The Food Is Health Revolution

Kelly Ryerson joined us live this week, and the timing couldn’t have been scripted better. The House had just voted 280-142 to strip a pesticide liability shield from the farm bill - with 73 Republicans breaking from leadership. That’s not a MAHA moment. That’s a population renegotiating a 60-year-old contract on how society handles the externalities of innovation. The contract was built for a world where you couldn’t measure the harm. We can measure it now. (And Carter wrote a banger piece on this yesterday morning - outstanding. Go read it if you haven’t.)Kelly walked us through her own root cause story, which until last Friday at Ryland’s I somehow had never heard - even though she’s one of my besties (how did we not meet nine years ago at the IFM conference huddled in the root-cause corner together?? Carter says us together would’ve been trouble. He’s probably right.). Mysterious illness. Every specialist at Stanford and UCSF. Diagnosis: she must be crazy. The intake bloodwork - done at Theranos, you can’t make this up - eventually confirmed she was a starving person nobody had thought to check. Zero vitamin D. Zero vitamin C. B12 of 50 when it should be 500. Full gut dysbiosis. She went gluten-free, started feeling better, and at a Columbia conference asked a question nobody had answers to: is something happening on the farm? A General Mills insider found her afterwards and dropped the bomb - farmers spray Roundup on grain right before harvest as a desiccant. It goes straight into the food supply. Glyphosate acts like an antibiotic that selects against beneficial gut bacteria. The stuff you’re paying for at Whole Foods in probiotic bottles. We’re eating an antibiotic every single meal.I shared my own version - the diagnostic rabbit hole from hell, thinking I had MS, the ER doctor telling me I was having a panic attack and sending me home, the eight months of nobody diagnosing me with anything. What got me better? Food. The Wahls protocol. Six months. And the icing on my cake: my husband had penetrated our entire Florida lawn with Roundup while I was working from home with the air handler pumping it back at me. (I love him anyway.)Carter pulled the lens up to the structural question - companies build things, those things have externalities, and we granted liability shields decades ago because we couldn’t really measure harm. Now we can. In silico testing. Animal models. AI sitting next to Dr. Joe Pizzorno at dinner in Nashville last week, holding its own on diabetogens - and Joe, the most skeptical AI critic at the table, conceding it was actually pretty right. The visibility era has arrived. The System B architecture was never designed to survive it.Kelly’s point that’s been sitting with me since: 57,000 pesticide products were sitting under that liability shield, the vast majority manufactured by ChemChina and foreign chemical corporations. We’re not protecting American companies anymore — Bayer is German, Monsanto got absorbed. There’s no national security defense left to make. Meanwhile rural red communities are getting the rawest end of it: well water contamination, air spray, the cancer that hits everyone in town. Kelly lost her father-in-law to ALS that Duke attributed to pesticide exposure, her mother-in-law to cancer, both in their early 70s in rural North Carolina. Those constituents are the ones who flipped this vote. Personal experience. Celiac. Kids who can’t focus until you take them off gluten and dyes. Pregnancies that won’t take. That’s what’s moving the Republicans, not a press release.The whole conversation kept circling the System C through-line. This isn’t about banning glyphosate into submission - it’s about making it so you don’t need it. Fix soil health, fix nutrient density, fix the feedback loop between food input and human outcome, and the chemical treadmill becomes economically irrational. Carter’s line that landed for me: the goal isn’t a grocery store where you have to pull out an app to figure out what’s safe. It’s a grocery store where you don’t have to ask the question at all. Pretty much anything you can buy is good for you. That’s the reusable rocket. And just like SpaceX, we get there by working backward from the first-principles outcome - not forward from where we’re stuck.We had to bring it in early because Bristol the German Shepherd was losing her mind over what may have been Kermit the Frog. Worth it. Get full access to Food is Health at foodishealth.substack.com/subscribe

