Anorexia nervosa has one of the highest mortality rates of any psychiatric illness, yet effective biological treatments remain limited. For many people living with the condition, even after successful weight normalization, persistent psychological symptoms, including obsessive thoughts about food, shape, and weight, continue to drive relapse.

In this conversation, Dr. Bret Scher sits down with Dr. Guido Frank, Professor of Psychiatry at UC San Diego with over 25 years of experience in eating disorder treatment, to discuss results from the first-ever clinical trial of ketogenic therapy in anorexia nervosa.

This 14-week supervised feasibility trial enrolled 22 individuals with weight-normalized anorexia nervosa. Among the 18 study completers:

✅ 72% scored in the recovered range on eating disorder assessments, no longer meeting the criteria for an anorexia nervosa diagnosis

✅ 100% of study completers saw improvements in depression symptoms, with 72% scoring within the normal range.

✅ Participants did not experience significant weight change throughout the study

In this conversation, Dr. Frank also discusses:

• What led a self-described skeptic to investigate ketogenic therapy for anorexia nervosa
• How the study was structured, who it enrolled, and what the weekly supervision looked like
• What participants experienced as symptoms improved, including reports of mental clarity and relief
• How weight remained stable throughout the ketogenic intervention
• The pushback from colleagues and how to engage with the skepticism
• What comes next, including ongoing brain imaging research and plans for a randomized controlled trial
• Early observations in bulimia nervosa and what they may suggest about metabolic factors in eating disorders

This trial demonstrated that ketogenic therapy is well tolerated by this population. Larger, controlled studies are needed to better evaluate efficacy.

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 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.

👉 Want to learn more about this study? Visit the Study Page on our website: https://www.metabolicmind.org/trials/featured-post/ketogenic-therapy-feasibility-trial-in-anorexia-nervosa-shows-promise-in-weight-normalized-adults/

Expert Featured:

Dr. Guido Frank

• linkedin.com/in/guido-k-w-frank-b7b42172
• https://profiles.ucsd.edu/guido.frank

Resources Mentioned:

Study

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

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Follow our channel for more information and education from Bret Scher, MD, FACC, including interviews with leading experts in Metabolic Psychiatry.

Learn more about metabolic psychiatry and find helpful resources at https://metabolicmind.org/

About us:

Metabolic Mind is a non-profit initiative of Baszucki Group working to transform the study and treatment of mental disorders by exploring the connection between metabolism and brain health. We leverage the science of metabolic psychiatry and personal stories to offer education, community, and hope to people struggling with mental health challenges and those who care for them.

Our channel is for informational purposes only. We are not providing individual or group medical or healthcare advice nor establishing a provider-patient relationship. Many of the interventions we discuss can have dramatic or potentially dangerous effects if done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications.