Dr. David T. Liebers, MD, MPhil, MPP, a research assistant professor of psychiatry at the NYU Grossman School of Medicine and a research psychiatrist at the Nathan Kline Institute, joins Dr. Ben Everett to explore metabolic psychiatry: the growing evidence linking mitochondrial function, bioenergetics, and whole-body metabolism to psychiatric illness. Building on a previous conversation about GLP-1 receptor agonists, this episode broadens the lens to ketogenic diet interventions, SGLT2 inhibitors, and metformin, tracing how each may support brain energetics in depression, schizophrenia, and bipolar disorder.This conversation arrives as clinicians increasingly confront the metabolic burden of antipsychotic treatment alongside a widening evidence base for interventions originally developed for diabetes and heart failure. Dr. Liebers discusses recent trial data on ketogenic diets in serious mental illness, the mechanistic case for SGLT2 inhibitors as a psychiatric tool, expanding guidelines for metformin co-prescription, and why brain energetics may represent a legitimate and increasingly tractable therapeutic target, not a replacement for existing models of psychiatric illness, but an additional clinical perspective.🎯 KEY EPISODE HIGHLIGHTS:🏛️ THE “ERA OF FOOD AS MEDICINE” ISN’T NEW [12:30]“We have now entered the era of food as medicine.”Dr. Liebers traces today's food-as-medicine rhetoric back through nearly two centuries of psychiatric interest in diet's role in mental illness.🧬 MITOCHONDRIAL DYSFUNCTION AS A TREATMENT TARGET [23:30]“The big challenge, I think, is identifying those interventions that can reliably improve, metabolic function in a way that can be measured and is suitable for randomized trial designs that let us talk about causation.”Dr. Liebers frames abnormal brain bioenergetics as a specific, measurable target for a subset of patients underserved by monoamine-based treatments.⚖️ METFORMIN IS DRAMATICALLY UNDERUSED [55:30]“I think ten to fifteen percent of the people that should be or would qualify under the new guidelines to get metformin are actually on it.”Despite expanded 2025 consensus guidelines, Dr. Liebers' EHR data suggest most eligible patients are still not receiving metformin for antipsychotic-associated weight gain.CHAPTERS:00:00 – Introduction: Building on the GLP-1 Conversation02:30 – An Unconventional Path to Metabolic Psychiatry10:30 – Diet in the Asylum Era: A History of Food as Medicine18:00 – Why Metabolism Returned to Scientific View23:30 – Imaging Brain Energetics: Bridging Peripheral and Central Metabolism28:30 – The Stanford Pilot Trial and the Abrams Follow-On RCT36:00 – Adherence, Meal Delivery, and the Path to GLP-1s39:30 – GLP-1 Receptor Agonists in Psychiatric Practice41:30 – Discovering SGLT2 Inhibitors: A Resident's Chance Encounter45:00 – The Ketogenic Mechanism Behind SGLT2 Inhibition49:30 – Trial Emulation and the Empagliflozin Pilot Study52:00 – Metformin's Expanding Role in Antipsychotic-Associated Weight Gain56:30 – SGLT2 Inhibitors as a Complement to Ketogenic Therapy61:30 – Toward a Whole-Person Model: Diet, Drugs, and Exercise66:00 – Confronting the Treatment Gap: Underused Medications68:00 – The Future of Metabolic Psychiatry: Integration, Not Revolution71:30 – Closing Thoughts and Sign-OffLINKS:Full transcript and show notes:https://www.psychiatrist.com/jcp/ep20-feeding-mind-metabolism-psychiatry-david-t-liebers/ Journal of Clinical Psychiatryhttps://www.psychiatrist.com/jcp/ Publisher of peer-reviewed research discussed in this episode.Dr. David T. Liebers – LinkedInhttps://www.linkedin.com/in/david-liebers-7b9706169/ Metabolic Mindhttps://www.metabolicmind.org/ Patient and clinician resource on ketogenic and metabolic therapies for mental illness, recommended by Dr. Liebers in this episode.The Emerging Role of GLP-1s in Psychiatry with Roger S. McIntyre, MD, FRCPCListen to a previous episode from April 21, 2026 covering GLP-1s in Psychiatry#MetabolicPsychiatry #KetogenicDiet #SGLT2Inhibitors #Metformin #Mitochondria

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