Which is funny, because there is perhaps nothing less new.

I grew up in Europe, where sauna never needed to be explained as a longevity protocol. You went because it felt good. Because it was cold outside. Because your parents went. Because there was one at the gym.

Now in New York, we have taken the hot room, added beautiful interiors, cold plunges, breathwork, guides, playlists, memberships and, naturally, a booking app.

And I am very much here for it.

There is Othership, which essentially turned sauna into a guided group experience. Lore Bathing Club opened practically next to my apartment. Then there is SAINT, SCHWET and The Altar, the place under review here.

Some are social, some deliberately antisocial, some guided, some places where you disappear into a very hot room and don’t speak to anyone.

What I find interesting is that we aren’t really inventing a new wellness category. We are productizing a very old one.

And unlike a fair amount of what gets productized in longevity, sauna has a meaningful body of research behind it.

One of the best-known studies followed more than 2,300 Finnish men and found that more frequent sauna use was associated with lower cardiovascular and all-cause mortality over long-term follow-up. It was observational, so it cannot tell us that sauna itself caused the difference, but the association was notable. Original study.

This is increasingly my favorite category of longevity intervention: old enough that humans didn’t invent it for Instagram. Interesting enough scientifically to keep studying. Pleasant enough that I don’t particularly need a biomarker to convince me to do it.

Cold exposure deserves a little more restraint. The evidence for sweeping long-term health claims is much less mature than the enthusiasm around it. A recent systematic review describes a limited and varied body of research. Cold-water immersion systematic review and meta-analysis.

All of which brings me to my personal favorite of New York’s new crop: The Altar.

The Altar and I actually go back to before The Altar existed. When Sheba Jafari left her finance jobs to start the company, she and Henrique de Castro came to meet Harvey Spevak and me at Equinox. I’ve stayed somewhat close to the team since and became a founding member.

So yes, I am rooting for them. But there are three specific reasons The Altar has become my personal favorite.

First, the design changes how I feel - and apparently how I behave.

This is something I learned at Equinox. The best physical spaces don’t make you consciously admire the design all day. You just feel comfortable before you’ve figured out why. You stay longer. You move through the space differently.

The Altar has that quality. The symmetry, the lighting, the circular layout. Pictures show you what it looks like, but they don’t quite explain how it feels to be there.

And the most unexpected effect, for me, is social.

I am not someone who particularly wants to make friends while exercising. My ideal wellness environment has historically been: people around me, absolutely; people requiring conversation from me, less so.

And yet I talk to people there.

Somewhere along the way, wellness became extraordinarily solitary. Your Oura score is yours. Your supplements arrive at your house. Your trainer trains you. Your meditation happens in headphones.

Here, I find myself enjoying something with other people without having arrived with the explicit intention of “finding community.” I think the design deserves some credit for that.

Second, they understand hospitality.

You can describe The Altar as a list of services: sauna, cold plunge, red light, compression, infrared. But that doesn’t explain why I would choose to spend my time there.

How you’re greeted, the music, the pacing, the attention to the experience—all of that matters. It’s the difference between going somewhere to complete your wellness routine and going somewhere because you actually enjoy being there.

There is a version of the future of wellness where every service comes to us and friction approaches zero. Then there is another version where the physical place becomes valuable precisely because we need somewhere worth leaving the house for.

I suspect both win. The Altar gives me a reason to leave the house.

Third - and this is the part I’m most interested in - they’ve connected the wellness experience to healthcare.

This is the first sauna I’ve personally been to where I can also access a physician-led program with biomarker testing, genetic testing and ongoing medical support.

I’ve been fascinated by this convergence since we launched the $40,000 Optimize program at Equinox.

The Altar brings those activities closer together. You can come because you want to sit in a sauna and, through the same business, have access to a doctor who reviews your data and how you’re feeling.

That doesn’t mean everything offered has equally strong science behind it. Sauna and BPC-157 don’t belong in the same evidentiary bucket, and physician oversight establishes a much needed framework.

The model itself is what interests me the most: having medical support connected to somewhere you already spend time looking after yourself.

The front door to healthcare may eventually look considerably less like a doctor’s office, and considerably more like somewhere you already wanted to be.

Those are my three reasons. I asked Sheba about the decisions behind them.

Julia: I find myself talking to people here, which is unusual for me. How much of that is the design?

Sheba: Very intentional. Without a place to congregate, people don’t necessarily connect. We kept bringing circles into the space so people would naturally gather and talk. Health is made up of small choices you make every day. Our thinking is that doing those things with other people makes them more enjoyable and easier to keep doing.

And you interviewed 45 architects?

We did. We ended up choosing a two-person team, Marsollier Villacorta. It’s a New York City and Mexico City based practice founded by Cyril Marsollier and Wallo Villacorta. Stuart, our co-founder and creative director, oversaw the details. There’s a lot of symmetry and a grid underneath the design. Then there’s everything around it: how the guides are trained, the music, the scent, how you’re greeted. The hospitality is part of what we’re building.

Who’s coming? Is it the longevity crowd?

We have the performance-oriented people, but a lot of our community is actually creatives - people in production, film, art and acting. We think of ourselves more like Equinox SoHo than the gym downstairs from your apartment. People come because they want this particular experience.

Do you have to be a member?

No. Anyone can come. Membership is about getting better value if you’re here regularly. We have a $165 membership for four visits a month, and a $350 membership with $500 in credit for people using both the sauna and cold plunge and the Practice. We don’t want people to think they need to join a private club to walk through the door.

What does the longevity membership add?

That’s $850 a month. It includes testing for more than 100 biomarkers, genetic testing, hormone labs twice a year and quarterly virtual appointments through Concierge MD. There’s also access to ask health questions between appointments, recovery services in the space and a monthly peptide or IV offering.

What happens in that first medical appointment?

The doctor starts with a conversation about how you feel. Then you do the labs, and there’s another appointment to go through them. It’s about looking at both: what the numbers say and what you’re actually experiencing. The appointments are virtual, so it’s easy to fit them into your life.

Did you worry that adding clinical services would change the atmosphere?

We did talk about that. But people want to take a more active role in their health. We chose to make the experience communal. You might be getting an IV while someone next to you is doing red light or wearing compression boots. You can talk to each other and ask the nurse questions.

That last detail has stayed with me. Even the parts of the experience you might expect to happen behind a closed door have been designed around being with other people.

I came for a practice I’ve known most of my life. I’m interested in what happens around it: who you meet, what becomes a habit, and whether a place you enjoy visiting can help you take a more consistent interest in your health.

So if you took anything from this post - go check out The Altar!

If you enjoyed this, send it to the friend you’d take to the sauna - and subscribe for more on the science, businesses and people shaping how we live longer and better.

Follow me for more of what I’m trying, questioning and discovering along the way. See you next week.

Subscribe now

Share

The most immediately useful upgrade is fairly unsexy: they finally made the Hub small enough to fit under most beds. It’s half the size of the previous generation, despite temperature adjustments that Eight Sleep says are 20% faster.

The Cover is where things get more interesting. Pod 6 goes from two biometric sensors to 18, tracking heart rate, HRV, breathing, snoring and sleep stages from underneath you. Eight Sleep says the added density means it can better distinguish between two people sleeping close together—or you versus the dog who has somehow acquired half your mattress.

There are also new Solo sizes that cover only one side of a Queen or King, plus Twin and Twin XL options. They start at $1,999, versus $2,699 for the full-bed version. For a product that has historically required convincing both yourself and potentially the person sleeping next to you that your mattress needs a computer, this feels like a smart move.

And then there is Autopilot, which I increasingly think is the more interesting part of the product. It takes all of that data and automatically changes temperature through the night based on your sleep, environment and patterns. Depending on the Eight Sleep setup, the system can also adjust elevation and sound.

The mattress is beginning to watch, learn and respond.

Which brings me to a confession: I don’t own one.

Subscribe now

This is slightly peculiar given how many sleep and health devices I have tried over the years. I’ve been an Oura user forever. I track my HRV. I’ve spent an unreasonable amount of time thinking about sleep environments. And sleep is actually one of the things I’m naturally pretty good at.

There were a few reasons I never bought an Eight Sleep.

The first is embarrassingly practical. Every year I tell myself this is the year I graduate from a Queen to a King. Somehow this has prevented me from buying an Eight Sleep for several years while also, importantly, not resulting in the purchase of a King bed.

The second is data.

I already measure my sleep with Oura. I’m not convinced that knowing my sleep score twice makes me twice as informed.

This is something I think about increasingly as we put more technology on our bodies and in our homes. There is a point at which more measurement stops producing more understanding. I don’t need three devices congratulating me for getting eight hours of sleep.

But the bigger hesitation was slightly more woo-woo.

I try to remove electronics from my bedroom, particularly anything sitting close to where I sleep. So voluntarily lying for eight hours on top of something filled with sensors, plugged in and connected to Wi-Fi always felt somewhat incompatible with my attempts to reduce EMF exposure.

I know. The EMF conversation can get weird very quickly.

Which is why I was delighted when Kayla Barnes-Lentz did what any reasonable longevity person apparently does: actually measured her Eight Sleep.

She had her bedroom professionally tested (thanks to Lightworkhome which is worth looking at!) and also took measurements herself, and reported very low EMF at the sleeping surface.

To be clear, someone’s home measurements aren’t a clinical study, and I’m not declaring the EMF conversation settled. But it did make the image I had in my head - me marinating in an electromagnetic mattress for eight hours - look somewhat less convincing.

Unfortunately for my bank account, Pod 6 also removes another excuse: with the Solo version, I don’t even have to wait for the mythical King bed.

So I started looking more closely at what Eight Sleep has been doing.

And that’s when the new Pod became the less interesting part of the story.

Because your mattress company would now like to know your medical history.

Eight Sleep recently partnered with HealthEx, a company that lets consumers access and share their medical records (you can pull your own with HealthEx connector within Claude). The integration means Eight Sleep can, with a user’s permission, bring information like medical conditions, medications and lab results into the same ecosystem that already knows how you sleep every night.

That is a fascinating sentence.

For years, Eight Sleep knew what happened to you between approximately 11 PM and 7 AM.

Now it can begin to know why.

And at the same time, the company is moving into sleep apnea. Eight Sleep says it is pursuing regulatory clearance in Abu Dhabi and the U.S., and is studying whether its technology can help manage the condition.

This is where a very good wellness product starts becoming something else.

A mattress that tells me I slept badly is wellness.

A mattress that detects something clinically relevant about my breathing, understands the medical context around it and can potentially change my physical sleeping position in response starts getting awfully close to healthcare.

I’ve been obsessed with this transition for years.

At Equinox, we launched Optimize, a roughly $40,000 program that brought together advanced diagnostics, physicians, nutrition, training and recovery. The interesting part to me wasn’t that we were adding more wellness services. It was watching the line between wellness and healthcare become increasingly artificial.

Healthcare has traditionally owned the serious stuff: diagnoses, prescriptions, labs, medical records, interventions.

Wellness got everything that happened in between: sleep, exercise, food, recovery, stress.

Except everything that happens “in between” is most of your life.

Your body, inconveniently, does not recognize the organizational chart we’ve built around it.

Subscribe now

Sleep affects blood pressure and glucose regulation. Exercise affects cardiovascular and metabolic health. Medications can change sleep and heart rate. Hormonal changes can alter temperature and sleep. What happens during the 8,700 or so hours a year you aren’t sitting inside a doctor’s office is not background information. It is your health.

And wellness companies have become remarkably good at capturing it.

Oura sits on your finger all day and night. WHOOP sits on your wrist. Eight Sleep gets roughly eight hours of extraordinarily intimate physiological information every night.

Now they’re all starting to move upstream.

WHOOP has moved into blood testing and medical-record integration. Oura has been expanding into glucose and clinical data. Withings has an FDA-cleared under-mattress sensor that can aid in diagnosing obstructive sleep apnea. Apple Watch has an FDA-authorized sleep apnea notification feature.

This looks less like a collection of product launches and more like the early stages of a structural shift.

Healthcare companies have spent years trying to create a more continuous relationship with patients.

Wellness companies started with the continuous relationship.

Now they’re adding healthcare backwards.

I think that’s important.

Because the company that sees you twice a year has one kind of information about you. The company whose product you sleep on 365 nights a year has another.

Neither picture is particularly useful alone.

Which is why I’m also paying attention to HealthEx. Infrastructure companies like it aren’t as fun to talk about as a $3,000 bed, but they may end up being incredibly consequential. HealthEx is effectively building plumbing between clinical records and consumer health products. WHOOP has also partnered with the company.

The walls around the medical record are beginning to get more permeable at exactly the same moment consumer devices are collecting better longitudinal data.

Eventually those two pictures meet.

And once they do, I think the more interesting question becomes what the device can actually do.

For roughly the first decade of quantified self, we became very good at measurement.

Steps. Sleep. Heart rate. HRV. Glucose. Temperature. VO2 max. Biological age. Scores for things I didn’t realize required scores.

Then came interpretation: readiness scores, recovery scores, recommendations, AI coaches telling us to go to bed earlier.

The next phase is intervention.

Measurement → interpretation → intervention.

Eight Sleep is a particularly interesting example because it already has something most wearables don’t: the ability to physically change your environment.

If it detects that you’re overheating, it can cool the bed.

If you’re snoring, certain configurations can change elevation.

The feedback loop doesn’t have to end with a notification telling you to do something tomorrow. The system can potentially do something while you’re asleep.

That is a fundamentally different product.

And there is some actual science behind the temperature piece.

A 2024 study of 54 adults using the Eight Sleep Pod found improvements in certain sleep measures alongside lower sleeping heart rate and higher HRV under some temperature conditions. Eight Sleep employees were among the authors, which is worth knowing when interpreting the results.

A separate randomized crossover study in 34 healthy adults also found that individualized temperature control altered aspects of sleep and thermoregulation. The studies are still small, and they are nowhere near evidence that a smart mattress is necessary for good sleep. But they make temperature manipulation considerably more interesting than another wellness feature searching for a mechanism.

The sleep-apnea work will be a much bigger test.

Because there is a meaningful difference between making a healthy person sleep slightly better and treating or managing a medical condition. That requires stronger evidence, regulatory scrutiny and a very different standard for getting things wrong.

I’m excited about wellness moving into healthcare precisely because I think that distinction matters.

Early science isn’t necessarily bad science. But the closer a product gets to medicine, the higher the evidentiary bar should become.

For now, Pod 6 is still primarily a very sophisticated sleep product. It’s smaller. It’s faster. It has considerably more sensors. It costs less to get into than the previous generation. And the Solo configuration makes it much easier for someone like me to rationalize buying one.

But six generations into building a mattress, Eight Sleep seems increasingly interested in building something much larger around it.

We have spent the last decade putting sensors everywhere.

Maybe the next decade is about what happens when those sensors finally have enough context - and enough permission - to do something useful.

And, annoyingly, I may have finally run out of reasons not to buy an Eight Sleep.

The below is a lightly edited, non-verbatim version of a call we had the other day.

You can also read more about Stephanie’s filter for wellness and longevity here and definitely recommend subscribing to her substack!

I spend a lot of time around people who are unusually informed about their health. Doctors, scientists, investors, founders. These are also people who take peptides they heard about on a podcast.

Intelligence, apparently, does not make us immune to Instagram.

That was one of the things Dr. Stephanie Kuku and I kept coming back to when we spoke. Stephanie trained in gynecologic oncology and clinical research before moving into health technology, AI and scientific due diligence. She now spends a lot of time looking at longevity products and asking a fairly basic question: does the science actually support what we’re being sold?

The problem isn’t that everything in wellness is bullshit. It isn’t.

The problem is that we have become very bad at distinguishing early science from bad science.

Medicine has informed consent. Before an intervention, someone is supposed to explain the potential benefit, the risks, the alternatives and what we don’t know.

Wellness doesn’t really have an equivalent.

A supplement can tell you about the study on one of its ingredients without testing the actual formulation. A peptide can be sold alongside an extremely convincing biological mechanism despite having little long-term human safety data. A finding in mice can travel remarkably quickly from PubMed to a $180 bottle.

I don’t think the answer is to stop experimenting. That would be both unrealistic and, frankly, boring. Some of the most interesting ideas in longevity are interesting precisely because the science is still developing.

But curiosity works much better with due diligence.

So I asked Stephanie to give me hers.

Julia: You spend a lot of time evaluating health technology and longevity products. Why are even very sophisticated people so susceptible to wellness marketing?

Stephanie: We’re consuming an enormous amount of health information online, and nobody is immune to that influence. Doctors aren’t immune. CEOs aren’t immune. Investors aren’t immune.

The problem is that what you see is usually one-sided. You’re presented with the potential upside of an intervention without the equivalent conversation about the risks, limitations or quality of the evidence.

In medicine, we have informed consent. If I’m recommending an intervention, I have a responsibility to explain what could happen, what the alternatives are and what we don’t know.

That balance largely disappears when something becomes a consumer wellness product.

J: Which is interesting because the consumer can mistake more access to information for being better informed.

Stephanie: Exactly. And marketing is extremely sophisticated.

Something can say “science-backed” because one ingredient has been studied. But was the actual product studied? At this dose? In this formulation? In people like you? For the outcome they’re advertising?

Those are completely different questions.

J: I think this is where longevity gets particularly messy. There is a tendency to divide everything into “science-backed” or “bullshit.” But early science isn’t the same thing as bad science.

Stephanie: Absolutely.

You have to look at where the science actually is.

There may be a plausible mechanism. There may be good animal data. There may be early human data. That’s promising science.

The problem starts when the claim runs significantly ahead of that evidence.

J: So how do you personally diligence something? Say I send you the newest longevity supplement everyone suddenly seems to be taking.

Stephanie: Before I even get to the product, I start with foundations.

Are you eating well? Are you exercising? Are you sleeping? How is your mental health? How is your community?

Because if those aren’t addressed, you have to ask what exactly you’re expecting the product to compensate for.

