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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.

Join Dr. Altamash Raja and Dr. Darsh Shah in a comprehensive discussion with Dr. Allison Grimaldi on femoral acetabular impingement (FAI) and hip health. This episode of Medicine Redefined dives into part two of the hip-focused conversation. Dr. Grimaldi provides a deep dive into FAI, discussing types of impingement, symptoms, and the importance of accurate diagnosis and individualized treatment. The conversation also touches on advances in hip arthroscopy, metabolic health, and the role of systemic inflammation in joint conditions. Tune in for valuable insights into hip pathology, patient care, and the future of hip health. 00:00 Introduction and Exciting Update 00:40 Recap of Part One and Introduction to FAI 01:04 Understanding Femoral Acetabular Impingement (FAI) 03:49 Imaging and Diagnosis of FAI 07:53 Development and Risk Factors of FAI 12:05 Weightlifting and FAI in Adolescents 16:07 Surgical Interventions and Outcomes 24:53 Non-Surgical Management and Rehabilitation 29:48 Post-Surgery Expectations and Long-Term Management 41:15 Micro Instability and Dysplasia 45:02 Understanding Hip Dysplasia and Instability 46:44 Clinical Tests and Imaging for Hip Dysplasia 49:29 Rehabilitation Approaches for Hip Instability 53:47 Exercises for Deep Muscle Recruitment 01:02:23 Metabolic Health and Tendon Pathology 01:09:41 Considerations for Aging Athletes 01:14:18 Future of Hip and Pelvic Pain Care 01:19:51 Shifts in Understanding Hip Impingement 01:22:28 Final Thoughts and Advice for Practitioners Resources & citations 2016 Warwick Agreement on FAIS (consensus statement).  UK FASHIoN RCT: arthroscopy vs physio for FAIS (BMJ 2019).  Australian FASHIoN trial: cartilage imaging & outcomes (BMC 2021).  Hip microinstability: international consensus diagnostic criteria.  Post-arthroscopy effusion/synovitis and outcomes: overview blog + PubMed.  Modern Hip Arthroscopy for FAIS May Delay the Natural History of Osteoarthritis in 25% of Patients: A 12-Year Follow-up Analysis. - PubMed Connect with Dr. Grimaldi Website: dralisongrimaldi.com.  Hip Academy: Program & membership.  Instagram: @dralisongrimaldi.  X (Twitter): @alisongrimaldi.

Ever felt like your insurance company is gaslighting you? Dr. Altamash Raja shares a real story that turned a routine billing error into a masterclass on how to actually navigate health insurance. From copays and deductibles to hidden tiers and the fine print that drains your wallet - this Progress Note breaks it all down. Join hosts Dr. Darsh Shah and Dr. Altamash Raja as they cut through the noise, explain the system in plain English, and arm you with the knowledge to advocate for yourself next time your claim gets “lost”. TIMESTAMPS 00:36 Insurance Negotiations Frustrations 06:33 Understanding Health Insurance Terms 17:26 Navigating Insurance Plans and Benefits 23:56 Navigating Insurance Verification 25:52 The Business Side of Healthcare 26:37 Challenges in Inpatient Rehab 28:41 Understanding Healthcare Metrics 31:59 Emergency Visits and Insurance 34:10 Planning for Medical Emergencies 37:14 Insurance Tiers Explained 40:01 Practical Tips for Managing Insurance 46:20 Final Thoughts and Recap 48:10 Outro and Disclaimer SOURCES [00:06:00] — Premiums, Deductibles, Coinsurance & Copays Explained – Aetna [00:17:00] — HMO vs. PPO: Which Is Right for You? – Humana [00:34:00] — What Is a “Surprise Medical Bill” and What Should I Know About the No Surprises Act? – Consumer Financial Protection Bureau [00:34:00] — No Surprises Act: Balance Billing Rules for Emergency and Air Ambulance Services – Centers for Medicare & Medicaid Services [00:40:00] — Navigating the Insurance Appeals Process –Patient Advocate Foundation

