a16zHow Truemed Is Incentivizing Americans to Invest in Prevention
EVERY SPOKEN WORD
45 min read · 8,564 words- 0:00 – 0:44
Introduction
- JMJustin Mares
When you look at our food system today, the majority of what people are eating is ultra-processed crap. The average child spends less time outside than, like, a maximum security prisoner. People are spending eight-plus hours on a phone. We are in the midst of one of the biggest problems in the country. If we don't fix this, like, America is going to have even more serious [laughs] problems. The environment that we exist in is just structurally just hard to be healthy, which is why you see the default health outcomes in the US being so poor. Why not just universal basic Ozempic? Why doesn't that solve the problem? I think now the problem is we're feeding our kids poison, and, like, all of them are sick. I think many of our problems are downstream of the fact that the majority of the country is just sick. No matter if we get rich or whatever, if most of the country is sick, it's kinda like, what is the point?
- ETErik Torenberg
You've been
- 0:44 – 4:19
The Environment That Makes Us Sick
- ETErik Torenberg
on a quest for the last few years to uncover and make a dent in solving our food crisis, our health crisis, our disease crisis. Why don't you trace your journey a little bit into how you became obsessed with this? Um, and then we'll get into what we're up to.
- JMJustin Mares
Yeah. So Peter Thiel has this idea of, like, a secret, and I, I feel like the idea that what you eat, your lifestyle, all these things, they impact your health outcomes, they impact your energy, they impact how you feel. Like, I kinda came across that idea when I was 20, and it felt like this secret where, you know, if you look at any data in the US, US healthcare outcomes are horrible. Like, they're bad. They're getting worse. Like obesity, you know, heart disease, all of these conditions are basically at record levels and continue to go up. And as I started to read more about our food system, about, you know, uh, environmental toxins, about all these sorts of things, like, I just became more and more convinced that the... Everyone's like, "What's going on with our obesity crisis? Why are we so sick?" And the answer is just, like, simply that we exist in an environment that systematically outputs unhealthy people, and that this, this idea that you could just change your food, change your diet, change your exercise, change your environment, and that would lead to, to much better health outcomes naturally feels to me like this secret that, you know, I've believed and invested behind and, like, started companies behind for 15 years, uh, that still, like, the average person does not totally, fully, like, internalize. Uh, and so it was just like, I just became obsessed with this idea, uh, the first time I came across it when I was, like, 20 or so.
- ETErik Torenberg
And you yourself have gone out of your way to, um, go against this, the g- the grain in terms of your own personal life in trying to be healthy, but it's very difficult to be healthy today. It's, it's almost like people used to say when they were canceling people on, on Twitter all the time like, "Hey, just build your own Twitter." Like, just- [laughs]
- JMJustin Mares
Yeah
- ETErik Torenberg
... if you want your own information, you can just build your own. And similarly, like, you have to build your own, like, food to eat.
- JMJustin Mares
Totally. Yeah, I mean, in so many ways, I feel like the things... Like, health used to just be an output of the environment that we existed in. Like-
- ETErik Torenberg
Yeah
- JMJustin Mares
... my, my great-grandmother, you know, she lived till she was 95. Very healthy until the day that she died. And she never shopped organic. She never, like, avoided and asked for no seed oils at the grocery store. She never did, like, any of the insanity that I've kind of had to learn, figure out, and do. Uh, that's because primarily she inv- in- lived and grew up in an environment that was not sickness promoting. She was not exposed to, like, 40,000 novel chemical compounds that exist in the US or eating foods that were, like, addictive and made her feel shitty and, and, like, impacted her health. Uh, and so I think that the environment that we exist in is just structurally just hard to be healthy, which is why you see the default health outcomes in the US being so poor.
- ETErik Torenberg
And h- how are the Amish exempt from this?
- JMJustin Mares
[laughs]
- ETErik Torenberg
Just as an example. Like, what, what do they do d- differently?
- JMJustin Mares
Uh, they do... I mean, they do a lot differently. [laughs] You should go to one of the communities. There's a lot of things they do very differently than you and I. Uh, but basically they're eating, you know, food that is grown locally, seasonally, all the time. They're outside all the time working with their hands. They're existing in a tight-knit community. Uh, you know, they... And there's, like, a whole host of [laughs] environmental and lifestyle, uh, differences that the Amish have. Uh, so you can argue, like, is it 100... You know, do you have to live like the Amish to have better health outcomes? But certainly they have much better health outcomes, and they live very differently than you or I.
- ETErik Torenberg
But they're not doom scrolling like us, so how do they make it?
- JMJustin Mares
[laughs]
- ETErik Torenberg
It's like they might live longer-
- JMJustin Mares
They're uninformed, I know. [laughs]
- ETErik Torenberg
They might live longer, but at what cost?
- JMJustin Mares
[laughs]
- ETErik Torenberg
Um, so when did things start to get really bad? Or like, like, um, has it just been monotonically for the last century, or w- was there sort of a moment where things started to escalate, and, and what happened?
