Metabolic psychiatry in Washington State

What is metabolic psychiatry?

Metabolic psychiatry is a growing field examining the relationship between metabolic health — blood sugar regulation, insulin sensitivity, inflammation, mitochondrial function, and sleep — and psychiatric symptoms. The central idea, articulated most clearly by Harvard psychiatrist Dr. Christopher Palmer in Brain Energy, is that many mental illnesses involve problems with how brain cells generate and use energy.

This isn't a replacement for psychiatry as we know it. It's an additional lens — one that asks why a person's symptoms are happening, not merely which diagnostic label fits them.

Why it matters clinically

Metabolic and psychiatric conditions travel together far more often than coincidence would explain. People with serious mental illness have markedly higher rates of type 2 diabetes, obesity, and cardiovascular disease, and die years earlier than the general population. Several psychiatric medications worsen metabolic health, which can start a cycle that's rarely addressed directly.

Meanwhile, the interventions with the most compelling early research — particularly ketogenic and other therapeutic nutrition approaches — are being studied precisely where conventional treatment struggles most: bipolar disorder, schizophrenia, and treatment-resistant depression.

How we practice it

We start by assessing the metabolic contributors to your symptoms — blood sugar and insulin resistance, lipids, inflammatory markers, thyroid and hormone function, nutrient status, and sleep quality. Much of this is standard lab work that simply never gets connected to psychiatric care.

Where the findings support it, we intervene: therapeutic nutrition strategies including ketogenic-informed approaches when appropriate, movement, circadian rhythm and light exposure work, and specific, practical behavioral recommendations rather than vague advice to "eat better and exercise."

Then we sustain it — small changes tracked over time and adjusted at every visit, because metabolic change is a practice, not a prescription. You can see how this reorders the usual treatment priorities on our treatment pyramid.

Who this tends to help

• People whose depression or mood instability hasn't responded to several medication trials
• Patients who've gained significant weight or developed metabolic problems on psychiatric medication
• Anyone with co-occurring insulin resistance, prediabetes, or metabolic syndrome alongside a mood disorder
• People who want to address root causes rather than add another prescription
• Patients navigating bipolar spectrum or psychotic disorders who want every reasonable tool considered

What we won't claim

This is emerging science, and we treat it that way. Metabolic approaches are used alongside proven treatment, never instead of it. We don't promise that nutrition will cure serious mental illness, we don't ask anyone to stop effective medication to try a diet, and we're direct about where the evidence is still thin. Ketogenic therapy in particular requires real medical supervision — it changes how some psychiatric medications behave, including lithium levels and blood pressure.

If you want to explore the science yourself, Metabolic Mind is a good non-commercial starting point.

Getting started in Washington

All care is delivered by secure video anywhere in Washington State, for adolescents and adults. Most major insurance is accepted — see our insurance page. Your first visit is a comprehensive diagnostic evaluation; metabolic assessment builds from there. Related services include genetic and functional testing and integrative and functional psychiatry.