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

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.

Therapeutic Potentials of Ketamine and Esketamine in Obsessive–Compulsive Disorder (OCD), Substance Use Disorders (SUD) and Eating Disorders (ED): A Review of the Current Literature

“…The findings are described in detail and organized in relation to the specific type of article and order of publication (see Table 1). Studies retrieved were represented by nine case series/case reports [13,[40][41][42][43][44][45][46][47][48], six randomized-controlled trials [49][50][51][52][53][54], ten open-label studies [55][56][57][58][59][60][61][62][63][64][65] and three double blind trials [66][67][68]. Most cases involved adult males (total M/F = 328/160= 2.1).…”

“…Patients were mostly diagnosed with OCD [13,40,45,47,55,56,[60][61][62][63][64] or a SUD, such as opioid dependence [41,[43][44][45][46][57][58][59], cocaine dependence [49,50,52,[66][67][68] or alcohol dependence [51,54,65]. Only three studies focused on ED [42,46,48]. Ketamine was mostly intravenously administered [42][43][44][45][47][48][49][50][51][52][53][54][55][56][57][59][60][61][65]…”

“…Only three studies focused on ED [42,46,48]. Ketamine was mostly intravenously administered [42][43][44][45][47][48][49][50][51][52][53][54][55][56][57][59][60][61][65][66][67], but intranasal [40,62], intramuscular [46,58,68] and oral [13,41] routes of administration were also recorded. Ketamine was administered together with Cognitive Behavioral Therapy (CBT) [40,43], or in the context of ketamine-assisted psychotherapy (KPT) sessions [58,68] or Trauma Interventions using Mindfulness Based Extinction and Reconsolidation of memories (TIMBER) [59].…”

“…IM ketamine was administered with repeat dosing at 4-6 week intervals in four patients chronically ill with an ED for more than 7 years, and current criteria for TRD show clinically meaningful changes in depression, and to a lesser degree anxiety, and ED symptoms [46]. An interesting recent case report of a 29-year-old woman with a long history of severe AN and intermittent alcohol dependence, and diagnosed with major depressive disorder, indicated complete recovery after a ketogenic diet associated with ketamine infusions [48].…”

The use of the ketogenic diet in the treatment of psychiatric disorders

“…Scolnick and colleagues 16 published a case report detailing the effects of the KD on a 29-year-old female with a 15-year history of anorexia nervosa. A KD of 2:1 to 1:1 ratio of fats to carbohydrates was used, and a KD nutritionist provided dietary education.…”