A new study demonstrates that ketogenic therapy could be an option for individuals living with weight-normalized anorexia nervosa.

One of the primary goals of anorexia nervosa treatment is restoring weight, and while this is an important milestone, many individuals continue to experience psychological symptoms.

Dr. Guido Frank, Professor of Psychiatry at UC San Diego, has spent more than 25 years researching and treating eating disorders. For much of his career, the lack of effective biological treatments for anorexia nervosa has been one of his greatest frustrations.

That changed when he began investigating ketogenic therapy.

In this video, Dr. Frank shares results from the first-ever clinical trial of ketogenic therapy in anorexia nervosa, published in Communications Medicine.

This 14-week outpatient feasibility trial enrolled adults living with weight-normalized anorexia nervosa who, despite weight restoration, continued to struggle with persistent eating disorder symptoms.

Of the 22 individuals enrolled in the study, 82% completed the trial. Among those who completed, 40% experienced mild early side effects, all of which resolved by study end, providing early evidence that ketogenic therapy may be a well-tolerated option in this weight-normalized population.

Among the study completers:

• ✅ 72% no longer met the criteria for an anorexia nervosa diagnosis
• ✅ All showed improvement in depression scores, with 72% reaching the normal range
• ✅ Participants also showed improvements in self-esteem, anxiety, and clinical impairment

One of the most common concerns about keto in this population is whether it will cause weight loss.

For this reason, weight was closely monitored and participants did not experience significant weight change during the study. These findings suggest that under clinical supervision, ketogenic therapy can be implemented in a way that supports weight maintenance, while also delivering far-reaching effects on brain function and psychiatric symptoms.

These results are encouraging early evidence of feasibility, but larger, controlled studies are needed to further evaluate efficacy.

The outcomes should not be generalized to severely underweight patients, who were not included in this trial. Dr. Frank's team is now actively studying whether ketogenic therapy can be applied at lower weights.

This intervention was conducted under close supervision by a licensed eating disorder specialist, with weekly check-ins, ketone monitoring, and regular psychiatric assessments. Anyone interested in exploring this approach should only do so under close medical supervision and in partnership with their care team. If you or someone you care for is living with anorexia nervosa, please speak with your healthcare provider before making any changes.

Learn more about this study: https://www.metabolicmind.org/trials/featured-post/ketogenic-therapy-feasibility-trial-in-anorexia-nervosa-shows-promise-in-weight-normalized-adults/

Study- Symptom impact and safety of ketogenic therapy in adults with anorexia nervosa: a feasibility trial:

• https://doi.org/10.1038/s43856-026-01644-0

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Anorexia nervosa, relapse, and unmet biological need

• Guido Frank has spent about 25 years as a clinician and researcher in eating disorders at UC San Diego.
• Anorexia nervosa remains severe, marked by restriction, significantly low body weight, and one of the highest mortalities in psychiatry.
• Even after weight restoration, body dissatisfaction, fear of eating, shape concerns, and weight concerns often persist and drive relapse.
• Novel biological options have been hard to establish, leaving a major gap in anorexia nervosa care.

Ketogenic dietary therapy as the intervention

• Entry into the ketogenic diet field occurred by chance, followed by fast and effective symptom decreases in anorexia nervosa.
• A neurobiological model links ketogenic dietary therapy with brain function and behavior in anorexia nervosa.
• The newly published Communications Medicine trial tested weight-maintaining ketogenic dietary therapy over 14 weeks.
• The trial enrolled 22 adults with anorexia nervosa; 18 completed the trial, equal to 82%.
• At trial end, 72% had eating restraint, eating concern, shape concern, weight concern, and depression scores within the normal range.
• Ketogenic dietary therapy did not precipitate symptom worsening or clinically significant weight loss in this group.
• The data support ketogenic dietary therapy as a potentially effective option for anorexia nervosa that requires larger follow-up studies.

Concerns, implications, and research directions

• A major concern in eating-disorder care was that ketogenic nutrition could trigger relapse or weight loss.
• That potential side effect did not occur in this study population.
• If future studies replicate these findings, ketogenic nutrition could become a major shift in eating-disorder care, especially for anorexia nervosa.
• Current research is tying glucose-related brain imaging to ketogenic diet intervention and symptom improvement.
• Additional work is testing whether the intervention can be used when people are underweight, not only after weight restoration.
• The research program also aims to expand into other eating disorders because metabolic problems may be transdiagnostic and modifiable through ketogenic dietary therapy.

References

• [01:06] Therapeutic ketogenic diet as treatment for anorexia nervosa — https://doi.org/10.3389/fnut.2024.1392135
• [01:16] Symptom impact and safety of ketogenic therapy in adults with anorexia nervosa: a feasibility trial — https://doi.org/10.1038/s43856-026-01644-0
• [02:47] Ketogenic Diet in Weight Recovered Anorexia Nervosa to Normalize Brain Metabolism and Persistent Eating Disorder Psychopathology — https://clinicaltrials.gov/study/NCT06540703
• [03:12] Ketogenic Diet in Eating Disorders to Target Metabolism and Normalize Persistent Eating Disorder Psychopathology — https://clinicaltrials.gov/study/NCT06000774

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