--:-- Daisy Wolf: There's no shortage of advice about how to optimize your health. Justin Mares thinks most people would be better off focusing on a much shorter list. In this episode, I sit down with Justin, co-founder and CEO of Truemed, to unpack what he actually does for his own health. We get into food, exercise, supplements, blood testing, sleep, sauna, and which changes he thinks offer the highest return without turning health into a full-time job. And we discuss the idea behind Truemed: if so much healthcare spending goes toward managing chronic disease, why don't we make it easier for people to spend their own healthcare dollars on prevention?
--:-- Justin Mares: I'm Justin, CEO and founder of Truemed. Truemed basically makes it possible for individuals to spend tax-free HSA and FSA dollars on medical interventions that are more lifestyle in nature — things like exercise, food, supplements, sleep aids. At a high level, if you qualify and you're working to treat, reverse, or prevent a specific disease, you can invest in a gym membership, an Eight Sleep, a Peloton, or something like that using tax-free HSA and FSA funds.
--:-- Daisy Wolf: I would love to understand a day in the life of Justin. I want to understand everything about how you eat, sleep, exercise, and take supplements. Maybe we can start with a very typical day. Let's start in the morning and end with the nighttime routine.
--:-- Justin Mares: Great. First, at a high level, I think a dynamic you see often on the internet is that every health influencer is incentivized to say the craziest stuff because that gets attention. People like Bryan Johnson — bless him, I think he's doing amazing things — he's almost incentivized to talk about injecting his son's stem cells or doing crazy therapies with his grandpa. I don't do almost any of that. My routines are pretty boring and consistent. But there are a couple areas I've gone deep on that I really care about.
--:-- On a normal day, I wake up around 7:00 or 7:30, go outside, and try to spend the first 30 to 60 minutes of every day outside. Often I'll go for a walk first thing and either listen to a podcast or call someone I need to chat with. I definitely think circadian rhythm and circadian biology are pretty underinvested in or underutilized. People don't really respect that idea, but it's a very real phenomenon. I feel much better, sleep better, and have higher energy when I'm outside in the morning for that first 30 to 60 minutes. So I do that every morning, hang outside, then have coffee. I do one to two cups of coffee, all before 11 a.m.
--:-- I'm actually currently trying something. Have you heard of Ray Peat by chance?
--:-- Justin Mares: Okay. I wrote about this in a recent newsletter. Recently, I started having one big cup of bone broth every morning, and then I basically only eat fruit and occasionally honey until about noon every day. I've been feeling really good, which is interesting. I'm on sort of a high-sugar diet — a much higher sugar diet.
--:-- Daisy Wolf: I saw you write about running this experiment. It's kind of the opposite of what we've been told recently, which is to balance your glucose, only have sugar with protein and fat.
--:-- Justin Mares: 100%. I am increasingly of the opinion that we lose a lot when we try to over-optimize on one specific metric. Over-optimizing and saying the human body should never have glucose spikes seems incorrect to me. If you look at how any tribe has existed, people have a desire for sugar, for carbohydrates. I did a ketogenic diet and started a keto company several years ago. I found keto was very effective for a while, but after a period of time, it kind of impacted me. If you are not working to lose weight or dealing with metabolic dysfunction, I think eating fruit — especially fruit and honey — is totally fine and probably very good for you.
--:-- I try to do that earlier in the day, then get a workout in ideally between 11 a.m. and 2 p.m. For the rest of the day, I'm on calls and doing work. Another big thing I did recently was get a treadmill desk, which I strongly recommend. It's really amazing and has been a great way to get an extra four to five thousand steps a day. I try to walk after every calorie I consume. It's super easy on the treadmill desk, or for all internal calls at Truemed, I basically take them walking around the office or my house. That has been a very useful thing and is a very easy upgrade to make generally.
--:-- Daisy Wolf: What do you eat for lunch on an average day?
--:-- Justin Mares: Normally, it's one of two things. Either ground beef — often what's called an ancestral blend with organ meats blended into it — plus carrots and often a side salad or side vegetable. Maybe some fruit if I'm feeling it. That's a standard lunch. Then again, potentially another bone broth. Dinner is normally a higher-protein, lower-carb thing — like fish and vegetables, or ground beef and vegetables. I have a fair number of tacos too, just because they're easy to put together. Nothing too crazy. My wife and I have very high sourcing standards for the foods we buy. That's where I put most of my energy — making sure almost all the foods we bring into our house are very high quality. I think that's the most important thing when it comes to health and nutrition.
