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Shiv K. Goel, MD

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Shiv K. Goel, MD

An internal medicine physician in San Antonio, Texas, who has spent twenty-five years in hospital medicine.

19 articles on KevinMD · 9 podcast episodes

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About

Shiv Kumar Goel is an internal medicine physician in San Antonio, Texas, who has spent twenty-five years in hospital medicine, the ICU, and functional medicine. He is the founder of Prime Vitality, a holistic wellness clinic, and TimeVitality.ai, an AI-driven platform for advanced health analysis.

Dr. Goel serves on the editorial committee of the Bexar County Medical Society, and his writing has appeared on KevinMD, in the San Antonio Express-News, and on Op-Med. He shares his clinical and educational work at drshivgoel.com, publishes on Medium and Substack, and hosts the Vitality Matrix with Dr. Goel channel on YouTube. He is the author of the forthcoming book Healing the Split: When Your Biology Is Fighting Your Biography.

Latest articles

Conditions and diseases

Food is medicine programs need infrastructure to work

I'd asked whether she was eating a lot of salt. Third admission in a year, I was going down her med list, and the question wasn't on the list. It came out sideways, the way things do at the end…

I’d asked whether she was eating a lot of salt. Third admission in a year, I was going down her med list, and the question wasn’t on the list. It came out sideways, the way things do at the end of a long afternoon.

Same as regular. Like everyone.

Two grams a day is what I’d told her. First visit, second visit, printed on both after-visit summaries. She nodded each time. I …

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Food is medicine programs need infrastructure to work

Conditions and diseases

Why your leaky gut tests aren’t fixing your symptoms

Irene came in for migraines. Thirty-six years old. Elementary school teacher. Already diagnosed with irritable bowel syndrome. Already scoped twice, endoscopy and colonoscopy both showing diffuse inflammation, gastritis, GERD. Already told she couldn't tolerate GLP-1 medications because of her IBS.…

Irene came in for migraines.

Thirty-six years old. Elementary school teacher. Already diagnosed with irritable bowel syndrome. Already scoped twice, endoscopy and colonoscopy both showing diffuse inflammation, gastritis, GERD. Already told she couldn’t tolerate GLP-1 medications because of her IBS. She had done her research online and found me.

She seemed, on the surface, like a patient with a well-documented GI history and a headache problem. I almost missed what was actually …

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Why your leaky gut tests aren’t fixing your symptoms

Drugs and prescribing

The hidden costs of anabolic steroid side effects

He sat down and said, "Doc, I just want to sleep again." Marc, name and details changed, was 54. He hadn't touched a needle in two years. His cardiologist was still watching his blood pressure. His body had not caught…

He sat down and said, “Doc, I just want to sleep again.”

Marc, name and details changed, was 54. He hadn’t touched a needle in two years. His cardiologist was still watching his blood pressure. His body had not caught up with his decision to stop.

His labs told the story his competition photos never did. Elevated red blood cell count consistent with secondary polycythemia. Suppressed LH and FSH. Low testosterone. …

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The hidden costs of anabolic steroid side effects

Physician voices

How relationships affect health, seen from the exam room

For the first decade of my medical career, I thought I was treating bodies. By the second decade, I noticed something else. I was usually treating relationships. Patients almost never told me directly. A woman in her late forties came…

For the first decade of my medical career, I thought I was treating bodies. By the second decade, I noticed something else. I was usually treating relationships. Patients almost never told me directly.

A woman in her late forties came into my office last year. She had gained 22 pounds in a year, on a routine that had worked for the decade before it. Her labs were normal. Her thyroid was …

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How relationships affect health, seen from the exam room

Health technology

What AI in medicine can and cannot do

The announcement landed the way tech announcements usually do: bold claims, a glossy render, the implication that health care's problems are basically engineering problems that nobody competent had gotten around to solving. Elon Musk envisions Optimus, his humanoid AI robot,…

The announcement landed the way tech announcements usually do: bold claims, a glossy render, the implication that health care’s problems are basically engineering problems that nobody competent had gotten around to solving.

Elon Musk envisions Optimus, his humanoid AI robot, stepping into medical care. Surgical precision. Universal access. Automation of the tasks that slow medicine down. He has gone so far as to claim Optimus could one day perform “any medical …

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What AI in medicine can and cannot do

Conditions and diseases

Normal labs miss what most patients are living through

She sat across from me, results in hand, and asked the question I have heard more times than I can count. "If everything is normal, why do I still feel like this?" I did not have a clean answer. Not…

She sat across from me, results in hand, and asked the question I have heard more times than I can count.

“If everything is normal, why do I still feel like this?”

