Treating binge eating and food addiction symptoms with low-carbohydrate Ketogenic diets: a case series

Abstract

Background: Many patients with obesity and comorbid binge eating symptoms present with the desire to lose weight. Although some studies suggest that dietary restriction can exacerbate binge eating, others show dietary restriction is associated with significant reductions in binge eating. The effect of a particular type of dieting on binge eating, the ketogenic diet (a high fat, moderate protein, very low carbohydrate diet), is not known.

Case presentations: We report on the feasibility of a low-carbohydrate ketogenic diet initiated by three patients (age 54, 34, and 63) with obesity (average BMI 43.5 kg/m2) with comorbid binge eating and food addiction symptoms. All patients tolerated following the ketogenic diet (macronutrient proportion 10% carbohydrate, 30% protein, and 60% fat; at least 5040 kJ) for the prescribed period (e.g., 6-7 months) and none reported any major adverse effects. Patients reported significant reductions in binge eating episodes and food addiction symptoms including cravings and lack of control as measured by the Binge-Eating Scale, Yale Food Addiction Scale, or Yale-Brown Obsessive-Compulsive Scale modified for Binge Eating, depending on the case. Additionally, the patients lost a range of 10-24% of their body weight. Participants reported maintenance of treatment gains (with respect to weight, binge eating, and food addiction symptoms) to date of up to 9-17 months after initiation and continued adherence to diet.

Conclusions: Although the absence of control cases precludes conclusions regarding the specific role of ketogenic diets versus other forms of dietary restriction, this is the first report to demonstrate the feasibility of prescribing a ketogenic diet for patients with obesity who report binge eating and food addiction symptoms. Further research should seek to reproduce the observed effects in controlled trials as well as to explore potential etiologies.

Keywords: Binge eating; Dietary restriction; Food addiction symptoms; Ketogenic diet; Obesity.

Conflict of interest statement

Competing interestsDr. Tro Kalayjian DO discloses spousal ownership of Rosette’s baked goods, a low carbohydrate based cookie mixing company and the LowCarbMD podcast. Dr. Eric Westman MD MHS discloses equity in AdaptFor Life and book royalties from Keto Clarity and Cholesterol Clarity. Remaining authors declare that they have no competing interests.

© The Author(s). 2020.

