We’ve talked before about our work with Caroline to help her recover from anorexia nervosa, and the subsequent pilot study with 5 women who had suffered from anorexia for many years. In both cases, we used a combination of a nutritional intervention that created therapeutic nutritional ketosis without weight loss and IV ketamine infusions to silence the anorexic voice. Recently, we participated in an interview on a video posted on twitter by Bret Scher, M.D., on a Metabolic Mind broadcast.
Dr. Scher interviewed three of the five of us who co-authored the pilot study: Barbara Scolnick, M.D., Guido Frank, M.D., Ph.D.
The idea behind the whole project was really sparked by Barbara Scolnick, MD. Barbara is Caroline’s aunt and had been searching for a way to help Caroline since she was a teenager.
Caroline began to suffer from the symptoms of anorexia when she was 14, and though her family helped her to get treatment, nothing worked. Even if she gained weight in treatment, she would lose it again once treatment was over. She had a drive to starve.
The “Anorexic Voice”
The problem was the need to silence the anorexic voice that mercilessly shamed and berated her for eating.
By the time Caroline was 30, she told her aunt she couldn’t live like this the rest of her life. Something had to change. She wanted help to find a way out of anorexia after suffering from it for 15 years. But, like most of those who suffer with anorexia, Caroline was afraid of food. The “voice” of anorexia convinced her that eating anything would make her disgusting and contemptible. So she had come to live on a few peanut m&m’s a day.
Barbara realized that the ketones Caroline’s body produced seemed to make Caroline feel good. At least at first. That the state of starvation felt “right” to Caroline. So Barbara first suggested Caroline take a dose of MCT oil daily to see if the ketones that came from it would help her.
Adding ketones to cells seemed to help
Caroline reported that, in fact, she did feel better as she took the MCT oil. The ketones were helping. She believed she was getting better. But not enough better. So Barbara and Caroline flew to see Beth, a registered dietitian Barbara had met a few years before in her search to understand what a therapeutic ketogenic diet might be able to do to help Caroline.
Beth taught Caroline about this way of eating small meals packed with nutritious fats to increase the load of ketones Caroline’s cells had at their disposal. And while Caroline started with small servings, she realized that this keto diet that made other people lose weight, did not make her lose weight. She said, “See? My body IS different!”
After some time eating these ketone producing meals – not a weight loss diet! – Caroline realized she was feeling even better still.
But there was a problem.
At times, while she was eating this way, she would say she was getting her old familiar “voice” back (the real Caroline). But the anorexic voice wasn’t fully gone.
So Barbara contacted me, to talk about adding IV ketamine infusions to Caroline’s therapy. By this time, Caroline’s weight was stable, but she was still plagued by the cruel, shaming anorexic voice. We hoped that the neuroplasticity that ketamine created would reduce the anorexic voice.
IV ketamine infusions
And so we started IV ketamine infusions. We were all learning together with her, as we sought to find a treatment that would work. In other words, a treatment that would erase the anorexic voice.
After the 3rd infusion, Caroline woke up the next morning and that shaming voice was silent. Gone!
She told me she didn’t think she needed any more ketamine, and felt like she had found a cure! But we did one more infusion for good measure.
Caroline felt elated!
And so were we.
After Caroline experienced such wonderful results, we began to talk about expanding this protocol with more people.
Caroline entered remission that lasted for months and months for the first time since she was 14. And she worked with us to design and carry out a pilot study as we sought to see if a small group of anorexia sufferers could experience similar results from therapeutic nutritional ketosis, and we followed that up with a series of ketamine infusions, like we did for her. Caroline’s support role for the participants turned out to be invaluable. Could we silence the anorexic voice?
Beth Zupec-Kania, the registered dietitian who specializes in ketogenic diet therapy, and who helped Caroline, designed a similar dietary intervention — like the one Caroline used — for the women in our pilot study. We carefully screened and chose 5 adult women who had suffered from anorexia for years, and were medically stable.
We invited them into a home setting, where we talked, prepared meals together, and ate together— 3 meals a day plus two snacks. All of the women helped prepare these ketogenic meals, and actually achieved ketosis by the end of the weekend… and it happened so gently and beautifully.
