What is metabolic psychiatry?
Metabolic psychiatry is a relatively new and expanding field that focuses on the interplay between metabolic processes and psychiatric conditions. It explores the relationship between metabolic dysregulation (poor glucose metabolism) and conditions, such as depression, anxiety, ADD/ADHD, bipolar, and schizophrenia. Research and studies have now shown that metabolism plays a significant role in brain function and poor metabolic health is correlated with poor mental health. Not only can poor metabolic health, such as obesity, diabetes, insulin resistance, inflammation, and oxidative stress contribute to the development and progression of psychiatric conditions, but psychiatric conditions can also influence metabolic processes, causing dysregulation in the cells.
Growing research has shown that when metabolic functioning is stabilized (i.e., blood glucose levels are stabilized), psychiatric symptoms are reduced and, in many cases, can resolve. This has been well documented in multiple studies and can benefit a wide range of psychiatric conditions with higher efficacy rates, an increase in numerous health markers, and fewer side effects than standard psychiatric medications.
What is metabolic dysfunction?
Metabolic dysfunction is any condition that interrupts metabolism. Metabolism is how the body converts food into energy or fuel for the body. Metabolic issues include insulin resistance (including diabetes type II), increased levels of inflammation, and obesity. These metabolic dysfunctions are detrimental to the entire body and the organs, including the brain. When the brain cannot access energy, it does not function properly. Symptoms of poor brain health might look like brain fog, fatigue, memory issues, headaches, depression, anxiety, mood disorders, panic attacks, and many more.
When we eat proteins, fats, and carbohydrates, the body breaks these down and through chemical processes, creates energy. The body can run on two energy sources: glucose (sugar) or fat (ketones). That is, you can be a sugar burner or a fat burner and in our modern-day, highly processed food world, most people are sugar burners. But the brain prefers ketones, which are produced when you are burning fat for fuel. When you are burning fat for fuel, you create ketones. Ketones are a cleaner energy for the body than glucose, especially if you suffer from a psychiatric condition. So, how do we produce more ketones? There are a few ways but first, let us dive into a simple lesson on what these macronutrients do for the body.
Basic Macronutrient Overview
- Proteins and fats are what we call “essential nutrients,” meaning we need them to survive. We would die without them. Amino acids are found in protein and are required for energy, to break down food, create hormones, repair body tissue/muscle, protect the immune system, and maintain healthy skin, hair, and nails. Several of the amino acids are also precursors to neurotransmitters that are crucial when it comes to brain health. Think of meats, seafood, eggs, and dairy as good protein sources.
- Fats are broken down into fatty acids and are essential for cellular function, protein absorption, managing adequate hormone levels, and maintaining skin health. Fatty acids are also fuel for your brain, and the brain and nervous system will not function efficiently without getting adequate fatty acids. Think of the natural fats that come with meats and seafood, dairy, avocado, nuts, and olive oil.
- Carbohydrates are non-essential, meaning the body does not require them. Carbohydrates, whether refined or whole, are all broken down into glucose(sugar), and when it comes to mental health, sugar should be poison. Think of bread, cakes, pasta, cookies, bagels, and many sugary beverages, including fruit juice, fruit, high-starch vegetables (i.e., potatoes, beans), and grains, such as rice.
This is not to say we can’t eat carbohydrates or shouldn’t eat them but to understand that they can cause a rollercoaster of glucose spikes throughout the day, and, in that process, block the body from burning fat, thus halting ketone production. Ketones are magic when we are treating psychiatric conditions.
When we eat carbohydrates, insulin goes up because it is needed to reduce blood glucose levels and shuttle glucose into muscles. The more muscle you have, the more glucose you can technically handle because you have the storage in your body for it. This is one of many reasons why working out and resistance training are crucial to mental health. It also uses up glucose, removing it from the bloodstream where it can be toxic. In a healthy body, when insulin goes up after carbohydrates have been consumed, glucose levels should titrate down and then, eventually, insulin comes down too. At this point, in a healthy body with low insulin levels, the body should begin to start burning fat for fuel, producing ketones. The issue is that most Americans are eating a snack or another meal before that can occur and the glucose-insulin rollercoaster is repeated. Spreading out meals is one way to prevent this. Over time, as a person continues to eat carbohydrate-rich foods, insulin continues to increase, attempting to manage glucose (remove it from the bloodstream) but the cells within our body can become resistant and will not let glucose in. They are exhausted and overworked and saying, “No, you cannot enter” to glucose. This is because they are already at capacity for glucose storage. When this happens, we eat a carbohydrate but insulin cannot shuttle the glucose out of the bloodstream because there is nowhere for it to go. When we go to the doctor to get labs done, this phenomenon and outcome of continuous excess carbohydrate intake is often revealed by high levels of fasting glucose. Sadly, if fasting insulin was checked weeks, months, or years ago, an increase in insulin would have been caught early on and would have been easier to treat. Remember, glucose and insulin are a relationship, and we must look at both to get a full picture. Someone could have a “normal” fasting blood sugar yet have high insulin, which is an early sign of metabolic dysfunction. For these reasons, advocating for your fasting insulin is one of the best things you can do for your health. Why? Not only do high levels of insulin and circulating glucose wreak havoc on the body physically, but it also blocks the brain from getting the energy it needs to work properly and can manifest in a variety of cognitive issues, mood instability, and more acute psychiatric conditions. It only takes approximately ½ a teaspoon of glucose in the blood to precipitate a diagnosis of diabetes. The spikes in insulin and glucose levels are correlated with a variety of common, but not normal, brain and mood conditions, such as dementia, Alzheimer’s, cognitive decline, and all psychiatric conditions previously mentioned.
