In Part 1, we established that psychiatry often treats a metabolic crisis as a simple chemical imbalance. Today, Dr. Matt Bernstein returns to give us the solution.

This episode is a masterclass on the ketogenic diet—not for weight loss, but as a critical medical intervention for serious mental illness. We explain why a "starving brain" (insulin resistance) leads to psychiatric symptoms and how ketones serve as a clean-burning alternative fuel that bypasses broken glucose pathways.

We break down the specific clinical protocols used at Dr. Bernstein’s residential program, Accord, including the "therapeutic zone" for ketone levels, how to balance protein intake to prevent muscle loss without breaking ketosis, and the role of GLP-1 agonists (like Ozempic) as a temporary bridge to metabolic flexibility.

What We Discuss:

• The "Starving Brain" Mechanism: Why neurons become insulin resistant and how ketones bypass this blockade to restore energy to the brain.

• The Therapeutic Zone: Dr. Bernstein’s specific targets for blood ketone levels (1.5 to 4.0 mmol/L) for bipolar and schizophrenia recovery, versus lower thresholds (0.5 mmol/L) for anxiety or ADHD.

• The Protein Paradox: How to eat enough protein to maintain muscle (1.2–1.6g/kg) without kicking yourself out of ketosis via gluconeogenesis.

• Exercise as Medicine: Why resistance training outperforms aerobic exercise for depression, and the shocking efficiency of High-Intensity Interval Training (HIIT) for metabolic health.

• The GLP-1 "Bridge": A fascinating strategy where Dr. Bernstein uses drugs like Ozempic temporarily to curb "food noise" and help patients transition into a ketogenic lifestyle before tapering off the drug.

• The Truth About Brain Scans: Why Dr. Bernstein believes SPECT scans (like those from Dr. Daniel Amen) are not yet clinically actionable for specific treatment protocols.

Resources & Links:

• Connect with Dr. Bernstein: LinkedIn | Accord Mental Health

• Reference: Dr. Mike & Dr. Daniel Amen Debate (The Checkup Podcast)

• Reference: Nature Paper on HIIT Volume vs. Moderate Cardio (Discussed in context of Rhonda Patrick)

• Work with Dr. Bernstein: Accord Comprehensive Metabolic Psychiatry

• Work with Dr. Raja:

  • Refining Health & Performance: Limited number of founding member spots for telemedicine practice. We focus on health span, longevity, and performance using a Medicine 3.0 approach. Apply at RefiningHealthRx.com.

About the Guest:

Dr. Matt Bernstein is the Chief Medical Officer at Ellenhorn and the creator of Accord’s Comprehensive Metabolic Psychiatry program.1 A graduate of Columbia University and the University of Pennsylvania School of Medicine, he trained at Mass General/McLean.2 With over 25 years of experience, he is a leading voice in moving psychiatry beyond symptom management toward full functional recovery through metabolic interventions.3+2

In this episode of Medicine Redefined, Dr. Altamash Raja and Dr. Darsh Shah sit down with psychiatrist Matt Bernstein, MD to question why mental health outcomes continue to worsen despite more medications and access to care.

Matt introduces metabolic psychiatry, a framework that looks beyond symptoms and diagnoses to the underlying biology of the brain — including metabolism, insulin resistance, and energy function. He explains why treating neurotransmitters alone often falls short, and how lifestyle-based interventions can lead to deeper, more lasting recovery.

They explore a new, human-centered approach to mental health that integrates nutrition, movement, circadian rhythm, and mind-body practices — challenging the way psychiatry is practiced today.

00:00 Introduction and Current State of Mental Health

01:20 The State of Psychiatry and Mental Health Outcomes

04:22 Understanding the DSM and Diagnostic Challenges

05:42 Introduction to Metabolic Psychiatry

06:31 Chemical Imbalance Theory vs. Metabolic Theory

17:27 The Role of Insulin Resistance in Mental Health

20:48 Assessing Metabolic Health in Psychiatry

25:37 Understanding Brain Energy and Mental Health

26:00 Insulin Resistance and Bipolar Depression

28:04 The Role of Fasting Insulin in Metabolic Health

28:43 Adverse Effects of Psychotropic Medications

30:20 Metabolic Health vs. Traditional Psychiatric Treatments

31:54 Innovative Approaches in Psychiatric Care

32:43 The Accord Program: A Comprehensive Metabolic Treatment

35:55 Challenges and Successes in Metabolic Interventions

46:10 Metabolic Dysfunction in Young Adults

50:04 Concluding Thoughts and Future Discussions

• Pillinger Study (Antidepressants): The effects of antidepressants on cardiometabolic and other physiological parameters (Pillinger et al., The Lancet 2025)