By 2050, it should be hard to make a bad decision in the grocery store. That’s the goal. What happened in this room was a step toward making it real.This week at Food Health LIVE, our Innovation Lab brought together over 50 cross-sector industry leaders representing the full chain of soil to cell. Farmers, seed geneticists, food banks, clinicians, ingredients companies, advanced diagnostics, CPG founders, health insurers, community food organizers, measurement technologists and many others, and asked them to do something rooms like this don’t attempt often. We asked them to build the system in real time, with real people, in the room. We threaded the needle from soil to cell and here are a few things I took away.P.s. keep an eye out for a soon to come list of exclusive discounts from the companies delivering System C for paid subscribers.The Pieces Exist. The Loop Doesn’t.One of the most important things that happened in that room wasn’t just a single conversation, it was the accumulation of all of them.At the end of the 3 hours, you could trace a line from the farmer who knows exactly how his growing practices affect the glucosinolate content of his broccoli, through the ingredient company that’s spent a decade developing a fiber profile that heals the gut, through the CPG brand whose products show a 21-point cholesterol reduction in clinical data, through the insurer who’s already covering food as medicine and showing a 3-to-1 return on investment, through the technologist who’s figured out how to measure metabolic health in under two minutes simply using an ultrasound and another innovator who is doing the same via cellphone.Every node in that chain was in the room but the loop doesn’t close here. Not yet.The Market Signal Is the Whole GamePeople miss this when they assume the problem is supply. Better seeds, cleaner ingredients, more regenerative farms. Yes. All of that matters but supply is not the real constraint.Consumer demand is the trigger that matters.Right now, food is priced on features – grams of fiber, sugar content, organic certification – not on outcomes. A farmer who grows broccoli with twice the glucosinolate content gets paid the same as the farmer who doesn’t, because no one downstream is asking for it. In large part because consumers can get that information. A CPG company that can demonstrate that its product reduces inflammation in a measurable, personalized way can’t communicate that without going through a pharmaceutical-grade FDA claims process it can’t afford. Yet the technology to measure human outcomes at the individual level is collapsing in cost with $80 blood panels, CGMs on instant order, and AI-powered metabolic imaging, but that data isn’t connected to the supply chain. Not yet.When a consumer can measure what a food does to their body, share it, and have that data feed backward through retail into CPG into ingredient sourcing into seed genetics, that’s the market signal that rewrites the economics of the entire food system. That’s the flywheel. The diagnostic infrastructure is the crank.The room saw this unfold over the course of the morning. The question then became how quickly and with what combination of existing measurement tools can this infrastructure to deliver the missing that outcome layer.Reimbursement Is Not the SolutionA lot of the work happening in food as medicine right now is focused on reimbursement. Getting medically tailored meals covered. Getting produce prescriptions into Medicaid. Getting food written into value-based care contracts. All of it matters and is important. All of that cost burden is downstream once disease is already established. It operates in System B (as B+). We need to expand this upstream so it isn’t reliant of downstream funding which is fundamental to System C.Downstream reimbursement as an intervention is System B+. It’s the best version of the current system and we should pursue it, because it funds the transition to System C and proves the outcomes. But, reimbursement still sits on top of a broken economic architecture. You haven’t changed the system when you’ve convinced it to pay for a workaround.Ellen pushed on this hard in the room. She asked one of the medically tailored meal founders point-blank, “if you could wave a magic wand, would you want to be upstream of all this where people never develop the disease that requires your intervention in the first place?” He said yes. So did almost everyone else when pressed.The goal is food that is so affordable, accessible, and nutritionally dense that chronic disease becomes rare. Not simply managed. Rare. That’s the engineering challenge and reimbursement is a funding mechanism on the way there, not the place you’re trying to get to.This distinction matters because it determines where you invest your energy. System B+ is about negotiating better terms inside a broken system. But when you add System C as the long game you can build it using System B to fund it.The Access Problem Is Built Into the Architecture, or It’s Not RealA food bank director stood up and said what is often avoided – if your solution requires people to be able to afford to shop differently, it’s not a new system, it’s a premium tier.And she was right.Ellen shared a story about a woman who graduated from a Food Is Medicine program. In 8 months she learned to cook – she and her son made eggplant together – and her relationship with food had been transformed. And then she shared – I’m going to have to go back to eating what I was eating before. I can’t afford anything else. The food bank doesn’t have eggplant.That’s not someone “unwilling to change”. That’s what it looks like when the system is designed from top to bottom for the wrong outcome. The economic model of System C isn’t “healthy food for people who can pay for it.” It’s “fix the cost structure upstream so that nutritionally dense food is the affordable default everywhere – in the grocery store, the food pantry, the hospital cafeteria, and the corner store.”That’s not simply charity, it’s engineering, and a complete system re-design.And it really comes back to outcomes data.AI Is The Reusable Rocket of Healthcare.Ellen made a point that I want to echo here, “AI primary care is effectively free already. For $20 a month you can access something better than most physician consultations for general health questions. The reusable rocket has landed.”What that means for the future design specifically is that the cost of knowledge – personalized, synthesized, acted on – is approaching zero. The “n of one” medicine that used to require a $500 blood panel at minimum, interpreted by a concierge doc charging $1000 to review, is moving towards less than $100.That changes the measurement economics, the clinical workflow, and who can access personalized nutrition guidance. At the same time, it creates a new problem – all that intelligence and information is worthless if it’s not connected to a food supply that can actually respond to it.The knowledge layer and the supply chain layer have to close the loop on each other. AI accelerates the knowledge layer. The supply chain transformation still needs work. And a new system.So What?The food and health system is not going to be reformed from the inside. The organizations embedded in the current state - the food companies, the insurance companies, the hospital systems – are doing exactly what they were designed to do. So much so that Ellen and Carter have named their first book “Nobody Did Anything Wrong”. These companies are not villains. They are optimizing for the metrics they were built around. The metrics that produce and monetize chronic disease.What will actually change the system is a parallel architecture that makes the old one irrelevant. That’s what System C is. Yesterday you could see all the pieces of it – the soil science, the measurement technology, the clinical proof points, the reimbursement innovation, the community infrastructure, the AI layer – come together.The reusable rocket doesn’t become reusable until launch. System C is doing its final pre-launch checklist. Not a paid subscriber yet? Get on it, new discount benefits hitting soon. You can take advantage of the special subscription opportunity for those who were physically in the room until Sunday - $99 for a full year (a discount of over 40% off!) for the first 20 (only 10 slots are left). Use this LINK and if the discount price doesn’t show, enter the url foodishealth.substack.com/first20. Get full access to Food is Health at foodishealth.substack.com/subscribe