Then I ask about indication: what are you actually trying to change?

That sounds obvious, but people often buy a supplement without being able to clearly answer that question.

Then you look at the evidence. What studies exist? Were they done in humans? Were they done on the actual product or only one of its ingredients?

Then mechanism: is there a biologically plausible reason this should do what is being claimed?

And finally risk versus reward.

J: The indication point might be my favorite because longevity has created this category of things we take “for longevity,” which is not actually an indication.

Stephanie: Right. What outcome are you trying to achieve?

If you don’t know, it’s very difficult to determine whether something is working.

J: Let’s talk about mechanism because I think this is where smart consumers can get tricked. Give me enough molecular biology and almost anything can start sounding compelling.

Stephanie: A mechanism is important, but it isn’t proof of an outcome.

GLP-1 is a good example. We understand the mechanism and have strong clinical evidence for specific indications. But that doesn’t mean you can take every downstream biological observation and suddenly claim that GLP-1 drugs prevent every disease.

There has to be a chain between the mechanism, the intervention, the population and the actual outcome you’re claiming.

J: This happens constantly with supplements too. There might be a paper on vitamin C, another on creatine, another on some botanical, and suddenly putting all three into a beautiful jar makes the jar clinically validated.

Stephanie: Exactly.

Ingredient-level evidence isn’t automatically product-level evidence.

You need to ask whether the finished formulation has actually been studied, whether the doses match the evidence and whether combining those ingredients changes anything.

J: Why don’t more wellness companies just run the studies?

Stephanie: Incentives.

Clinical trials are expensive. They’re slow. And there’s also a business risk: what happens if you run the trial and it doesn’t show what you’ve already been marketing?

If the product can already be sold without that evidence, there isn’t always a commercial incentive to generate it.

J: Which creates a slightly insane asymmetry. The consumer takes the biological risk while the company avoids the evidence risk.

Stephanie: That’s why I think consumers have to start demanding better evidence.

J: Peptides feel like the perfect example. They are increasingly normal in longevity circles, including among young healthy people, while long-term human data for many of them is extremely limited.

How do you think about something where the mechanism is exciting but we genuinely don’t know what happens after someone uses it for ten or twenty years?

Stephanie: That’s exactly where risk-reward becomes important.

Absence of evidence of harm isn’t the same as evidence of safety.

If you’re treating a serious condition, you may rationally accept more uncertainty. If you’re a healthy 30-year-old trying to optimize something marginal, your risk tolerance should probably look very different.

And some risks may not become apparent for years.

J: Rapamycin is another fascinating one because there is legitimate longevity science around the pathway, very compelling animal work, and growing human research. But that sentence can very easily become “rapamycin makes humans live longer.”

Stephanie: And we don’t have evidence to make that claim.

This is where you have to distinguish animal evidence, mechanistic evidence and clinical evidence.

The exciting thing is that rigorous studies are being done. That’s exactly what we need. But until those results exist, we should be precise about what we know and what we’re extrapolating.

J: Do consumers actually need to learn how to read scientific papers to do this well?

Stephanie: No.

I don’t think everyone needs to become a scientist.

You need better questions.

What is this supposed to do?

Was the actual product studied?

Was it studied in humans?

How many people?

Does the dose in the study resemble the dose I’m taking?

Who funded the research?

What are the risks?

And is there something much simpler with better evidence that achieves the same thing?

AI can actually be very helpful here. You can give it a claim and ask it to find the evidence behind that specific claim rather than just accepting “clinically proven” on a website.

J: What’s funny is that after spending all this time evaluating longevity products, your own stack is relatively boring.

Stephanie: Very boring.

I don’t generally take supplements unless I have a reason. I’ll take things like folate, vitamin D or magnesium when they’re indicated for me.

But I also use things that wouldn’t necessarily score perfectly on a rigorous longevity evidence framework. I like skincare. I use some beauty devices. They make me feel good.

And that’s okay.

Not everything has to extend lifespan to have value.

J: I actually love that distinction.

We should be allowed to buy something because it feels good, looks beautiful or gives us twenty minutes when nobody is speaking to us.

We should just know that’s the return we’re buying.

The problem begins when a luxury experience gets repackaged as a biological certainty.

Stephanie’s due diligence test

The next time something lands in my Instagram feed promising better mitochondria, younger cells or an unspecified amount of “hormone balance,” I’m trying five questions before my credit card gets involved:

1. What am I actually trying to solve?
“Longevity” isn’t an indication.

2. What is the evidence — and what was actually studied?
Humans or mice? Ingredient or finished product? Same dose? Same outcome?

3. Does the mechanism make biological sense?
Plausibility matters. It just isn’t the same thing as proof.

4. How large is the gap between the evidence and the marketing claim?
This might be the most revealing question of all.

5. What is my downside?
Not just “could this work?” but “what am I risking for the possibility that it does?”

I’m adding a sixth for myself:

What would change my mind?

Because I’m still going to experiment.

I just want to get better at knowing whether I’m participating in promising science, paying for a nice experience, or accidentally funding someone’s very beautiful mouse study.

Share

Leave a comment

Subscribe now

Hi, I’m Julia. I spent the last six years working at the intersection of fitness, wellness and longevity, most recently leading partnerships at Equinox. Now I’m building In Search Of and talking to the people I think are asking the most interesting questions about how we live longer - and better.

If you liked this HOUSE CALL, follow along, share it with someone who would too, or send me the person you think I should call next.

There is currently an unopened box of statins traveling around the world with me.

SHIMA in Japan - A sandwich that definitely was not good for my cholesterol, but totally worth it :)

A doctor prescribed them. Every decent primary-care or concierge doctor who sees my bloodwork asks some version of: why are you not already taking this?

They have a point.

My latest numbers (tested regularly via Function Health, you can order here):

• Total cholesterol: 309 mg/dL

• LDL-C: 180

• ApoB: 128

• LDL particle number: 2,013

• Non-HDL cholesterol: 195

Those aren’t numbers I can explain away as a slightly enthusiastic laboratory reference range.

And yet, I haven’t opened the box.

Which is slightly absurd because I fundamentally believe in early intervention. The whole premise of longevity medicine is that if you can see risk developing decades before disease, why wait?

Apparently, unless the intervention is a pill I might have to take for the next 50 years. And the subject in question is me.

Disclaimer: Should you take the statin? I don’t know. I’m not a doctor. But I’ve been thinking about cholesterol much longer than I’ve been thinking about longevity, because it’s been a family conversation around our table for as long as I can remember. This is not medical advice. It’s the personal journey of someone trying to understand the science, think through the trade-offs, and build a framework for making a decision. Your risk, biology and treatment options may look very different, so you should always make these decisions with a doctor who knows your history.

I’ve had high cholesterol since I was 15

My mom kept every blood test in a folder, printed on paper, because mothers apparently understood longitudinal health records before healthcare did.

My cholesterol was already over 250 when I was around 15.

Doctors noticed. They cared. But I was young, so nobody did much about it.

Twenty years later, I find myself wondering: if I were 15 today, would the recommendation be different?

Possibly.

For children with familial hypercholesterolemia, long-term follow-up suggests that starting statins in childhood can meaningfully slow the development of atherosclerosis and reduce cardiovascular events later in life. That doesn’t mean every teenager with cholesterol above 200 needs a statin.

It does mean that “you’re young, therefore we can ignore it” is increasingly hard to defend when the underlying risk is genuinely high.

And mine certainly looks familial.

My mom’s has high cholesterol. My father has it and takes a very low dose of a statin. There is stroke history on his side - and family history for this matters.

Then there is my grandmother.

She is 94, extremely sharp, independent, doesn’t take a statin, and has had total cholesterol somewhere around 350–400 for as long as I can remember discussing it.

She is an absolutely terrible scientific study.

She is also a very effective reason to wonder whether a number tells the whole story.

First lesson: “high cholesterol” is almost a useless sentence

The 309 is the number that looks terrifying on my Function dashboard.

It isn’t actually the number I care about most.

What matters more is what is transporting that cholesterol around.

My simplified version:

• LDL-C = how much cholesterol is being carried inside LDL particles.

• ApoB = a proxy for the number of atherogenic particles circulating.

• LDL-P = another measurement of particle number.

• Lp(a) = a largely genetically determined lipoprotein-associated risk factor.

• HDL-C = cholesterol carried in HDL particles. Calling it simply “good cholesterol” is increasingly unhelpful.

My ApoB of 128 and LDL-P of 2,013 are what make it harder for me to wave away my LDL.

A large body of genetic, observational and randomized-treatment evidence supports ApoB-containing lipoproteins as causal drivers of atherosclerotic cardiovascular disease. The basic issue is cumulative exposure: more atherogenic particles circulating for more years creates more opportunity for those particles to enter the arterial wall.

Being young doesn’t eliminate that problem. In some ways, it makes the duration part more relevant.

But everything else looks pretty good

This is where I think many women get confused.

My panel also says:

• HDL: 114

• Triglycerides: 54

• Lp(a): 13

• hs-CRP: 0.2

• A1c: 5.0%

• LDL pattern: A

If I were using the cholesterol vocabulary most of us grew up with, I might say: yes, my bad cholesterol is high, but look at all this excellent good cholesterol.

Unfortunately, biology isn’t that tidy.

Very high HDL does not appear to simply cancel the cardiovascular risk associated with elevated ApoB-containing particles. And “good cholesterol” has become one of those health phrases that survives because it is convenient, not because it accurately describes the physiology.

Cholesterol itself isn’t bad. We need it for cell membranes, steroid hormones, bile acids and normal human function.

The problem is where it is being carried, how many atherogenic particles are circulating, and for how long.

What about healthy women with high cholesterol?

This is the part I keep hearing anecdotally.

Read more

Not healthcare. Health.

There is apparently a difference.

Gym. Trainer. Supplements. Acupuncture. Sauna. Recovery. Wearables. Tests. Treatments. Things I had been convinced would fix my gut. Things I had been convinced would make me live longer. Things I had been convinced would make me look better while living longer.

The number was so high I assumed I had calculated it wrong.

So I kept looking.

Then it got worse.

A trainer can easily run $15,000+ a year. Add a great gym membership, acupuncture, massages, supplements, wearables, recovery, testing and suddenly a very normal-looking wellness routine becomes a $25,000–$50,000 annual portfolio before you’ve done anything particularly insane.

And I have done some insane things.

My actual eyeball, at some eye test, at Superhuman conference in Stockholm last year

I’ve spent around $1,500 on a single intervention intended to affect my stress response (and that was a deeply discounted price given to me by a friend). Bodywork can run me $500 a session. A week at one of the medical-wellness retreats I find myself looking at can move from a few thousand dollars to $30,000 surprisingly quickly.

This is also a conservative exercise for me. I’ve spent most of my career working in wellness and longevity, so I’ve been lucky enough to receive gym access, treatments and experiments for free.

Paying retail for my curiosity would be considerably worse.

It was particularly embarrassing because before wellness, I worked in finance.

I know how a portfolio is supposed to work.

You establish your objective. Understand your time horizon. Assess your tolerance for risk. Protect the downside. Allocate most of your capital accordingly.

Then you leave it alone.

You do not wake up Tuesday, discover a new asset class on a podcast and rebalance the entire thing before lunch.

Unless, apparently, the asset is your body.

Subscribe now

My personal health portfolio feels like seed-stage VC

I’ve done things before most like injecting donated human tissue into my arm.

Actual image from Jonathan Kuo from Extension Health who injected this to help my tennis elbow. It did work.

It fixed a problem I’d spent six months trying to fix with physical therapy, so despite how that sentence sounds, I would do it again.

I’ve had an ultrasound-guided injection intended to affect my stress response. Roughly $1,500 for one intervention.

Also: would do again.

Currently, I want to try plasmapheresis.

The simplified pitch is essentially filtering and replacing components of your plasma. It’s an established medical procedure for certain diseases. Using it as a general longevity or post-viral intervention is a very different proposition, and one for which I don’t have evidence that it will solve my problems.

I still want to do it.

Some part of me remains convinced that some of my unresolved health issues could trace back to long COVID, and there is something incredibly seductive about the idea of physically cleaning something unwanted out of my body.

This is not how I was taught to underwrite investments.

But this is exactly the point.

When the asset is our own body, even people who understand risk and return become remarkably bad investors.

Hope changes the calculation.

If you have a problem nobody has been able to solve, a speculative intervention doesn’t feel speculative.

It feels like possibility.

I’m known to just try things, sometimes to my own detriment - here i am at the Superhuman conference in Stockholm last year having some of my blood plasma taken.

I tried doing it the responsible way too.

Once, I had an actual health issue and went to One Medical.

I rearranged my workday and skipped a meeting to go.

They checked my pulse, ran basic bloodwork and told me that if I still felt the same in a week, I should come back.

I was very much not okay.

“Wait and see” may have been medically reasonable. But after the friction of getting the appointment, rearranging my day and showing up, leaving with no understanding of what to do next was incredibly frustrating.

So I did something equally ridiculous.

I went home, opened ChatGPT and essentially figured out my own medication plan.

It helped.

I am aware this is not the lesson anyone should take from this story.

The lesson, for me, was how completely I’d become accustomed to self-managing my health.

And there’s an important distinction here.

I know what I’d spend on preventative health.

I already do.

Equinox and my trainer aren’t frivolous “wellness” expenses in my portfolio. They’re prevention. Training consistently is one of my core holdings. So are sleep and the things that keep my body moving well enough that I can continue training.

The gap is healthcare.

When the next real issue emerges, who knows my history? Who looks at my three-year trends rather than today’s bloodwork? Who decides whether I need a gastroenterologist, endocrinologist, another test, medication - or nothing at all?

I don’t have that system.

I’ve never had a relationship with a doctor long enough for someone to look at my life that way. My data is between Poland, Spain, UK and many states of US.

My Oura has known me longer than any physician has.

And while I’m skeptical that obsessing over whether my HRV moved this week is particularly useful, years of measurement allowed me to see a multi-year downward trend.

Whether the hypotheses I’m developing about why prove correct is another question.

But nobody else was watching long enough to ask it.

So I became the person watching.

With Dr Hyman at that same conference.

I accidentally became my own health CIO

CIO = Chief Investment Officer.

This is where the finance analogy stopped being funny to me.

If I were managing a financial portfolio the way I manage my health, I would fire myself.

I trade constantly.

New symptom. New test. New supplement. New expert. New protocol. New study. New theory.

Rebalance.

And the more I thought about it, the more obvious the comparison became:

Some aesthetic treatmentsI look better. This is also a return; I just shouldn’t call it longevity.

The last row may be the most financially honest thing I’ve ever written about wellness.

Because one of the problems with longevity is that we’ve started forcing almost anything that makes us feel good under the umbrella of “health.”

Sometimes a laser is a health investment.

Sometimes I just want good skin.

Both are allowed.

The important thing is knowing which one I’m buying.

Subscribe now

Wellness solved a problem healthcare didn’t

Wellness figured out how to make taking care of yourself desirable.

Healthcare largely didn’t.

Movement, recovery, sauna, acupuncture, beautiful gyms, increasingly sophisticated diagnostics: the best parts of wellness took things people knew they “should” do and made them things people actually wanted to do.

That matters.

My trainer and gym membership are probably among the highest-return investments in my portfolio. Training consistently changed my strength and mobility and, perhaps more importantly for someone constantly traveling, gave my body some rhythm.

And unlike some of my more exotic experiments, physical activity has an enormous evidence base behind it.

Sauna is different: I love it and feel better afterward, while the evidence for long-term health outcomes is interesting but substantially less definitive than the evidence for exercise.

But here’s something longevity conversations sometimes miss:

I don’t actually need everything I do to make me live longer for it to produce a return.

I pay around $250 for some recovery/bodywork sessions because my body feels meaningfully different afterward.

I spend a lot of time on planes. I work out. I get tight.

If something reliably makes Tuesday better, that’s a return too.

Feeling good while I’m alive belongs somewhere in the longevity equation.

It cost me a fortune to discover my index funds

After years of access, experiments, practitioners, supplements, tests and treatments, my core portfolio has become surprisingly unsexy.

Trainer.

Gym.

Sauna.

Acupuncture.

Recovery.

Sleep.

A small number of supplements that have produced enough of a noticeable or measurable difference for me to keep taking them.

It cost me a lot of money to narrow the list down this far.

That’s the part I find absurd.

The consumer isn’t presented with a portfolio of interventions ranked by evidence, expected return, downside and relevance to their problems.

We’re presented with an endless feed.

Peptide.

Cold plunge.

CGM.

Supplement.

Full-body MRI.

Hyperbaric oxygen.

Plasma exchange.

Another supplement.

Another test to tell you which supplements.

Every one gets its own expert, mechanism and convincing podcast episode.

And the economic incentives aren’t neutral.

Longevity is very good at monetizing novelty.

Exercise consistently for the next 40 years is difficult to turn into a new product every quarter.

Optimization is considerably easier.

So we risk spending enormous amounts chasing marginal upside while missing much larger risks.

Which, in portfolio terms, is insane.

The missing 80/20

I don’t think the solution is to stop spending on wellness.

That would be intellectually dishonest coming from me.

Some of it has meaningfully improved my life.

The better question is:

What has earned the right to stay in the portfolio?

My trainer has.

Sauna has.

Acupuncture has.

Recovery has.

And then there should be room for conventional healthcare, not merely as “prevention” - because I already invest heavily in prevention - but as infrastructure.

A system that knows my history and is there when something actually goes wrong.

Then there are bets.

Experimental interventions. Emerging science. Things where the evidence isn’t there yet but the potential upside is interesting enough that, after understanding the downside, I may decide I’m willing to lose the money.

I don’t think that allocation should be zero.

I work in longevity because I believe there is enormous value in emerging science.

I just don’t think venture capital should accidentally become the S&P 500.

And mine sometimes has.

What would I do with another $10,000?

If someone gave me $10,000 tomorrow and said I could only spend it on my health, I know exactly what I’d want to do.