Join hosts Darsh and Altamash as they sit down with Dr. Allison Grimaldi to dive deep into the complexities of hip pain and the latest research in the field. In this episode, Dr. Grimaldi sheds light on the challenges of diagnosing and treating hip issues, the anatomy of the hip joint, and the critical role of gluteal tendinopathy.  Learn how significant lifestyle changes and thorough education can alleviate symptoms more effectively than traditional corticosteroid treatments. Don't miss this enlightening discussion aimed at both clinicians and patients who are eager to better understand their bodies. TIME STAMPS 00:00 Introduction to Postpartum Health Challenges 00:27 Welcome to Medicine Redefined 01:05 Exciting Update: New Practice Launch 01:34 Introducing Dr. Allison Grimaldi 01:46 Why Focus on the Hip? 06:18 Understanding Hip Anatomy 08:44 Lateral Hip Pain and Its Complexities 22:55 Diagnosing Gluteal Tendinopathy 27:16 Identifying Hip Pain: Key Questions and Symptoms 27:52 Differentiating Gluteal Tendinopathy from Other Conditions 29:19 Common Presentations and Misdiagnoses 31:14 Effective Sleep Positions for Hip Pain Relief 36:07 Diagnostic Tests for Gluteal Tendinopathy 39:31 Insights from the LEAP Study 44:16 Balancing Short-term Relief and Long-term Solutions 46:11 The Role of PRP in Treatment 50:13 Concluding Thoughts and Next Steps SOURCES LEAP Trial: https://www.bmj.com/content/361/bmj.k1662 Gluteal Masterclass: https://pubmed.ncbi.nlm.nih.gov/39854929/

Dr. Darsh Shah and Dr. Altamash Raja sit down with Dr. Nisha Chellam to explore her journey from traditional internal medicine to functional medicine. Together, they discuss the “revolving door” of chronic disease, why she stopped attending supplement-driven conferences, and how she blends evidence-based care with lifestyle change. Dr. Chellam shares how she helps patients uncover the true root causes of illness and reclaim ownership of their health. SOURCES: 00:10:00 — Discovering Functional Medicine Institute for Functional Medicine: What Is Functional Medicine? 00:18:00 — Root Cause Medicine Explained Cleveland Clinic: Functional Medicine Approach 00:34:00 — Functional vs. Lifestyle Medicine American College of Lifestyle Medicine: What Is Lifestyle Medicine? 00:58:00 — Functional Labs and Data-Driven Care PubMed: The Value of Advanced Biomarkers in Functional Medicine 01:06:00 — Metabolic Health and Insulin Resistance American Heart Association: Understanding Insulin Resistance 01:15:00 — Redefining What “Good Medicine” Means BMJ: Rethinking Medicine — The Movement to Redefine Care Contact Dr. Chellam: Linkedin | Nisha Chellam Instagram, YouTube, X | @holisticicon Find Us Here: Instagram, Threads, X, TikTok | @medredefined Thank you for listening! Let us know what you think!

Darsh and Altamash talk to Dr. Leah Houston, an emergency medicine physician turned healthcare entrepreneur, for insights on the broken physician credentialing system and how technology could restore autonomy to doctors. TIMESTAMPS: 00:01:00 – Evercred (decentralized physician credentialing platform) evercred.com 00:04:00 – Centers for Medicare & Medicaid Services (CMS) oig.hhs.gov 00:05:00 – Relative Value Unit (RVU) definition en.wikipediaorg 00:12:00 – The Joint Commission (healthcare accreditation body) 00:14:00 – National Provider Identifier (NPI) en.wikipedia.org 00:19:00 – Interstate Medical Licensure Compact (IMLC) imlcc.com 00:28:00 – Decentralized Identity (DID) in healthcare healthdatamanagement.com 00:29:00 – Direct Primary Care (DPC) payment model https://www.healthinsurance.org/glossary/direct-primary-care/ 00:39:00 – Blockchain (distributed ledger technology) explained techtarget.com Thank you for listening!

