The Health Interventions Actually Worth Your Time | Justin Mares

Health advice has become an endless stream of supplements, diets, wearables, and biohacks. Which interventions are actually worth your time? Truemed CEO Justin Mares argues that most people should ignore the extremes and focus on a few fundamentals: better food, movement, sleep, and reducing harmful exposures. Justin joins a16z General Partner Daisy Wolf to walk through his own approach to health, from what he eats and how he exercises to supplements, blood tests, sauna, sleep, and the changes he’s made to his home. They also discuss the larger problem behind Truemed: while chronic disease drives the vast majority of U. S. healthcare spending, relatively little goes toward prevention. Justin explains how Truemed is trying to change that by making it easier for eligible consumers to use tax-free HSA and FSA dollars on qualified lifestyle interventions.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Erik Torenberg?

  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, A16Z's Daisy Wolf sits 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?

• 0:42Speaker 01

  So I'm Justin, I'm the CEO and founder of TrueMed. TrueMed basically makes it possible for individuals to spend tax-free HSA FSA dollars on medical interventions that are more lifestyle in nature. So things like exercise, food, supplements, sleep aids, things like that. Then so the high level is if you qualify, if you're working to treat or reverse or prevent a specific disease, you can invest in a gym membership or an eight-sleeper Peloton or something like that using tax-free HSA FSA fund.

• 1:07Speaker 02

  I would love to just understand a day in the life of Justin. I want to understand everything about how you eat, sleep, exercise, supplement. So maybe we can just start with a very typical day in the life. Let's start in the morning, we'll end with the nighttime routine. How do you wake up in the morning?

• 1:31Speaker 01

  Great. So first thing I would say is like at a very high level, I think that a dynamic that you see often on the internet is basically like every health influencer is incentivized to say like the craziest shit because that's what gets a lot of attention. And so people like Brian Johnson, who bless him, I think, doing amazing things, he is like almost incentivized to talk about, oh, I injected by son's stem cells into my body and did this crazy therapy with my grandpa. He does all that stuff that I think is very interesting. I'm glad people are doing it. I like don't do almost any of that. So like my routines are pretty boring or consistent, but I think that there's a couple of areas that I've gone deep that I really care about, which I'll kind of talk about.

• 2:12Speaker 01

  So I basically think from a normal day, like we'll wake up, call around like 7:00, 7:30, wake up, go outside. I try and spend like the first 30 to 60 minutes of every single day outside. Often I'll go for a walk like first thing and either listen to a podcast or call somebody that I just have to have to call and chat with. So I definitely will say, I think that circadian rhythm and circadian biology is pretty, it's pretty under invested or under utilized. People don't really respect that idea and I think it's a very real phenomenon. I feel much better, I sleep better, my days are better, I have higher energy when I'm outside in the morning for the first 30 to 60 minutes. So do that every morning, hang outside, then have coffee. I basically do one to two cups of coffee all before 11:00 AM.

• 2:55Speaker 01

  I'm actually currently trying something, have you heard of Ray Pete by chance?

• 3:00Speaker 02

  No.

• 3:00Speaker 01

  Okay, so I wrote about this in a recent newsletter, but recently I have started doing, I have one big cup of bone broth every morning and then I basically only eat fruit and occasionally honey until like noon every day. And I've been feeling really good, which is kind of interesting. So I'm like on sort of a high sugar diet, like a much higher sugar diet than I'm on.

• 3:21Speaker 02

  I saw you write about running this experiment. And it's kind of the opposite of what we've been told recently, which is balance your glucose, only have sugar, add protein and fat.

