At a moment when the country is debating everything from psychiatric overprescribing to the rise of GLP-1s, and the role of nutrition in chronic disease, psychiatry is finally confronting a fundamental oversight in the field: the clinical cost of treating the brain as an island, separate from the body’s physiological energy systems.
For most of my career, psychiatry treated the brain as if it existed in isolation. A patient would come in struggling with psychosis, severe depression, or bipolar disorder, and our focus would narrow almost entirely to neurotransmitters, symptom management and psychotherapy support. The fact that the patient was gaining weight on medication, developing insulin resistance, and living in a state of chronic inflammation would be almost entirely unexamined.
That approach no longer makes sense. After more than two decades as a psychiatrist and neuroscientist, I’ve come to believe that one of the biggest blind spots in modern medicine is our failure to take metabolic health seriously enough. We have spent decades trying to stabilize the mind while ignoring the cellular energy processes that allow the brain to function in the first place.
The brain as an energy consumer
The brain is the most energy-demanding organ in the human body. When the body’s ability to produce and regulate energy becomes dysregulated, the brain is often among the first organs to suffer. Decades of rigorous scientific research spanning fields from neuroimaging to genetics provide convergent evidence that disruptions in the bioenergetic foundations of brain health, including insulin resistance, chronic inflammation, and mitochondrial dysfunction, play a central role in psychiatric illness. These processes are not only causal contributors to the development of mental health disorders, but are also further exacerbated by many psychiatric medications, which can contribute to broader systemic metabolic imbalance.
A key insight driving this field is the impact of insulin resistance. Insulin is far more than a peripheral hormone involved in glucose metabolism and disrupted in diabetes; it is also a powerful regulator of critical brain functions, including neurotransmission, neuroplasticity, cognition, and maintenance of the blood-brain barrier. Even without a diabetes diagnosis, insulin resistance creates an unhealthy, unstable environment for the brain. Today, millions of Americans live in metabolically imbalanced states fueled by diets high in refined sugars and high-glycemic foods. This imbalance can be a primary driver of mental health disorders.
I’m increasingly seeing younger patients arrive with severe psychiatric symptoms alongside profound metabolic instability years before they develop formal metabolic disease. They struggle with disrupted sleep, inflammatory conditions, blood sugar dysregulation, obesity, and extreme energy instability. What stands out clinically is not just the presence of these metabolic issues, but how early they appear and how consistently they track with symptom severity and treatment resistance.
Countless patients have cycled through medication after medication, only stabilizing once we addressed the underlying metabolic dysfunction contributing to their condition. In many cases, metabolically imbalanced patients even fail to respond to advanced interventions like Transcranial Magnetic Stimulation (TMS) because the biological environment supporting brain function remains dysregulated. These cases increasingly point to the same conclusion: that brain health and metabolic health are deeply interdependent in ways psychiatry is only beginning to fully account for.
Moving beyond symptom management
In modern psychiatry, the standard model of care is frequently a long process of trial and error with medications. While these medications provide essential relief during a crisis, they are not always a complete solution, and shouldn’t be treated as such. Many patients face side effects, such as significant weight gain and metabolic shifts, which can be as debilitating as the original diagnosis.
Current clinical gaps are wide: we hand out prescriptions, but we rarely work on the foundational lifestyle factors, like glycemic index management and sugar elimination, that dictate brain health. Stabilizing a patient’s immediate crisis through medication is only one piece of the puzzle. To move someone from a state of survival to a life where they can thrive, we have to address the underlying metabolic foundation that allows the brain to heal and remain stable. By repairing a patient’s metabolic foundation, we restore the biological environment necessary for the brain to function reliably.
A growing movement
A growing number of interested researchers, clinicians and organizations have accelerated this approach and are working to prove the link between ketogenic therapies and psychiatric recovery, and raise public awareness.
This movement is now reaching the highest levels of policy, including a push to re-evaluate dietary guidelines for children and recognize that metabolic health is a matter of national mental health security. Some of the public conversation around metabolic psychiatry has become overly simplistic; severe mental illness cannot be reduced to diet alone, and psychiatric medications remain lifesaving and essential for many patients. But acknowledging that reality should not prevent us from confronting another: the brain does not function independently from the body that sustains it.
A new standard of care
While the need for high-acuity treatment is expanding, access to the kind of intensive, in-person care required for complex conditions is shrinking across the country. We can no longer rely on brief visits, virtual-first models, and fragmented crisis systems to manage profoundly complex illness; and we cannot medicate our way out of this crisis alone.
The conversation we must have should be about the quality of the care vs just the access to it. We have to ask if we are willing to rebuild our clinical infrastructure to treat people as complete, integrated biological systems. This means incorporating objective physical markers, such as blood sugar regulation, inflammatory markers, and sleep architecture, into psychiatric evaluation.
Medications and psychotherapy remain essential and powerful tools in the treatment of mental illness, but for too long psychiatric care has largely ignored the metabolic dysfunction that both contributes to the development of psychiatric illness and can emerge as a consequence of treatment itself. Metabolic psychiatry has moved past being a fringe theory. It is a practical, evidence-based necessity for a field that has been stagnant for too long. In other areas of medicine, we would never ignore the underlying biological systems contributing to disease progression, and psychiatry should not be the exception.
If we are ever going to get ahead of the mental health crisis, we have to start by making sure the brain has the fuel it needs to function.
Ultimately, metabolic health is mental health. It’s time our standard of care finally caught up to that reality.
Photo: Only Flags, Getty Images
Dr. Scott Fears, Chief Medical Officer of Amae Health, is a psychiatrist and neuroscientist. He serves as a Professor of Psychiatry at UCLA and has spent over 20 years dedicated to clinical research and the treatment of severe mental illness.
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