How Does the Brain Enter the Zone?

You may remember moments when you were in flow state, or being "in the zone," when you get involved in a task or are working on something creative. This research study from Drexel University is studying how flow state works in the brain. They focus on flow state with musicians, but engaging in art can rely on the flow state as well. Flow state is also what can work very well in art therapy for deeper processing.

What has your experience been with the flow state?

https://neurosciencenews.com/creativity-zone-neuroscience-25697/

Unlocking Creative Flow: 

How the Brain Enters the Zone

FeaturedNeuroscience

·March 4, 2024

Summary: A new study unveils how the brain enters the creative flow state, famously known as being “in the zone.” By analyzing jazz improvisations through EEGs, the research confirms that creative flow combines extensive experience with a conscious release of control, allowing for automatic idea generation.

This “expertise-plus-release” model suggests that deep creative flow is more accessible to those with significant experience and the ability to let go. The findings offer a new understanding of flow, challenging previous theories and opening avenues for enhancing creativity through practice and relinquishment of control.

Key Facts:

1. The study supports the “expertise-plus-release” theory of creative flow, indicating that expertise and the ability to release control are essential for achieving deep creative states.
2. High-flow states are associated with increased activity in the brain’s auditory and touch areas, and decreased activity in executive control regions, supporting the idea of reduced conscious control during creative flow.
3. Practical implications suggest that achieving productive flow states requires building expertise in a creative field and then training to “let go,” enabling the brain’s specialized circuits to operate autonomously.

Source: Drexel University

Effortless, enjoyable productivity is a state of consciousness prized and sought after by people in business, the arts, research, education and anyone else who wants to produce a stream of creative ideas and products.

That’s the flow, or the sense of being “in the zone.” A new neuroimaging study from Drexel University’s Creativity Research Lab is the first to reveal how the brain gets to the creative flow state.

The study isolated flow-related brain activity during a creative task: jazz improvisation. The findings reveal the creative flow state involves two key factors: extensive experience, which leads to a network of brain areas specialized for generating the desired type of ideas, plus the release of control – “letting go” – to allow this network to work with little or no conscious supervision.

Led by John Kounios, PhD, professor in the College of Arts and Sciences and Creativity Research Lab director, and David Rosen, PhD, a recent graduate from the College and Johns Hopkins University postdoc – the team determined their results suggest that creative flow can be achieved by training people to release control when they have built up enough expertise in a particular domain.

“Flow was first identified and studied by the pioneering psychological scientist Mihaly Csikszentmihalyi,” said Kounios. “He defined it as ‘a state in which people are so involved in an activity that nothing else seems to matter; the experience is so enjoyable that people will continue to do it even at great cost, for the sheer sake of doing it.’”

Kounios noted that although flow has long been a topic of public fascination as well as the focus of hundreds of behavioral research studies, there has been no consensus about what flow is. Their new study decided between different theories of how flow is involved when people produce creative ideas.

Theory: Is Flow a State of Hyperfocus?

One view is that flow might be a state of highly focused concentration or hyperfocus that shuts out extraneous thoughts and other distractions to enable superior performance on a task.

A related theory based on recent research on the neuroscience of creativity is that flow occurs when the brain’s “default-mode network,” a collection of brain areas that work together when a person daydreams or introspects, generates ideas under the supervision of the “executive control network” in the brain’s frontal lobes, which directs the kinds of ideas the default-mode network produces. Kounios likened it to the analogy of a person “supervising” a TV by picking the movie it streams.

Alternative Theory: Flow is Expertise Plus Letting Go

An alternative theory of creative flow is that through years of intense practice, the brain develops a specialized network or circuit to automatically produce a specific type of ideas, in this case musical ones, with little conscious effort. In this view, the executive control network relaxes its supervision so that the musician can “let go” and allow this specialized circuit to go on “autopilot” without interference.

