Carmen Matthew, Safer Debra Lynn, Saslow Laura R, Kalayjian Tro, Mason Ashley E, Westman Eric C, Sethi Shebani
1The University of Michigan, Ann Arbor, MI USA.
2Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305 - 5723 USA.
J Eat Disord. 2020 Jan 29;8:2. doi: 10.1186/s40337-020-0278-7. eCollection 2020.
Many patients with obesity and comorbid binge eating symptoms present with the desire to lose weight. Although some studies suggest that dietary restriction can exacerbate binge eating, others show dietary restriction is associated with significant reductions in binge eating. The effect of a particular type of dieting on binge eating, the ketogenic diet (a high fat, moderate protein, very low carbohydrate diet), is not known.
We report on the feasibility of a low-carbohydrate ketogenic diet initiated by three patients (age 54, 34, and 63) with obesity (average BMI 43.5 kg/m) with comorbid binge eating and food addiction symptoms. All patients tolerated following the ketogenic diet (macronutrient proportion 10% carbohydrate, 30% protein, and 60% fat; at least 5040 kJ) for the prescribed period (e.g., 6-7 months) and none reported any major adverse effects. Patients reported significant reductions in binge eating episodes and food addiction symptoms including cravings and lack of control as measured by the Binge-Eating Scale, Yale Food Addiction Scale, or Yale-Brown Obsessive-Compulsive Scale modified for Binge Eating, depending on the case. Additionally, the patients lost a range of 10-24% of their body weight. Participants reported maintenance of treatment gains (with respect to weight, binge eating, and food addiction symptoms) to date of up to 9-17 months after initiation and continued adherence to diet.
Although the absence of control cases precludes conclusions regarding the specific role of ketogenic diets versus other forms of dietary restriction, this is the first report to demonstrate the feasibility of prescribing a ketogenic diet for patients with obesity who report binge eating and food addiction symptoms. Further research should seek to reproduce the observed effects in controlled trials as well as to explore potential etiologies.
许多患有肥胖症并伴有暴饮暴食症状的患者都有减肥的愿望。尽管一些研究表明节食会加剧暴饮暴食，但其他研究显示节食与暴饮暴食的显著减少有关。一种特殊类型的饮食，即生酮饮食（高脂肪、适量蛋白质、极低碳水化合物饮食）对暴饮暴食的影响尚不清楚。
我们报告了三名患有肥胖症（平均体重指数为43.5kg/m²）并伴有暴饮暴食和食物成瘾症状的患者（年龄分别为54岁、34岁和63岁）开始采用低碳水化合物生酮饮食的可行性。所有患者在规定时间（如6 - 7个月）内耐受生酮饮食（宏量营养素比例为10%碳水化合物、30%蛋白质和60%脂肪；至少5040千焦），且均未报告任何重大不良反应。根据具体病例，患者报告称，通过暴饮暴食量表、耶鲁食物成瘾量表或为暴饮暴食修改的耶鲁 - 布朗强迫症量表测量，暴饮暴食发作次数和食物成瘾症状（包括渴望和失控）显著减少。此外，患者体重减轻了10% - 24%。参与者报告称，自开始治疗至随访9 - 17个月以来，在体重、暴饮暴食和食物成瘾症状方面的治疗效果得以维持，并且仍持续坚持饮食。
尽管由于缺乏对照病例，无法就生酮饮食相对于其他形式节食的具体作用得出结论，但这是第一份证明为生有暴饮暴食和食物成瘾症状的肥胖患者开处生酮饮食的可行性的报告。进一步的研究应寻求在对照试验中重现观察到的效果，并探索潜在病因。
