Next Phase Human

Show NotesDr. Ayad has been board-certified in obesity medicine since 2013 and has practiced only weight management for over 12 years. His path started during his family medicine residency in Wheeling, West Virginia, where he watched the same patients readmitted again and again with ever-longer medication lists, and concluded the weight itself had to be treated.He explains the Obesity Medicine Association’s definition of obesity as a chronic, treatable, progressive, relapsing, multifactorial disease, with genetics, environment, physiology, and behavior all contributing. He breaks down food noise and why patients who regained weight after sleeve and bypass surgery often still had it, until medication quieted it.On weight regain, he outlines the three forces of metabolic adaptation: a lower metabolic rate that lags behind regain, elevated ghrelin, and reduced leptin. He covers why BMI misses visceral fat, why Asian populations use lower BMI cutoffs (overweight from 23, obesity from 27), and why body composition matters more than the scale.The medication tour covers phentermine and its cardiac cautions, Qsymia’s evening craving coverage and teratogenic risk, Contrave for emotional eating (avoid with seizures or opioids), orlistat’s limits, and metformin for insulin resistance and PCOS. He explains how GLP-1s mimic our natural gut hormones with a longer half-life, why that causes nausea and constipation, how he chooses between semaglutide and tirzepatide, and the SELECT trial’s cardiovascular benefit. He contrasts oral Wegovy (semaglutide, taken on an empty stomach) with Foundayo (a different molecule, any time of day), and previews retatrutide and CagriSema.Safety topics include protecting muscle and bone with 1.5 to 2 g/kg of protein and resistance training, dizziness from overtreated blood pressure or rebound hypoglycemia, dehydration, contraindications including GLP-1–triggered pancreatitis and medullary thyroid cancer, stopping two months before conception, avoiding use while breastfeeding, and holding even daily pills before anesthesia. He closes with how to vet online prescribers, when bariatric surgery still fits, and a message for anyone who has blamed themselves for years: it’s biology, not a character flaw.

Dr. Maheep Virdi is a board-certified neurologist who joins Dr. Rasham Sandhu to walk through Parkinson's disease in depth, from the earliest, easy-to-miss symptoms through the latest treatment technology.In this conversation, they cover:The soft early symptoms that can precede a Parkinson's diagnosis by roughly six years, including new-onset constipation, shoulder pain unrelated to movement, difficulty turning over in bed, and REM behavior disorder (physically acting out dreams)The gut-brain connection in Parkinson's, including how the vagus nerve links the gut to the brain and how a protein called alpha-synuclein, produced by certain gut bacteria, may travel to the brain and contribute to the diseaseEnvironmental risk factors including paraquat and other pesticides, manganese exposure from welding, the industrial solvent TCE, carbon monoxide exposure, air pollution, and contaminated well waterWhy coordination-focused exercise, such as small hand-muscle work, balance training, dancing, Tai Chi, and boxing, has shown more benefit for Parkinson's patients than strength training or high-intensity cardioDietary guidance including the Mediterranean diet, avoiding processed foods, and why patients need to separate protein intake from their carbidopa/levodopa medication by at least an hour, since dietary protein competes with the medication for transport across the blood-brain barrierThe DaTscan, a diagnostic imaging test used alongside clinical evaluation rather than as a standalone diagnosisGenetic factors, including the LRRK2 and parkin genes, and why genetic testing alone hasn't proven to be a reliable predictorDeep brain stimulation (DBS): how it works, its dramatic effect on tremor, and the extensive psychological screening required beforehand due to a risk of suicidal ideationNewer treatment technology, including subcutaneous infusion devices for carbidopa/levodopa and a newer drug pathway (A2A receptor antagonist) that works outside the traditional dopaminergic systemA rapid-fire round on coffee, alcohol, sauna, cold plunge, artificial sweeteners, and other everyday lifestyle factors and their effect on Parkinson's risk

IntroIn this episode of Next Phase Human, Dr. Rasham Sandhu continues his conversation with Dr. Rasha Quran, an infectious disease specialist at Kern Medical Center and UCLA and director of the infectious disease fellowship, picking up where they left off in part one. This time they focus on Valley fever, a fungal infection responsible for roughly a third of community acquired pneumonia in the Central Valley, then work through a wide ranging discussion of prevention, treatment, and where infectious disease medicine is headed next.Topics CoveredWhat Valley fever is and how it spreads through dust and soilWho is most likely to get infected versus who is most likely to develop severe diseaseWhy cases are rising across the Central Valley and the broader desert SouthwestWhen and how doctors should test for Valley fever, and why the blood test can be misleading early onCommon misconceptions among both patients and healthcare providersWhat treatment actually involves and why relapse remains a lifelong riskOther fungal and tick borne infections that are becoming more commonEveryday habits, from cooking at home to blood sugar control, that lower infection riskThe role of exercise and sleep in immune functionA topical hormone treatment that helps prevent UTIs in postmenopausal womenHer honest take on supplements and probioticsA rapid fire myth or fact round covering raw milk, antibiotics, hand sanitizer, zinc, and moreWhy she believes immune modulation could reduce reliance on antibiotics in the futureMentioned in EpisodeValley fever (coccidioidomycosis)Brucellosis and raw milkUCLA genetic and DNA sequencing research into Valley fever susceptibilityDr. Manish Butte's published research on treating disseminated Valley fever with cytokine therapyTopical estrogen for preventing UTIs in postmenopausal womenHistorical use of the ketogenic diet to treat UTIs before antibiotics existedConnect with Dr. Sandhu California Cardiovascular Institute | cacvinst.com

