Metabolic Psychiatry: Ketosis And The Journey To Healing PTSD And Anxiety

A Personal Testimony At Biohacker Summit 2023 Amsterdam

At Biohacker Summit 2023 Amsterdam, held in the Netherlands on 14 and 15 October 2023, Dr. Simone Koch delivered a presentation that was at once clinically provocative and deeply personal. Titled Ketosis as a Calming State for Anxiety & PTSD, the talk moved beyond the language of wellness trends and into a more urgent argument: that post-traumatic stress disorder and anxiety may not be understood fully through psychology alone, but as disorders rooted in energy failure, mitochondrial dysfunction and the brain’s diminished capacity to repair itself.

Koch, a German physician, gynecologist and specialist in environmental, nutritional and orthomolecular medicine, brought to the stage not only her medical training but her own history of trauma. In doing so, she gave the subject a human weight that statistics alone rarely carry.

The Hidden Face Of Trauma

PTSD, Koch argued, is often misread. It does not always arrive as visible collapse. More often, it disguises itself as competence, discipline and relentless productivity. The person who seems to have mastered life may in fact be trapped in a state of chronic fight-or-flight.

“Success looks one way from the outside,” she said, “but if your nervous system is in a state of constant fight, it does not feel good at all.”

That observation formed one of the strongest currents of the talk. Trauma, she suggested, can masquerade as overachievement. The books get written. The meetings happen. The clinic expands. But beneath the polished exterior, the nervous system remains locked in survival mode, unable to settle into safety.

Drawing from her own experience after a sexual assault in Berlin, Koch described how she initially refused to identify herself as traumatised. Instead, she pressed harder into work, writing three books in a year and opening a second clinic. It looked, from the outside, like resilience. In reality, she said, it was hyper-arousal.

PTSD As A Systemic Metabolic Crisis

Koch’s central claim was both simple and radical: PTSD is not only a psychological condition but a systemic metabolic crisis.

Only around 15% of people exposed to trauma go on to develop clinical PTSD, she noted. That gap, in her telling, raises a profound question. If trauma alone does not determine outcome, what biological vulnerabilities tip one person into chronic illness while another recovers?

Her answer pointed to mitochondrial health, cellular damage and impaired energy metabolism.

“Mental illnesses,” she argued, “have to be seen as whole-body conditions.”

She linked psychiatric suffering to physical markers including DNA damage, shortened telomeres and the accumulation of toxic proteins, suggesting that disorders such as PTSD and depression are inseparable from the body’s underlying capacity for maintenance and repair. The consequence is not merely emotional suffering, but a measurable reduction in lifespan. People with mental illness, she said, often live seven to 10 years less, even when suicide is excluded from the calculation.

The Brain As The Canary In The Coal Mine

Koch’s most memorable metaphor cast the brain as an early-warning system for deeper metabolic trouble.

“The brain is the canary in the coal mine,” she said, “telling us that there is something on a very deep basis wrong with our energy supply. It is such a demanding organ that it requires twenty percent of the energy we produce.”

The phrase worked because it reframed psychiatric symptoms not as failures of will or personality, but as biological distress signals. The brain, with its immense energy needs, may be the first organ to reveal when the body’s fuel systems are faltering.

From that perspective, flashbacks, emotional numbness, impaired concentration and hyper-vigilance are not only expressions of unresolved memory. They may also be signs of a brain struggling to generate the energy needed for healing.

Why Sleep Matters So Much

If trauma traps the brain in a loop, sleep deprivation tightens it.

Koch stressed that REM sleep is indispensable to recovery, because it is during sleep that the brain processes traumatic material and performs some of its most essential restorative functions. Trauma sufferers, however, are often deprived of that very mechanism by nightmares, intrusions and chronic hyper-arousal.

“Sleep is not negotiable for health,” she said. “The worse you sleep, the worse your health gets, and you enter a vicious cycle where your brain is unable to process trauma. REM sleep is essential for the brain to process and heal.”

In that framing, insomnia is not a side effect of PTSD. It is part of the engine that keeps the condition alive.

