A recent study published in Frontiers in Nutrition suggests that a therapeutic ketogenic diet (TKD) may offer a new approach to treating anorexia nervosa (AN), a severe psychiatric condition characterized by extreme weight loss, food avoidance, and a distorted body image. This neurobiological model integrates behavioral traits, brain metabolism, and neurotransmitter function, providing a comprehensive understanding of how TKD might address the underlying mechanisms of AN.
AN poses a significant health burden, with limited treatment effectiveness and a mortality rate that is 12 times higher in females aged 15 to 24 compared to the general population. Patients recovering from AN often experience persistent fears related to body dissatisfaction and weight gain, which can last for years. Understanding the core behaviors associated with AN and its recovery is crucial for developing effective therapies.
The proposed model indicates that anxiety and perfectionistic traits can disrupt normal brain glucose metabolism in individuals predisposed to AN. This disruption may lead to a reliance on ketone bodies as an alternative energy source, perpetuating a cycle of self-starvation and anxiety relief.
Research has shown structural and functional alterations in the brains of individuals with AN. The authors of the study previously found that weight loss and food avoidance affect brain circuits responsible for processing reward and motivation. Many individuals with AN overestimate their body size despite being underweight, a perception exacerbated by social media and other environmental factors.
The study suggests that high levels of anxiety and stress increase the brain’s demand for glucose while simultaneously reducing its utilization. This imbalance may contribute to the development and maintenance of AN, as individuals may resort to starvation as a coping mechanism.
The TKD, which mimics fasting, reduces glucose and insulin levels, prompting the body to metabolize fat for energy. This process generates ketone bodies, which can be used as an alternative energy source by the brain. Previous research indicates that higher levels of ketones can lead to decreased glucose uptake in the brain, potentially alleviating some symptoms of AN.
The researchers propose that TKD could help eliminate self-starvation behaviors and support energy balance in individuals with AN. By shifting the brain’s energy source from glucose to ketones, TKD may reduce anxiety and improve emotional regulation, addressing both the metabolic and psychological aspects of the disorder.
A preliminary case study demonstrated that a patient with AN showed significant recovery after undergoing TKD followed by ketamine infusion. Building on this, researchers conducted an open-label trial involving five adults with persistent eating disorder symptoms. After maintaining ketosis for 4 to 8 weeks, participants received ketamine infusions.
All participants adhered to the TKD for at least eight weeks and exhibited notable improvements in various assessments related to eating disorders, including the Eating Disorder Examination Questionnaire (EDEQ) and the Eating Disorders Recovery Questionnaire (EDRQ). Importantly, body weight remained stable throughout the trial. Four participants have maintained recovery for at least one year, while one individual who discontinued the diet experienced a relapse.
Conclusion
While these findings are promising, they are preliminary and based on a small sample size. The researchers emphasize the need for further studies involving larger, more diverse populations to validate the efficacy and safety of TKD as a treatment for AN.
In conclusion, the neurobiological model presented in this study highlights the complex interplay between metabolic and psychological factors in anorexia nervosa. As researchers continue to explore TKD as a potential therapeutic avenue, ongoing investigations aim to assess its impact on AN-specific behaviors and thoughts, paving the way for more effective treatment strategies.
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