• 3:30Speaker 01

  Yeah, 100%. I mean, I am like increasingly of the opinion that we just lose a lot when you sort of try and like over-optimize on one specific metric. But I think that like over-optimizing and say the human body should never have glucose spikes seems just like incorrect to me. If you look at how any tribe basically has existed, people have a desire for sugar, for carbohydrates, for all these sorts of things. And I did a ketogenic diet, I started a keto company several years ago. And I think that keto, like I found was very effective for a while. After a period of time, it like kind of impacted my. And so I think that if you are not working to lose weight or you're not dealing with metabolic dysfunction or other sorts of things,

• 4:11Speaker 01

  I think that eating fruit is like, especially fruit honey, is like totally fine and probably very good for you. So I try and do it earlier in the day and then I'll get a workout in ideally between 11:00 and 2:00 PM. And then for the rest of the day, I'm sort of like on, on calls, doing work, whatever. Another big thing that I did recently is I got a treadmill desk, which I strongly recommend. It's really, really amazing and has been a great way to get anywhere extra between 4,000 and 5,000 steps a day. I kind of try and walk after every calorie that I consume. It's again, it's super easy on the treadmill desk or just like all internal calls that TrueMed, I basically take on the phone, like walking around the office or my house.

• 4:55Speaker 01

  And so that has actually been a very, very useful thing. And I think something that is a very easy upgrade to make generally.

• 5:02Speaker 02

  What do you eat for lunch on an average day?

• 5:04Speaker 01

  Yeah, so normally it is, it's one of two things. It's either like ground beef, often it was called like an ancestral blend, so with organ meats blended into it. So that plus carrots and then often a side salad or side vegetable and maybe, maybe some fruit if I'm feeling like it. So that's sort of like a standard lunch. And then again, potentially like another bone broth. And then a dinner is normally like a higher protein, lower carb kind of thing. So like a fish and vegetables or ground beef and vegetables. I have a fair number of tacos and stuff like that too, just it's easy to put together. But yeah, nothing like too, too crazy. We just have, my wife and I have like very, very high sourcing standards in terms of the foods that we buy.

• 5:47Speaker 01

  And that is where I put most of my energy is just making sure that almost all of the foods that we bring into our house are like very, very high quality. Cause I think that is like the most important thing when it comes to a lot of health and nutrition stuff.

• 5:59Speaker 02

  I've noticed you didn't say chicken and I've seen you write before about some of the perils of chicken. Can you tell us about that?

• 6:07Speaker 01

  Yeah, so I think that the average American gets way too much of their caloric intake in the form of what's called polyunsaturated fatty acids, PUFA. So PUFA's are the primary fatty acid found in a lot of seed oils. They're very high in nuts. They're like in everything basically. And what's key is they actually, these PUFA's will, they make up a lot of the meat concentration in chickens specifically. So chickens have, they're monogastric, they have one stomach. So it means when they eat, what they eat goes directly into their meat tissue, whereas cows have two and so they basically can actually eat things like grass. They have a rumen, they process it and it gets integrated in their muscle tissue differently. And so in the US, most chickens are fed corn and soy almost exclusively.

• 6:52Speaker 01

  And so you have these chickens basically that have the muscle and fat profile of something resembling a seed oil. And so I think that like chickens basically, I think, used to be much healthier. I think that if you're trying to cut down on PUFA's, which I think is broadly just a very good idea, especially if you live in the US, eating chicken every single day, changing that is probably a very easy way to lower your PUFA intake and which I think has a whole host of benefits from inflammation and other kinds of standpoint. But yeah, I avoid it, avoid it.

• 7:22Speaker 02

  Oil is like universally, universally bad. Can you give us a few thoughts on that?

• 7:28Speaker 01

  Yeah, so this is a, what I would say is a contested area. I think that the evidence is fairly clear personally. I think at the very least, even the people that are most pro seed will say things that will agree that these are among the most highly processed things that you can put in your body. They're basically, you think about what is a seed oil? It's extracting very, very small amounts of oil from a soybean or a sunflower or the canola plant. Think about a soybean. Where is the oil in a soybean? You never eat a soybean and you're like, oh wow, this is such an oily thing, the way that you experience an olive or an avocado or something like that. And that's because there are barely any oil in that. Same with corn, there's not a lot of oil in these sorts of things.

