Medicine Redefined

EPISODE DESCRIPTION

How many hard sets does muscle actually need, and does the weight on the bar matter? In part two of the training series, Dr. Altamash Raja and Dr. Darsh Shah work through the 2026 ACSM position stand: strength and size as two goals with two prescriptions, why effort matters more than load for growth, and how little it takes to maintain what you've built. They audit their own programs live, then make the case for building a training floor around your real constraints before adding anything.

TOPICS COVERED

• Strength vs. hypertrophy: two goals, two prescriptions, and why you need to know which one you're chasing
• What the 2026 ACSM position stand asks for: heavy loads for strength, at least 10 hard sets per muscle per week for size, effort over load
• Progressive overload, momentary failure vs. 2–3 reps in reserve, and correcting the "80% = RPE 8" slip from part one
• A live audit of both hosts' programs with fractional set counting, plus the Nordic hamstring evidence debate
• The maintenance dose: keeping strength and size on as little as one session a week, and what older adults need
• Allostatic load, rest intervals, full-body vs. split training, and why you build the floor first, then add

RESOURCES & LINKS MENTIONED

Studies

• Currier et al., ACSM Position Stand on Resistance Training Prescription, Med Sci Sports Exerc (2026) (https://doi.org/10.1249/MSS.0000000000003897)
• Pelland et al., The Resistance Training Dose Response, Sports Medicine (2026) (https://link.springer.com/article/10.1007/s40279-025-02344-w)
• van Dyk et al., Nordic hamstring exercise halves the rate of hamstring injuries, BJSM (2019) (https://www.mendeley.com/catalogue/3a292a92-fca1-3d9b-9fb2-654d278d38b9/)
• Impellizzeri et al., Reappraisal: Nordic hamstring effect inconclusive, J Clin Epidemiol (2021) (https://www.semanticscholar.org/paper/8938af53d1760cb9d5aa328dc663059bdd9f7ff5)
• Spiering et al., The minimal dose of exercise to preserve endurance and strength, J Strength Cond Res (2021) (https://pubmed.ncbi.nlm.nih.gov/33629972/)
• Singer et al., Inter-set rest intervals and muscle hypertrophy, Front Sports Act Living (2024) (https://www.frontiersin.org/journals/sports-and-active-living/articles/10.3389/fspor.2024.1429789/full)
• Zhang et al., Resistance training volume and mortality, BJSM (2026) (https://doi.org/10.1136/bjsports-2025-110503)
• McEwen and Stellar, Stress and the individual, Arch Intern Med (1993) (https://pubmed.ncbi.nlm.nih.gov/8379800/)

Concepts & tools

• Progressive overload (https://en.wikipedia.org/wiki/Progressive_overload) · One-repetition maximum (https://en.wikipedia.org/wiki/One-repetition_maximum) · RPE (https://en.wikipedia.org/wiki/Rating_of_perceived_exertion)
• Allostatic load (https://en.wikipedia.org/wiki/Allostatic_load) · DOMS (https://en.wikipedia.org/wiki/Delayed_onset_muscle_soreness) · Nordic hamstring curl (https://www.physio-pedia.com/Nordic_Hamstring_Training)

On-air corrections

• Allostatic load was coined by McEwen and Stellar in 1993, not the 1930s or 40s.
• In Zhang 2026, the lowest mortality was in people combining resistance training with aerobic activity. These are observational cohort data.

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The Show

• Website: medicineredefined.com (https://medicineredefined.com)
• Instagram / X: @medredefined (https://instagram.com/medredefined)

Dr. Altamash Raja

• Instagram: @draltraja (https://instagram.com/draltraja)
• LinkedIn: Altamash Raja (https://www.linkedin.com/in/altamash-raja-do-rmsk-cscs)
• Refining Health & Performance (https://refininghealthrx.com)

Dr. Darsh Shah

• Instagram: @doctor.darsh (https://www.instagram.com/doctor.darsh/)
• LinkedIn: doctordarsh (https://www.linkedin.com/in/doctordarsh/)

Want a clear plan for longevity, performance, and staying active with fewer setbacks? Work with Dr. Raja directly. Book at refininghealthrx.com (https://refininghealthrx.com).

Is your training week built on evidence, or on habit? In part one of a five-part series, Dr. Altamash Raja and Dr. Darsh Shah unpack the American College of Sports Medicine's 2026 resistance training position stand: what didn't consistently matter (training to failure, machines versus free weights, complex periodization) and what did, depending on the goal. They lay out four training qualities, three questions to ask before writing a program, and a realistic week for people who already train, plus a fallback for when life interferes.

