Dr. Satchin Panda on How Your Body Clock Shapes Metabolic Health

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

Some “healthy” foods may be working against your metabolic health. In this episode of Metabolic Mind, Dr. Bret Scher examines how products such as agave nectar, commercial green juices, low-fat fruit yogurt, and açaí bowls can create a health halo while delivering large amounts of rapidly digestible sugar. Dr. Scher explains how liquid carbohydrates, added sugars, and concentrated fructose may affect satiety, insulin response, hunger, and other markers of metabolic health. He also examines how front-of-package phrases such as “natural,” “low fat,” “made with real fruit,” and “superfood” can make certain products appear healthier than their nutrition labels suggest. The episode covers: How liquid and rapidly digestible carbohydrates affect satiety differently from whole foods Why agave nectar’s low glycemic index does not tell the full story about how its fructose content is processed by the liver How removing fiber and adding fruit can change the metabolic effects of some commercial green juices How some low-fat fruit yogurts replace fat with added sugar Why some açaí bowls can deliver a large, rapidly absorbed sugar load How to assess total carbohydrates, added sugar, and ingredient lists Why front-of-package health claims may offer an incomplete picture of a food’s nutritional content