- JMJustin Mares
Yeah, s- things started
- 4:19 – 6:10
What Went Wrong in the 1970s
- JMJustin Mares
to get much worse in the 1970s. Uh, you know, basically, I think my, my view is that that is around the time when you started to see childhood obesity tick up. You started to see, uh, obesity, heart disease, things like this kind of start to move. And in my view, a big reason for that is there was a lot of shareholder and other pressure, uh, specifically geared towards big food companies around that time, where basically these companies are today, like, 150 years old. Almost every big food company is shareholder owned. They are not run, controlled, or anything by CEOs. They're basically just, like, these lumbering, you know, co- corporations that the market is just optim- having them optimize for, like, earnings per share. And what that means is these companies for the last 50 years have consistently decided to trade a real ingredient for something that's, like, kind of a, a fake version of that. Like, they've moved from strawberries to strawberry flavoring, or they've moved from sugar to high fructose corn syrup. And you kind of roll this out over a 50-year period, and you, you look at our food system today, and the majority of what people are eating is ultra-processed crap that is, like, addictive, is not nutrient dense, and is full of, like, environmental toxins, chemical compounds, um, you know, things like this that the human body has in our entire millions of years of evolution never encountered many of these compounds. And so I think that that shift started in the '70s. Um, you know, it's compounded generationally. Uh, it certainly doesn't help today that the average child spends less time outside than, like, a maximum security prisoner. Uh, you know, like, most kids today are eating, like 70% of their diet is ultra-processed foods. Uh, you know, people are spending eight-plus hours on phones. Like, all, all these sorts of things are factors. But I really think that our food system started to become uniquely poisonous in the '70s, and that is why you saw, especially in the US, that's why you started to seeMany healthcare and health outcomes trend in such a negative direction, especially relative to the rest of the world.
- 6:10 – 8:49
The Subsidy Problem
- ETErik Torenberg
What are the levers that could, uh, make a dent in, in reversing some of these trends as it relates to the, to the food system?
- JMJustin Mares
Yeah. From a food system standpoint, I think the biggest single lever that we could pull, which would be extraordinarily politically challenging to pull, is fixing our, like, crop subsidy system. So if you look, the US government over the last, uh, I think it's the last decade, has spent close to, like, $100 billion on crop subsidies. They're basically subsidizing corn, soy, and wheat, uh, which-- so that American farmers can grow corn, soy, and wheat. Because it's subsidized, it's artificially cheap, so we grow a lot of it. Because it's subsidized, it's artificially cheap, and so these big food companies use it in everything. And so these big food companies have basically gone on, like, a thirty-year journey to replace sugar with high fructose corn syrup or to replace, um, olive oil or something like that with soybean oil, which is highly processed and inflammatory, causes obesity in all sorts of, like, rat and human models. Um, and, and I think that this sort of wholesale swapping of, like, let's take the, the worst ingredients in their most highly processed form and replace them with an ingredient, um, that, that humans traditionally ate is one of the root causes of chronic disease. Like, today, the average American gets almost twenty percent of their caloric intake from soybean oil. Like, this is historically anomalous, and it's not because anyone wants soybean oil. Like, you're probably not, like, a big consumer of soybean oil or anything like this. It's just because it's artificially cheap, and because it's artificially cheap, it ends up in everything. And I think that that is one of the core kinda root causes of what is going wrong in our food system today.
- ETErik Torenberg
And is that a uniquely US problem, or is this-
- JMJustin Mares
Yes. Yeah. It's a uniquely US problem. I mean, the US, our food system relative to, like, Europe or something like that, uh, Europe, many of-- you know, their countries are smaller. Uh, they tend to lean much more into, like, a local food agriculture system. They also don't have as much of a, like, federal intervention on their food system. Uh, you know, the US, like, in many ways, this sort of subsidy of corn, soy, wheat, things like that, it had good intent. I mean, in the... A lot of the s- the crop subsidy stuff, uh, started with a farm bill in the '80s where basically, like, farmers were exposed to inclement weather, bad weather that was, like, impacting their, their crop yields. The US government stepped in and was like, "Okay, we're gonna try and keep these farmers solvent." Um, I think that the intent was good, but now here we are, like, years later, we have billions a year going towards these crop subsidies that are making Americans sick. And I think that we used to say, "Okay, we just need to make sure that we're growing enough calories and make sure that Americans are not dying of starvation. They're not, like... You know, make sure our kids have enough to eat." I think now the problem is, like, we're feeding our kids poison, and, like, all of them are sick.
- ETErik Torenberg
Why not just universal basic Ozempic? I mean, what's the, what's the-
- JMJustin Mares
[laughs]
- ETErik Torenberg
Why doesn't that solve the problem?