• 8:10Speaker 01

  And so it takes something like the equivalent, I think of 98 years, years of corn to get five tablespoons of corn seed oil. And so what that means is because there's so little oil, they have to go through a very chemically intensive process to extract those small amounts of oil at very high heat to turn them into what we call a seed oil. There is this multi-crazy step process to take something from corn or soybeans and turn it into the seed oil. Like if you think about how you make olives, you pull them, press them, that's olive oil. That is not at all the process that we go through to make seed. And so I think that the evidence is quite clear that this process,

• 8:51Speaker 01

  in this process, these oils oxidize, they have a fatty acid and linoleic acid composition that I think is very unfriendly to human health. There've been a lot of studies where they've basically taken rats or other mammals and they've swapped out sunflower oil for cocoa oil and seen metabolic diseases basically go up. Inflammation, fatty liver disease, all these sorts of things massively go up. And if you think about like the average, I think it was 1970, soybean oil made up almost to 0% of the average American's caloric intake. We said we had much lower rates of obesity, inflammation, chronic disease, things like that. Today, the average American gets 20%, almost 20% of their total caloric intake in the form of soybean oil. And we have this record chronic disease crisis.

• 9:36Speaker 01

  And so I think in a best case scenario, you could say these are highly processed things that are maybe okay to not. That's not where I land, but I think that's like a best case scenario. In the worst case, I think you could make a very compelling argument that seed oils are among the chief reasons for the massive and rampant chronic disease crisis that we see today. So yeah, I think they're like very, very smart to avoid. But I really, really do think that like for so many of these things, the lens that the average person does not have and think about the food system is the quality lens. And like we say, is gluten with bread good or bad? Or is sugar good or bad? Is chicken good or bad? I really think that the thing that people are not thinking about is

• 10:21Speaker 01

  the quality of this stuff matters a tremendous degree. Where freshly milled, well sourced, like all this sort of like bread like that is a totally different product than buying Wonder Bread from the center of the grocery store. Yet we call them both bread and say like categorically you should avoid Wonder Bread, which I think is kind of a mistake.

• 10:38Speaker 02

  What's the most indulgent thing or thing that's like bad for your health that you do with some regularity?

• 10:44Speaker 01

  Oh man, I think, so again on the quality thing, like I've recently been totally into this, it's called Alex, A-L-E-C-S, A2. They have this like regenerative ice cream that is insanely good. And so my wife and I have been having like, having that a couple of days a week recently. And it's, you know, phenomenal, like incredibly well sourced, incredibly high quality, but definitely an indulgent.

• 11:09Speaker 02

  I forgot to ask you about protein.

• 11:11Speaker 01

  Yeah.

• 11:13Speaker 02

  Do we all need 100 grams a day of protein? How many grams of protein do you get on an average day?

• 11:19Speaker 01

  I, I think that this is one of those things that is really person dependent. Like probably like a, a man's needs are different from a protein standpoint than a woman's need. A pregnant woman's needs for protein are different than like, uh, you know, someone who's not pregnant. And so I, and also like it varies often by activity level. And so if you are like active weight training, uh, trying to get some movement in all these sorts of things. I think that you should, you know, improve, increase your protein requirements, uh, in, in line with that. Like I probably have, I don't track it super, super tightly, although I probably should. But I probably get somewhere in the neighborhood of like 120 to 150 grams of protein a day. Like I will have most days, some sort of protein powder shake.

• 12:04Speaker 01

  Uh, and then every day I'll have like one to two cups of bone broth. And so that's like 50 grams right there and that's not very calorie dense. And so that's outside of like eating any other food.