TOPICS COVERED

• What the 2026 ACSM position stand found on failure training, equipment choice, and periodization, and the goal-specific variables that do matter
• RPE versus reps in reserve (RIR), and why "close to failure" is harder to judge than it sounds
• The four qualities: aerobic fitness, strength, power, and mobility and stability, with everyday examples
• Three questions before writing a program: what to improve, what you can repeat, and how you'll know it's working
• A sample 45–60 minute training week, Darsh's HYROX prep, and what group classes like Pilates and F45 leave out
• How Dr. Raja adapts his own training around surgery and joint limitations, allostatic load, and the two-week planning assignment

RESOURCES & LINKS MENTIONED

Studies

• Currier et al., ACSM Position Stand: Resistance Training Prescription for Muscle Function, Hypertrophy, and Physical Performance in Healthy Adults, Medicine & Science in Sports & Exercise (2026). Strength: at least 80% of 1RM, 2+ sessions a week. Size: about 10+ sets per muscle per week. Power: 30–70% of 1RM moved fast (https://pubmed.ncbi.nlm.nih.gov/41843416/)
• Oja et al., sport type and mortality in 80,306 British adults, British Journal of Sports Medicine (2017). Observational; racquet sports linked to 47% lower all-cause mortality (https://pubmed.ncbi.nlm.nih.gov/27895075/)
• Lee et al., leisure-time physical activity intensity and mortality, Circulation (2022). Covered in the cardio episode (https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.058162)

Concepts & tools

• CDC adult guidelines: 150 min moderate or 75 min vigorous aerobic activity a week, plus strength training 2+ days (https://www.cdc.gov/physical-activity-basics/guidelines/adults.html)
• Rating of perceived exertion and the Borg 6–20 scale (https://en.wikipedia.org/wiki/Rating_of_perceived_exertion) · Sports periodization (https://en.wikipedia.org/wiki/Sports_periodization)
• SAID principle (https://en.wikipedia.org/wiki/SAID_principle) · Allostatic load (https://en.wikipedia.org/wiki/Allostatic_load)
• VO2 max (https://en.wikipedia.org/wiki/VO2_max) · HYROX (https://hyrox.com)

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The Show

• Website: medicineredefined.com (https://medicineredefined.com)
• Instagram / X: @medredefined (https://instagram.com/medredefined)

Dr. Altamash Raja

• Instagram: @draltraja (https://instagram.com/draltraja)
• LinkedIn: Altamash Raja (https://www.linkedin.com/in/altamash-raja-do-rmsk-cscs)
• Refining Health & Performance (https://refininghealthrx.com)

Dr. Darsh Shah

• Instagram: @doctor.darsh (https://www.instagram.com/doctor.darsh/)
• LinkedIn: doctordarsh (https://www.linkedin.com/in/doctordarsh/)

Ready to stop guessing and start performing? Dr. Raja is now seeing patients through his telemedicine practice — limited founding member spots available at refininghealthrx.com (https://refininghealthrx.com).

EPISODE DESCRIPTION

Should doctors be worried about AI, or should administrators? Family physician Dr. Sam Robinson left a 2,200-patient insurance panel with a 13-week waitlist to build Altaura Health, a direct primary care longevity practice outside Sacramento. He joins Drs. Raja and Shah on the four pillars he actually measures, the routine panel that caught a diagnosis nobody was looking for, and why the physicians automating their administration, not their judgment, will define the next era of private practice.

TOPICS COVERED

• Why family medicine is the natural home for preventive care, and the four conditions longevity medicine is really aiming at
• Four pillars measured, not marketed: visceral fat by DEXA, VO2 max, muscle mass and strength, and extensive biomarker panels
• Leaving insurance: 2,200 patients down to 300, 13-week waits to same-week access, pricing, super bills, and working around HMO coverage
• Will AI replace doctors: the pilot analogy, Mark Cuban's argument, and why the administrative layer is the more obvious target
• Testing philosophy: the ferritin that caught hemochromatosis, full-body MRI counseling, consumer lab panels, and reassurance as a deliverable
• Advice for physicians going DPC: brand the value you deliver, automate the back office, and what a one-assistant practice can actually do

RESOURCES & LINKS MENTIONED

Referenced on the show

• Mark Cuban on why AI won't replace physicians, and his follow-up that it will replace administrative tasks (https://www.barchart.com/story/news/4119132/mark-cuban-says-ai-cant-replace-doctors-because-it-cant-see-a-patient-collapse-and-start-cpr-you-just-puked-lets-find-out-why)
• Dr. Derya Unutmaz on FoundMyFitness, "Why AI Could Add Decades to Your Lifespan" (https://www.foundmyfitness.com/episodes/derya-unutmaz)
• Function Health (https://www.functionhealth.com)

