Oral butyrate supplementation as a supportive therapy in the treatment of anorexia nervosa
DOI:
https://doi.org/10.12775/QS.2026.58.72450Keywords
anorexia nervosa, intestinal microbiota, gut-brain axis, dysbiosis, short-chain fatty acids, butyrate, postbioticsAbstract
Background. Anorexia nervosa (AN) is an eating disorder manifested by extremely low body weight and a disturbed perception of the patient's own body. Genetic predisposition and psychological factors are considered the most important causes. However, it has been suggested that altered intestinal microbiota composition and microbial metabolite profiles may contribute to the pathogenesis or persistence of AN.
Aim. The aim of this review is to present current knowledge on the role of short-chain fatty acids (SCFAs) and the potential of oral butyrate supplementation in the treatment of patients with AN.
Material and methods. We conducted a narrative review by searching the Scopus, PubMed, and Web of Science databases up to April 2026 for studies addressing AN, the microbiota, and SCFAs.
Results. The reviewed studies indicate that AN is associated with gut microbiota dysbiosis, altered microbial metabolite profiles, and reduced concentrations of SCFAs, particularly butyrate. SCFAs play an important role in maintaining intestinal homeostasis, regulating appetite, and supporting gut–brain axis communication. Butyrate contributes to intestinal barrier integrity and promotes anti-inflammatory pathways. Its reduced availability has been associated with impaired intestinal permeability, low-grade systemic inflammation, neurotransmitter imbalance, increased severity of psychiatric symptoms, and disturbances in eating behavior.
Conclusions. Current evidence suggests that AN is associated with gut microbiota dysbiosis, reduced levels of SCFAs, and low-grade inflammation, all of which may contribute to disease pathophysiology and psychiatric symptom severity. Due to the recognized involvement of SCFAs in intestinal homeostasis and gut–brain axis signaling, enteral butyrate administration may represent a promising adjunctive therapy in AN. However, because only a limited number of studies have been initiated and no trial results are currently available, further research is needed.
References
Azienda Ospedaliero-Universitaria Careggi. Effect of Treatment With Butyric Acid in Anorexia Nervosa (AN-BUTIX). ClinicalTrials.gov. Updated December 17, 2025. Accessed May 16, 2026. https://clinicaltrials.gov/study/NCT07289581
Borgo F, Riva A, Benetti A, et al. Microbiota in anorexia nervosa: The triangle between bacterial species, metabolites and psychological tests. PLoS One. 2017;12(6):e0179739. Published 2017 Jun 21. doi:10.1371/journal.pone.0179739
Carbone EA, D'Amato P, Vicchio G, De Fazio P, Segura-Garcia C. A systematic review on the role of microbiota in the pathogenesis and treatment of eating disorders. Eur Psychiatry. 2020;64(1):e2. Published 2020 Dec 16. doi:10.1192/j.eurpsy.2020.109
Cristofori F, Calabrese FM, Iacobellis I, et al. Calcium butyrate efficacy in pediatric irritable bowel syndrome: Randomized placebo-controlled multiomics-based clinical trial. J Pediatr Gastroenterol Nutr. 2025;81(3):551-561. doi:10.1002/jpn3.70154
Dhopatkar N, Keeler JL, Mutwalli H, Whelan K, Treasure J, Himmerich H. Gastrointestinal symptoms, gut microbiome, probiotics and prebiotics in anorexia nervosa: A review of mechanistic rationale and clinical evidence. Psychoneuroendocrinology. 2023;147:105959. doi:10.1016/j.psyneuen.2022.105959
Fan Y, Støving RK, Berreira Ibraim S, et al. The gut microbiota contributes to the pathogenesis of anorexia nervosa in humans and mice. Nat Microbiol. 2023;8(5):787-802. doi:10.1038/s41564-023-01355-5
Frank GK, Kaye WH, Sahu A, Fernstrom J, McConaha C. Could reduced cerebrospinal fluid (csf) galanin contribute to restricted eating in anorexia nervosa?. Neuropsychopharmacology. 2001;24(6):706-709. doi:10.1016/S0893-133X(00)00251-7