To simplify, insulin blocks fat burning and, therefore, ketone production, and is contraindicated in psychiatric conditions. By keeping insulin low, we can stabilize glucose levels, burn fat for fuel to create ketones, and stabilize psychiatric conditions. How do we do this? By controlling carbohydrates. This is where the ketogenic or low-carb lifestyle enters, the most effective tool used in metabolic psychiatry to help thousands of people who are suffering.
When we reduce carbohydrates, the body must create another fuel source since no glucose is coming in. For many, this is when mood fluctuations happen, “hanger,” irritability, and more, are signs of poor metabolic health. If you cannot go several hours without eating due to moodiness, consider yourself to have some level of metabolic dysfunction, even mild, because that is a sign that your body cannot switch to burning fat for fuel. The body ideally should be able to burn glucose, if needed, then switch to burning fat (producing ketones for energy). When carbohydrate restriction continues, the body will eventually create ketones, and this is a good thing. Ketones are created by a combination of lowering or, for some, eliminating carbohydrates and increasing fats. If you are controlling carbohydrates, this will not make you fat because the body will be burning fat (your own and dietary fat) and creating ketones from your fat for energy. When your body becomes trained to burn fat instead of glucose, this is when the magic happens. When you are producing ketones, you are in a state called “ketosis.” People in ketosis report many symptoms such as:
- Mental clarity
- Feeling calm or zen
- No hunger or cravings
- Better sleep
- Focus and attention
- Mood regulation and stability
- More physical and mental energy
- Reduction or total reversal in psychiatric issues
This information is crucial as metabolic dysfunction is an epidemic worldwide, especially in the United States. The Standard American Diet, often referred to as the “SAD diet,” is rich in refined carbohydrates, low in protein, and high in inflammatory fats, such as processed seed oils, including soybean oil, canola oil, and safflower oil. This is a recipe for metabolic disaster, and that is exactly what is occurring. Food is mood, and what you eat will impact how your brain works or does not work. Some brains are more sensitive than others, and not everyone will need a ketogenic lifestyle. For some people, just reducing refined and processed foods can make a huge difference in their mental well-being.
If you know someone who is struggling with mental health issues, I invite you to share this article. If you are struggling with a severe psychiatric condition or would like to improve your mental health, this is for you. If you are unhappy with medications that are not helping, if the side effects are too harsh, or if you are medication-averse, this is a tool to try. As a cautionary note, if you are taking any psychiatric medications, you must work with your prescriber or a medical professional. As you change your metabolism, medications will need to be titrated to lower doses as you adjust.
Please remember that there is always hope. If anyone ever tells you otherwise, find a new practitioner, clinician, or prescriber, who is willing to offer you another treatment, or is, at least, willing to learn from you, because other treatments do exist and increasing numbers of professionals in the health and medical fields are acknowledging this new and exciting field.
Please see the resources provided below if you are interested in receiving more information, or reach out if you need more support.
- Metabolic Health Practitioner Directory: Provider Directory – Society of Metabolic Health Practitioners (thesmhp.org)
- Standford Medicine Metabolic Psychiatry Clinic: Metabolic Psychiatry Clinic | Department of Psychiatry and Behavioral Sciences | Stanford Medicine
- Dr Georgia Ede’s Website is filled with research and resources (she also has numerous talks on YT): https://www.diagnosisdiet.com/
- Nicole Laurent, LMHC is a licensed therapist and is trained in implementing metabolic diets: https://mentalhealthketo.com/
- Brain Energy by Christopher Palmer is a book all on metabolic psychiatry that outlines the current problems in the system and an alternative treatment using solid research.
Articles:
- 8 Reasons to Try Low-Carb for Mental Health: https://www.psychologytoday.com/us/blog/diagnosis-diet/201906/8-reasons-try-low-carb-mental-health
- Ketogenic Diets and Psychiatric Medications: https://www.psychologytoday.com/us/blog/diagnosis-diet/201803/ketogenic-diets-and-psychiatric-medications