• Perry Study (Insulin & Psychosis): Longitudinal Trends in Childhood Insulin Levels and Risks of Psychosis (Perry et al., JAMA Psychiatry 2021)

• Book Mentioned: Brain Energy by Dr. Chris Palmer

• Testing Tool: Keto-Mojo (Glucose & Ketone Meter)

• Residential Program: Accord MH (accord.health)

• Professional Bio: LinkedIn Profile

• Clinical Group: Ellenhorn

• Website: medicineredefined.com

• Instagram: @medredefined

• Twitter/X: @medredefined

• Newsletter: The Progress Note

• Refining Health & Performance: refininghealthrx.com

  • Dr. Raja’s musculoskeletal and longevity practice (Telemedicine available in NJ, NY, PA, FL).

Darsh and Altamash break down why health outcomes are shaped by small, repeated choices (not occasional slip-ups). Using weight gain around the holidays as an example, they discuss how consistency and habit adherence matter more than intensity or “reset” culture.

They explore how simplifying habits makes them easier to stick with, and why prioritizing maintenance during high-risk periods can prevent long-term health decline.

A practical conversation on building health that actually lasts.

• 04:30 – Holiday Survival and why maintenance matters

• 08:15 – Managing workouts at Disney World & South Korea.

• 13:00 – Nutrition Tips with protein treats and fasting

• 20:15 – James Clear’s Rule: "Reduce the scope, stick to the schedule."

• 28:00 – The Protein Debate

• 36:00 – The cost of going all in

• 39:30 – Why you need to decide in advance what you will fail at.

• 48:00 – Future guests, the newsletter returns, and what’s next!

Protein Targets & Muscle Physiology

• The Helms Paper (Bodybuilders/Lean Mass): A systematic review of dietary protein during caloric restriction in resistance trained lean athletes (Helms et al., 2014)

• Protein for Adults: Optimizing Protein Intake in Adults (Wolfe, 2017)

• Supplements & Training: Meta-analysis of protein supplementation on resistance training gains (Morton et al., 2018)

• Anabolic Resistance: Skeletal muscle protein metabolism in the elderly (Breen & Phillips, 2011)

• Position Stand: ISSN Position Stand: Protein and Exercise (2017)

Sleep & Circadian Protocols

• Morning Light: Phase advancing human circadian rhythms with morning bright light (Crowley & Eastman, 2015)

• Exercise Timing: Circadian rhythm phase shifts caused by timed exercise (Thomas et al., 2020)

• Jet Lag: Physical exercise accelerates reentrainment of human sleep-wake cycles (Yamanaka et al., 2010)

• Sleep Tools: Eight Sleep System | 15% off Remade Sleep Supplement: https://getremade.com/?ref=doctor.darsh

Habits, Identity & Mindset

• James Clear: Atomic Habits ("Reduce the scope, stick to the schedule")

• Jonathan Haidt: Conversations with Tyler (Transcript regarding "The Anxious Generation")

• Oliver Burkeman: Four Thousand Weeks

• Intermittent Fasting: Intermittent fasting strategies and effects on cardiometabolic risk factors (BMJ, 2024)

• Website: medicineredefined.com

• Follow: @doctor.darsh | @dr.altraja

• Altamash’s New Practice: Refining Health & Performance (Now accepting patients in NJ, NY, PA, FL)

Join Dr. Altamash Raja and Dr. Darsh Shah on Medicine Redefined as they introduce Dr. Darren Candow, a leading researcher on creatine supplementation. The episode dives into the benefits of creatine, not just for muscle performance, but also for brain health, bone density, and cardiovascular health. Addressing myths and misconceptions, the conversation highlights creatine's potential role in cognitive function, aging, cancer prevention, and post-concussion recovery.

Brain Health, TBI & Sleep Deprivation

• The "Germany Study" on Sleep Deprivation (30g Dose):

  • Reference: Gordji-Nejad, A., et al. (2024). Single dose creatine improves cognitive performance and induces changes in cerebral high energy phosphates during sleep deprivation. Scientific Reports.