- 8:49 – 12:21
Universal Ozempic Won't Save Us
- JMJustin Mares
Yeah. Well, so th- I think there's two things. One, I think that GLP-1s are potentially an incredibly interesting technology. Like, I, I think that we are in the midst of the, the worst chronic disease crisis, one of the biggest problems in the country, and if we don't fix this, like, America is going to have even more serious [chuckles] problems, like, twenty years from now. So given that, given that the average American is overweight, we're looking at almost eighty percent obesity overrate-overweight rates, I think that it does make sense to put a bunch of these people on a GLP-1 to try and jumpstart them in a direction where they are moving towards health. Uh, that said, I don't at all think that giving universal GLP-1s to, to everyone is, like, necessarily a, a, a universal solve. Like, the-- There's just a very poor history of saying, "Here is an intervention that, like, is going to solve all of our problems as a species." [chuckles] Uh, you know, and I, and I just think that it is quite unlikely that Ozempic is the one thing that is gonna be a cure-all. Like, just to use one example, what is... You know, h-how does Ozempic work? Uh, it, is it-- Basically, it, it turns down someone's appetite, so you're just eating less. If you're still eating the same crap, uh, that the average American is eating today, but you're on Ozempic and eating less of it, like, you are almost certainly going to be deficient in protein and micronutrients, in a bunch of things that will have, like, long-term health implications, uh, if you, like, under eat or get exposed to not enough of those nutrients for a very long period of time. So I think we fundamentally, like, have to solve the food issue-
- ETErik Torenberg
Yeah
- JMJustin Mares
... if we wanna have a healthy country.
- ETErik Torenberg
By the way, h-have we yet updated our food pyramid in the sense that we have an accurate understanding of what we should be getting on a, on a country level in terms of nu-nutrients?
- JMJustin Mares
Yeah. I mean, the, the new food pyramid is a tremendous improvement-
- ETErik Torenberg
Great
- JMJustin Mares
... over, over the old guidelines. I mean, not only is the site super sexy, you know, Joe Gebbia did a great [chuckles] job on that. Uh, but finally, for the first time, people are saying, like, "Eat whole foods, eat more vegetables, eat, you know, meats, and, like, other, other well-sourced sources of protein, vegetables, fruits." It's crazy that it took until now to say, "Maybe we shouldn't be giving kids, you know, 15 servings of whole grain and saying that, like, sugar is totally fine for kids under two. Like, we recommend some amount of sugar for kids on the age of two," uh, which was the past, you know, past administration's sort of guidelines. So I think they're a tremendous, tremendously positive step.
- ETErik Torenberg
And so for people who wanna make a difference in, in the food system, you know, you mentioned that policy recommendation. What about people who want to do something direct? You obviously... You know, before Truemed, you started a, a bone broth c-com-company. What are other big companies that could be built, uh, in, in the space or, or opportunities to, to make a difference?
- JMJustin Mares
Yeah. I, I think there's a ton of opportunities, I mean, within the space that I... Like, I think the core problem is that a bunch of these lifestyle interventions, like eating a healthier diet, exercising, uh, taking certain supplements, taking, like, peptides if that makes sense for, for your sort of individual person and risk profile, all of these things can be considered healthcare interventions. And yet, if you look at our healthcare system, nothing in the healthcare system thinks about someone who is at risk of heart disease exercising as a healthcare intervention. No payer pays for it. No one incentivizes you to do that. It's just sort of like a doctor is like, "Yeah, you should, like, clean up your diet and exercise." And so I think that there is a tremendous, tremendous opportunityFor people that wanna make a dent on this problem, uh, figuring out how to make these sorts of lifestyle interventions part of the healthcare system is what we're doing at Truemed, uh, and incentivizing people to actually invest in their health, to invest in prevention, uh, to invest in things that, like, move the needle from a chronic disease
- 12:21 – 15:59
Building Truemed
- JMJustin Mares
standpoint.
- ETErik Torenberg
Yeah. So let, let, let's get to Truemed. F-first, first trace the idea maze a little bit in terms of, you know, you, you've been obsessed with, with th-this problem, this kind of meta problem, this series of problems, and it's kind of like, where do you even start? I'm sure you, you know-
- JMJustin Mares
Yeah
- ETErik Torenberg
... nook, picked over every nook and cranny. Um, how, how did you settle that, hey, th-this was the opportunity? And what were maybe some other things you had considered?
