Medicine Redefined

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

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).