Medicine Redefined

Casey Stevens is a trauma-informed therapist, speaker, and guide focused on nervous system healing, consciousness, emotional resilience, and the relationship between trauma, identity, and human potential. In this conversation, we explore high performance, vulnerability, trauma, nervous system regulation, parenting, purpose, and the hidden emotional costs of achievement. Casey shares her perspective on mysticism, somatic healing, post-traumatic growth, value systems, and why true peace comes from alignment rather than external success.

• Why vulnerability is necessary for real peace and connection
• High performance, ambition, and the loneliness of success
• Compensatory strategies, avoidance, and emotional protection
• Elon Musk, Steve Jobs, Kobe Bryant, and the trade-offs of greatness
• Trauma, nervous system dysregulation, and somatic healing
• Parenting, resilience, post-traumatic growth, and emotional regulation

• The Body Keeps the Score (https://en.wikipedia.org/wiki/The_Body_Keeps_the_Score)

• The Diary of a CEO (https://stevenbartlett.com/doac/)

• Modern Wisdom (https://chriswillx.com/podcast/)

• Elon Musk by Walter Isaacson (https://www.simonandschuster.com/books/Elon-Musk/Walter-Isaacson/9781982181284)

• Steve Jobs by Walter Isaacson (https://www.simonandschuster.com/books/Steve-Jobs/Walter-Isaacson/9781451648546)

• Good Inside (https://www.goodinside.com)

• The Tim Ferriss Show (https://tim.blog/podcast/)

GUEST SOCIAL LINKS

• Instagram: @shrinkbigger (https://www.instagram.com/shrinkbigger/)

• Website: https://shrinkbigger.com/

Ready to stop guessing and start performing? Dr. Raja is now seeing patients through his telemedicine practice — limited founding member spots available at refininghealthrx.com

Dr. Tanuja Sharma is a board-certified family and integrative medicine physician and the Medical Director of Integrative Medicine and Arts at Tampa General Hospital. She completed her integrative medicine fellowship through the Andrew Weil Center at the University of Arizona and is leading one of the most ambitious hospital wellness overhauls in the country — from redesigning the patient menu with a Michelin-rated chef to running evidence-based mindfulness, acupuncture, and music therapy programs at the bedside.

TOPICS COVERED
 •   Why Tampa General Hospital partnered with a celebrity chef to rebuild their patient menu from scratch
•   Music therapy, massage, acupuncture, art therapy, reiki, and how TGH gets buy-in across a Level 1 trauma center
•   98% patient improvement in pain and anxiety scores, preliminary opioid reduction data, and the research pipeline ahead
•   Tampa Well's food pharmacy, community garden, and free produce programs targeting food insecurity
•   MBSR and mindfulness programs: evidence-based stress reduction for staff and patients, and why experience is the best recruitment tool
•   Fiber vs. protein: the deficiency most patients have, Blue Zones longevity foods, and how to counsel patients at different performance goals

RESOURCES & LINKS MENTIONED

•   Tampa General Hospital (https://www.tgh.org)

•   TGH Integrative Medicine and Arts Program (https://www.tgh.org/services/integrative-medicine-and-arts)

•   Tampa Well (TGH Community Wellness Initiative) (https://www.tgh.org/tampawell)

•   Geoffrey Zakarian — Celebrity Chef (Iron Chef, Chopped) (https://www.geoffreyzakarian.com/about)

•   Mediterranean Diet — Wikipedia (https://en.wikipedia.org/wiki/Mediterranean_diet)

•   Anti-Inflammatory Diet — Hopkins Medicine (https://www.hopkinsmedicine.org/health/wellness-and-prevention/anti-inflammatory-diet)

•   Mindfulness-Based Stress Reduction (MBSR) — Wikipedia (https://en.wikipedia.org/wiki/Mindfulness-based_stress_reduction)

•   Andrew Weil Center for Integrative Medicine (U of Arizona) (https://integrativemedicine.arizona.edu)

•   American College of Lifestyle Medicine (https://www.lifestylemedicine.org)

•   Blue Zones — Wikipedia (https://en.wikipedia.org/wiki/Blue_zone)

•   Sarcopenia — Wikipedia (https://en.wikipedia.org/wiki/Sarcopenia)