I did not have a clean answer. Not because she was wrong to ask. Because she was right, and medicine, at that moment, had run out of language.

Her CBC was normal. Her CMP was normal. Thyroid unremarkable. Inflammatory markers unimpressive. …

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Normal labs miss what most patients are living through

Physician voices

Symptoms with normal labs deserve a better question

She sat across from me, results in hand, and asked the question I have heard more times than I can count. "If everything is normal, why do I still feel like this?" I did not have a clean answer. Not…

She sat across from me, results in hand, and asked the question I have heard more times than I can count.

“If everything is normal, why do I still feel like this?”

I did not have a clean answer. Not because she was wrong to ask. Because she was right, and medicine, at that moment, had run out of language.

Her CBC was normal. Her CMP was normal. Thyroid unremarkable. Inflammatory markers unimpressive. …

Read more…

Symptoms with normal labs deserve a better question

Conditions and diseases

Natural disaster trauma requires mental health planning

Super Typhoon Sinlaku got the coverage it deserved, the satellite loops, the wind speed updates, the landfall reports over the Northern Marianas. Every wobble in the eye wall drew a headline. No one was talking about what was happening inside…

Super Typhoon Sinlaku got the coverage it deserved, the satellite loops, the wind speed updates, the landfall reports over the Northern Marianas. Every wobble in the eye wall drew a headline. No one was talking about what was happening inside people’s bodies. I have sat with patients days after a storm passed, experiencing blood pressure that will not budge and hands that will not stop shaking, and the sky has …

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Natural disaster trauma requires mental health planning

Physician voices

Make America Healthy Again fails true functional medicine

I grew up in a family of nine in New Delhi, where scarcity was our daily companion. We had no processed food, no artificial dyes, no glyphosate-laced cereal aisles stretching into infinity. We ate whole foods, not by philosophy, but…

I grew up in a family of nine in New Delhi, where scarcity was our daily companion. We had no processed food, no artificial dyes, no glyphosate-laced cereal aisles stretching into infinity. We ate whole foods, not by philosophy, but by necessity. We moved our bodies, not by gym membership, but because life demanded it. We slept when the sun went down and woke when it rose. Circadian rhythm was …

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Make America Healthy Again fails true functional medicine

Conditions and diseases

Is HPA axis dysregulation causing your chronic insomnia?

Cortisol. Almost always cortisol. I say this to patients more than almost anything else. And I say it having lived it myself, years of high-output clinical work, late nights, early mornings, and the particular exhaustion of lying in bed completely…

Cortisol. Almost always cortisol. I say this to patients more than almost anything else. And I say it having lived it myself, years of high-output clinical work, late nights, early mornings, and the particular exhaustion of lying in bed completely depleted but unable to actually fall asleep. Tired but wired. It is a real physiological state, and it has a name: hypothalamic-pituitary-adrenal (HPA) axis dysregulation. It is not insomnia in …

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Is HPA axis dysregulation causing your chronic insomnia?

Drugs and prescribing

The clinical evidence and reality of peptide therapy

There is a sentence I have been practicing for two years. I believe peptide therapy works. It sounds simple. It is not simple. In the culture of evidence-based medicine, a culture I was trained in, believe in, and have practiced…

There is a sentence I have been practicing for two years. I believe peptide therapy works. It sounds simple. It is not simple. In the culture of evidence-based medicine, a culture I was trained in, believe in, and have practiced inside for over two decades, saying you believe something that the evidence has not yet fully validated carries consequences. Raised eyebrows at conferences. The careful distance of colleagues. The quiet …

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The clinical evidence and reality of peptide therapy

Physician voices

Why leaving hospital medicine for private practice was worth the risk

The day I handed in my credentials as medical director, I sat in my car in the parking lot for a long time. I had held that role at Methodist Specialty and Transplant Hospital in San Antonio for years. I…

The day I handed in my credentials as medical director, I sat in my car in the parking lot for a long time. I had held that role at Methodist Specialty and Transplant Hospital in San Antonio for years. I had built protocols, chaired committees, mentored residents, and managed crises at hours when the rest of the city slept. I was, by every conventional metric, succeeding. And yet there was …

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Why leaving hospital medicine for private practice was worth the risk

Drugs and prescribing

Oral Wegovy: the miracle and the mess of the new GLP-1 pill

A patient stopped me in the hallway recently, not in an exam room, not seated, not "ready" for a clinical conversation. Just a human being catching me between visits and asking a question that felt heavier than any lab result:…

A patient stopped me in the hallway recently, not in an exam room, not seated, not “ready” for a clinical conversation. Just a human being catching me between visits and asking a question that felt heavier than any lab result:

“Doc, is this finally the thing that will work? Or is it just another trap?”