When Glucose Is Not Enough

This is where Koch turned to ketosis, though not in the evangelising style often associated with dietary movements. Her interest was metabolic and therapeutic: what happens when a traumatised brain cannot efficiently use glucose for repair?

“If the brain is damaged, it may not be able to process glucose for repair,” she said. “Ketone bodies provide a different source of energy that helps the brain heal alongside other treatments like neuroplasticity and therapy.”

It was the key proposition of the presentation. Ketosis, in Koch’s account, was not a cure in isolation, nor a replacement for established interventions such as EMDR, psychotherapy or other trauma-focused treatments. Instead, it functioned as the biological substrate that made those interventions more likely to work.

If talking therapy asks the brain to rewire itself, then the brain must first have the fuel to carry out that task. Without energy, the machinery of change stalls.

The Promise Of Metabolic Psychiatry

Koch’s talk sat squarely within the emerging field of metabolic psychiatry, which seeks to understand mental illness through the intertwined lenses of metabolism, inflammation, mitochondrial function and brain energetics.

Her presentation suggested that conventional psychiatry may have underestimated the body’s role in psychiatric recovery. Therapy, in this view, is necessary but incomplete if it ignores the underlying conditions required for neuroplastic change.

She described ketosis as a supportive state that could help the brain exit repetitive trauma loops, especially when paired with interventions designed to foster healing and plasticity. These included both orthodox treatments and less conventional approaches, from breathwork to psychedelics to symbolic rituals of closure.

The point was not that every method carries equal evidence. It was that trauma recovery, as she saw it, demanded a broader architecture of care.

Healing Beyond The Old Narrative

The emotional culmination of the presentation came when Koch described reaching a point where she no longer identified herself through the trauma that had shaped her life.

“I can proudly say that here I am today, in this foreign city, coming here alone and feeling completely healed and symptom-free,” she told the audience. “I have burned the old narrative and stand here as a woman who has reclaimed her life.”

It was a striking ending, not because it offered a neat universal template, but because it captured the deeper ambition of her argument. Healing, in Koch’s account, was neither purely psychological nor purely biochemical. It was both. A person must change the story, yes, but the brain must also have the fuel to sustain that change.

A Challenge To How Mental Illness Is Understood

What lingered after the presentation at Biohacker Summit 2023 Amsterdam was not simply the claim that ketones may help anxious or traumatised brains. It was the broader challenge Koch posed to the way mental illness is still too often discussed.

If PTSD is understood only as a disorder of memory, then treatment risks becoming narrowly verbal, as though insight alone could rebuild a damaged system. Koch asked the audience to think differently: to see trauma as something that seizes the nervous system, disrupts sleep, impairs cellular repair and leaves the brain underpowered.

That perspective does not diminish therapy. It deepens the case for it by insisting that the biology of recovery matters as much as the psychology.

In the end, Koch’s message was both scientific and compassionate. The traumatised brain, she suggested, is not weak. It is exhausted. And before it can heal, it may first need a better source of energy.

Frequently asked questions

Why does Simone Koch call PTSD a metabolic crisis?

Because trauma alone does not determine outcome. Only around 15% of people exposed to trauma go on to develop clinical PTSD, she noted, and that gap raises the question of which biological vulnerabilities tip one person into chronic illness while another recovers.

How can PTSD hide in plain sight?

By looking like competence. PTSD does not always arrive as visible collapse, Koch argued; more often it disguises itself as discipline and relentless productivity. Success looks one way from the outside, she said, but the nervous system may be in a state of constant fight.

Why is the brain the canary in the coal mine?

Because of its energy demand. The brain is the canary in the coal mine, Koch said, telling us that something on a very deep basis is wrong with our energy supply, since it is such a demanding organ that it requires twenty percent of the energy we produce.

About the event

This recap is part of the Biohacker Summit 2023 Amsterdam series, recorded in Amsterdam on 14 and 15 October 2023. Read the summary of the whole event or join the next edition, HOLOLIFE Summit 2026 Amsterdam, on 14 and 15 November 2026.