The research team said the key to this notion is the idea that people who do not have extensive experience at a task or who have difficulty releasing control will be less likely to experience deep creative flow.

The study’s results support the “expertise-plus-release” view of creative flow.

The researchers tested these competing theories of creative flow by recording high-density electroencephalograms (EEGs) from 32 jazz guitar players, some highly experienced and others less experienced. Each musician improvised to six jazz lead sheets (songs) with programmed drums, bass and piano accompaniment and rated the intensity of their flow experience for each improvisation.

The resulting 192 recorded jazz improvisations, or “takes,” were subsequently played for four jazz experts individually so they could rate each for creativity and other qualities. The researchers then analyzed the EEGs to discover which brain areas were associated with high-flow takes (compared to low-flow takes).

The high-experience musicians experienced flow more often and more intensely than the low-experience musicians. This shows that expertise enables flow. However, expertise is not the only factor contributing to creative flow.

The EEGs showed that a high-flow state was associated with increased activity in left-hemisphere auditory and touch areas that are involved in hearing and playing music. Importantly, high flow was also associated with decreased activity in the brain’s superior frontal gyri, an executive control region.

This is consistent with the idea that creative flow is associated with reduced conscious control, that is, letting go. This previously hypothesized phenomenon has been called “transient hypofrontality.” 

For the high-experience musicians, flow was associated with greater activity in auditory and vision areas. However, they also showed reduced activity in parts of the default-mode network, suggesting that the default-mode network was not contributing much to flow-related idea generation in these musicians.

In contrast, the low-experience musicians showed little flow-related brain activity.  

“A practical implication of these results is that productive flow states can be attained by practice to build up expertise in a particular creative outlet coupled with training to withdraw conscious control when enough expertise has been achieved,” said Kounios. “This can be the basis for new techniques for instructing people to produce creative ideas.”

Kounios added, “If you want to be able to stream ideas fluently, then keep working on those musical scales, physics problems or whatever else you want to do creatively—computer coding, fiction writing—you name it. But then, try letting go. As jazz great Charlie Parker said, ‘You’ve got to learn your instrument. Then, you practice, practice, practice. And then, when you finally get up there on the bandstand, forget all that and just wail.’”

About this creativity and neuroscience research news:

Author: Annie Korp
Source: Drexel University
Contact: Annie Korp – Drexel University
Image: The image is credited to Neuroscience News

Original Research: Open access.
“Creative flow as optimized processing: Evidence from brain oscillations during jazz improvisations by expert and non-expert musicians” by John Kounios et all. Neuropsychologia

---

Abstract

Creative flow as optimized processing: Evidence from brain oscillations during jazz improvisations by expert and non-expert musicians

Using a creative production task, jazz improvisation, we tested alternative hypotheses about the flow experience: (A) that it is a state of domain-specific processing optimized by experience and characterized by minimal interference from task-negative default-mode network (DMN) activity versus (B) that it recruits domain-general task-positive DMN activity supervised by the fronto-parietal control network (FPCN) to support ideation. We recorded jazz guitarists’ electroencephalograms (EEGs) while they improvised to provided chord sequences.

Their flow-states were measured with the Core Flow State Scale. Flow-related neural sources were reconstructed using SPM12. Over all musicians, high-flow (relative to low-flow) improvisations were associated with transient hypofrontality. High-experience musicians’ high-flow improvisations showed reduced activity in posterior DMN nodes.

Low-experience musicians showed no flow-related DMN or FPCN modulation. High-experience musicians also showed modality-specific left-hemisphere flow-related activity while low-experience musicians showed modality-specific right-hemisphere flow-related deactivations.

These results are consistent with the idea that creative flow represents optimized domain-specific processing enabled by extensive practice paired with reduced cognitive control.

 

Spirituality and Faith May Improve Mental and Physical Health

This article notes how faith and spirituality can help both mental and physical health. Improvements have been shown in areas such as longevity, quality of life, cortisol levels, immunity, and levels of anxiety, depression, and substance use. 

