Your experiences with the low-carb “MAD” movement got me thinking: I remember you wrote years ago about a study comparing the cognitive effects of a ketogenic low carb-diet with a non-ketogenic diet, and how the keto diet showed negative effects. Great question – and after my experiences with the online low-carb ‘community’ and a certain of their incoherent ‘gurus’, I couldn’t help but wonder the same thing.
Is this a case of the diet causing people to behave irrationally, or irrational people being attracted to this style of eating? After observing the antics of low-carbers and other dietary sectarians, and reviewing the research examining the actual effects of diet on mood and cognition, I’m inclined to think that a combination of all the above factors is in play.
A study that compared a high-carb meal, a high-protein meal, or a meal containing equal amounts of protein and carbohydrate found the latter two provided superior cognitive performance after the meal[Fischer K]. Short-term comparisons also indicate that the type of carbohydrate consumed has an affect on subsequent cognitive performance; low-glyemic index (GI) carbohydrates produce better memory recall than high-GI carbohydrates[Benton]. The problem with these acute short-term studies is, while they show us what happens in the hours following a meal, they don’t demonstrate the potential dietary-induced changes that may occur in one’s mood and cognitive state over the longer term.
In 1982, researchers from the University of Vermont compared two 827-calorie diets, one containing zero carbohydrate, the other containing 29% carbohydrate (60 grams). After six weeks, STAI-T scores showed the subjects in both groups were significantly less anxious.
Although ketone concentrations were significantly higher in the zero carbohydrate group, there were no differences in fat loss between the two groups, further confirming the fallacy of the “ketosis = greater fat loss” theory.
A more recent but slightly shorter study by Tufts University researchers involved nineteen women who self-selected a low-carbohydrate or a diet similar to that recommended by the American Dietetic Association (ADA diet). Researchers from the CSIRO (Commonwealth Scientific and Industrial Research Organisation) in Adelaide, Australia compared the effects of a low-carbohydrate, high-fat diet with a conventional high-carbohydrate, low-fat diet on mood and cognitive function.
After eight weeks, mean scores on the Beck Depression Inventory, Spielberger State Anxiety Inventory and Total Mood Disturbance of the Profile of Mood States psychological questionnaires had improved similarly on both diets. Noting that most studies on the topic were relatively short in duration, the CSIRO researchers later published a 12-month report[Brinkworth].
Scores on the Beck Depression Inventory, Total Mood Disturbance of the Profile of Mood States and anger-hostility, confusion-bewilderment, and depression-dejection subscales of the Profile of Mood States decreased (improved) initially in both diet groups and tended to remain low in the high-carbohydrate group but rebounded toward baseline levels over time in the low-carbohydrate group.
So here we have the longest-running study so far, and it showed significantly worse psychological outcomes for the low-carbohydrate diet.
The researchers were quick to point out that the present findings were limited to “healthy, obese, young to middle-aged adults with normal mood state and cannot be generalized to clinical populations”. The paper analysed both physical and psychological symptoms experienced by the two groups, including "negative affect", "fatigue", "somatic symptoms", "physical effects of hunger", "insomnia", "hunger", and "stomach problems". So here we have the only study that has reported significantly more favourable psychological results for a low carbohydrate diet, and guess what? Not only that, but instead of using widely accepted and validated psychological questionnaires, the researchers of this study chose to use the “Atkins Health Indicator Test (AHIT)”. Any impartial observer would feel much more comfortable if the researchers had used established psychological tests devised by detached researchers, rather than a non-validated one invented by the promoter of one of the diets being studied.
As another group of researchers commented, this study “was limited in that mood was not assessed using validated scales. Another glaring discrepancy in this study was the fact that only the Atkins dieters received nutritional supplements. So to sum it up again, the only study showing superior psychological effects for a very low-carb diet was conducted by Atkins-sponsored researchers, one of whom was Atkins himself, used a psychological questionnaire designed by Atkins, and administered nutritional supplements including omega-3 fats to the low-carbohydrate group only. It’s worth mentioning another study that, at first glance, appears to support favorable psychological outcomes on a low-carbohydrate diet. It bears keeping in mind that the above studies were conducted in generally healthy volunteers carefully screened to exclude those with psychiatric problems. At the age of forty-seven and weighing 252 pounds, the patient decided to go on the Atkins diet. Although she believed her diet was connected to these symptoms, she did not stop the diet because she had lost over seven kilograms.