Concepts & tools

• Direct primary care (https://en.wikipedia.org/wiki/Direct_primary_care)
• VO2 max (https://en.wikipedia.org/wiki/VO2_max) · DEXA (https://en.wikipedia.org/wiki/Dual-energy_X-ray_absorptiometry) · Visceral fat (https://en.wikipedia.org/wiki/Abdominal_obesity)
• HOMA-IR (https://en.wikipedia.org/wiki/Homeostatic_model_assessment) · Hereditary hemochromatosis (https://en.wikipedia.org/wiki/Hereditary_haemochromatosis) · Gilbert's syndrome (https://en.wikipedia.org/wiki/Gilbert%27s_syndrome)

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Dr. Sam Robinson

• Altaura Health (https://www.altaurahealth.com)

The Show

• Website: medicineredefined.com (https://medicineredefined.com)
• Instagram / X: @medredefined (https://instagram.com/medredefined)

Dr. Altamash Raja

• Instagram: @draltraja (https://instagram.com/draltraja)
• LinkedIn: Altamash Raja (https://www.linkedin.com/in/altamash-raja-do-rmsk-cscs)
• Refining Health & Performance (https://refininghealthrx.com)

Dr. Darsh Shah

• Instagram: @doctor.darsh (https://www.instagram.com/doctor.darsh/)
• LinkedIn: doctordarsh (https://www.linkedin.com/in/doctordarsh/)

Ready to stop guessing and start performing? Dr. Raja is now seeing patients through his telemedicine practice — limited founding member spots available at refininghealthrx.com (https://refininghealthrx.com).

EPISODE DESCRIPTION

Acid reflux isn't a problem of too much acid. Gastroenterologist Dr. Badal Shah joins Drs. Raja and Shah to break down what's actually failing (the lower esophageal sphincter), how patients end up on PPIs for decades, and how to wean off without rebound. They cover the long-term risks of acid suppression, fiber as the most underrated GI intervention, SIBO vs. leaky gut, what probiotics can and can't do, and why fecal transplants cure recurrent C. diff more than 95% of the time.

TOPICS COVERED

• From scopes to lifestyle: why a procedure-trained GI left the reactive model for post-acute care and lifestyle-first practice
• Reflux pathophysiology: transient LES relaxations, not excess acid; stress, sleep, obesity, and immobility as drivers
• PPIs: who truly needs them, rebound reflux, weaning protocols, and long-term risks (C. diff, pneumonia, fractures)
• Fiber and FODMAPs: the 30–35 g/day target, soluble vs. insoluble, and elimination diets done right
• Microbiome without the hype: dysbiosis, SIBO vs. leaky gut, breath tests, and what stool tests actually check
• Probiotics to fecal transplants: strains and timelines, prebiotics and postbiotics, and the gut-brain axis

RESOURCES & LINKS MENTIONED

Studies

• Famotidine activates the vagus nerve inflammatory reflex to attenuate cytokine storm, Molecular Medicine (2022) (https://molmed.biomedcentral.com/articles/10.1186/s10020-022-00483-8). Note: read on air as "formoterol inactivates"; the drug is famotidine (Pepcid), and it activates the reflex.
• Turnbaugh et al., An obesity-associated gut microbiome with increased capacity for energy harvest, Nature (2006) (https://www.nature.com/articles/nature05414)

Concepts & tools

• GERD (https://en.wikipedia.org/wiki/Gastroesophageal_reflux_disease) · Proton-pump inhibitors (https://en.wikipedia.org/wiki/Proton-pump_inhibitor) · Barrett's esophagus (https://en.wikipedia.org/wiki/Barrett%27s_esophagus)
• Low-FODMAP diet (https://en.wikipedia.org/wiki/Low-FODMAP_diet) · Dietary fiber (https://en.wikipedia.org/wiki/Dietary_fiber)
• SIBO (https://en.wikipedia.org/wiki/Small_intestinal_bacterial_overgrowth) · Hydrogen breath test (https://en.wikipedia.org/wiki/Hydrogen_breath_test) · Dysbiosis (https://en.wikipedia.org/wiki/Dysbiosis) · Intestinal permeability (https://en.wikipedia.org/wiki/Intestinal_permeability)
• Probiotics (https://en.wikipedia.org/wiki/Probiotic) · Prebiotics (https://en.wikipedia.org/wiki/Prebiotic_(nutrition)) · Postbiotics (https://en.wikipedia.org/wiki/Postbiotic) · Akkermansia muciniphila (https://en.wikipedia.org/wiki/Akkermansia_muciniphila)
• Fecal microbiota transplantation (https://en.wikipedia.org/wiki/Fecal_microbiota_transplant) · Vowst (https://www.vowst.com) · C. difficile infection (https://en.wikipedia.org/wiki/Clostridioides_difficile_infection)
• Gut-brain axis (https://en.wikipedia.org/wiki/Gut%E2%80%93brain_axis) · Vagus nerve (https://en.wikipedia.org/wiki/Vagus_nerve)
• The Tim Ferriss Show #824 with Dr. Kevin Tracey on vagus nerve stimulation (https://tim.blog/2025/08/27/kevin-tracey-vagus-nerve/)

