Medicine Redefined

EPISODE DESCRIPTION

Can you stand on one leg for 10 seconds? In the training series finale, Dr. Altamash Raja and Dr. Darsh Shah cover the qualities that keep you upright: balance, mobility, and stability. They look at why balance plus strength work cuts falls by about a third and why controlled range beats passive flexibility. They also cover whether a short static stretch hurts your lift and how core-specific work compares with general exercise for back pain. They close with two simple tests you can do tonight.

TOPICS COVERED

• Flexibility, mobility, balance, and stability: what each means and why stability may matter most
• Fall prevention: balance plus resistance training, the right side for a cane, and talking to aging parents
• Stretching vs. mobility: FRC, CARs, PAILs/RAILs, and their overlap with osteopathic muscle energy technique
• Static stretching before training: under 60 seconds plus a dynamic warm-up costs little
• Core stability vs. general exercise for back pain: a short-term edge that fades, and why adherence wins
• Two at-home tests: the 10-second single-leg stance and the sit-to-rise test, plus how to train balance daily

RESOURCES & LINKS MENTIONED

Studies

• Sherrington et al., Exercise for preventing falls in community-dwelling older people, Cochrane (2019) (https://doi.org/10.1002/14651858.CD012424.pub2)
• Lesinski et al., Balance training dose-response in healthy older adults, Sports Med (2015) (https://doi.org/10.1007/s40279-015-0375-y)
• Konrad et al., Chronic effects of stretching on range of motion, J Sport Health Sci (2024) (https://pmc.ncbi.nlm.nih.gov/articles/PMC10980866/)
• Afonso et al., Strength training vs. stretching for range of motion, Healthcare (2021) (https://doi.org/10.3390/healthcare9040427)
• Behm et al., Acute effects of muscle stretching on performance, Appl Physiol Nutr Metab (2016) (https://doi.org/10.1139/apnm-2015-0235)
• Wang et al., Core stability vs. general exercise for chronic low back pain, PLOS One (2012) (https://pmc.ncbi.nlm.nih.gov/articles/PMC3524111/)
• Brito et al., Sit-to-rise ability and all-cause mortality, Eur J Prev Cardiol (2014) (https://doi.org/10.1177/2047487312471759)
• Araújo et al., 10-second one-legged stance and survival, BJSM (2022) (https://bjsm.bmj.com/content/56/17/975)
• Oja et al., Specific sports and all-cause mortality, BJSM (2017) (https://doi.org/10.1136/bjsports-2016-096822)

Concepts & tools

• PNF stretching (https://en.wikipedia.org/wiki/Proprioceptive_neuromuscular_facilitation) · Muscle energy technique (https://en.wikipedia.org/wiki/Muscle_energy_technique)
• Stuart McGill, Back Mechanic (https://www.backfitpro.com/books/) · Ed Thorp (https://en.wikipedia.org/wiki/Edward_O._Thorp)

On-air corrections

• The 91–120 minutes a week of balance training (3 sessions, about 12 weeks) comes from Lesinski 2015, not the ACSM.
• Regular stretching does produce lasting range-of-motion gains (Konrad 2024). Full-range strength training produces similar gains (Afonso 2021).
• Oja 2017 found racquet sports, not tennis alone, had the lowest mortality of the six sport types studied.

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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).

EPISODE DESCRIPTION

Strength is how much force you can make. Power is how fast you make it, and it fades roughly twice as fast with age. In part four of the training series, Dr. Altamash Raja and Dr. Darsh Shah explain why most of that loss isn't about muscle size, how to train power with moderate loads moved fast, and why you stop a set while the reps are still fast. They close with how to get back to sprinting without a hamstring strain.

TOPICS COVERED

• Strength, power, speed, and rate of force development: where each sits on the force–velocity curve
• Why power fades faster than strength, and why most of the loss is muscle quality, not muscle mass
• The sit-to-stand power test: a simple at-home check linked to mortality and hospitalization in older adults
• How to train power: moderate loads moved fast, low volume, long rest, and contrast sets
• Stop the set while reps are still fast: velocity loss, fewer reps, better jump gains
• Speed without injury: strides, hill sprints, and why a recent hamstring strain is the biggest red flag

