Welcome to the final installment in our Mental Health Heroes series. Today we explore the groundbreaking work of Dr. Shebani Sethi, whose integration of metabolic health and psychiatry is creating new healing pathways for those struggling with mental illness.

Where Medicine Meets Metabolism

Dr. Shebani Sethi stands at the crossroads of two specialties rarely combined: psychiatry and obesity medicine. As the founder of Stanford University’s Metabolic Psychiatry Clinic — the first of its kind in the nation — she’s pioneering an approach that could fundamentally transform how we understand and treat mental illness.

“Mental health and metabolic health are deeply interconnected. We can’t effectively treat one without addressing the other.” — Shebani Sethi

Double board-certified in psychiatry and obesity medicine, Sethi brings unique expertise to questions that have puzzled clinicians for decades: Why do psychiatric medications often cause metabolic side effects like weight gain? Why do conditions like depression and anxiety frequently co-occur with obesity and diabetes? Could metabolic dysfunction be driving some mental health conditions rather than merely accompanying them?

At Exodus Counseling, Sethi’s integrative vision resonates profoundly with our whole-person approach. Your mind and body are inextricably interlinked. Her work validates what’s been known in some capacity for centuries — proven clinically while providing a rigorous scientific framework to guide our interventions.

Metabolic Psychiatry: A Field Takes Shape

Sethi didn’t just join an existing field — she created one. The term “metabolic psychiatry” itself emerged largely through her efforts to establish this new discipline at the intersection of mental and metabolic health.

Her background uniquely prepared her for this pioneering role. After completing her psychiatry residency at Stanford, she pursued additional training in obesity medicine, recognizing that the body’s metabolic function profoundly influences brain health. This dual expertise allows her to see connections others might miss.

Sethi was the first physician in the U.S. to be triple-board-certified in adult psychiatry, obesity medicine, and metabolic psychiatry.

The Metabolic Psychiatry Clinic she established at Stanford serves as both a clinical care center and research hub, generating data that continues to validate and refine this approach. Unlike many specialty clinics, Sethi’s accepts patients with various psychiatric diagnoses — from depression and anxiety to bipolar disorder and schizophrenia — recognizing that metabolic factors may underlie multiple conditions.

What makes this approach particularly valuable is its potential to help people who haven’t responded well to conventional treatments. For those who’ve tried multiple medications without success, metabolic interventions often provide new hope and tangible improvements.

The Insulin-Brain Connection

Central to Sethi’s work is her focus on insulin resistance — a condition where cells become less responsive to insulin, the hormone that regulates blood sugar. While traditionally associated with diabetes and cardiovascular disease, Sethi’s research suggests insulin resistance may also play a crucial role in mental health.

Her 2022 paper published in the American Journal of Psychiatry detailed how insulin resistance affects brain function through multiple pathways:

• Reducing energy availability to brain cells
• Promoting inflammation in brain tissue
• Disrupting neurotransmitter systems, including dopamine and serotonin
• Impairing the brain’s ability to form new connections
• Accelerating brain aging and cognitive decline

Studies show that people with insulin resistance have a 42% higher risk of developing depression compared to those with normal insulin function.

This connection helps explain why conditions like diabetes and obesity so frequently co-occur with mental health problems. It also suggests why lifestyle interventions that improve insulin sensitivity — like dietary changes, exercise, and improved sleep — often have positive effects on mood, anxiety, and cognitive function.

What distinguishes Sethi’s approach is her emphasis on measuring metabolic biomarkers in psychiatric patients. Rather than assuming metabolic health based on appearance or BMI, she advocates for comprehensive testing that can detect insulin resistance and other metabolic problems even in people of normal weight.

The Ketogenic Diet as Psychiatric Treatment

Perhaps Sethi’s most innovative clinical contribution is her research on ketogenic diets for psychiatric conditions. Building on emerging research in neurology (where ketogenic diets are established treatments for certain types of epilepsy), she’s conducted groundbreaking studies on using this approach for serious mental illness.

A ketogenic diet drastically reduces carbohydrate intake while increasing fat consumption, shifting the body’s metabolism to produce ketones instead of relying primarily on glucose for energy. This metabolic state — ketosis — appears to have powerful effects on brain function.

In Sethi’s 2020 pilot study, patients with bipolar disorder who followed a ketogenic diet for 12 weeks experienced significant improvements in mood stability, depression, and anxiety.