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The Show

• Website: medicineredefined.com (https://medicineredefined.com)
• Instagram / X: @medredefined (https://instagram.com/medredefined)

Dr. Altamash Raja

• Instagram: @draltraja (https://instagram.com/draltraja)
• LinkedIn: Altamash Raja (https://www.linkedin.com/in/altamash-raja-do-rmsk-cscs)
• Refining Health & Performance (https://refininghealthrx.com)

Dr. Darsh Shah

• Instagram: @doctor.darsh (https://www.instagram.com/doctor.darsh/)
• LinkedIn: doctordarsh (https://www.linkedin.com/in/doctordarsh/)

Ready to stop guessing and start performing? Dr. Raja is now seeing patients through his telemedicine practice — limited founding member spots available at refininghealthrx.com (https://refininghealthrx.com).

EPISODE DESCRIPTION

If antidepressants haven't worked, is that the end of the road? Dr. Patrick "Rocky" Sullivan returns to break down transcranial magnetic stimulation — what it actually does to the brain, how it differs from ECT, and where it fits alongside ketamine and Spravato. He covers accelerated theta burst protocols, why insurance decides your session count, the gap between response and remission, and what clinics are overselling. Treatment-resistant, he argues, doesn't mean untreatable.

TOPICS COVERED

• What TMS is doing at the level of the brain, and how it differs from ECT
• Why depression is likely several conditions sharing one label
• Standard vs. accelerated protocols — theta burst, SAINT, and the 36-session insurance ceiling
• Choosing between TMS, ketamine, Spravato, and ECT for a specific patient
• Neuromodulation for chronic pain — CRPS, fibromyalgia, and the pain-mood overlap
• Field critique: what clinics oversell, and what patients should ask before starting

RESOURCES & LINKS MENTIONED

Studies & protocols

• STAR*D trial — diminishing returns with each successive antidepressant (https://www.nimh.nih.gov/funding/clinical-research/practical/stard)
• SAINT / Stanford accelerated protocol — Dr. Nolan Williams (https://med.stanford.edu/nolanwilliams.html)
• Clinical TMS Society — annual meeting, TMS-for-pain training (https://www.clinicaltmssociety.org/)

Concepts & tools

• Transcranial magnetic stimulation (https://en.wikipedia.org/wiki/Transcranial_magnetic_stimulation) · Theta burst stimulation (https://en.wikipedia.org/wiki/Theta_burst_stimulation)
• Electroconvulsive therapy (https://en.wikipedia.org/wiki/Electroconvulsive_therapy) · Esketamine / Spravato (https://en.wikipedia.org/wiki/Esketamine)
• Dorsolateral prefrontal cortex (https://en.wikipedia.org/wiki/Dorsolateral_prefrontal_cortex) · Primary motor cortex (https://en.wikipedia.org/wiki/Primary_motor_cortex)
• Treatment-resistant depression (https://en.wikipedia.org/wiki/Treatment-resistant_depression) · D-cycloserine (https://en.wikipedia.org/wiki/Cycloserine)
• Complex regional pain syndrome (https://en.wikipedia.org/wiki/Complex_regional_pain_syndrome) · Fibromyalgia (https://en.wikipedia.org/wiki/Fibromyalgia) · Central sensitization (https://en.wikipedia.org/wiki/Central_sensitization)
• Deep TMS / Brainsway (https://www.brainsway.com/) · IntellxxDNA genomic testing (https://intellxxdna.com/)

Related episodes

• Ep. 177: Rocky Sullivan on ketamine (round one)
• Ep. 191 & 192: Metabolic psychiatry two-parter with Dr. Matt Bernstein

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Dr. Patrick "Rocky" Sullivan

• Initia Nova — Cherry Hill, NJ & Wilmington, DE (https://myinitianova.com/)

The Show

• Website: medicineredefined.com (https://medicineredefined.com)
• Instagram / X: @medredefined (https://instagram.com/medredefined)

Dr. Altamash Raja

• Instagram: @draltraja (https://instagram.com/draltraja)
• LinkedIn: Altamash Raja (https://www.linkedin.com/in/altamash-raja-do-rmsk-cscs)
• Refining Health & Performance (https://refininghealthrx.com)

Dr. Darsh Shah

• Instagram: @doctor.darsh (https://www.instagram.com/doctor.darsh/)
• LinkedIn: doctordarsh (https://www.linkedin.com/in/doctordarsh/)

Ready to stop guessing and start performing? Dr. Raja is now seeing patients through his telemedicine practice — limited founding member spots available at refininghealthrx.com (https://refininghealthrx.com).