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We are creating System C. Therefore, we are focused on the operating framework and inviting guests accordingly.We were joined by one of our favorite MDs - Adam Carewe MD. We talked about how AI is actively reshaping healthcare delivery not in theory, but right now, in clinical practice. Adam’s work at General Medicine is a live example: using AI to aggregate patient-provided data before visits, provide decision support, and catch what humans miss. This ultimately seeks to solve the 7 minute visit dilemma. He gave the example of a colon cancer screening catch (positive stool test buried in 21 pdfs). I shared my use case of Claude for a primary care visit to arrive with better synthesis than the clinician, only to be told the system B response: “I didn’t have a chance to read what you sent over - note I sent a 300 character detaile summary with biometrics. Something that takes 1 minute at best to read. Instead she said “tell me what’s going on, and just to set expectations, we only have 20 minutes.” The System C alternative is already being lived by a small group of early adopters who’ve figured out how to use AI as a genuine health partner, not a search engine.The second thread was about where System C breaks down at scale and what it would actually take to get there. Carter Williams busted out the Raptor 1/2/3 engine analogy that cut to the heart of it: the technology is getting dramatically better, but the feedback loops that would let the system learn from failure (missed aneurysms, false positives, ineffective cancer drugs) are slow, siloed, and politicized. Adam’s vision for what comes next was brilliant, a platform that intercepts healthcare demand upstream, before people even enter the traditional system. It’s the System C end state: frictionless, concierge-quality, AI-augmented care that makes the incumbent model as obsolete as the horse and buggy that is AFFORDABLE AND SCALABLE. The friction-removal frame (air fryer broccoli, grocery store design, end cap placement) connected food system and healthcare system design as the same engineering problem. System C is being built now by the people in the room.Thank you for those that jumped into comments such as Tina Simpson, Mental Health, Mark Miller, APASAS Health, and all of the others for tuning into our live video! Join me for my next live video in the app. Get full access to Food is Health at foodishealth.substack.com/subscribe

00:00 Introduction to Food is Health01:13 Personal Health Journey and Technology Integration07:53 Leveraging AI for Health Insights14:32 The Role of AI in Empowering Individuals20:18 Exploring VO2 Max and Human Performance27:11 Shifting Perspectives on Health and Disease33:44 First Principles in Health System Design35:24 Innovative Biomarkers in Health Diagnostics36:53 Market Readiness and Early Adoption38:31 Understanding Molecular Fitness Scores40:23 Collaborations and Partnerships in Health Tech42:22 Data-Driven Insights for Athletes44:25 Rethinking Clinical Trials and Health Research50:54 Building a Comprehensive Health Database55:46 The Future of Biobanks and Reference Ranges01:09:30 Building an Aerobic Base for Fitness01:11:38 Understanding VO2 Max and Training Intensity01:12:46 Practical Tips for Improving VO2 Max01:15:25 The Future of Health Data and Algorithms01:18:00 Integrating Body Composition and Fitness Data01:20:50 Personalized Health Insights and Inflammation01:24:34 Wrapping Up: Key Takeaways and Future Directions01:30:19 NEWCHAPTER Get full access to Food is Health at foodishealth.substack.com/subscribe

