Y. Liang, A. Taylor, V. Haas and C. Qiu (2026). A ketogenic diet for the management of binge-eating disorder: a pilot study. Eating and weight disorders : EWD, 31(1). https://doi.org/10.1007/s40519-026-01843-7

PubMed 41886041

[Abstract]
BACKGROUND: Binge-eating disorder (BED) is common and often persistent despite evidence-based psychotherapy, highlighting the need for scalable adjunctive interventions.

OBJECTIVE: To evaluate feasibility, acceptability, and preliminary efficacy of a dietitian-supported ketogenic diet (KD) in adults with BED.

METHODS: In this 12-week, single-arm pilot study conducted at Charité - Universitätsmedizin Berlin, adults (18-65 years) with DSM-5 BED and BMI 25-45 kg/m2 received a structured KD (< 20 g net carbohydrates/day; 15-20% energy from protein; 70-80% from fat) with dietitian counseling. Capillary β-hydroxybutyrate (BHB) was self-monitored twice weekly to index nutritional ketosis (BHB ≥ 0.5 mmol/L). Outcomes were assessed at baseline and week 12, including binge-eating days/week (EDE), BED severity (Y-BOCS-BE), eating-disorder psychopathology (EDE-Q), depressive symptoms (PHQ-9), and body weight.

RESULTS: Of 39 individuals screened, 20 enrolled and 85% completed the 12-week assessment. Mean adherence (percent BHB readings ≥ 0.5 mmol/L) was 76% (SD 14), with mean BHB 1.3 mmol/L (SD 0.4). Binge-eating days/week decreased from 4.2 (SD 1.3) to 1.1 (SD 1.5) (p < 0.001). Y-BOCS-BE improved from 28.9 (SD 3.1) to 11.8 (SD 7.2) (p < 0.001). EDE-Q decreased from 4.3 (SD 0.9) to 2.4 (SD 1.3) (p = 0.002), PHQ-9 from 16.5 (SD 3.8) to 8.2 (SD 4.5) (p = 0.005), and body weight from 102.4 (SD 16.1) kg to 95.8 (SD 16.9) kg (p < 0.001).

CONCLUSIONS: In this single-arm pilot study, a dietitian-supported ketogenic diet was feasible and acceptable in adults with BED, and improvements in binge-eating behaviors and related psychopathology were observed during the 12-week intervention period. These findings are preliminary and do not establish therapeutic efficacy. Controlled trials with active comparators and longer follow-up are required to evaluate safety, sustainability, and clinical utility.