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)
• Skelton et al., Strength, power and functional ability in people aged 65–89, Age Ageing (1994) (https://doi.org/10.1093/ageing/23.5.371)
• Baltasar-Fernández et al., Relative muscle power loss in older adults over 8 years, Eur J Appl Physiol (2026) (https://doi.org/10.1007/s00421-025-05947-3)
• Toledo Study for Healthy Aging: low sit-to-stand power, hospitalization and mortality, J Sport Health Sci (2026) (https://doi.org/10.1016/j.jshs.2025.101080)
• El Hadouchi et al., Power vs. strength training in older adults, Eur Rev Aging Phys Act (2022) (https://pmc.ncbi.nlm.nih.gov/articles/PMC9367108/)
• Pareja-Blanco et al., Velocity loss during resistance training, Scand J Med Sci Sports (2017) (https://doi.org/10.1111/sms.12678)
• Green et al., Risk factors for hamstring strain injury, BJSM (2020) (https://bjsm.bmj.com/content/54/18/1081)

Concepts & tools

• Rate of force development (https://en.wikipedia.org/wiki/Rate_of_force_development) · Contrast (complex) training (https://en.wikipedia.org/wiki/Complex_training) · Sarcopenia (https://en.wikipedia.org/wiki/Sarcopenia)

On-air corrections

• The power and strength decline rates (about 3.5% vs. 1–2% a year) come from adults aged 65–89, not from age 30.
• In the Toledo study, women with low sit-to-stand power had about double the risk of death (HR 2.04), not 204%. These are observational data.
• The velocity-loss study was Pareja-Blanco's group in Spain, not Brazil.

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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).

EPISODE DESCRIPTION

Is zone 2 really the secret to longevity? In part three of the training series, Dr. Altamash Raja and Dr. Darsh Shah dig into the cardio evidence: why the biggest drop in mortality comes from going from nothing to something, how much benefit sits beyond 150 minutes a week, and what the J-curve and athlete AFib data actually show. They question the zone 2 and Norwegian 4x4 hype, test wearable VO2 max estimates, and share a single-run rule for avoiding running injuries.

TOPICS COVERED

• The floor and the ceiling: the 150/75-minute guideline, benefit out to 560–610 minutes a week, and why the least fit need more
• Nothing to something: the mortality curve and why even five vigorous minutes a week registers
• The J-curve revisited: no mortality penalty at high volumes, but a real AFib signal in some athletes
• Zone 2 and the Norwegian 4x4: what the evidence supports, and why consistency beats the "ideal" protocol
• Measuring intensity: heart-rate zones, chest straps vs. wrist devices, and how far off Apple Watch VO2 max can be
• Running injuries: why a single long run matters more than the 10% weekly-mileage rule

RESOURCES & LINKS MENTIONED

Studies

• Liang et al., Physical activity, fitness, and cardiovascular disease, BJSM (2026) (https://pmc.ncbi.nlm.nih.gov/articles/PMC13479690/)
• Potter et al., Physical activity and all-cause mortality in 594,000 US adults, Ann Epidemiol (2026) (https://pubmed.ncbi.nlm.nih.gov/42309274/)
• Lee et al., Physical activity intensity and mortality, Circulation (2022) (https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.058162)
• Schnohr et al., Dose of jogging and long-term mortality, JACC (2015) (https://pubmed.ncbi.nlm.nih.gov/25660917/)
• Newman et al., Atrial fibrillation in athletes, BJSM (2021) (https://pubmed.ncbi.nlm.nih.gov/34253538/)
• Storoschuk et al., Much Ado About Zone 2, Sports Medicine (2025) (https://doi.org/10.1007/s40279-025-02261-y)
• Helgerud et al., High-intensity intervals and VO2 max, Med Sci Sports Exerc (2007) (https://pubmed.ncbi.nlm.nih.gov/17414804/)
• Lambe et al., Apple Watch VO2 max validation, PLOS One (2025) (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0323741)
• Frandsen et al., Identifying high-risk running sessions, BJSM (2025) (https://pmc.ncbi.nlm.nih.gov/articles/PMC12421110)

Concepts & tools

• VO2 max (https://en.wikipedia.org/wiki/VO2_max) · Atrial fibrillation (https://en.wikipedia.org/wiki/Atrial_fibrillation) · Cooper test (https://en.wikipedia.org/wiki/Cooper_test)

On-air corrections

• Liang's genetic analysis supported fitness lowering heart failure risk; it didn't test all-cause mortality.
• Moderate intensity is roughly 65–75% of max heart rate (ACSM), not 40–70%.
• The "subtract 10 for chronic medication" rule is from Phil Maffetone's 180-minus-age formula, an aerobic ceiling, not max heart rate.
• In Helgerud 2007, both interval protocols (15/15 and 4x4) beat steady-state training for VO2 max.
• The coronary-calcium overlap was Dr. Raja's hypothesis, not a Newman 2021 finding.

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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).

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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• 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

FOLLOW US

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)

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-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

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-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).