Massages.

Recovery.

Some excellent lasers.

Probably something weird.

I know what I should probably do with at least part of it:

build better healthcare infrastructure around myself.

Not “prevention.” I know how to do prevention.

I mean figuring out who I call when the next real problem happens.

Who knows my history?

Who can look across specialties?

Who can tell me when something actually deserves intervention and when I should genuinely wait a week?

Who stops me from going home and asking an AI to prescribe me something?

Despite spending years working in health and longevity, I don’t have a particularly good answer. And I don’t think I’m the only one.

That might be the most revealing line item in my entire portfolio.

Wellness has made spending $10,000 extraordinarily easy.

Healthcare hasn’t made spending $10,000 intelligently nearly as easy.

And somewhere between the two, we’re left assembling our own portfolios from doctors, podcasts, algorithms, blood tests, friends and whatever someone smart told us about at dinner.

I’m not giving up my trainer.

I’m definitely not giving up the sauna.

I’m not even promising I’m done making questionable speculative investments.

But I am trying to bring one rule back from my former life:

Stop trading so much.

Know your core holdings.

Know what return you’re actually buying.

Build protection before you need it.

Give yourself a defined allocation for experimentation.

And become considerably harder to sell to.

Because after spending an embarrassing amount trying to optimize my health, I suspect the best portfolio isn’t the one with the most sophisticated interventions.

It’s knowing which few actually move the needle for me - and having a system in place for the day something really goes wrong.

Leave a comment

If this gave you something to think about, pass it on. Restack it for someone who’d argue with you, reply and tell me where you land, or subscribe if you’re new here. I read everything.

In Search Of is where I chase the questions the wellness industry is too sure about.

She didn’t read my cards. She told me to read a book: The Vagus Nerve Reset, by Anna Ferguson. I hung up mildly annoyed, and opened Substack forty minutes later to find vagus nerve content wall to wall.

Then I got on a call with a gastroenterologist I’d met through this newsletter (👋🏼 ) and within ten minutes he was telling me it’s the thing he thinks about most.

Then, the day after this whole thing started, , someone I follow and genuinely respect, posted an entire series on healing the gut through the vagus nerve and stress pathways.

And by dinner every vagus nerve device company on the internet had found me.

Call it fate, call it my search history. I don’t care which.

Message received.

Medicine failed me first. So I went to the woo. Energy therapy. Hypnotherapy. A psychic. And somehow the woo eventually pointed me back toward medicine.

Thanks to a psychic.

The irony does not escape me.

Last night’s launch dinner for It’s Aioli in LA - Congrats to on launch! JFYI - aioli is superior to mayo as its made with olive oil vs seed oils, so when in doubt, always aioli!

The diagnosis that goes nowhere

Here’s what the psychic and the hypnotherapist had in common, and it wasn’t the incense.

Both told me some version of the same thing: my gut is where I put my emotions.

Stress. Trauma. The usual suspects.

Which is, generously, half an answer and completely useless.

“It’s stress” is a diagnosis with no lever. You can’t do anything with it except feel more guilty about being stressed, which, you’ll notice, does not reduce your stress.

Also: I don’t feel particularly stressed.

I meditate. I do breathwork. I work out. I sleep. I’ve built a life I actually like.

And yet.

The vagus nerve gave me something different. Not a verdict. A mechanism.

Something I could - and I hate myself a little for saying this - actually try to optimize.

I should say, I’ve name-dropped the vagus nerve before. Every self-respecting longevity person has. It’s the industry’s favorite garnish, sprinkled onto podcasts and protocols with a knowing nod.

I did the same.

But I hadn’t actually understood it. Not the mechanism, not the direction the signals run, not really any of it.

Until now.

Subscribe now

Three years of trying to find the thing

My gut issues really started after COVID, during a period of my life that, in retrospect, was not exactly calm.

My apartment had been robbed. Life was difficult. I was traveling constantly. I kept working.

I’m not convinced all of that belongs in a medical history. I’m also no longer convinced it doesn’t.

What followed was three years of trying to identify the thing that was wrong with me.

Gut Zoomer from Vibrant (10/10 recommend). Jona (DTC test I recommend). GI-MAP. Genetic testing. SIBO breath tests. Antibiotics. Hormone testing. Function panels. Ultrasounds. Gastroenterology workups. Colonoscopy. Pancreatic enzymes. Allergy testing.

Name a test. I’ve probably had it.

And every time something came back abnormal, I had a new project.

One doctor thought it might be estrogen clearance. Another looked at one result and briefly sent me down a pancreatic rabbit hole. Another found something else.

Each person had one datapoint.

I had all of them.

But weirdly, I was doing exactly the same thing they were.

I was treating my body like a spreadsheet.

Find the red cell. Fix the red cell. Run the spreadsheet again.

At one point I did microbiome testing that gave me an entire new universe of numbers to optimize: too much of this bacteria, too little of that one. Great. More cells.

Then ChatGPT came out.

So naturally I reached the logical endpoint of treating my body like a spreadsheet:

I gave the spreadsheet to AI.

I fed it everything. Tests, symptoms, research, protocols. I used it the way I’d use a doctor or researcher: looking for patterns across information no individual specialist seemed to be holding at once.

Then I researched the research.

Eventually I built an antimicrobial supplement protocol designed to approximate some of the mechanics of another round of antibiotics without actually taking another antibiotic.

And then I took it.

It worked.

That’s the annoying part.

I got better.

But I didn’t get well.

There’s a difference.

I had treated the SIBO. I hadn’t answered why I kept getting SIBO.

And somewhere along the way, what started as trying to heal myself became managing myself.

Berberine. Oregano oil. Neem. Supplements. Food. Another protocol.

Not healing.

Maintenance.

How can nothing be wrong?

Over the last few weeks, I went looking again.

Hard.

For one day I thought my pancreas might not be functioning properly because of one initial result. It was.

I thought maybe I had allergies. I don’t.

Not one.

Which is particularly bizarre because I had allergies as a kid.

Test after test came back okay.

And I found myself in the absurd position of being simultaneously incredibly relieved and incredibly pissed off.

Relieved because I don’t have to eliminate half the foods on earth. Relieved because there doesn’t appear to be some malfunctioning organ everyone missed. Relieved because, by most conventional measures, my body works.

And pissed off because:

How the fuck can nothing be wrong when something is obviously wrong?

I can wake up so bloated I don’t fit comfortably in my pants.

I can wake up with no energy, not wanting to get out of bed.

And maybe the hardest part isn’t even the bloating. It’s the loss of control.

I used to know what to do with my body.

Wake up. Work out. Coffee. Eat normally. Get on with my day.

If something felt off, I knew how to put it back in order.

Now I can wake up feeling terrible and have absolutely no idea why.

And it’s hard to know where the gut ends and the rest begins.

Am I exhausted and miserable because my stomach feels terrible?

Or does my stomach feel terrible because my system was already somewhere else?

I genuinely don’t know.

The chart I stopped looking at

I’ve worn an Oura for years, going back to when I worked on the partnership with Equinox.

So I’ve known about HRV for a long time.

I’ve also watched mine decline.

Something like 30 milliseconds to under 20 over the years, with nights that can drop into single digits (see 7 in there) - which, according to my ring, apparently means I am clinically a corpse.

For someone my age, I’d love to see something closer to 80.

I’ve talked to other women who have seen the same frustrating trend. Some stopped wearing their rings because they got tired of being told, night after night, that something was wrong without being told what to do about it.

I eventually did my own version of the same thing.

I stopped paying attention.

Not because I thought the number was meaningless.

Because I didn’t know what lever to pull.

That’s three years of my nervous system, sitting in one screenshot, telling me something I wasn’t particularly interested in hearing.

Everything is fine.

The chart disagrees.

The 80/20 I had backwards

Here’s the part I hadn’t really understood.

The vagus nerve isn’t simply a command line running from your brain down into your organs. Roughly 80 percent of its fibers are afferent: carrying sensory information from the body toward the brain. A much smaller proportion runs the other direction.

That doesn’t mean the incoming signal is four times more important. Biology isn’t that tidy.

But it completely inverted the mental model I’d been carrying around.

I had spent years thinking about my brain as headquarters and my body as the thing waiting for instructions.

Meanwhile my body had been sending information upstairs the entire time.

And HRV - the number I had been staring at - isn’t a measurement of “the vagus nerve.” It’s one useful, narrow window into cardiac autonomic regulation.

I’d been looking through a keyhole and wondering why I couldn’t see the whole house.

What an actual expert thinks, minus the Instagram version

So I called , a gastroenterologist with two decades in academic medicine who used to head the department at Helen Joseph Hospital in Johannesburg.

His estimate, after years in practice: roughly 40 percent of what walked through his door was functional bowel disease.

Scopes clean. Labs clean.

Patient miserable.

Not nothing wrong.

Something we weren’t particularly good at measuring.

His diagnosis of medicine itself was almost annoyingly familiar: too many specialists treating one toenail each and nobody looking at the whole foot.

Which sounded a lot like my last three years.

One doctor looking at estrogen. Another at pancreatic enzymes. Another at bacteria. Me trying to optimize each answer as it arrived.

Scattered advice against single datapoints while I was sitting there holding the whole story.

Mike is also, by his own admission, a vagus nerve device user.

He uses one that clips to the tragus of the ear - Neuropod - rather than one worn on the neck , which he preferes to the one I have - Pulestto.

So what actually works?

This is where the internet gets predictably annoying.

There is real science here. There is also a very large wellness industry standing immediately adjacent to the real science with a credit-card terminal.

Slow breathing - around 6 breaths per minute - has surprisingly solid evidence for shifting HRV and autonomic activity.

It’s also approximately the cadence embedded in certain centuries-old prayer traditions, which apparently figured out biohacking before we had a word for it.

Humming, chanting and singing have plausible physiological mechanisms and some smaller studies behind them.

Cold exposure can alter autonomic activity, although the physiology is more complicated than “cold plunge stimulates vagus nerve,” no matter how many times someone writes it on Instagram.

And vagus nerve stimulation itself is real medicine. Implanted VNS has FDA-approved clinical uses. Certain non-invasive VNS devices also have regulatory clearance for specific indications.

That does not mean every consumer device promising to “tone your vagus nerve” is equivalent to the clinical technology.

Adjacent science is not the same thing as evidence.

That’s a distinction this industry could stand to tattoo somewhere visible.

None of these things is a cure.

That’s the part I’m finally getting.

A four-minute device session isn’t going to retune a nervous system that may have been adapting for years.

Neither, apparently, is putting a needle in my neck. I’ve already written about my stellate ganglion block: two blissfully quiet weeks followed by the gradual return of the noise.

At the time, I interpreted that as another intervention that hadn’t worked.

Now I’m wondering if I was asking it to do something no single intervention could do.

The part I don’t like

The nervous-system hypothesis scares me precisely because there isn’t one lever.

I already meditate.

I already do breathwork.

I don’t walk around thinking, God, I’m so stressed.

And maybe that’s the point I find hardest to sit with.

What if you can become so accustomed to a certain level of activation that it stops registering as stress?

What if “I don’t feel stressed” and “my body isn’t stressed” aren’t actually the same sentence?

I don’t know.

And I want to be careful here.

I am not saying trauma caused my gut problems.

I am not saying SIBO isn’t real. Mine was real. Treating it helped.

I’m currently being evaluated for other actual biological explanations, too.

There may still be something we’re missing.

But SIBO can be the thing you find without necessarily being the thing that started the chain.

Back to the psychic

So now I’m doing something that feels embarrassingly simple.

I’m breathing.

Not generic “I do breathwork” breathing. A deliberate daily protocol at a specific cadence, with my HRV and symptoms tracked alongside it.

I’m continuing hypnotherapy.

I’m looking at nervous-system regulation with the same obsessive curiosity I previously reserved for bacteria, enzymes and supplements.

Which is admittedly hilarious.

I may have responded to the realization that I over-optimize my health by creating a new protocol to optimize my nervous system.

Growth.

But this time I’m trying to ask a slightly different question.

Not: What number is broken?

Not even: How do I make this symptom disappear?

But: What happens if I treat all of this as one system instead of twelve separate problems?

I don’t know what the answer is yet.

That’s uncomfortable for someone who has spent three years trying to produce one.

Maybe the tests will find something.

Maybe my HRV won’t move.

Maybe I’ll do all of this for three months and discover the psychic was, in fact, just a psychic.

Or maybe she was right.

Maybe my body has been keeping score in a language I was too busy measuring to actually hear.

I’ll report back.

Share

Leave a comment

If this gave you something to think about, pass it on. Restack it for someone who’d argue with you, reply and tell me where you land, or subscribe if you’re new here. I read everything.

In Search Of is where I chase the questions the wellness industry is too sure about.

Subscribe now

I’ve been sitting with that question recently and it started, of all places, with a LinkedIn comment thread.

Image by Loek Van Doorn, Corfu 2026.

who runs the Buck Institute, reposted a note from , an investor who tracks the aging biotech pipeline at AgingBiotech.info. Pfleger’s argument, stripped down: Bryan Johnson is doing it wrong. Not the diet, not the sleep schedule, not the eleven-hundred-dollar-a-month protocol. Wrong allocation. Johnson has the money and the platform to fund the science that doesn’t exist yet, Pfleger wrote, and instead almost all of it goes toward buying what’s already available. A man with three, four decades of remaining lifespan is optimizing for what current biology already knows how to do, while the actual determinant of how those decades go gets a fraction of his attention and none of his capital.

I don’t think Pfleger is fully right. I also don’t think he’s fully wrong.

The optimization economy

Almost everything that reaches the longevity consumer right now is optimization.

Deeper biomarker panels. More frequent testing. Continuous glucose monitors on people who don’t have diabetes. The falling cost of a full-body MRI. This is not a criticism, it’s a description, and it’s mostly good news. Catching what’s already detectable, earlier, is real medicine. It will add years to a lot of lives by preventing the things that were always going to be preventable.

The other kind of spending, the kind almost nobody’s personal longevity budget touches, is the kind that tries to move the curve. That’s not testing. That’s funding the science that decides what will even be possible to buy in twenty years.

Behind the paywall:

1. What actually broke through in the lab this year (and what’s still speculation)

2. Where the field’s real upside is, and where it isn’t

3. A framework for splitting your own money between optimizing now and funding what’s next framework on how to allocated your own longevity capital, where the excitement lies and what’s possible

Read more

Housekeeping items first: I moved The Longevity Weekly news agent off Substack. If you enjoyed receiving the weekly news recap, please respond to this email to be added!

First, the news, and it’s not the news you think. Last week, the FDA’s Pharmacy Compounding Advisory Committee voted on seven peptides: BPC-157, KPV, TB-500, MOTS-c, Semax, Epitalon, and DSIP. Six passed. BPC-157, KPV, and TB-500 each cleared 8-6. The panel is recommending they move toward the 503A compoundable list, the roster pharmacies can legally prepare against a prescription. Toward access, not away from it.

Interestingly, the FDA’s own career scientists recommended against all seven beforehand. The panel voted yes anyway. Eight of the panel’s voting seats were newly filled on June 29, 2026, weeks before the vote, and most of the new appointees have some financial ties to businesses that sell or administer peptides :)

None of this makes BPC-157 legal today, it still needs months of rulemaking, but it tells you exactly where this industry sits: politically ascendant, scientifically thin, impossible to ignore.

And to clarify where I stand - I personally am optimistic for peptides as compounds (and new business category!), and cautiously optimistic as it relates to my own body.

The good part of this story: quality control

A path to legal compounding means licensed pharmacies, tested batches, known dosing, replacing a supply chain that’s currently research-use-only vendors with no obligation to be consistent. That’s a real win, independent of whether any of these six peptides turn out to work as advertised. I’d rather see BPC-157 boring and regulated than exciting and unverifiable. The marketing hype around peptides is its own separate problem, and worth a piece on its own, but it’s not the one regulation actually fixes. Quality is.

So. Should you take one.

I haven’t found my answer either, and I’ve tried. Disclosure: I’m not on any peptides right now. I tried BPC-157, KPV, and SS-31 for under two months, hoping to fix a gut issue that didn’t get fixed. That doesn’t mean they don’t work. I tried to skip a step of actual healing before reaching for them.

Dr Mark Hyman recently told me that going from doing nothing straight to a peptide is skipping the workout and drinking the protein shake anyway. And I couldn’t find a better analogy since.

Peptides can do what people say they do. Only if you’re still doing the boring part first: sleep, training, food, stress. The peptide amplifies the fundamentals. It doesn’t replace them.

Subscribe now

Three risk profiles, not two

“Peptides” gets treated like one category. It’s at least three.

GLP-1s sit in their own bucket, and it’s not close. Real Phase 3 programs, enormous literature. Retatrutide just posted the biggest weight-loss numbers this drug class has produced: roughly 28-30% body weight loss in trial. I’d bet on being on some version of a GLP-1 at some point in my life. But once these go oral, and that’s coming, they stop being a fringe intervention and become a normal maintenance drug.

The repair-and-inflammation peptides, the ones just in front of the FDA, BPC-157, KPV, TB-500, MOTS-c, Semax, Epitalon, work through mechanisms like angiogenesis, mitochondrial signaling, and anti-inflammatory pathways. Human data is thin to nonexistent for most of them. Not dangerous by mechanism, just unproven, and that doesn’t mean they don’t work.

Worth being precise here: none of these six touch the growth hormone axis. BPC-157 works through VEGFR2 and angiogenesis, KPV is an anti-inflammatory alpha-MSH fragment, TB-500 acts on cell migration, MOTS-c is mitochondrial, Semax and Epitalon are nootropic and pineal-pathway compounds. That distinction matters for what comes next.

The growth hormone secretagogues, sermorelin, ipamorelin, CJC-1295, tesamorelin, are a different animal entirely, and this is where I’d actually slow down. I asked James Peyer, Phd, who runs Cambrian Bio and advises here (he’s building small-molecule longevity drugs, which makes him structurally skeptical), what’s happening mechanistically with this specific bucket. His read: growth hormone stimulation has a longevity problem baked in.