- JMJustin Mares
Yeah. So in, in growing, uh, Kettle & Fire, basically, when we launched, it was like $16 a carton for 16 ounces of bone broth, and everyone was like, "This is good, but this is, like, very expensive." And, you know, now nine years in, we're in every grocery store in the country, and the average price per box is, like, $7. Uh, people... Way more people buy it, but they're also like, "This is very expensive." Uh, I kind of, like, had that experience and then looked at things like Costco and Walmart are the two largest sellers of organic products in the country. To me, that is a signal that, like, people want to invest in products that are good for them. They want to buy products that leave them off better, healthier, and the like, but it's just cost prohibitive. And then if you look at the healthcare system, we have this weird dynamic where if I'm at risk of cardiovascular disease or heart disease, like, I basically can exercise, I can eat well, uh, I can do all of these things that will prevent an acute heart attack or something like that, and I'm basically not... Uh, that's all, like, cash pay. I'm, I'm paying out of pocket. I'm doing all of that kind of stuff totally on my own. Whereas if you take someone that doesn't do any of those things, basically, they have a heart attack early, and then the healthcare system will pay hundreds of thousands or millions of dollars to manage that person's condition basically for the rest of their lives. And so I think that fundamentally, like, we need to incentivize people to invest in prevention, to invest in, you know, y- leveraging lifestyle interventions that can make a dent on chronic conditions. Um, and that was kind of the lens through which I was looking at, what's the company that I want to start after Kettle & Fire? When I met, um, Dr. Mark Hyman, who is basically, you know, he's a functional medicine doctor, co-founder of Function, he mentioned that something he was doing with a bunch of his patients was for patients that would come in, he would recommend lifestyle interventions, and he would write them something called a letter of medical necessity, which is basically a letter that the IRS has said, uh, for certain people where an intervention matches, uh, matches, like, a l- a lifestyle intervention matches a condition someone's working to treat, reverse, or prevent, um, they can spend... They can get that letter and use tax-free HSA, FSA dollars on sleep aids, healthy, you know, better diet, uh, supplements, exercise, things like that. And so when Mark Hyman told us kind of about that idea, I was like, "This is a really interesting thing." Like, we could basically try and build infrastructure that allows the average person to get one of these LMNS if they qualify, uh, and use, like, the telemedicine rails that Hims, Ro, and other companies have spent the last several years building. But rather than prescribing Ozempic or prescribing TRT, we can actually prescribe food interventions, exercise, things like that. Uh, so that was kind of the, kind of the idea and, like, where it started from. Uh, I looked at a whole host of other things, like thought about starting a grocery store, uh, thought about starting, like, a life insurance company that would be aggressive in terms of, like, helping you live longer and making lifestyle interventions, um, but ultimately felt like this was the type of thing that had the potential to direct hundreds of billions of dollars towards lifestyle interventions over the next couple years. Uh, and so it felt like it was, it was the right thing to do.
- ETErik Torenberg
So yeah, everyone knows we need to shift more f- you know, from chronic to, to preventive care and, and this is basically a way to financially incentivize people to do it.
- JMJustin Mares
Exactly. Yeah.
- ETErik Torenberg
So yeah.
- JMJustin Mares
Exactly.
- ETErik Torenberg
One, one of your, your
- 15:59 – 18:33
The Zoo Animal Theory of Human Health
- ETErik Torenberg
ideas is that the, the, the root cause of a, of a lot of issues is this mismatch between our genes and our environment. Why, why don't you flush that out a, a, a little bit more?
- JMJustin Mares
Yeah. So if you look... Like, think of a, an animal in the zoo. Like, you... An animal in the wild, with few exceptions, like they can get-- break their leg, get an infection, whatever, but when an animal is, like, exists in a, a species-appropriate environment, that animal tends to be healthy. Like, there's a natural match between the, the health of the environment and the health of an animal. When you take an animal away from its natural habitat and put it in the zoo or something like that, like, zoo animals e-exhibit all of these diseases that their counterparts in the wild just don't get. They have weird ticks. They get depressed. Um, you know, in some notable cases, like, animals have even killed themselves, which is just something [chuckles] you, like, don't see in the wild. Um, and they get obese. They get all sorts of things. And so my, uh, my take and what I think is very true is that the health of an animal is basically a reflection of the health of an animal's environment. If an animal is existing in an environment that is not health promoting, like you're in a season of drought or there's not a lot of food, that animal gets skinny and dies. Like, you, you basically can kind of see that that, that animal is not existing in an environment that's health promoting. I think that over the last hundred years or so, we basically as humans have, have seen, uh, you know, we've built an environment that is not considering or not underwriting, not thinking about what is the right thing to do for human health. Like, how do we promote human health and, and flourishing? Um, and so I think that so often when we think about health, we think about, like, what is going on with you, Eric, with this specific condition, as opposed to thinking about what is the environment that you exist in that leads to you not getting 8,000 steps a day, that leads to you spending all day on your phone, that leads to you, like, eating a, a, a terrible diet. No, not, you know, not you actually, but I mean-
- ETErik Torenberg
[laughs]
- JMJustin Mares
Uh, so, so I think that that is, like, an important idea that people don't think about enough is just how do you shape your environment so that it's naturally health promoting as opposed to, uh, you know, having to, like-Discipline yourself and doing all the stuff that most people frankly fail at, myself included.
- ETErik Torenberg
There's this, uh, you know, there's this Twitter competition for a million dollars for who gets the best article, and there's this like, uh, some people are doing kinda clickbait stuff, and there's one guy who's like, uh, you know, "How to change your life in a day," "How to change your life in an hour," like these kinds of posts. And there was one that went super viral that was, "How to change your life in one minute," and it was a photo of smashing the phone. [both laughing]
- JMJustin Mares
That's pretty good.
- ETErik Torenberg
Yeah. Totally. The, um... Okay, so I'm curious for more, um, you know, you've, you've talked about this idea of, hey, we should
- 18:33 – 27:52
The Chronic Disease Crisis as National Security
- ETErik Torenberg
take this health crisis as serious as we take sort of our, you know, national security crisis. Like, you know, we, we as a country should have something of a NRA for health or, or something of a, you know, collective effort because it's, uh, it's a, you know, problem that, hey, the market might not sol- what isn't solving on its own-
- JMJustin Mares
Yeah
- ETErik Torenberg
... and in fact, you know, exacerbates. What would, um... You know, you gave one example of, uh, of, and, and the subsidies. What, what are some of the biggest levers, you think?
