Potential of Ketogenic Metabolic Therapy as an Adjunct in Serious Mental Illness

Ketogenic metabolic therapy allows patients with serious mental illness to improve aspects of quality of life through dietary change and return a measure of control to patients, said Shebani Sethi, MD. Sethi highlighted the usefulness of this type of intervention: "Medications are extremely important and life-saving and I'm not endorsing that patients get off their medication, but at least having an opportunity to have another tool at their disposal is very exciting."¹

Additional medications under study for potential effects on mental health outcomes further expanded the available toolbox, which Sethi said the field needed.

Insulin signaling was of particular interest because it was necessary for neuroplasticity, meaning brain structure and function could change through food or medication acting on central and systemic energy metabolism.² "It's not just about insulin signaling for glucose disposal in the muscle and liver. It's thinking about the brain and how that's impacting your mental health," Sethi said. She characterized these as modifiable factors that could be manipulated to affect change.

Access to metabolic psychiatry care remained rare, and 2 clinics were being formed on the East Coast in addition to the original program at Stanford. Metabolic Psychiatry Labs, a Stanford spinout based on Sethi's research, was developed to extend this care beyond academic centers to patients in additional states. The company's telemedicine digital health platform integrated clinically relevant data, including wearable data, and used artificial intelligence tools to train interested physicians to deliver care to patients covered by Medicare, Medicaid, or commercial insurance. The platform was intended to deliver care directly to patients while also serving partner organizations. Sethi said the company also intended to partner with providers and clinics that wanted to integrate metabolic psychiatry into their models but lacked the know-how, supported by built protocols and treatment algorithms that were kept current with the latest science. The motivation was a gap in care Sethi noticed early on, and she considered translating rigorous, evidence-based science into practice to be a form of leadership and innovation.

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.