Darsh and Altamash are back, trading thoughts on what’s been capturing their attention lately - from the tech tools boosting daily efficiency to the appeal of living more “pro-analog.” They dive into the hype and science behind ketones, unpack how GLP-1s are reshaping the way we think about food and cravings, and share insights on what it really means to find preventive, proactive healthcare today. It’s a thoughtful but approachable conversation, blending current events, health trends, and practical takeaways. TIMESTAMPS 00:00 Introduction to Medicine Redefined 00:33 Current Events and Political Landscape 02:10 Random Show Concept and Personal Updates 02:44 Writing and Creative Outlets 06:48 Tech Tools and Apps for Efficiency 10:32 Medical Innovations: Vagus Nerve and Hydrodissection 19:48 Breathwork and Meditation Techniques 23:49 Exploring Exogenous Ketones 28:31 Understanding Brain Health and Mood Disorders 29:31 Exploring Ketone Supplements 30:52 Nootropics and Cognitive Enhancers 32:48 The Future of Social Connection 40:44 The Concept of Misogi and Mental Fortitude 42:34 GLP-1 and Obesity Treatment 49:36 Navigating Healthcare and Finding the Right Provider SOURCES 05:12 | How and Why To Try Alternate Nostril Breathing (Cleveland Clinic) 08:47 | Buteyko vs Soma Breathing: Origins, Benefits and Differences (Buteyko Clinic International) 14:33 | OU Researchers Explore Vagus Nerve Stimulation for Multiple Conditions (University of Oklahoma) 19:55 | Exogenous Ketones: Do They Work, and Are They Safe? (Medical News Today) 24:18 | Ozempic Quiets Food Noise in the Brain — But How? (Scientific American) 27:42 | “Food Noise”: Do Weight Loss Drugs Stop It? (Health.com) 33:11 | How to Find a Medicine 3.0 Doctor like Dr. Peter Attia (Vitality / AWI Longevity Clinic) 37:40 | Embracing an Analog Lifestyle: Opt Out of Overwhelm (The Tiny Life) 41:05 | “The ‘Boring Phone’ – Gen Z Ditch Smartphones for Dumbphones” (The Guardian) 45:22 | Alfred – Productivity App for macOS (Official Site) 47:36 | OpenAI Whisper (Speech Recognition AI)

Darsh and Altamash dive into Netflix’s Fit for TV and the wild story behind The Biggest Loser. From shocking weight loss tactics to the billion-dollar business of reality TV, tune in as they break down the science of obesity, GLP-1s, and the dark side of weight-loss entertainment. Sources:  00:01 | Fit for TV (Netflix doc) 01:30 | The Biggest Loser (NBC show) 02:50 | Jillian Michaels (trainer) 03:45 | Bob Harper (trainer) 04:15 | GLP-1 drugs (Ozempic/Wegovy) 05:20 | Calories In/Out model 14:20 | Dr. Robert Huizenga 15:20 | Motivational interviewing 15:30 | Metabolic ward studies 25:20 | NYT: After The Biggest Loser 25:25 | Kevin Hall (NIH) 26:00 | Hall et al. 2016 (Obesity) 27:10 | Yo-yo dieting 27:30 | Leptin hormone 30:50 | Alan Aragon (nutritionist) 32:00 | Set point theory 32:45 | Stephan Guyenet (author) 33:20 | Sarcopenia 35:00 | Temptation challenges 35:10 | Big Brother (reality show) 35:15 | Survivor (reality show) 38:50 | Dr. Mike Varshavski 39:05 | Dr. Mike Israetel 39:10 | Aesthetic Revolution (concept/book) Thanks for listening!