Dr. Darsh Shah and Dr. Altamash Raja catch up on hybrid athlete training, peptides, AI, red light therapy, health tech, and the balance between optimization and resilience.

From HYROX prep and the rise of competitions like the Lifetime Games to recent peptide committee votes, CMS reimbursement cuts, and AI tools like Claude and ChatGPT, the conversation explores how new trends are changing fitness, medicine, and daily decision-making for both patients and doctors. They also reflect on building a “second brain” with AI, using wearables without letting data run your life, and why building capacity matters more than chasing a perfect balance.

TOPICS COVERED

• High Rocks prep, hybrid athlete training, and the rise of functional fitness competitions
• Lifetime Games and the evolution of volume-based fitness challenges
• Peptide committee vote, FDA approval process, and what it means for clinical practice
• AI updates: Claude Opus 5, ChatGPT, token maxing, and avoiding LLM dependency
• Building mental models with Naval Ravikant, Morgan Housel, and James Clear
• Red light therapy, photobiomodulation, and joint health
• CMS same-day procedure cuts and the business of medicine
• Luna Band wearable, AI coaching, and health data integration
• Stephen Bartlett, optimization culture, and the danger of letting tools own you
• Building capacity, resilience, and why balance is overrated

RESOURCES & LINKS MENTIONED

• High Rocks (https://en.wikipedia.org/wiki/Hyrox)
• Lifetime Games (https://www.lifetime.life/events/lt-games.html)
• BPC-157 & TB-500 (https://en.wikipedia.org/wiki/BPC-157)
• Claude AI (https://claude.ai)
• ChatGPT (https://openai.com/chatgpt)
• Naval Ravikant (https://nav.al)
• Morgan Housel (https://www.morganhousel.com)
• James Clear (https://jamesclear.com)
• David Senra / Founders Podcast (https://www.founderspodcast.com)
• Luna Band (https://lunaband.com)
• Photobiomodulation / Red Light Therapy (https://en.wikipedia.org/wiki/Photobiomodulation)
• CMS Reimbursement Updates (https://www.cms.gov)
• Managing Oneself by Peter Drucker (https://www.amazon.com/Managing-Oneself-Harvard-Business-Classics/dp/142212312X)

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The Show

• Website: medicineredefined.com (https://medicineredefined.com)
• Instagram / X: @medredefined (https://instagram.com/medredefined)

Dr. Altamash Raja

• Instagram: @draltraja (https://instagram.com/draltraja)
• LinkedIn: Altamash Raja (https://www.linkedin.com/in/altamash-raja-do-rmsk-cscs-0b1a8039/)
• Refining Health & Performance (https://refininghealthrx.com)

Dr. Darsh Shah

• Instagram: @doctor.darsh (https://www.instagram.com/doctor.darsh/)
• LinkedIn: doctordarsh (https://www.linkedin.com/in/doctordarsh/)

Ready to stop guessing and start performing? Dr. Raja is now seeing patients through his telemedicine practice — limited founding member spots available at refininghealthrx.com (https://refininghealthrx.com).

Dr. Darsh Shah and Dr. Altamash Raja sit down with Dr. Marissa McCarthy, a board-certified physical medicine and rehabilitation physician, brain injury specialist, and residency program director for the University of South Florida PM&R program. Dr. McCarthy practices at the USF Concussion Center and the Performance Lab in Tampa, where she works with athletes, military veterans, and patients recovering from traumatic brain injury.

This conversation goes far beyond the basics of concussion care. From why complete rest is no longer the standard after a concussion to how sleep, exercise, nutrition, and inflammation influence recovery, Dr. McCarthy breaks down what the current evidence says about supplements like creatine, magnesium, and omega-3s. She also explores post-concussion syndrome, hyperbaric oxygen therapy, cognitive reserve, and what it really takes to build a brain that's resilient—not just after injury, but throughout life.

