The world is facing a growing mental health crisis. While standard treatment can be life-changing for some, for others of millions living with conditions like depression, bipolar disorder, and schizophrenia, current treatments often fall short—offering limited relief, difficult side effects, or no meaningful improvement at all. In the search for more effective solutions, a growing number of researchers and clinicians are turning their attention to a different approach: the role of metabolism in mental health in a growing field called Metabolic Psychiatry.
Metabolic psychiatry is an emerging field that reexamines mental illness through the lens of brain energy, mitochondrial function, and cellular health. Rooted in over a century of research on ketogenic therapy for epilepsy, it explores how metabolic interventions might offer new pathways to healing.
So, what exactly is metabolic psychiatry, and what types of therapeutic tools does it involve?
Let’s take a closer look.
Understanding Metabolic Psychiatry
What is Metabolic Psychiatry?
Metabolic psychiatry is an emerging field that views serious mental illnesses as stemming from metabolic dysfunction that impairs brain function. It draws on growing evidence that conditions like depression, bipolar disorder, and schizophrenia are not solely chemical imbalances or psychological phenomena, but are also deeply connected to disruptions in energy metabolism, inflammation, and cellular health.
As an intersection of mind and body, metabolic psychiatry explores how therapies that restore metabolic function — such as ketogenic diets, sleep optimization, and lifestyle changes — may treat, prevent, or even reverse these conditions.
What is Metabolic Health?
To understand the role metabolic psychiatry plays in mental health, we first need to explore what metabolic health is and why it matters for the brain.
At its core, metabolic health refers to how efficiently your body converts food into energy and maintains stable levels of key markers, such as blood sugar, insulin, triglycerides, HDL cholesterol, and blood pressure. When these systems are in balance, the brain and body have the fuel they need to function properly. But when metabolism breaks down, as in insulin resistance or type 2 diabetes, it can quietly impair brain health[*].
This is where the connection between metabolism and mental health comes into focus.
A growing body of research shows that people with metabolic dysfunction face a significantly higher risk of serious mental illnesses, including depression, bipolar disorder, and schizophrenia. And the relationship appears to go both ways: those with psychiatric conditions are also more likely to experience metabolic problems, suggesting a deeper, bi-directional link[*][*].
Even without obvious signs of metabolic disease, disrupted brain energy metabolism (particularly how the brain uses glucose) may contribute to psychiatric symptoms. Metabolic psychiatry explores whether restoring metabolic health through nutrition, sleep, exercise, or therapies like ketogenic diets can improve mental health.
Emerging evidence and clinical experience suggest it can.
What are Metabolic Therapies?
Metabolic therapy is an umbrella term for a range of interventions aimed at improving metabolic health and enhancing the body and the brain’s ability to use energy efficiently. These therapies can include anything from nutritional strategies and physical activity to sleep optimization and stress management. Below is an overview of some of the most common and well-studied metabolic therapies.
Types of Metabolic Therapies
Nutritional Therapies and Dietary Interventions
Nutrition is one of the most powerful interventions for improving metabolic function. Dietary protocols can range, but one of the most effective is ketogenic therapy. With that said, there are nuances between a traditional ketogenic diet and ketogenic therapy.
Ketogenic Therapy
A ketogenic diet typically refers to a low-carbohydrate, high-fat eating pattern aimed at achieving nutritional ketosis. In this metabolic state, the body shifts from using primarily glucose to using mainly fat and ketones for fuel. Ketogenic therapy (KT), on the other hand, refers to the clinical use of this diet as a targeted intervention to treat a specific condition, such as epilepsy or serious mental illness. It’s often used under medical supervision, with tailored protocols, lab monitoring, and integration with other treatments.
Another significant difference between ketogenic therapy and standard ketogenic diets is that KT relies on a well-formulated ketogenic diet (WFKD) at its core, as opposed to ketogenic diets that are high in processed foods. In short, while any “keto diet” could get you into a state of ketosis, ketogenic therapy focuses on nourishing your body with high-quality foods while also integrating other therapeutic approaches.