References

1. 1. Da Luz F, Hay P, Touyz S, Sainsbury A. Obesity with comorbid eating disorders: associated health risks and treatment approaches. Nutrients. 2018;10(7):829.
2. 1. Da Luz FQ, Hay P, Gibson AA, Touyz SW, Swinbourne JM, Roekenes JA, Sainsbury A. Does severe dietary energy restriction increase binge eating in overweight or obese individuals? A systematic review. Obes Rev. 2015;16(8):652–665.
3. 1. Yanovski SZ, Billington CJ, Epstein LH, Goodwin NJ, Hill JO, Pi-Sunyer FX, Rolls BJ, Stern JS, Wadden TA, Weinsier RL, Wilson GT. Dieting and the development of eating disorders in overweight and obese adults. Arch Intern Med. 2000;160(17):2581–2589.
4. 1. Polivy J, Herman CP. Dieting and binging: A causal analysis. Am Psychol. 1985;40(2):193.
5. 1. Telch CF, Agras WS. The effects of a very low calorie diet on binge eating. Behav Ther. 1993;24(2):177–193.
6. 1. Yanovski SZ, Sebring NG. Recorded food intake of obese women with binge eating disorder before and after weight loss. Int J Eat Disord. 1994;15(2):135–150.
7. 1. Raymond NC, de Zwaan M, Mitchell JE, Ackard D, Thuras P. Effect of a very low calorie diet on the diagnostic category of individuals with binge eating disorder. Int J Eat Disord. 2002;31(1):49–56.
8. 1. De Zwaan M, Mitchell JE, Crosby RD, Mussell MP, Raymond NC, Specker SM, Seim HC. Short-term cognitive behavioral treatment does not improve outcome of a comprehensive very-low-calorie diet program in obese women with binge eating disorder. Behav Ther. 2005;36(1):89–99.
9. 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). Washington, DC: American Psychiatric Pub; 2013.
10. 1. Gearhardt AN, Corbin WR, Brownell KD. Preliminary validation of the Yale food addiction scale. Appetite. 2009;52(2):430–436.
11. 1. Meule A, Gearhardt AN. Five years of the Yale food addiction scale: taking stock and moving forward. Curr Addict Rep. 2014;1(3):193–205.
12. 1. Eichen DM, Lent MR, Goldbacher E, Foster GD. Exploration of “food addiction” in overweight and obese treatment-seeking adults. Appetite. 2013;67:22–24.
13. 1. Burmeister JM, Hinman N, Koball A, Hoffmann DA, Carels RA. Food addiction in adults seeking weight loss treatment. Implications for psychosocial health and weight loss. Appetite. 2013;60:103–110.
14. 1. Lent MR, Eichen DM, Goldbacher E, Wadden TA, Foster GD. Relationship of food addiction to weight loss and attrition during obesity treatment. Obesity. 2014;22(1):52–55.
15. 1. Meule A, Heckel D, Kübler A. Factor structure and item analysis of the Yale food addiction scale in obese candidates for bariatric surgery. Eur Eat Disord Rev. 2012;20(5):419–422.
16. 1. Clark SM, Saules KK. Validation of the Yale food addiction scale among a weight-loss surgery population. Eat Behav. 2013;14(2):216–219.
17. 1. Gearhardt AN, White MA, Masheb RM, Morgan PT, Crosby RD, Grilo CM. An examination of the food addiction construct in obese patients with binge eating disorder. Int J Eat Disord. 2012;45(5):657–663.
18. 1. Gearhardt AN, Corbin WR, Brownell KD. Development of the Yale Food Addiction Scale Version 2.0. Psychol Addict Behav. 2016;30(1):113.
19. 1. Polivy J, Coleman J, Herman CP. The effect of deprivation on food cravings and eating behavior in restrained and unrestrained eaters. Int J Eat Disord. 2005;38(4):301–309.
20. 1. Phinney SD, Volek JS. The art and science of low carbohydrate living: an expert guide to making the life-saving benefits of carbohydrate restriction sustainable and enjoyable. Lexington: Beyond Obesity; 2011.
21. 1. Paoli A, Rubini A, Volek JS, Grimaldi KA. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr. 2013;67(8):789.
22. 1. Gibson AA, Seimon RV, Lee CM, Ayre J, Franklin J, Markovic TP, Caterson ID, Sainsbury A. Do ketogenic diets really suppress appetite? A systematic review and meta-analysis. Obes Rev. 2015;16(1):64–76.
23. 1. Löwe B, Unützer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression treatment outcomes with the patient health questionnaire-9. Med Care. 2004;1:1194–1201.
