Therapeutic Ketogenic Diet in Anorexia Nervosa

NCT ID: NCT06000774

Last Updated: 2025-09-05

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 20 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-10-03
• Study Completion Date: 2027-06-30

Brief Summary

This study will investigate the effects of therapeutic ketogenic diet (TKD) on eating behavior including drive to restrict, body dissatisfaction, mood and anxiety in individuals with anorexia nervosa who have been weight normalized (body mass index of 17.5 or greater) but continue to struggle with eating disorder behaviors including a high drive for thinness and body dissatisfaction.

The Underweight Anorexia Nervosa (AN) Sub-Study will investigate the effects of TKD on eating behavior including drive to restrict, body dissatisfaction, mood and anxiety in individuals with anorexia nervosa who are currently underweight (body mass index between 16.0 and 17.49) and continue to struggle with eating disorder behaviors including a high drive for thinness and body dissatisfaction.

The Bulimia Nervosa Pilot will will investigate the effects of TKD on eating behavior including drive to binge and purge, body dissatisfaction, mood and anxiety in individuals with bulimia nervosa.

Detailed Description

For this 14-week study, the investigator will recruit twenty individuals with anorexia nervosa who have been weight normalized but continue to have high impairment from the illness with a high (2 standard deviations above average) drive for thinness and body dissatisfaction and a high drive for food restriction and thus are at high risk for full relapse. Study participants will be carefully assessed and oriented to the ketogenic diet according to the procedures in our small previous trial (Calabrese, et al., 2022). The study will be conducted in a university medical environment, showing feasibility and safety in a typical medical setting. A commercial supplier will provide the ketogenic diet. After ketosis induction over two weeks, study participants will be assessed weekly for ketosis and mood, anxiety, and eating disorder symptoms.

For the BN Pillot study we will also complete a small pilot in 5 individuals with bulimia nervosa.

For the Underweight Anorexia Nervosa (AN) Sub-Study we will also recruit 30 individuals with anorexia nervosa who are mild to moderately underweight and have a body mass index of between 16.0 to 17.49.

Primary Objective 1 is to test the effects of ketogenic diet in individuals with anorexia nervosa who are weight recovered but continue to suffer severely from drive for thinness and are at very high relapse risk. Participants will be evaluated for tolerability of the study and weight trajectory. Primary Objective 2 is to assess improvement in AN symptoms and behaviors in relation to the ketogenic diet over a 12-week course. Participants will be assessed for specific symptoms such as drive for thinness and body dissatisfaction, fear of eating and weight gain. Primary Objective 3 is to assess the underlying genetic basis for the treatment effect of the ketogenic diet.

Bulimia Nervosa Pilot Objective 1: To test the effects of ketogenic diet in individuals with bulimia nervosa.

Bulimia Nervosa Pilot Objective 2: To assess improvement in BN symptoms and behaviors in relation to the ketogenic diet over a 2-week induction period followed by a 12-week course of the intervention. We expect especially a reduction in binge eating episodes and associated purging episodes in response to the treatment and in addition to improvement of the cognitive emotional symptoms.

Underweight AN Sub-Study Objective 1: To test the effects of ketogenic diet in individuals with anorexia nervosa who are currently mildly underweight and assess how the intervention impacts weight normalization in this population.

Underweight AN Sub-Study Objective 2: To assess improvement in AN symptoms and behaviors in relation to the ketogenic diet over a 2-week induction period followed by a 12-week course of the intervention.

Underweight AN Sub-Study Objective 3: To assess the underlying genetic basis for the treatment effect of the ketogenic diet.

Conditions

Anorexia Nervosa in Remission; Bulimia Nervosa; Anorexia Nervosa

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Therapeutic Ketogenic Diet

A 2-week therapeutic ketogenic diet (TKD) induction will be implemented to establish nutritional ketosis (the goal are BHB blood levels of 0.5-3.0 millimoles per liter \[mmol/L\]). After establishing the ketotic state, study participants will continue TKD for 12 weeks.

Group Type: EXPERIMENTAL

Therapeutic Ketogenic Diet

Intervention Type: OTHER

therapeutic ketogenic diet

Interventions

Therapeutic Ketogenic Diet

therapeutic ketogenic diet

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

1. Provision of signed and dated informed consent form

2. Stated willingness to comply with all study procedures and availability for the duration of the study

3. Persons, aged 18 to 45 years

4. History of anorexia nervosa according to DSM-5 criteria

5. Weight recovered at the time of study inclusion (body mass index > 17.5 kg/m2)

6. Greater or equal to 2 standard deviations scores of eating disorder-relevant behaviors on the Eating Disorder Inventory-3 and Eating Disorder Examination Questionnaire

7. The following types of psychiatric medications are allowed: antidepressant, anxiolytic, atypical antipsychotic, mood stabilizers

8. English is primary spoken language

1. Provision of signed and dated informed consent form

2. Stated willingness to comply with all study procedures and availability for the duration of the study

3. Persons, aged 18 to 45 years

4. Anorexia nervosa according to DSM-5 criteria

5. Current Body Mass Index (BMI) at the time of study inclusion of 16.0 to 17.49

6. An elevated EDE-Q global score of 2.09 or greater

7. The following types of psychiatric medications are allowed: antidepressant, anxiolytic, atypical antipsychotic, mood stabilizers

