Scolnick Barbara, Zupec-Kania Beth, Calabrese Lori, Aoki Chiye, Hildebrandt Thomas
Internal Medicine & Addiction Medicine, Waban, MA, United States.
Consultant-Ketogenic Diet Therapy LLC, Elm Grove, WI, United States.
Front Psychiatry. 2020 Jul 30;11:763. doi: 10.3389/fpsyt.2020.00763. eCollection 2020.
Chronic anorexia nervosa is a tragic disease with no known effective pharmacological or behavioral treatment. We report the case of a 29 year-old woman who struggled with severe and enduring anorexia nervosa for 15 years, and experienced a complete recovery following a novel treatment of adopting a ketogenic diet followed by ketamine infusions. Her remission has persisted for over 6 months.
At age 14.5, the patient embarked on an effort to "eat healthy." She quickly lost control of the dieting, developed associated compulsions and obsessions about food, body dissatisfaction, emotional lability, and lost nearly 13.6 kilograms (30 pounds). She was hospitalized for 6 weeks, and while she regained some weight, she did not attain full weight restoration. For 15 years, she continued to eat in a restrictive manner, exercise compulsively, and have intermittent periods of alcohol dependence. Nevertheless, she always hoped to get well, and at age 29, she began a novel treatment for anorexia nervosa.
This is the first report of a ketogenic diet used specifically for the treatment of anorexia nervosa, followed by a short series of titrated IV ketamine infusions leading to complete remission of severe and enduring anorexia nervosa, with weight restoration, and sustained cessation of cognitive and behavioral symptoms, for 6 months. Although these treatments were used sequentially the relationship between these modalities, and possible synergy, is unclear, and deserves further study. Complete and sustained remission of chronic anorexia nervosa is quite rare, and the novel use of a ketogenic diet and IV ketamine treatment in this potentially lethal condition suggests avenues for further research, and hope for patients and their families.
慢性神经性厌食症是一种悲惨的疾病，目前尚无已知有效的药物或行为治疗方法。我们报告了一名29岁女性的病例，她与严重且持久的神经性厌食症抗争了15年，在采用生酮饮食随后进行氯胺酮输注的新治疗方法后实现了完全康复。她的缓解状态已持续超过6个月。
14.5岁时，患者开始努力“健康饮食”。她很快就无法控制饮食，出现了与食物相关的强迫观念和强迫行为、身体不满、情绪不稳定，并减重近13.6公斤（30磅）。她住院6周，虽然体重有所恢复，但并未完全恢复到正常体重。在接下来的15年里，她继续以限制饮食的方式进食，强迫性锻炼，并间歇性地出现酒精依赖。尽管如此，她一直希望康复，29岁时，她开始了一种针对神经性厌食症的新治疗方法。
这是首例专门使用生酮饮食治疗神经性厌食症的报告，随后进行了短疗程的滴定静脉注射氯胺酮，导致严重且持久的神经性厌食症完全缓解，体重恢复，认知和行为症状持续消失达6个月。尽管这些治疗是相继使用的，但这些治疗方式之间的关系以及可能存在的协同作用尚不清楚，值得进一步研究。慢性神经性厌食症的完全且持续缓解非常罕见，在这种潜在致命疾病中对生酮饮食和静脉注射氯胺酮治疗的新应用为进一步研究指明了方向，并给患者及其家人带来了希望。