Interestingly, last year I received an email from a friend in New York, telling me about a fellow at his gym who experienced anxiety attacks while on the ketogenic “induction phase” of the Atkins Diet. The dieter is indeed doing something wrong: following a nutritionally inadequate diet promoted by biased and clueless individuals who have not thoroughly and impartially researched said diet. The ketogenic variants of low-carbohydrate diets have, overall, returned poorer psychological and cognitive results in research than higher carbohydrate diets. Because I can’t get inside the heads of all these people (and probably wouldn’t want to even if I could!), I can’t say with any scientific sense of certainty. Similarly, vegan and fruitarian diets, whose followers have also been known to engage in some rather whackopathic behavior, can induce various nutrient deficiencies, including those of B12 and essential fatty acids (both crucial for neurological health). Virtually everything Billings has reported in his observations can also be applied to the low-carb movement. In the dietary arena, this us-versus-them mindset leads to the development of absolutist attitudes that cause dietary devotees to brand outsiders as inferior or even evil. Low-carbohydrate followers meanwhile, have been so thoroughly indoctrinated about the “evils” of carbohydrates that they frequently exhibit a phobic attitude towards this naturally occurring macronutrient. Low-carbohydrate devotees routinely exhibit a deep sense of distrust and often hostility towards those who make favourable public commentary about carbohydrates. Let’s be perfectly frank: when you’re talking about the kind of people who purchase, read, and take seriously the kind of biased infomercial-like tripe found in most popular low-carb diet books, you’re not exactly talking about the most intelligent and reasoning demographic. Low-carb authors, with their promises of quick easy weight loss and their metabolic advantage theories that apportion blame for obesity not to the dietary and lifestyle indiscretions of the reader but to “evil” carbohydrates, insulin, and the low-fat movement, have successfully pushed yet another common human hot button. The metabolic advantage theory, by proclaiming we can eat more and still lose weight, appeals to the widespread albeit childlike wish to have our cake and eat it too.
In contrast, information that conflicts with what we want to believe is discomforting and upsetting. In other words, the participant's brains had little problem handling negative information about the opposition party candidate, but started ‘freaking out’ when faced with negative information about the candidate from their favored party. I suspect the irrational behavior that characterizes certain segments of the dietary arena, including the low-carb arena, is a mix of several factors, including the convergence of several deeply ingrained human traits that may have served protective functions in simpler primitive times, but often lead to self-destructive outcomes in today’s far more complex information-rich society. It’s not unreasonable to suspect, given the findings of the research discussed above, that negative psychological effects of ketogenic low-carb diets may exacerbate this kind of behavior. Atkins also dismissed the results of a ward study by Pilkington et al, complaining that it “dealt with the 1,000-calorie level, a level at which nearly everyone loses weight”. Rabast et al claimed that the greater weight loss in their low-carb groups must have been due to that eternally elusive and mythical phenomenon, the “metabolic advantage” - but they never measured body fat composition. Atkins, by the way, is not the only low-carb promoter to have selectively interpreted the evidence; Dr.
Neither Atkins nor Eades appear to have been troubled by the fact that, despite repeated attempts, the Rabast findings have never been replicated by other researchers. Good evidence = that which supports their theories, no matter how shabbily performed and poorly controlled. Bad evidence = that which contradicts their theories, no matter how professionally conducted and tightly controlled. Comments and questions from readers are always welcome, but due to time constraints a response cannot be guaranteed. Anthony Colpo is an independent researcher, physical conditioning specialist, and author of the groundbreaking books The Fat Loss Bible and The Great Cholesterol Con. Disclaimer: All content on this web site is provided for information and education purposes only. These people seem to have a far greater than normal capacity for denying reality, and for going off like a wayward firecracker when someone presents views that contradict their cherished dogma.

Or is the behavior of the low-carb ‘community’ just another example of the human tendency to form sectarian groups that promulgate an either-or mentality, that reinforce their own beliefs by selectively feeding each other with supportive ‘evidence’, and reacting with hostility towards those who present opposing viewpoints and non-supportive evidence? The mere act of eating itself can cause changes in mood and cognition, regardless of dietary composition.
Although the results are not universal, common findings are increased drowsiness and greater calmness after high-carbohydrate meals, and increased alertness and feelings of tension after high-protein meals.
In another study comparing high-carbohydrate, high-protein, or balanced meals, only the high-carbohydrate meal worsened post-meal fatigue and cognitive performance[Spring B]. Fortunately, there have been a number of studies looking at the longer-term cognitive and psychological effects of lower- versus higher-carbohydrate diets. This study was performed under metabolic ward conditions, giving us the confidence that the subjects actually followed the diets they were assigned. The study also examined the effect of ketogenic versus non-ketogenic diets on cognitive function. So again, what were effectively being compared were very low-calorie ketogenic and non-ketogenic low-carb diets. Although the decrease appeared to be greater during the carbohydrate-containing diet, it was not statistically significant.