TOPICS COVERED

• What PM&R is and why brain injury is a fellowship within the specialty
• Why concussion is a clinical diagnosis and what gets missed in the ER
• The inflammatory cascade after brain injury and how to address it
• Why the "dark room and rest" protocol is outdated
• The Mediterranean diet, fish oil (DHA), and magnesium as foundational interventions
• Creatine for brain health: 20 grams a day and why it matters
• Post-concussion syndrome: the miserable minority and why some people don't recover
• Hyperbaric oxygen therapy: the evidence, the risks, and CNS toxicity
• Sleep as the most underrated recovery tool and how to sleep train your kids
• Cognitive reserve, neuroplasticity, and preventing early onset dementia
• The glymphatic system, autophagy, and why a 16-hour fast matters
• How the Performance Lab in Tampa is redefining interdisciplinary brain injury care

RESOURCES MENTIONED

Dr. Marissa McCarthy
USF Concussion Center: https://health.usf.edu/medicine/neurology/concussion
The Performance Lab Tampa: https://tpltampa.com/
Instagram: @tpltampadoc

The End of Alzheimer's by Dr. Dale Bredesen
Book: https://www.drbredesen.com/books

Sport Concussion Assessment Tool (SCAT)
Resource: https://bjsm.bmj.com/content/57/11/622

Nordic Naturals ProDHA
Website: https://www.nordicnaturals.com/

Omega Quant (Omega-3 testing)
Website: https://omegaquant.com/

Dr. Bruce Letty (Sub-symptom threshold exercise research)
University at Buffalo Concussion Management Clinic

REDUCE-IT Trial (Icosapent Ethyl/Vascepa)
Study: https://www.nejm.org/doi/full/10.1056/NEJMoa1812792

Glymphatic System
Concept: https://en.wikipedia.org/wiki/Glymphatic_system

Cognitive Reserve
Concept: https://en.wikipedia.org/wiki/Cognitive_reserve

ApoE4 and Alzheimer's Risk
Concept: https://en.wikipedia.org/wiki/Apolipoprotein_E

Blue Zones
Concept: https://en.wikipedia.org/wiki/Blue_zone

The Comfort Crisis by Michael Easter
Book: https://www.michaeleasterwriter.com/the-comfort-crisis

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The Show

• Website: medicineredefined.com (https://medicineredefined.com)
• Instagram / X: @medredefined (https://instagram.com/medredefined)

Dr. Altamash Raja

• Instagram: @draltraja (https://instagram.com/draltraja)
• LinkedIn: Altamash Raja (https://www.linkedin.com/in/altamash-raja-do-rmsk-cscs-0b1a8039/)
• Refining Health & Performance (https://refininghealthrx.com)

Dr. Darsh Shah

• Instagram: @doctor.darsh (https://www.instagram.com/doctor.darsh/)
• LinkedIn: doctordarsh (https://www.linkedin.com/in/doctordarsh/)

Ready to stop guessing and start performing? Dr. Raja is now seeing patients through his telemedicine practice — limited founding member spots available at refininghealthrx.com (https://refininghealthrx.com).

Dr. Darsh Shah and Dr. Altamash Raja sit down with Dorian Greenow, founder of Keto-Mojo, for a wide-ranging conversation on ketosis, metabolic flexibility, chronic disease, and what it means to make health measurable.

Dorian shares how his own experience with weight gain, depression, and discovering nutritional ketosis shaped the creation of Keto-Mojo. From the history of ketogenic diets to the difference between nutritional and therapeutic ketosis, the conversation explores food addiction, ketone testing, metabolic psychiatry, cancer research, exogenous ketones, and why the future of healthcare may depend on outcomes — not sick care.

TOPICS COVERED

• Why keto is more than a fad diet or marketing term
• Dorian’s personal journey with weight loss, depression, and nutritional ketosis
• How Keto-Mojo began by making ketone testing more affordable
• The difference between nutritional ketosis and therapeutic ketosis
• How ketones work as both fuel and signaling molecules
• Emerging research on ketogenic diets for bipolar disorder, schizophrenia, and glioblastoma
• Protein, muscle loss, aging, and how to think about keto beyond weight loss
• How ultra-processed foods, sugary drinks, and food policy shape metabolic health
• Why healthcare should focus on outcomes instead of sick care

RESOURCES MENTIONED

Dorian Greenow / Keto-Mojo
Website: https://keto-mojo.com/
Dorian Greenow: https://keto-mojo.com/our-team/dorian-greenow-president-founder/

MyMojoHealth
Website: https://keto-mojo.com/mymojohealth/

The Art and Science of Low Carbohydrate Living by Stephen Phinney and Jeff Volek
Book: https://www.amazon.com/Art-Science-Low-Carbohydrate-Living/dp/0983490708

Volek et al., “Metabolic characteristics of keto-adapted ultra-endurance runners,” Metabolism (2016)
Study: https://pubmed.ncbi.nlm.nih.gov/26892521/

