Metabolic Psychiatry Integrates Nutritional and Pharmacological Interventions

Metabolic psychiatry can be mistaken for a purely nutritional approach, rather than the medical treatment it is, according to Shebani Sethi, MD. The field is complementary to other areas of focus, such as lifestyle psychiatry and nutritional psychiatry, and it examines central and peripheral metabolic pathways and how various interventions affect bioenergetic pathways. "Metabolic psychiatry is really the compilation of various interventions, whether they're nutritional or whether they're pharmacological," Sethi said. Because it integrated multiple aspects of current fields of study, metabolic psychiatry was not separate from them, Sethi added.

Another misconception was that ketogenic diets were fad or weight loss diets. Sethi said she uses the term ketogenic metabolic therapy because the approach is a medical intervention, not a lifestyle change that is adopted and then abandoned. The treatment has also been used to treat epilepsy historically.

Because ketogenic metabolic therapy was a medical intervention, it requires monitoring, so patients and clinicians need to ensure that a clinician with expertise in the area provides that monitoring. "It also is important to think about safety, especially when patients are on medications and you have to think about titrating the medications," Sethi said. Medication side effects required consideration alongside the metabolic intervention, which could affect medication levels and cause electrolyte and fluid shifts.

Various tools were being studied in an evidence-based fashion, and clinicians were encouraged to remain open-minded about whether a drug, nutritional, or metabolic intervention with a metabolic indication might also have a psychiatric indication, which Sethi described as the first step.

Dr Sethi is an associate professor at Stanford University School of Medicine and founder of Metabolic Psychiatry Labs.

References

1. Sethi S, Wakeham D, Ketter T, et al. Ketogenic diet intervention on metabolic and psychiatric health in bipolar and schizophrenia: a pilot trial. Psychiatry Res. 2024;335:115866.

2. Sethi S, Berk M, Andreazza AC, et al. Metabolic psychiatry targeting metabolic dysregulation in mental health. Nat Ment Health. 2026;4:508-520.