Get full access to Food is Health at foodishealth.substack.com/subscribe

Get full access to Food is Health at foodishealth.substack.com/subscribe

Get full access to Food is Health at foodishealth.substack.com/subscribe

Get full access to Food is Health at foodishealth.substack.com/subscribe

Get full access to Food is Health at foodishealth.substack.com/subscribe

Two Healthcare Nerds Looking for a Better Way (and One Investor Who's Done Waiting) Get full access to Food is Health at foodishealth.substack.com/subscribe

Get full access to Food is Health at foodishealth.substack.com/subscribe

Join us for our Weekly Livestream Today April 2, 2026 | @1pm ET | Click Here to JoinI was not planning to livestream on Monday.I was standing in a room at Nicklaus Children's Hospital in South Florida, amongst a small invite-only gathering centered around an announcement coming from HHS & CMS by the leaders making it themselves, in-person. The lead-up antics had me confused about the entire thing. Added to the constant reminder I have to provide to many that I’m not in the room for the messenger but the message. Restoring human health. That I’m not looking to add to the ongoing thread of whether more harm than good has been done.My objective is to understand all of the tailwinds that could accelerate the creation of System C and a parallel Human Outcome-based economy. A $9T economy. But as the unexpected announcement began, I decided to simply go live on Substack. I’ve never done that before. Within about 3 minutes, more people joined from the outside via Substack than were physically in the room. When I saw the names pop up - many of them leaders of the Food Is Medicine movement across this country - I knew I had made the right decision.It should come as no surprise that the media in attendance completely missed what the announcement actually represented. And so, as Carter Williams and I debriefed with Maura Plante who was one of the leaders/hosts of the event, yesterday, it became clear we owed it to our (now) 18,000 strong subscriber base to dive in properly. Today we will go live at 1pm ET with Maura, founder of Living Hungry and the Florida Health and Nutrition Coalition. Maura has been doing the unglamorous, essential, deeply human work of building food-as-health infrastructure in communities that the policy conversation references constantly but rarely actually involves. She is the real thing. And she is part of why Monday even happened.She and a few others got it across the finish line despite all of the attempted blocking and tackling.We are going to do what we always do: riff about what we think the announcements actually mean. Too bad I didn’t get a chance to chat with Sayer Ji at the event, would be fun to have him join the conversation as well.The headline in case you missed itMonday morning, HHS & CMS announced two things:* CMS sent a memo to every hospital in the country. Not a suggestion. A memo reminding hospitals that under existing conditions of participation - the mechanism that determines Medicare and Medicaid eligibility - they must ensure patient menus align with the updated Dietary Guidelines for Americans (DGAs). That is a federal mandate in everything but name. Whether it can be enforced or how isn’t what we will focus upon, but instead on the opportunity this presents as it relates to Food Is Health and System C.* Secretary Kennedy announced a pledge he is asking hospitals to make to source 5% of food from local farmers, increasing every year. At the event, Nicklaus Children's Hospital committed to sourcing 5% of food from local Florida farmers, increasing by 1% every year. Oz went on to remind everyone:“Starting April 1st, for the first time in history, CMS will pay for app developers and digital technologies that support personalized nutrition services.”In the span of 10 minutes 4 major tailwinds were shared in rapid succession that accelerate the need for measurement infrastructure, the need for infrastructure to scale local farm supply and distribution, the need for the coordination layer that connects food inputs to health outcomes and more.In essence, System B prioritizing & funding infrastructure for System C unknowingly.Join us Today April 2, 2026 | @1pm ET | Click Here to Join for a live riff about what this actually means for the people doing implementation - not the people making the announcement. Get full access to Food is Health at foodishealth.substack.com/subscribe