Campbell et al., “A pilot study of a ketogenic diet in bipolar disorder,” BJPsych Open (2025)
Study: https://www.cambridge.org/core/journals/bjpsych-open/article/pilot-study-of-a-ketogenic-diet-in-bipolar-disorder-clinical-metabolic-and-magnetic-resonance-spectroscopy-findings/7AF8E2ECB765A65B03C97F770BB90BC7

Baszucki Group Metabolic Psychiatry Initiative
Website: https://baszuckigroup.com/our-work/metabolic-mental-health/metabolic-psychiatry-initiative/

Metabolic Mind
Website: https://www.metabolicmind.org/

Brain Energy by Dr. Chris Palmer
Book: https://brainenergy.com/

Amaral et al., “A phase 1 safety and feasibility trial of a ketogenic diet plus standard of care for glioblastoma,” Scientific Reports (2025)
Study: https://www.nature.com/articles/s41598-025-06675-6

Glucose ketone index / GKI Calculator
Keto-Mojo: https://keto-mojo.com/glucose-ketone-index-gki/

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The Show

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• Instagram / X: @medredefined (https://instagram.com/medredefined)

Dr. Altamash Raja

• Instagram: @draltraja (https://instagram.com/draltraja)
• LinkedIn: Altamash Raja (https://www.linkedin.com/in/altamash-raja-do-rmsk-cscs (https://www.linkedin.com/in/altamash-raja-do-rmsk-cscs-0b1a8039/))
• Refining Health & Performance (https://refininghealthrx.com)

Dr. Darsh Shah

• Instagram: @doctor.darsh (https://www.instagram.com/doctor.darsh/)
• LinkedIn: doctordarsh (https://www.linkedin.com/in/doctordarsh/)

Ready to stop guessing and start performing? Dr. Raja is now seeing patients through his telemedicine practice — limited founding member spots available at refininghealthrx.com (https://refininghealthrx.com).

Dr. Darsh Shah and Dr. Altamash Raja sit down with Brian Devorkin, a third-year medical student at Case Western and host of BackedBriScience, for a wide-ranging conversation on fulfillment, longevity, chronic illness, and the harder questions behind choosing medicine.

Brian shares how chronic fatigue and Lyme disease shaped his understanding of health, agency, and what it means to “get your life back.” From his gap year working with longevity researcher David Sinclair to the realities of medical school, the conversation explores success versus fulfillment, the loneliness of thinking differently, the slippery slope of wellness marketing, and why the basics - sleep, exercise, nutrition, relationships, and stress - still matter most. At its core, this episode asks why health span matters more than simply living longer.

TOPICS COVERED

• Why success and fulfillment are not the same thing
• How health shapes agency, identity, and the ability to live fully
• Brian’s experience with chronic fatigue, Lyme disease, and feeling like himself again
• Why health span matters more than simply living longer
• The problem with chasing supplements, protocols, and “silver bullet” wellness
• How functional medicine, longevity medicine, and PM&R overlap — and where the language can get complicated
• How exercise, nutrition, and discipline become part of someone’s identity
• The difference between healthy discipline and unhealthy rigidity
• The loneliness that can come with thinking differently in medical school
• Whether living forever would actually make life more meaningful

RESOURCES MENTIONED

• Brian Devorkin/BackedBriScience
  Website: https://www.backedbriscience.com/
  Instagram: @briandevorkin (https://www.instagram.com/briandevorkin/)
  Podcast: BackedBriScience (https://podcasts.apple.com/us/podcast/backedbriscience/id1725648624)
• David Sinclair (https://davidasinclair.com/)
  Lifespan by David Sinclair (https://lifespanbook.com/)
• Jocko Willink (https://jocko.com/)
  Discipline Equals Freedom by Jocko Willink (https://www.amazon.com/Discipline-Equals-Freedom-Field-Manual/dp/1250156947)
• Chris Williamson (https://chriswillx.com/)
  Modern Wisdom Podcast (https://chriswillx.com/podcast/)
• The Consistency Project
  Podcast by EC Synkowski (https://optimizemenutrition.com/theconsistencyproject/)
• Charles Duhigg (https://charlesduhigg.com/)
  The Power of Habit by Charles Duhigg (https://charlesduhigg.com/the-power-of-habit/)
• Longevity escape velocity (https://en.wikipedia.org/wiki/Longevity_escape_velocity)
• Health span (https://en.wikipedia.org/wiki/Healthspan)
• Functional medicine (https://en.wikipedia.org/wiki/Functional_medicine)
• PM&R / Physiatry (https://www.aapmr.org/about-physiatry)

FOLLOW US

Website: medicineredefined.com (https://medicineredefined.com)
Instagram / X: @medredefined (https://instagram.com/medredefined)

