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 Conversation
02:30 – An Unconventional Path to Metabolic Psychiatry
10:30 – Diet in the Asylum Era: A History of Food as Medicine
18:00 – Why Metabolism Returned to Scientific View
23:30 – Imaging Brain Energetics: Bridging Peripheral and Central Metabolism
28:30 – The Stanford Pilot Trial and the Abrams Follow-On RCT
36:00 – Adherence, Meal Delivery, and the Path to GLP-1s
39:30 – GLP-1 Receptor Agonists in Psychiatric Practice
41:30 – Discovering SGLT2 Inhibitors: A Resident's Chance Encounter
45:00 – The Ketogenic Mechanism Behind SGLT2 Inhibition
49:30 – Trial Emulation and the Empagliflozin Pilot Study
52:00 – Metformin's Expanding Role in Antipsychotic-Associated Weight Gain
56:30 – SGLT2 Inhibitors as a Complement to Ketogenic Therapy
61:30 – Toward a Whole-Person Model: Diet, Drugs, and Exercise
66:00 – Confronting the Treatment Gap: Underused Medications
68:00 – The Future of Metabolic Psychiatry: Integration, Not Revolution
71:30 – Closing Thoughts and Sign-Off
LINKS:
Full transcript and show notes:
https://www.psychiatrist.com/jcp/ep20-feeding-mind-metabolism-psychiatry-david-t-liebers/
Journal of Clinical Psychiatry
https://www.psychiatrist.com/jcp/
Publisher of peer-reviewed research discussed in this episode.
Dr. David T. Liebers – LinkedIn
https://www.linkedin.com/in/david-liebers-7b9706169/
Metabolic Mind
https://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, FRCPC
Listen to a previous episode from April 21, 2026 covering GLP-1s in Psychiatry
#MetabolicPsychiatry #KetogenicDiet #SGLT2Inhibitors #Metformin #Mitochondria