That question is the GLP-1 era in one sentence. And with the launch of oral Wegovy, it …

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Oral Wegovy: the miracle and the mess of the new GLP-1 pill

Health technology

Agentic AI in medicine: the danger of automating the doctor

"Can AI scale in medicine?" is the wrong question. The real question is: Can AI protect the soul of medicine while people who have never sat with our patients decide their fate? The ADVOCATE program: an overview The Trump administration…

“Can AI scale in medicine?” is the wrong question.

The real question is: Can AI protect the soul of medicine while people who have never sat with our patients decide their fate?

The ADVOCATE program: an overview

The Trump administration recently launched the ADVOCATE program: Agentic AI-Enabled Cardiovascular Care Transformation. Run by ARPA-H, this initiative aims to build and deploy autonomous “clinical AI agents” for cardiovascular disease, with an FDA authorization pathway of …

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Agentic AI in medicine: the danger of automating the doctor

Conditions and diseases

Methamphetamine-induced lung injury: the hidden diagnosis in South Texas

Methamphetamine has become an unavoidable presence in South Texas medicine. It shows up in our EDs, clinics, and ICUs, usually framed as a cardiotoxic, neurotoxic, or psychiatric problem. But over the past few years, a different pattern has kept surfacing…

Methamphetamine has become an unavoidable presence in South Texas medicine. It shows up in our EDs, clinics, and ICUs, usually framed as a cardiotoxic, neurotoxic, or psychiatric problem. But over the past few years, a different pattern has kept surfacing in my practice: “pneumonia” cases that don’t behave like pneumonia, young lungs that look like ARDS, and hypoxic patients whose imaging and labs do not match the story, until someone …

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Methamphetamine-induced lung injury: the hidden diagnosis in South Texas

Physician voices

Why lifestyle matters more than BPC-157 and semaglutide

"Doc, can you prescribe me some BPC-157 with sermorelin, and maybe semaglutide too?" He didn't come in asking about his sleep. He didn't mention that his last meal the night before was at 11:30 p.m., eaten in front of a…

“Doc, can you prescribe me some BPC-157 with sermorelin, and maybe semaglutide too?”

He didn’t come in asking about his sleep.

He didn’t mention that his last meal the night before was at 11:30 p.m., eaten in front of a laptop glowing with unanswered emails.

He didn’t bring up the statin he’d been taking for years, the creeping fatigue he’d started to normalize, or the way his waistline had slowly expanded as his …

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Why lifestyle matters more than BPC-157 and semaglutide

Health technology

Claude for Healthcare vs. administrative burden: a physician’s review

Last week, I spent over two hours on a prior authorization for a patient who needed a medication she'd been stable on for years. Two hours of hold music, transferred calls, and faxed forms, while patients waited. That same week,…

Last week, I spent over two hours on a prior authorization for a patient who needed a medication she’d been stable on for years. Two hours of hold music, transferred calls, and faxed forms, while patients waited.

That same week, Anthropic announced Claude for Healthcare: An AI system that can verify coverage requirements, build claims appeals, and streamline prior authorizations in minutes. OpenAI launched ChatGPT Health days earlier. Both promise to …

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Claude for Healthcare vs. administrative burden: a physician’s review

Physician voices

The hidden link between circadian rhythm and physician burnout

By 11 p.m., my clinic was dark but my brain wasn't. I found myself scrolling through my schedule for the next day: 22 patient visits, a pile of unsigned notes, two meetings squeezed into "lunch," and a post-call morning that…

By 11 p.m., my clinic was dark but my brain wasn’t. I found myself scrolling through my schedule for the next day: 22 patient visits, a pile of unsigned notes, two meetings squeezed into “lunch,” and a post-call morning that somehow still started at 7 a.m. None of these tasks were unusual, but what struck me was the growing tightness in my chest and the realization that I had quietly …

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The hidden link between circadian rhythm and physician burnout

Physician voices

Mind-body connection in chronic disease: Why traditional medicine falls short

Linda had seen seven physicians in three years. She was on five medications. And she was exhausted, not just physically, but existentially. "Dr. Goel," Linda said quietly, "I've done everything they told me. The diets. The pills. The exercise programs.…

Linda had seen seven physicians in three years. She was on five medications. And she was exhausted, not just physically, but existentially.

“Dr. Goel,” Linda said quietly, “I’ve done everything they told me. The diets. The pills. The exercise programs. Why isn’t anything working?”

At 54, Linda was a meticulous accountant living with hypertension, type 2 diabetes, obesity, chronic fatigue, and generalized anxiety disorder. Her lab results painted a picture of metabolic …

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Mind-body connection in chronic disease: Why traditional medicine falls short

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