A patient came in with weight gain nobody could explain, and every test came back clean. Shiv K. Goel, an internal medicine and functional medicine physician in San Antonio, went looking at what had changed in her life instead of ordering more labs. What he found was a husband's shift change, six years of barely seeing each other, and a body carrying a load no panel had measured.
⏱️ Chapters:
0:00 Introduction
0:31 The patient whose workup came back completely clean
2:59 A relationship is not only a marriage
4:00 The question: do you feel safe where you live
4:34 Loneliness as a clinical finding
5:33 Some relationships are medicine, some are a diagnosis
6:56 What he rules out before he asks anything personal
8:12 What a flat cortisol curve actually means
9:28 The year that three things happened at once
10:48 Why he will not say adrenal fatigue
13:44 He is not a marriage counselor, and says so
15:34 What he actually changes first
16:08 The husband's shift change that started the weight gain
20:08 The ten-minute visit that never asks
22:31 Take home messages
About this episode:
Shiv K. Goel is a board-certified internal medicine and functional medicine physician practicing in San Antonio. He describes a patient whose unexplained weight gain came with a completely clean workup, and what he found when he asked what had changed in her life rather than ordering another panel. He is careful about the claim: a difficult relationship does not cause disease, it changes the load the body is carrying, and that load shows up physically. He walks through what he rules out first, including thyroid disease, anemia, diabetes, sleep apnea, adrenal insufficiency and Cushing syndrome, and only then asks when the symptoms began and what else was happening at that time. He explains why he uses the term HPA axis overload rather than adrenal fatigue, and what a four-point salivary cortisol curve tells him, including the case of a patient whose morning level was two when eight to 15 is typical. He is explicit that his role stops at helping the patient understand, and that the referral to a therapist belongs to someone else. He also names what keeps people in situations they cannot leave, including financial dependence and simply not seeing a second option. He closes with two questions, one for physicians and one for everyone else.
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