• 12:15Speaker 01

  The other thing that I think is very important from a protein standpoint is everyone is eating the same types of protein. And so when you're thinking about eating protein, you're like almost always getting your protein from, uh, cuts of muscle meat. So like ground beef, steak, chicken, uh, you know, salmon, whatever. What I think that most people miss, and if you look at like hunter gatherer diets or ancestral diet, um, they would sort of get a full spectrum amino acids and many different types of protein in their diet, uh, and, you know, get a lot more collagen, a lot more gelatin, a lot more glycine, a lot more of these, these other sorts of proteins and amino acids that are so key in building a very healthy gut, skin, uh, joints and the like. That is almost entirely missing in the average person's diet today.

• 12:59Speaker 01

  And so I think that something that people get a lot of, like a very high ROI thing to introduce into your diet is some sort of like glycine, gelatin and collagen supplementation, either in the form of whole foods, which would be like, honestly, like bone broth and stuff like that. Or, um, you can get like very, very high quality gelatin and collagen supplement.

• 13:20Speaker 02

  Talk to us about supplementation.

• 13:23Speaker 01

  Yeah.

• 13:23Speaker 02

  What do you take every day? When do you take it? Why do you take it?

• 13:26Speaker 01

  Yeah. So I think that this is, this is very, it, it very much depends on the person and what you're trying to work on. Uh, like if you get function or superpower, like you can understand your blood work basically, and look at what are the things that you're trying to, you know, treat or reverse, prevent, whatever. And so for me, uh, I think that there's a couple of buckets that are really important. We talked about protein. I really do think that like for, from an ROI standpoint, in increasing your, your gelatin and collagen intake is going to be one of the highest ROI health inventions that almost anyone can make. Because almost everyone is like clinically deficient in these sorts of, uh, in these sorts of protein. Secondly, I think that, uh, there's something called the NTHFR mutation. It's a mutation that 30 to 40% of people have.

• 14:09Speaker 01

  That means that you have a harder time like methylating and, and sort of breaking down, uh, clearing compounds from the body. So I have that mutation. So I take what's called a methylated B vitamin complex. Uh, that seems to help a lot in terms of not feeling like brain fog or, you know, allergies or anything like that.

• 14:28Speaker 01

  I take that every day. I take, uh, Maui Newey, the deer company that I talked about earlier. Uh, they have a organ blend, basically, that's a blend of like liver, kidney, spleen, I think. Organs, basically, uh, just dried up. I take that every day. It's, some people call it like nature's multivitamin. It's incredibly nutrient dense. It tastes horrible. Uh, and so I tend not to eat liver, although some people do. And then what else do I take? Uh, and then actually I, I recently started in the last couple of months, taking a, I have, I spend a lot of time on a screen. Uh, you know, I know it's like not the healthiest thing, but it's, we're building a company and, uh, that's what it takes. And so I take this, uh, thorn product for, that helps with like macular degeneration.

• 15:13Speaker 01

  Um, it's basically like to improve your eyesight and that helps a lot, uh, which is kind of interesting. And then lastly, for almost everyone, um, you know, people get very concerned about their lipid, their like heart markers. Uh, you know, cardiovascular disease, number one killer of American. And so, uh, many people have, especially if they get their blood work back, they're like, oh, my LPA or my ApoB or my LDL are high from a risk standpoint. Uh, I think that that is like a very, very smart thing to manage. And so I actually, um, I take this, this supplement. It's an enzyme, uh, called Natto kinase. It's basically like, it's an enzyme that comes from fermented soybeans. Uh, it's a very popular, it's in a food called Natto in Japan, which is very popular.

• 15:57Speaker 01

  And so this is, I think for me, like one of the highest bang for your buck kind of supplements that you can take generally, especially if you're concerned about heart health. And so, um, it really matters, the efficacy and the dosage. And so I take this brand called Toku, uh, that has T O K U, which has like the effective dose. Uh, that research has shown works lit like slightly better than statin for preventing and breaking down arterial plaque, which, you know, ultimately is what leads to heart, heart attack. So that's kind of my, my like supplement stat. I really think that the, the right thing to do is basically look at, get your blood work done. Look at areas that you're deficient. Uh, also frankly, like, how do you feel? How's your energy?