--:-- Daisy Wolf: I noticed you didn't say chicken. I've seen you write before about some of the perils of chicken. Can you tell us about that?
--:-- Justin Mares: Yeah. I think the average American gets way too much of their caloric intake in the form of polyunsaturated fatty acids — PUFAs. PUFAs are the primary fatty acid found in a lot of seed oils. They're very high in nuts. They're in everything basically. These PUFAs make up a lot of the meat concentration in chickens specifically. Chickens are monogastric — they have one stomach — so what they eat goes directly into their meat tissue. Cows have two stomachs and a rumen, so they process things differently. In the U.S., most chickens are fed corn and soy almost exclusively. So you have chickens whose muscle and fat profile resembles something like a seed oil. I think chickens used to be much healthier. If you're trying to cut down on PUFAs — which I think is broadly a very good idea, especially if you live in the U.S. — eating chicken every day, changing that is probably a very easy way to lower your PUFA intake. That has a whole host of benefits from an inflammation and other standpoints. So yeah, I'd avoid it.
--:-- Daisy Wolf: What about seed oils? Can you give us a few thoughts on that?
--:-- Justin Mares: This is a contested area. I think the evidence is fairly clear personally. At the very least, even the people who are most pro-seed oil will agree these are among the most highly processed things you can put in your body. Think about what a seed oil is: it's extracting very small amounts of oil from a soybean, a sunflower, or the canola plant. Think about a soybean — where is the oil in a soybean? You never eat a soybean and think, "Wow, this is so oily," the way you experience an olive or an avocado. That's because there's barely any oil in it. Same with corn. It takes something like the equivalent of 98 ears of corn to get five tablespoons of corn seed oil. Because there's so little oil, they have to go through a very chemically intensive process at very high heat to extract those small amounts and turn them into what we call a seed oil. It's a multi-step, crazy process. If you think about how you make olive oil, you pick olives and press them — that's it. That is not at all the process for seed oil.
--:-- I think the evidence is quite clear that in this process, these oils oxidize and have a fatty acid and linoleic acid composition that is very unfriendly to human health. There have been a lot of studies where they've taken rats or other mammals and swapped out sunflower oil for coconut oil and seen metabolic diseases go up — inflammation, fatty liver disease, all these sorts of things massively increase. In 1970, soybean oil made up almost 0% of the average American's caloric intake, and we had much lower rates of obesity, inflammation, and chronic disease. Today, the average American gets almost 20% of their total caloric intake in the form of soybean oil, and we have this record chronic disease crisis. In a best-case scenario, you could say these are highly processed things that are maybe okay — that's not where I land. In the worst case, you could make a very compelling argument that seed oils are among the chief reasons for the massive chronic disease crisis we see today. So yes, I think they're very smart to avoid.
--:-- But I really do think that for so many of these things, the lens the average person doesn't have when thinking about the food system is the quality lens. We ask, "Is gluten in bread good or bad? Is sugar good or bad? Is chicken good or bad?" The thing people aren't thinking about is that the quality of this stuff matters a tremendous degree. Freshly milled, well-sourced bread is a totally different product than buying Wonder Bread from the center of the grocery store. Yet we call them both bread and say categorically you should avoid bread, which I think is a mistake.
--:-- Daisy Wolf: What's the most indulgent thing or thing that's bad for your health that you do with some regularity?
--:-- Justin Mares: On the quality thing, I've recently been totally into this brand called Alec's A2. They have this regenerative ice cream that is insanely good. My wife and I have been having that a couple of days a week recently. It's phenomenal — incredibly well-sourced, incredibly high quality — but definitely an indulgence.
--:-- Daisy Wolf: I forgot to ask you about protein. Do we all need 100 grams a day? How many grams do you get on an average diet?
--:-- Justin Mares: I think this is really person-dependent. A man's needs are different from a woman's needs. A pregnant woman's needs are different from someone who's not pregnant. It also varies by activity level. If you are active, weight training, trying to get movement in, you should increase your protein requirements in line with that. I probably get somewhere in the neighborhood of 120 to 150 grams of protein a day. I don't track it super tightly, although I probably should. Most days I have some sort of protein powder shake, and every day I have one to two cups of bone broth. That's about 50 grams right there, and it's not very calorie-dense.
