
Hosted by Altamash Raja, DO and Darsh Shah, DO · EN

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 MedicineInstitute for Functional Medicine: What Is Functional Medicine?00:18:00 — Root Cause Medicine ExplainedCleveland Clinic: Functional Medicine Approach00:34:00 — Functional vs. Lifestyle MedicineAmerican College of Lifestyle Medicine: What Is Lifestyle Medicine?00:58:00 — Functional Labs and Data-Driven CarePubMed: The Value of Advanced Biomarkers in Functional Medicine01:06:00 — Metabolic Health and Insulin ResistanceAmerican Heart Association: Understanding Insulin Resistance01:15:00 — Redefining What “Good Medicine” MeansBMJ: Rethinking Medicine — The Movement to Redefine CareContact 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.com00:04:00 – Centers for Medicare & Medicaid Services (CMS) oig.hhs.gov00:05:00 – Relative Value Unit (RVU) definition en.wikipediaorg00:12:00 – The Joint Commission (healthcare accreditation body) 00:14:00 – National Provider Identifier (NPI) en.wikipedia.org00:19:00 – Interstate Medical Licensure Compact (IMLC) imlcc.com00:28:00 – Decentralized Identity (DID) in healthcare healthdatamanagement.com00:29:00 – Direct Primary Care (DPC) payment model https://www.healthinsurance.org/glossary/direct-primary-care/00:39:00 – Blockchain (distributed ledger technology) explained techtarget.comThank 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.TIMESTAMPS00:00 Introduction to Medicine Redefined00:33 Current Events and Political Landscape02:10 Random Show Concept and Personal Updates02:44 Writing and Creative Outlets06:48 Tech Tools and Apps for Efficiency10:32 Medical Innovations: Vagus Nerve and Hydrodissection19:48 Breathwork and Meditation Techniques23:49 Exploring Exogenous Ketones28:31 Understanding Brain Health and Mood Disorders29:31 Exploring Ketone Supplements30:52 Nootropics and Cognitive Enhancers32:48 The Future of Social Connection40:44 The Concept of Misogi and Mental Fortitude42:34 GLP-1 and Obesity Treatment49:36 Navigating Healthcare and Finding the Right ProviderSOURCES05:12 | 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!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!

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

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)

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

In this episode of Medicine Redefined, Darsh and Altamash sit down with Dr. Patrick “Rocky” Sullivan, an emergency physician turned ketamine therapy pioneer, to explore how this powerful molecule is quietly transforming mental health care. Drawing from years of ER experience and clinical innovation, Dr. Sullivan breaks down the science, stigma, and promise behind ketamine treatment for depression, PTSD, addiction, and chronic pain.We unpack the nuances of off-label prescribing, why most depression treatments miss the mark, and how ketamine-assisted psychotherapy (KAP) is helping patients rewire trauma in real time.If you’ve ever wondered how ketamine really works, who it's for (and who it’s not), or what a responsible treatment plan should look like, this conversation will change your perspective. It's an eye-opening look into the future of mental health care.TIMESTAMPS00:00 Introduction to Medicine Redefined00:36 Meet Dr. Patrick Sullivan01:46 The Evolution of Ketamine Therapy03:18 Rocky's Journey into Psychiatry07:57 Understanding Ketamine's Mechanism08:49 Off-Label Uses and Research11:12 Ketamine in Emergency and Pain Management14:14 The Importance of Set and Setting15:29 From Anesthetic to Antidepressant17:15 Mainstream Depression Treatments23:02 Navigating Treatment Options26:45 Screening and Safety Protocols37:29 Ketamine Assisted Psychotherapy41:42 Telehealth and Ketamine Delivery42:16 The Importance of Provider Interaction43:11 Case Studies: Depression and OCD43:55 Case Studies: Pain and Trauma44:24 Case Studies: Alcohol Use Disorder46:12 The Role of Therapy in Ketamine Treatment47:54 Ketamine's Mechanism and Benefits52:09 Maintenance and Dosage Variability01:05:13 Challenges in Ketamine Research and Regulation01:16:14 Conclusion and Contact InformationSOURCES04:13: Ketamine suicidal ideation meta-analysis; Ketamine depression meta-analysis05:09: What is ketamine?06:01: History of ketamine07:36: Off-label prescriptions07:44: Research referenced on alcoholism and ketamine:1997 study1998 study2001 study2018 study07:44: 2000 study done on depression and ketamine07:44: 2006 study repeated09:30: Ketamine dose-dependent responses10:13: Ketamine on respiratory drive10:58: Ketamine for asthma13:47: Psychedelic therapy15:21: Treatment-resistant depression16:18: SSRIs and other antidepressant drugs17:36: ECT and Ketamine therapy studies:Study 1Study 2Study 3 (70% statistic)18:48: TMS18:48: Spravato study18:48: IV Infusion ketamine study22:19: Treatment resistance depression prevalance25:20: Mathew Perry story28:05: Studies on how Ketamine works in the brain:Study 1Study 229:30: Adjustment disorders32:21: Studies on BDNF and ketamine:Study 1Study 2Study 3Study 432:37: Exercise and BDNF 32:39: HIIT and BDNF35:08: Ketamine assisted psychotherapy research38:08: Ketamine for PTSD44:27: EMDR44:46: How to change your mind:

In this episode of Medicine Redefined, Darsh and Altamash take a deep dive into the complex world of medications with Dr. Vinay Patel, pharmacist and founder of MakoRx. Dr. Patel exposes the hidden realities behind Big Pharma, explaining why generic drugs can be so confusing and revealing the true factors driving skyrocketing pharmacy prices. We also explore how cutting-edge AI technology is revolutionizing drug discovery and development. This conversation will fundamentally change how you understand the medications you rely on every day. Whether you’re a healthcare professional or simply curious, this episode delivers powerful knowledge and a fresh perspective. Tune in!TIMESTAMPS00:00 Introduction to Medicine Redefined00:36 Meet Vinay Patel: Healthcare Innovator01:04 Understanding PBMs: The Hidden Middlemen02:47 The Evolution of PBMs05:29 Vertical Integration and Its Impact15:52 The Complexities of Drug Pricing26:30 Compounding Pharmacies and GLP-1 Medications34:15 Mark Cuban's Cost Plus Solution37:39 The Dominance of Employer-Based Health Insurance39:46 The Generic vs. Brand Medication Debate40:52 Challenges in Generic Drug Manufacturing45:05 The Role of Pharmacists in Medication Management50:50 Solutions for a Broken Healthcare System53:54 Introduction to Make O Rx58:29 Overcoming Barriers in the Healthcare Market01:01:31 The Future of Pharmaceuticals and AI01:05:54 Key Takeaways for Healthcare Providers01:08:04 Final Thoughts and Contact InformationSOURCES00:19: Price We Pay Book01:35: Pharmacy Benefit Management History03:24: Medical Modernization Act03:53: Affordable Care Act04:13: Vertical Integration04:33: Big Three Control 80% of Prescriptions04:56: 20% of Smaller Companies05:40: Tyson Foods RightWay06:01: Smaller PBMs Gaining Traction07:42: Antitrust enforcement in healthcare08:22: Affordable Care Act and High Deductible Plans09:24: Gag clauses09:58: Trump’s Law to Eliminate Gag Clauses10:39: Elizabeth Warren and Josh Hawley's Bill on PBMs13:25: Clawbacks14:32: Clawback disclosure law14:52: Losing money on drugs15:00: GLP-1 drugs16:27: Info on drug pricing17:05: Insurance companies set drug prices22:01: Article on rebates22:30: Net prices have gone down22:39: List prices have gone up24:21: Deep dive into drug prices in US24:45: US VS Europe drug pricing26:49: US subsidizes the world’s drug prices27:32: History of Ozempic28:31: Current status of Ozempic shortage29:11: Compounding drugs law32:21: Compounding pharmacy credit...