I am interested to hear from you how your faith - or observed faith from others - have helped with mental or physical issues.

https://www.deseret.com/2023/8/3/23818675/spirituality-improves-mental-health-expert-says/

Keep the faith: Spirituality can improve mental health, expert says

People say faith can move mountains. According to these sources, it can also ease symptoms of anxiety and depression

Published: Aug 3, 2023, 2:19 p.m. MDT

The Rev. Curtis Price, of the First Baptist Church, holds hands and prays with the Rev. Monica Dobbins, of the First Unitarian Church, in front of the House chambers at the Capitol in Salt Lake City on Friday, Feb. 8, 2019. Deseret News

By Britney Heimuli

Spirituality positively impacts the mind and leads to a decreased risk of suicide and addiction, psychologist Lisa Miller told NPR on Sunday.

NPR said Miller “has dedicated most of her career to the study of neuroscience and spirituality.” She found that people who said they have a meaningful spiritual life were 80% less likely to become addicted to drugs or alcohol, compared to someone who said they don’t.

In an interview with NPR, Miller said:

• The higher the risk for depression genetically, the greater the effect of spirituality as a source of resilience against depression.
• Recalling a powerful, spiritual memory triggers the same reaction in the brain as receiving a hug from a family member as a baby.
• Those who say they have a spiritual life are 82% less likely to commit suicide.

Miller previously told the Deseret News in an interview that “depression and spirituality are two sides of one door,” and that she is “very interested in how recovery and renewal from depression, despair or hard times is often found through spiritual life.”

How does spirituality affect the body?

USA Today reported earlier this year on the effects of spirituality on the body.

The article quoted the Mayo Clinic and said, “Most studies have shown that religious involvement and spirituality are associated with better health outcomes, including greater longevity, coping skills and health-related quality of life (even during terminal illness) and less anxiety, depression and suicide.”

The National Library of Medicine published a study that said prayer, a common spiritual practice, can reduce or increase stress and anxiety, depending on what the prayer is about.

USA Today quoted studies that said spirituality and spiritual practices were linked to lower cortisol levels as well as improved immune function and vitality.

“One-third of spirituality is innate, two-thirds environmentally cultivated,” Miller told Deseret News.

Tyler VanderWeele, professor of epidemiology in the Departments of Epidemiology and Biostatistics at the Harvard T.H. Chan Public School of Health, told the school, “Focusing on spirituality in health care means caring for the whole person, not just their disease.”

“Integrating spirituality into care can help each person have a better chance of reaching complete well-being and their highest attainable standard of health,” said Howard Koh, the Harvey V. Fineberg Professor of the Practice of Public Health Leadership at Harvard T.H. Chan School.

 

Acupuncture Helps PTSD Symptoms

 Art Therapy Thursday!

At my place of work, we offer Battlefield Acupuncture (BFA) with semipermanent needles for pain, anxiety, and mood improvement. Many service members have found benefit from it, especially because it is not another pharmaceutical. Newer research is showing that acupuncture also may be beneficial for PTSD symptom improvement, which can be a cost-effective approach with minimal side effects.

If you have had acupuncture before, how has it helped you?

https://www.medpagetoday.com/psychiatry/anxietystress/108851

Acupuncture Tops Sham for Easing PTSD in Combat Veterans

— Large treatment effect observed for clinical and biological measures of combat-related PTSD

by Shannon Firth, Washington Correspondent, MedPage Today

February 22, 2024 • 3 min read

Acupuncture outperformed "sham" needling in clinical and biological measures of combat-related post-traumatic stress disorder (PTSD) in veterans, a prospective randomized trial showed.

In the intention-to-treat analysis, there was a large treatment effect of verum acupuncture (Cohen d 1.17), a moderate effect of sham acupuncture (d 0.67), and a moderate between-group effect favoring verum acupuncture (d 0.63, P=0.005), reported Michael Hollifield, MD, of the Tibor Rubin VA Medical Center in Long Beach, California, and co-authors in JAMA Psychiatry.

