Hello, I’m Dr. Matt Bernstein, and I’m here to share a journey with you—that’s not just about treating mental illness, but about understanding the intricate relationship between our minds and bodies. This journey has led me to Metabolic Psychiatry, a field that’s not only fascinating but also transformative for those struggling with mental health issues.

What is Metabolic Psychiatry?

For years, traditional psychiatry has focused on neurotransmitter imbalances in the brain. While this approach has brought relief to many, I’ve often found myself asking: What about those for whom this isn’t providing benefits? What about the many people who experience the debilitating side effects of the medications that I prescribe? What if the answers we seek lie not just in the brain but in the complex metabolic processes that govern our entire bodies?

Metabolic Psychiatry has provided many answers to these questions. It’s an approach that examines the profound impact of metabolism on mental health. The definition of Metabolic Psychiatry is simple yet revolutionary: it’s a field that acknowledges how metabolic dysfunctions—such as insulin resistance, inflammation, and mitochondrial dysfunction—can influence psychiatric disorders. Instead of solely focusing on neurotransmitters, we look at how the body’s overall metabolic health contributes to mental health challenges.

Origins and Historical Background of Metabolic Psychiatry

My interest in the origins of Metabolic Psychiatry began years ago when I heard a lecture from Dr. Chris Palmer where he described the complete reversal of symptoms in individuals with treatment resistant schizophrenia who adopted a ketogenic diet. I wouldn’t have believed this was possible if I hadn’t known Dr. Palmer for years and trusted his reporting. I started to learn more and was impressed with the level of basic science underlying why this approach would work. This wasn’t just a coincidence. There was proof that ketogenic diets reversed epilepsy for the past 100 years and scientists had been spending decades understanding how ketones improved both metabolic and brain health. In fact, this has led me to assert: “the scientific understanding of how ketones improve brain health is far more compelling to me than the science underlying how the psychiatric medications that I prescribe every day improve mental health symptoms.”

The historical background of Metabolic Psychiatry dates back to some very early research linking metabolic health and mental well-being. Studies showed that conditions like diabetes were often accompanied by depression, and vice versa. But it wasn’t until recent years that we began to truly understand the biochemical pathways connecting these dots.

As I delved deeper into this field, I became convinced that Metabolic Psychiatry was more than a novel idea—it was a necessary evolution in the way we approach mental health care. As I often say, “The mind and body are not separate entities; they are deeply interconnected. By understanding the metabolic factors that influence mental health, we can develop more effective treatments for psychiatric disorders.”

Why Metabolic Psychiatry Matters

Why does this matter? Because mental health is complex, and a one-size-fits-all approach rarely works. When patients and families come to me after years of battling mental illness with little to no relief, I see the frustration in their eyes. They’ve tried everything—multiple medications, therapy, lifestyle changes—yet they’re still suffering, often not only from the symptoms of their underlying illness, but also from medication side effects and the years of psychosocial trauma that this whole experience has caused.

This is where Metabolic Psychiatry offers a new perspective. It’s about understanding that metabolismplays a crucial role in the health of all cells, and therefore is a powerful driver of mental health. For instance, insulin resistance isn’t just a precursor to diabetes; it can also affect brain function, leading to mood disorders. Chronic inflammation doesn’t just cause pain; it can contribute to anxiety and depression. Mitochondrial dysfunction isn’t just about fatigue; it can be a driving factor in cognitive decline and other mental health disorders.

By addressing these metabolic disorders, we’re not just treating symptoms—we’re tackling the root causes of mental health issues. This is what makes Metabolic Psychiatry so powerful and why I’ve dedicated so much of my professional life to it.

Key Studies and Research in Metabolic Psychiatry

The research in Metabolic Psychiatry is as compelling as it is promising. Take, for example, the study from UCLA that linked insulin resistance to poor outcomes in depression treatment. This study was a game-changer. It suggested that by addressing insulin resistance, we might improve mental health outcomes for those who don’t respond to traditional antidepressants.

Another study that has deeply influenced my work looked at using metformin to reverse insulin resistance in people with treatment resistant bipolar depression. The individuals whose insulin resistance was improved by taking metformin had a significant reduction in depression from just adding metformin. This is profound, yet it’s crucial to note that metformin is a far less powerful way to reverse insulin resistance than the ketogenic diet and exercise.

Inflammation is another area where Metabolic Psychiatry has made significant strides. Chronic inflammation has been linked to a range of mental health issues, from depression to cognitive decline. We now know that by reducing inflammation, whether through diet, medication, or lifestyle changes, we can potentially alleviate these symptoms and improve overall mental well-being.