Fasting and Intermittent Fasting (IF)
Time-restricted eating and other forms of intermittent fasting can also support metabolic health by improving insulin sensitivity, reducing inflammation, and promoting autophagy (cellular repair processes). Many individuals find fasting protocols complement ketogenic therapy or other dietary changes[*][*][*].
Exercise and Physical Activity
Physical activity is a powerful metabolic intervention in its own right. Regular movement, whether structured exercise or daily walking, can[*][*][*][*]:
- Improve insulin sensitivity
- Support mitochondrial biogenesis (the creation of new mitochondria)
- Reduce systemic inflammation
- Enhance metabolic flexibility (the ability to switch between fuel sources)
Even moderate-intensity movement can yield meaningful improvements in metabolic and mental health over time.
Sleep Optimization
Sleep is a critical yet often overlooked pillar of metabolic health. Poor sleep can worsen insulin resistance, increase stress hormones, and impair mitochondrial function, all of which may exacerbate psychiatric symptoms[*][*][*][*]. Prioritizing consistent, high-quality sleep can support both emotional regulation and energy metabolism[*].
Stress Management
Chronic stress is metabolically disruptive. It raises cortisol, impairs glucose regulation, and can contribute to both mental and physical illness. Techniques such as mindfulness, breathwork, and nervous system regulation practices can help buffer the metabolic toll of stress[*][*].
Removing Metabolic Stressors
Supporting metabolic health also involves removing or reducing factors that impair it. These can include:
- Smoking or exposure to environmental toxins
- Excessive alcohol or caffeine intake
- Highly processed foods and added sugars
- Sedentary behavior
Identifying and minimizing these stressors can enhance the impact of other metabolic therapies and support long-term mental health.
How Metabolic Therapies Support Mental Health
At the heart of metabolic psychiatry is the understanding that many mental illnesses are not just “chemical imbalances” or purely psychological; they’re rooted in problems with how the brain uses energy[*].
Dr. Chris Palmer’s Brain Energy Theory proposes that most mental disorders are actually metabolic disorders of the brain. In other words, when the brain can’t get or use the energy it needs to function properly, things begin to break down, leading to the emotional, cognitive, and behavioral symptoms we recognize as psychiatric conditions.
One major factor is glucose metabolism. The brain relies heavily on glucose for fuel, but in people with poor metabolic health due to diet, chronic stress, poor sleep, or other factors, the brain often becomes insulin-resistant, meaning it struggles to access that fuel. This can lead to mitochondrial dysfunction, oxidative stress, and inflammation—a perfect storm that damages brain cells and impairs communication between brain regions.
This disrupted brain energy metabolism can impact[*][*]:
- Neurotransmitters like serotonin, dopamine, and GABA, leading to mood instability, anxiety, or psychosis.
- Hormone regulation, which affects everything from stress response to sleep.
- Brain regions involved in memory, emotional regulation, and decision-making, especially the hippocampus and prefrontal cortex.
Research shows that people with metabolic disorders (like insulin resistance or type 2 diabetes) are up to three times more likely to have serious psychiatric illnesses. And the relationship goes both ways—people with depression, bipolar disorder, or schizophrenia often show signs of poor metabolic health, even if they’re not overweight[*][*].
This is where metabolic therapies can help break the cycle.
By targeting the root metabolic dysfunction, therapies like ketogenic diets, intermittent fasting, exercise, and sleep optimization help reduce blood sugar spikes, lower insulin levels, and decrease chronic inflammation.
These interventions can:
- Reduce oxidative stress by limiting the buildup of damaging molecules caused by excess glucose
- Protect and repair mitochondria, the tiny power plants inside our cells
- Promote mitophagy, which clears out damaged mitochondria
- Support mitochondrial biogenesis, helping the brain build new, more efficient energy-producing cells
- Balance neurotransmitters, especially glutamate, which in excess can lead to overstimulation and damage (a phenomenon called excitotoxicity)
Ketogenic therapy, in particular, shifts the brain from relying only on glucose to using primarily ketones—a cleaner, more efficient fuel that supports mitochondrial function, reduces inflammation, and may protect vulnerable brain structures.