The effect pattern was similar in the treatment-completed analysis between the group receiving verum acupuncture -- which means "true" or "real acupuncture according to a healing tradition and protocol," said Hollifield -- and the sham group.

"While [PTSD is] thought of as a mental illness, it's really not, in some sense. It's an environmentally caused, whole-body illness that affects the brain and other parts of the body," Hollifield told MedPage Today. "And that's why we believe acupuncture, as a somatic treatment, works, because trauma is stored deep in other body systems."

"It's not just a psychological process," he added, noting this is his opinion, but one with which many of his patients agree.

While previous studies of acupuncture in civilians and active military troops have demonstrated its effectiveness, Hollifield said his study, which used improved controls, was needed to "definitively" support acupuncture for PTSD. He noted that "acupuncture ought to be considered a potential first-line treatment for PTSD."

There was also a significant pretreatment to post-treatment reduction in fear-conditioned extinction, which was assessed by a fear-potentiated startle response -- a sudden blast of air paired with a certain image, such as a blue box -- in the group receiving verum acupuncture versus the sham group, and a significant correlation (r=0.31) between symptom reduction and fear extinction.

For this secondary outcome, the startle response was measured using eyeblink electromyography, Hollifield explained. After treatment with either sham or verum acupuncture, Hollifield and his co-authors looked to see how long it takes for that fear response to dissipate when the stimulus -- that blast of air -- no longer occurs with the image.

"And we found that acupuncture distinguished itself very nicely from the sham procedure, by people extinguishing that fear response more rapidly after treatment in the acupuncture group than in the sham group," he said.

For this two-arm, parallel-group, blinded single-center study, participants were recruited using flyers and emails from April 2018 to May 2022. The researchers included 85 male and eight female veterans ages 18 to 55 (mean age 39.2, 47.3% white, 18.3% Asian) with moderate to severe PTSD.

About one-third of veterans saw moderate combat, 30% saw moderate heavy combat, and 16% saw heavy combat.

Both groups received 1-hour sessions twice weekly and were given 15 weeks to complete as many as 24 sessions.

The study used the Clinician-Administered PTSD Scale-5 (CAPS-5), the "gold standard" for PTSD assessment, to measure symptom reduction by assessing symptom severity pre- and post-treatment. The CAPS-5 includes 20 items, rated from 0 to 4 (with 4 representing the most severe), which are then totaled into a single severity score.

As for safety, 64 adverse events occurred, seven of which were study related, and three were potentially related.

Three participants experienced anxiety during physiology testing; one had nocturnal panic attacks; one had increased suicidal ideation, which resolved; and one withdrew prior to randomization owing to increased symptoms. One participant withdrew for intervention-related symptoms. No participants withdrew as a result of suicidal or homicidal ideation.

A limitation of the study was that it was difficult to design a "truly blinded study" of acupuncture, Hollifield said. "People know what they're getting, and the acupuncturist knows what they're delivering."

With this study completed, next steps are to compare acupuncture with other evidence-based treatments and to conduct cost-effectiveness studies.

Shannon Firth has been reporting on health policy as MedPage Today's Washington correspondent since 2014. She is also a member of the site's Enterprise & Investigative Reporting team. Connect:

How Does Art Help People's Well-Being?

 Art Therapy Thursday!

How does art benefit health? Art therapy can be used in many ways in healthcare settings, and the Mayo Clinic explores how art therapy and other creative arts can be helpful to people in a variety of ways for both medical and mental health. See more in this article below:

https://mcpress.mayoclinic.org/living-well/the-intersection-of-art-and-health-how-art-can-help-promote-well-being

The intersection of art and health: How art can help promote well-being

Art can be helpful in a healthcare setting, whether it's prescribed therapy, something you participate in for fun or part of the environment around you.

