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  • 185. The Functional Medicine Revolution That Went Wrong | Nisha Chellam, MD

    185. The Functional Medicine Revolution That Went Wrong | Nisha Chellam, MD
    Oct 13 2025

    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!
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    1 Std. und 31 Min.
  • 184. Fixing Credentialing and the Future of Physician Autonomy | Leah Houston, MD

    184. Fixing Credentialing and the Future of Physician Autonomy | Leah Houston, MD
    Sep 29 2025

    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!
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    59 Min.
  • 183. Tech Tools, Living Pro-Analog, Ketones, and Finding Preventive Healthcare

    183. Tech Tools, Living Pro-Analog, Ketones, and Finding Preventive Healthcare
    Sep 15 2025

    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)
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    1 Std. und 6 Min.
  • 182. How The Biggest Loser Revealed the Dark Side of Weight Loss

    182. How The Biggest Loser Revealed the Dark Side of Weight Loss
    Sep 1 2025
    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!
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    52 Min.
  • 181. The Truth About Menstrual Cycle Training & Hormonal Impacts on Performance | Shawn Arent, PhD, CSCS

    181. The Truth About Menstrual Cycle Training & Hormonal Impacts on Performance | Shawn Arent, PhD, CSCS
    Aug 18 2025
    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!TIMESTAMPS00:00 Introduction to Medicine Redefined00:37 Deep Dive into Hormone Physiology00:54 Female Physiology and Menstrual Cycle01:03 Thyroid Hormone Optimization01:12 Catecholamines and Autonomic Balance01:23 GLP-1 Agonists and Muscle Preservation01:58 Guest Introduction: Dr. Shawn Arent02:21 Discussion on Female Physiology02:29 Menstrual Cycle and Training07:28 Hormonal Influence on Injury07:50 Autoregulation in Training19:03 Thyroid Hormone and Metabolism33:55 Catecholamines and Training Response40:55 Sympathetic vs. Parasympathetic Dominance45:30 Tracking Trends for Better Interventions45:53 Wearables and Recovery in Rugby46:55 Debunking Post-Workout Downregulation50:52 Contextualizing Fitness Advice57:06 Balancing Training Methods01:04:30 The Role of IGF-1 in Recovery01:07:02 GLP-1 Agonists and Muscle Preservation01:15:22 Myostatin Inhibitors: The Future of Muscle Growth?01:21:25 Final Thoughts on Health and PerformanceThe Impact of Menstrual Cycle Phase on Athletes’ Performance: A Narrative Review MDPICurrent evidence shows no influence of women’s menstrual cycle phase on acute strength performance or adaptations to resistance exercise training FrontiersThe Effects of Menstrual Cycle Phase on Exercise Performance in Eumenorrheic Women: A Systematic Review and Meta-Analysis SpringerInfluence of Menstrual Cycle Phases on Maximal Strength, Power and High-Intensity Interval Performance – A Systematic Review with Meta-Analysis MDPIEvidence-Based Training Guidelines for Elite Women Football and Team Sports Human KineticsHormones, Hypertrophy, and Hype: An Evidence-Guided Primer on Endogenous Endocrine Influences on Exercise-Induced Muscle Hypertrophy ESSRMenstrual Cycle Effects on Sports Performance and Adaptations to Training: A Historical Perspective PubMedEffect of Estrogen on Musculoskeletal Performance and Injury Risk FrontiersAnterior Cruciate Ligament Injuries in Female Athletes: A Narrative Review of Prevention, Risk Factors, and Management Bone Jt OpenThe Influence of Age on the Effectiveness of Neuromuscular Training to Reduce ACL Injury in Female Athletes: A Meta-Analysis PMCCatecholamine and Cardiovascular Responses to Exercise: An Update SpringerEffects of Different Training Interventions on Heart Rate Variability in People with Overweight and Obesity: A Systematic Review FrontiersBlood-Based Biomarkers for Monitoring Workload and Recovery in Athletes Sports Med OpenChanges in Lean Body Mass with the Use of Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss and Strategies to Mitigate LBM Loss WileyADA Newsroom: GLP-1 Agonists and Lean Body Mass ADA NewsEffects of Subjective and Objective Autoregulation Methods in Resistance Training: A Systematic Review PeerJBiomarkers in Sports and Exercise: Tracking Health, Performance, and Recovery in Athletes SpringerExercise, Training, and the HPT/HPA/HPG Axes in Athletes CSMRCirculating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance PMCOptimizing Health and Athletic Performance for Women SpringerThank you for listening!
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    1 Std. und 27 Min.
  • 180. The Truth About Cortisol, Insulin & Overtraining | Shawn Arent, PhD, CSCS

    180. The Truth About Cortisol, Insulin & Overtraining | Shawn Arent, PhD, CSCS
    Aug 5 2025
    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.TIMESTAMPS00:00 Introduction to Medicine Redefined00:36 Welcoming Dr. Sean Arent02:11 The Importance of Cortisol02:49 Understanding Cortisol's Role in Performance04:59 Chronic Cortisol and Overtraining13:51 Monitoring Stress and Performance22:30 The Role of Nutrition in Cortisol Management33:31 Insulin: The Anabolic Hormone39:27 Exercise and Insulin Sensitivity40:43 Impact of Stress and Sleep on Glucose Levels43:02 Continuous Glucose Monitors: Pros and Cons47:42 Athlete Nutrition and Performance55:52 Hormonal Responses to Training01:07:18 Sex Hormones and Athletic Performance01:17:37 Conclusion and Future TopicsSOURCES00:00:22 | Cortisol deficiency (Addison’s disease) is life-threatening00:04:42 | 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 release01:04:42 | 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 fractures01:12:29 | Amenorrheic female athletes have lower IGF-1 (growth factor) 01:08:53 | Testosterone even within normal range affects strength/mass
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    1 Std. und 21 Min.
  • 179. Is Medicine Worth It? Real Talk on Debt, Purpose, and The Future of Doctors