Garcia N, Gutierrez E. Anorexia nervosa and microbiota: systematic review and critical appraisal. Eat Weight Disord. 2023;28(1):1. Published 2023 Feb 8. doi:10.1007/s40519-023-01529-4
Ghenciulescu A, Park RJ, Burnet PWJ. The Gut Microbiome in Anorexia Nervosa: Friend or Foe?. Front Psychiatry. 2021;11:611677. Published 2021 Jan 12. doi:10.3389/fpsyt.2020.611677
Glenny EM, Fouladi F, Thomas SA, et al. Gut microbial communities from patients with anorexia nervosa do not influence body weight in recipient germ-free mice. Gut Microbes. 2021;13(1):1-15. doi:10.1080/19490976.2021.1897216
Hata T, Miyata N, Takakura S, et al. The Gut Microbiome Derived From Anorexia Nervosa Patients Impairs Weight Gain and Behavioral Performance in Female Mice. Endocrinology. 2019;160(10):2441-2452. doi:10.1210/en.2019-00408
Igudesman D, Sweeney M, Carroll IM, Mayer-Davis EJ, Bulik CM. Gut-Brain Interactions: Implications for a Role of the Gut Microbiota in the Treatment and Prognosis of Anorexia Nervosa and Comparison to Type I Diabetes. Gastroenterol Clin North Am. 2019;48(3):343-356. doi:10.1016/j.gtc.2019.04.003
Jafar W, Morgan J. Anorexia nervosa and the gastrointestinal tract. Frontline Gastroenterol. 2021;13(4):316-324. Published 2021 Aug 20. doi:10.1136/flgastro-2021-101857
Jensen EA, Young JA, Mathes SC, et al. Crosstalk between the growth hormone/insulin-like growth factor-1 axis and the gut microbiome: A new frontier for microbial endocrinology. Growth Horm IGF Res. 2020;53-54:101333. doi:10.1016/j.ghir.2020.101333
Kelly JR, Borre Y, O' Brien C, et al. Transferring the blues: Depression-associated gut microbiota induces neurobehavioural changes in the rat. J Psychiatr Res. 2016;82:109-118. doi:10.1016/j.jpsychires.2016.07.019
Korten NM, Thelen AC, Voelz C, et al. Exploring the Link Between the Gut Microbiota and Epigenetic Factors in Anorexia Nervosa. Brain Behav. 2025;15(8):e70733. doi:10.1002/brb3.70733
Landini L, Dadson P, Gallo F, Honka M-J, Cena H. Microbiota in anorexia nervosa: potential for treatment. Nutrition Research Reviews. 2023;36(2):372-391. doi:10.1017/S0954422422000130
Li S, Liu M, Han Y, et al. Gut microbiota-derived gamma-aminobutyric acid improves host appetite by inhibiting satiety hormone secretion. mSystems. 2024;9(10):e0101524. doi:10.1128/msystems.01015-24
Di Lodovico L, Mondot S, Doré J, Mack I, Hanachi M, Gorwood P. Anorexia nervosa and gut microbiota: A systematic review and quantitative synthesis of pooled microbiological data. Prog Neuropsychopharmacol Biol Psychiatry. 2021;106:110114. doi:10.1016/j.pnpbp.2020.110114
Mack I, Cuntz U, Grämer C, et al. Weight gain in anorexia nervosa does not ameliorate the faecal microbiota, branched chain fatty acid profiles, and gastrointestinal complaints. Sci Rep. 2016;6:26752. Published 2016 May 27. doi:10.1038/srep26752
Marano G, Rossi S, Sfratta G, et al. Gut Microbiota in Women with Eating Disorders: A New Frontier in Pathophysiology and Treatment. Nutrients. 2025;17(14):2316. Published 2025 Jul 14. doi:10.3390/nu17142316
Marano G, Sfratta G, Marzo EM, Cozzo G, Abate F, Traversi G, Mazza O, Capristo E, Gaetani E, Mazza M. The Pediatric Microbiota–Gut–Brain Axis: Implications for Neuropsychiatric Development and Intervention. Children. 2025; 12(11):1561. https://doi.org/10.3390/children12111561
Morita C, Tsuji H, Hata T, et al. Gut Dysbiosis in Patients with Anorexia Nervosa. PLoS One. 2015;10(12):e0145274. Published 2015 Dec 18. doi:10.1371/journal.pone.0145274
Mörkl S, Lackner S, Meinitzer A, et al. Gut microbiota, dietary intakes and intestinal permeability reflected by serum zonulin in women. Eur J Nutr. 2018;57(8):2985-2997. doi:10.1007/s00394-018-1784-0
Navarro-Tapia E, Almeida-Toledano L, Sebastiani G, Serra-Delgado M, García-Algar Ó, Andreu-Fernández V. Effects of Microbiota Imbalance in Anxiety and Eating Disorders: Probiotics as Novel Therapeutic Approaches. Int J Mol Sci. 2021;22(5):2351. Published 2021 Feb 26. doi:10.3390/ijms22052351
