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From Sophie Maclean, London, UK

I was very concerned reading your piece on the use of the keto diet as a treatment for anorexia. This diet has the potential to cause serious harm to someone with, or at risk of, an eating disorder (13 June, p 28).

The study your story references is a feasibility trial, which isn’t an evaluation of the effectiveness of a treatment. The trial was completed by only 18 participants, none of whom was even moderately underweight. This sample size is surely too small for any definitive verdict, and the study offers no insight into treating people with moderate or severe anorexia.

I am a mathematician and a science communicator, and I also understand anorexia nervosa all too well. In 2020, I spent two months in an inpatient psychiatric ward, fighting severe anorexia. I have also, sadly, lost three people to the illness. When I was ill, I ended up in hospital in ketosis. A friend also relapsed into anorexia after going on the keto diet.

I hope those at risk read this letter and know that the keto diet isn’t the answer.