Dr. Altamash Raja

Instagram: @draltraja (https://instagram.com/draltraja)
LinkedIn: Altamash Raja (https://www.linkedin.com/in/altamash-raja-do-rmsk-cscs)
Refining Health & Performance (https://refininghealthrx.com)

Dr. Darsh Shah

Instagram: @doctor.darsh (https://www.instagram.com/doctor.darsh/)
LinkedIn: doctordarsh (https://www.linkedin.com/in/doctordarsh/)

Ready to stop guessing and start performing? Dr. Raja is now seeing patients through his telemedicine practice — limited founding member spots available at refininghealthrx.com (https://refininghealthrx.com)

EPISODE DESCRIPTION

Is arthritis really just wear and tear? Dr. Altamash Raja and Dr. Darsh Shah make the case for metabolic osteoarthritis — the phenotype where fat tissue drives joint inflammation through hormones, not load. They cover the semaglutide and metformin trials, new weight-independent cartilage data, and how to spot the metabolic-OA patient in clinic. The takeaway: treat the disease, not just the symptom.

TOPICS COVERED

• Reframing OA from "wear and tear" to a disease with a distinct metabolic phenotype
• The OA phenotypes — age-related, post-traumatic, inflammatory, malalignment, pain-sensitization, and metabolic syndrome OA
• The hand-OA clue: why obesity links to arthritis even in joints that bear no weight
• New drug evidence — semaglutide (STEP 9), metformin (JAMA), and weight-independent cartilage protection in mice
• How adipokines, insulin resistance, AGEs, and Hoffa's fat pad drive joint inflammation
• Clinic application: identifying the MetS-OA patient, which labs to order, and the muscle-loss risk of rapid weight loss

RESOURCES & LINKS MENTIONED

Studies

• Zhuo et al., "Metabolic syndrome meets osteoarthritis," Nature Reviews Rheumatology (2012) (https://www.nature.com/articles/nrrheum.2012.135)
• STEP 9 trial — semaglutide 2.4 mg in obesity and knee OA, NEJM (2024) (https://www.novonordisk-us.com/media/news-archive/news-details.html?id=171970)
• Pan et al., "Metformin for Knee Osteoarthritis in Patients With Overweight or Obesity," JAMA (2025) (https://jamanetwork.com/journals/jama/fullarticle/2833338)
• Semaglutide, weight-loss-independent OA mechanism, Cell Metabolism (2026) (https://www.cell.com/cell-metabolism/abstract/S1550-4131(26)00008-2) Concepts & tools
• Osteoarthritis (https://en.wikipedia.org/wiki/Osteoarthritis) · Metabolic syndrome (https://en.wikipedia.org/wiki/Metabolic_syndrome)
• WOMAC (https://en.wikipedia.org/wiki/WOMAC) · Kellgren–Lawrence grading (https://en.wikipedia.org/wiki/Kellgren%E2%80%93Lawrence_grading_scale)
• GLP-1 (https://en.wikipedia.org/wiki/Glucagon-like_peptide-1) · AMPK (https://en.wikipedia.org/wiki/AMP-activated_protein_kinase)
• Advanced glycation end-products (https://en.wikipedia.org/wiki/Advanced_glycation_end-product) · Infrapatellar (Hoffa's) fat pad (https://en.wikipedia.org/wiki/Infrapatellar_fat_pad)
• Leptin (https://en.wikipedia.org/wiki/Leptin) · HOMA-IR (https://en.wikipedia.org/wiki/Homeostatic_model_assessment) · hs-CRP (https://en.wikipedia.org/wiki/C-reactive_protein)
• Seronegative arthritis (https://en.wikipedia.org/wiki/Seronegative_arthropathy) · DMARDs (https://en.wikipedia.org/wiki/Disease-modifying_antirheumatic_drug)

FOLLOW US

The Show

• Website: medicineredefined.com (https://medicineredefined.com)
• Instagram / X: @medredefined (https://instagram.com/medredefined)

Dr. Altamash Raja

• Instagram: @draltraja (https://instagram.com/draltraja)
• LinkedIn: Altamash Raja (https://www.linkedin.com/in/altamash-raja-do-rmsk-cscs)
• Refining Health & Performance (https://refininghealthrx.com)

Dr. Darsh Shah

• Instagram: @doctor.darsh (https://www.instagram.com/doctor.darsh/)
• LinkedIn: doctordarsh (https://www.linkedin.com/in/doctordarsh/)

Ready to stop guessing and start performing? Dr. Raja is now seeing patients through his telemedicine practice — limited founding member spots available at refininghealthrx.com (https://refininghealthrx.com).