• Brain Creatine in Vegans vs. Omnivores (The "Brazil Study"):

  • Reference: Solis, M. Y., et al. (2013). Brain creatine depletion in vegetarians? A cross-sectional 1H-magnetic resonance spectroscopy (1H-MRS) study. British Journal of Nutrition.

• Creatine for TBI in Children:

  • Reference: Sakellaris, G., et al. (2006). Prevention of traumatic headache, dizziness and fatigue with creatine administration. A pilot study. Acta Paediatrica.

• Creatine for Depression (The "Utah Studies"):

  • Reference: Kondo, D. G., et al. (2011). Open-label adjunctive creatine for female adolescents with SSRI-resistant major depressive disorder. Journal of Clinical Psychiatry.

  • Reference: Roitman, S., et al. (2007). Creatine monohydrate in resistant depression: a preliminary study. Bipolar Disorders.

Bone Health, Aging & Long COVID

• Creatine for Long COVID:

  • Reference: Slankamenac, J., Ostojic, S. M., et al. (2023). Creatine supplementation combined with breathing exercises reduces respiratory discomfort and improves creatine status in patients with long-COVID. Journal of Postgraduate Medicine.

• Creatine & Bone Health (Post-Menopausal Females):

  • Reference: Chilibeck, P. D., Candow, D. G., et al. (2015). Effects of creatine and resistance training on bone health in postmenopausal women. Medicine & Science in Sports & Exercise.

• Alzheimer’s Disease (The 2024 Study):

  • Reference: Fairman, C. M., et al. (2024). Eight weeks of creatine monohydrate supplementation is associated with increased muscle strength and size in Alzheimer's disease. Frontiers in Aging Neuroscience. (Note: This is likely the "groundbreaker" he mentioned from this year).

Bioavailability & Dosing

• The Original "Big Paper" (1992):

  • Reference: Harris, R. C., et al. (1992). Elevation of creatine in resting and exercised muscle of normal subjects by creatine supplementation. Clinical Science.

• Meat vs. Solution vs. Candy (Gummies):

  • Reference: Harris, R. C., et al. (2002). Absorption of creatine supplied as a drink, in meat or in solid form. Journal of Sports Sciences.

  • Note: This is the study confirming that creatine in solid forms (like gummies/candy) is bioavailable.

• Caffeine Interference (The "350mg" Threshold):

  • Reference: Vandenberghe, K., et al. (1996). Caffeine counteracts the ergogenic action of muscle creatine loading. Journal of Applied Physiology.

  • Reference: Trexler, E. T., & Smith-Ryan, A. E. (2015). Creatine and Caffeine: A Brief Review of Concurrent Use. ACSM's Health & Fitness Journal.

People Mentioned

• Dr. Sergej Ostojic: Leading researcher on creatine for Long COVID and clinical applications (University of Novi Sad).

• Dr. Scott Forbes: Frequent collaborator with Dr. Candow on brain and bone health.

• Dr. Chad Kerksick & Dr. Andrew Jagim: Cited for their reviews on creatine safety in children.

Join Dr. Altamash Raja and Dr. Darsh Shah in a comprehensive discussion with Dr. Allison Grimaldi on femoral acetabular impingement (FAI) and hip health. This episode of Medicine Redefined dives into part two of the hip-focused conversation. Dr. Grimaldi provides a deep dive into FAI, discussing types of impingement, symptoms, and the importance of accurate diagnosis and individualized treatment. The conversation also touches on advances in hip arthroscopy, metabolic health, and the role of systemic inflammation in joint conditions. Tune in for valuable insights into hip pathology, patient care, and the future of hip health.

00:00 Introduction and Exciting Update

00:40 Recap of Part One and Introduction to FAI

01:04 Understanding Femoral Acetabular Impingement (FAI)

03:49 Imaging and Diagnosis of FAI

07:53 Development and Risk Factors of FAI

12:05 Weightlifting and FAI in Adolescents

16:07 Surgical Interventions and Outcomes

24:53 Non-Surgical Management and Rehabilitation

29:48 Post-Surgery Expectations and Long-Term Management

41:15 Micro Instability and Dysplasia

45:02 Understanding Hip Dysplasia and Instability

46:44 Clinical Tests and Imaging for Hip Dysplasia

49:29 Rehabilitation Approaches for Hip Instability

53:47 Exercises for Deep Muscle Recruitment

01:02:23 Metabolic Health and Tendon Pathology

01:09:41 Considerations for Aging Athletes

01:14:18 Future of Hip and Pelvic Pain Care

01:19:51 Shifts in Understanding Hip Impingement

01:22:28 Final Thoughts and Advice for Practitioners

Resources & citations

• 2016 Warwick Agreement on FAIS (consensus statement). 

