Halley put on her makeup and looked in the mirror. She abhorred her round face and the fat on her chest and arms. She quietly resolved that she’d swim more laps tomorrow, because the 30 laps she swam daily just wasn’t improving her appearance. It was hard, so hard, to go out in public because she knew in her gut that she would be secretly criticized for her excess weight. She saw an article about treating anorexia with a ketogenic diet plus IV ketamine, but she didn’t read it. She tossed it aside. Halley didn’t believe in anyone’s solution. She wanted nothing to do with it.
Maybe it was denial. Or maybe it was some sort of cosmic nagging and shaming. She didn’t know. But she didn’t want to hear it. She fought guilt and shame every day.
Halley had been avoiding family meals for a year or more, because she just couldn’t load up on all that heavy food. It was easier to go to the gym during dinner time, and privately eat 4 peanuts, drink powerade, and chew a stick of gum. When she ate with the family, it always seemed to descend into a conflict over what she ate. Too exhausting.
One day, Halley’s mom walked into her room and found her crying in front of the mirror.
“What is it, honey?” She put her arm around her painfully thin daughter and gently squeezed her.
Halley’s tears rolled down her cheeks.
“I’m so fat! I try and try to diet and exercise but I stay so heavy. I hate myself.”
Her mom embraced her. “Halley, you’re not fat! You’re really thin…”. Then, her mom realized they might slip into a conflict, so she added, “Honey, you’re beautiful, inside and out.”
Halley rushed out of the room. She felt like a total failure.
As her weight dropped more, her mom became more and more worried. Halley’s face went from slender to gaunt, and her arms lost shape, as her muscle mass diminished.
But Halley kept working out, running now and swimming laps, eating little to nothing. And feeling like she was heavily overweight. She felt appalled at her appearance, but it was a distorted perception. To observers, she looked rail thin, but when she looked in the mirror she thought she looked massive.
At some point, Halley realized she hadn’t had a period in months. She’d been so busy with working out she hadn’t noticed. This scared her because she thought she wanted to have children some day. Her hair was brittle and falling out. It collected on her brush like a haystack.
Finally, her mom convinced her to get a check up so the doctor could evaluate why her hair was falling out and her periods had stopped.
The doctor spent time evaluating her, asking questions, doing lab work, and listening. Then diagnosed anorexia nervosa. Her doctor referred her to a dietitian and a psychiatrist.
But there was a problem.
Even though the doctor recommended group therapy for Halley, the inner drive to restrict her eating and push through excessive exercise continued. There was a voice in her head that drove her. It shamed her for eating, it shamed her when she looked in the mirror, it degraded her and made her feel deeply unworthy.
So she tired of the group therapy eventually. The reason? That anorexic voice still drove her.
She was angry about the anorexia diagnosis. Didn’t believe anything was wrong with her. Not really.
But she felt bad… sad…pretty hopeless. And empty. She felt ashamed to be around friends, and just didn’t feel very connected anymore. To anyone.
Halley also felt light-headed more and more often. Sometimes dizzy, and somewhat weak.
One day she collapsed.
Her mom ran to her room when she heard the crash and found Halley on the floor unconscious. Mom dialed 911 and paramedics arrived in 7 minutes. They told her mom her blood pressure was low, and her pale color could be anemia. They transported Halley to the hospital and admitted her to ICU.
Halley remained semiconscious for 3 days, while she received IVs of electrolytes, TPN (total parenteral nutrition), fluids, and iron. Lab work revealed her electrolytes were out of balance, and her liver and kidney function were out of whack, too. And she was very anemic. Thankfully, her heart wasn’t damaged — but it could have been.
As her body’s electrolytes, fluids, and glucose balanced, Halley did a lot of thinking. She had to face that something was very wrong with her life … and potentially damaging. Even though she was glad she had survived this, she knew she needed to do something. She decided she needed to open herself to help, treatment, and changes in her life.
The day before she was discharged from the hospital, a nurse came to talk to her. She told her that her own daughter had suffered from anorexia for years and but had recently turned it around using a special program developed by a team of specialists. Medical doctors, a registered dietitian specializing in medical ketogenic nutrition, peer counselling, and a psychiatrist.
The approach included education, peer support counselling, a specially designed therapeutic ketogenic diet plus IV ketamine treatment.
And it is new. We first wrote about it here 2 years ago, in a blog about Caroline, the first patient we treated with this sequence. And then published a case report about her remission from chronic anorexia.
Another Study To Replicate Results
Recently we conducted a pilot study with 5 women who had struggled with chronic anorexia for at least 10 years. This was our next step to replicate our outcomes from the first case study. We’ve just recently published that data in Eating and Weight Disorders: Studies on Anorexia, Bulimia and Obesity.
Our team included an internist, a registered dietitian specializing in medical ketogenic nutrition, a psychiatrist, peer support counselling.
Similar to the initial case study with Caroline in 2020, the subjects in our pilot study were thin—but partially weight restored—and medically stable enough to participate. (This was key.) But they were still plagued by the shaming anorexia inner voice, distorted perceptions of their shape and weight, and seriously low self esteem.
They began a specially designed therapeutic ketogenic diet — aimed at nurtritional ketosis, not weight loss — and maintained it for several weeks.
There is no psychiatric medication that targets specific residual symptoms of the compulsions, self-starvation, and the anorexic voice — and so they often continue even after weight has been restored to normal. And all too often, relapse occurs. Because the anorexic voice just hangs on and torments.
To effectively treat anorexia, the compulsions and that shaming voice must be targeted and quieted.
This is what this two-part protocol was aimed to address and where IV ketamine infusions come in.
After at least 4 weeks of maintaining the therapeutic ketogenic diet, each participant received a series of IV ketamine infusions (modeled after the success of the first patient we treated with this approach.)
And the voice quieted. In fact, it disappeared.
We followed the participants closely, presented our preliminary results in Oxford, UK and published our results at six months follow-up. Four women showed significant improvements across the measures we used to assess recovery and remission; one relapsed and was admitted to a residential program.
This approach of using a therapeutic ketogenic diet (an approach that induces safe, nourishing nutritional ketosis — not weight loss or starvation ketosis) may seem counterintuitive, but it’s based on science, and evidence supports it.
This isn’t keto from YouTube.
Our approach offers a potentially life-altering and lifesaving two-part treatment for a deadly disorder.
More research is needed to understand the mechanisms in the brain that result in quieting these compulsions and the anorexic voice, and in studying this treatment sequence in anorexia. A lot more research. But we’re excited to discover and report something truly new and hopeful for so many who have suffered so long: a very careful therapeutic ketogenic nutritional approach followed by IV ketamine.
If you’ve struggled with symptoms of chronic anorexia for a long time … if you think you might want to work with us … if you’re interested in the program we’re developing, please contact us.
Tell us a little about yourself and your story.
Let’s talk. Let’s start something new.
To the restoration of your best self,