Her research suggests several mechanisms by which ketogenic diets might improve mental health:

1. Reduced brain inflammation: Ketones have anti-inflammatory properties that may calm overactive immune responses in the brain.
2. Enhanced mitochondrial function: Ketones provide an efficient energy source for brain cells, potentially correcting energy deficits.
3. Improved neurotransmitter balance: Ketosis may increase GABA (a calming neurotransmitter) while stabilizing glutamate (an excitatory neurotransmitter).
4. Better insulin sensitivity: Ketogenic diets dramatically improve insulin function, potentially reversing the negative brain effects of insulin resistance.

What makes this approach particularly valuable is its potential to improve multiple conditions simultaneously. Patients in Sethi’s studies often report not just psychiatric benefits but also improvements in physical health markers, energy levels, and cognitive function.

Beyond Diet: The Comprehensive Metabolic Approach

While Sethi’s ketogenic research captures headlines, her clinical approach extends beyond diet alone. She emphasizes a comprehensive framework for metabolic health that includes:

1. Nutritional interventions: Beyond ketogenic diets, she explores how various dietary patterns affect brain function and which approaches might benefit specific conditions.
2. Strategic exercise: Physical activity improves insulin sensitivity and promotes the release of BDNF (brain-derived neurotrophic factor), which supports neuron growth and connection.
3. Circadian rhythm optimization: Aligning sleep-wake cycles with natural light patterns improves metabolic function and mental health.
4. Stress management: Chronic stress disrupts both metabolism and mental health, making stress reduction techniques an essential component of treatment.
5. Environmental considerations: Toxin exposure, medication effects, and even social factors can influence metabolic health and must be addressed.

“We need to stop separating the brain from the body in our treatment approaches. Mental illness is a whole-body condition.” — Shebani Sethi

This comprehensive approach aligns perfectly with our integrated model at Exodus. We’ve long recognized that physical and mental health are inseparable, but Sethi’s work provides specific metabolic pathways to target and measurable biomarkers to track progress.

The Science and Evidence

What distinguishes Sethi’s work from many alternative approaches is her commitment to rigorous scientific investigation. As a clinical researcher at a top academic institution, she designs and conducts studies that meet high scientific standards, publishing her findings in peer-reviewed journals.

Her 2019 review paper in Current Psychiatry Reports synthesized existing research on metabolic dysfunction in psychiatric disorders, making a compelling case for the field of metabolic psychiatry. Subsequently, her team’s original research has provided some of the first clinical data on ketogenic interventions specifically for psychiatric conditions.

A particularly valuable aspect of Sethi’s research is her focus on biomarkers. Rather than relying solely on subjective symptom reports, she measures concrete biological indicators before and after interventions:

• Insulin and glucose levels
• Inflammatory markers like C-reactive protein
• Lipid profiles
• Body composition changes
• HbA1c (a measure of long-term blood sugar control)

These objective measures help demonstrate that metabolic interventions produce real biological changes alongside symptom improvements. This evidence-based approach is crucial for gaining broader acceptance in mainstream psychiatry.

Cases of Transformation

The power of Sethi’s approach becomes most evident through patient outcomes. While protecting confidentiality, we can share that we’ve witnessed remarkable transformations when implementing her protocols:

• A client with treatment-resistant bipolar disorder who had cycled through numerous medications found mood stability for the first time after adopting a ketogenic diet and addressing insulin resistance.
• A young adult with severe anxiety and panic attacks experienced an 80% reduction in symptoms after three months of metabolic interventions, despite minimal response to previous medication trials.
• A middle-aged client with depression and cognitive complaints saw dramatic improvements in both mood and thinking clarity when metabolic issues were addressed, even though their BMI was in the normal range.

These cases reflect patterns similar to those documented in Sethi’s research. A particularly encouraging aspect is the relatively rapid timeline for improvement — many patients begin noticing benefits within weeks, unlike the longer waiting periods often experienced with psychiatric medications.

The Exodus Approach: Implementing Sethi’s Insights

At Exodus Counseling, we’ve integrated Sethi’s metabolic framework into our practice in several key ways:

1. Expanded assessment: We include questions about metabolic symptoms, eating patterns, and physical health markers in our initial evaluations as well as our ongoing work.
2. Biomarker testing: We work with clients’ primary care providers to obtain relevant metabolic testing that might reveal underlying factors contributing to their mental health symptoms.
3. Targeted interventions: Based on assessment results, we develop individualized plans that may include dietary changes, exercise recommendations, sleep optimization, and stress management techniques.
4. Collaborative care: We coordinate with physicians, nutritionists, and other healthcare providers to address both psychiatric symptoms and metabolic factors simultaneously.
5. Progress tracking: We monitor both subjective improvements in mental health and objective changes in metabolic biomarkers when available.

