Keto diet study finds clear improvements in anorexia

A small, closely supervised study found that following a ketogenic diet for 14 weeks helped many women with anorexia fall below diagnostic thresholds for anorexia and depression, though experts stress the need for specialist monitoring and larger randomized tr

For people living with anorexia nervosa, “more food” can feel like danger. In a condition marked by extreme dieting and one of the highest mortality rates among mental health disorders, that push to restrict isn’t just about willpower—it can become a compulsive drive.

In that context, a ketogenic diet—high in fat, moderate in protein, and very low in carbohydrates—may sound like the wrong direction. Yet in a small study, following the diet under close supervision led 3 in 4 participants to fall below the diagnostic threshold for anorexia.

The finding comes from research led by Guido Frank at the University of California, San Diego. Frank’s central idea is that clinicians could potentially reduce the compulsion to self-starve by creating the internal state patients “crave,” while still ensuring they receive enough food.

“People tell me clinically, it’s like an addiction, [saying] ‘I crave this’,” Frank said. “Perhaps if you create that state that they crave while giving them enough food, it can be beneficial.”

The study recruited 22 women with anorexia whose body mass index (BMI) had risen enough to place them in the healthy to slightly underweight range. The diet was supervised for 14 weeks by a dietician, a psychiatrist, and a peer support counsellor who had experienced anorexia. Weight. mood. and anorexia symptoms were monitored weekly using questionnaires designed to track changes in body image. depression. food-related anxiety. and fear of weight gain.

Only 18 women stayed on the diet for the full 14 weeks. Those participants showed significant improvement in anorexia symptoms, and also improvements in depression—an issue that commonly occurs alongside anorexia. Thirteen of the 18 women. representing 72 per cent. improved enough to drop below the threshold for clinical diagnosis for both anorexia and depression.

Frank described the results as unusually strong. “The level of recovery was far better than what we see in other anorexia treatments,” he said.

Importantly, the researchers said the aim of the study was not to test whether the ketogenic diet made participants gain weight. Instead, all participants remained within a healthy to slightly underweight BMI range and did not relapse during the study period.

The diet itself is based on a metabolic switch. Ketogenic diets are named for the shift that occurs when carbohydrates are scarce. Since plant-based metabolism depends heavily on carbohydrates—broken down into glucose that cells burn in energy-releasing mitochondria—cutting carbohydrates forces the body to adapt. When carbs are unavailable. the body burns fat. releases it from storage. and converts it in the liver into ketone bodies. These can then be burned in the mitochondria in place of glucose.

The ketogenic diet has been around for nearly a century. It was invented in the 1920s as a treatment for epilepsy, not as a weight-loss strategy. At the time, fasting for several days could reduce or stop seizures, but it was also unsustainable. The ketogenic diet offered a compromise: restricting carbohydrates enough to mimic starvation while providing enough dietary fat to prevent people from losing weight.

More recent research has suggested that epilepsy—and many mental health conditions, including anorexia—are linked to problems related to releasing energy from glucose in the brain. In that framing, ketone bodies may help by providing an alternative fuel.

But even if the early results look promising, not everyone is ready to treat the ketogenic diet as a straightforward option for anorexia. Sahib Khalsa at the University of California, Los Angeles, who researches and treats eating disorders, urged caution.

“It is important to distinguish between close monitoring from an eating disorder psychiatrist. dietitian and treatment team. and attempting to do this independently.” Khalsa said. “Until we have more data from large. randomised controlled trials. it is too early to change the way we treat anorexia. he says. which typically involves therapy and nutritional support.”.

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