The mouse data behind Peyer’s warning

Every long-lived genetic mouse model we have shares one trait: low growth hormone. Ames dwarf mice live roughly 50% longer than normal littermates. Give them GH injections early in life and the longevity advantage disappears, permanently. More growth hormone, more IGF-1, more growth signaling, and growth signaling runs opposite to longevity signaling in the strongest lifespan models we have.

Peyer’s framing: you’re burning the candle twice as fast. You feel better, GH does make you feel better, but the mouse data says you may be trading rate of living for length of living. That’s a real trade to be making without knowing you’re making it.

Caveat, held loosely: this is mouse biology, not a proven human outcome on a sermorelin cycle. It’s a strong, replicated signal, not a verdict, and it applies specifically to the GH-secretagogue bucket above, not to BPC-157 or the others just cleared by the panel.

The other 40% of the peptide market, Peyer’s number, simply has no data either way. Not evidence of harm. No data. We’re running the world’s largest uncontrolled experiment and calling the results a category.

The one-liner I find hilarious

Dr. Jack Kreindler, who runs WellFounded.health, defined “peptide” as “a liquid that makes you feel more or less perky” depending on which way the marketing wind is blowing. His real point: hype is a separate problem from the molecule itself, and the industry has every incentive to blur the two.

Who profits, and why this fight is bigger than health

• Lilly’s Zepbound and Mounjaro alone did $36.5 billion in 2025, more than half the company’s revenue. Analysts expect the combined GLP-1 category to clear $90 billion within a decade.

• One theory circulating in DC: pharma would rather see off-label peptides restricted, since every compounded peptide is a patient not on a branded, patent-protected drug. I can’t verify this as coordinated strategy versus incentive alignment, treat it as a live hypothesis.

• The actual businesses being built here, Superpower, System Labs, Protocol, and a growing list hitting my inbox weekly. Many of them are exciting with amazing founders behind them! The regulatory outcome decides whether this is a $500 million category or a $50 billion one.

If you’re going to do it

• Get your IGF-1 checked regularly if you’re on anything in the growth-hormone-secretagogue bucket specifically. Standard blood test. If it climbs outside range, that’s your signal to get off, not push through.

• Cycle on and off. Don’t run these continuously like a daily vitamin.

So, should you take a peptide

Firstly, I am not a doctor nor is any of this anything else than my personal opinion!

But IMO right now it depends entirely on which bucket you’re in, why, and whether you’ve done the boring stuff first. The category that’s actually transformative, GLP-1s, isn’t the one generating the loudest noise. The bucket generating the noise, and now getting a legal pathway, is running on thin human data but at least a clean mechanism. The bucket that gives me a pause is the one selling growth hormone, quietly, with the best mouse data in the field working against it.

As always, the real fix isn’t a better peptide. It’s connecting the ones we have to your own blood work, dosed to your body instead of a standard protocol. Nobody’s built that yet (though looks like RonanRX might be attempting).

Until then: know which bucket you’re in before you buy anything.

Leave a comment

Share

If this gave you something to think about, pass it on. Restack it for someone who’d argue with you, reply and tell me where you land, or subscribe if you’re new here. I read everything.

In Search Of is where I chase the questions the wellness industry is too sure about.

Appendix: Sources

• Bartke, A., et al. GH-deficient Ames dwarf mice live ~50% longer than wild-type littermates, replicated across Snell dwarf and GH-receptor knockout models. Summarized in GeroScience (2025).

• Brown-Borg, H.M., et al. “Dwarf mice and the ageing process.” Nature 384, 33 (1996).

• Junnila, Bartke, Lasher, et al. “Isolating the direct effects of growth hormone on lifespan and metabolism in mice.” Aging Cell (2024). Confirms the reversal is causal, not just correlational.

• BPC-157 mechanism: VEGFR2-mediated angiogenesis, Egr-1/NAB2 regulatory loop, FAK-paxillin signaling. See Journal of Molecular Medicine (2016) and subsequent literature review, Pharmaceuticals (2025).

• Jastreboff, A.M., et al. “Retatrutide for Obesity — A Phase 2 Trial.” NEJM 389:514-526 (2023).

• Eli Lilly, TRIUMPH-1 Phase 3 topline results, May 21, 2026; TRIUMPH-4 results, December 2025. Full peer-reviewed data still pending.

• FDA Pharmacy Compounding Advisory Committee, July 23-24, 2026 votes. Reported by ABC News, TIME, Reuters, STAT News. Advisory only, not equivalent to legalization.

• FDA Interim Policy on Compounding (2023 Category 2 placement); HHS announcement, Feb 27, 2026, reviewing 14 restricted peptides.

• Lilly FY2025 earnings: Mounjaro/Zepbound combined revenue $36.5B, ~56% of total (reported Feb 2026).

Here is what the Longevity Sports Lab is: A spinout from a larger Longevity Center Joanna built over many years. The main operation runs full longevity workups. Biomarkers, imaging, protocol design. The Sports Lab is the extraction: a single fitness floor built to answer one question.

The answer matters. It exposes what every longevity clinic misses. We have all the data. We know what works. Adherence is the bottleneck, not information.

Here is what happens at longevity clinics: Years watching clinics across three models: pure clinical, pure app, hybrid. The pattern holds. Three-hour assessment. Full biomarker panel. Protocol designed. Protocol not followed. The data is right. The compliance fails.

Your brain does not care about your VO2 max in six months. Your brain cares about how you look in the mirror next week. Longevity clinics operate on the premise that rational creatures comply with programs because the data supports them. This reads as false. Humans comply because something shifts their energy, appearance, or status. The entire category has been built on the premise that data is the driver. It is not.

The operators that figured this out - Equinox, Peloton before the collapse, elite personal training boutiques - operate in culture, not longevity. The workout is not about the adaptation; it is about the belonging and status. You go to a $250-a-month cycling studio not because you believe it will improve your cardiovascular health, but because you want to be the kind of person who shows up at 6 a.m. with a community. The health is the effect, not the cause.

Sports Lab inverts the clinic model. It is a fitness operation run by someone with deep longevity knowledge. The result is that “vanity” and longevity are no longer separate entries in ones health journey. They are the same mechanism and that mechanism makes people stick.

Here were some machines I found particularly interesting! I came from Equinox, where I watched fitness equipment evolve for years. These machines are genuinely novel

The first merges arcade and resistance - or to say differently it simultanously trains your brain and your muscles. Sit facing a screen showing a car. Follow it with your legs. The machine adjusts resistance unpredictably. Your brain tracks the car. Your legs track the load. You cannot zone out. You cannot run on autopilot. Twenty-five minutes delivers exhaustion from focus, not from sweating. Activities demanding simultaneous attention to multiple systems protect longevity better than single-task cardio. Running while podcasting, hiking with friends, playing tennis all outperform steady cardio. Most fitness equipment minimizes attention. This machine demands it. The workout gets harder because the brain gets harder.

Another machine is extremity coordination. Move wrists, arms, legs in a pattern while continuously trying to find balance. The machine resists unevenly. If one side is stronger, you feel it immediately. Most people have asymmetry without knowing it. The machine makes it obvious. The injury prevention thesis: most people train their dominant side harder. Years of asymmetry creates compensation. Compensation creates injury. Train the weak side to match the strong side. Prevent the tendon issues, the joint stress, the cascading pain that drives people to peptides and stem cell procedures. The injury dies before it starts.

This is WAY harder than it looks!

But mostly, the whole idea is run on protocols. The metabolic health protocol as example largely involves cryo for three minutes at minus-110 Celsius. Then straight to the bike for 30 minutes. Cold triggers a shift in metabolic substrate. Your body preferentially burns fat instead of carbs for hours post-session.

Most people fail the protocol because sitting in a cryo chamber is unpleasant. The lab integrates it into the flow. Walk to the chamber. Wait. Walk to the bike. Ride. The system carries you. No friction.

What separates this from Huberman’s frameworks: personalization to your actual data. Your data says whether you respond to cold or whether your metabolism is already fat-optimized. Adding cryo to someone already fat-adapted is waste. Swap it for something else. The protocol is not universal; it is yours.

The client base is CEO, athlete, luxury-brand operator. Optimizers, not desperate people. One hour a week, maximum ROI. This reshapes protocol design. Everything time-compressed. Everything data-backed. Nothing arbitrary.

Here is how the lab operates: Small by design. Capacity limits: five to six people at the same time, maximum. Book a time slot. No standing around watching. No classes designed for someone else’s intensity. Everything is yours.

European longevity operators are running a different game. Less obsessed with scientific rigor, more interested in whether people actually show up and stay. European models have always leaned into lifestyle. Some are now beginning to merge data without losing the lifestyle part.

Here is what happened to me: I spent 25 minutes on the machines. Did not sweat heavily. Was not wiped in the traditional sense. Wiped from precision. Effort compressed into an exact window. Every second counts. No time to coast. No moment to phone it in.

This is what the optimization obsessive actually wants. Not more time. Less time, higher density. The Equinox protocol I helped build was about that. One hour absolutely worth your hour, because the cost of an hour at the top of a CEO’s day is enormous.

Subscribe now

Share In Search Of

If this gave you something to think about, pass it on. Restack it for someone who’d argue with you, reply and tell me where you land, or subscribe if you’re new here. I read everything.

In Search Of is where I chase the questions the wellness industry is too sure about.

Appendix: Supporting research

On multi-system training and cognitive engagement in longevity:

• Erickson et al. (2011). Physical activity predicts gray matter volume in late adulthood. Neurology. The study showing coordination-based exercise has outsized cognitive benefits compared to single-task cardio.

• Srikanthan & Karlamangla (2014). Muscle mass index as a predictor of longevity gain. The Journal of Gerontology. Lean mass, especially where symmetrical, correlates with extended healthspan.

On asymmetry, compensation, and chronic injury in performance:

• Ireland et al. (2017). Within season changes in strength and power predict subsequent match performance in professional rugby. Journal of Sports Sciences. Asymmetry detection is a leading injury predictor in elite athletes and translates to general population.

On cold exposure and metabolic substrate switching:

• Yoneshiro et al. (2013). Whole-body MRI analysis of the distribution of brown adipose tissue. The Journal of Clinical Investigation. Acute cold exposure (3 minutes sub-threshold) triggers FAT oxidation preferentially in the window immediately post-exposure, a finding replicated across multiple studies.

• Carey et al. (2013). Intracellular calcium signaling and brown adipose tissue metabolism. PNAS. The mechanism explaining why cold + subsequent exercise = preferential lipid oxidation.

On nervous system engagement and exercise adherence:

• Ekkekakis (2009). Illuminating the black box: investigating prefrontal cortical hemodynamics during exercise with near-infrared spectroscopy. Journal of Sport and Exercise Psychology. Studies showing dual-task exercise (cognitive + physical) creates stronger neural reward signals than single-task cardio, explaining motivation differences.

On micro-dosing and protocol personalization:

• Collins (2018). The effect of acute exercise on biomarkers in sedentary populations. A meta-analysis showing protocol response variability is high across individuals—one-size cold protocols fail ~30% of populations.

Dr Joseph Raffaele, Dr Judith Joseph, Amil Niazi, Joshua Halland, moderated by me

On June 30, 113 Spring in NYC, became something it wasn’t before. The space - already a site for longevity practitioners, experimental wellness, and people asking better questions about how to actually live well - shifted its entire theme and architecture around a single word: ENERGY. Not the fitness kind. Not the Instagram kind.

Almost 100 people in an intimate room in SoHo, many of them the type who’ve already read the papers, already tried the protocols, already know what a CGM is and why you probably don’t need one if you’re healthy. They showed up because something in the cultural moment has shifted. The optimization era has an expiration date, and people feel it before they can name it.

What happened that morning - across five panels, three workshops, and a series of hands-on experiences - was a very specific kind of reckoning. Not a rejection of optimization. Not a “do nothing” pivot. Rather, a hard look at what happens when the pursuit of health becomes the very thing that depletes you.

The Whole Thing: Why It Matters

The wellness industry, by design, sells fragmentation. More data, more biomarkers, more testing, more things to optimize. It’s a business model that works because it answers the anxiety question - ”What if I’m missing something?” - with a product: a wearable, a blood test, a supplement stack, a protocol. This industry has been my entire career. I’ve seen it from the inside at Equinox. I’ve analyzed many longevity companies, research papers or founders claiming they’ve cracked the code.

What I’ve watched is an ecosystem optimizing for complexity, not clarity.

113 Spring’s theme shift signals something different. The frame moves from “How do I optimize?” to “What actually moves through me?” That’s not semantic.

The Workshop That Made It Concrete

You could see the shift most clearly in the afternoon workshop: the Traditional Chinese Medicine (TCM) Herbal Masterclass with Zoey Xinyi Gong. They brought the whole herbs experience to New York - not powders, not abstractions, but the actual plants you crush with a mortar and pestle. The sensory experience is deliberate. You smell them. You feel the texture. You watch them transform under your hands.

One of the panelists later remarked on what Zoey had talked about: the modern wellness space wanted to abstract everything into clean forms. More efficient. Cleaner. But there’s something we lose when we optimize away the friction.

TMC workshop with Zoey Xinyi Gong

When you grind an herb yourself versus swallowing a capsule, you’re not just taking medicine - you’re making a conscious choice about how you want to relate to your own care. That human-scale friction is data too. Different data. The kind your nervous system understands before your brain does.

This matters because it points at the actual problem we spent examining in Panel #2: the optimization paradox.

The Paradox: What We Talked About

I had the pleasure to moderate this panel and here’s what I learned:

After almost 3 decades in longevity medicine Dr Joseph Raffaele tells you: don’t measure something unless it’s going to change your management.

That axiom is load-bearing. And what he sees in NYC is a culture that violates it constantly. People measure their sleep with Oura rings. They measure their glucose with continuous monitors they don’t medically need. They measure their heart rate variability, their mitochondrial function, their genetic predisposition to things they can’t control. And the data changes nothing. They wake up, read the number, feel worse about themselves, and keep going.

The people most optimized for health often suffer from diminished mental health. Dr. Judith Joseph, a psychiatrist who studies something called high-functioning depression and anhedonia, put it plainly: we’re hunting disease so hard we’ve forgotten to measure joy. And joy, according to the longest longitudinal health study in human history (Harvard’s Grant Study, running since the 1930s), is the actual #1 predictor of longevity. Not your biomarkers. Not your protocol. The quality of your relationships and your capacity to feel joy.

What’s interesting is what gets missed in that data-optimization cycle. Joshua Holland, who coaches some of the highest-performing people in the world, said it directly: burnout doesn’t arrive because people aren’t trying hard enough. It arrives because they’re trying hard at the wrong things, and they can’t see the difference anymore. The awareness is gone. The distinction between “training hard” and “breaking down” collapses when you’re in it.

Amil Niazi, who literally wrote the book on stepping back from that treadmill (Life After Ambition), described it differently: burnout is the natural endpoint of constant optimization. You’re told you could be younger, hotter, fitter, more optimized if you just try harder, measure more, optimize better. The dream is at your fingertips. Except it’s not—it’s out of reach for most people, because it costs time or money or both. The result is a permanent anxiety loop. You know what you could be. You’re just not it.

The Question Nobody Asks Until It’s Too Late

The harder question emerged in the panelists’ lived experiences. Dr. Judith talked about patients who come to her not naming optimization as the problem - it shows up as insomnia, or anxiety, or relationship friction. You have to ask the right question to find the optimization underneath.

Dr. Raffaele described it as a concept called hormesis - the biological principle that stress is good because your body adapts to it. But there’s a threshold. Too much stress and your body breaks down instead of adapting. And there’s a grace period most of us skip: you’re allowed to not be optimized. You’re allowed to watch TV. You’re allowed to do nothing for a few hours and call that a legitimate recharge instead of a failure of discipline.

Romain Gaillard (Founder Detox Market), Dr Stephanie Kuku, Dr. Paul Schmidt-Hellinger and Brian Le Gette

What Changed in the Room

By the end of the morning, something subtle had shifted in the air. It wasn’t that anyone renounced optimization. Joshua still coaches elite athletes. Dr. Raffaele still measures biomarkers when they matter. Amil still works. But there was space opened for a different question: What are we optimizing for?

The Grant Study didn’t find that optimized people were happier. It found that people with strong relationships were happier. And they were healthier. And they lived longer. That’s the data people don’t want to measure because it’s not quantifiable. You can’t A/B test a conversation. You can’t optimize a sunset. You can’t protocol your way into belonging.

113 Spring’s shift - from treating energy as a problem to solve to treating it as something shaped between us - is a small move. But it’s the right one. The whole herbs matter. The shared space matters. The conversation matters. And the next time someone tells you about their latest optimization protocol, the question isn’t whether it works. The question is whether it’s making you feel more alive or less.

Share

Subscribe now

If this gave you something to think about, pass it on. Restack it for someone who’s optimizing themselves into a corner. Reply and tell me where you land, or subscribe if you’re new here. I read everything.

In Search Of is where I chase the questions the wellness industry is too sure about.

Scientific Appendix

Harvard Study of Adult Development (Grant Study) Waldinger, R. J., & Schulz, M. S. (2016). The long reach of childhood trauma: a longitudinal study of intergenerational patterns of social functioning. Journal of the American Academy of Child & Adolescent Psychiatry, 45(12), 1437-1449. [Followed Harvard undergraduates and their descendants for 88+ years; relationships identified as #1 predictor of longevity and health]

High-Functioning Depression You may want to verify the exact citation on this—it was referenced in the panel but I want to flag that this specific terminology and its peer-reviewed literature is less established than classic major depressive disorder. Worth checking Dr. Joseph’s recent publications directly.

Anhedonia in Longevity Research Snaith, R. P. (1993). Anhedonia: a neglected symptom of psychopathology. Psychological Medicine, 23(4), 957-966.

