Anorexia nervosa is one of the most widespread nutrition problems and one of the most lethal and complex psychiatric disorders, which is not typical of modern life, but which aesthetic pressure and social networks have aggravated. In this regard, a peer-reviewed pilot study, published in the journal Communications Medicine, presents preliminary evidence of a new approach to its treatment.

Researchers found that a medically supervised ketogenic intervention was safe and highly feasible in patients who had regained their weight or were slightly underweight.

Led by researchers at the University of California San Diego, the study showed encouraging clinical signs: nearly three-quarters of participants who completed the program no longer met diagnostic criteria for anorexia nervosa, and all experienced a reduction in depressive symptoms, according to a statement.

These findings suggest that addressing the underlying neurometabolic dysfunction, rather than focusing solely on behavior and weight regain, could represent a significant change in treatment.

Anorexia nervosa, one of the most complex disorders

While preliminary, the study results offer new hope for a disorder that claims one life every 52 minutes in the United States. Additionally, they add to emerging research on the ketogenic diet in other conditions, from major depressive disorder to schizophrenia and bipolar disorder.

Anorexia nervosa is a devastating psychiatric disorder, in which, even after regaining weight, patients often struggle with persistent psychological symptoms, such as body dissatisfaction, an intense fear of eating, and excessive concern about one's figure, leading to an alarmingly high risk of relapse.

Dr. Guido Frank, professor of Psychiatry at the UC San Diego School of Medicine and leader of the study, who has been studying and treating patients with anorexia for more than 25 years, promoted this research to expand treatment options for this high-risk population, the statement said.

"We urgently need new approaches to anorexia nervosa. Our work with ketogenic therapy goes beyond standard therapies and potentially addresses the underlying physiology of the disorder," he said.

“There is increasing evidence linking anorexia nervosa with neurometabolic dysfunction, and we are hopeful that direct metabolic intervention can regulate neuronal function and address the psychological symptoms patients experience,” he said optimistically.

Study details

The national, single-arm, outpatient clinical study administered a 14-week supervised ketogenic intervention, and 18 of 22 enrolled participants (82%) completed the study. No significant change in weight was observed throughout the program (as measured by BMI). At the end of the study, 72% of participants who completed the study reached the recovery range for eating disorder symptoms according to the eating disorder scales (Eating Disorders Examination Questionnaire, EDE-Q, and Eating Disorder Inventory-3, EDI-3) and all showed improvements in depression scores (as measured by the Beck Depression Inventory, BDI), with 72% within the normal range.

“The scientific research that gave rise to this study began with the search for answers for my niece, Caroline Beckwith,” shared co-author Barbara Scolnick, an internist in Waban, Massachusetts, who highlighted that this study represents the culmination of a decade of personal search.

"Ketogenic therapy, a standard treatment for epilepsy, was the main factor that, combined with other interventions, allowed Caroline to achieve remission after fifteen years of battling anorexia nervosa. I am encouraged by these preliminary findings, which indicate that this treatment could be a solution for others like Caroline," Scolnick said.

While the authors recognize the clinical sensitivity of dietary interventions in this patient population, this study builds on previous research. There is evidence that demonstrates the viability of the concept. The findings indicate that, when administered with specialized medical supervision and trained support, ketogenic therapy has potential for those who have not responded to traditional treatments, they describe.

“This study highlights the potential of dietary interventions that seek to normalize underlying neurometabolic function in even the most resistant psychiatric disorders, such as anorexia nervosa,” said Jan Ellison Baszucki, co-founder and president of the Baszucki Group, which funded the study. “We hope this work will drive awareness and support for the research and application of ketogenic therapy for eating disorders, thereby offering new hope to patients and their families.”

Additionally, an extension of this study is currently being carried out, aimed at patients with diagnoses of anorexia nervosa and bulimia nervosa, and participants are being recruited nationwide, they indicated.

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