• UK FASHIoN RCT: arthroscopy vs physio for FAIS (BMJ 2019). 

• Australian FASHIoN trial: cartilage imaging & outcomes (BMC 2021). 

• Hip microinstability: international consensus diagnostic criteria. 

• Post-arthroscopy effusion/synovitis and outcomes: overview blog + PubMed. 

• Modern Hip Arthroscopy for FAIS May Delay the Natural History of Osteoarthritis in 25% of Patients: A 12-Year Follow-up Analysis. - PubMed

Connect with Dr. Grimaldi

• Website: dralisongrimaldi.com. 

• Hip Academy: Program & membership. 

• Instagram: @dralisongrimaldi. 

• X (Twitter): @alisongrimaldi. 

Join hosts Darsh and Altamash as they sit down with Dr. Allison Grimaldi to dive deep into the complexities of hip pain and the latest research in the field. In this episode, Dr. Grimaldi sheds light on the challenges of diagnosing and treating hip issues, the anatomy of the hip joint, and the critical role of gluteal tendinopathy. 

Learn how significant lifestyle changes and thorough education can alleviate symptoms more effectively than traditional corticosteroid treatments. Don't miss this enlightening discussion aimed at both clinicians and patients who are eager to better understand their bodies.

TIME STAMPS

00:00 Introduction to Postpartum Health Challenges

00:27 Welcome to Medicine Redefined

01:05 Exciting Update: New Practice Launch

01:34 Introducing Dr. Allison Grimaldi

01:46 Why Focus on the Hip?

06:18 Understanding Hip Anatomy

08:44 Lateral Hip Pain and Its Complexities

22:55 Diagnosing Gluteal Tendinopathy

27:16 Identifying Hip Pain: Key Questions and Symptoms

27:52 Differentiating Gluteal Tendinopathy from Other Conditions

29:19 Common Presentations and Misdiagnoses

31:14 Effective Sleep Positions for Hip Pain Relief

36:07 Diagnostic Tests for Gluteal Tendinopathy

39:31 Insights from the LEAP Study

44:16 Balancing Short-term Relief and Long-term Solutions

46:11 The Role of PRP in Treatment

50:13 Concluding Thoughts and Next Steps

SOURCES

LEAP Trial: https://www.bmj.com/content/361/bmj.k1662

Gluteal Masterclass: https://pubmed.ncbi.nlm.nih.gov/39854929/

Ever felt like your insurance company is gaslighting you? Dr. Altamash Raja shares a real story that turned a routine billing error into a masterclass on how to actually navigate health insurance. From copays and deductibles to hidden tiers and the fine print that drains your wallet - this Progress Note breaks it all down.

Join hosts Dr. Darsh Shah and Dr. Altamash Raja as they cut through the noise, explain the system in plain English, and arm you with the knowledge to advocate for yourself next time your claim gets “lost”.

TIMESTAMPS
00:36 Insurance Negotiations Frustrations
06:33 Understanding Health Insurance Terms
17:26 Navigating Insurance Plans and Benefits
23:56 Navigating Insurance Verification
25:52 The Business Side of Healthcare
26:37 Challenges in Inpatient Rehab
28:41 Understanding Healthcare Metrics
31:59 Emergency Visits and Insurance
34:10 Planning for Medical Emergencies
37:14 Insurance Tiers Explained
40:01 Practical Tips for Managing Insurance
46:20 Final Thoughts and Recap
48:10 Outro and Disclaimer

SOURCES

[00:06:00] — Premiums, Deductibles, Coinsurance & Copays Explained – Aetna

[00:17:00] — HMO vs. PPO: Which Is Right for You? – Humana

[00:34:00] — What Is a “Surprise Medical Bill” and What Should I Know About the No Surprises Act? – Consumer Financial Protection Bureau

[00:34:00] — No Surprises Act: Balance Billing Rules for Emergency and Air Ambulance Services – Centers for Medicare & Medicaid Services

[00:40:00] — Navigating the Insurance Appeals Process –Patient Advocate Foundation

Dr. Darsh Shah and Dr. Altamash Raja sit down with Dr. Nisha Chellam to explore her journey from traditional internal medicine to functional medicine. Together, they discuss the “revolving door” of chronic disease, why she stopped attending supplement-driven conferences, and how she blends evidence-based care with lifestyle change. Dr. Chellam shares how she helps patients uncover the true root causes of illness and reclaim ownership of their health.