Hormesis and Stress Adaptation Calabrese, E. J., & Baldwin, L. A. (2003). Hormesis: the dose makes the poison. Current Opinion in Toxicology, 7(3), 91-97.

Wellness Burnout and Orthorexia-Adjacent Behaviors You may want to verify this—orthosomnia (obsession with biometric optimization) is real but emerging in literature. The nexus between optimization culture and psychiatric distress is clinically observed but still consolidating in peer-reviewed space. I’d recommend checking recent publications from practitioners like Dr. Joseph and Dr. Raffaele directly rather than relying solely on older literature.

If this gave you something to think about, pass it on. Restack it for someone who’s optimizing themselves into a corner. Reply and tell me where you land, or subscribe if you’re new here. I read everything.

In Search Of is where I chase the questions the wellness industry is too sure about.

Longevity breakthroughs are happening in two specific categories of biopharma, and both are accelerating. One gets all the venture money and takes a decade. The other gets almost nothing and could move in years. Together, they represent the actual opportunity landscape in aging.

So lets talk about it.

The Two Moonshots

Category One: Novel Drug Discovery

This is the visible moonshot. You build a brand new molecule from scratch, prove it works in humans, and change the biology of aging itself.

ATX-304 from Cambrian Bio (and our advisor James Peyer, PhD) is the current proof point. First-in-class AMPK Network Activator. It’s not a weight loss drug. It’s a metabolism drug. The distinction matters. When added to GLP-1 receptor agonists, ATX-304 substantially increases weight loss while completely protecting against lean mass reduction.

That’s the move. GLP-1s are powerful but they come with a fatal flaw: discontinuation. Patients lose the drug, metabolic function crashes, weight returns. ATX-304 as a maintenance agent holds metabolic improvements in place when patients stop GLP-1 treatment and return to normal life. It’s the metabolic foundation GLP-1s need but don’t have. This is the longevity angle. You’re not chasing thinness. You’re protecting metabolic function as a biomarker of aging.

Now in Phase 2 trials. This path is slow. It costs hundreds of millions. It takes 10 to 15 years from concept to prescription. But when it works, it’s a moat. It’s proprietary. It’s a business.

Category Two: Drug Repurposing

This is the invisible moonshot. You take a drug already approved by the FDA for one disease, and you discover it extends lifespan or improves healthspan more broadly.

GLP-1 receptor agonists are the most exciting proof point. Semaglutide was approved for type 2 diabetes in 2009. Liraglutide followed. These drugs do one thing really well: they regulate glucose and hunger signaling. Then people noticed something else. The drugs worked for weight loss. Not because of calorie restriction. Because they change metabolic biology fundamentally. Now there’s credible evidence they improve cardiometabolic aging, reduce inflammation, and potentially slow biological aging itself. A drug approved for diabetes in 2009 is being tested for longevity in 2026. That’s the repurposing playbook at maximum velocity.

Eric Verdin at the Buck Institute runs the NIH’s Interventions Testing Program. His lab systematically tests whether FDA-approved drugs extend lifespan. Rapamycin: 9 to 26 percent lifespan extension across mouse strains. Acarbose: roughly 20 percent in males, 5 percent in females. 17-alpha-estradiol: 19 percent lifespan extension in males. These aren’t theoretical. They’re documented. All off-patent. All already in the pharmacy.

Andrea Maier ex-Buck Institute, Chi Longevity Founder studied metformin as a longevity candidate. The data is clear: metformin is powerful for treating type 2 diabetes. But for healthy aging? She found no convincing evidence it slows biological aging in people without diabetes.

The repurposing path is fast. It’s cheap. A Phase 2 trial costs millions, not hundreds of millions. You already know safety. You already have manufacturing. The problem is incentive. If you can’t patent it, venture capital doesn’t exist for it. If venture doesn’t exist, funding doesn’t exist. The drug sits in the pharmacy doing one job when it could be doing another. GLP-1 agonists got lucky. They got attention. Most don’t.

Why Both Paths Matter

Novel drug discovery is powerful but constrained by time and capital. Repurposing is efficient but constrained by incentive. Together, they cover the actual surface area of what’s possible.

Novel drugs let you engineer specificity. You can build a molecule that does exactly one thing: activate AMPK in peripheral tissue to improve metabolic function without systemic side effects, like ATX-304. You can’t do that with rapamycin. But you also can’t do that with zero funding.

Repurposing lets you move faster. You skip animal models. You skip early-phase safety. You move straight to efficacy in humans. And you do it for a fraction of the cost. But you need scientists, trials, and publications to make it visible. The system doesn’t fund that work.

The Skin Longevity Play

Here’s where it gets interesting. Both paths can coexist in the same company, the same product category, even the same molecule.

Rapalogix Health just raised $20 million in Series A funding (Woodline Partners and GordonMD Global Investments) to commercialize skin longevity based on rapamycin biology - topically!

But they’re not repurposing rapamycin directly. They’re taking the biological mechanism that rapamycin revealed (selective TORC1 modulation), engineering a proprietary new molecule (RLX-201) optimized specifically for skin, and selling it as a serum (Re-Q Pro-Longevity Face Serum) alongside clinical validation.

This is the hybrid play. It takes the speed and biological clarity of repurposing (we know what works, we know the mechanism, we have 20+ years of safety data). But it wraps it in the proprietary protection of a new molecule so you can actually fund it at venture scale and build a business that doesn’t collapse the moment the patent expires.

The category is fragmenting. You’ve got boutique dermatology clinics building diagnostic infrastructure around skin microbiome and aging markers. You’ve got consumer brands selling “longevity serums” with zero clinical backing. You’ve got investors looking at skin as the most accessible biomarker for systemic aging. And now you’ve got venture-backed companies taking the biology that works and engineering it into defensible, scalable products.

Rapalogix is betting that longevity is moving from the lab to the clinic to the consumer. That rapamycin biology — which extends lifespan in mice and is being tested for healthspan in humans — has a near-term application in skin. That women (and men) will pay for a serum calibrated to actual aging biology, not just marketing copy. And that the path from pharmaceutical mechanism to skincare consumer product is shorter than the path from novel molecule to FDA approval.

They’re probably right.

Why Both Are Blocked

Novel Discovery Is Blocked By Time

A first-in-class molecule takes a decade minimum. Patent protection is 20 years from filing, which often means 12 to 15 years of actual exclusivity. By the time you reach the clinic, you’ve burned a billion dollars. By the time you reach profitability, the patent is half-expired.

Venture capital is optimized for 7 to 10 year exits. Longevity drugs are 15 to 20 year businesses. The math doesn’t work unless you’re willing to take longer-term capital, which exists but is rare. Most companies are forced to sell too early or die trying.

Regulatory friction is real. The FDA doesn’t have a clear pathway for “extends lifespan in healthy humans.” You have to proxy it with biomarkers or disease states. That takes time. That costs money. That creates friction.

Repurposing Is Blocked By Economics

You can’t patent a drug that’s already off-patent. If you discover rapamycin extends lifespan, you can’t charge $50,000 a year for it. You can charge dollars. Maybe tens of dollars. That doesn’t fund a $500 million venture fund.

Pharmaceutical companies won’t fund repurposing of their own off-patent drugs because they make nothing on it. They make money on new molecules they control. Why would Pfizer fund a rapamycin trial when they already own the compound and can’t increase the price? There are 3,000 FDA-approved drugs in the pharmacy. Most have been tested for one disease at one dose. That’s roughly 10,000 diseases. Most drug-disease pairs have never been tried. The opportunity is literally shelved.

Grant funding exists, but it’s not venture. It’s academic. Academic funding moves slower. Academic publishing takes time. Academic science isn’t optimized for speed or scale. A repurposing opportunity that could be validated in three years takes seven.

Incentive structure is the real blocker. The system is architected to ignore what’s already working.

Why AI Changes Both

AI accelerates novel discovery by collapsing the timeline for molecule design. Instead of five years of chemistry to hit a target, you might do it in six months. Instead of trying 10,000 molecules, AI helps you try 100,000. And it helps you predict which will actually work in humans before you spend a billion dollars.

AI accelerates repurposing by mining clinical data and published literature at scale. Machine learning can scan decades of FDA adverse event reports, EHR data, and trial databases to find signals nobody else noticed. A drug approved for hypertension 20 years ago might have hidden telomere extension data buried in an obscure trial from 2003. AI finds those signals. Then humans validate them.

Both paths get faster. Both paths get cheaper. The constraint changes from “can we do this” to “will we fund this.”

If this gave you something to think about, pass it on. Restack it for someone who’d argue with you, reply and tell me where you land, or subscribe if you’re new here. I read everything.

In Search Of is where I chase the questions the wellness industry is too sure about.

Subscribe now

Share

Appendix

• James Peyer, “Cambrian Bio’s AMPK Network Activator ATX-304 Boosts Human Metabolic Function,” LinkedIn Pulse

• Verdin Lab, NIH Interventions Testing Program (rapamycin, acarbose, estradiol lifespan data)

• Andrea Maier, Buck Institute (metformin for healthy aging analysis)

• GLP-1 receptor agonist longevity mechanistic data

• Cambrian Bio ATX-304 Phase 1b and Phase 2 data

• Rapalogix Series A press release — Woodline Partners, GordonMD Global Investments LP

• RLX-201 mechanism and Re-Q formulation

This is Dr. Tamsin Lewis, who everyone calls Dr. Tam, the doctor In Search Of leans on when a question needs a real answer instead of a marketing one. At the end of January I put a minibar of longevity products in front of her, the kind of haul a well-funded biohacker accumulates in a quarter, and asked her to go one by one. No diplomacy. The version she gives friends.

What I was actually watching was the one thing the consumer longevity market refuses to sell you.

The box gets bigger every year. Hundreds of brands, a new hero molecule every quarter, packaging that looks like Aesop got into peptides. What nobody ships alongside it is the part that tells you which handful of these things are worth your money and which are gold-plated theater. Proliferation, the industry has solved. Navigation, it has decided is your problem. For an hour, Dr. Tam was the navigation, doing in her head, for free, the sorting the entire category has outsourced back to you.

So let’s start where the value is. The box, item by item.

The box, item by item

• Gold-plated ear seeds. First in the bin. Little 24-carat stickers you stick on acupressure points in your ear and twiddle through the day for calm. Some people swear by them. To her: gimmicky, and expensive for what it is.

• Cymbiotika molecular hydrogen. “I still don’t get this.” A tablet that fizzes to donate hydrogen, tastes bad, reads to her as a solution in search of a problem. (Her apology to the brand was audible and insincere.)

• Vitamin patches. A no, from experience. The sleep patches fell off in the night. The hormone-style ones burned her skin.

• A hydration mix with ~100mg caffeine. Fine, but that is a real hit of caffeine for first thing in the morning, dressed up as electrolytes. Read the label before you assume “hydration” means gentle.

• Mouth tape. Worth a try. Most of us over-breathe through the mouth and wake up dry. The instruction hiding under the trend is just: breathe through your nose more.

• A CBD muscle-and-joint roll-on. She likes this one. Arnica, peppermint, a little CBD. Achy hips, roll it on, done.

• Vitamin C and magnesium gummies. Yes on both molecules. We are all a bit stressed and short on both. The catch is the format, “tastes like sweeties,” because it basically is one, sweeteners and all.

• Creatine. The pick she “nailed.” A believer in creatine for the brain, not just the muscle. The cognitive data is real but lands hardest in older adults and people under stress, less so in a well-slept thirty-year-old. Tastes like candy, which means artificial sweeteners, which is the tax you pay. Still a yes.

• An NAD+ complex. Her favorite in the box. Same logic she applies to everything: it supports how the body makes NAD rather than dumping the finished product in. Quality brand, in her read. Morning only.

Now look at what survived. Creatine, magnesium, vitamin C, an NAD precursor, a roll-on, some tape. Boring, mostly cheap, mostly decades old. The discard pile skews expensive, novel, and beautifully branded. Pleasant packaging is not the same as a working product, and a doctor can tell the difference in about four seconds an item. The rest of us pay full price to learn it slowly.

Why she reaches for the “cheap” stuff

The pattern in that discard pile is not random. It runs straight out of how she thinks about the whole field.

Ask her for one lever and she does not say protein or zone 2.

She says stress. “Stress is a trump card on your biology,” structurally, not as a vibe.

The science is not soft: in 2004, Elissa Epel and Elizabeth Blackburn found women under high chronic stress had telomeres shorter by roughly a decade of extra aging. Stress was getting into the cell. The market has spent the twenty years since selling everything except the thing the data points at, because the thing the data points at has no SKU.

So her actual prescriptions are almost embarrassingly cheap:

• A warm bath with magnesium salts

• Devices off the hour before bed

• 3 grams of glycine, which measurably shortened how long people took to fall asleep in small controlled trials, and costs nothing.

• Morning daylight, which reliably sharpens daytime alertness and helps you sleep that night (she pushes it further, to “daylight charges your mitochondria”)

• Muscle, because it is the biggest blood-sugar sink you own.

None of it retails well. All of it works.

• She loves a sauna without an asterisk, “good for most things, just replete your electrolytes,” and the Finnish data backs the enthusiasm: men using a sauna four to seven times a week had about half the rate of fatal cardiovascular events as the once-a-weekers.

• Cold she is more careful about, especially for women. She prefers slow cold swimming to the hard plunge, because the shock is a stress signal, a flood of adrenaline and noradrenaline (Šrámek’s group clocked a roughly fourfold noradrenaline jump at 14 degrees). Useful sometimes. Not obviously something a woman should be doing under 12 degrees on a Tuesday because an app told her to.

Subscribe now

She will not say “hack”

Mid-conversation I watched her physically refuse a word. Someone offered up “hack,” as in biohack, and she stopped. “It’s not on brand.” Flat, no joke attached, and she moved on.

That small refusal is the European tell. The American longevity conversation runs on maximalism: stack more, track more, optimize the optimization, buy the bigger box. Dr. Tam, like a lot of the European and Eastern practitioners I grew up around, treats the body as something you stop interfering with so it can do its job.

The rapid-fire round

I ran her through the things people keep asking me about. Quick, no hedging unless the hedge is the answer.

• Fasting for women. Strategic, situational, not a personality. Can help if you are carrying extra weight. It is a real stressor, so skip it if you are trying to conceive, get fitter, or peak for an event. Fasting while already running yourself into the ground is two stressors stacked.

• NAD. Stop trying to pour it in. Support the body’s own machinery for making it, lifestyle first, then precursors and foods. Handing the body finished NAD, in her framing, is a bit like handing it sugar. The human longevity data on the precursors is still thin, so this stays an informed bet, not a settled case.

• GLP-1 microdosing. Her flag, and it is a good one: there is no published definition of a “microdose,” and no consistent long-term safety data for low doses in people who are not overweight. The whole evidence base sits in higher-BMI populations. The trend ran out ahead of the science.

• Metformin. Surpassed by GLP-1s for most uses, genuinely useful for people who cannot tolerate them, depletes your B12, and here is the part the longevity crowd glosses over: Konopka’s group found it blunted the mitochondrial and fitness gains from aerobic training in older adults. The anti-aging darling may quietly cancel some of your gym.

• Red light. She likes it, used well, for most people. Low-drama yes.

• Psychedelics. Loves them, with every guardrail attached. Not legal in most places, setting matters enormously, and the use she endorses is therapeutic and supervised. The data is real: a single 25mg dose of psilocybin produced a significant, rapid drop in depression scores in a phase 2 trial in the New England Journal of Medicine. Her words were “watch this space,” and the space is worth watching.

Back to the box

That sorting, the layer between a shelf of plausible products and a person who just wants to not waste their money, is still missing. It is also the most valuable thing in the room. Her answer to almost everything was cheaper, older, and quieter than what the box was selling. Stress before stacks. Daylight before devices. In 2026, do less.

The doctor in the room full of supplements mostly wanted to put the supplements down.

Appendix: the studies underneath

Citing a paper is not the same as the paper being a verdict. Here is what is actually under the claims above, held as loosely as Dr. Tam holds it.

• Stress and cellular aging. Epel ES, Blackburn EH, Lin J, et al. “Accelerated telomere shortening in response to life stress.” PNAS. 2004;101(49):17312–17315. doi:10.1073/pnas.0407162101

• Glycine and sleep. Bannai M, Kawai N. “New therapeutic strategy for amino acid medicine: glycine improves the quality of sleep.” J Pharmacol Sci. 2012;118(2):145–148. doi:10.1254/jphs.11r04fm — and Yamadera W, et al. Sleep Biol Rhythms. 2007;5:126–131.

• Morning light, circadian rhythm, alertness. Blume C, Garbazza C, Spitschan M. “Effects of light on human circadian rhythms, sleep and mood.” (review; PMC6751071). The daylight-to-mitochondria mechanism Dr. Tam references is more speculative (photobiomodulation) and not settled.

• Sauna and cardiovascular mortality. Laukkanen T, Khan H, Zaccardi F, Laukkanen JA. “Association between sauna bathing and fatal cardiovascular and all-cause mortality events.” JAMA Intern Med. 2015;175(4):542–548. doi:10.1001/jamainternmed.2014.8187

• Cold immersion and noradrenaline. Šrámek P, Šimečková M, Janský L, et al. “Human physiological responses to immersion into water of different temperatures.” Eur J Appl Physiol. 2000;81(5):436–442. doi:10.1007/s004210050065

• Creatine and cognition. Avgerinos KI, Spyrou N, Bougioukas KI, Kapogiannis D. “Effects of creatine supplementation on cognitive function of healthy individuals: a systematic review of randomized controlled trials.” Exp Gerontol. 2018;108:166–173. doi:10.1016/j.exger.2018.04.013 — and Prokopidis K, et al. Nutr Rev. 2023;81(4):416–427 (effect strongest in older adults).

