New research from UC San Diego School of Medicine reports that a ketogenic may provide a new approach to treating anorexia nervosa, a disorder for which effective treatments have been significantly limited.  Anorexia nervosa is an eating disorder defined by restriction of energy intake relative to requirements, leading to a significantly low body weight.

An estimated 9% of the U.S. population will have an eating disorder in their lifetime.

Anorexia nervosa is one of the deadliest mental illnesses. One study reported that among individuals with anorexia nervosa, one in five died by suicide. Anorexia nervosa is characterized by a significant and persistent reduction in food intake leading to extremely low body weight in the context of age, sex, and physical health; a relentless pursuit of thinness; a distortion of body image and intense fear of gaining weight; and extremely disturbed eating behavior. Many people with anorexia see themselves as overweight, even when they are starved or severely malnourished. Even after successful weight restoration, patients often struggle with persistent psychological symptoms — including body dissatisfaction, an intense fear of eating, and a preoccupation with shape — that drive an alarmingly high risk of relapse.

In the study using a ketogenic nutritional intervention — a high-fat, low-carbohydrate, moderate-protein diet — was feasible and safe for patients with weight-normalized and mildly underweight anorexia nervosa. The ketogenic intervention was well-tolerated by participants, with high adherence rates and no significant weight loss observed throughout the program. Furthermore, significant improvements were observed in eating disorder symptoms, with nearly 3 in 4 of study completers in the recovered range at study end, no longer meeting criteria for an anorexia nervosa diagnosis, and all completers experiencing an improvement in depression scores.

Addressing Anorexia Nervosa: Awareness and Treatment

Raising awareness about anorexia nervosa and its prevalence is vital for improving diagnosis, treatment, and support for those affected.

• Early Intervention: Early detection and intervention are key to improving individual outcomes. Education and awareness campaigns can help identify at-risk individuals and encourage them to seek help sooner.
• Comprehensive Treatment: Effective treatment typically involves a multidisciplinary approach, including medical care, nutritional counseling, and psychotherapy. Family involvement is also crucial, particularly for younger individuals.

For those with Anorexia Nervosa there is evidence that the vicious cycle of weight loss followed by more food restriction is, at least in part, due to the interactions between conditioned fear of weight gain and altered dopamine which may drive dread and avoidance of food. A person in that situation loses weight and enters a ketosis state, the brain will then use ketones as an alternative energy source that may be less affected by anxiety. Thus, the individual learns that starvation provides a better subjective feeling of having sufficient energy, and food restriction becomes self-reinforcing.

The underlying principle of the ketogenic diet is that most energy is supplied via fat in the diet, which is then broken down into fatty acids for energy consumption. However, sufficient calories are in the food to maintain normal weight. The ketogenic diet may be an effective treatment intervention for Anorexia Nervosa to normalize energy homeostasis and remove the need to self-starve for nutritional ketosis.

Findings indicate that, when delivered with specialized medical supervision and trained support, ketogenic therapy holds potential for those who have failed to respond to traditional treatments. We hope this work drives awareness and support for researching and delivering ketogenic therapy for eating disorders, providing new hope for patients and their families.

References:

New evidence offers hope for ketogenic therapy in treatment of anorexia nervosa https://www.eurekalert.org/news-releases/1130610

Eating Disorders https://www.nimh.nih.gov/health/statistics/eating-disorders

Therapeutic ketogenic diet as treatment for anorexia nervosa  https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2024.1392135/full

https://www.eatingrecoverycenter.com/resources/eating-disorder-statistics/