New Evidence Supports Ketogenic Therapy as a Potential Treatment for Anorexia Nervosa
A pilot clinical study published in Communications Medicine has reported promising early evidence that a ketogenic nutritional intervention may be both safe and potentially beneficial for individuals with anorexia nervosa, a severe psychiatric disorder that has historically been extremely difficult to treat and carries one of the highest mortality rates of any mental illness.
The research, conducted by investigators at the UC San Diego School of Medicine, evaluated whether a structured ketogenic diet—characterized by high fat, low carbohydrate, and moderate protein intake—could be feasibly implemented in a clinically supervised outpatient setting for patients with weight-normalized or mildly underweight anorexia nervosa. The study found that participants were able to adhere to the intervention at high rates, experienced no significant weight loss during treatment, and demonstrated notable improvements in both eating disorder symptoms and mood-related outcomes.
These findings add to a growing body of exploratory research examining metabolic and neurobiological contributors to eating disorders, and they suggest that targeted dietary interventions may play a future role in expanding treatment options for a condition that currently has limited effective therapeutic pathways.
A Severe Psychiatric Disorder With Limited Treatment Options
Anorexia nervosa is a complex psychiatric illness characterized by restrictive eating behaviors, distorted body image, intense fear of weight gain, and significant disturbances in self-perception. It is widely recognized as one of the most dangerous mental health disorders, with a mortality rate higher than that of most psychiatric conditions.
In the United States alone, estimates indicate that a death related to anorexia nervosa or its complications occurs approximately every 52 minutes. Despite its severity, treatment options remain limited, and relapse rates are high even after patients achieve weight restoration.
One of the key challenges in treating anorexia nervosa is that restoring weight alone does not address the underlying psychological and neurobiological drivers of the illness. Many patients continue to experience persistent symptoms such as anxiety around food, body dissatisfaction, obsessive thoughts related to weight and shape, and depressive symptoms. These factors often contribute to relapse and long-term disease persistence.
Given these challenges, researchers have increasingly explored whether metabolic and neurological pathways may contribute to the disorder, potentially opening new avenues for intervention beyond traditional psychotherapy and nutritional rehabilitation.
Exploring a Ketogenic Approach to Treatment
The study was led by Guido Frank, MD, Professor of Psychiatry at UC San Diego School of Medicine, who has spent more than 25 years studying and treating individuals with eating disorders. Dr. Frank initiated the research program to explore whether targeting metabolic pathways through dietary intervention could help address underlying physiological mechanisms associated with anorexia nervosa.
The ketogenic diet used in the study is a well-established nutritional approach commonly used in the treatment of epilepsy. It is designed to shift the body’s primary energy source from carbohydrates to fats, leading to the production of ketone bodies that serve as an alternative fuel for the brain and other tissues.
In recent years, interest has grown in the potential neurological and psychiatric applications of ketogenic therapy, particularly in conditions where brain energy metabolism may be altered. This study represents one of the first structured clinical investigations applying a ketogenic intervention specifically to anorexia nervosa in a supervised outpatient setting.
Dr. Frank noted that emerging evidence suggests anorexia nervosa may involve neurometabolic dysfunction, meaning that disruptions in brain energy regulation could contribute to the psychological and behavioral symptoms of the disorder. He suggested that metabolic interventions such as ketogenic therapy may help regulate neural function and, in turn, reduce pathological eating behaviors and associated psychological distress.
Study Design and Patient Population
The pilot study was designed as a nationwide, single-arm outpatient clinical trial. Participants received a medically supervised ketogenic intervention over a 14-week period.
A total of 22 individuals were enrolled in the study, all of whom had either weight-normalized or mildly underweight anorexia nervosa. The outpatient design allowed participants to follow the dietary intervention while continuing to live in their home environments, supported by clinical monitoring and structured medical oversight.
Of the 22 enrolled participants, 18 completed the study, representing a completion rate of 82%. High adherence to the dietary protocol was reported throughout the intervention period, indicating that the ketogenic approach was generally feasible and acceptable within this population when supported by clinical supervision.
Importantly, researchers observed no significant change in body mass index (BMI) during the course of the study, suggesting that the intervention did not result in further weight loss, a key concern when evaluating dietary approaches in individuals with anorexia nervosa.
Improvements in Eating Disorder and Mental Health Symptoms
One of the most notable findings from the study was the significant improvement in eating disorder-related symptoms among participants who completed the intervention.
By the end of the 14-week program, 72% of study completers were classified within the “recovered range” based on standardized eating disorder assessment tools, including the Eating Disorder Examination Questionnaire (EDE-Q) and the Eating Disorder Inventory-3 (EDI-3). This classification indicated that these individuals no longer met diagnostic criteria for anorexia nervosa at study completion.