- JMJustin Mares
Yeah. Um, so I'll answer that, but like just to frame how I think about the problem, you know, if, if for example, like China or one of our adversaries deployed a bioweapon that made 75% of our population obese or overweight, 45% of kids obese or overweight, like, and, and healthcare like the, the largest cost in the country all of a sudden 'cause everyone was sick, everyone in America would be up in arms and trying to figure out, like, how do we solve this as an existential crisis. This is like a matter of national security that we make a dent in it. You know, no matter if we [chuckles] win the AI race, get rich or whatever, if most of the country is sick, it's kinda like, what is the point? You know, we're not thriving as a nation. I think many of our political problems are downstream of the fact that many, the majority of the country is just sick. And so if I was like able to wave a magic wand and do anything, I think fixing the subsidies would be one thing for sure that I would do. Um, secondly, I would have our healthcare system just invest far more in prevention. Uh, you look at other countries that have incredible like health outcomes on a per capita basis, uh, Singapore is a good example. They basically have these people that are not quite doctors, but are, are like coaches or something like that that will check in with you and try and like nudge you towards making better, better choices. Uh, then I, I would take a much stronger stance, one much, much more similar to that that Europe takes, um, when it comes to like certain environmental toxins, chemical regulation, things like that. Like in the US, we basically take the approach that if a company makes or, um, manufactures a totally novel environmental chemical, that as long as they tell us under current, you know, regulations, something called GRAS, Generally Recognized as Safe, as long as they tell us, "Hey, this chemical is safe," we can introduce it into our food system. Uh, this is how like you've heard of the forem- forever chemicals and stuff like this got into our food system and basically are all over the planet now, uh, because 3M invented them something like 60 years ago, and basically they just started using them. Uh, in the EU, these novel chemical compounds have to go through something that is much more like what it takes to like unleash or w- uh, you know, get a pharmaceutical approved in the, in the US today, where they have to do many years of safety testing, they have to show that it doesn't cause acute harm, uh, and they basically have to approve it before it's allowed on the market. And the, the end result is we have between like 60,000 and 80,000 chemical compounds in the US that are not allowed in, in the EU, and I think that that regulatory approach is one of like the hidden reasons why so many people are sick and I think is one of the reasons that, you know, the, the US, uh, Americans are exposed to more toxic compounds and novel chemical compounds than basically any nation in, in the world. And I think that is like a big kinda hidden part of our chronic disease crisis, and it's something you're gonna hear a lot more about in the coming years.
- ETErik Torenberg
Yeah. Fascinating. I had one college professor, uh, I have no idea if this is even remotely accurate, but w- they were, they were convinced that Monsanto was evil. Um, not just in terms of its, uh, you know, h- health impacts, but they thought, they thought they were sort of like getting involved in all sorts of foreign wars and like influencing our foreign policy and stuff. And I just say that to say, could there be com- competitors to some of these like mega play-- Like could startups even emerge that would begin to, or is it just like structurally unsound?
- JMJustin Mares
I think it's really hard structurally, and I think that that doesn't mean that it's not going to happen, and hopefully it will. But one of the things that you have seen is with Monsanto, for example, like the, the pesticide lobby and the, the chemical and ag lobby is one of the strongest in America, and a big part of what they're doing is like, for example, a couple months ago, uh, Monsanto was lobbying hard, spent tens of millions of dollars to get a, uh, a rider and a bill that would basically make sure that no one could ever sue them for the potential health impacts of one of their most popular products, glyphosate. Uh, that sort of thing is like these companies get big, they provide a bunch of chemicals. Monsanto specifically has done a lot of things that, uh, you know, I think are incredibly like morally dubious. Um, and, and then once they get big enough, once they like start selling billions and billions of dollars of these products, they spend a lot of that money on lobbying and making sure that they are immune from any of the harms and health impacts, uh, that come from some of the s- some of these like toxic products that they spray everywhere. Uh, like glyphosate is the number one pesticide sprayed in the US, and the largest maker of it is spending as much as they possibly can to make sure that glyphosate, which, you know, there's been $14 billion of damages awarded to people that have gotten cancer or other diseases from glyphosate exposure, Monsanto is spending as much as they can to try and like buy basically pesticide liability shields and other things that shield them from competition and, or that shield them from the actions and the consequences of like the diseases their compounds have caused. Uh, I think that when, when these companies can kind of rig the game in that way, it becomes very, very challenging for a startup to kinda come along and make a real play at some of these things.
- ETErik Torenberg
Yeah.You mentioned a grocery store just as a simple idea. I-is there-- What, what's the opportunity that Whole Foods hasn't done with, with, with, with what they've tried to do?
- JMJustin Mares
Yeah. I mean, Whole Foods is amazing, and so, uh, I think that John Mackey was like a total pioneer and like legendary entrepreneur. I think that the thing that grocery stores have not really done is and this is kind of the thesis for Truemed, is like, think about food as like a healthcare intervention. And to me, I think there's a ton of potential for people to, for example, like look at their biomarkers and have a grocery store or some other entity that is responsible for improving your health. Like, I think that if you think increasingly about food, grocery as a health intervention, as like part of one's healthcare and, you know, part of the fight against chronic disease, you would think about a grocery very-- a grocery store very differently than today, which is basically just like, let's figure out the sourcing and then people can buy whatever they want. Um, so I, I think there's like, you know, my idea was that I think there's a ton of room for a grocery store that is a more active participant in your, in your health, telling you to eat certain things, you know, tracking your macros, like all these sorts of things that I think would solve a lot of problems for people.
