191. Psychiatry Abandoned Biology: The Metabolic Crisis in the Brain | Matt Bernstein, MD

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).