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

Lori Calabrese, Barbara Scolnick, Beth Zupec-Kania, Caroline Beckwith, Kayla Costello, Guido K W Frank, Lori Calabrese, Barbara Scolnick, Beth Zupec-Kania, Caroline Beckwith, Kayla Costello, Guido K W Frank

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.

Keywords: Anorexia nervosa; Eating disorders; Ketamine; Ketamine treatment; Keto diet; Ketogenic diet.

Conflict of interest statement

No author reports any conflict of interest.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Graphical representation of composite values for behavioral measures and body mass index (BMI) over time

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