The zero-carbohydrate group did however experience something the non-ketogenic group didn't: namely, significantly poorer exercise performance[Bogardus].
Individuals who chose the low-carb diet received instructions to limit their daily carbohydrate intake to zero for one week, 5-8 grams during the second week, and 10–16 grams in the third week.
The low-carbohydrate diet provided 35% of total energy as protein, 61% as fat, and 4% as carbohydrate; the high-carbohydrate diet provided 24% of total energy as protein, 30% as fat, and 46% as carbohydrate. Working memory test scores increased similarly in both groups, while speed of processing improved to statistically significantly greater degree on the high-carbohydrate diet[Halyburton].
After one year, both groups lost the same amount of weight (13.7 kg) and experienced similar reductions in plasma glucose and serum insulin levels. At 12 months, scores on the Profile of Mood States subscales of anger-hostility, confusion-bewilderment, and depression-dejection and the Total Mood Disturbance of the Profile of Mood States score were significantly lower in the high-carbohydrate group than in the low-carbohydrate group. Even though the low-carb group fared worse, the CSIRO researchers point out that mood state scores on average for both groups at baseline and throughout the study remained within the normal range for healthy adults.
Given the evidence reported thus far, those with a tendency towards anger or depression, or those suffering from any other psychological condition should steer clear of ketogenic low-carb diets. They tend to produce poorer overall cognitive and psychological outcomes than higher carbohydrate diets, and no study has shown they produce superior overall effects. The Atkins dieters were instructed to consume less than 20 grams of carbohydrate initially, and were permitted to increase this amount incrementally as the study progressed.
All these reported outcomes were more favourable on the low-carb diet, with the exception of insomnia, which scored higher in the low-carb group throughout most of the study[McClernon].
And in this case, such concerns are more than justified; in his 1992 book Dr Atkins’ New Diet Revolution, Atkins clearly displayed a woeful inability to impartially report evidence concerning the comparative weight loss effects of high versus low-carbohydrate diets (*for more details, see the "Notes" section below).
It is well known that nutritional deficiencies, commonplace among those following Western diets, can negatively affect mood state. Although attempts were made by the authors to control for weight loss in the statistical models because of the association between weight loss and psychological well-being, the possibility cannot be dismissed that the greater weight loss with the low-carbohydrate diet accounted for the greater reported reductions in negative affect (so-called “multivariate analyses” can never take the place of randomized controlled trials where such confounding factors have been removed). When it comes to impartial, tightly controlled evidence for any psychological or cognitive benefit of low-carbohydrate diets, this study fails miserably. The high-carbohydrate diet contained 15% protein, 30% fat and 55% carbohydrate, while the “low-carbohydrate” diet provided 30% protein, 30% fat and 40% carbohydrate. As such, these studies don’t tell us what would happen to individuals suffering behavioural or psychiatric conditions when they attempt to follow ketogenic low-carbohydrate diets. The 2006 report, published in the journal Psychosomatics, described a woman with well-controlled panic disorder who developed a return of her panic symptoms after starting the Atkins diet. The next day, she began to experience an internal sensation of “shakiness”, which progressed to a fully-fledged panic attack later that day. When this fellow reported his experiences on a popular low-carbohydrate forum, he was told to “suck it up” and that “it wasn't the diet”.
Unfortunately, authors such as Atkins, Eades, Agatston et al, whose plans kick off with a 2-week extremely-low-carbohydrate phase, have successfully convinced many dieters that there is something special about ketosis. Do the psychological effects of ketogenic diets contribute to the irrational and sometimes downright bizarre behavior exhibited by many online low-carb devotees? What I will say is this: diets that are inherently unbalanced seem to be associated with more than their fair share of extremist behavior compared with more moderate plans (as an example, I’ve yet to see any noteworthy level of shrill behaviour from followers of “Zone” or “Mediterranean”-style diets). Like vegans, low-carbers often display an us-versus-them mentality, a negative feature that is of course hardly exclusive to diet sectarians.
