Research We’re Excited About: Metabolic Psychiatry and the Ketogenic Diet

Treatment: Nutrition
Written By Emily Hackenburg, FNP

In our recurring series Research We’re Excited About, we highlight emerging science that expands our understanding of the mind-body connection and informs our integrative approach to mental health.

One such area gaining momentum is metabolic psychiatry—a growing field exploring how disruptions in cellular energy production may contribute to psychiatric conditions like major depression, schizophrenia, and bipolar disorder.

What Is Metabolic Psychiatry?

Metabolic psychiatry shifts the focus from neurotransmitters alone to the brain’s energy systems—specifically, how mitochondria (the “powerhouses” of cells) generate fuel and how glucose and insulin are processed throughout the body and brain. A growing body of research shows that many individuals who struggle with significant mental health issues, much like those with epilepsy, exhibit signs of impaired brain metabolism, oxidative stress, and chronic inflammation.

This realization is catalyzing a new wave of therapeutic strategies called metabolic therapies—interventions that aim to stabilize brain function by improving metabolic health and restoring efficient energy flow to the brain.

Why Metabolism Matters for Mental Health

Although the brain comprises just 2% of body weight, it consumes more than 20% of the body’s resting energy. When energy production becomes impaired—as often happens in people with mental illness—cognition, emotional regulation, and stress resilience can all suffer.

Because ketones (an alternative fuel source) can bypass damaged glucose pathways and deliver energy directly to brain cells, scientists are investigating nutritional ketosis—and the ketogenic diet—as a potential way to reduce symptoms and restore brain function.

What Is the Ketogenic Diet?

The ketogenic diet is a high-fat, very low-carbohydrate, moderate-protein way of eating. It was originally developed in the 1920s to treat drug-resistant epilepsy in children. By drastically reducing carbohydrate intake, the body shifts from relying on glucose for fuel to using ketones, compounds produced from fat metabolism. This metabolic state is called nutritional ketosis.

Ketones provide a cleaner, more stable energy source for the brain—offering up to 27% more usable energy than glucose. They also lower oxidative stress, support mitochondrial efficiency, and reduce neuroinflammation—all of which may be helpful for stabilizing brain function in serious mental illness.

What the Research Is Showing

Early findings are promising:

  • Case Reports: Psychiatrist Dr. Lori Calabrese has documented significant symptom reduction in patients with treatment-resistant schizophrenia and bipolar disorder following a medically supervised ketogenic diet.

  • Pilot Trial (Sethi et al., 2024): In an open-label trial from Stanford University, individuals with bipolar disorder or schizophrenia who followed a ketogenic diet for 16 weeks experienced improvements in mood, sleep, metabolic health, and quality of life. Biomarkers of inflammation and body composition also improved.

  • Retrospective Study (Danan et al., 2023): A study of 31 psychiatric inpatients with severe mental illness found that nearly all showed marked improvements in psychiatric symptoms—including hallucinations and mood instability—after following a ketogenic diet. Metabolic markers such as weight, blood pressure, and insulin sensitivity also improved.

These results build on a century of data from epilepsy treatment, suggesting that stabilizing brain energy through ketosis may help mitigate other forms of neural dysregulation—such as the mood and cognitive symptoms seen in psychiatric disorders.

A New Frontier in Mental Health Care

Nutrition has long been considered a “supportive” factor in mental health—but not necessarily a frontline treatment. That mindset is beginning to change.

Just as we now prioritize sleep and exercise for emotional well-being, emerging research suggests that how the brain fuels itself may be just as critical—especially when psychiatric and metabolic symptoms overlap.

The ketogenic diet is now being explored not just as a tool for weight loss or seizure control, but as a serious therapeutic option in psychiatry. By helping the brain access more efficient fuel, reduce inflammation, and support cellular repair, ketogenic therapy may offer new treatment options for people with complex or treatment-resistant mental health conditions.

A Word of Caution

The ketogenic diet is a powerful therapeutic intervention, but it is not appropriate for everyone. Entering a state of nutritional ketosis impacts various biological systems, including electrolyte balance, digestion, and hormonal regulation.

If you’re considering a ketogenic approach to support your mental health, we strongly recommend working with a qualified healthcare provider who can offer clinical guidance, track your progress, and ensure the diet is implemented safely and effectively.

Take the next step with confidence—partner with New York Integrative Psychiatry to ensure your mental health journey is grounded in evidence, safety, and expert support.

Emily Hackenburg, FNP
Next

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