--:-- The other thing that's very important from a protein standpoint is that everyone is eating the same types of protein. You're almost always getting your protein from some cut of muscle meat — ground beef, steak, chicken, salmon. What most people miss is that if you look at hunter-gatherer or ancestral diets, they would get a full spectrum of amino acids and many different types of protein. They got a lot more collagen, gelatin, and glycine — amino acids that are key for building healthy gut, skin, and joints. That is almost entirely missing in the average person's diet today. I think a very high ROI thing to introduce into your diet is some sort of glycine, gelatin, and collagen supplementation, either in the form of whole foods like bone broth, or very high-quality gelatin and collagen supplements.
--:-- Daisy Wolf: Talk to us about supplementation. What do you take every day? When do you take it? Why?
--:-- Justin Mares: It very much depends on the person and what you're trying to work on. If you get a functional medicine practitioner or superpower, you can understand your blood work and look at what you're trying to treat, reverse, or prevent. For me, there are a couple buckets that are really important. We talked about protein — from an ROI standpoint, increasing your gelatin and collagen intake is one of the highest ROI health interventions almost anyone can make because almost everyone is clinically deficient in those proteins.
--:-- Second, there's something called the MTHFR mutation. It's a mutation that 30 to 40% of people have, meaning they have a harder time methylating and clearing compounds from the body. I have that mutation, so I take a methylated B vitamin complex. That seems to help a lot with brain fog and allergies.
--:-- I take Maui Nui — the deer company I talked about earlier — they have an organ blend of liver, kidney, and spleen. Some people call it nature's multivitamin. It's incredibly nutrient-dense. It tastes horrible, so I tend not to eat liver, although some people do.
--:-- I recently started taking a Thorne product that helps with macular degeneration. I spend a lot of time on a screen — I know it's not the healthiest thing, but we're building a company. This helps improve eyesight, which is interesting.
--:-- Lastly, for almost everyone, people get very concerned about their lipid and heart markers. Cardiovascular disease is the number one killer of Americans. Many people get their blood work back and see their Lp(a), ApoB, or LDL are high. I think that is a very smart thing to manage. I take a supplement called nattokinase — an enzyme that comes from fermented soybeans, from a very popular food called natto in Japan. For me, this is one of the highest bang-for-your-buck supplements, especially if you're concerned about heart health. Efficacy and dosage matter. I take a brand called Toku, which has the effective dose that research has shown works slightly better than statins for preventing and breaking down arterial plaque, which ultimately leads to heart attacks.
--:-- I really think the right thing to do is get your blood work done, look at areas you're deficient, and also consider how you feel. If your energy is bad or your cognition is slow, maybe you want a certain set of supplements. If you want to improve digestion, there are things like TUDCA you can experiment with. It's very personal. The biggest thing I would do is get your labs done, put them into ChatGPT or something, and say, "Based on this, what supplement intervention should I consider running for the next 90 to 180 days?" Then retest. I've done that loop for a while and now just take supplements mostly for maintenance — to feel good and prevent things I'm aware of as general risk factors.
--:-- Daisy Wolf: That's a good transition to our next topic. What is your approach to preventative care in general? You've mentioned blood work. What kind do you do? Do you do imaging? Do you go to your doctor for an annual checkup? Talk to us about everything you do from a preventative perspective.
--:-- Justin Mares: Great question. I have gotten labs done every six months for the last five years or so. I think that is probably one of the best places to start. If you are qualitatively tracking how you feel, what areas you can improve, and what doesn't feel right, that is a very interesting data point. There are tons of experiments you can always run in the background — does X, Y, or Z help with my sleep? Do I feel better after doing this? It is a very personal thing where you look at your labs, decide what markers you want to improve, and then do a couple interventions to work on them over the next six months.
--:-- From a scan standpoint, about once every 18 months — my labs are very good and I'm pretty healthy, so I don't obsess about getting an annual scan — I will do a calcium test, which tests for calcium buildup in your arteries. I also did an Ezra scan 18 months ago, which looks for precancerous growths. I think that is smart, especially if you have risk factors or a family history of these things.
--:-- Daisy Wolf: I think what you're saying is a real thing. For people who are really interested in health and taking it into their own hands, the annual physical is often quite underwhelming. You're so in this every day that you're already doing a layer beyond what you're going to get. The average PCP spends something like 40 minutes with a patient per year. If you have a primary care physician, they don't have the context and haven't gone deep on a lot of the chronic conditions people are likely to work with. If I talked to them and said, "I'm concerned about my ApoB or Lp(a) markers, should I go on a statin?" many would say, "I don't really know what those markers are, but probably you should go on a statin." I just clinically don't think that's the right intervention for someone younger, healthier, with a low risk profile.