Breakthrough Discoveries in Metabolic Psychiatry

One of the most exciting breakthrough discoveries in this field is the role of the gut-brain axis. It’s something we’ve all heard about in passing, but its significance in mental health is profound. The gut-brain axis refers to the communication network between your digestive system and your brain, and it’s heavily influenced by the gut microbiome—the community of bacteria and other microorganisms in your gut.

Research has shown that an imbalanced gut microbiome can contribute to mental health issues like depression and anxiety. This discovery has led to new treatment approaches, such as dietary interventions rich in probiotics and prebiotics, which can help restore gut health and, in turn, support mental health.

There are also multiple case series and case reports in the literature with impressive results from using a ketogenic diet to drastically improve the symptoms of severe mental illnesses such as Schizophrenia, Schizoaffective disorder, Bipolar disorder, Major depressive disorder and more. In my clinical practice, I have been incredibly impressed by the power of metabolic interventions to improve all aspects of mental health in a wide variety of people with various challenges.

At Accord, we’ve embraced this knowledge. We offer personalized dietary plans crafted by a registered dietitian designed to improve gut health, reduce inflammation, reverse insulin resistance, improve mitochondrial health and support brain function. It’s not just about what you eat—it’s about how what you eat influences your entire metabolism, including your mental well-being.

How the Accord Residential Program Brings Metabolic Psychiatry to Life

So, how does this all come together in the real world? At the Accord Residential Program, we’ve designed a treatment approach that brings Metabolic Psychiatry to life and makes its profound benefits attainable in a supportive and sustaining environment. This program isn’t just about managing symptoms; it’s about addressing the whole person—mind and body.

We start with comprehensive assessments that include metabolic evaluations. We look at factors like insulin resistance, inflammation, lipid markers, micronutrients, body composition as well as mental health history and medications. These assessments give us a clear picture of your overall health and help us pinpoint the metabolic disorders that might be contributing to your mental health challenges.

From there, we create a personalized treatment plan that targets these issues. This will consist of a well-formulated, individualized and delicious ketogenic meal plan and may also include supplements, and medications designed to improve your metabolic health. We also integrate exercise, psychotherapy, mindfulness and other holistic approaches to ensure we’re addressing every aspect of your well-being. By combining all of these approaches together, the potential benefits are even greater than the already impressive benefits seen with a ketogenic diet alone.

Integrated Care is at the heart of what we do. By combining the best of psychiatry, nutrition, and physical health, we’re able to offer a comprehensive treatment approach that addresses the root causes of mental illness, not just the symptoms.

The Future of Metabolic Psychiatry

Looking ahead, I’m excited about the future of Metabolic Psychiatry. There are more than a dozen well designed controlled research studies in process at academic medical centers around the world looking at ketogenic diets and various mental health conditions, and we’re learning more every day about how metabolism influences mental health. As new discoveries emerge, we’ll continue to refine our approaches at Accord, ensuring that our clients receive the most effective care possible.

In conclusion, Metabolic Psychiatry isn’t just a field of study—it’s a paradigm shift in understanding and treating mental illness. By acknowledging the deep connection between our metabolic health and our mental well-being, we can develop treatments that are not only more effective, and more holistic, but also more personalized.

If you’re struggling with mental health challenges that haven’t responded to traditional treatments or don’t like the side effects of those treatments, I encourage you to consider the role that metabolism might be playing in your condition. At Accord, we’re here to help you explore that connection and find the relief you deserve.

Thank you for allowing me to share this with you. I look forward to continuing this journey together.

References:

Peter J. Gianaros, et al.”Insulin Resistance as a Mediator of the Link Between Obesity and Depression”. JAMA Psychiatry, 2020               

Cynthia Calkin et. al., “Treating Insulin Resistance With Metformin as a Strategy to Improve Clinical Outcomes in Treatment-Resistant Bipolar Depression (the TRIO-BD Study): A Randomized, Quadruple-Masked, Placebo-Controlled Clinical Trial.” J Clin Psychiatry, 2022       

Charles L. Raison, et al. “The Role of Inflammation in Depression and Other Neuropsychiatric Disorders”. Annual Review of Clinical Psychology, 2019

Albert Danan et al. “The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of 31 Inpatients.” Frontiers in Psychiatry, 2022.

Kirsten Tillisch, et al. “Gut Microbiota’s Effect on Mental Health: The Role of Prebiotics and Probiotics”.Journal of Clinical Gastroenterology, 2021