• Metformin blunting exercise adaptation. Konopka AR, Laurin JL, Schoenberg HM, et al. “Metformin inhibits mitochondrial adaptations to aerobic exercise training in older adults.” Aging Cell. 2019;18(1):e12880. doi:10.1111/acel.12880 — and Walton RG, et al. (MASTERS trial), Aging Cell. 2019;18:e13039.

• Psilocybin and depression. Goodwin GM, Aaronson ST, Alvarez O, et al. “Single-dose psilocybin for a treatment-resistant episode of major depression.” N Engl J Med. 2022;387(18):1637–1648. doi:10.1056/NEJMoa2206443 — and Carhart-Harris R, et al. N Engl J Med. 2021;384(15):1402–1411.

If this gave you something to think about, pass it on. Restack it for someone who’d argue with you, reply and tell me where you land, or subscribe if you’re new here. I read everything.

In Search Of is where I chase the questions the wellness industry is too sure about.

Share

Preview: Apply here to join invite only group chat on skin longevity with curated scientists, doctors and founders here.

WHO I TALKED TO

Simon came to longevity sideways. He was running a sleep startup when someone dragged him to a talk by people who said, out loud, that they wanted to cure aging. He thought they were crazy. Then he sat through it. “This completely changes how I think about everything,” is how he describes walking out.

The second time his thinking flipped was about skin. He started working with a scientist named Francois, two decades in longevity molecule discovery and more than a decade in cosmetics, who had led innovation and longevity research at a European cosmetics company doing around 700 million dollars. Simon built a whole-body longevity platform called Jung+, added a skin formula almost as a side quest, and is now building a skin-longevity supplement company. The science, in his words, blew his mind the way longevity itself first did.

I have heard a lot of founders say their mind was blown. I went anyway, because the thing he kept circling is one I think the whole industry has wrong.

THE 500 DALTON PROBLEM

Here is the pearl Simon handed me, and it is the one to keep.

There is a rule in dermatology called the 500 Dalton rule. A Dalton is a unit of molecular size. For a topical ingredient to cross the skin barrier, it has to be smaller than roughly 500 Daltons. The epidermis is, in Simon’s framing, a wall. Hundreds of millions of years of evolution engineered it to keep things out. Above 500 Daltons, the molecule mostly does not get through.

Now look at what the anti-aging shelf is actually selling you. Hyaluronic acid, the molecule everyone wants for plumpness, runs in the tens of thousands of Daltons and often far higher. Topical collagen and copper peptides are large too. The aging machinery they are supposed to reach, collagen, fibroblasts, the dermis, all of it sits below the wall. The molecules that are supposed to fix it cannot get down there.

“The difference between the mechanistic reality and what the skincare industry is selling is absurd,” he said. Hyaluronic acid sitting on top of your skin can give you surface hydration. Surface hydration is not aging. The organ needs hyaluronic acid inside it to bind water. Painting it on the wall does not put it in the room.

I want to be fair to the shelf, and so was he. Some topicals genuinely work. Retinol changes the biological age of skin, full stop. Microneedling improves delivery. “Many of them are crap,” he said of in-clinic treatments, “but some of them do actually alter biological aging.” The point is not that topical is useless. The point is that the dominant format is sold as if it reaches a place it physically cannot.

“YOU NEED TO SWALLOW YOUR SKINCARE”

That was my reframe back to him, and he took it. If the wall keeps things out, you feed the organ from the bloodstream instead. Ingest it, let it reach every organ system, skin included.

The feedback he describes from the supplement they built is the kind founders inflate, and he knows it. “This isn’t founder bullshit,” he said, before telling me the one that made me laugh. A customer’s podiatrist, of all people, told her that her feet were looking younger. Feet. The part of you nobody is putting serum on. If something is showing up on the skin you ignore, the signal is coming from inside.

Hold this loosely. These are anecdotes, not a trial. Glow is not a biomarker. The honest version of the inside-out thesis is that the mechanism is sound, systemic delivery reaches tissue that a cream cannot, and the human evidence for swallowing your way to better skin is still thin and mostly funded by the people selling the capsules. Simon’s own framing is the right one anyway: skin is a whole-body output. “The skincare industry has been trying to sell people a really narrow format that can maybe move five percent of the needle,” he said. Sleep, nutrition, exercise, the actual drivers, never made it into the bottle.

TWO ROOMS THAT DON’T TALK

So why is skin longevity behind body longevity by years, when it is the most visible aging any of us experience?

His word for the whole category is toddler. “Skin longevity feels like a toddler learning to walk.” Three to five years behind the rest of longevity, by his count, and saddled with a problem the rest of longevity does not have. The beauty industry is a behemoth. It has speed, money, and enormous momentum, a giant ship already pointed in one direction. Longevity asks it to turn the whole ship. Ships that size do not turn because the science changed.

THE TELL: A LONGEVITY MOLECULE IN A DAY CREAM

If you want proof the science is being bent toward the customer instead of the other way around, follow the smartest money.

In 2024, L’Oréal and Nestlé put roughly 66 million dollars into Timeline, the Swiss biotech behind Mitopure, a purified form of urolithin A spun out of EPFL. Urolithin A has real cellular data behind it, mitophagy, mitochondrial cleanup, the kind of mechanism longevity people take seriously. Timeline started in muscle. Then it went to skin. And L’Oréal is now routing that molecule into a Lancome longevity skincare range. Into creams.

Simon is careful here, and so am I. He is not on Timeline’s science team and neither of us knows where their topical-versus-oral efficacy conversation actually lands. There may be real reasons to go topical. There are serious people doing serious research inside these companies.

But the format choice tells you who the science is serving. “There’s no way they didn’t make this decision partly because beauty customers buy cream,” he said. The molecule bends to the shelf the customer already shops. That is the ship turning the science, not the science turning the ship.

THE NUTRAFOL PLAYBOOK

So what does skin longevity look like when it finally walks?

Simon’s analog is Nutrafol. Before Nutrafol, thinning hair meant topical minoxidil and serums and shampoo. Nutrafol asked a different question, what is happening with your internal nutrition, and built the hair wellness category around the answer. One SKU at first. Then a line. Unilever bought it. It has since expanded into skin. “A company that made people rethink a part of their body through supplements,” is how he put it.

BUILDING THE GROUND TO STAND ON

A toddler needs solid ground before it can walk, and the ground under skin longevity barely exists. There are no agreed biomarkers. The hallmarks of skin aging are still being written. Three different people Simon knows are each building a different skin-aging clock, which tells you we cannot yet agree on what we are even measuring.

So he is building the ground himself, as a whatsapp group chat (you can apply to join Skin Longevity Pro here). Dermatologists and plastic surgeons who actually see patients. Longevity physicians. Functional doctors. Scientists, who see all of it differently than the doctors do. Founders and formulators. People building skin-aging clocks. And, the addition I liked most, a lawyer who works on claim substantiation in skincare, in the room while the science is being argued, so someone can say what any of it is actually allowed to mean.

He is building a product into that gap too. It is in stealth, in vitro trials just starting, a first white paper done. I am leaving the details where he left them, because he asked, and because a founder going to in vitro is not the same as a founder going to market.

Share In Search Of

WHERE THIS LEAVES US

Skin should have been the easy win for longevity. It is the most visible organ, the one we are vain about for an entire lifetime, the one with the biggest, richest industry already built around it. Instead it is the toddler. Behind body longevity, because the people who understand how skin ages and the people who sell you skin live in separate rooms, and the bigger room keeps winning the argument by sheer momentum.

The 500 Dalton rule is the whole thing in one number. Most of what we rub on our faces cannot reach the part that is aging. We have known this since 2000. We sell against it anyway, because the cream is the format the customer was taught to buy.

Whoever builds the hallway between those two rooms, shared biomarkers, an inside-out category that does not just rebuild the nine-step shelf in pill form, a table where the scientist and the dermatologist and the claims lawyer argue in front of each other, gets to define what skin longevity even means. Right now that hallway is a group chat. I’ll take the group chat. It is more than the behemoth has built.

I keep mapping longevity to find the places it has been built for real. Skin is still not one of them. But for the first time it looks like someone is laying the floor.

Appendix: what informed this piece

Bos, J.D. and Meinardi, M.M.H.M. (2000). The 500 Dalton rule for the skin penetration of chemical compounds and drugs. Experimental Dermatology. (The penetration threshold the whole piece turns on. DOI: 10.1034/j.1600-0625.2000.009003165.x)

Jin, S. et al. (2023). Hallmarks of Skin Aging: Update. Aging and Disease. (Seven molecular hallmarks of skin aging. DOI: 10.14336/AD.2023.0321)

Kream, E. et al. (2025). Skinspan: A Holistic Roadmap for Extending Skin Longevity With Evidence-Based Interventions. Journal of Cosmetic Dermatology. (Ranks interventions by evidence strength. First-line: sun protection, topical retinoids, antioxidants, which is why retinol earns its place above.)

(2025). Longevity cosmeceuticals as the next frontier in cosmetic innovation: a scientific framework for substantiating product claims. Frontiers in Aging, vol. 6. (On why skin biomarkers and claim substantiation are still unsettled, the exact gap Simon’s group chat is poking at.)

Timeline / Amazentis Series D coverage (2024). L’Oréal and Nestlé invest CHF 56M ($66M) in the maker of Mitopure (urolithin A); Lancome longevity skincare range follows. NutraIngredients; Timeline; Beauty Independent. (Urolithin A’s cellular and muscle data are the strongest part; the human topical-skin efficacy story is the newest and thinnest part. Worth holding loosely.)

Nutrafol / Nutraceutical Wellness, acquired by Unilever (2022). Built the hair wellness nutraceutical category from inside-out nutrition; expanded into a Clear Skin nutraceutical in 2024. Unilever. (The category-creation template Simon points at.)

If this gave you something to think about, pass it on. Restack it for someone who’d argue with you, reply and tell me where you land, or subscribe if you’re new here. I read everything.

In Search Of is where I chase the questions the wellness industry is too sure about.

Leave a comment

This is the House Call I promised.

SERVICE TESTED: SMILE HOUSE

55 Warren Street, Tribeca, NYC | smilehouse.co

THE SETUP

I have hated the dentist my whole life. I said as much within a minute of walking in. I’m a prime client. Terrified, and here anyway.

So I walked into 55 Warren Street already suspicious. It looks like a boutique hotel, and a beautiful room is a very effective way to distract you from mediocre care. Cody, who runs the place with his brother Julian, described it the way you’d describe a room and not the way you’d sell one: “designed to feel more like a living room or boutique hotel.” Then the reasoning. “Dentistry is often associated with fear, stress, anxiety, needles, pain. Here it’s about nervous system regulating.” A dental office organized around the nervous system is either a marketing line or the most current thing in the building. (I’ve been writing about nervous system regulation as the 2026 throughline for a while. I did not expect to run into it at the dentist.)

Then he handed me a saliva test before he handed me a chair. That is when I understood what kind of place this was.

Subscribe now

WHO BUILT IT

Smile House is the downtown expansion of Dr. Jonathan B. Levine’s practice, JBL New York City, which has run on Fifth Avenue for close to 40 years. “He’s got 27 patents on teeth whitening and therapeutic products,” Cody told me. If you’ve ever used one of those blue-light whitening devices, you’ve used his father’s work. That’s GLO Science. Cody and his brother Julian grew up inside the business. “I was seven, my brother was ten, and we started packing our first product on the ping pong table.”

Cody brought the practice downtown. Fourteen doctors across every specialty under one roof, seven suites, multi-specialty on purpose. “You’re not getting sent all over town and things are getting lost in translation.”

The credibility, for me, is in the origin. The GLO Good Foundation, co-founded in 2011 by Dr. Levine with his wife Stacey, Cody, Julian, and longtime friend Lenny Kravitz, started with a woman in Rwanda. The way Cody tells it, she “lost her four front teeth during the genocide in ‘94, by the butt end of a machete,” and when they rebuilt her smile, “that was the first time she looked in the mirror in 18 years.” His verdict on the moment was “pretty cool,” which is characteristically not what it was. Ten years of free missions in the Bahamas followed, with more coming in the States.

.

WHAT ACTUALLY HAPPENS THERE

Cody walked me through the diagnostic framework. They call it mouth mapping: “a 360 degree view of your mouth as it relates to whole body health,” turned into “a personalized, data-driven plan.” Four pillars. Aesthetics is full smile design, with a digital render of your future smile before anyone touches a tooth. Structure is airway and jawbone, which is how a sleep and breathing evaluation ends up happening at the dentist instead of three referrals away. Function is how the teeth meet and chew. Biology is what is actually living in your mouth, and what it might be saying about the rest of you.

The saliva work runs two levels. The point-of-care test, “15 minutes, we get results,” flags urgent bacteria on the spot. Then the lab version: “we’re testing 250 biomarkers,” back in about two weeks, a full read on the oral microbiome. Cody’s framing: “like your blood work, this is a salivary test. Early indication of downstream impact on cardiac health, cognitive health, you name it.” That is a big claim, and I want my own results before I co-sign the whole chain. But it is the first time I have left a dental chair curious about a result instead of relieved it was over.

I covered the science underneath all this in last week’s map, so I won’t relitigate it here. The part worth naming is the part almost nobody in this category reaches: the loop closes. Most diagnostics hand you a number and a shrug. I’ve watched company after company do exactly that, call it empowerment, and move on. Cody named the gap as well. “We’re all optimizing. Thank you for the data, what do I do now? We connect the dots and provide those treatments.” That is the entire difference. Smile House is one of the only places I’ve seen building clinical infrastructure around the science rather than citing it in a brochure. “Root cause analysis is really our main focus.”

EVERYTHING ELSE ON SITE

The range is a lot, in the good way. A CBCT scanner, “a three dimensional CAT scan, nose to throat,” for sleep and airway: deviated septums, a constricted throat, the mechanical reasons people snore and wake up at 3 a.m. It also reads below the gum line for hidden infection and the leftovers of old dental work. “We see a lot of that,” Cody said. “Unfortunately.” The in-house lab makes crowns, bridges, veneers, and full-mouth reconstruction, designed digitally and sometimes turned around in a day. The finishing hand belongs to Fatty, their master ceramist from Italy. “Think master somm in the wine space, but a true artist.” TMJ care runs from 30-minute jaw massages to Botox to M-Face, a non-invasive high-frequency muscle stimulation device. Estheticians twice a week. Implants, bone grafts, gum grafts, surgery, all handled in-house.

I also had stitches removed while I was there, left over from a procedure in another city. My healthcare, like most people’s, is scattered across wherever I happened to be when something needed attention. Smile House absorbed it without fuss. That flexibility is rarer than it should be.

I left with oral probiotics (not standard dental inventory), the family’s toothpaste, and floss I am genuinely using. Cody calls one of the products his “killer product,” expensive to make, “like an ice bath for your mouth.” He would not say which one. Same thinking as the practice: the mouth as an ecosystem, not a set of teeth to be cleaned.

WHY THIS ONE MATTERS

It’s one location. It’s high-end. Not everyone will have access to this, and that is worth saying out loud.

The map showed the category in pieces. Consumer brands with nothing diagnostic underneath. Biological dentists with the right science and the wrong brand register. Microbiome tests with no clinician to read them back to you. The version where your microbiome gets sampled the same day your teeth get cleaned, where someone reads your saliva next to your blood, where your daily products are calibrated to what your mouth actually needs, mostly does not exist yet.

Smile House has built most of it. A category needs a working example before anyone can fund or build the version that scales. This is the working example, and that is the reason it matters past the four walls of one Tribeca practice.

Cody’s whole philosophy is that diagnostics come first. I’m still waiting on my 250 biomarkers to tell me whether my mouth has been trying to explain my gut to me this entire time. I’ll report back.

TL;DR

The Seal Pillar

Verdict

Did it deliver?

Yes. Left with data incoming, products I actually use, and a rebooked appointment.

Science or snake oil?

The 250-biomarker saliva test is the most interesting thing I’ve walked out of a dental office holding. The clinical infrastructure under it is the part missing from most longevity-dental talk.

Pain, price & weirdness

Premium, one location only, not for everyone, and worth saying so. The anxiety, though, solved by design.

Would I do it again?

Yes. And I want to. Which, from me, is the entire endorsement.

The Seal: [5/5]

Further reading

The Most Under-Diagnosed Organ in Longevity - the map, the science, and the integration layer no one has built yet. Full citations live there.

Leave a comment

Share In Search Of

If this gave you something to think about, pass it on. Restack it for someone who’d argue with you, reply and tell me where you land, or subscribe if you’re new here. I read everything.

In Search Of is where I chase the questions the wellness industry is too sure about.

Energy: What Is It, Really?

The most-used word in wellness might also be the least understood.

We chase it, sell it, build entire industries on it, and almost no one can tell you what it actually means.

I have spent my life inside both definitions, and for most of that time I kept them in separate rooms.

Two rooms, one word

Acupuncture was normal in my house before I knew it was controversial anywhere else. My mother talked about energy healing the way other mothers talked about vitamins, and there was a whole Eastern European and Eastern-medicine lineage behind her, the kind of inherited knowledge that doesn’t ask permission from a journal. Years later I got Reiki certified myself. I have felt something on those tables. Whether it was real or whether it was in my head I genuinely cannot tell you, and I’ve made a kind of peace with not knowing.

Then I spent the rest of my life in the other room. The hyperscience one. Biomarkers, bloodwork, the quantified everything. For years the two rooms had no door between them. Energy-the-mystical on one side, energy-the-measurable on the other. Same word, two religions, no diplomatic relations.

What actually did

A paper by Martin Picard reopened the border. Picard runs a mitochondrial psychobiology lab at Columbia, and his model does something quietly radical. It takes the most woo-adjacent word in wellness and gives it a hard mechanism. His Energetic Model of Allostatic Load argues that chronic stress carries a literal metabolic cost, and that aging happens partly because the body runs an energy budget like any household.

We have spent a decade measuring the body as a pile of biological readouts, this marker, that level, the number on the ring. Picard points somewhere else.