--:-- Justin Mares: Yeah. I think the way medicine is done today is going to change a huge amount in the coming decade. A big piece of that is people taking health into their own hands, armed with information about their labs and other things that traditional doctors historically haven't cared about.
--:-- Daisy Wolf: Talk to us about the rest of your physical environment. How do you think about cleaning? How do you avoid toxins? What should we care about? We're all existing in this world and there's only so much we can do. What do you do, and if you're giving advice to an average person to make a few changes, what are the things you would actually recommend?
--:-- Justin Mares: I think the two highest leverage interventions people can make on their health daily are maximizing nutrient density — massively improving the quality of food you're sourcing — and minimizing toxin exposure. A big source of toxin exposure is in the home. If you are not installing a whole house filter, or at least getting a reverse osmosis system or a very high quality countertop system, drinking better water is such an easy leverage point. It's going to have such a positive impact on people's health. If you look at tap water databases across New York, San Francisco, Austin — any major city — it's astounding how bad the chemicals are and the exposure to things we know are carcinogenic or have a huge impact on your hormones. Cleaning up your water is a big first step.
--:-- Second, putting air filters in your house is a very high leverage intervention. You can get a lot of ROI from that. It's very cheap, they run all the time, and it's easy. Lastly, using clean materials for cleaning — we buy from Branch Basics — is a really easy way to do it. Upgrading your Tupperware and making sure you're not getting Teflon chemicals in your eggs or whatever on a daily basis is a really smart thing to do.
--:-- Daisy Wolf: Obviously, you've been able to devote your life to this. Every company you've built is empowering people to live healthier lives. Do you want to tell us a little more about Truemed and how it's helping with that?
--:-- Justin Mares: For sure. One of the things that is so broken about the American healthcare system is that 90% of healthcare spend goes toward treating or managing chronic conditions, yet less than 3% goes toward anything resembling prevention or lifestyle intervention. We can argue about what the right amount society should spend on prevention, but I think we can all say 3% is not it. You see it in the healthcare outcomes — they're all bad.
--:-- One reason Americans are so sick today is because we have this very strange system where someone at risk of type 2 diabetes or obesity can get sicker and sicker, and basically no one in the existing healthcare system is incentivized to spend a single dollar helping prevent that person from getting type 2 diabetes. Yet the minute they get type 2 diabetes, the system activates and will spend an average of $3 million managing that person's diabetes for the duration of their lifetime. That is totally crazy.
--:-- The one area of the entire healthcare system where an individual has choice and is actually incentivized to spend their own money on things that can treat, reverse, or prevent disease is HSA and FSA accounts. They're tax-free accounts — it's your money, you can spend it how you want. If you go through a company like Truemed, the IRS has explicitly said that things like exercise, food interventions, sleep interventions, and supplements can all count for tax-free HSA and FSA spending if accompanied by a doctor's note. We've built a platform that helps facilitate access for people who are qualified to spend their HSA and FSA dollars on things like exercise, supplements, food, healthy food, and sleep aids. Our goal is to incentivize and make it slightly more affordable and lower friction for someone like you or me to invest in preventing obesity, treating or preventing heart disease, and preventing the myriad of chronic conditions that are decimating American health. I think affordability is a key component of the healthcare crisis. If every American maxed out their HSA account and everyone who qualified was able to spend those dollars on effective lifestyle intervention, I think it would change the trajectory of American healthcare.
--:-- Daisy Wolf: Thanks for listening to this episode of the a16z Podcast. If you liked this episode, be sure to like, comment, subscribe, leave us a rating or review, and share it with your friends and family. For more episodes, go to YouTube, Apple Podcasts, and Spotify. Follow us on X at @a16z and subscribe to our Substack at a16z.substack.com. Thanks again for listening, and I'll see you in the next episode. As a reminder, the content here is for informational purposes only, should not be taken as legal, business, tax, or investment advice, or be used to evaluate any investment or security, and is not directed at any investors or potential investors in any a16z fund. Please note that a16z and its affiliates may also maintain investments in the companies discussed in this podcast. For more details, including a link to our investments, please see a16z.com/disclosures.