    179. Is Medicine Worth It? Real Talk on Debt, Purpose, and The Future of Doctors
    Jul 21 2025
    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.TIMESTAMPS00:00 Introduction to Medicine Redefined00:54 Is Medicine Still Worth It?02:24 Challenges in Modern Medicine05:20 Financial Realities of Medical Education10:46 Diversifying Medical Careers17:40 The Importance of Diverse Experiences22:20 Generational Shifts in Medical Practice22:55 The Importance of Professional Diversification23:21 Shared Decision Making with Patients23:48 Challenging the Culture of Self-Destruction24:15 Advice for Aspiring Neurosurgeons24:32 Balancing Interests and Professional Growth25:54 The Business of Medicine27:59 Frameworks for Medical Students29:33 Reframing Medical Careers33:49 Setting Prices in Direct Pay Practice41:18 Final Thoughts and Parting WordsSOURCES| [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)
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    44 Min.
  • 178. The Cost of Secrecy in Insurance: Why Transparency Matters | Dr. Vincent Marchese, DO

    178. The Cost of Secrecy in Insurance: Why Transparency Matters | Dr. Vincent Marchese, DO
    Jul 7 2025
    In this episode of Medicine Redefined, Dr. Darsh and Dr. Altamash sit down with Dr. Vince Marchese, sports medicine physician and founder of Apex Medicine, to explore how transparency and direct pay models are transforming healthcare. We break down why traditional insurance creates confusion and barriers, how clear pricing empowers patients, and what happens when physicians reclaim time to focus on care - not paperwork.TIMESTAMPS00:00 Introduction to Medicine Redefined00:35 Meet Dr. Vince Marchese01:13 Journey to Sports Medicine01:37 Breaking Away from Insurance02:06 Life as a Direct Pay Practitioner09:33 Understanding Insurance Complexities10:27 The History of Insurance11:56 Navigating the Insurance Maze15:37 The Case for Direct Pay17:31 Empowering Patients with Knowledge41:39 The Insurance Dilemma42:00 State Mandates and Penalties42:58 Self-Insurance and Cost-Saving Strategies44:40 Catastrophic Insurance and HSAs52:04 The Benefits of Direct Pay Models55:02 Building a Patient-Centric Practice01:04:31 Scaling and Future of Direct Pay Medicine01:11:44 Support Systems and Taking the Leap01:16:03 Closing Thoughts and ResourcesSOURCESHealthcare Spending & Insurance Costs[00:16:01] “51 cents of every healthcare dollar goes to insurance” – In fact, CMS and KFF data show [1, 2] private insurers cover ~30% of U.S. health spending, and federal/state programs ~51%. Administrative overhead is only about 7.4% of spending [1]. [00:10:00] Average premium costs – Kaiser Family Foundation reports that in 2024 the average annual employer health insurance premium is ~$8,951 for single coverage and ~$25,572 for family coverage [4], illustrating why monthly premiums can seem “crazy high.”Policy & Regulations[00:31:54] Balance billing protections (No Surprises Act) – Effective Jan 1, 2022, federal law bans surprise/“balance” bills for most emergency and certain other out-of-network services [5, 6]. For example, CFPB explains that patients generally will no longer face balance bills for emergency care [5, 6] under the No Surprises Act.Health Savings Accounts (HSAs)[00:43:30] Triple tax advantage of HSAs – HSAs are truly tax-advantaged. According to IRS rules and financial guides, HSA contributions are tax-deductible, earnings grow tax-free, and qualified withdrawals are tax-free [7, 8]. Bank of America and IRS publications both highlight this “triple-tax” benefit.[00:44:17] HSA contribution limits – For 2024, IRS rules allow $4,150 annual HSA contributions for self-only HDHP coverage and $8,300 for family coverage [7] (The podcast guest’s “~$4,000” estimate for solo coverage aligns with the $4,150 limit for 2024 [7]).Price Transparency & Cash Payments[00:21:30] MRI cash prices – Pricing guides show that uninsured (cash) MRI costs vary widely. For example, a 2025 SingleCare review finds a national average MRI cost of ~$1,325 (range ~$400–$12,000) without insurance [9]. A cash-pay platform (MDsave) reports a $1,335 average for an MRI, with their cash price as low as ~$805 [10]. These sources confirm that self-pay MRI prices can be far below billed/insurance prices.[00:21:30] Cash vs. negotiated prices – Studies show many hospitals set their cash (self-pay) rates lower than insurer-negotiated rates. For example, one analysis found 60% of insurer-negotiated hospital rates exceed the hospital’s cash price for the same service [11], and a JAMA-published study reports that cash prices are often below the commercial prices insurers pay [12]. In short, paying cash (or high-deductible plans) can sometimes cost less than the “discounted” insurance rate.Referenced Book[00:21:24] The Price We Pay – Dr. Marty Makary
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    1 Std. und 17 Min.