College students with major depression who followed a ketogenic diet for 10–12 weeks saw rapid improvements in mood, well-being, and cognition, pointing to diet as a powerful ally in mental health care.
Study: A pilot study examining a ketogenic diet as an adjunct therapy in college students with major depressive disorder. Image credit: PeopleImages/Shutterstock.com
Ketogenic (“keto”) diets have become popular among the population to improve metabolic health. A paper published in Translational Psychiatry examines whether this could add value to the management of depression.
Introduction
Major depression affects both adults and young people, being reported in up to 5% of adults worldwide. College campuses have seen increasing rates of depression. While behavioral and psychotherapy strategies are in use, either for individuals or groups, medications are often added. However, these may cause decreased libido, increased anxiety, and metabolic complications, potentially worsening depressive symptoms.
Obesity or being overweight increases the odds of depression. Dietary factors may lead to dysregulated metabolism, which may trigger or worsen inflammation, another risk factor for depression. This has prompted research on the potential impact of dietary interventions on depression.
The keto diet has improved metabolic health, especially for people with insulin resistance or obesity. A well-formulated ketogenic diet (WFKD) provides <50 g/day of carbohydrates, 1.5 g/kg/day of protein, and fat to induce satiety. The aim is to induce nutritional ketosis, with energy obtained chiefly from fatty acids and ketone bodies.
A WFKD may reduce inflammation, improve brain chemicals that stimulate positive mood and learning, regulate body fat, and stabilize neurotransmission. The current study sought to understand if a WFKD would work for most college students, help improve metabolic health, and alleviate symptoms of depression.
About the study
The researchers looked at 24 students who had major depression at the beginning of the study. All were receiving counseling with or without pharmaceutical treatment when enrolled in the keto diet intervention for 10-12 weeks. They were first educated about the diet to ensure higher compliance.
The participants were also coached after the study began. They were provided with several keto-friendly meals at the outset to help them understand how to pick foods for the rest of the study period at their homes. Some additional ketogenic foods, such as olive oil, packaged salmon and sardines, or beef jerky, were also provided to help cut food costs. Broth or other electrolyte packs were given to prevent sodium and fluid depletion, a common accompaniment of such diets.
They were instructed to be aware that cramps could occur and could be offset by increasing their magnesium and calcium intake through their diet. Their blood was monitored every morning for capillary levels of the metabolite capillary R-beta-hydroxybutyrate (R-BHB).
Of the 24 enrolled, 16 completed the study, with most dropouts occurring for reasons unrelated to the diet itself. This represented an attrition rate of about 33%, with some students leaving due to stress or semester scheduling conflicts.
Study findings
In the 16 students who completed the study, ketosis was achieved 73% of the time. R-BHB levels were maintained at the appropriate levels, while blood glucose levels were normal.
Symptoms of depression showed a ~70% reduction on average after the study. While two participants had medication adjustments, analysis showed no significant interaction between medication status and depression outcomes. However, the ketone levels were not correlated with the improvement in symptoms.
Most students began to feel better within 2-6 weeks. They reported an overall improvement in their well-being by threefold, as measured using the WHO-5 well-being index. By the end of the study, WHO-5 scores had nearly tripled compared to baseline, reflecting a substantial gain in overall quality of life.
There was a 32% increase in brain-derived neurotrophic factor (BDNF), a brain chemical that is reduced in certain key brain areas in depression but is increased by β-hydroxybutyrate.
Participants lost an average of five kilograms of body mass, and almost all experienced clinically relevant weight loss. On average, their body composition improved, with 6% of their body mass and 13% of their fat mass lost. There was no correlation between body weight changes and symptomatic improvement.
Metabolic markers remained largely unchanged, but urea and calcium increased. In addition, serum leptin decreased by about 52%, and alanine transaminase (ALT) levels declined, consistent with improved metabolic regulation. Cognitive improvement was also observed across multiple domains, including auditory, processing speed, flexibility, and accuracy.
The strongest improvements were in auditory verbal learning, processing speed, and executive functions, with other domains unchanged. The authors note, however, that practice effects from repeated testing could partly explain these gains, and that improvements may also be linked to reduced depressive symptoms and better metabolic regulation.
Conclusions
“This pilot study provides preliminary evidence that a WFKD is a feasible and synergistic strategy adjunctive to a counseling and consultation treatment program for young adults with MDD.”
However, the study did not have a control group, so improvements cannot be attributed solely to diet rather than counseling, medication, or time. Future research should embrace a broader and more diverse participant group, but health awareness, financial constraints, and the accessibility of dietary counseling could influence the feasibility of such interventions.
When applying this type of dietary intervention beyond college students, especially in settings where health literacy, financial barriers, or limited access to dietary counseling may pose challenges, messaging apps and providing individualized support may help improve outcomes.
The authors also caution that college students may have unique advantages, such as easier access to resources and support, which may not apply to other populations, and that adherence to the diet could be more difficult in groups without comparable structure or support.
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