October 16, 2023•

By Mayo Clinic Press Editors

For thousands of years, people have been using arts like singing, painting and dancing for healing purposes. Modern healthcare settings continue to use art to help treat specific conditions, contribute to overall well-being and even help prevent diseases.

You might use art to support your own well-being without even thinking about it. For example, you might doodle when you feel stressed or enjoy playing an instrument at the end of a long day. In fact, artistic expression and appreciation are not only enjoyable but also have the potential to benefit your well-being.

Two approaches commonly used in healthcare settings include:

• Arts in health, which can include artists trained to help patients have positive creative experiences in a healthcare setting. It also can refer to art in the physical spaces where healthcare is delivered — think hospitals, care facilities, etc. This might include art on the wall, musical performances in the lobby and healing gardens.
• Creative arts therapies, which include a licensed professional engaging a patient in arts to address a specific condition or health goal. Therapy can be delivered through visual art, dance, music, poetry or drama and there are corresponding licenses for each type of art specialization.

What are some common creative arts therapy activities?

Music, dance, writing, storytelling, collage-making and painting can all be used in creative arts therapy. Creative arts therapists draw upon their training and the needs and interests of patients to meet clinical goals.

The success of art therapy isn’t measured by the quality of the art produced in a session, but instead by the healing that can happen during the process of making art.

How can creative arts therapy promote healing?

Creative arts therapy is used in treatment for a variety of conditions spanning mental health, cancer, stroke and more. The idea behind creative arts therapy is that artistic expression can help people to feel better and motivated to recover and address clinical needs such as reducing anxiety and blood pressure.

The American Congress of Rehabilitation Medicine says making or even just seeing art can impact the brain. Whether it’s part of a creative arts therapy exercise, or something you experience in your everyday life, art can help:

• Increase serotonin levels.
• Increase blood flow to the part of the brain associated with pleasure.
• Foster new ways of thinking.
• Imagine a more hopeful future.

How is creative arts therapy used for mental health?

In the 1940s, healthcare providers noticed that people with mental illness would express themselves through art. This observation inspired the use of creative arts therapy as a healing technique for conditions including anxiety, depression, mood disorders, schizophrenia and dementia.

Creative arts therapy is used to help treat mental health conditions because it can improve focus, assist with processing emotions, improve communication and increase self-esteem.

What are the benefits of creative arts therapy?

As therapy, research shows that art facilitated by a professional creative arts therapist has the potential to positively impact elements of your physical and mental health, including:

• Overall well-being.
• Quality of life.
• Interpersonal relationships.
• Freedom of expression, when talking about thoughts and feelings is difficult.
• Emotional resilience.

What are the benefits of creative arts therapy for children?

Although creative arts therapy is used with people of all ages, it can have some unique benefits for kids. The American Art Therapy Association shares that art therapy can help kids express themselves and share their feelings without using words, which can be especially helpful when working with younger or nonverbal children. Specifically, it can assist with communication in children with autism, soothe kids with cancer and help improve focus in kids with attention-deficit disorders.

Can art help even if it’s not prescribed therapy?

Yes! In addition to creative arts therapy, the arts also can be beneficial to your physical and mental health when you experience them — as an appreciator or creator. For example, creating visual art like drawings or paintings can provide enjoyment and distraction from things like pain and anxiety. Listening to music might help to improve blood pressure and sleep quality, and can help keep you calm and relaxed during a medical procedure.

In addition to having an impact on overall well-being and specific health outcomes, art can support the overall healthcare experience. Through three humanities-focused centers in Arizona, Florida and Minnesota, Mayo Clinic incorporates arts for enjoyment and creative arts therapy in patient care.

