What a Ketogenic Diet Did to Anorexia Nervosa Symptoms in a New Pilot Trial

Bret: 
This is Metabolic Mind Bitesize. I’m Dr. Bret Scher. 

Guido: 
Hi, I’m Guido Frank. I’m a professor of psychiatry at the University of California, San Diego, and have been in the eating disorders field for about 25 years as a clinician and researcher, and have been very invested in understanding and treating individuals with eating disorders.

What has been very frustrating, to put it that way, is that the innovation of novel treatments in eating disorders has been difficult, and especially biological treatments have not been really established for anorexia nervosa. Anorexia nervosa is a severe psychiatric disorder characterized by food restriction and significantly low body weight.

Even after weight restoration, core symptoms, such as body dissatisfaction, intense fear of eating, and preoccupations with body shape and weight often persist, contributing to a very high risk of relapse, and while this disorder is one of the psychiatric problems with one of the highest mortalities.

So, after getting into the ketogenic diet field, which I got into by chance, I want to say, I was incredibly impressed by how quickly and how effective this treatment helped reduce symptoms in anorexia nervosa. And we developed a neurobiological model, how we think this is affecting the brain and behavior in folks with anorexia nervosa.

This study that was just published in Communications Medicine tested the feasibility and safety of a weight-maintaining ketogenic dietary therapy administered over 14 weeks in adult individuals with anorexia nervosa. And 22 individuals participated, and 82% of those completed the trial. At the end of the study, 72% of participants showed eating restraint, eating concern, shape concern, and weight concern as well as depression scores within the normal range. In summary, the study suggests that ketogenic dietary therapy did not precipitate worsening of symptoms or clinically significant weight loss. But rather, these findings support that ketogenic dietary therapy could be an effective treatment for anorexia nervosa and should be investigated further.

There has been much concern about using a ketogenic nutrition in the eating disorders field. And there was, in particular, the concern raised that it could lead to relapse and maybe weight loss. We did not encounter this problem, this potential side effect, in our study population. If we can replicate these data in future studies, I do believe that ketogenic dietary nutrition could revolutionize the treatment of eating disorders, especially anorexia nervosa, and that we will dramatically be able to improve the course of illness.

At this point, we are furthering our research in different directions. One is a study that ties glucose-related brain imaging to the ketogenic diet intervention, so we want to understand how does the brain metabolism relate to the ketogenic nutrition and symptom improvement. And on the other hand, we started working with individuals who are underweight to test whether this is an intervention that can, not only in the normal weight state be applied, but also when people are at a lower weight.

And further, we would like to expand that to other eating disorders because I do believe that problems with metabolism are a trans-diagnostic problem, if you wish, in individuals with eating disorders that could be ameliorated, helped with the ketogenic dietary treatment. If you would like to learn more about our studies, please go to the UC San Diego website and look for ketogenic therapy in anorexia nervosa and eating disorders.