•   Dietary Fiber — Wikipedia (https://en.wikipedia.org/wiki/Dietary_fiber)

•   Food as Medicine — ASN (https://nutrition.org/food-as-medicine/)

•   Refining Health & Performance — refininghealthrx.com (https://refininghealthrx.com)

GUEST SOCIAL LINKS

•   Instagram:@tjasharmamd (https://www.instagram.com/tanujasharmamd?igsh=cXprNW04bGt2Zzhr)

•   TGH Provider Profile (https://www.getcare.tgh.org/providers/tanuja-sharma-1598133233)

•   TGH Integrative Medicine (https://www.tgh.org/services/integrative-medicine-and-arts)

Ready to stop guessing and start performing? Dr. Raja is now seeing patients through his telemedicine practice — limited founding member spots available at refininghealthrx.com

Dr. Altamash Raja and Dr. Darsh Shah sit down with Amy Morin, LCSW, to discuss how to turn pressure into strength, build resilience through small wins, and navigate burnout in today’s work culture. Morin gives us simple tools and a practical approach to manage anxiety, dread, and difficult situations. We talk about significance of self-awareness, focusing on what you can control, and how using actionable strategies like a “motivation buddy,” clearer communication, and adapting to others can help you perform better without burning out.

TOPICS COVERED

• Genes upbringing stress
• Pandemic burnout cycle
• Grinding vs strength
• Busyness as numbing
• Showing up in grief
• Anxiety spills into work
• Dread anxiety rumination
• How to use 50 tools
• Motivation buddy hack
• Measuring mental strength
• Overrated vs underrated mental resilience hacks

RESOURCES & LINKS MENTIONED

• 13 Things Mentally Strong People Don’t Do: https://amymorinlcsw.com/books/
• Cognitive Behavioral Therapy (CBT) Overview: https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
• The Happiness Curve (Arthur Brooks–related concepts): https://www.youtube.com/watch?v=G7Z0MyRsm9M
• Emotional Avoidance (Psychology Today): https://www.psychologytoday.com/us/blog/overcoming-destructive-anger/202603/the-harmful-consequences-of-emotional-avoidance
• Motivation Buddy/Accountability Importance: https://www.npr.org/2025/01/15/nx-s1-5217975/the-secret-to-doing-hard-things-and-getting-stuff-done

Connect with Amy Morin:

• Website: https://amymorinlcsw.com/
• Instagram: @amymorinauthor
• LinkedIn: https://www.linkedin.com/in/amymorinlcsw/

Darsh and Altamash unpack the first major ACC/AHA lipid update since 2018, now reframed as a dyslipidemia guideline expanding beyond LDL to include triglycerides, ApoB, and lipoprotein(a). They highlight earlier prevention, the new PREVENT risk calculator, return of numeric LDL and non-HDL targets, routine Lp(a) screening, stepwise therapy beyond statins, and greater use of CAC imaging. Using a “trucks and cargo” analogy, they clarify lipid markers, review therapies from statins to PCSK9 inhibitors and inclisiran, compare CTA vs CAC, and explain why most supplements show no benefit.

TOPICS COVERED

• What changed in the new cholesterol guidelines
• Why earlier prevention matters for lifetime risk
• New PREVENT calculator for estimating risk
• Understanding LDL, ApoB, and “bad cholesterol” markers
• Lipoprotein(a): the genetic cholesterol risk to check once
• New LDL targets and when to treat more aggressively
• Medication options beyond statins
• When to use calcium score (CAC) scans
• CTA vs CAC: which heart scan to choose
• Do supplements actually help cholesterol?

RESOURCES & LINKS MENTIONED

• ACC/AHA Dyslipidemia Guideline Update: https://www.acc.org/latest-in-cardiology/journal-scans/2026/03/13/15/20/acc-aha-release-new-clinical-guideline-for-managing-dyslipidemia
• PREVENT Risk Calculator: https://professional.heart.org/en/guidelines-and-statements/prevent-calculator
• Lipoprotein(a) [Lp(a)] Overview: https://www.heart.org/en/health-topics/cholesterol/genetic-conditions/lipoprotein-a
• Apolipoprotein B (ApoB) Explanation: https://en.wikipedia.org/wiki/Apolipoprotein_B
• Coronary Artery Calcium (CAC) Scan: https://www.mayoclinic.org/tests-procedures/heart-scan/about/pac-20384686
• Coronary CT Angiography (CTA): https://www.mayoclinic.org/tests-procedures/ct-coronary-angiogram/about/pac-20385117
• PCSK9 Inhibitors Overview: https://en.wikipedia.org/wiki/PCSK9
• REDUCE-IT Trial (Icosapent Ethyl/Vascepa): https://www.brighamandwomens.org/campaigns/physicians/reduce-it-clinical-trial
• AHA Life’s Essential 8: https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8
• SPORT Trial (supplements vs statin): https://www.jacc.org/doi/10.1016/j.jacc.2022.10.013