In Minnesota, Sarah Mensink is the program director for the Mayo Clinic Dolores Jean Lavins Center for Humanities in Medicine, which manages a variety of arts programs, including:

• Arts at the Bedside, a program where artists visit with and offer people the opportunity to create art during a hospital stay.
• Mayo Humanities TV Channel, which offers recorded concerts, lectures and other art programs on demand in hospital rooms.
• The “Music is Good Medicine Concert Series” and the “Rosemary and Meredith Wilson Harmony for Mayo Concert Series” that offer live music performances in Mayo Clinic facilities.

“Arts at the Bedside is a nice opportunity to enhance the patient experience. You’re treated as a whole person. Healing is more than a cure. It offers a creative outlet and an opportunity for fun,” says Mensink.

Patients aren’t the only people helped by art in a healthcare setting. It can benefit family members and healthcare providers too. Mensink says that when the patient experience is improved with art, the burden of healthcare providers is lessened.

“When patients are happy and occupied with an art project, staff members are glad to see the person doing well,” she says.

Whether it’s the design of a hospital’s physical space, an impromptu concert to enjoy or a dedicated therapy session that uses art to achieve a clinical goal, each has its place in promoting the well-being of individuals and communities. Art has the potential to go beyond treating symptoms and improve your whole self — including physical, mental and emotional elements.

Does the Ketogenic Diet Help Mental Health?

As a part of my PhD program, one of the majors that we can pursue is functional and integrative nutrition. More research has been done to find out how nutrients and food actually improve or worsen our mental health. This article explores whether the keto diet is helpful as a mental health treatment. What experience have you had with nutrition's helping not only your physical health, but also your mental health?

https://www.medpagetoday.com/special-reports/features/108857

Can the Ketogenic Diet Treat Mental Illness?

— Reports are promising, but rigorous trials are needed, experts say

by Jennifer Henderson, Enterprise & Investigative Writer, MedPage Today

February 22, 2024 • 5 min read

The ketogenic diet has long been known for its use in treatment-resistant epilepsy, but attention is now turning to its potential benefits in mental illness as well.

Could something as simple as a diet actually improve notoriously difficult-to-treat conditions including major depressive disorder, bipolar disorder, and schizophrenia?

The evidence to date has been less rigorous than gold-standard randomized controlled trials. But new studies are underway, and more clinicians are keen to explore reports of patients whose psychiatric conditions improved when they adhered to a ketogenic diet.

Nonetheless, there are challenges inherent to dietary intervention trials that must be mitigated, and broader buy-in from the medical community at large remains to be seen.

"There have to be randomized trials before we can make enthusiastic and evidence-based treatment recommendations," Drew Ramsey, MD, a nutritional psychiatrist and member of the American Psychiatric Association, told MedPage Today. "That said, I'm hopeful and optimistic that patients are going to have more tools to treat their mental health disorders."

What Does the Evidence Say?

Ramsey noted that some randomized controlled trials have shown that dietary interventions -- albeit not specifically the ketogenic diet -- can help improve depression. For instance, the SMILES trial showed better symptomatic improvement and remission rates with a dietary intervention compared with a control social support group, and the AMMEND study showed greater improvements in symptoms and quality of life for young men on the Mediterranean diet compared with controls.

As for the ketogenic diet specifically, Georgia Ede, MD, a nutritional psychiatrist based in Massachusetts, told MedPage Today that the body of research for its use in psychiatric conditions "is really starting to grow."

Ede co-authored a French study published in Frontiers in Psychiatry in 2022 entitled, "The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of 31 Inpatients."

Patients with severe and persistent mental illness (major depressive disorder, bipolar disorder, and schizoaffective disorder), with poorly controlled symptoms were admitted to a psychiatric hospital and placed on a ketogenic diet as an adjunct to conventional care.

Though 3 patients were unable to adhere to the diet for more than 14 days, the researchers concluded that following the ketogenic diet for treatment-refractory mental illness was "feasible, well-tolerated, and associated with significant and substantial improvements in depression and psychosis symptoms and multiple markers of metabolic health."

