Medicine Redefined

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

Resources & Links:

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

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

Resources & Studies Mentioned

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)

Connect with Dr. Bernstein

Residential Program: Accord MH (accord.health)

Professional Bio: LinkedIn Profile

Clinical Group: Ellenhorn

Connect with Medicine Redefined

Website: medicineredefined.com

Instagram: @medredefined

Twitter/X: @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).

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.

On this episode…

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!

Resources mentioned…

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)

Connect with Us!

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.