Connect with Us:

• Instagram: @draltraja, @doctordarsh
• LinkedIn: https://www.linkedin.com/in/altamash-raja-do-rmsk-cscs-0b1a8039/; https://www.linkedin.com/in/doctordarsh/

We welcome back sleep expert Jade Wu to discuss practical sleep strategies for high performers, especially around travel, naps, and sleep technology. Dr. Wu suggests we may be over-relying on technology for our sleep, making the case for simplicity when it comes to sleep scores, managing jet lag, and even mattresses.

Jade Wu, PhD, DBSM, is a board-certified behavioral sleep medicine psychologist, founder of Thrive Sleep Clinic, and author of Hello Sleep: The Science and Art of Overcoming Insomnia Without Medications. She trained at Cornell, Boston University, and Duke University School of Medicine and specializes in helping high performers build a sustainable, resilient relationship with sleep without medications, gadgets, or rigid optimization.

• Jet lag, circadian rhythms, and how light shapes your body clock
• Naps as a performance and recovery tool
• Sleep debt, sleep banking, and limits of “catching up”
• Wearables, sleep metrics, and avoiding score obsession
• Understanding fatigue vs true sleepiness and when to seek help
• The future of sleep tech while learning to trust your body

RESOURCES & LINKS MENTIONED

• Book: Hello Sleep: The Science and Art of Overcoming Insomnia Without Medications by Jade Wu
• Clinic: Thrive Sleep Clinic — thrivesleepclinic.com
• Practice: Refining Health & Performance — refininghealthrx.com
• Concept: Acceptance and Commitment Therapy (ACT) (https://en.wikipedia.org/wiki/Acceptance_and_commitment_therapy)
• Concept: Cognitive Behavioral Therapy for Insomnia (CBT-I) (https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy_for_insomnia)
• Concept: Circadian Rhythm (https://en.wikipedia.org/wiki/Circadian_rhythm)
• Concept: Social Jet Lag (https://en.wikipedia.org/wiki/Social_jet_lag)
• Concept: Chronotypes (https://en.wikipedia.org/wiki/Chronotype)
• Concept: Adenosine & Sleep Pressure (https://en.wikipedia.org/wiki/Adenosine)
• Concept: REM Sleep (https://en.wikipedia.org/wiki/Rapid_eye_movement_sleep)
• Concept: Sleep Efficiency (https://en.wikipedia.org/wiki/Sleep_efficiency)
• Tool: Light Therapy (10,000 lux light boxes) (https://en.wikipedia.org/wiki/Light_therapy)
• Concept: Sleep Tracking & Wearables (https://en.wikipedia.org/wiki/Actigraphy
• Practice: Refining Health & Performance — refininghealthrx.com

• Website: drjadewu.com (https://www.drjadewu.com/)
• LinkedIn: linkedin.com/in/drjadewu (https://www.linkedin.com/in/drjadewu/)
• Clinic: thrivesleepclinic.com (https://www.thrivesleepclinic.com/)

Behavioral sleep psychologist Dr. Jade Wu returns for round three to explain why sleep is the ultimate performance enhancer — not a cost to be paid. She breaks down sleep's role in physical repair, cognitive function, and emotional regulation, and shares why both neglecting sleep and over-optimizing it backfire. Practical strategies for high performers: daytime light exposure, strength training, sensory-based wind-downs, and treating sleep like a friend — not an engineering problem.

Jade Wu, PhD, DBSM, is a board-certified behavioral sleep medicine psychologist, founder of Thrive Sleep Clinic, and author of Hello Sleep: The Science and Art of Overcoming Insomnia Without Medications. She trained at Cornell, Boston University, and Duke University School of Medicine, and specializes in helping high performers build a sustainable, resilient relationship with sleep — without medications, gadgets, or rigid optimization.