- ETErik Torenberg
Yeah. So l-let's talk more about if we, you know, fully identified the health crisis as one of our main sort of national priorities, what, what else we, we would do? Maybe we could start looking at it in the light of like, what were some of the pillars or main principles, and maybe we talk about where they are so far.
- JMJustin Mares
Yeah. Uh, so I think that you have seen across all of healthcare, across all of food, just corporate capture of our food guidelines, of our health guidelines, of all these sorts of things. Like the previous FDA commissioner, uh, you know, their stated goal with running the FDA, their number one goal was to combat misinformation. The current one is to, like, make Americans healthy. That means grass reform, so cleaning up like how we regulate chemicals. Uh, that means fixing school lunches, fixing like military lunches, basically what we feed kids. You know, eighty percent of schools have contracts with soda companies. These soda companies literally like will pay a school district to put these vending machines all over the schools. It helps fund schools, but it also like comes with a cost of getting kids sick. Um, so I think like cleaning up school lunches, cleaning up military lunches, uh, cleaning up like the food guidelines. Second thing is like improving and streamlining the way that we look at regulating drugs, make it faster for companies to like lean in and launch innovative therapies that can make a dent on the chronic disease crisis. Uh, and just trying to like bring common sense back into the way that we think about health, the way that we think about food, uh, and try and make a dent in the chronic disease crisis.
- ETErik Torenberg
Are, are some of these ingredients that we're, we're discussing or, or, or foods or, or, you know, soda or like, so danger-- so addicting or so dangerous or so appeasing that they should be outlawed? Or so like how do we think about it?
- JMJustin Mares
No, I, I actually don't think that many of these things should be outlawed. Like, I, I do actually think that consumer choice is a very important thing. Um, you know, but we have gu-- like specifically with kids, we have guidelines, and we already don't think that kids should have free choice, like we don't let them drink. So I think that there is a place for soda in this country. I just also think that if you want to drink soda all the time, that probably we shouldn't be subsidizing it by subsidizing high fructose corn syrup. Probably we should not have Coca-Cola spending a hundred forty million dollars to influence our, our nutrition guidelines like they have over the last, you know, fifteen years. Uh, and I think that it's things like that where a lot of times the big food companies and people will sort of fall back on this idea of consumer choice. I think it's very important, but we also are like currently grappling with an incredibly important chronic disease crisis. And like, if we don't take effort to uniquely like address this thing, I think that the US is like in an incredibly tough spot ten, twenty, thirty years from now.
- ETErik Torenberg
I wanna ask you about psychedelics. Um, and I'm cur-- like, is that in this
- 27:52 – 35:49
Psychedelics as Mental Health Therapy
- ETErik Torenberg
discourse at all? Does that move outcomes or is that kind of not really k- not really a piece?
- JMJustin Mares
I think that if you just look at the data, ps- psychedelics are an incredibly powerful intervention. Like ketamine therapy, ketamine-assisted therapy works better than SSRIs in many cases, especially for treating things that are very intense, like treatment-resistant depression, PTSD, things like this. Um, I think that for many of our veterans and others that suffer from PTSD and like intense depression, psychedelics should be part of a menu of treatments that we like are open to giving people. Uh, you know, I, I think that we probably vastly under invest in them. I think that there's a ton of really promising research around their efficacy and things like this. Um, I think it's an open question of like how ready the average American is to think about these things, not as like a group of people dropping acid in Golden Gate Park in the sixties, but as like a, a vital mental health therapy for people that are really, really struggling. I'm very supportive of, you know, again, just looking at psychedelics as another therapy that can address the many mental health and depression issues that we have in this country. And if you look at it just as that through that lens, a therapy that has few to no side effects, um, especially when done, you know, with doctor oversight and things like this, I think these should be part of how we treat and address many of the mental health crises that we see today.
- ETErik Torenberg
Yeah. Are there any other really big levers that you would focus on if, if, if one of your main goals was to target the mental health crisis?
- JMJustin Mares
I think that we are hugely underestimating the impact of, uh, biological health and how that is tied to mental health. Like, there's some really interesting studies out there around taking a functional medicine approach where, you know, you come in and say you're depressed and rather than like doing talk therapy and things like this that statistics show like sort of don't work very well for many people, uh, we focus just on like reducing your inflammation and fixing your gut. Uh, and there have been studies that show just by focusing and taking a functional medicine approach, uh, you know, focusing on sleep, focusing on gut health, focusing on lowering your inflammation through diet and exercise, that combination of therapies works better than, you know, just talk therapy and things like that. So I think that we massively under, underestimate the degree to which we areYou know, human beings, we're biological organisms, and like our mental health is very tightly coupled to our emotional, um, you know-- sorry, to our physical health.
- ETErik Torenberg
Yeah.