In addition to improvements in eating disorder symptoms, participants also demonstrated significant improvements in mood and depression-related measures. All study completers experienced reductions in depressive symptoms, as measured by the Beck Depression Inventory (BDI), and 72% achieved scores within the normal range by the end of the study.
These findings are particularly meaningful given that depression is a common and often persistent comorbidity in individuals with anorexia nervosa. Improvements in mood may also play an important role in supporting recovery and reducing relapse risk.
Clinical Significance and Emerging Scientific Rationale
While the study was exploratory in nature and not designed to establish definitive efficacy, the results provide early proof-of-concept evidence supporting further investigation of ketogenic therapy in eating disorders.
The authors emphasized that dietary interventions in this patient population must be approached with careful clinical oversight due to the potential risks associated with nutritional changes in individuals with disordered eating patterns. However, the results suggest that when administered in a structured, medically supervised environment, ketogenic therapy may be both safe and potentially beneficial.
The findings also contribute to a growing scientific discussion about the role of brain energy metabolism in psychiatric disorders. If anorexia nervosa is partially driven by neurometabolic dysregulation, then interventions that modify brain fuel utilization—such as ketogenic diets—may help restore balance in neural circuits involved in reward processing, cognition, and emotional regulation.
Personal and Collaborative Perspectives
The study also reflects a deeply personal dimension for some of the researchers involved.
Co-author Barbara Scolnick, MD, an internal medicine physician based in Waban, Massachusetts, described the research as the culmination of a decade-long effort to understand and address anorexia nervosa through alternative treatment pathways. Her interest in ketogenic therapy was initially sparked by its established use in epilepsy care and by its potential application in severe psychiatric conditions.
Dr. Scolnick shared that her exploration of ketogenic therapy was partly inspired by her niece, who achieved remission after a prolonged struggle with anorexia nervosa. She noted that combining ketogenic therapy with other interventions appeared to play a role in recovery, motivating further scientific inquiry into its potential broader use.
While emphasizing that the current findings are preliminary, she expressed optimism that ketogenic therapy could eventually offer a meaningful treatment option for individuals who have not responded to conventional approaches.
Support for Continued Research and Clinical Innovation
The study was funded in part by Baszucki Group, an organization focused on advancing research into metabolic psychiatry and novel treatment approaches for brain-based disorders.
Jan Ellison Baszucki, co-founder and president of Baszucki Group, highlighted the significance of exploring dietary interventions that target underlying neurometabolic dysfunction. She noted that the findings provide encouraging early evidence that metabolic therapies may offer new hope for individuals with severe and treatment-resistant psychiatric conditions, including anorexia nervosa.
The organization has expressed support for continued research into ketogenic therapy as part of a broader effort to expand understanding of the metabolic underpinnings of mental illness.
Ongoing and Future Research
Building on the results of the pilot study, the research team has initiated a follow-up clinical trial that includes patients diagnosed with both anorexia nervosa and bulimia nervosa. This extension study is currently recruiting participants nationwide.
The new study aims to further evaluate safety, feasibility, and clinical outcomes in a broader population of individuals with eating disorders, with the goal of better understanding how ketogenic interventions may be applied across different diagnostic categories.
As research continues, investigators hope to determine whether the early improvements observed in this pilot study can be replicated and sustained in larger, controlled clinical trials.
Although still in its early stages, the UC San Diego study represents an important step in exploring alternative approaches to one of the most challenging psychiatric disorders. The findings suggest that ketogenic nutritional therapy, when carefully supervised, may be feasible and potentially beneficial for some individuals with anorexia nervosa.
If validated in larger studies, this approach could contribute to a significant shift in how eating disorders are understood and treated—moving beyond traditional psychological and nutritional models toward integrated strategies that also consider metabolic and neurological factors.
For now, the results offer cautious but meaningful optimism that new therapeutic pathways may be emerging for a condition that has long been considered among the most difficult in psychiatric medicine.
About Baszucki Group
Launched in 2021 by Roblox founder and Chief Executive Officer David Baszucki and best-selling author Jan Ellison Baszucki, Baszucki Group leverages grantmaking, impact investing, advocacy, storytelling, and community building to drive foundational change in science, medicine, farming, food, and environmental ecosystems. A primary focus of Baszucki Group is supporting initiatives at the intersection of metabolism, psychiatry, and neuroscience with the goal of improving mental health outcomes. To learn more about metabolic approaches to mental disorders and brain health, including ketogenic therapy, visit Metabolic Mind, a nonprofit initiative of Baszucki Group.