• 16:42Speaker 01

  If your energy is bad or your cognition is slow, maybe you want to take like, uh, certain sets of supplements that would help with that. If you want to improve your digestion, like there's Tedka and like other sorts of things that you could kind of experiment with taking. Uh, but I think it's, it's very, very personal. And the biggest thing that I would do frankly is like, get your labs done. Put them in chat GPT or something and be like, hey, based on this, what supplement intervention should I consider running for the next 90 days? 180 days and then retest. And so I've kind of done that loop, uh, a while and now just take supplements mostly for maintenance and trying to like feel good and either prevent things that I, that I'm aware of, uh, or just general risk factors. Or, um, you know, work on things like improving my methylation.

• 17:27Speaker 02

  Cool. Okay. That brings, that's a good transition to our next topic, which is like, what is your approach to preventative care in general? You've mentioned blood work. What kind of blood work do you do? Do you do imaging? Um, talk to us about like, do you go to your doctor for, you know, an annual checkup? Talk to us about like, you know, everything you do and help care from a preventative perspective to monitor your health.

• 17:52Speaker 01

  Yeah, it's a great question. So I have gotten labs done every like six months for the last couple of years, like five years, I would say. And I think that that is probably one of the best places to start. Like, I think that if you sort of qualitatively, qualitatively are, are tracking, how do I feel? What are areas that I feel like can improve? What are things that like, don't feel right? That is a very interesting data point. There's a ton of experiments you can always be running in the background around like, it does X, Y, and Z help with my sleep to this like, do I feel better after doing this? And so I really do think it is a very personal thing where, you know, you just look at like, what are your labs? What markers do you want to make better? And then you do like a couple of interventions to try and work on them over the next six months.

• 18:36Speaker 01

  From a scan standpoint, about once a year for, I, I guess it's been like once every 18 months. Like my labs are very good and I'm, um, pretty healthy. And so I, I don't like overly obsessed about getting like an annual scan or anything like that. But about every 18 months, I will do like a, a calcium test, uh, which tests just like calcium buildup in, in your arteries. And then also go get like a, I did like an Ezra scan, um, 18 months ago. That's just like looking for precancerous growths and things like this, uh, which I think is smart, especially if you have risk factors or like a family history of these things.

• 19:15Speaker 02

  Totally. I mean, I, I think what you're saying is a real thing where it's like for people who are really interested in health, who are taking health into their own hands, you, their annual physical is often like quite underwhelming. You're so in this every day, uh, that it's like, you're already probably doing a layer beyond what, what you're.

• 19:33Speaker 01

  Yeah. And like the, the average PCP spends something like 40 minutes with a patient per year. I mean, so if you have a primary care physician, they're just not, they, they don't have like the context. They often don't, uh, know or like have not gone deep on a lot of the chronic conditions that people are likely to work with. Uh, you know, if I, if I talk to them and said, hey, I'm concerned with my like ApoB or LPA markers. Should I go on a statin? Like many of them would be like, I don't really know what those markers are. I'm not really, I'm not really up to date on them, but like probably you should go on a statin, which I just like clinically don't think is the right intervention, uh, for someone that is, you know, younger, healthier and like has a, a pretty low risk profile.

• 20:13Speaker 01

  Uh, so yeah, I, I generally am like, I think that the way medicine is done today is going to change a huge amount in the coming decade or so. Uh, and I think that a big piece of that is going to be people are taking health into their own hands and they're going to do so armed with a bunch of information about their labs and other stuff that traditional doctor didn't get, didn't have, uh, didn't just historically have not cared about.

• 20:36Speaker 02

  Talk to us about like the rest of your physical environment.

• 20:41Speaker 02

  House cleaning, like, how do you avoid toxins? What should we care about? I know in this, like, we're all existing in this world and there's only so much we can do. But what do you do? And if you're giving advice to, like, you know, an average person to make a few changes, what are the things that, you know, you would actually?