Then, they went home and continued it with peer coaching, to maintain ketosis without weight loss, for 4 to 8 weeks. At that point, they received a series of ketamine infusions.
Conquering Fear of Food
Keep in mind that fear of food, fear of eating because of the fear of gaining weight, is a primary characteristic of anorexia. So for these women to participate in a study that was very different from the “all good is good food” approach they’d had in treatment settings, they wanted assurance they wouldn’t gain weight from eating fat.
Fat is a four letter word for a lot of people with anorexia.
Because they had anorexia, we wanted to assure that they wouldn’t lose weight. We didn’t want it to backfire and kick up their anorexia.
That’s the beauty—and the challenge—of this dietary intervention: because the keto diet is famous for making people lose weight who WANT to lose weight, they were reassured that they would not gain. So they were willing to try this.
It wasn’t “a diet.” It was a ketogenic metabolic therapy — an approach used as a medical treatment— in this case, to reduce psychiatric symptoms associated with anorexia.
Happily, we got to witness wonderful outcomes from our work with these women. Then we wrote the paper together and published it. We’re so thrilled to have it out so that others can see our results, and spread the word about the continuing research that still needs to be done to bring this treatment safely to those who need it.
Through this experience with Caroline and the women in our pilot study, we’ve come to recognize that the core of this illness … that thing we target to bring to remission… is the “anorexic voice.”
That even though a patient with anorexia may go into residential treatment and begin to eat and gain weight, once they are home from treatment, they often loses the weight they have gained…because of the cruel anorexic voice.
To silence the anorexic “voice”
In Caroline’s case, it seemed the dietary intervention provided the ketones her brain needed and even hungered for, but it wasn’t enough until ketamine infusions silenced the voice. Still… can the voice be truly silenced without the therapeutic ketone dietary intervention? And what about our ketogenic metabolic therapy alone, without ketamine infusions? Can that work by itself as effectively as the combination did? We need studies that explore these and many more questions. And carefully controlled studies involving larger populations of people are also needed.
And these studies need to be conducted with strict supervision and care.
Dr. Frank pointed out that we don’t know what causes anorexia or depression, and the symptoms of both can overlap. In addition, anxiety plays a large role in anorexia.
But he emphasized that what you eat can change your brain. He is interested in dopamine. And neurotransmitters like dopamine can be normalized in the neurons by certain fats added to the diet. We can learn so much more by studies along this line.
I often tell my own patients that we all start out with big, beautiful neuronal trees, branched out in gorgeous canopies. These broad, luscious branches become continually pruned by stress, trauma, inflammatory processes, and anxiety. As this happens, we have symptoms of depression, anxiety, eating disorders, and more.
Neuroplasticity can help us find a way out.
If you can reduce inflammation through a therapeutic ketogenic diet, enhance GABA through a therapeutic ketogenic diet, provide emotional and metabolic support throughout this with per counseling and medical and psychiatric supervision… and put this together so that patients flourish metabolically, you might SPARK something that gets neuroplasticity going through BDNF (brain-derived-neurotrophic-factor). Then you may have real possibility for growth to happen. And that new dendritic growth can get myelinated by the lipids (healthy natural fats) that you’re eating on a ketogenic metabolic therapy that you weren’t eating before.
Don’t Try This At Home
We see enormous hope to silence the anorexic voice. But this protocol isn’t something to do on your own. Anorexia is a metabolically dangerous condition that must be managed very carefully. We need a foundation of extensive research to establish a safe protocol before this treatment is widely applied.
And we do hope to see this effective treatment for anorexia nervosa emerge through more research.
If you have symptoms of depression, anxiety, PTSD, or suicidal thoughts that aren’t being helped, call us.
We address brain energy and how therapeutic nutritional ketosis as well as IV ketamine treatment can help a variety of psychiatric conditions every day through the arms of our Metabolic Psychiatry and Ketamine treatments.
We’re on a mission to find new ways to help you get better and live your best life.
To the restoration of your best self,