In the vegan arena, this may translate to the belief that avoidance of meat is virtuous while those who eat meat are “bad” (indeed, “Meat is Murder” is a popular catchcry among the vegan animal rights movement). Seriously, I’ve read Internet posts where the author was fretting as to whether or not they should eat liver because of it’s carbohydrate content – a miniscule five grams of glycogen-derived carbohydrate per 100 grams of cooked liver! Low-carb commentators will scour through research papers unsupportive of their beliefs with a fine-toothed comb, looking for any and every possible flaw or discrepancy that could be used to discount the results. Telling many low-carbers that their beloved metabolic advantage is non-existent is like taking a favorite toy away from a toddler, a sure-fire method for triggering a Texas-sized tantrum. Receiving information that confirms what we already believe is comforting, reassuring, and self-validating. During the 2004 US Presidential election, researchers used functional neuroimaging to study the neural responses of thirty committed partisans presented with negative information about both their preferred and opposition candidates[Westen D, 2006].
Their brains didn’t return to a less frantic state until they had found a way to distort and rationalize the negative information in a way that comfortably co-existed with their belief in the superiority of their favored candidate. The tendency to slander and ostracize those from outside groups or with opposing viewpoints is further encouraged by the protection of distance and anonymity garnered by Internet communication. Whether very low-carbohydrate nutrition does in fact contribute to anti-social behavior is a question only controlled scientific research can definitively answer.
Yet he had no qualms about embracing the results of an allegedly supportive ward study by Rabast et al - that also employed the 1,000 calorie level! To claim that greater fat losses occurred when fat loss was never even measured is most disingenuous, to say the least. Michael Eades, co-author of Protein Power and an ardent promoter of the metabolic advantage theory, eagerly embraces supportive free-living studies (he appears to have very little to say about the abundance of non-supportive ones).
Nor were they troubled by the unusually high dropout rates in the larger of Rabast’s two supportive studies for which no explanation was ever given (most ward studies have zero dropout rates thanks to the constant supervision and support)[Rabast, 1979][Rabast, 1981].
Mood and cognitive performance effects of isocaloric lunches differing in fat and carbohydrate content.
The delivery rate of dietary carbohydrates affects cognitive performance in both rats and humans. Comparison of carbohydrate-containing and carbohydrate-restricted hypocaloric diets in the treatment of obesity: effects on appetite and mood. Comparison of carbohydrate-containing and carbohydrate-restricted hypocaloric diets in the treatment of obesity.
Low- and high-carbohydrate weight-loss diets have similar effects on mood but not cognitive performance. Long-term Effects of a Very Low-Carbohydrate Diet and a Low-Fat Diet on Mood and Cognitive Function. The Effects of a Low-Carbohydrate Ketogenic Diet and a Low-Fat Diet on Mood, Hunger, and Other Self-Reported Symptoms. Psychological benefits of a high-protein, low-carbohydrate diet in obese women with polycystic ovary syndrome—A pilot study.

Winning Hearts and Minds: Why Rational Appeals Are Irrational If Your Goal is Winning Elections. Feeling validated versus being correct: a meta-analysis of selective exposure to information. Dietetic treatment of obesity with low and high-carbohydrate diets: comparative studies and clinical results.
Loss of weight, sodium and water in obese persons consuming a high- or low-carbohydrate diet.
You do an excellent job of showing how personal prejudice and blind dogma determine so much of what is presented to the public as ‘scientific’ diet and health information. I can’t help but wonder if the weird behavior demonstrated by so many online low-carb followers is related to the diet they follow. And their penchant for performing all manner of mental contortionism in order to rationalize scientifically untenable beliefs would garner envy from even the most fanatical Creationist. It is well established, for example, that skipping breakfast results in a prolonged hypoglycaemic state that results in poorer cognitive performance. Contrary to what the metabolic advantage promoters would have you believe, there was no statistically significant difference in weight loss between the two groups. The researchers found that, in the first week, ketogenic dieters performed far worse on the trail making task, a widely used test that measures a range of neuropsychological skills including letter and number recognition, visual scanning, motor speed and sequencing ability.
Before, during, and after the diets, participants completed the including the Profile of Mood States questionnaire and a battery of cognitive tests. The diets were designed to be isocaloric and to have a moderate calorie restriction of around 30% for 8 weeks. On the Spielberger State Anxiety Inventory, differences were also evident between the diet groups at 12 months. I say ketogenic, because all the studies showing negative effects have utlized ketogenic variants of low-carbohydrate diets (ie, those supplying less than 50 grams of carbohydrate daily). Omega-3 supplements, for example, have been shown to favourably effect symptoms of hostility, depression, and even serious psychiatric conditions such as schizophrenia. Before low-carb advocates start running (or is that waddling?) around the room, whooping and hollering in victory, one important discrepancy with this study should be pointed out. In this study, that equates to 143 grams of carbohydrate daily, well above the commonly cited low-carbohydrate threshold of 100 grams and even further north of the widely accepted ketogenic threshold of 50 grams.