• 20:59Speaker 01

  Yeah, so I think that the two highest leverage thing, like intervention that people can make on their health today is basically like maximizing nutrient density. So making like massively improving the quality of food that you're sourcing and then minimizing toxin exposure. And a big source of toxin exposure is in the home. And so I think that like, if you are not installing a whole house filter or like, you know, at least getting like a reverse osmosis system or like very high quality countertop system, that like, drink better water is such a, such an easy leverage point. And it's such, it's gonna have like such positive impact on people's health. Like, if you look at tap water databases across New York, San Francisco, Austin, like

• 21:44Speaker 01

  any major city, it's astounding how bad like the chemicals are and the exposure to a bunch of things that we know are carcinogenic, a bunch of chemicals that we know are, have a huge impact on your hormone. So I think that cleaning up your water is really a big first step. And then secondly, like putting air filters in your house, I think is a very high leverage intervention. You can get a lot of ROI from that, it's very cheap, they just run all the time, it's easy. And then lastly, I think that using clean materials for like good cleaning material, we buy from Branch Basics is a really easy way to do it. And then upgrading your Tupperware, making sure that you're not like getting Teflon,

• 22:26Speaker 01

  you know, chemicals in your eggs or whatever it is on a daily basis, is a really, really smart thing to do.

• 22:34Speaker 02

  Awesome. Obviously, you've been able to devote, you know, your life to this and then your, you know, every kind of, your serial entrepreneur, every company you've built is empowering people to live healthier lives.

• 22:48Speaker 01

  Yep.

• 22:48Speaker 02

  Do you want to tell us a little bit more about TruMed and how it's helping with that?

• 22:53Speaker 01

  For sure. Yeah, I mean, so one of the things that I think is just so broken about the American healthcare system today is if you look, where does spend go? 90% of healthcare spend goes towards treating, treating or managing chronic condition. Yet, less than 3% goes towards anything resembling prevention or anything resembling lifestyle intervention. And so I think that we can argue about like, what is the right amount that society should be spending on prevention? I think we can all say like, 3% is not the right amount. Like, that's not like the perfect amount of prevention. And you see it in the healthcare outcomes, they're all bad. One of the reasons that, you know, that I believe that Americans are so sick today is because we have this very strange system where someone who is at risk of type 2 diabetes

• 23:36Speaker 01

  or obese or something like that can get sicker and sicker and sicker. And basically, no one in the existing healthcare system is incentivized and will, or will spend a single dollar helping prevent that person from getting type 2 diabetes. And yet, the minute that they get type 2 diabetes, the system activates and they'll spend an average of $3 million managing that person's type 2 diabetes for the duration of their lifetime. That is like totally crazy. And so the one area of the entire healthcare system where an individual has choice and they're actually incentivized to spend their, you know, to spend their own money basically on things that can treat, reverse, or prevent disease is HSA and FSA account, like tax-free accounts, it's your money, you can spend it how you want.

• 24:17Speaker 01

  And if you go through a company like TruMed, the IRS has explicitly said that things like exercise, things like food interventions, things like sleep interventions or supplements can all count for tax-free HSA/FSA spending if accompanied by a doctor's note. And so what we've done is we've built a platform that helps facilitate access for people that are qualified to spend their HSA and FSA dollars on things like exercise, supplements, food, you know, healthy food, sleep aids, and the like. And our goal is basically to incentivize and make it slightly more affordable and slightly lower friction for someone like you or me to invest in preventing obesity, preventing or treating, you know, heart disease, preventing or treating the myriad of chronic conditions

• 24:59Speaker 01

  that are just decimating American health. And so I, I think that like affordability is a key component of the healthcare crisis. And I think that if every American maxed out their HSA account and, and, you know, all, everyone that qualified was able to spend these dollars on effective lifestyle interventions, I think it would change the trajectory of American healthcare.

• 25:23Erik Torenberg?

  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.

• 25:49Erik Torenberg?

  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.