8. English is primary spoken language

1. Provision of signed and dated informed consent form

2. Stated willingness to comply with all study procedures and availability for the duration of the study

3. Persons, aged 18 to 45 years

4. History of bulimia nervosa according to DSM-5 criteria

5. An elevated EDE-Q global score of 2.09 or greater

6. The following types of psychiatric medications are allowed: antidepressant, anxiolytic, atypical antipsychotic, mood stabilizers

7. English is primary spoken language

Exclusion Criteria

1. Pregnancy or lactation

2. Electrolyte, blood count, kidney function or liver function abnormalities

3. Psychosis

4. Neurocognitive disorders including dementias or traumatic brain injury that is symptomatic

5. Current alcohol use disorder (AUD) or substance use disorder (SUD) according to DSM-5 criteria

6. Uncontrolled hypertension

7. Hepatic impairment (Class-Pugh b or c)

8. Diabetes mellitus

9. Family history of porphyria

10. History of recent heart attack, vascular disease, or any other current acute medical conditions as determined by the principal investigator

11. Inability or unwillingness to adhere to the TKD diet for the duration of the study

12. Blind or illiterate individuals

1. Pregnancy or lactation

2. Electrolyte, blood count, kidney function or liver function abnormalities

3. Psychosis

4. Neurocognitive disorders including dementias or traumatic brain injury that is symptomatic

5. Current alcohol use disorder (AUD) or substance use disorder (SUD) according to DSM-5 criteria

6. Uncontrolled hypertension

7. Hepatic impairment (Class-Pugh b or c)

8. Diabetes mellitus

9. Family history of porphyria

10. History of recent heart attack, vascular disease, or any other current acute medical conditions as determined by the principal investigator

11. Inability or unwillingness to adhere to the TKD diet for the duration of the study

12. Blind or illiterate individuals

1. Pregnancy or lactation

2. Electrolyte, blood count, kidney function or liver function abnormalities

3. Psychosis

4. Neurocognitive disorders including dementias or traumatic brain injury that is symptomatic

5. Current alcohol use disorder (AUD) or substance use disorder (SUD) according to DSM-5 criteria

6. Uncontrolled hypertension

7. Hepatic impairment (Class-Pugh b or c)

8. Diabetes mellitus

9. Family history of porphyria

10. History of recent heart attack, vascular disease, or any other current acute medical conditions as determined by the principal investigator

11. Inability or unwillingness to adhere to the TKD diet for the duration of the study

12. Blind or illiterate individuals

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 45 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of California, San Diego

OTHER

Sponsor Role: lead

Responsible Party

Guido Frank

Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Guido Frank, MD

Role: PRINCIPAL_INVESTIGATOR

University of California, San Diego

Locations

University of California San Diego

San Diego, California, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Megan Shott, BS

Role: CONTACT

mshott@health.ucsd.edu

848-246-5272

Facility Contacts

Megan E Shott, BS

Role: primary

mshott@health.ucsd.edu

858-246-5272

Guido Frank, MD

Role: backup

gfrank@health.ucsd.edu

References

Scolnick B, Zupec-Kania B, Calabrese L, Aoki C, Hildebrandt T. Remission from Chronic Anorexia Nervosa With Ketogenic Diet and Ketamine: Case Report. Front Psychiatry. 2020 Jul 30;11:763. doi: 10.3389/fpsyt.2020.00763. eCollection 2020.

Reference Type: BACKGROUND

PMID: 32848935 (View on PubMed)

Frank GKW, Shott ME, DeGuzman MC. The Neurobiology of Eating Disorders. Child Adolesc Psychiatr Clin N Am. 2019 Oct;28(4):629-640. doi: 10.1016/j.chc.2019.05.007. Epub 2019 Jul 4.

Reference Type: BACKGROUND

PMID: 31443880 (View on PubMed)

Frank GKW, Shott ME, Stoddard J, Swindle S, Pryor TL. Association of Brain Reward Response With Body Mass Index and Ventral Striatal-Hypothalamic Circuitry Among Young Women With Eating Disorders. JAMA Psychiatry. 2021 Oct 1;78(10):1123-1133. doi: 10.1001/jamapsychiatry.2021.1580.

Reference Type: BACKGROUND

PMID: 34190963 (View on PubMed)

Dignon A, Beardsmore A, Spain S, Kuan A. 'Why I won't eat': patient testimony from 15 anorexics concerning the causes of their disorder. J Health Psychol. 2006 Nov;11(6):942-56. doi: 10.1177/1359105306069097.

Reference Type: BACKGROUND

PMID: 17035265 (View on PubMed)

Calabrese L, Scolnick B, Zupec-Kania B, Beckwith C, Costello K, Frank GKW. Ketogenic diet and ketamine infusion treatment to target chronic persistent eating disorder psychopathology in anorexia nervosa: a pilot study. Eat Weight Disord. 2022 Dec;27(8):3751-3757. doi: 10.1007/s40519-022-01455-x. Epub 2022 Aug 23.

Reference Type: BACKGROUND

PMID: 35997954 (View on PubMed)

Other Identifiers

807674

Identifier Type: -

Identifier Source: org_study_id