Shebani Sethi Dalai MD

All Publications

• Treating binge eating and food addiction symptoms with low-carbohydrate ketogenic diets: a case series Carmen , M., Safer, D. L., Saslow, L. R., Kalayjian , T., Mason, A. E., Westman, E. C., Sethi Dalai , S., et al Journal of Eating Disorders. Biomed Central . 2020

  Abstract

  Background: 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. Case presentations: 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/m2) 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. Conclusions: 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. Keywords: Binge eating, Food addiction symptoms, Obesity, Ketogenic diet, Dietary restriction

• Ketogenic diet as a metabolic treatment for mental Illness. Current Opinion in Endocrinology, Diabetes and Obesity. Norwitz , N., Sethi Dalai , S., Palmer , C. 2020 ; 27 (5)

  View details for DOI 10.1097/MED.0000000000000564

• Low Carbohydrate Ketogenic Therapy as a Metabolic Treatment for Binge Eating and Ultra-processed Food Addiction. Current Opinion Endocrinology, Diabetes and Obesity Sethi Dalai , S., Anika, S., Ashley , G. 2020; 27 (5)

  View details for DOI 10.1097/MED.0000000000000571

• If Americans were healthier, we could have been better prepared for this pandemic. Sethi Dalai , S. The Hill Op-Ed. 2020
• A randomized, placebo‐controlled crossover trial of phentermine‐topiramate ER in patients with binge‐eating disorder and bulimia nervosa International Journal of Eating Disorders Safer, D. L., Adler, S., Sethi Dalai , S., Bentley , J., Toyama, H., Parajito , S., Najarian , T., et al 2019

  View details for DOI 10.1002/eat.23192

• Study protocol and rationale for a randomized double-blinded crossover trial of phentermine-topiramate ER versus placebo to treat binge eating disorder and bulimia nervosa. Contemporary clinical trials Dalai, S. S., Adler, S., Najarian, T., Safer, D. L. 2018; 64: 173–78

  Abstract

  Bulimia nervosa (BN) and binge eating disorder (BED) are associated with severe psychological and medical consequences. Current therapies are limited, leaving up to 50% of patients symptomatic despite treatment, underscoring the need for additional treatment options. Qsymia, an FDA-approved medication for obesity, combines phentermine and topiramate ER. Topiramate has demonstrated efficacy for both BED and BN, but limited tolerability. Phentermine is FDA-approved for weight loss. A rationale for combined phentermine/topiramate for BED and BN is improved tolerability and efficacy. While a prior case series exploring Qsymia for BED showed promise, randomized studies are needed to evaluate Qsymia's safety and efficacy when re-purposed in eating disorders. We present a study protocol for a Phase I/IIa single-center, prospective, double-blinded, randomized, crossover trial examining safety and preliminary efficacy of Qsymia for BED and BN.Adults with BED (n=15) or BN (n=15) are randomized 1:1 to receive 12weeks Qsymia (phentermine/topiramate ER, 3.75mg/23mg-15mg/92mg) or placebo, followed by 2-weeks washout and 12-weeks crossover, where those on Qsymia receive placebo and vice versa. Subsequently participants receive 8weeks follow-up off study medications. The primary outcome is the number of binge days/week measured by EDE. Secondary outcomes include average number of binge episodes, percentage abstinence from binge eating, and changes in weight/vitals, eating psychopathology, and mood.To our knowledge this is the first randomized, double-blind protocol investigating the safety and efficacy of phentermine/topiramate in BED and BN. We highlight the background and rationale for this study, including the advantages of a crossover design.Clinicaltrials.gov identifier NCT02553824 registered on 9/17/2015. https://clinicaltrials.gov/ct2/show/NCT02553824.

  View details for PubMedID 29038069

• Could Pokémon Go Have Some Mental Health Benefits? Sethi Dalai, S. American Psychiatric Association . Washington DC. 2016