24. 1. Gormally J, Black S, Daston S, Rardin D. The assessment of binge eating severity among obese persons. Addict Behav. 1982;7(1):47–55.
25. 1. Deal LS, Wirth RJ, Gasior M, Herman BK, McElroy SL. Validation of the Yale-Brown obsessive compulsive scale modified for binge eating. Int J Eat Disord. 2015;48(7):994–1004.
26. 1. Swink TD, Vining EP, Freeman JM. The ketogenic diet: 1997. Adv Pediatr. 1997;44:297–329.
27. 1. Sackner-Bernstein J, Kanter D, Kaul S. Dietary intervention for overweight and obese adults: comparison of low-carbohydrate and low-fat diets. A meta-analysis. PLoS One. 2015;10(10):e0139817.
28. 1. Hashimoto Y, Fukuda T, Oyabu C, Tanaka M, Asano M, Yamazaki M, Fukui M. Impact of low-carbohydrate diet on body composition: meta-analysis of randomized controlled studies. Obes Rev. 2016;17(6):499–509.
29. 1. Kirk JK, Graves DE, Craven TE, Lipkin EW, Austin M, Margolis KL. Restricted-carbohydrate diets in patients with type 2 diabetes: a meta-analysis. J Am Diet Assoc. 2008;108(1):91–100.
30. 1. Austin GL, Thiny MT, Westman EC, Yancy WS, Shaheen NJ. A very low-carbohydrate diet improves gastroesophageal reflux and its symptoms. Dig Dis Sci. 2006;51(8):1307–1312.
31. 1. Austin GL, Dalton CB, Hu Y, Morris CB, Hankins J, Weinland SR, Westman EC, Yancy WS, Jr, Drossman DA. A very low-carbohydrate diet improves symptoms and quality of life in diarrhea-predominant irritable bowel syndrome. Clin Gastroenterol Hepatol. 2009;7(6):706–708.
32. 1. Olendzki BC, Silverstein TD, Persuitte GM, Ma Y, Baldwin KR, Cave D. An anti-inflammatory diet as treatment for inflammatory bowel disease: a case series report. Nutr J. 2014;13(1):5.
33. 1. Phelps JR, Siemers SV, El-Mallakh RS. The ketogenic diet for type II bipolar disorder. Neurocase. 2013;19(5):423–426.
34. 1. Kraft BD, Westman EC. Schizophrenia, gluten, and low-carbohydrate, ketogenic diets: a case report and review of the literature. Nutr Metab. 2009;6(1):10.
35. 1. Pacheco A, Easterling WS, Pryer MW. A pilot study of the ketogenic diet in schizophrenia. Am J Psychiatr. 1965;121(11):1110–1111.
36. 1. Klok MD, Jakobsdottir S, Drent ML. The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review. Obes Rev. 2007;8(1):21–34.
37. 1. Stubbs BJ, Cox PJ, Evans RD, Cyranka M, Clarke K, de Wet H. A ketone ester drink lowers human ghrelin and appetite. Obesity. 2018;26(2):269–273.
38. 1. Huda MS, Wilding JP, Pinkney JH. Gut peptides and the regulation of appetite. Obes Rev. 2006;7(2):163–182.
39. 1. Zhao X, Han Q, Gang X, Lv Y, Liu Y, Sun C, Wang G. The role of gut hormones in diet-induced weight change: a systematic review. Horm Metab Res. 2017;49(11):816–825.
40. 1. Chearskul S, Delbridge E, Shulkes A, Proietto J, Kriketos A. Effect of weight loss and ketosis on postprandial cholecystokinin and free fatty acid concentrations. Am J Clin Nutr. 2008;87(5):1238–1246.
41. 1. De Silva A, Bloom SR. Gut hormones and appetite control: a focus on PYY and GLP-1 as therapeutic targets in obesity. Gut Liver. 2012;6(1):10.
42. 1. Hu T, Yao L, Reynolds K, Niu T, Li S, Whelton P, He J, Bazzano L. The effects of a low-carbohydrate diet on appetite: a randomized controlled trial. Nutr Metab Cardiovasc Dis. 2016;26(6):476–488.
43. 1. Considine RV, Sinha MK, Heiman ML, Kriauciunas A, Stephens TW, Nyce MR, Ohannesian JP, Marco CC, McKee LJ, Bauer TL, Caro JF. Serum immunoreactive-leptin concentrations in normal-weight and obese humans. N Engl J Med. 1996;334(5):292–295.
44. 1. Fraser DA, Thoen J, Bondhus S, Haugen M, Reseland JE, Dioseland O, Forre O, Kjeldsen-Kragh J. Reduction in serum leptin and IGF-1 but preserved T-lymphocyte numbers and activation after a ketogenic diet in rheumatoid arthritis patients. Clin Exp Rheumatol. 2000;18(2):209–214.
45. 1. Lebrun B, Bariohay B, Moyse E, Jean A. Brain-derived neurotrophic factor (BDNF) and food intake regulation: a minireview. Auton Neurosci. 2006;126:30–38.