Dr. Darsh Shah and Dr. Altamash Raja continue their conversation with Dr. Shawn Arent on hormone physiology and performance. They dive into female physiology and menstrual cycle myths, the overlooked role of thyroid and reverse T3, catecholamines and autonomic balance, and the future of performance enhancement with GLP-1s and muscle-preserving drugs. A practical, evidence-based look at optimizing health and performance! TIMESTAMPS 00:00 Introduction to Medicine Redefined 00:37 Deep Dive into Hormone Physiology 00:54 Female Physiology and Menstrual Cycle 01:03 Thyroid Hormone Optimization 01:12 Catecholamines and Autonomic Balance 01:23 GLP-1 Agonists and Muscle Preservation 01:58 Guest Introduction: Dr. Shawn Arent 02:21 Discussion on Female Physiology 02:29 Menstrual Cycle and Training 07:28 Hormonal Influence on Injury 07:50 Autoregulation in Training 19:03 Thyroid Hormone and Metabolism 33:55 Catecholamines and Training Response 40:55 Sympathetic vs. Parasympathetic Dominance 45:30 Tracking Trends for Better Interventions 45:53 Wearables and Recovery in Rugby 46:55 Debunking Post-Workout Downregulation 50:52 Contextualizing Fitness Advice 57:06 Balancing Training Methods 01:04:30 The Role of IGF-1 in Recovery 01:07:02 GLP-1 Agonists and Muscle Preservation 01:15:22 Myostatin Inhibitors: The Future of Muscle Growth? 01:21:25 Final Thoughts on Health and Performance The Impact of Menstrual Cycle Phase on Athletes’ Performance: A Narrative Review MDPI Current evidence shows no influence of women’s menstrual cycle phase on acute strength performance or adaptations to resistance exercise training Frontiers The Effects of Menstrual Cycle Phase on Exercise Performance in Eumenorrheic Women: A Systematic Review and Meta-Analysis Springer Influence of Menstrual Cycle Phases on Maximal Strength, Power and High-Intensity Interval Performance – A Systematic Review with Meta-Analysis MDPI Evidence-Based Training Guidelines for Elite Women Football and Team Sports Human Kinetics Hormones, Hypertrophy, and Hype: An Evidence-Guided Primer on Endogenous Endocrine Influences on Exercise-Induced Muscle Hypertrophy ESSR Menstrual Cycle Effects on Sports Performance and Adaptations to Training: A Historical Perspective PubMed Effect of Estrogen on Musculoskeletal Performance and Injury Risk Frontiers Anterior Cruciate Ligament Injuries in Female Athletes: A Narrative Review of Prevention, Risk Factors, and Management Bone Jt Open The Influence of Age on the Effectiveness of Neuromuscular Training to Reduce ACL Injury in Female Athletes: A Meta-Analysis PMC Catecholamine and Cardiovascular Responses to Exercise: An Update Springer Effects of Different Training Interventions on Heart Rate Variability in People with Overweight and Obesity: A Systematic Review Frontiers Blood-Based Biomarkers for Monitoring Workload and Recovery in Athletes Sports Med Open Changes in Lean Body Mass with the Use of Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss and Strategies to Mitigate LBM Loss Wiley ADA Newsroom: GLP-1 Agonists and Lean Body Mass ADA News Effects of Subjective and Objective Autoregulation Methods in Resistance Training: A Systematic Review PeerJ Biomarkers in Sports and Exercise: Tracking Health, Performance, and Recovery in Athletes Springer Exercise, Training, and the HPT/HPA/HPG Axes in Athletes CSMR Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance PMC Optimizing Health and Athletic Performance for Women Springer Thank you for listening!

We are back with a powerhouse guest, Dr. Shawn Arent, for part 1 of a series on hormone optimization. From cortisol misconceptions to insulin fearmongering, they cut through the noise with science-backed insight into performance, recovery, and stress physiology. You’ll rethink everything you’ve seen on social media about hormones. TIMESTAMPS 00:00 Introduction to Medicine Redefined 00:36 Welcoming Dr. Sean Arent 02:11 The Importance of Cortisol 02:49 Understanding Cortisol's Role in Performance 04:59 Chronic Cortisol and Overtraining 13:51 Monitoring Stress and Performance 22:30 The Role of Nutrition in Cortisol Management 33:31 Insulin: The Anabolic Hormone 39:27 Exercise and Insulin Sensitivity 40:43 Impact of Stress and Sleep on Glucose Levels 43:02 Continuous Glucose Monitors: Pros and Cons 47:42 Athlete Nutrition and Performance 55:52 Hormonal Responses to Training 01:07:18 Sex Hormones and Athletic Performance 01:17:37 Conclusion and Future Topics SOURCES 00:00:22 | Cortisol deficiency (Addison’s disease) is life-threatening 00:04:42 | Cortisol peaks in early morning (chronobiology)  00:05:25 | Acute sleep deprivation significantly increases cortisol  00:05:42 | One week of 5h/night sleep restriction lowers testosterone by \~10–15%  00:22:11 | Cortisol stimulates gluconeogenesis (maintains blood glucose upon waking)  00:27:38 | No single reliable biomarker for overtraining syndrome  00:27:38 | Overtrained athletes show blunted HR, blood lactate and cortisol responses  00:29:00 | Prolactin rises in response to stress/exercise  00:30:00 | Dietary fat guidelines: 20–35% of calories from fat  00:33:30 | Insulin is an anabolic hormone promoting nutrient storage  00:33:30 | Low-fat (∼20% fat) diets reduce testosterone 10–15% vs high-fat diets  00:39:26 | Regular exercise improves insulin sensitivity  00:39:26 | ~38% (~98M) of U.S. adults have prediabetes  00:40:29 | Shorter sleep duration impairs insulin sensitivity  00:01:02:57 | Exercise above the lactate threshold elicits maximal GH release 01:04:42 | Resting lactate \~1–2 mmol/L; intense exercise >20 mmol/L  01:08:53 | Higher testosterone levels correlate with greater lean mass in men  01:11:51 | Winners in competition show post-event testosterone spikes  01:12:29 | Female athlete amenorrhea leads to low bone density and stress fractures 01:12:29 | Amenorrheic female athletes have lower IGF-1 (growth factor)  01:08:53 | Testosterone even within normal range affects strength/mass

