191. Psychiatry Abandoned Biology: The Metabolic Crisis in the Brain | Matt Bernstein, MD
Medicine Redefined
Outro
Hosts wrap up, preview part two on ketogenic diet and medications, and provide show notes and disclaimers.
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).
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