- JMJustin Mares
And so I would have much-- I think that we should fund much, much more of research along these lines of what's called metabolic psychiatry, uh, which is basically this idea that many diseases that we put in the mental health bucket, things like epilepsy, depression, uh, schizophrenia, many of these things have causes that are actually metabolic in root. And like, for example, one of the best therapies for someone that is schizo-schizophrenic or epileptic or even in many cases bipolar, if you put them on a ketogenic diet, these things will in many cases just resolve. That is not a thing that our current like mental health world really underwrites.
- ETErik Torenberg
Yeah. Yeah, it reminds me of a conversation I once had with Daniel Gross when he, he was saying, "Hey, anytime someone is feeling depressed, it would behoove them to, you know, before attributing it to psych-some psychological, you know, de-defect or making some deep psychoa- uh, you know, analysis about it, first just saying, 'Hey, am I sleeping well? Am I eating well?'"
- JMJustin Mares
Yeah.
- ETErik Torenberg
"Am I exercising?"
- JMJustin Mares
Totally.
- ETErik Torenberg
Um.
- JMJustin Mares
Have I been outside recently?
- ETErik Torenberg
Yeah.
- JMJustin Mares
Yeah.
- ETErik Torenberg
Totally. The, um-- I wanna sh-shift lastly to another topic, um, that you've just been really curious about, um, for a while, which is, which is consciousness. Um, what, what is sort of your-- driven your, your hunch or, or curiosity there and, and, and w-where is your thinking drawing you?
- JMJustin Mares
Yeah. I think that I have just been interested in this idea of like what, what does it mean to be healthy? What does it mean to live a life that people are like excited about, have energy with, you know, have energy and are just like... W-what does it mean to like feel great in your body and your, in your mind and everything? Um, and I think that consciousness is sort of this root layer of like what does it mean to-- what is your experience of being alive, of, of, of life? Uh, and frankly, like we don't really have a great answer to this right now. Um, you know, like a lot of our, a lot of our theories and philosophies and things of like what is consciousness are, are not great. They're not predictive. And, and you ask the average person, you ask even like philosophers that have thought a lot about this, um, and there's not, there's nothing near consensus. And so I think that I don't-- Th-th-- It is an area that I'm very interested in. I think we're going to learn a lot about in the next decade. I hope to like have friends and like play somewhat of a role in like exploring and learning more about, uh, about what consciousness is, like how to change it, how to improve it, you know, all these sorts of things. Um, but yeah, I would put it very much in like personal pet interest bucket. Uh, not like I'm doing anything around it right now.
- ETErik Torenberg
Yeah. Well, to that, obviously you're, you're focused on building Truemed. We'll close there. But if, if you could scale yourself, you know, infinitely, like for people listening who are like al-also obsessed with this problem, is, is there something else you think is underexplored under-- whether it's a research area or a company idea or, or, or, or some s- or po- some sort of policy thing that not enough people are looking into that we haven't yet discussed that you want more people to spend time on?
- JMJustin Mares
Yeah. An, an idea I've been thinking about recently is, uh, like how we mentioned at the beginning that the health of an organism is like the health of your environment. And in my view, what that means is that if we started thinking about not improving just Erik's health, but improving the health of like all of your friends and community and people around you that exist in the same environment, like in-in-intervening and improving your environment could have a much larger impact on health than just like optimizing your own health. And so I think that there's like potentially interesting models of improving one's environment, whether that's building like a health-oriented city or town or like suburb, you know, development or something like that. Um, whether that's like group health insurance for people that are deciding to live differently and like make-- have different interventions, uh, and invest in, in sort of like root cause lifestyle interventions. I think there's a lot of interesting things that could come about when you start thinking about health through the lens of a community or like tens, hundreds of people, not just through the lens of like me as an individual. So if I had copies of myself, I would, I would explore companies in that, in that direction.
- ETErik Torenberg
Yeah. No, love that. Let's, um, let's close on, on, on Truemed and, and go deeper into it in the sense of we're obviously, uh, the company's done phenomenally. We're obviously very lucky to, to, to be a part of it. Um, say more for, for people who are not sort of in terms of the, the actual product and, and, uh, and the direction in terms of where it's going.
- JMJustin Mares
Sure. Yeah. So Truemed, uh, basically what it is, is we, for people that qualify, we allow them to spend, uh, tax-free HSA and FSA dollars on things that treat, reverse, and prevent disease that fall within like the lifestyle intervention category. So like we're partners with Eight Sleep, we're partnered with Peloton, we're partnered with Momentous, Lifetime, Lifetime Fitness. All of these brands that, you know, for someone that is working to treat, reverse, and prevent heart disease or obesity or things like this, these lifestyle interventions are healthcare. And so we've built a payment integration that allows people to spend their tax-free HSA, FSA dollars on these interventions, um, and are scaling that up. Like, I think that where this can go over the next decade is every American that is at risk or has some sort of chronic condition should be incentivized, and tax-free money is a great incentive, to spend their own money, their dollars on things that treat, reverse, or prevent disease. And there's no mechanisms in today's healthcare system for someone to actually spend, uh, you know, for someone to get like a gym membership for cheaper than the list price or to get a gym membership covered, uh, by their employer, by an insurance provider like that. Uh, and so that's kinda the thing, the way that I think about what we're building is building infrastructure that allows people and incentivizes them to invest in lifestyle interventions to stave off and prevent different chronic conditions.