In this episode of Medicine Redefined, Darsh and Altamash dive deep into the question on every future and current physician’s mind: is medicine still worth it? What starts as a reflection on the financial and emotional toll of the profession quickly evolves into a powerful conversation about agency, reinvention, and longevity in medicine. With honesty and humor, they unpack their own journeys from burnout to building lives and careers on their own terms, sharing hard-earned insights and tactical frameworks for thriving in a changing healthcare landscape. If you’ve ever felt disillusioned about your path in medicine or wondered how to break free from the constraints of the job, this episode will challenge and inspire you to rethink what’s possible. TIMESTAMPS 00:00 Introduction to Medicine Redefined 00:54 Is Medicine Still Worth It? 02:24 Challenges in Modern Medicine 05:20 Financial Realities of Medical Education 10:46 Diversifying Medical Careers 17:40 The Importance of Diverse Experiences 22:20 Generational Shifts in Medical Practice 22:55 The Importance of Professional Diversification 23:21 Shared Decision Making with Patients 23:48 Challenging the Culture of Self-Destruction 24:15 Advice for Aspiring Neurosurgeons 24:32 Balancing Interests and Professional Growth 25:54 The Business of Medicine 27:59 Frameworks for Medical Students 29:33 Reframing Medical Careers 33:49 Setting Prices in Direct Pay Practice 41:18 Final Thoughts and Parting Words SOURCES | [00:06:45] | One Big Beautiful Bill Act (H.R.1, 119th Congress) – A 2025 budget reconciliation bill passed by the House and signed into law, containing sweeping tax and spending changes (health, taxes, etc.)  | [00:06:51] | Medicaid coverage cuts – CBO estimated the reconciliation bill would reduce Medicaid enrollment by on the order of 10–12 million people | [00:06:53] | Fiscal impact of the bill – Analyses (e.g. by the CRFB) show the bill adds roughly $3.4 trillion to the deficit (≈$4.1 trillion including interest) | [00:07:30] | Student loan policy changes – H.R.1 eliminates Grad PLUS loans (effective July 1, 2026) and caps borrowing for medical/law students at $50,000/year ($200,000 total) | [00:07:45] | AAMC medical school cost data – The AAMC reports median 4‑year cost of attendance for public med schools ~$286K (2025 cohort, i.e. ~$71–73K/year including living) | [00:08:04] | AAMC medical school debt – AAMC data show the median debt at graduation for MD grads is about $205,000 | [00:09:39] | Primary care physician trend – Reports indicate many U.S. med students are “turning away from primary care in favor of more lucrative specialties”, leading to projected shortages.  | [00:09:39] | Primary care shortage (projected) | [00:09:39] | Overall physician shortage – AAMC projects an all‑specialty physician shortage up to ~86,000 doctors by 2036  | [00:09:49] | Healthcare spending share (physicians) – U.S. health expenditure data: hospitals ~31% and physicians/clinics ~20% of total spending in 2023 (so physician pay is a fraction of total cost)  | [00:10:00] | Private equity in healthcare – Deal activity surged in 2024 | [00:10:05] | PE healthcare deals (2024) – A recent analysis counted ~1,069 private‑equity healthcare deals in the U.S. in 2024. | [00:17:15] | Peter Attia – Physician who left surgical residency [00:21:09] | Emphasizing diversity of thought and experience in healthcare teams can broaden insight and drive innovation [00:21:34] | The notion of a physician “martyr complex” [00:32:20] | Nearly 39% of U.S. doctors now have side “gigs” [00:33:23] | A 2023 randomized trial (knee bursitis) found local corticosteroid injections relieved pain significantly more than extracorporeal shockwave therapy (ESWT) [00:34:16] | Concierge medicine and Direct Primary Care (DPC) are growing trends [00:39:58] | Patients paying concierge/DPC fees gain perks (shorter wait times, direct doctor access)