IntroIn this episode of Next Phase Human, Dr. Rasham Sandhu sits down with Dr. Sandeep S. Walia, a Harvard trained cataract and refractive surgeon who serves as chief medical officer and owner of West Coast Eye Institute in Bakersfield. They cover the real truth about screen time and vision, why cataracts are unavoidable, and what is actually driving the dry eye epidemic, then close with a look at where eye care is headed next.Topics CoveredDr. Walia's path from stand up comedy and an MBA to Harvard trained eye surgeryWhether eyes are aging faster today than in past generationsBlue light, smartphones, and what the data actually showsWhether staring at screens really damages children's visionThe difference between optometry and ophthalmologyLASIK, PRK, and SMILE, and how to know which fits youComplications, age limits, and whether vision can regress after LASIKLight adjustable lenses and what is coming next in refractive technologyWhich eye supplements and foods are backed by real dataWhy every person will eventually develop a cataractWhat speeds up cataract formation, from smoking to steroids to UV exposureThe many contributors to dry eye, from air conditioning to hormones to contact lens useHow sleep quality affects eye health, including a look at red light therapyThe silent eye diseases that can progress without obvious symptomsFloaters and retinal tears, and when they are actually an emergencyRapid fire verdicts on coffee, sunglasses, eye vitamins, and moreThe most common regret he hears from patientsHis top advice for protecting eyesight for lifeMentioned in EpisodeAREDS2 (Age-Related Eye Disease Study) supplement formulaAtropine eye drops for myopia controlLight adjustable lens (LAL) technologyLipiflow and IPL (intense pulse light) for dry eye treatmentWhoop and Eight Sleep, mentioned by Dr. Sandhu for his own sleep trackingAn Australian study on iPad reading and next day sleep qualityConnect with Dr. Sandhu California Cardiovascular Institute | cacvinst.com

IntroDementia is one of the most feared diagnoses in medicine, and one of the most misunderstood. Dr. Maheep Virdi, board-certified neurologist at California Neurology Institute, joins Dr. Sandhu to draw a clear line between normal aging and the real thing, and to walk through exactly what protects long-term brain health, from the basics of sleep and exercise to the newest amyloid-targeting drug therapies reshaping the field.Topics CoveredNormal aging vs. real warning signs of dementiaWhat's happening in the brain years before any symptom appearsThe different types of dementia and how they behave differentlyGenetics vs. lifestyle, and what an APOE4 result actually meansThe heart-brain connection, and the single highest-yield lifestyle changeSleep, the glymphatic system, and memory consolidationExercise, blood flow, and neuroplasticityDiet, cholesterol, and the truth about supplementsSocial connection, purpose, and loneliness as risk factorsHearing loss, vision, dental health, sleep apnea, and AFib as contributing factorsSmoking, vaping, and substance useThe diagnostic workup: MRI, PET amyloid scans, centiloid scoring, MoCA/MMSE, ApoE4 testingNew anti-amyloid drug therapies and their real risksLewy body dementia and why it's treated differentlyChoosing a care facility, and what actually improves outcomesMentioned in EpisodeAPOE4 genetic testingPET amyloid scan and centiloid scaleMoCA (Montreal Cognitive Assessment) and MMSE (Mini-Mental State Examination)Anti-amyloid monoclonal antibody infusion therapiesARIA (amyloid-related imaging abnormalities)The glymphatic systemREM behavior disorderLewy body dementia and frontotemporal dementiaConnectDr. Rasham Sandhu Instagram: @nextphasehumanDr. Maheep Virdi / California Neurology Institute Website: caneuroinst.com Instagram: @caneuroinst 8335 Brimhall Rd., Bldg. 1100, Bakersfield, CA 93312 (661) 432-7851Next Phase Human Podcast Instagram: @nextphasehuman Spotify: https://open.spotify.com/show/033qZ46toArgzpRrRrlpvb Apple Podcasts: https://podcasts.apple.com/podcast/next-phase-human-w-dr-sandhu/id1896859526California Cardiovascular Institute 8337 Brimhall Rd Building 1200, Bakersfield, CA 93312 cacvinst.comInterested in being a guest on Next Phase Human? Contact: [email protected]