Dr. Shebani Sethi
speaker
159 appearances
2 recordings
1 series
first heard Feb 2025
last heard Mar 2025
Dr. Shebani Sethi’s voice in public audio — every appearance, attributed to the second.
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And this is our local Safeway. This is the heart of Silicon Valley. So in this context, it wasn't about affordability or access. That is what motivated me to kind of get that public message out on this topic.
Yes. What I have noticed is that a lot of my patients that come for psychiatric treatment and evaluation, a lot of them have pre-diabetes and diabetes. And when I look up the statistics on this in our country, 44% of adults today in our country are either pre-diabetic or they have diabetes. And I wonder to myself, what is that doing to our brain?
We know that affects all these different organ systems, the liver, the pancreas, the heart, but what is that doing to the brain, right? And so, I'm happy to talk more about my research and patient care. But one thing that I felt I didn't completely answer before was kind of how these hormones affect the brain with the addictive piece.
Yeah. Yeah. So kind of going back to that, you know, so I was talking about the definition of addiction. And we know that hormones like insulin and leptin, which is the hormone that tells us we're full, it sends a signal to our brain, and ghrelin that tells us that we're hungry, these hormones modify natural and drug reward pathways in the brain. I mean, they have so many effects on the brain.
Our hunger hormones go awry and it can actually increase the reactivity itself of the dopamine system. And so this happens when we consume that excess sugar and the excess carbohydrates in our diet. And they cause these rapid shifts in blood glucose and insulin levels similar to other addictive substances. So my approach in patient care has been to work on this system to decrease
these shifts that occur in our blood sugar and our hormone levels to kind of go back to the homeostatic state that our body and our brains were meant to be in. And so I treat the metabolic dysfunction and I look at how that improves both metabolic issues as well as psychiatric outcomes.
So the field has come a long way. There's a lot of research that's been done on the biological piece and neuroscience and looking at obviously the serotonin hypothesis, but that's a hypothesis and an observation from like 30 years ago.
And all of these research and money has been thrown on developing drugs, but we're not necessarily addressing some of the root causes of why are these chemicals imbalanced. And so That's an important question that I and others are trying to study through research studies and clinical trials.
And like you said, we know that although our medications are necessary and lifesaving for many, they have undesirable side effects that can worsen metabolic health. And while it's helping in one domain, it may in some people also be hindering improvement in psychiatric symptoms, especially if the metabolic health is poor. So psychiatric treatment is never going to be a one-size-fits-all approach.
Mental health conditions are varied. They're heterogeneous and they have different phenotypes or presentations. We don't have a single mutation. or a gene that we can point to, or a lesion. There's no smoking gun. It's a complex relationship of multiple genes and environment. And unfortunately, a metabolic assessment is not part of that routine care, and stigma certainly plays a role in this.
Obesity is stigmatized, and so is mental health. education about nutrition and metabolism was lacking in medical education. Most psychiatrists recognize this relationship.
They're starting to. They understand that there are side effects with psychotropic medications. I think they don't necessarily have the expertise to treat it or address it. They don't know necessarily what to do about it. But most psychiatrists that I speak with, and my department certainly has been very supportive of this idea,
And someone has to do the research and someone has to do the work to kind of move the field forward. And there's a growing body of other researchers working on this. And we hope that evidence-based research has to be done to kind of change the mainstream standard of care.
I think that is changing. There's a complex relationship between metabolic dysfunction and nutrition, food, mental health. And I want to start off by saying that the idea of food as medicine is not a new concept in the field of nutritional psychiatry. It's really grown over the past few decades by several prominent psychiatrists and researchers.
However, the focus has largely been looking at specific foods or supplements, eliminating certain things from the diet, the microbiome, or looking at the Mediterranean diet, for example, affecting depression symptoms?
And these are all very important questions, but what I thought was missing and why I named our clinic and our group's work metabolic psychiatry is to distinguish that this is a study of how treatment of metabolic dysfunction can affect psychiatric symptoms. If a majority of us are suffering from obesity, type 2 diabetes, insulin resistance, metabolic syndrome, What is that doing to our brain?
We know that these diseases affect multiple things. Mental illness rates have increased over the past 20 years, in fact doubled. We know that mental illness like depression, bipolar disorder, psychosis, they're strongly associated with inflammation. That research is really indisputable. And research is also showing that there's an energy deficit in these brain illnesses
and the mitochondria the energy powerhouses of ourselves are not functioning optimally causing changes in brain signaling itself and the thought is if we can target inflammation insulin resistance the abnormal blood sugar etc as a method to improve mental health symptoms then we can really improve our patients lives further and
Again, mental illness has many different causes, but even if we, you know, can 5 to 10% of people have an improvement in these symptoms with this method, then I think that would be a pretty significant improvement of the overall mental and physical health of our country.
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