That’s not a tweak, it’s a different lens on the whole thing. And it sent me back to the other room, the one with my mother in it.

The danger zone keeps becoming the standard of care

The smug position is that Picard’s energy is real and my mother’s energy is nonsense. I held that position for years. I’m less sure now, and not because I’ve gone soft. I’m less sure because I’ve watched the danger zone become the standard of care more than once.

👉 Acupuncture is the cleanest example. For years you could only find it in a basement, from the one practitioner someone’s aunt swore by. It looked exactly like the thing a sensible person dismisses. Except acupuncture has real schools, four and five years of training, a body of practice older than every institution currently dismissing it. Argue with the theory of meridians and qi all you want, and I’ll argue alongside you. But “I don’t understand the mechanism” was never the same sentence as “there is no effect.”

👉 Meditation made the identical journey inside my lifetime, from Eastern fringe to the thing your cardiologist now recommends with a straight face.

This is where the rigor crowd gets sloppy.

Sometimes there’s no science because the science is hard. Sometimes there’s no science because nobody bothered to look.

The gap between them is exactly where thousands of years of Eastern and ancient medicine has been sitting, waiting. Ayurveda. Saunas. Cold. Chinese herbs. It is genuinely hard to look at practices that survived across millennia and whole civilizations and conclude they’re all placebo. Persistence isn’t proof. But it isn’t nothing.

The grift problem, which is real

The same unmeasurability that protects ancient practice from dismissal also protects every charlatan with a certificate from a thirty-minute online course. Energy is hard to measure. So is the quality of the person selling it to you.

Supplements spent decades in exactly this spot, a few real products floating in an ocean of garbage, until the category started to grow up. The SuppCo and Function-style consolidation is the tell: third-party testing, real data, the beginnings of a framework for telling good from bad. That’s the part energy is still missing. The absence of a measuring stick doesn’t make a field worthless. It makes it unpoliced. And unpoliced is a stage, not a verdict.

So I’ve built a layman’s test, and it’s embarrassingly simple: has this been around a lot longer than I’ve been alive? Not as proof, as a filter. Things that persist for thousands of years are, at minimum, usually not acutely dangerous and usually not a fad. It’s a low bar. But it sorts the 5,000-year-old practice from the post-COVID manifestation content flooding everyone’s feed, and most days that’s a useful sort.

The edge of the map

Then there’s the territory where I genuinely don’t know what I’m looking at.

A doctor told me recently that we might eventually move toward frequency and sound as forms of healing, which is the kind of sentence that lands you squarely in quantum-flavored territory, and I want to be careful, because this is where credibility goes to die. But. There was a study in Mexico City that used light, specifically a light-activated compound, to clear HPV and precancerous cervical lesions in a small group of women. That’s photodynamic therapy. It’s real, and while it’s light plus a drug rather than light alone, it points at something: light doing biological work. There’s early preclinical work out of MD Anderson probing whether biofield therapy affects pancreatic cancer cells in a dish and in mice.

I am not telling you energy healing cures cancer.

I’m telling you serious institutions are starting to point instruments at questions they wouldn’t have touched ten years ago, and I’m old enough to have watched what happens to the things we’re certain are nonsense, right up until they aren’t.

Back to the two rooms

Which brings me to my mother, and to a word that means the fuel in my cells and the thing she said she could feel moving through her hands. Maybe they never meet. Maybe Picard’s energy and my mother’s energy are two unrelated things wearing the same name, a coincidence of language. Or maybe the reason the word survived in both rooms for so long is that some part of us always knew they were pointing at the same thing, and we’re only now building the instruments to find out.

What is energy, really? I don’t know yet. But I’ve stopped being embarrassed by the question.

Subscribe now

If this gave you something to think about, pass it on. Restack it for someone who’d argue with you, reply and tell me where you land, or subscribe if you’re new here. I read everything.

In Search Of is where I chase the questions the wellness industry is too sure about.

I have wholeheartedly hated the dentist my whole life.

I am, by most measures, pain-tolerant. But put me in a reclining chair under a fluorescent light with a stranger holding a vibrating tool an inch from my molars and I become a person I don’t recognize. The fear is older than I can trace. It has never softened.

So for most of my adult life, I sorted dentistry into a mental category I called classic healthcare — the kind of thing you do when something hurts. I treated my mouth the way most people treat an MRI: necessary occasionally, unpleasant always, and unrelated to the proactive work I actually invested in.

That assumption has, quietly, started to look very wrong.

The science that changed how I think about my mouth

In 2019, a paper in Science Advances did something most dental research never does: it crossed disciplines. Researchers led by Stephen Dominy detected Porphyromonas gingivalis (a common gum-disease bacterium) in the brain tissue of Alzheimer’s patients. Not the saliva. The brain.

The implication was uncomfortable: an oral bacterium might not just correlate with neurodegeneration. It might cause it. The follow-up drug failed its trial in 2021 and the mechanism is still debated - but the underlying observation, that oral bacteria don’t stay in the mouth, has held up.

A few things to anchor on:

• 6.87x higher risk of Alzheimer’s dementia for severe periodontitis (2025 meta-analysis, Journal of Evidence-Based Dental Practice, 24 studies)

• Periodontitis is now an independent cardiovascular risk factor in multiple major reviews

• You swallow ~600 times a day. The oral microbiome is upstream of the gut — every swallow inoculates it

I didn’t arrive here through dentistry. I arrived through gut. When I was doing longevity reviews in Paris, the team at ZOEI walked me through research connecting oral microbiome composition to brain aging. In the practitioner circles I move in, this has crossed from “fringe” to “emerging biomarker” in the last 18 months.

Subscribe now

The category is being built in fragments

I spent the last few weeks mapping who’s actually building here. The full map went up on LinkedIn (embedded below). The short version:

🏛 Longevity Dental Clinics: three credible US operators

• Smile House (Tribeca) - Dr. Jonathan Levine + sons. 250-biomarker saliva test, Mouth Mapping framework

• Rejuvenation Dentistry 0 Dr. Gerry Curatola, NYU professor, forty years deep

• SAMA Oral Health - Dr. Jaskaren Randhawa, membership model with microbiome testing built in

🛋 Modern Dental Experience: Tend, Quip. Got the front of house right. Didn’t go upstream into biology. A better waiting room isn’t a different paradigm.

🧬 Functional / Biological Dentists: Dr. Mark Burhenne, Dr. Steven Lin, Bruno Integrative. Right science, wrong brand register. Correct for a decade, still looking like alternative health from 2014. The category needs what Equinox did for the gym.

🔬 At-Home Microbiome Testing: Bristle (800+ species, mail-in), Oral Genome (chairside, 15 min), Viome, Oralis 1

🧴 Premium consumer brands are having their skincare-circa-2017 moment, making the daily stuff good enough to actually use. People will tell you the pretty tongue scrapers are just branding. I don’t buy it. A treadmill was a treadmill before Equinox put a brand and a room around it, and that is what got people on it five times a week. Design is not the opposite of substance. It is how substance gets used.

• Boka (nano-hydroxyapatite, 320% YoY growth), RiseWell, Davids, Twice, Lumineux, Agent Nateur, Marvis (the heritage benchmark)

• Ancient Practice, Modern Packaging: tongue scraping and oil pulling, 5,000-year-old Ayurvedic rituals now rebranded as “microbiome support.” Which is exactly what they always were: Cosmic Dealer, Surya, Terra & Co.

🧠 AI Diagnostics: Pearl, Overjet, VideaHealth. The radiograph-reading layer that makes the rest of the stack affordable at scale.

⚙️ Infrastructure: Torch Dental (the Boukadoum brothers), digitizing the $20B+ dental supply chain. The clinic of the future can’t exist on an analog back-end.

What the comments surfaced

The map went up Tuesday and the comments did something better than agree - they extended it. Two sub-categories I’d underweighted, all shown to me by people building and practicing in the space:

Oral microbiome therapeutics: engineering the bacteria, not just testing or cleaning:

• Primal Health (Dr. Emily Stein): patented, NIH-funded science shifting bacteria from sugar- to protein-metabolizing

• Ostia Sciences (Dr. Michael Glogauer, UofT): a Phase 2 probiotic lozenge for gingivitis

• FoodBIOME (Guy Lopez): a functional-food platform engineered to feed beneficial bacteria

• MyFitStrip + Per Os Biosciences: a prebiotic gum shifting the mouth toward nitric-oxide-producing bacteria

Chairside biomarker testing: same-visit diagnostics between the mail-in test and the clinic:

• Drül: nucleic-acid saliva testing, results in ~30 minutes

• ARKRAY’s SillHa; seven biomarkers in five minutes, already in practices

The pattern underneath both: the consumer brands at the top of the stack are only as good as the therapeutics and diagnostics underneath them. The thesis applies a layer deeper than the original map gave it credit for.

And the most valuable part wasn’t the map - it was who it brought in. I had the pleasure of connecting with Dr. Megan Pugach-Gordon and Dr. Jill Sirko, both out of the ADA Forsyth Institute (formed when the Forsyth Institute joined the American Dental Association’s research arm). Megan’s work sits right at the enamel-microbiome-saliva interface, including using beneficial bacteria to prevent tooth decay. The two of them are building something together in this space - exactly the kind of science-first work the category needs more of.

What’s actually missing

What no one has built - and what investors should be looking for - is the layer that integrates all of this into something a consumer can actually use.

The dream version is mundane, but:

• Your microbiome is sampled the same day your teeth are cleaned

• Your dentist functions as a longevity practitioner, reading saliva alongside blood

• Your daily products are calibrated to what your microbiome needs, not what a brand is selling

• The data goes somewhere useful

That workflow doesn’t exist yet. The data exists. The clinicians, the brands, the diagnostics, the infrastructure - all exist. What’s missing is the connective tissue that turns disconnected purchases into one coherent picture.

And the mouth is just one example of a pattern repeating across consumer longevity: a category emerges in fragments, the science outpaces the infrastructure, and consumers end up with another biomarker, another test, another product, and no way to integrate any of it.

We are not short on data. We are short on the layer that makes it usable. The next decade of longevity isn’t about generating more measurements. It’s about helping people navigate the ones they already have.

What I’m actually doing

• 💧 Water flosser: won’t travel without it

• 🪥 Tongue scraper every morning (Cosmic Dealer; Surya is the accessible US option)

• 🌿 Oil pulling with Terra & Co., when I remember

• 🧪 Saliva microbiome test: results pending. I’ll write about what comes back.

Subscribe now

Next Thursday’s House Call goes deep with Cody Levine at Smile House — the closest thing I’ve found to the full-stack longevity dental practice this category needs. Subscribe if you want to read it.

Disclaimer: This is one person’s reading of an emerging and unsettled area, not medical advice. Talk to someone who knows your own history before changing anything.

At a recent dinner on longevity, after the usual macro trends and clinic talk, the question landed where it always lands.

What supplements are you taking?

The answer worth giving is the same one worth giving every time the question comes up.

For what?

Three things happened over the past few weeks that mean the question is finally about to matter.

Three moves. One outcome.

1. Function Health acquired SuppCo (May 12, 2026).

SuppCo is the independent supplement verification platform that anonymously buys products off brand websites, ships them to ISO 17025 accredited labs, and posts the results, pass or fail, on a public product page.

• TrustScore rates more than 35,000 products on a 10-point scale across 30-plus quality attributes.

• In one round of testing, four of six popular creatine gummies on Amazon contained essentially no creatine. Two contained none at all. The failing products had sold more than 50,000 units on Amazon the month before.

• Across SuppCo’s broader testing, roughly six in ten products fail basic identity and potency.

That platform now sits inside Function Health, which already runs diagnostic panels for hundreds of thousands of people (and i’m proud to be an early investor in). The watchdog nobody was paying for is now baked into the place people actually look at their numbers!!

2. H.R. 8370, the Dietary Supplement Listing Act of 2026 (introduced April 20).

Rep. Maxine Dexter’s bill would create the first mandatory FDA listing regime for supplements.

• Every supplement marketed in the U.S. has to register with the FDA.

• Within 2 years, the agency builds a public, searchable database of every product, every ingredient, every claim.

• Existing products get 18 months to list. Labels eventually carry a listing number.

• The bill explicitly does not require pre-market approval, which is exactly why it has a real shot at passing.

3. FDA finalized its updated General Wellness guidance (January 6, 2026).

Wearables that measure blood pressure, glucose, HRV, blood oxygen can now sit in the wellness lane if they do not claim clinical equivalence. WHOOP got a warning letter in July 2025 for crossing that line. The rules are clearer now.

The boring true thing about blends

Most supplement blends cannot fit clinical doses of their headline ingredients into one capsule. The peer-reviewed sports medicine literature has been pointing this out for years (Burke et al. in Sports Medicine, on the dosing problem in multi-ingredient performance products). Even when an ingredient is well-studied at, say, three grams a day, the blend gives you two hundred milligrams of it on a base that may or may not disintegrate properly in the gut.

The brand is real. The dosing.. that’s another story.

This is the question the TrustScore is about to make legible to a normal consumer for the first time: not “is this product good,” but “does this product deliver what it says, at the dose the studies actually used?”

What supplement partnerships are actually solving

Inside any operator with a member base, gym, clinic, hotel, beauty platform, supplement deals usually solve one of three things:

• A revenue line

• A retention story

• A perceived science gap in the offer

Almost none of them are solving a deficiency. Almost none of them are clinically dosed. The brands that get through a serious procurement filter, that is, the ones that survive on safety, dosing, and supply chain rather than margin, are a small subset of what the consumer sees at retail.

A 1:1 personalized service model breaks the minute the front desk becomes an upsell counter. That is the same structural problem the consumer faces in their own bathroom. The verification layer being built now collapses that asymmetry: the front-desk pitch and the lab report finally live in the same place.

What survives a verification layer

Mono-ingredients with real supply chain authority.

• Vitamin D

• Magnesium(s)

• Creatine monohydrate (ironically, given the gummy story above) etc.

• Thorne is the canonical example of a brand built to survive this kind of scrutiny: NSF-certified facility, 40+ NSF Certified for Sport products tested against 270+ banned substances, minimum four rounds of testing per product. That stack is defensible on paper. The TrustScore will reflect it.

Longevity-specific blends only when the trial work is actually there.

NOVOS Core is one of the few longevity-branded products with a registered human trial. Their randomized, double-blind, placebo-controlled trial out of the University of Surrey (ClinicalTrials.gov NCT06145087) showed:

• +3.4% improvement in endothelial function (FMD)

• −8.5 mmHg in systolic blood pressure over six months

The endothelial number is in the range of what sustained HIIT produces in published exercise studies. That is an uncommon result for a multi-ingredient supplement, which is precisely why it is worth pointing at.

What does not survive.

The rest of the longevity supplement aisle, the lifestyle blends, the celebrity-doctor-fronted stacks, the twenty-pill subscription “core” routines, are about to face the database, the TrustScore, and a consumer who can finally see the math.

What this means for the bathroom counter

It gets smaller, more boring, and more honest.

• Legacy brands with real supply chain moats survive at scale.

• The knock-offs get cleaned up.

• Longevity supplements grow, but as a thin fringe on top of a defensible core stack, not as the whole stack.

The category levels up overall. That is good for the consumer. It is good for the science. It is bad for anyone who has been pricing branding into a capsule.

Back to the dinner question. The right one is still for what.

• Are you deficient and your blood shows it?

• Are you trying to sleep better, recover faster, hit a specific number?

Start there. Take the data. Then look at the product.

Now, for the first time, the data and the product finally meet in the same app.

Stop paying for expensive pee.

CTA

What is actually in the bottle on your counter? Take a photo, look it up, see what the TrustScore says. If something on the shelf surprises you, tell me. The group chat that swears by their twelve-pill stack probably needs this one more than you do.

Subscribe, share, see you next week.

Share

References

• Function Acquires SuppCo to Bring Trust and Clarity to Supplements. PR Newswire, May 12, 2026. https://www.prnewswire.com/news-releases/function-acquires-suppco-to-bring-trust-and-clarity-to-supplements-302769718.html

• SuppCo. Creatine Reality Check: The Failures We Found When Testing Popular Products (lab analysis, four of six gummies failed). https://supp.co/articles/suppco-tested-creatine-testing-results-gummies-failed-lab-analysis

• SuppCo. Product TrustScore methodology (10-point scale, 30+ quality attributes, 35k+ products). https://supp.co/trustscore/about/product-trustscore

• H.R. 8370 - Dietary Supplement Listing Act of 2026, 119th Congress, introduced April 20, 2026. https://www.congress.gov/bill/119th-congress/house-bill/8370/text

• FDA. General Wellness: Policy for Low Risk Devices, final guidance, January 6, 2026. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/general-wellness-policy-low-risk-devices

• Burke, L.M., et al. (2017, with subsequent updates). Practical Issues in Evidence-Based Use of Performance Supplements. Sports Medicine, 47(Suppl 1). https://link.springer.com/article/10.1007/s40279-017-0687-1

• NOVOS Core Clinical Trial Reveals Cardiovascular Benefits in Aging Adults. PR Newswire; trial registered as NCT06145087, University of Surrey. https://novoslabs.com/blog/supplements/novos-core-clinical-trial-results-longevity-supplement/

• Thorne. Unparalleled Quality (NSF Certified for Sport program, 270+ banned substances tested). https://www.thorne.com/quality

• Crawford, C., et al. (2024). Label Accuracy and Quality of Select Weight-Loss Dietary Supplements. PubMed: 39770990. https://pubmed.ncbi.nlm.nih.gov/39770990/

I got my first acupuncture needles at nine. My mom said it was important to help with stress from school. I didn’t push back.

I’m telling you this because it’s the framing I gave the room at Wellist Week in Miami and it’s the framing I keep coming back to: nothing has changed in 3000 years, and yet everything is changing.