SOURCES:

00:10:00 — Discovering Functional Medicine
Institute for Functional Medicine: What Is Functional Medicine?

00:18:00 — Root Cause Medicine Explained
Cleveland Clinic: Functional Medicine Approach

00:34:00 — Functional vs. Lifestyle Medicine
American College of Lifestyle Medicine: What Is Lifestyle Medicine?

00:58:00 — Functional Labs and Data-Driven Care
PubMed: The Value of Advanced Biomarkers in Functional Medicine

01:06:00 — Metabolic Health and Insulin Resistance
American Heart Association: Understanding Insulin Resistance

01:15:00 — Redefining What “Good Medicine” Means
BMJ: Rethinking Medicine — The Movement to Redefine Care

Contact Dr. Chellam:

Linkedin | Nisha Chellam 

Instagram, YouTube, X | @holisticicon 

Find Us Here:

Instagram, Threads, X, TikTok | @medredefined 

Thank you for listening! Let us know what you think!

Darsh and Altamash talk to Dr. Leah Houston, an emergency medicine physician turned healthcare entrepreneur, for insights on the broken physician credentialing system and how technology could restore autonomy to doctors.

TIMESTAMPS:

00:01:00 – Evercred (decentralized physician credentialing platform) evercred.com

00:04:00 – Centers for Medicare & Medicaid Services (CMS) oig.hhs.gov

00:05:00 – Relative Value Unit (RVU) definition en.wikipediaorg

00:12:00 – The Joint Commission (healthcare accreditation body) 00:14:00 – National Provider Identifier (NPI) en.wikipedia.org

00:19:00 – Interstate Medical Licensure Compact (IMLC) imlcc.com

00:28:00 – Decentralized Identity (DID) in healthcare healthdatamanagement.com

00:29:00 – Direct Primary Care (DPC) payment model https://www.healthinsurance.org/glossary/direct-primary-care/

00:39:00 – Blockchain (distributed ledger technology) explained techtarget.com

Thank you for listening!

Darsh and Altamash are back, trading thoughts on what’s been capturing their attention lately - from the tech tools boosting daily efficiency to the appeal of living more “pro-analog.” They dive into the hype and science behind ketones, unpack how GLP-1s are reshaping the way we think about food and cravings, and share insights on what it really means to find preventive, proactive healthcare today. It’s a thoughtful but approachable conversation, blending current events, health trends, and practical takeaways.

TIMESTAMPS

00:00 Introduction to Medicine Redefined

00:33 Current Events and Political Landscape

02:10 Random Show Concept and Personal Updates

02:44 Writing and Creative Outlets

06:48 Tech Tools and Apps for Efficiency

10:32 Medical Innovations: Vagus Nerve and Hydrodissection

19:48 Breathwork and Meditation Techniques

23:49 Exploring Exogenous Ketones

28:31 Understanding Brain Health and Mood Disorders

29:31 Exploring Ketone Supplements

30:52 Nootropics and Cognitive Enhancers

32:48 The Future of Social Connection

40:44 The Concept of Misogi and Mental Fortitude

42:34 GLP-1 and Obesity Treatment

49:36 Navigating Healthcare and Finding the Right Provider

SOURCES

05:12 | How and Why To Try Alternate Nostril Breathing (Cleveland Clinic)

08:47 | Buteyko vs Soma Breathing: Origins, Benefits and Differences (Buteyko Clinic International)

14:33 | OU Researchers Explore Vagus Nerve Stimulation for Multiple Conditions (University of Oklahoma)

19:55 | Exogenous Ketones: Do They Work, and Are They Safe? (Medical News Today)

24:18 | Ozempic Quiets Food Noise in the Brain — But How? (Scientific American)

27:42 | “Food Noise”: Do Weight Loss Drugs Stop It? (Health.com)

33:11 | How to Find a Medicine 3.0 Doctor like Dr. Peter Attia (Vitality / AWI Longevity Clinic)

37:40 | Embracing an Analog Lifestyle: Opt Out of Overwhelm (The Tiny Life)

41:05 | “The ‘Boring Phone’ – Gen Z Ditch Smartphones for Dumbphones” (The Guardian)

45:22 | Alfred – Productivity App for macOS (Official Site)

47:36 | OpenAI Whisper (Speech Recognition AI)