytm, whatever it is let's not discourage someone who is having a great practical benefit.

In this case there is literature & studies on epilepsy and keto, and OP was on put on epileptic medicine & describes a link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361831/

>You have zero proof

Proof of what? I fully accept that this guy finds keto really helpful and I have made no effort to dispute that. There is a world of difference between "a thing that some people find helpful" and "an evidence-based clinical intervention".

>Just because there is no direct studies backing it up yet doesn't mean there isn't real effect.

The entire point of my comment is that the chance of there being a "real" effect (i.e. greater than placebo) is extremely low. That isn't the same as saying "this is definitely, 100% bogus".

Your chance calculation has zero arguments & zero proof.

You do know things can be effective without evidence-based clinical trials?

Just because there isn't any clinical trial done on it, doesn't mean it defaults to a placebo effect. What makes this case even more convincing is that there is literature on Epilepsy and keto, and OP was on put on epileptic medicine before: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361831/

Everything new, and old but unprofitable, lack clinical trials. Clinical trials are extremely hard and expensive. Especially on complicated issues with hard to control variables: for instance mental issues with similar symptoms might have different causes.

Clinical trials are trying to prove what works safely for a large group, that's it, nothing more.

It is actually not low. There are numerous studies on how cutting out gluten has positive health outcomes for schizophrenia, epilepsy, and autism. [1,2,3] Not to mention numerous anecdotes from diabetics about how going on keto got them to reduce or stop using insulin.

As someone who has allergies and a ton of symptoms that were alleviated by cutting out foods, it is really tiresome to hear that it is placebo or it is psychosomatic. Before I knew it was allergies and had the test in hand, I just had to grin and nod along when someone said my chronic sinus headaches were essentially make believe. Now I have a piece of paper that confirmed just about every food I had cut out or naturally avoided.

You are clearly not familiar with the research in this area. People dealing with mystery symptoms that are cleared up by cutting out certain foods will generally be. Maybe hold off on telling them it is placebo?

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6606425/

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6586915/

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3747763/

> chronic sinus headaches

As I am writing this, I am going through something like this. Over a longer period of time I have made myself believe that it is related to what/when I eat etc. If you can, could you share what were the triggers for you?

I’m not drawing any conclusions or promoting it for anyone else. I’m expressing excitement that there is clearly _something there_ that other people see too and are willing to put through research rigor. It’s validating to see that others might have found treatment this way in their own vacuum and is worth looking into.

Regarding placebo - they do touch on this in the article. I have pretty high confidence it’s not placebo for me. But that’s the point, we just don’t know yet and all I’m saying is I’m glad we will soon know more based on my experience.

It's questionable whether it's placebo, or whether the placebo intervention itself is a non-placebo intervention.

To partake in a study you need to get out of the house, go somewhere new, talk to new people a few times, do something new, get some daylight, etc. Those are all things we know has a positive effect on depression.

Big part of treating depression is to make people do those sorts of things, despite their bodies and mind screaming stay in bed, it's not worth it.

Did you read the story, OP has no depression but BiPolar with psychotic episodes and was previously put on epileptic medicine

Right, and I was responding to the remarks made in the parent post about depression.

Except OP has noticed that when they go out of ketosis everything gets worse again. They've effectively run numerous trials on themselves.

Surely you realize that this not an effective test against the placebo effect.

If society wants to determine if X is generally an effective treatment for Y, there need to be robust experiments that involve multiple people as subjects.

If, however, one guy feels a lot better doing X, and feels worse they stop doing X, then sure, that person should probably keep doing X. Why does X work for that person? Who knows?

> Common mental illnesses - particularly depression and anxiety - have incredibly high placebo response rates.

In my experience, both long term, major depressive disorder and generalized anxiety disorder only substantially improve through understanding, which of course is realized in at least 2 ways: experience and/or therapy.

We can say with some certainty that antidepressants' effectiveness is questionable, at best, long term, but of particular interest for effective indication would be any number of psychoactive substances, which routinely make headlines for this type of treatment but remain taboo for some still yet to be resolved reasons.

Of course this ultimately boils down to personal choices, but attitudes towards drugs will change before we see any real progress in this area, I'm afraid.

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