a16zHow Truemed Is Incentivizing Americans to Invest in Prevention
CHAPTERS
- 0:00 – 0:58
Why America’s default health outcomes are collapsing
Justin Mares argues the U.S. now produces sickness by default: ultra-processed food dominance, low outdoor time, and phone-centric lifestyles. He frames poor health as a foundational threat that undermines prosperity and social stability.
- •Ultra-processed foods are now the majority of many Americans’ diets
- •Kids spend less time outside than prisoners; screen time dominates
- •Health is framed as an existential, society-wide issue
- •Sickness cascades into broader national problems (economics, politics, quality of life)
- 0:58 – 3:23
A personal “secret”: environment and lifestyle drive health more than most people internalize
Justin describes discovering early that lifestyle inputs (food, movement, environment) shape energy and long-term outcomes, yet the insight remains under-adopted. He contrasts past generations, who stayed healthy without “biohacking,” with today’s need for constant vigilance.
- •US health outcomes are worsening (obesity, heart disease) despite high spend
- •Modern life requires intentional effort to be healthy in a way it didn’t historically
- •Great-grandmother example: longevity without modern optimization
- •Core claim: today’s environment is structurally anti-health
- 3:23 – 4:18
What healthier subcultures reveal: the Amish comparison
The conversation uses the Amish as a natural experiment highlighting different inputs: local food, outdoor labor, and tight community structure. The point isn’t to fully copy their lifestyle, but to notice which environmental defaults protect health.
- •Local, seasonal foods vs. industrial supply chains
- •High daily movement and time outdoors
- •Community cohesion and reduced digital exposure
- •Health outcomes appear meaningfully better under different defaults
- 4:18 – 6:16
The 1970s inflection point: shareholder-driven ultra-processing takes over
Justin identifies the 1970s as the period when obesity trends accelerated and food quality degraded. He attributes much of the shift to public-company incentives that rewarded ingredient substitution and engineered hyper-palatable, low-nutrient products.
- •Childhood obesity and chronic disease trends begin to worsen notably in the 1970s
- •Food companies optimize for earnings per share, not health outcomes
- •Long-run ingredient swaps: real ingredients → flavorings; sugar → HFCS
- •Ultra-processed foods become addictive, less nutrient-dense, and chemically complex
- 6:16 – 8:44
The subsidy engine behind cheap calories: corn, soy, wheat and downstream toxicity
Justin argues crop subsidies are a major upstream driver of unhealthy diets by making certain commodity inputs artificially cheap and ubiquitous. He highlights soybean oil and HFCS as examples of subsidized ingredients that became default additives across the food supply.
- •~$100B spent on crop subsidies over roughly a decade (as cited)
- •Subsidies concentrate production on corn/soy/wheat; cheap inputs flood processed foods
- •HFCS and soybean oil displace traditional ingredients due to price signals
- •Example: soybean oil approaches ~20% of average American caloric intake (as cited)
- 8:44 – 10:21
Why “universal Ozempic” isn’t a cure-all—and why food quality still matters
GLP-1s are framed as a potentially helpful jumpstart for an overweight population, but not a comprehensive fix. Justin warns that appetite suppression without nutrient improvement can lead to protein/micronutrient deficiencies and fails to address root-cause inputs.
- •GLP-1s may be valuable at population scale for near-term risk reduction
- •Medical history suggests single ‘silver bullet’ interventions rarely solve complex health crises
- •Eating less of the same low-quality diet can worsen nutrient adequacy
- •Long-term national health requires fixing the food environment, not only pharmacology
- 10:21 – 12:41
From food guidelines to entrepreneurial leverage: making prevention economically rational
They discuss how updated dietary guidance is improving, but real change needs better incentives. Justin argues that exercise, diet, supplements, and other lifestyle interventions should be treated as healthcare—yet payers rarely fund them—creating a major opportunity.
- •Newer nutrition guidance emphasizes whole foods and better protein/produce framing
- •Current healthcare doesn’t pay for prevention (exercise, diet changes) as interventions
- •Consumers want health-supporting products, but cost remains a barrier
- •This gap motivates the move toward building incentive infrastructure
- 12:41 – 16:09
Building Truemed: letters of medical necessity + HSA/FSA rails for lifestyle interventions
Justin traces Truemed’s origin from observing preventive behaviors being cash-pay while downstream disease care is reimbursed. Truemed productizes “letters of medical necessity” to unlock tax-advantaged spending on qualified lifestyle interventions via telemedicine-like workflows.