Nikolova VL, Smith MRB, Hall LJ, Cleare AJ, Stone JM, Young AH. Perturbations in Gut Microbiota Composition in Psychiatric Disorders: A Review and Meta-analysis. JAMA Psychiatry. 2021;78(12):1343-1354. doi:10.1001/jamapsychiatry.2021.2573
Prochazkova P, Roubalova R, Dvorak J, et al. Microbiota, Microbial Metabolites, and Barrier Function in A Patient with Anorexia Nervosa after Fecal Microbiota Transplantation. Microorganisms. 2019;7(9):338. Published 2019 Sep 10. doi:10.3390/microorganisms7090338
Prochazkova P, Roubalova R, Dvorak J, et al. The intestinal microbiota and metabolites in patients with anorexia nervosa. Gut Microbes. 2021;13(1):1-25. doi:10.1080/19490976.2021.1902771
Prochazkova P, Jezkova J, Roubalova R, et al. Microbiome and metabolic disruption in acute vs. severe and enduring anorexia nervosa. NPJ Biofilms Microbiomes. 2025;11(1):217. Published 2025 Nov 26. doi:10.1038/s41522-025-00847-y
Quagebeur R, Dalile B, Raes J, Van Oudenhove L, Verbeke K, Vrieze E. The role of short-chain fatty acids (SCFAs) in regulating stress responses, eating behavior, and nutritional state in anorexia nervosa: protocol for a randomized controlled trial. J Eat Disord. 2023;11(1):191. Published 2023 Oct 26. doi:10.1186/s40337-023-00917-6
Scala M, Tabone M, Paolini M, et al. Unlocking the link between gut microbiota and psychopathological insights in anorexia nervosa: a systematic review. Eur Eat Disord Rev. 2025;33:700-718. doi:10.1002/erv.3179
Serrano-Fernández V, Carmona-Torres JM, López-Fernández-Roldán Á, et al. Short-chain fatty acids in the treatment of ulcerative colitis: systematic review and meta-analysis. Inflamm Res. 2025;74:142. doi:10.1007/s00011-025-02112-6
Smitka K, Prochazkova P, Roubalova R, et al. Current Aspects of the Role of Autoantibodies Directed Against Appetite-Regulating Hormones and the Gut Microbiome in Eating Disorders. Front Endocrinol (Lausanne). 2021;12:613983. Published 2021 Apr 19. doi:10.3389/fendo.2021.613983
Speranza E, Cioffi I, Santarpia L, et al. Fecal Short Chain Fatty Acids and Dietary Intake in Italian Women With Restrictive Anorexia Nervosa: A Pilot Study. Front Nutr. 2018;5:119. Published 2018 Nov 29. doi:10.3389/fnut.2018.00119
Trinh S, Keller L, Herpertz-Dahlmann B, Seitz J. Fäkale Mikrobiotatransplantationen im Zusammenhang mit (kinder- und jugend-)psychiatrischen Erkrankungen [Fecal Microbiota Transplants in the Context of (Child and Adolescent) Psychiatric Disorders]. Z Kinder Jugendpsychiatr Psychother. 2023;51(6):431-440. doi:10.1024/1422-4917/a000928
Wagner-Skacel J, Dalkner N, Moerkl S, et al. Sleep and Microbiome in Psychiatric Diseases. Nutrients. 2020;12(8):2198. Published 2020 Jul 23. doi:10.3390/nu12082198
Wei Y, Peng S, Lian C, Kang Q, Chen J. Anorexia nervosa and gut microbiome: implications for weight change and novel treatments. Expert Rev Gastroenterol Hepatol. 2022;16(4):321-332. doi:10.1080/17474124.2022.2056017
van de Wouw M, Schellekens H, Dinan TG, Cryan JF. Microbiota-Gut-Brain Axis: Modulator of Host Metabolism and Appetite. J Nutr. 2017;147(5):727-745. doi:10.3945/jn.116.240481
Xu J, Landberg R, Lavebratt C, Bulik CM, Landén M, Nilsson IAK. Plasma Concentrations of Short-Chain Fatty Acids in Active and Recovered Anorexia Nervosa. Nutrients. 2022;14(24):5247. Published 2022 Dec 9. doi:10.3390/nu14245247
Zhao W, Kodancha P, Das S. Gut Microbiome Changes in Anorexia Nervosa: A Comprehensive Review. Pathophysiology. 2024;31(1):68-88. Published 2024 Feb 2. doi:10.3390/pathophysiology31010006
Zheng P, Zeng B, Zhou C, et al. Gut microbiome remodeling induces depressive-like behaviors through a pathway mediated by the host’s metabolism. Mol Psychiatry. 2016;21(6):786-796. doi:10.1038/mp.2016.44
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Julia Białas, Alicja Kodura, Milena Mordarska, Joanna Paluchowska, Alicja Piwowarczyk, Jan Łozowski, Przemysław Piątek, Artur Merc, Łukasz Szymański
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 76
Number of citations: 0