The result? In many individuals, this metabolic shift leads to symptom reduction or even full remission, as well as improved cognition and better overall functioning.
While this field is still evolving, early clinical experience and emerging research suggest that restoring brain energy metabolism could be a key to unlocking new hope for those living with serious mental illness.
Ketogenic Therapy as a Cornerstone Intervention
Among the many tools in metabolic psychiatry, ketogenic therapy stands out as a cornerstone intervention thanks to its powerful impact on brain energy and its long-standing clinical use in neurology.
Originally developed over a century ago to treat drug-resistant epilepsy, the ketogenic diet has helped stabilize abnormal brain activity for decades[*]. Today, this neurological foundation is more relevant than ever as we deepen our understanding of the metabolic roots of mental illness.
Ketogenic therapy works by targeting core disruptions in how the brain uses energy. In people with serious mental illness, insulin resistance often prevents brain cells from effectively accessing glucose, their primary fuel. By shifting the body into ketosis (a natural state in which ketones become the primary brain energy source), this therapy delivers fuel through an alternate pathway, restoring function in areas of the brain tied to mood, cognition, and behavior.
Beyond fueling the brain, ketones can also reduce inflammation, lower oxidative stress, improve mitochondrial function, and help rebalance key neurotransmitters[*][*][*]. Together, these changes create a more stable, resilient brain; one better equipped for healing and symptom relief.
To learn more about the history of the ketogenic diet and its use in neurological health, see our Timeline of Ketogenic Therapy Research for Mental Illness.
Scientific Research and Evidence For Metabolic Therapies
While metabolic therapy is gaining new attention for its role in mental health, it’s far from untested. As mentioned previously, ketogenic therapy has been used for over a century, most notably in children with drug-resistant epilepsy, demonstrating both efficacy and long-term safety under clinical supervision. This strong neurological foundation has opened the door to exploring similar interventions for psychiatric conditions.
Emerging studies and case series now suggest that metabolic therapies may improve symptoms of depression, bipolar disorder, and schizophrenia, in both those with underlying metabolic dysfunction as well as seemingly metabolically healthy individuals. Clinical reports describe reduced reliance on medication, stabilized mood, and, in some cases, complete remission of symptoms.
Here are a handful of recent trials on depression, schizophrenia, and bipolar disorder:
- Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial
- A pilot study examining a ketogenic diet as an adjunct therapy in college students with major depressive disorder
- A pilot study of a ketogenic diet in bipolar disorder: clinical, metabolic, and magnetic resonance spectroscopy findings
If you would like to explore further, you can find more clinical, pilot, and case studies here: The Science of Metabolic Psychiatry
Looking ahead, the field is moving toward larger, more rigorous clinical trials. Several pilot studies are already underway investigating ketogenic therapy in serious mental illness, and early results are promising. As this research expands, it will help clarify not only who can benefit most but also how to implement these therapies safely, effectively, and in conjunction with existing treatments.
Getting Started with Metabolic Therapies
If you’re ready to explore how metabolic therapy might support your mental health journey, or that of a loved one, we have plenty of resources to help you get started:
- Check out THINK+SMART, our free, evidence-informed framework designed to help you and your care team begin building a personalized metabolic mental health plan. When you sign up for the THINK+SMART email course, you’ll get access to practical tools, including a downloadable eBook, interactive worksheets, and guided email lessons. You can move at your own pace, when the time feels right for you.
- Looking for professional support? Browse our Clinician Directory to find practitioners familiar with metabolic psychiatry.
- You can also connect with others through our growing Metabolic Collective, a community of individuals, families, and professionals raising awareness and exploring this promising path forward.
- Explore our YouTube channel to see expert interviews, stories of transformation, Q&A’s, and more.