- •Preventive behaviors are paid out-of-pocket; late-stage disease care is reimbursed
- •Dr. Mark Hyman introduces the Letter of Medical Necessity (LMN) mechanism
- •Truemed helps qualifying people use HSA/FSA dollars for lifestyle categories
- •Considered other ideas (grocery store, life insurance) but chose highest-leverage capital redirection
- 16:09 – 18:58
The ‘zoo animal’ theory: health is a reflection of environment, not individual willpower
Justin explains his core model: animals in species-appropriate environments tend to be healthy; zoo environments generate depression, obesity, and abnormal behaviors. He maps this to humans, arguing modern built environments produce predictable dysfunction—and redesign beats discipline.
- •Wild vs. zoo animal outcomes used as an analogy for human chronic disease
- •Environment shapes defaults: steps, food availability, phone time, social patterns
- •Individual ‘willpower’ strategies often fail against systemic incentives
- •Focus shifts from treating symptoms to engineering healthier environments
- 18:58 – 26:37
Chronic disease as national security: prevention, chemical regulation, and anti-capture reforms
Justin frames widespread sickness as an existential vulnerability akin to an adversary attack. He outlines key levers: subsidy reform, prevention-oriented healthcare nudges, and stronger U.S. chemical regulation closer to EU standards—plus resistance to lobbying and corporate capture.
- •If an adversary caused current obesity rates, it would be treated as an emergency
- •Prevention investment: coaching/nudges (Singapore-style model)
- •Chemical policy: U.S. GRAS vs EU-style premarket testing; many more allowed compounds in the U.S.
- •Lobbying and regulatory capture (e.g., pesticide liability shields) impede reform
- •Institutional reforms: school and military food, guideline integrity, ‘GRAS reform’
- 26:37 – 27:49
Consumer choice vs public health: focusing restrictions on kids and removing structural subsidies
Justin argues most items shouldn’t be outlawed, but the system shouldn’t subsidize unhealthy defaults or allow industry to shape guidelines. He highlights schools as a critical battleground where soda contracts and food environments can shape lifelong trajectories.
- •Opposes broad prohibition; supports consumer choice for adults
- •Kids are different: society already limits harmful choices (e.g., alcohol)
- •Remove implicit supports: subsidies that make junk cheaper and more pervasive
- •Reduce industry influence on nutrition guidelines; improve school food environments
- 27:49 – 34:31
Psychedelics and metabolic psychiatry: expanding the mental health toolkit
They pivot to mental health, with Justin supporting psychedelics (e.g., ketamine-assisted therapy) as effective options for severe conditions under medical oversight. He also argues mental health is deeply tied to metabolic/physical health and calls for more research into inflammation, gut health, and diet-based interventions.
- •Ketamine/psychedelics show strong efficacy for treatment-resistant depression and PTSD
- •Reframing psychedelics as clinical therapy, not counterculture
- •Functional medicine approaches: sleep, gut health, inflammation reduction can improve depression outcomes
- •Metabolic psychiatry: metabolic roots may underlie conditions like epilepsy, bipolar disorder, schizophrenia; ketogenic diet as an example intervention
- 34:31 – 35:45
What Truemed is today and where it’s going: scaling tax-advantaged prevention
Justin describes Truemed’s current product and partner ecosystem, positioning it as infrastructure to make prevention cheaper and easier for people at risk. The long-term vision is mainstream reimbursement-like support for lifestyle interventions across chronic conditions.
- •Truemed enables HSA/FSA spending on qualified lifestyle interventions for eligible users
- •Partners include sleep, fitness, supplements, and wellness brands (e.g., Eight Sleep, Peloton)
- •Goal: incentivize lifestyle spending that treats/reverses/prevents chronic disease
- •Addresses the ‘no mechanism’ gap for cheaper access to interventions like gyms or sleep tools
- 35:45 – 40:35
Peptides and personalized nutrition experimentation: potential disruption beyond traditional pharma
Closing topics cover peptides as a potentially disruptive, non-patentable class focused on ‘human enhancement’ outcomes, though Justin notes more research is needed. They also discuss nutrition uncertainty, arguing for N-of-1 experimentation using labs and wearables, including interest in Ray Peat-style metabolism-focused diets.
- •Peptides may deliver energy, libido, inflammation, and gut improvements; more evidence needed
- •Non-patentability and low cost could challenge pharma business models
- •Nutrition science is distorted by funding incentives; tribes fill the void
- •Use biomarkers and wearables to test diets empirically (N-of-1)
- •Ray Peat (‘Peaters’) seen as contrarian vs longevity caloric restriction dogma