She had been diagnosed at the age of thirty-seven with panic disorder, which was successfully managed for the next ten years with daily usage of alprazolam and sertraline.
She increased her sertraline dose in an attempt to control the symptoms, but continued to have frequent panic attacks.
In a way, they’re right – no other dietary strategy seems to so quickly decimate sports performance and induce lethargy, constipation, dizziness, heart rhythm irregularities, mineral deficiencies, rotten breath and repulsive body odor than ketogenic diets. Ketogenic diets are characterized by extremely low-carbohydrate intakes that may alter serotonergic expression[Christensen L] and induce or exacerbate deficiencies in important minerals including potassium, magnesium and selenium. Human beings in general are imbued with this trait, something that politicians and other professional manipulators are never slow to exploit. Meanwhile, even the sloppiest of evidence is embraced with open arms and little if any critical analysis when it returns results supportive of the low-carb paradigm (again, see the “Notes” section below for some classic examples of this behavior by prominent low-carbohydrate authors).
No matter how much evidence you throw at them and no matter how carefully and painstakingly you state your case, many low-carbers deeply resent being told that judicious nutrition and regular exercise, not carefree gluttony, are the real keys to getting truly lean. While people are quick to pay lip service to the importance of “keeping an open mind”, scientific research shows most people preferentially seek out information that is in accordance with their existing beliefs[Hart]. The purpose of the study, led by Drew Westen, professor of psychology and psychiatry at Emory University, was to observe "how partisan brains reasoned during the polarized 2004 election.
These findings go a long way toward explaining why certain myopic segments of the dietary arena – such as low-carb devotees – act in such an irrational and often hostile manner when presented with information that contradicts their treasured dogma. However, after reviewing the research, prudence dictates that those with a tendency towards anger, depression, anxiety and especially those with diagnosed behavioural or psychiatric conditions should avoid ketogenic low-carbohydrate diets. He dismisses metabolic ward studies as “rife” with inaccuracies, even when the authors of said studies outlined in detail the meticulous controls maintained over study participants. After the first week, the ketogenic group began to improve their test results, but by the time the study concluded at 28 days, their results were still lagging behind the non-ketogenic dieters[Wing]. They were admitted to the Clinical Research Center of the University of Vermont College of Medicine for the duration of the study.
As for the self-rating scores, there was a consistent, but non-significant, trend in both groups for deterioration in mood, diet-related attitude, and self-esteem during the first week on both diets. During complete withdrawal of dietary carbohydrate, the low-carbohydrate group performed worse on memory-based tasks than ADA dieters. A similar pattern of change was evident on the Beck Depression Inventory, although the difference between the diet groups did not reach statistical significance (P = .11).
As we've seen, some of the studies actually compared ketogenic and non-ketogenic low-carb diets and found no evidence of ill-effect with the latter.
Omega-3 supplements were among the supplements given to the Atkins dieters but not to the low-fat dieters. During this time, she had only two full-blown panic attacks, rare limited-symptom attacks, and “normal functioning”. Over the next four weeks the patient experienced a marked increase in her baseline anxiety level. Back in the Stone Age, such a trait may have conferred survival advantages by reinforcing group cohesion and resistance to hostile tribes. In this, they are like the young child who protests loudly at a reality that refuses to conform to his whims and desires. As evidence for the metabolic advantage theory, the Rabast studies are about as “robust” as a wet paper bag. All the women were hospital employees and they were allowed to continue their jobs, but they slept and took all meals under supervision at the center.
This was followed by an improvement after six weeks so that psychological adjustment was equal to or better than that at the start of the study. In our modern complex society, it allows leaders to exploit such phenomena as patriotism and nationalism to cajole populations into highly destructive wars, the true agendas of which are often very different from those presented for public consumption. After all, this saves them from often uncomfortable soul-searching and introspection, and the unsettling possibility they will need to make fundamental changes in their beliefs and lifestyle. When confronted with compelling negative evidence about their candidate, the brains of Democrats and Republicans registered conflict and distress. The psychological tests administered included the state-trait anxiety inventory-trait anxiety (STAI-T) and the Beck depression inventory (BDI) at baseline and at the end of the diet periods. There was no significant difference between the two diets for ratings of hunger or craving[Rosen].
Low-carbohydrate dieters reported less confusion and responded faster during an attention vigilance task than the ADA dieters[Danci]. It’s far easier to just blame someone else for one’s problems, a mindset further encouraged by today’s victim-mentality, litigation-mad culture.
The scale categories included depressed mood, anxious mood, interpersonal sensitivity, self-esteem, diet attitude, and appetite.

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