More than 40% of patients experienced remission from their diagnosis, Ede said, and 64% left the hospital on less psychiatric medication than when they entered.

Among other recent research, a feasability pilot study of the ketogenic diet in bipolar disorder was recently completed in the U.K.

Findings of the study, published in BJPsych Open last October, found that of 27 participants, 20 completed 6 to 8 weeks of the ketogenic diet. A majority of participants reached and maintained ketosis, indicating adherence to the diet, and adverse events were generally mild and modifiable, the researchers found.

What Studies Are Underway?

In an email, a spokesperson for the National Institute of Mental Health (NIMH) pointed MedPage Today to two trials that it is supporting in an investigation of the effects of the ketogenic diet on mental illness -- one led by researchers based in Maryland, and another by a team in California.

Deanna Kelly, PharmD, of the Maryland Psychiatric Research Center -- a joint program between the University of Maryland School of Medicine and state Department of Health -- is leading an inpatient randomized controlled trial of a gluten-free diet in a subgroup of people with schizophrenia.

These patients were found to have high levels of IgG anti-gliadin antibodies. The goal of the trial is to determine whether participants benefit from a gluten-free diet, predicted to result in lower levels of schizophrenia symptoms and antibodies to gliadin.

The inpatient setting enables complete control over what the participants eat, she said. Lending another layer of stringency to the trial is that individuals performing the psychiatric ratings are blinded.

Judith Ford, PhD, of the University of California San Francisco, who also received NIMH funding, and her team will look at whether neural network instability in schizophrenia can be improved by a ketogenic diet. Particularly, they are exploring whether deficient glucose metabolism -- at least partially mediated by insulin resistance -- contributes to network instability in the disorder, a mechanism underlying accelerated aging and cognitive impairment in patients.

"So far, it's helping people's overall intellectual function," Ford said.

As for current funding opportunities available through NIMH, the agency told MedPage Today that there are not any that "specifically focus on diet and mental health," but that it would "consider relevant applications submitted under broader funding opportunity announcements."

What Challenges Remain?

A number of researchers pursuing work pertaining to ketogenic diets and mental health have turned to a private organization funding work in this area.

Securing federal funding can be difficult, in part because of the need to show targets of engagement, Kelly said. Even if someone had a cure for depression, she explained, they would have to show, for instance, what links the outcome, improvement in depression, to the brain.

"People have to spend their lives [in order to] understand the target," Kelly said. "Not everybody can afford that. Sometimes, it's not really even that clear."

"That's why we need other funding agencies to step up and take risks," she added.

Other hurdles for researchers include added costs for inpatient stays during clinical trials, and the lack of pharmaceutical funding for dietary interventions, Kelly said.

Mackenzie Cervenka, MD, medical director of the Adult Epilepsy Diet Center at Johns Hopkins Hospital in Baltimore and a member of the American Epilepsy Society, noted that potential interest in and promise of ketogenic diets for mental health is due in part to a more than 100-year history of the use of such diets for epilepsy patients.

However, Cervenka also noted that "awareness that there can be long-term side effects of the diet is important."

If patients no longer see their doctor for prescription medications, they may not be monitored for potential areas of concern like kidney stones, hyperlipidemia, and bone health, she said.

Cervenka also noted that short-term studies "might not be sufficient to indicate what the benefits could be in real-world applications." For instance, "in our experience about 50% [of individuals] will stop the diet within 6 months, whether they are responders or not," she said.

This can be due to adherence difficulties, she said, or in the case of patients with epilepsy, not achieving sufficient seizure control, for instance, for the purpose of driving.

Ramsey also cautioned that it's important to remember that "not everything works for everybody."

Ultimately, regarding randomized controlled trials, "we need more," Ede said. "Many clinicians will not feel comfortable until we have more."

Jennifer Henderson joined MedPage Today as an enterprise and investigative writer in Jan. 2021. She has covered the healthcare industry in NYC, life sciences and the business of law, among other areas.