• Why high performers wreck their sleep — neglect and over-optimization
• Sleep's three buckets: physical repair, memory consolidation, emotional regulation
• Daytime levers that beat nighttime hacks: light, strength training, intentional rest
• Chronotype, social jet lag, and finding your biological sleep window
• Seasons of life, values-based living, and the Five Senses wind-down
• Treat sleep like a friend — not an engineering problem or a resource to extract

• Book: Hello Sleep: The Science and Art of Overcoming Insomnia Without Medications by Jade Wu, PhD
• Clinic: Thrive Sleep Clinic — thrivesleepclinic.com (https://www.thrivesleepclinic.com/)
• Concept: Acceptance and Commitment Therapy (ACT) (https://en.wikipedia.org/wiki/Acceptance_and_commitment_therapy)
• Concept: CBT for Insomnia (CBT-I) (https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy_for_insomnia)
• Concept: Non-Sleep Deep Rest (NSDR) (https://en.wikipedia.org/wiki/Yoga_nidra)
• Concept: Social Jet Lag (https://en.wikipedia.org/wiki/Social_jet_lag)
• Concept: Chronotypes (https://en.wikipedia.org/wiki/Chronotype)
• Concept: REM Sleep & Emotional Processing (https://en.wikipedia.org/wiki/Rapid_eye_movement_sleep)
• Concept: Growth Hormone & Deep Sleep (https://en.wikipedia.org/wiki/Growth_hormone)
• Concept: Circadian Rhythm (https://en.wikipedia.org/wiki/Circadian_rhythm)
• Practice: Refining Health & Performance — refininghealthrx.com

• Website: drjadewu.com (https://www.drjadewu.com/)
• LinkedIn: linkedin.com/in/drjadewu (https://www.linkedin.com/in/drjadewu/)
• Clinic: thrivesleepclinic.com (https://www.thrivesleepclinic.com/)

Dr. Lauren Spivack is a board-certified OB-GYN, Menopause Society Certified Practitioner, and fellowship-trained minimally invasive gynecologic surgeon. She treats patients in South Jersey and through the evidence-based telehealth platform Alloy (https://www.myalloy.com/). In this episode, we break down the Women's Health Initiative, the FDA's 2025 removal of the black box warning from estrogen products, the newly named musculoskeletal syndrome of menopause, testosterone in women, and why the formulation you choose matters more than most providers realize.

What We Discuss:

00:00 HRT Timing Window

00:25 Meet the Hosts

01:19 Dr Spivack Background

02:47 Pelvic Pain to Menopause

03:34 Menopause Care Gaps

09:19 Defining Menopause Stages

11:01 WHI Study Breakdown

19:37 Why Age Matters

21:59 Recognizing Symptoms

25:32 Musculoskeletal Links

27:57 Team Based Referrals

31:33 FDA Label Update

34:23 Bioidentical vs Compounded

36:51 Vaginal Estrogen GSM

39:43 Systemic Options and Risks

45:54 Dosing and Expectations

46:57 HRT Starting Doses

48:08 Progesterone Dosing Basics

48:53 Perimenopause and HRT

51:16 Breast Cancer Risk Talk

55:12 When HRT Is Not Right

58:39 Lifestyle and Sleep Focus

01:01:46 Progesterone Only Option

01:03:04 Testosterone for Women

01:07:13 Labs and Monitoring

01:11:56 HRT Hype and Telehealth

01:20:51 Overtreatment and Pellets

01:23:33 Fixing Menopause Care

01:26:25 Putting Health Back

01:28:43 Wrap Up and Disclaimer

Studies & Literature Mentioned:

• WHI Original Trial: Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women (https://pubmed.ncbi.nlm.nih.gov/12117397/) (Rossouw et al., JAMA 2002)
• WHI 30-Year Review: The Women's Health Initiative Randomized Trials and Clinical Practice (https://pubmed.ncbi.nlm.nih.gov/38691368/) (Manson et al., JAMA 2024)
• Musculoskeletal Syndrome of Menopause: The Musculoskeletal Syndrome of Menopause (https://pubmed.ncbi.nlm.nih.gov/39077777/) (Wright et al., Climacteric 2024)
• FDA Announcement: HHS Removes Misleading FDA Warnings on Hormone Replacement Therapy (https://www.fda.gov/news-events/press-announcements/hhs-advances-womens-health-removes-misleading-fda-warnings-hormone-replacement-therapy) (November 10, 2025)
• HHS Fact Sheet: FDA Initiates Removal of Black Box Warnings from MHT Products (https://www.hhs.gov/press-room/fact-sheet-fda-initiates-removal-of-black-box-warnings-from-menopausal-hormone-replacement-therapy-products.html)
• Veozah (Fezolinetant): FDA Safety Communication on Liver Injury Risk (https://www.fda.gov/drugs/drug-safety-and-availability/fda-adds-warning-about-rare-occurrence-serious-liver-injury-use-veozah-fezolinetant-hot-flashes-due)

Concepts & People:

• Dr. Vonda Wright (https://www.womensportsforummd.com/) — Orthopedic surgeon, lead author on the musculoskeletal syndrome of menopause paper
• Dr. Mary Claire Haver (https://thepauselife.com/) — OB-GYN, author of The New Menopause (NYT Bestseller)
• Dr. Lisa Mosconi (https://www.lisamosconi.com/) — Neuroscientist, Director of the Women's Brain Initiative at Weill Cornell, researching estrogen and Alzheimer's risk
• The Menopause Society (https://menopause.org/) — Professional organization and certified menopause provider directory
• Mark Cuban Cost Plus Drugs (https://www.costplusdrugs.com/) — Affordable medication option for uninsured patients

Connect with Dr. Spivack:

• Alloy Profile: Dr. Lauren Spivack (https://www.myalloy.com/expert/lauren-spivack)
• Virtua/Rowan Medicine: Provider Profile (https://doctors.virtua.org/provider/lauren-spivack/2136705)
• LinkedIn: Lauren Spivack, MD (https://www.linkedin.com/in/lauren-spivack-937b8210/)

Connect with Medicine Redefined:

• Website: medicineredefined.com
• Instagram: @medredefined (https://www.instagram.com/medredefined/)
• Twitter/X: @medredefined (https://x.com/medredefined)
• Newsletter: The Progress Note

Work with Dr. Raja:

• Refining Health & Performance: refininghealthrx.com
  • Dr. Raja's musculoskeletal and longevity practice (Telemedicine available in NJ, NY, PA, FL).

In this episode, Dr. Altamash Raja and Dr. Darsh Shah break down the newly released 2025–2030 U.S. Dietary Guidelines, explore new research on exercise variety and longevity, and discuss how rapid advances in artificial intelligence are reshaping healthcare, clinical workflows, and the future of medicine.

From nutrition policy controversies to BMJ research insights and real-world AI tools saving physicians time, this conversation examines how policy, science, and technology intersect with everyday clinical practice and personal health decisions.

What We Discuss:

00:27 Catching Up: Surgery Leave, Back to Work, and Practice Updates

01:21 AI Avatars & Social Media: When the Prompt Makes You Too Real

01:52 2025–2030 Dietary Guidelines: The Inverted Food Pyramid Explained

04:12 How the Guidelines Were Made: Rejected Report, Expedited Panels & Conflicts

07:38 What’s Good vs. Contradictory: Protein, Sugar, Saturated Fat, and the Visual Problem

09:51 Affordability & Access: SNAP/WIC, Schools, and the Real Cost of “Eat Healthy”

14:53 Practical Takeaways + Seasonal Fruit, Frozen vs Fresh, and Berry Prices

17:17 New BMJ Study: Does Exercise Type & Variety Matter More Than Zone 2 Hype?