- ETErik Torenberg
Yeah. No, uh, and I actually have to ask, uh, what are your
- 35:49 – 40:34
Why Peptides Will Disrupt Pharma
- ETErik Torenberg
thoughts on peptides and w-- any, any predictions as it relates to-
- JMJustin Mares
Oh man, I think peptides are going to be so disruptive to our current healthcare system.
- ETErik Torenberg
Yeah.
- JMJustin Mares
You know, I think that if you look at peptides, uh, there needs to be way more research. I'm like not totally yet a peptide believer. Uh, but there needs to be way more research. But from early, early signs and even just like N of one, people taking these things and using them, uh-This seems like a class of compounds that are very effective. Uh, they are not patentable. Um, you know, like you can basically buy these for fairly cheap, and I would put them in the bucket of like human enhancement companies. Like our current healthcare system and most of our pharmaceuticals are kind of like, "Don't die." Like, "Oh, here's a statin." Like, "Don't die. Take this pill." Uh, I think that the pep-- these peptides are in a different class where many of them are like, "Give me more energy, improve your sex drive-"
- ETErik Torenberg
Yeah.
- JMJustin Mares
"... lower your inflammation, improve your gut health." Like they're just a different category of compound. And I think that as many people start to experiment with them and try them and things like this, you're gonna see like really interesting positive healthcare, you know, um, outcomes from a class of compounds that like no one has thought about for, for a long period of time. I think it's gonna be exceptionally disrupt- disruptive to pharma and to like a bunch of other players in the healthcare sy- healthcare system.
- ETErik Torenberg
And I'm also curious for, for, for you or just or collectively, like are we learning more about, um, you know, optimizing our nutrition? You, you got into the, the Ray Peat diet, uh, or you were writing about it. What, what, what are, what are your thoughts there, there more broadly?
- JMJustin Mares
I think that nutrition science is probably among the worst of the sciences, [chuckles] uh, in the US right now. You know, most of nutrition s-science is funded by a big food company, uh, they outfund the NIH like eleven to one on nutrition science, at least historically. It's hopefully changing. Um, I think that there are all of these different diet tribes out there. The, the Peaters, the Ray Peat crowd, I think is one that's particularly interesting that's focused on like ramping up your metabolism. Um, but I think that for, for many people, you should just kind of try and experiment with the diet that where you feel good. Like we now have lab tests that you can get, you know, via Function or something like that to show how does this diet impact your energy, your biomarkers, things like this. You have wearables that can actually give you feedback around how is your sleep, how's your HRV, how's your resting heart rate, uh, since switching your diet or since doing things differently. And I think that that combination of like getting insight into how these things are actually making you feel, uh, and how they're impacting your biomarkers means that people should be just way more open to experimenting and seeing like, "Hey, I'll try a Peating diet for like ninety days and just see how I feel." Uh, so I'm, I'm very bullish on like people doing N of one dietary like exploration and experimentation, and I think that the Peating community is like probably the most interesting one out there for me right now.
- ETErik Torenberg
Um, and, and why is that?
- JMJustin Mares
Because there is like two schools of thought, basically. There's like the Bryan Johnson school of thought, which is we've done all the research, we know that you need to eat a plant-based diet, we know that you need to do caloric restriction all in the name of longevity. Um, that is like the current dogma in many ways. The Peaters are the exact opposite and, you know, and Bryan Johnson would say like, "Sugar is bad. You should not eat carbohydrates," all this. The Peaters are like, "You should eat as much sugar as you possibly can, mostly in the form of like honey and fruit and stuff like this. Um, you should try and avoid ma-- like hugely avoid seed oils, hugely avoid things that are going to impair your metabolism." But if Bryan Johnson is like, "I want to eat less and ramp down my metabolism, it means I can live longer," the Peaters are like, "Ramp it up as much as you can, and like the more energy you have, the longer you are able to use that energy over a long period of time." Uh, and so it is like such a contrarian view to a hundred years of nutrition dogma that says sugar is bad, should be avoided, that I think it's a very interesting idea, and a lot of the people in the Peating community have seen phenomenal results. Like I've, I've started drinking orange juice and like eating fruit in the morning and like I feel great. Uh, my biomarkers have gotten even better from-
- ETErik Torenberg
Yeah
- JMJustin Mares
... you know, I've been doing, uh, probably a decade plus of like mostly low carb kinda paleo. And so it's just a very interesting different lens that is worth playing with.
- ETErik Torenberg
Yeah. Um, no that's interesting. I'll have to check out the Peaters. You know, Bryan Johnson's obviously been so interesting on so many topics. One question I, I was just curious if, if I, you know, if I get a girlfriend, should I make a launch video?
- JMJustin Mares
[laughing]
- ETErik Torenberg
Um, Justin, uh, the company is Truemed. Thank you so much for coming on the podcast.
- JMJustin Mares
Thanks for having me on.
- ETErik Torenberg
Lucky to be involved. [upbeat music]
Episode duration: 40:35
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