OBESITY AND NUTRITION: Edited by Eric C. WestmanLow carbohydrate ketogenic therapy as a metabolic treatment for binge eating and ultraprocessed food addictionSethi, Shebania; Sinha, Anikab; Gearhardt, Ashley N.c Author Information aMetabolic Psychiatry Clinic, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine bDepartment of Human Biology, Stanford University, Stanford, California cDepartment of Psychology, University of Michigan, Ann Arbor, Michigan, USA Correspondence to Shebani Sethi, MD, MS, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305 – 5723, USA. Tel: +1 650 721 4419; fax: +1 650 731 0555; e-mail: [email protected] Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.co-endocrinology.com). Current Opinion in Endocrinology & Diabetes and Obesity 27(5):p 275-282, October 2020. | DOI: 10.1097/MED.0000000000000571 Buy SDC Metrics Abstract Purpose of review The aim of this study was to highlight the recent advancements and future directions for potential use of a low carbohydrate ketogenic dietary approach to treat binge eating and ultraprocessed food addiction. Herein, we explore proposed mechanisms of why a diet low in refined carbohydrates, processed sugar and higher fat content may be helpful in alleviating symptoms. Recent findings Emerging evidence suggests there may be a metabolic role in development of maladaptive eating. These findings broaden our understanding of eating psychopathology causes. Ultraprocessed, refined or high glycemic index carbohydrates are a possible trigger mediating neurochemical responses similar to addiction. The carbohydrate-insulin model of obesity supports observations of these foods triggering abnormal blood sugar and insulin spikes subsequently leading to changes in metabolic and neurobiological signaling. This results in overeating symptoms and hunger exacerbation, which differs from observed effects of healthy fat consumption and lack of similar insulin spikes. As supported in recent case series, significantly reducing or abstaining from these addictive-like ultraprocessed foods and highly refined carbohydrates could be considered a treatment approach. Summary The current review highlights recent and pertinent evidence with respect to theoretical and practical application of low carbohydrate ketogenic therapeutic approaches for ultraprocessed food addiction and binge eating symptoms. https://links.lww.com/COE/A18 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.