Introducing MetPsy: A Global Community for Metabolic Psychiatry

Meal timing, morning light, sleep, and exercise can all influence circadian rhythm, with potentially important effects on metabolic health. In this episode, Dr. Bret Scher speaks with circadian biology expert Dr. Satchin Panda about how our internal clocks work, what disrupts them, and how everyday timing choices can affect metabolism, brain function, and long-term health. Dr. Panda describes how light helps synchronize the brain’s central clock, while food timing may influence clocks in other organs and tissues. He also breaks down why the timing of your first and last meals matters, what shift work can do to metabolic health, and how even a one-hour clock change for “daylight savings” can disrupt circadian biology. They discuss: How circadian rhythms influence metabolism and brain function Why morning light and daytime light exposure matter The difference between central and peripheral circadian clocks Why Dr. Panda recommends waiting one to two hours after waking before eating Why eating several hours before bed may support sleep and metabolic health Why the timing of a time-restricted eating window matters, not just its length What research in firefighters suggests about food timing during shift work Practical strategies for people working overnight or irregular schedules How light exposure is being used in some mental health settings Why Dr. Panda favors permanent standard time over changing the clocks twice a year

Can ketogenic therapy help offset some of the metabolic side effects of clozapine while preserving its psychiatric benefits? Dr. Deanna Kelly, a leading clozapine researcher, joins Dr. Bret Scher to discuss what she has seen clinically when ketogenic therapy is used alongside clozapine and other antipsychotic medications. Dr. Kelly shares the case of a patient taking clozapine who also had diabetes and metabolic syndrome. After five weeks on a ketogenic diet, the patient’s glucose, insulin, and hemoglobin A1C returned to the normal range. She also explains why people taking antipsychotics such as clozapine or olanzapine may have a harder time reaching ketosis and why careful monitoring matters. They discuss: Using ketogenic therapy alongside clozapine Metabolic side effects associated with antipsychotic treatment Why ketosis may be harder to achieve on clozapine or olanzapine Changes in clozapine blood levels that may occur with ketogenic therapy Why lower clozapine levels do not automatically mean the dose should be increased The possibility of gradually reducing antipsychotic doses once someone is stable Why Dr. Kelly views dose reduction through a harm-reduction lens The importance of expert clinical supervision when adjusting psychiatric medications

A recent study published in JAMA Psychiatry found that adults with ADHD had more than a fourfold higher association with cognitive impairment and dementia later in life. The finding doesn't mean ADHD causes dementia, but it raises important questions about what these conditions may share biologically. In this video, Dr. Bret Scher breaks down the study and explores one possible connection: brain energy metabolism. Researchers analyzed data from more than 187,000 adults and also found that people with a higher genetic risk for ADHD had a 35% greater likelihood of cognitive decline, even without an ADHD diagnosis. Dr. Scher explains why these findings may point toward shared biological pathways involving glucose metabolism, mitochondrial function, insulin sensitivity, and the brain’s ability to meet its energy needs. He covers: What the study found about ADHD and later cognitive decline Why association doesn't establish causation The possible connection between ADHD, brain energy metabolism, and dementia How sleep, chronic stress, and metabolic health may influence long-term brain health Why ketogenic therapy is being explored as a way to provide the brain with an additional fuel source How exercise and sleep may support brain metabolic function Why this research makes early attention to metabolic health worth considering

ADHD is often described as a problem with attention or hyperactivity, but psychiatrist Dr. Georgia Ede argues that the condition is much more complex, involving executive function, dopamine regulation, and potentially brain energy metabolism. In this episode of Metabolic Mind, Dr. Bret Scher and Dr. Georgia Ede take a deeper look at ADHD, from how it is diagnosed and treated to emerging research on nutrition and glucose metabolism, including questions about ketogenic therapy Dr. Ede draws on years of experience treating ADHD, including her time at Harvard University, Smith College, and the Hallowell Center. She explains why some people living with ADHD can focus intensely on things that interest them while struggling with everyday tasks, why stimulants can be so effective for some people, and where lifestyle strategies may fit alongside conventional care. They cover: What ADHD actually is and why the name can be misleading How inattentive and hyperactive symptoms can look very different Why ADHD can affect work, relationships, self-esteem, and quality of life How stimulant and non-stimulant medications work What older studies found when children living with ADHD followed simplified whole-food diets Evidence of altered brain glucose metabolism in ADHD Why researchers are exploring possible links between ADHD and metabolic health, including research on mitochondrial dysfunction and inflammation What Dr. Ede has observed clinically with whole-food and ketogenic approaches How ketogenic therapy may interact with stimulant medications Why there is no established ketone level for ADHD The first randomized controlled trial now underway at Oxford studying ketogenic therapy in adults living with ADHD and depression

Does perimenopause make ketosis harder? Can a carnivore diet provide too much protein? And which nutrient deficiencies matter most for mental health? In this episode of Metabolic Mailbag, Dr. Bret Scher and psychiatrist Dr. Georgia Ede answer listener questions about ketogenic therapy, menopause, carnivore diets, protein intake, and nutrition for mental health. They discuss how hormonal changes during perimenopause and menopause can affect insulin sensitivity and ketone levels, and why some women may need to adjust their carbohydrate intake, exercise, or other aspects of their routine to maintain the same metabolic response. They also cover: Why perimenopause and menopause can make ketosis more difficult How changing estrogen levels may affect insulin resistance and mental health Histamine intolerance and gut changes during perimenopause Whether carnivore diets can become too high in protein How to think about protein intake when therapeutic ketosis is the goal Why adding fat may help adjust the protein-to-fat ratio on carnivore Common nutrient deficiencies that can affect mental health The roles of B12, choline, folate, iron, iodine, and omega-3 fatty acids Why correcting a deficiency does not always resolve psychiatric symptoms The difference between folic acid and methylfolate