Behind the Brain

Metabolism and mental health are two areas in which American adults are struggling. Over 40% of American adults are obese, and over 35% of American adults and anxiety and/or depression.

In 2015, Dr. Shebani Sethi, board certified in psychiatry and obesity medicine, realized that there is a connection between metabolic disorders and mental illness.

Sethi realized that the best way to address metabolic disorders and mental health problems among adults who have both these issues, is to address them contemporaneously. Hence, she founded the Standford Medicine’s Metabolic Psychiatry Clinic, and coined the term “metabolic psychiatry”.

Metabolic Psychiatry

Metabolic psychiatry is a subspecialty founded by Dr. Shebani Sethi (shown below) focused on treating metabolic problems in order to improve mental illness. These treatments also include medications, dieting and lifestyle changes.

Why do metabolic focused drugs help with treatment of psychiatric disorders?

Metabolic focused drugs often reduce insulin resistance in the human body. Now why does insulin resistance cause psychiatric disorders?

1.  Insulin resistance can impact the hypothalamic–pituitary–adrenal axis (HPA). A impaired HPA could affect glucocortoid secretion, which acts on many organ systems to manage energy resources. When we are feeling stressed HPA also releases corticotrophin releasing hormone (CRH), which are released from hypothalamic paraventricular nucleus (PVN) neurons. CRH is able to regulate our stress in a good manner. So, since insulin resistance is impacting HPA, it impacts our ability to manage stress and energy, leading to depression, anxiety, and all sorts of mental health problems.
2. Insulin resistance weakens the blood-brain-barrier (BBB) thus leading to a pileup of toxic materials. This results in increased inflammation, which is a key sign of mental illness.
3. Metabolic disorders also can result in mitochondrial dysfunction, leading to unstable communication between neurons. This negatively affects cognition and can worsen mental health.

Metabolic Psychiatry in Practice

1. Dr. Cindy Calkin, a associate professor at Dalhousie University realized that Metmorfin, a diabetes drug that reverses insulin resistance, significantly improved treatment of bipolar disorder.
2. Ketogenic diet has been shown to help patients with mental health issues. In fact, keto diet has been used to treat pediatric epilepsy and neurodegenerative conditions for the last few decades. How does this work? Well, a keto diet in theory should decrease amount of glucose intake, resulting in the liver producing ketones, a replacement fuel for brain cells. Ketosis, the process of producing ketones results in increase mitochondria production and decreased inflammation in the brain.