Medical Bulletin 12/September/2025

The research involved 24 college students, with 16 completing the study. All participants had been receiving medication, counseling, or both for depression prior to joining. They were educated on following a well-formulated ketogenic diet, which involved consuming fewer than 50 grams of carbohydrates per day alongside moderate protein and high fat intake. The goal was to achieve nutritional ketosis—a metabolic state where the body uses ketones, rather than glucose, for fuel.

Participants’ depression levels were assessed using the standard Patient Health Questionnaire-9 (PHQ-9) and clinician-rated evaluations.

Over the course of the study, students' self-reported depression scores dropped by 69%, while clinician assessments confirmed a 71% reduction. Participants also showed nearly a three-fold improvement in global well-being and enhanced performance on cognitive tasks. Most students lost weight, with an average loss of 11 pounds and a 2.4% drop in body fat.

According to lead author Jeff Volek, PhD, “There is more science yet to do, but because there is evidence of a benefit, expanding accessibility to a well-formulated ketogenic diet as an augmentation to treatment for depression is something to think about.”

Despite the promising results, the study lacked a non-keto control group, and researchers acknowledge the need for larger, controlled trials.

Reference: Decker, D.D., Patel, R., Cheavens, J. et al. A pilot study examining a ketogenic diet as an adjunct therapy in college students with major depressive disorder. Transl Psychiatry 15, 322 (2025). https://doi.org/10.1038/s41398-025-03544-8

Healthy Eating Can Ease Chronic Pain — Even Without Weight Loss: Study Finds

A healthy diet may do more than promote general wellness—it could significantly reduce chronic musculoskeletal pain, according to a new study published in European Journal of Nutrition. Conducted by researchers from the University of South Australia (UniSA), the study found that improving diet quality over just three months led to reduced joint and muscle pain, independent of weight loss.

The research involved 104 Australian adults living with overweight or obesity, all of whom participated in a weight-loss trial. Over a 12-week period, participants followed a diet aligned with the Australian Dietary Guidelines, reducing their energy intake by approximately 30%. The intervention focused on increasing consumption of fruits, vegetables, whole grains, and lean proteins, while cutting back on discretionary foods and alcohol.

Participants improved their diet quality by 22% and reported a significant reduction in chronic musculoskeletal pain—from 50% of participants experiencing it at the start to just 24% by the end. Pain severity and quality of life related to pain also improved. While most participants lost an average of seven kilograms, researchers found that the reduced pain severity was directly linked to improvements in diet quality, regardless of weight or body fat changes.

Lead researcher and PhD candidate Sue Ward explained that the findings challenge the common belief that weight loss is the primary driver behind pain relief. “Chronic musculoskeletal pain is one of the most common and debilitating conditions worldwide. While excess weight is often thought to put stress on joints and drive pain, our study shows that what you eat may independently influence chronic pain,” Ward said.

“While weight loss helps many people, this study suggests that improving diet quality itself also eases the severity of people’s pain. This is a very hopeful finding for people living with chronic pain.”

The researchers say more studies are needed, but their work adds to growing evidence that nutrition plays a central role in both physical and mental health.

Reference: Ward, S.J., Coates, A.M., Carter, S. et al. Exploring the role of diet quality and adiposity in the pain experience: a mediation analysis. Eur J Nutr 64, 266 (2025). https://doi.org/10.1007/s00394-025-03772-0

From Treadmill to Therapy: Exercise May Be Primary Prescription for Depression

Exercise should no longer be treated as an optional add-on in mental health care—it should be prescribed as a standard part of treatment for depression, argues Dr. Nicholas Fabiano, a psychiatry resident at the University of Ottawa. In a compelling editorial published in the British Journal of Sports Medicine, Dr. Fabiano calls for a shift in the way psychiatrists and mental health professionals approach the treatment of depression, emphasizing that physical activity must be taken as seriously as medication or psychotherapy.

Dr. Fabiano's editorial critiques the current standard of care, where physical activity is often sidelined or mentioned as a vague recommendation. “Ignoring exercise as a treatment for depression isn’t just a missed opportunity. It might even cross the line into negligence,” he writes. Citing growing research, he stresses that the antidepressant effects of exercise are well-documented, and the medical field can no longer afford to treat it as an afterthought.

The key, according to Dr. Fabiano, is not simply telling patients to “go for a walk,” but prescribing exercise in a structured and personalized way. He advocates for using the FITT principle—Frequency, Intensity, Time, and Type—to tailor exercise prescriptions to each patient’s specific condition, goals, and lifestyle limitations.

Beyond clinical settings, Dr. Fabiano is urging systemic changes. These include integrating exercise prescription training into medical education, incorporating physical activity into official clinical guidelines for depression, ensuring insurance coverage for related services, and making referrals to certified exercise professionals more accessible. He also highlights the role of technology, encouraging the use of fitness trackers and apps for monitoring progress and encouraging adherence.

“If we don’t hesitate to prescribe a pill, why do we hesitate with exercise?” Dr. Fabiano concludes. His message is clear: it’s time to reframe how we think about treating depression. With a strong evidence base and numerous physical and mental health benefits, exercise deserves a permanent seat at the table in modern mental health care.

Reference: Fabiano N, Puder D, Stubbs B, Could not prescribing exercise for depression be psychiatric malpractice?

British Journal of Sports Medicine Published Online First: 09 September 2025. doi: 10.1136/bjsports-2025-110405.