Using ketogenic and other metabolic therapies for mental health recovery is powerful. Thousands of testimonials tell the story of people who suffered for decades without relief, feeling like they’d lost years from their lives, only to have clarity and mental health restored with things like therapeutic nutrition and lifestyle shifts.
But life can interrupt even the most solid routines. Acute stressors can take their toll, chronic nervous system dysregulation can throw you off balance. Or maybe it was a piece of birthday cake that knocked you out of ketosis and out of your rhythm. The point is never perfection and these things happen. And it doesn’t mean the tools you’re using aren’t effective. It means you’re dealing with real life. What matters is how you respond.
In the context of metabolic psychiatry, setbacks are not failures. They’re part of the process. They offer a chance to pause, reassess, and re-engage, ideally with support, strategy, and self-awareness.
To better understand how people recover momentum and stay engaged with therapeutic lifestyle changes, we spoke with three respected leaders in metabolic psychiatry: Nicole Laurent, LMHC; Dr. Matthew Bernstein; and Dr. Georgia Ede. Each brings years of clinical experience and a shared commitment to using metabolic therapies to support mental health. Their insights reflect what truly helps people stay engaged, even when it’s hard.
What Do Setbacks Really Look Like?
Setbacks aren’t always dramatic. They often show up in subtle, everyday ways and they’re nearly universal on the path to recovery.
Sometimes it’s a missed meal or a few days of disrupted sleep. Other times, it’s a more complex situation: an increase in psychiatric symptoms, a medication adjustment that impacts appetite or energy, or the emotional toll of navigating a high-stress period. Even positive life events like travel or celebrations can throw off your rhythm.
One of the most common challenges we hear about is complications with medication management. Changes in dosage, starting or stopping a medication, or dealing with side effects like weight gain, cravings, or sedation can quickly interfere with therapeutic nutrition efforts. This doesn’t mean the strategy isn’t working, it means the body is responding to multiple variables at once, and it needs support.
Other common challenges include:
- Experiencing intense cravings or emotional eating
- Feeling overwhelmed by meal planning or tracking
- Facing skepticism or lack of support from family, clinicians, or peers
- Navigating mental health symptoms like low motivation, brain fog, or anxiety
The truth is, all of this is part of the process. Metabolic therapies are powerful, but they’re not immune to the realities of life with a psychiatric condition. Understanding the kinds of challenges that can arise makes it easier to meet them with strategy and self-compassion, not shame.
How to Bounce Back from Challenges and Setbacks
1. Reframe Setbacks Without Judgment
Nicole Laurent, LMHC
It’s natural to want to parktake in social gatherings that revolve around food. It can be especially tempting to eat what everyone else is eating when you’re feeling good.
When someone veers off course, Nicole Laurent encourages curiosity over criticism. “Social situations are a common challenge, especially when there’s real or perceived pressure around food,” she says. “What matters is how we make sense of those moments afterward.”
Instead of framing food choices as deprivation, Nicole suggests seeing them as part of a larger therapeutic goal. “It’s not about telling yourself you’ll never eat a certain food again. It’s about making decisions that support your brain over time. That framing makes a real difference.”
She also points out that food often plays an emotional role, and how processed foods can lose their appeal as your brain heals. “Many people use ultra-processed foods to regulate mood when their brain isn’t functioning well. As metabolic health improves, that dynamic starts to shift. Food becomes more about nourishment than coping.”
2. Expect Setbacks and Prepare for Them
Dr. Matthew Bernstein
“Setbacks are part of life, especially in recovery,” says Dr. Matthew Bernstein. “They’re not a sign of failure. They’re something to prepare for.”
His advice: make a plan when things are going well. That means identifying early warning signs, knowing which tools are most helpful, and writing out a set of steps you can turn to when momentum dips. “Your support system is key here,” he adds. “People often underestimate how willing others are to help.”
He also points to mindfulness as a useful practice. “Losing focus and returning to your breath—it’s a simple but powerful reminder of how recovery works. It’s not about staying on track all the time. It’s about noticing when you’ve drifted and being able to return.”
When setbacks happen, even small decisions can feel overwhelming. That’s why Dr. Bernstein encourages people to write down a recovery plan while they’re feeling stable and clearheaded.
He often recommends tools like the Wellness Recovery Action Plan (WRAP) or the Think+Smart worksheets. These frameworks help individuals identify what helps them feel better, what warning signs to watch for, and what steps to take when things begin to slide.
“Having that roadmap ahead of time gives people something to lean on when clarity is harder to find,” Bernstein says. “It’s a way to stay anchored, even when things feel uncertain.”
3. Use Quick-Start Tools to Regain Metabolic Momentum
Dr. Georgia Ede
When someone falls out of ketosis, Dr. Georgia Ede recommends focusing on physiology first. “The sooner you get back on track, the easier it usually is, especially for those with a history of food addiction,” she explains.
One of the most effective strategies? Intermittent fasting. “It lowers insulin levels quickly and allows ketone production to resume. Exercise can help as well, and so can simplifying meals for a few days.”
She often recommends a short-term “fat fast”—meals made up entirely of naturally high-fat, low-carb foods like eggs, avocado, or fatty cuts of meat. “They help regulate appetite and support ketosis without the need to weigh or track.”
But she also emphasizes mindset: “This isn’t about being perfect. If ketone levels are lower than expected, see it as information. Ask what may have contributed—stress, sleep, a new food—and adjust. It’s a process of learning, not a pass/fail test.”
4. Trust the Body and Foster Self-Compassion
Nicole Laurent, LMHC
For people living with mental illness, the relationship with their body can become strained, even adversarial. Nicole Laurent sees this often in her work and encourages a mindset shift that supports healing.
“I like to remind people—and I absolutely believe this is true—that their body is actually working towards optimal wellness,” she says.
“Any symptoms that they get, or difficulties that they have implementing some of these behavioral strategies… that really is just their body trying to put them back into balance, trying to get them to the exact place that they’re trying to go.”
She explains that when people view their body as something untrustworthy—or worse, as the source of their suffering—it compounds stress, which can disrupt metabolism and recovery.
“If I have developed a relationship with my body that says, ‘I can’t trust you. You create symptoms for me. You make it so I can’t function. You make it so I have trouble regulating’… that really turns it into an adversarial relationship. And it increases stress because you’re wrestling with the signals that go on in your body.”
Instead, Nicole encourages people to begin rebuilding trust: to see symptoms not as punishments, but as signals—a way the body communicates what it needs. Reframing this internal dialogue, she suggests, is a meaningful step in the recovery process.
5. Supplements That Support
Dr. Georgia Ede
While food and lifestyle changes are the foundation of therapeutic ketosis, Dr. Georgia Ede acknowledges that supplemental tools can be useful, especially in the short term.
Some individuals use exogenous ketones, MCT oil, or ketone esters to help ease symptoms like brain fog, low energy, or intense cravings during a setback. “They’re not a substitute for the work,” she notes, “but they can help some people bridge the gap when re-engaging with dietary changes.”
That said, she still prioritizes whole food strategies—like the fat fast—because they both regulate appetite and support long-term stability. “After falling out of ketosis, hunger can come roaring back. Choosing foods that naturally support ketone production helps manage that while keeping you on track.”
Final Thoughts
Setbacks don’t erase progress. They reveal where adjustments may be needed and offer an opportunity to reconnect with what works. Whether it’s refining food choices, reaching out for support, or adjusting your routines, what matters is re-engaging.
As each expert made clear, the work of healing doesn’t happen in a straight line. But with the right mindset and tools, it continues—even after a step back.
You’re not starting over. You’re building on what you’ve learned.