What makes this approach particularly valuable is its complementary nature. These interventions can work alongside traditional treatments like therapy and medication when needed. For some clients, metabolic approaches reduce or eliminate the need for psychiatric medications; for others, they enhance medication effectiveness or reduce side effects.

“This approach empowers patients. Instead of feeling dependent on medications, they discover their own ability to influence brain function through daily choices.” — Shebani Sethi

Our experience aligns with Sethi’s observations: metabolic interventions seem to help most people to some degree, but some experience truly transformative results. With ongoing research, we’re learning more about which specific approaches benefit particular conditions and individuals.

Challenges and Considerations

Despite its promise, Sethi’s approach faces several challenges in gaining widespread adoption:

1. Medical silos: Psychiatry and metabolic medicine have traditionally operated as separate specialties with limited cross-training.
2. Limited physician training: Most psychiatrists receive minimal education in nutrition and metabolism during their training.
3. Implementation complexity: Interventions like ketogenic diets require careful planning, monitoring, and adjustment — more intensive than simply prescribing medication.
4. Insurance coverage: Many insurance plans don’t cover nutritional counseling or metabolic testing for psychiatric patients.

Sethi addresses these challenges through education and advocacy. Her lectures, publications, and training programs for healthcare providers aim to build capacity for metabolic psychiatry even before formal medical education catches up with this emerging field.

At Exodus, we navigate these challenges by staying current with research, collaborating across specialties, and helping clients advocate for appropriate testing and treatment within their healthcare systems.

The Future of Metabolic Psychiatry

Sethi’s work points toward an exciting future where mental health treatment routinely incorporates metabolic factors. As research continues, we expect to see:

• More specific protocols tailored to particular psychiatric conditions
• Clearer guidelines for identifying which patients will benefit most from metabolic interventions
• Expanded insurance coverage as evidence accumulates
• Integration of metabolic approaches into standard psychiatric care
• Prevention strategies targeting metabolic health to reduce mental illness risk

What makes Sethi’s contribution so valuable is how she bridges cutting-edge research and practical clinical application. She doesn’t wait for perfect evidence before helping patients who are suffering now, while simultaneously conducting the research needed to refine these approaches.

Practical Applications: Supporting Your Metabolic and Mental Health

While comprehensive metabolic treatment should involve healthcare providers, Sethi offers several science-backed strategies anyone can implement:

1. Reduce refined carbohydrates and sugars: These foods cause blood sugar spikes and crashes that can affect mood, energy, and focus.
2. Eat adequate protein: Protein provides essential amino acids for neurotransmitter production and helps stabilize blood sugar.
3. Include healthy fats: The brain is primarily fat and needs adequate dietary fat for optimal function.
4. Consider time-restricted eating: Limiting eating to an 8–10 hour window may improve metabolic health and reduce inflammation.
5. Prioritize sleep: Poor sleep disrupts glucose metabolism and increases insulin resistance, affecting both body and brain.
6. Move regularly: Even walking helps improve insulin sensitivity and boost brain-derived neurotrophic factor (BDNF).

For those interested in more intensive approaches like ketogenic diets, Sethi emphasizes the importance of medical supervision, particularly for people taking psychiatric medications, as dosage adjustments may be necessary as metabolic health improves.

Completing Our Journey: The Integrated Vision

As we conclude our Mental Health Heroes series, Dr. Shebani Sethi’s work represents a fitting culmination of the integrative approach we’ve explored throughout. Like the other pioneers we’ve featured, she reminds us that truly effective mental health care must address the whole person — including the fundamental biological processes that support brain function.

At Exodus Counseling, we’re committed to this integrated vision. By combining insights from relationship science (Gottman), meaning and responsibility (Peterson), existential wisdom (Yalom), metabolic function (Palmer), nutritional psychiatry (Ede), and Sethi’s metabolic psychiatry framework, we offer a truly comprehensive approach to mental wellness.

The future of mental health treatment lies not in choosing between biological, psychological, or social approaches, but in understanding how these dimensions interact and influence each other. Our Mental Health Heroes have each illuminated a crucial piece of this complex puzzle, and together, their insights form a roadmap for more effective, personalized care.

We invite you to reflect on which aspects of these approaches might benefit your own mental health journey. Whether you’re struggling with specific symptoms or simply seeking greater wellbeing, these integrated insights offer powerful tools for transformation and healing.