With Tino de Martino and Greg Scheinman

A city making a claim

Wellist was the first edition of a new global forum for the business of wellness, built by Myk Likhov and Alhia Chacoff-Berger, anchored by the Miami Design District, and co-signed by the city itself. Mayor of Miami Beach Steven Meiner opened the week. Mayor of Miami Eileen Higgins closed parts of it.

The whole thing read less like a conference and more like a city making a claim. And it did the job: 680 registrants, 70 curators, 92 speakers, 53 satellite events.

It was a city overtake, one that I envision becoming the new Art Basel at scale. And i’m here for it!

I went as both speaker and reporter. I am still processing what I think, but here is off the cuff recap.

What hasn’t changed

We have been doing most of this for three thousand years. The Greeks. The Romans. My family in Poland.

Sauna, cold, fasting, breath, sleep, walking, time outside, time with people. Everything we now sell with a clinical asterisk and a recurring revenue model has been, somewhere, somebody’s grandmother.

The Swami who spoke on Day One - Chidananda, a former investment banker turned Vedic monk, which is its own incredible American story - said the quiet part out loud: the fear of death is the hidden driver behind most of the desire to live longer, and spirituality is the only thing that meaningfully resolves it.

I don’t think you have to be religious to take the point. The point is that the wisdom layer is older than the data layer, and we keep rediscovering it under new branding.

Myk Likhov and Alhia Chacoff-Berger, founders of Wellist, at the Opening Party

What’s changing

Health left the doctor’s office. That is the actual shift.

At the conference, McKinsey said that 84% of consumers globally list wellness is a top priority. They also stated that only thirteen percent of these same consumers say they are achieving their goals. Funny aside: Eric Farlardeau from MckInsey who presented at the conference and I worked on Equinox’s strategy together years ago, when “longevity” still made every brand nervous.

Almost 20% of americans have already tried GLP-1s. That is a behavioral statistic dressed in clinical language, and it tells you the consumer has stopped waiting for permission. And if you want to read more on consumer agency (a topic I think is the KEY driver of this industry), I couldn’t recommend David Shaywitz thinking more!

AI is the unlock

This was in every single conversation whether the panel was about it or not.

And I can’t argue this more: AI is the unlock. Not because it diagnoses better than your doctor (it sometimes does, and sometimes doesn’t), but because it solves a problem the wellness industry has had since the first multivitamin: personalization at scale was a contradiction in terms.

You either had a $40,000-a-year concierge program (I helped build one of those ;)) or you had a generic supplement aisle. There was no middle. AI collapses the middle.

That is the actual story underneath every “AI in wellness” panel - and it’s why even Soho House, which is in the relationship business, is now investing in an AI-powered chatbot to help members navigate amenities across properties.

Tino De Martino, Soho House’s Head of Wellness for North America, told me and Greg Scheinman this during our panel: membership is a relationship, not an access pass, and AI is what lets you scale the relationship without diluting it.

A brand for everyone is a brand for no one

Tino and I spent most of our time on stage debating how you build a brand and a community in a market that has become, frankly, commoditized.

My provocation, which I will say again (and I did pick it up from Equinox’s Chairman), here because I believe it: a brand for everyone is a brand for no one.

Equinox’s President - Marc - and Eileen Higgins - Mayor of the city of Miami - discussing what makes Equinox special!

The capital is here, and it’s sorting

The investment room had the most institutionally credentialed lineup I have seen at a wellness event from L Catterton (LVMH-backed) to Goldman Sachs alums.

The bar has moved from post-revenue to post-profit. They are screening for measurable outcomes, clinical credibility, and founders who can command their numbers without a deck.

The Future Laboratory’s Madeleine Boyd called this “the Age of Proof.” She also pointed out that 57% of US and UK early adopters now think “longevity” has become an overused marketing term, rising to 64% among Gen Z. I’d argue we crossed that threshold a year ago. The market is just catching up to its own fatigue.

The Age of Proof, embodied

Speaking of the Age of Proof - I had a long dinner with Chris Mirabile, founder of Novos. More to come on what he’s building, but the headline for this piece is simpler: Novos Core has a study showing it actually works, and Unilever just put capital behind the company.

There is a particular pleasure in watching someone you connected with years ago (and use the product), when the category was still mostly vibes and TED talks, grow up into the version of the company they always said they were going to be. Chris was disciplined about the science when discipline was unfashionable. Now the discipline is the moat. The clinical data is the product. The strategic acquirers are circling.

This is exactly what the room at Wellist was telling founders to become. Chris is already there

Catching up with Chris Mirabile from Novos, where he shared with me details behind the exciting double-placebo study. More on this to come!

NAD, and changing my mind in public

Now the part where I had my mind changed in real time, which is supposed to be the whole point of going to a conference and almost never is.

I did a hot-takes session with my friend Dr Halland - longevity doctor who recently launched Cell Theory Labs (@celltheorylabs) and has been heads-down on NAD biology for years - and I went in with my standard skepticism. NAD is a category I have largely written off as overpromised, expensive, and oral-bioavailability-questionable.

Halland did not argue with my priors. He went under them.

The conversation moved through:

• Precursor distinctions (NR vs. NMN vs. NAD+ direct)

• The actual mechanistic case for cellular energy in aging tissues

• What the human data does and does not say

• Where the marketing has run ahead of the science (which is most places)

I left the stage rethinking whether I should have NAD support back in my stack. That is not a sentence I expected to type. Halland’s point that stuck: the molecule is not the problem; the delivery, dosing, and category discipline are.

This is the exact pattern that defines this entire moment. The substrate is real. The story around it is mostly noise.

A different kind of hot seat: Elaine Glass

Hot seat with Elaine Glass

The counterweight came in a hot seat with Elaine Glass, whose book Get Quiet: 7 Simple Paths to the Truth of Who You Are lays out seven paths inward, starting with awareness - the willingness to actually look at your own life instead of around it - and ending at a still point where the question is not what to add but what to listen to. After two days of talking about what to put in the body, sitting with Elaine was a hard reset. Her premise is simple and inconvenient: most of the answers we reach for in compounds and protocols are already in us, if we get quiet enough to hear them. I needed the reminder. Probably you do too.

So back to where I started

Three thousand years ago, my ancestors figured out that going from very hot to very cold made you feel better. Three years ago, my Oura ring told me the same thing.

The sauna hasn’t changed. What’s changed is that I now have:

• A personalized, AI-mediated, longitudinal read on my own physiology

• A research literature on contrast therapy that can be scanned in seconds

• A peer group of operators and scientists I can text mid-thought

• A market that has finally decided wellness is infrastructure rather than indulgence

That is not a small upgrade. But it does not replace the original technology, which was: do something hard, then rest, then do it with people you love.

The Blue Zones research has been telling us this for two decades. Harvard study confirms it. We are still acting surprised every time we rediscover it.

Nothing has changed. Everything is changing. The sauna is still a sauna. The needles are still needles.

Select event partners I got to sample!

Share In Search Of

Appendix - Sources & Studies

• McKinsey & Company. (2025). The Future of Wellness 2025: Trends and Strategic Imperatives.

• The Future Laboratory × Together Group. (2026). Wellness: Trends, Opportunities and Strategies for Scale.

• Boston Consulting Group. (2024). Why Wellness Has Become A Massive Global Market.

• Euromonitor International. (2025). Beauty & Personal Care: Health-Positioned Supplements.

• Laukkanen, T. et al. (2018). Sauna bathing and risk of cardiovascular and all-cause mortality. Mayo Clinic Proceedings.

• Patrick, R.P. & Johnson, T.L. (2021). Sauna use as a lifestyle practice to extend healthspan. Experimental Gerontology.

• Yoshino, M. et al. (2021). Nicotinamide mononucleotide increases muscle insulin sensitivity in prediabetic women. Science.

• Martens, C.R. et al. (2018). Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults. Nature Communications.

• Aliper, A. et al. (2022). Novos Core formulation effects on human dermal fibroblast aging biomarkers. (Novos Labs published research — please verify exact citation against most recent version before publishing.)

• Buettner, D. & Skemp, S. (2016). Blue Zones: Lessons from the world’s longest lived. American Journal of Lifestyle Medicine.

• Holt-Lunstad, J. et al. (2010). Social relationships and mortality risk: a meta-analytic review. PLoS Medicine.

I have since joined as an advisor. This is our first public conversation.

Petal is your tracker in the form of bra insert, as pictured above. link here.

Julia: Start with your background, because Petal is not your first company and the path here matters.

Anand: I fell in love with wireless communications very young, back when it was still car phones. By the time I graduated it was cell phones, and I ended up doing research on 3G and 4G protocols sponsored by Nokia Research Center. Then seven years at Motorola Mobility, where I worked on the 3G Razr, the platform that became Android, the first Android tablet, and something we called a smart watch before anyone used the word wearable. That was the Moto Active.

I moved to San Francisco because I was entrepreneurial and the VC infrastructure in Chicago wasn’t there yet. Worked at a few companies, including on the Jambox and at Lab 126, then started my first company in 2015. UJet. The thesis was that people communicate visually and contextually through smartphones, except when they’re talking to a business. I built that for almost ten years. The name is dedicated to someone I lost to breast cancer. Everyone around me, including my investors, knew I was going to come back to that.

Julia: So Petal was always the plan.

Anand: Always. I started looking more closely at women’s health and saw two major crises running in parallel. The first is cardiovascular disease. One in three women ultimately dies from it. Women live longer but sicker. They are dismissed at emergency rooms without proper cardiac testing at seven times the rate of men, and their symptoms present differently, what medicine calls atypical, which I find a frustrating term. Jaw pain, back pain, nausea instead of the textbook chest and arm. The second crisis is breast cancer, and the trend lines are going in the wrong direction. The largest relative increase in incidence is now in women in their 20s and 30s.

Julia: Tell everyone what Petal actually is, because even I had to see it to believe it.

Anand: Petal is a bra insert. It sits at a woman’s anatomical core, right over the heart and the fibro-glandular tissue. It uses bioimpedance analysis sensors, not the optical PPG sensors or temperature sensors you find in wrist and finger wearables. We are not shining a light and extrapolating from the blood flow response. We are listening directly to what the heart is telling the ventricles to do. The signal is the same as an ECG. That matters because it is more accurate, and because it does not require the hand to be still.

Every other wearable is designed around the assumption that you filter out movement. We don’t need to. Women move their torsos significantly less than their arms. So our signal quality during a workout, a commute, a stressful presentation, a walk pushing a stroller, is high when others are filtering noise.

Julia: Which is the part that got me. Most wearables are still essentially optimized for sleep recovery. You are going the other direction.

Anand: Exactly. Cardiovascular and cardiometabolic events happen during the day, under stress, during activity. Women wear bras for an average of twelve hours a day in our research. So the adherence is built in. It fits into the lifestyle women already have rather than asking them to build a new one.

The other thing that is distinct is style. A lot of women stop wearing wrist wearables because they are bulky, or they interfere with strength training, or the battery life drops off. This is invisible. You associate it with your sports bra, you use it for a workout two or three times a week, forty-five minutes to an hour, and you are getting real data measured at the source.

Julia: Walk me through what I am actually tracking.

Anand: Right now, heart rate, HRV, breathing, and adipose tissue composition through the bioimpedance sensors. That last one is significant. The breast is majority adipose fat tissue. Characterizing that gives you a proxy for midsection fat composition, which is more predictive of longevity risk and disease than BMI. It is also invisible. No scale. No number that follows you around.

The app shows you what zone you are in, accurate HRV, and real breathing data, not a timer but an actual visualization of your heart rate declining and your breathing pattern shifting when you do breathwork. The app was designed starting from women, not adapted from a male athlete use case after the fact.

Julia: And where is this going. Because the cardiovascular piece is the first chapter.

Anand: The second chapter is early anomaly detection for breast cancer. We are building the foundational model right now. Women were excluded from early clinical trials until 1993. Mice do not have a menstrual cycle. The data we have is not built on women’s physiology, and that is the gap we are filling.

Mammograms are a 2D rendering of a 3D organ. Over 50% of women have dense tissue, which means they get a letter after their mammogram saying the results may be incomplete. Our approach starts from 3D, from the breast in its natural form, characterizing tissue types, looking for deviation longitudinally over time. The head of breast radiation oncology at UCSF is part of the team. We have FDA clarity on the classification of the bioimpedance sensors. We are moving.

The goal is ambient. Technology that disappears into your life and builds a baseline specific to you, over time, that is actually useful when something changes.

Julia: Last question. Who are you looking to connect with?

Anand: Anyone obsessed with women’s health. Get the device, petal.today. Try it. The more women using it, the stronger the model, the stronger the mission.

Petal is available at petal.today. $199. Bra insert with app, two colors currently shipping.

That’s the question I keep coming back to every time I read another profile of someone who lost forty pounds on a GLP-1 and then, almost as an aside, mentions they also stopped wanting wine. And shopping. And the 2am spiral of should-I-or-shouldn’t-I. The food noise went quiet, and then, a little more quietly, so did everything else.

The science on this is genuinely interesting and genuinely incomplete, which is how most useful science tends to be. GLP-1 receptor agonists, semaglutide and tirzepatide specifically, don’t just talk to your stomach. They communicate with the brain’s reward circuitry. Nora Volkow at the National Institute on Drug Abuse has spent decades mapping exactly these dopaminergic pathways, the ones that make you reach for another glass, refresh the feed, text back too fast. GLP-1s modulate wanting itself. And they do it, from what the early data suggests, quite well.

Which should probably give us a moment’s pause.

I’ll say where I sit in this, since it’s relevant to the argument. I’ve been trying to answer this question for myself. Not academically. Personally. Sitting with whether to try them. And there’s a view I’ve arrived at that I find mildly inconvenient: if you work in this space and you haven’t tried the thing you’re forming strong opinions about, that’s a gap worth being honest about. Especially if you’re a doctor (which i’m clearly not!). The n=1 data point you’re missing is your own, and that tends to show up in the quality of the thinking.

So I remain curious, genuinely. And equally unsettled. Not by the mechanism. By the category. The idea of getting hooked on a pharmaceutical solution to maintain something I’d always understood as being about will, desire, the kind of person you are. That framing runs deep. Replacing it with a weekly injection feels less like an answer and more like a sharper version of the original question.

The premium wellness market spent decades building a very expensive infrastructure around a single idea: that craving was the problem. Too much appetite, too much indulgence, too much noise. GLP-1s are the logical conclusion of that project, delivered once weekly, subcutaneously, elegantly.

But here’s the thing. Desire is also, inconveniently, what gets things made. The longing that drives creative work. The hunger that makes someone call the person, stay in the argument, order the dessert and mean it. I’m not making a case against the drugs. That would be facile and also not my lane. I’m making a case for noticing what we’re framing as the problem.

Subscribe now

Because when “decreased interest in reward-seeking behavior” is listed as a side effect with quiet neutrality, we’re describing something more than a reduced appetite at dinner. We’re describing a modulation of how a person moves through the world. Research from Olivia M. Farr and colleagues in Diabetologia established that GLP-1 receptors exist in the parietal cortex and hypothalamus — brain regions with nothing to do with digestion and everything to do with how we process experience. A 2025 clinical review by Tveit and colleagues went further: GLP-1s increase serotonergic activity at the 5-HT2C receptor, the same pathway behind SSRI-induced motivational blunting and reduced sexual desire. The mechanism for quieting desire isn’t just theoretical.

The broader psychiatric picture is net positive and I want to be clear about that. Large population studies find GLP-1s associated with meaningful reductions in psychiatric hospitalization, not increases. This is not a story about a drug making people worse in the ways medicine knows how to measure.

What medicine isn’t measuring yet is this: those trials track hospitalization, adverse events, depression scales. They are not tracking whether someone stopped wanting to call the person, lost the pull toward the project that used to wake them up at 6am, or found the things they used to hunger for simply quieter than before. Those don’t register in any database. They’re the texture of a life. And they may be exactly what the 5-HT2C pathway is modulating.

The question isn’t whether these drugs work. They do. The question, and I think it’s the more interesting one, is what we believed was broken that made us reach for them in the first place.

We are all in search of something. That’s the whole premise. But it’s worth asking, occasionally, whether we’re searching for less wanting, or for wanting the right things.

Share

If you’re not subscribed yet:

In Search Of covers the intersection of longevity science, culture, and the questions the industry isn’t asking loudly enough. No hype. No supplement stacks. Just rigorous thinking on what it actually means to build a longer, better life.

→ Subscribe below. One post a week.

Subscribe now

References

• Farr, O.M. et al. (2016). GLP-1 receptors exist in the parietal cortex, hypothalamus and medulla of human brains and the GLP-1 analogue liraglutide alters brain activity related to highly desirable food cues in individuals with diabetes: a crossover, randomised, placebo-controlled trial. Diabetologia, 59(5), 954–965. PMID 26831302

• Volkow, N.D. & Koob, G.F. (2015). Brain disease model of addiction: why is it so controversial? Lancet Psychiatry, 2(8), 677–679. PMID 26249284

• Volkow, N.D. et al. (2025). GLP-1R agonist medications for addiction treatment. Addiction. doi:10.1111/add.16626

• Tveit, M. et al. (2025). Clinical review of how glucagon-like peptide-1 agonist obesity medications decrease sexual desire, and a biopsychosocial model for why we don’t ‘see’ it. The Journal of Sexual Medicine, 22(Suppl 1). PMC12704374

• Sa, B. et al. (2026). Psychiatric effects of GLP-1 receptor agonists: a systematic review of emerging evidence. Diabetes, Obesity and Metabolism, 28(1), 50–59. PMID 41126551

• Taipale, H. et al. (2026). Association between GLP-1 receptor agonist use and worsening mental illness in people with depression and anxiety in Sweden: a national cohort study. The Lancet Psychiatry. PMID 41862258

• Watabe-Uchida, M., Eshel, N. & Uchida, N. (2017). Neural circuitry of reward prediction error. Annual Review of Neuroscience, 40, 373–394. PMID 28441114