22:17 Why Sports Win: Tennis, Zone Mixing, Coordination, and Training Variety

23:22 Study Caveats: Observational Data, Self-Report & Healthy User Bias

24:25 Actionable Takeaway: Diversify Your Training Portfolio (80/20)

25:07 Wearables Talk: WHOOP Metrics & Eight Sleep “Performance Zone”

26:23 DeepMind & The Road to AGI: ‘The Thinking Game’ + Protein Folding Breakthroughs

28:39 AI in the Hospital: Cerner/Oracle Note-Writing That Saves 40 Minutes a Day

30:27 Dictation Tools & Being Trained by Tech: WhisperFlow vs Dragon

31:35 Which LLM Is ‘Best’? Workflow Benchmarks, Hallucinations & Model Whiplash

34:14 Patients, Privacy & AI ‘Gaming’ the System in Rehab/Insurance

35:47 Productivity Addiction & Education: When AI Makes Us Do More, Not Less

38:46 AI Wars & Tesla’s Bet: Super Bowl Ads, FSD, Optimus Robots + Closing Thoughts

Connect with Us:

• Instagram: @draltraja, @doctordarsh,
• LinkedIn: https://www.linkedin.com/in/altamash-raja-do-rmsk-cscs-0b1a8039/, https://www.linkedin.com/in/doctordarsh/

Studies & Literature Mentioned:

• 2025–2030 U.S. Dietary Guidelines for Americans (https://cdn.realfood.gov/DGA.pdf)

• Hans et al., BMJ Medicine (2026): Exercise Type, Variety, and Mortality Outcomes (https://pubmed.ncbi.nlm.nih.gov/41574252/)

Podcasts & Videos Mentioned:

• The Thinking Game - DeepMind documentary: (https://www.youtube.com/watch?v=d95J8yzvjbQ)

Want to personally work with Dr. Raja?

• Refining Health & Performance is opening a limited number of founding member spots for Dr. Raja’s telemedicine practice. We focus on healthspan, longevity, and performance using an data-driven, evidence-based, proactive approach. Apply at RefiningHealthRx.com.

Today, Dr. Priya Jaisinghani joins us to cut through the headlines. We move beyond the "cheating" narrative and explore the biology of obesity as a chronic disease. We discuss the phenomenon of "Food Noise"—the constant mental static about eating—and why silencing it is a matter of brain chemistry, not willpower.

We get into the weeds of patient selection, explaining why BMI is a broken metric (especially for South Asian populations) and why being "skinny" doesn't mean you’re metabolically healthy. We also tackle the serious risks: the "muscle crisis" (sarcopenia), the dangers of unregulated compounding pharmacies, and what happens when you stop these drugs.

What We Discuss:

• The "Food Noise" Phenomenon
• Patient Selection & The Broken BMI
• The Muscle Crisis: Quality vs. Quantity
• Safety, Side Effects & The Compounding Trap
• The Future of Metabolic Medicine

Connect with Dr. Jaisinghani:

• NYU Langone Profile: Dr. Priya Jaisinghani
• Instagram: @DrJ_NYU
• LinkedIn: Priya Jaisinghani, MD

Studies & Literature Mentioned:

• SURPASS-3 MRI Sub-study: Reduction in Liver Fat and Muscle Fat with Tirzepatide
• SELECT Trial: Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (The "MACE" reduction data)
• FLOW Trial: Semaglutide in Patients with Type 2 Diabetes and Chronic Kidney Disease
• GRAMS Trial (Upcoming): GLP-1s and Musculoskeletal Outcomes
• Medscape Article: Do GLP-1s Have Deleterious Effects on Muscle?

Podcasts & Videos Mentioned:

• Podcast: Drug Story by Thomas Goetz (Episode on GLP-1s)
• TEDx Talk: Dr. Melanie Jay: Weight Bias in Medicine

Concepts & People:

• Dr. Gabrielle Lyon: Muscle-Centric Medicine
• Dr. Spencer Nadolski: Lipidologist & Obesity Physician

Want to work with Dr. Raja?

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

Guest Bio:

Dr. Priya Jaisinghani is a triple-board certified physician in Internal Medicine, Endocrinology, and Obesity Medicine, and currently serves as a Clinical Assistant Professor at NYU Grossman School of Medicine.

She completed her training at Weill Cornell and New York-Presbyterian Hospital before becoming a key architect at NYU Langone, where she helped build their official obesity clinical care pathway.

Dr. Jaisinghani is a leading voice in the cardiometabolic space, specializing in the intersection of hormonal health and metabolic dysfunction. She is deeply passionate about treating obesity as a chronic, complex disease rather than a willpower failure.

Beyond her clinical practice, she is a dedicated educator who has secured grant funding to develop tools that teach residents how to dismantle weight bias in the exam room. She serves as a vital bridge between endocrinology, bariatric surgery, and sports medicine to treat the whole patient.

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