Remission from Chronic Anorexia Nervosa With Ketogenic Diet and Ketamine: Case Report

Barbara Scolnick, Beth Zupec-Kania, Lori Calabrese, Chiye Aoki, Thomas Hildebrandt, Barbara Scolnick, Beth Zupec-Kania, Lori Calabrese, Chiye Aoki, Thomas Hildebrandt

Abstract

Background: Chronic anorexia nervosa is a tragic disease with no known effective pharmacological or behavioral treatment. We report the case of a 29 year-old woman who struggled with severe and enduring anorexia nervosa for 15 years, and experienced a complete recovery following a novel treatment of adopting a ketogenic diet followed by ketamine infusions. Her remission has persisted for over 6 months.

Case presentation: At age 14.5, the patient embarked on an effort to "eat healthy." She quickly lost control of the dieting, developed associated compulsions and obsessions about food, body dissatisfaction, emotional lability, and lost nearly 13.6 kilograms (30 pounds). She was hospitalized for 6 weeks, and while she regained some weight, she did not attain full weight restoration. For 15 years, she continued to eat in a restrictive manner, exercise compulsively, and have intermittent periods of alcohol dependence. Nevertheless, she always hoped to get well, and at age 29, she began a novel treatment for anorexia nervosa.

Conclusions: This is the first report of a ketogenic diet used specifically for the treatment of anorexia nervosa, followed by a short series of titrated IV ketamine infusions leading to complete remission of severe and enduring anorexia nervosa, with weight restoration, and sustained cessation of cognitive and behavioral symptoms, for 6 months. Although these treatments were used sequentially the relationship between these modalities, and possible synergy, is unclear, and deserves further study. Complete and sustained remission of chronic anorexia nervosa is quite rare, and the novel use of a ketogenic diet and IV ketamine treatment in this potentially lethal condition suggests avenues for further research, and hope for patients and their families.

Keywords: activity-based-anorexia animal model; anorexia nervosa; brain-derived-neurotrophic factor (BDNF); ketamine; ketogenic diet.

Copyright © 2020 Scolnick, Zupec-Kania, Calabrese, Aoki and Hildebrandt.

