Ketogenic diet and ketamine infusion treatment to target chronic persistent eating disorder psychopathology in anorexia nervosa: a pilot study

Lori Viscogliosi Calabrese · Barbara Scolnick · Beth Zupec‐Kania · Caroline Beckwith · Kayla Costello · Guido Frank

56 citations0/0 files storedEating and Weight Disorders - Studies on Anorexia Bulimia and Obesity

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Eating Disorders and Behaviors Nutrition, Health and Food Behavior Diet and metabolism studies

Abstract

PURPOSE: Anorexia nervosa (AN) is a severe psychiatric disorder, and shape and weight concerns are often chronic despite weight normalization. No specific treatments exist for those preoccupations that interfere with recovery and trigger relapse. A case study using a ketogenic diet followed by ketamine infusions led to sustained remission in one patient with chronic AN. Here we conducted an open-label trial to test whether this response could be replicated. METHODS: Five adults weight recovered from AN but with persistent eating disorder thoughts and behaviors adopted a therapeutic ketogenic diet (TKD) aimed at maintaining weight. After sustaining nutritional ketosis, participants received six ketamine infusions and were followed over 6 months. RESULTS: All participants completed the study protocol without significant adverse effects. Two participants maintained TKD for 8 weeks prior to ketamine infusions due to good behavioral response and remained on TKD. Three participants received TKD for 4 weeks prior to and during ketamine, then tapered off after the final infusion. The group showed significant improvements on the Clinical Impairment Assessment (p = 0.008), Eating Disorder Examination Questionnaire (EDEQ) Global score (p = 0.006), EDEQ-Eating Concerns (p = 0.005), EDEQ-Shape Concerns (p = 0.016), EDEQ-Weight Concerns (p = 0.032), Eating Disorders Recovery Questionnaire (EDRQ) Acceptance of Self and Body (0.027) and EDRQ-Social and Emotional Connection (p = 0.001). Weight remained stable, except for one participant who relapsed 4 months after treatment and off TKD. CONCLUSION: This novel treatment appears to be safe and effective for adults with chronic AN-related psychopathology. The results from this open trial support that there are specific neurobiological underpinnings of AN that can be normalized using TKD and ketamine. LEVEL OF EVIDENCE: Level IV, multiple time series with intervention.

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References

2019Genome-wide association study identifies eight risk loci and implicates metabo-psychiatric origins for anorexia nervosa 2015Severe and enduring anorexia nervosa (SE-AN): in search of a new paradigm 1998Treatment of compulsive behaviour in eating disorders with intermittent ketamine infusions 2021Association of Brain Reward Response With Body Mass Index and Ventral Striatal-Hypothalamic Circuitry Among Young Women With Eating Disorders 2020Remission from Chronic Anorexia Nervosa With Ketogenic Diet and Ketamine: Case Report

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