References

    1. Murray SB, Loeb KL, LeGrange K. Treatment outcome reporting in anorexia nervosa: time for a paradigm shift? J Eating Disord (2018) 6:10 . 10.1186/s40337-018-00195-1
    1. Eddy KT, Tabri TN, Thomas JJ, Murray HB, Keshaviah A, Hastings E, et al. Recovery from anorexia nervosa and bulimia nervosa at 22-year follow up. J Clin Psychiatry (2017) 78(2):184–9. 10.4088/JCP.15m10393
    1. Fichter MM, Quadflieg N, Crosby RD, Koch S. Long-term outcome of anorexia nervosa: results from a large clinical longitudinal study. Int J Eat Disord (2017) 50:1018–30. 10.1002/eat.22736
    1. Touyz S, Hay P. Severe and enduring anorexia nervosa in search of a new paradigm. J Eat Disord (2015) 3:26. 10.1186/s400337-015-00650-z
    1. Shih PB, Yang J, Morisseau C, German JB, Zeeland AA, Armando AM, et al. Dysregulation of soluble epoxide hydrolase and lipidomic profiles in anorexia nervosa. Mol Psychiatry (2016) 21(4):537–46. 10.1038/mp.2015.26
    1. Watson HJ, Yilmaz Z, Thornton LM, Hubel C, Coleman JR, II, Gaspar HA, et al. Genome-wide association study identifies eight risk loci and implicates metabo-psychiatric origins for anorexia nervosa. Nat Genet (2019) 51(8):1207–14. 10.1038/s41588-019-0439-2
    1. Holman RT, Adams CE, Nelson RA, Grater SJ, Jaskiewicz JA, Johnson SB, et al. Patients with Anorexia Nervosa Demonstrate deficiencies of selected essential fatty acids, compensatory changes in nonessential fatty acids and decreased fluidity of plasma lipids. J Nutr (1995) 125(4):901–7.
    1. Scolnick B. Hypothesis: Clues from mammalian hibernation for treating patients with anorexia nervosa. Front Psychol (2018) 9:2159. 10.3389/fpsyg.2018.02159
    1. Kraeuter AK, Phillips R, Sarnyai Z. Ketogenic therapy in neurodegenerative and psychiatric disorders: From mice to men. Prog. Neuropsychopharmacol Biol Psychiatry (2020) 101:109913. 10.1016/j.pnpbp.2020.109913
    1. Giordano C, Marchio M, Timofeeva E, Biagnin G. Neuroactive peptides as putative mediators of antiepileptic ketogenic dies. Front Neurol Rev (2014) 29(5):63. 10.3389/fneuro.2014.00063
    1. Marucci S, Ragione LD, De Iaco G, Mococci T, Vicini M, Guastamacchia E, et al. Anorexia Nervosa and Comorbid Psychopathology. Endocr Metab Immune Disord Drug Targets (2018) 18(4):316–24. 10.2174/1871530318666180213111637
    1. Fond G, Loundou A, Rabu C, Macgregor A, Lancon C, Brittner M, et al. Ketamine administration in depressive disorders: a systematic review and meta-analysis. Psychopharmacol (Berl) (2014) 231(18):3663–76. 10.1007/s00213-014-3664-5
    1. Calabrese L. Titrated serial ketamine infusions stop outpatient suicidality and avert ER visits and hospitalizations. Int J Psychiatr Res (2019) 2(6):1–12.
    1. Mills IH, Park GR, Manara AR, Merriman RJ. Treatment of compulsive behavior in eating disorders with intermittent ketamine infusions. QJM (1998) 91(7):493–503. 10.1093/qjmed/91.7.493
    1. Le Grange D. The Maudsley family-based treatment for adolescent anorexia nervosa. World Psychiatry (2005) 4(3):1142–146.
    1. Schebendach JE, Mayer LE, Devlin MJ, Atia E, Contento IR, Wolf RL, et al. Food choice and diet variety in weight-restored patients with anorexia nervosa. J Am Diet Assoc (2011) 111(5):732–6. 10.1016/j.jada.2011.02.002
    1. Beard C, Hsu KH, Rifkin LS, Busch AB, Bjorgvinsson T. Validation of the PHQ-9 in a psychiatric sample. J Affect Disord (2016) 193:267–73. 10.1016/j.jad.2015.12.075
    1. Guisinger S. Adapted to flee famine: adding an evolutionary perspective on anorexia nervosa. Psychol Rev (2003) 110(4):745–61. 10.1037/0033-295X.110.4.745
    1. Aoki C. Synaptic changes in the hippocampus of adolescent female rodents associated with resilience to anxiety and suppression of food restriction-evoked hyperactivity in an animal model for anorexia nervosa. Brain Res (2017) 1654(PtB):102–15. 10.1016/j.brainres.2016.01.019
    1. Barboriak JJ, Wilson AS. Effect of diet on self-starvation in the rat. J Nut (1972) 102(11):1543–6. 10.1093/jn/102.11.1543
    1. Brown AJ, Avena NM, Hoebel BG. A high fat diet prevents and reverses the development of activity-based anorexia in rats. Int J Eat Disord (2008) 41(5):383–9. 10.1002/eat.20150
    1. Freeman JM, Kossoff EH. Ketosis and the ketogenic diet.2010: advances in treating epilepsy and other disorders. Adv Pediatr (2010) 57(1):315–29. 10.1016/j.yapd.2010.08.003
    1. Strafstrom CE, Rho JM. The ketogenic diet as a treatment paradigm for diverse neurological disorders. Front Pharmacol (2012) 3:59. 10.3389/fpharm.20012.00059
    1. Ang QY, Aleaxander, Newman JC, Tian Y, Cai J, Turnbaugh PJ. Ketogenic diets alter the gut microbiome resulting in decreased intestinal Th17 cells. Cell (2020) 181:1263–75. 10.1016/j.cell.2020.04.027
    1. Chen YW, Sherpa AD, Aoki C. Single injection of ketamine during mid-adolescence promotes long-lasting resilience to activity based anorexia of female mice by increasing food intake and attenuating hyperactivity as well as anxiety like behavior. Int J Eat Disord (2018) 51:1020 –1025. 10.1002/eat.22937
    1. Acevedo-Diaz E, Cavanaugh GW, Kraus C, Bashkim K, Zarate CA. Comprehensive assessment of the side effects associated with a single dose of ketamine in treatment-resistant depression. J Affect Disord (2019) 263:568–75. 10.1016/j.jad.2019.11.028
    1. Hartman AL, Gasior M, Vining E, Rogawski MA. The neuropharmacology of the ketogenic diet. Pediat Neurol (2007) 36(5):281–92. 10.1016/j.pediatrneurol.2007.02.008
    1. Zanos P, Moaddel R, Morris PJ, Riggs LM, Highland JN, Georgiou P, et al. Ketamine and ketamine metabolite pharmacology- insights into therapeutic mechanisms. Pharmacol Rev (2018) 70(3):621–60. 10.1124/pr.117.015198

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