We’re going live (here) Tuesday, March 17th at 11:30am ET.I bumped into the FHIR Data guy on Substack after reading his version of a very similar thought experiment with Claude for healthcare last month. I invited him into the show and then we made sure to rendezvous during my breif time at HIMSS in Vegas last week. We managed to record a quick rif and photographic evidence of our meetup and it’s shared above. Yes I look exhausted in this one. Yes the writing is on the wall that I will get hit by a freight train by immune system later that night. But alas, humans still have human constraints.Like me, Gene is a healthcare veteran, but he has been deep on the data side of things (large provider systems, payers, PBMs), digital health startup founder, interoperability platform builder. He writes Fire Data Guy on Substack, and five years ago did something most people with that kind of institutional knowledge never do: he left. He’s also built a consumer-facing interoperability platform from scratch. Started writing about what patients could actually do with their own data if someone showed them how. He’s right up our alley. A System C thinker in a System B world.Our current plan, which as everyone here knows is completely subject to change is have a live, hands-on demonstration of how to pull your own health insurance claims data, de-identify it, and use Claude to build a family health dashboard - longitudinal timelines, financial summaries, and those “gotcha” moments in your coverage you’ve never been able to surface. Gene has built a de-identification tool specifically so privacy-conscious participants can follow along safely.Carter’s goal for everyone is that by the end of the episode, you’ll know exactly how to do this yourself - that night, if you want. Which really means you have at least an inkling of how you might go about doing such a thing. Moreso if you’ve done more than use AI as a glorified version of Google, which is where most everyone is at the moment. 35% of U.S. healthcare spending is administrative overhead. Most patients are walking into every encounter with no briefing documents and no backup. AI is the equalizer - but only if you know how to use it. This is a how-to of sorts.While it’s tactical, the reason we are doing this isn’t to focus on optimizing System B. It’s about the importance of giving individuals the agency that was previously available only to large healthcare organizations - a first step toward a world where patients aren’t the least informed party in every healthcare transaction.For those of you who’ve been following our AI doctor panel series, including the yet to be published 45 minute deep dive yesterday into Ellen’s most recent foray with Claude. Here is the most recent discussion with Pryce Ancona Where I figured out how to make my data useful, Gene figured out how to build the tools to make it secure, structured, and something a regular human being can actually use without a computer science degree.We grabbed a few minutes in the media lounge at HIMSS before I bolted for my flight on the first officialy day. You watch the clip. But that conversation was maybe 10% of what Gene and I and I got into on our prep call. The real thing is happening Tuesday, March 17th at 11:30am ET, and if you’ve ever stared at an EOB you couldn’t parse, gotten a bill that made zero sense, or just wondered what all those years of labs and claims data actually add up to, add the livestream session to your calendar and pull up a chair.HIMSS In A Few WordsI explained that walking into HIMSS when you’re building for System C is like walking into the Home Depot when you’re trying to build something that doesn’t exist yet.Everyone around you is very excited about their specific product. The pipes. The fixtures. The smart home integration. BUT they’re building it for the architecture that exists today. Which is impressive to most. And also completely beside the point if you’re trying to build something the current blueprints can’t accommodate. Gene added, “We’ve got the pipes kind of connected. They’re not 100% connected. It’s like we’re all on this street, living in different houses - one house doesn’t have hot water, another doesn’t have a sink. And nobody’s even designed the blueprints yet.” To which I counter, the blueprints are still being designed on old architecture because the incumbents don’t want to risk diverting the flow elsewhere when the new infrastructure comes online.Within a System B lens, there are “cool” things happening - Gene mentioned Databricks going all-in on AI ecosystem building, the first payer (shoutout to our friend Andrew Toy, CEO at Clover Health) who in typical Andrew style surprised the industry by being the first health plan to actually share data under CMS Aligned Networks. You’ll be seeing me mention him alot more over the coming weeks because I have an unreleased recording with him from last year that is beyond relevant now. Plus, Uni and Wilson were involved on that front so they will write about him too.Brendan Keeler and the HTD crew was in the house (sadly sans Pryce) HIMSS is their total wheelhouse. They were there doing what they always do, which is quietly (and in Brendan’s case, loudly) moving the whole interoperability conversation forward. And Gene mentioned his buddy Jason Coltonga at Fasten Health - one of the first healthcare companies to integrate with Claude - is connecting clinical records in ways that felt impossible a few years ago.I was lucky enough to find a few focused minutes with Priyanka Agarwal, one of the founders of HealthEx, who is stealthily building the pipes for System C by giving consumers license with their own health data. We’ve written about HealthEx before.The pipes exist. The standards exist. And yet most patients are still completely on their own trying to put it together - and the people who built the pipes aren’t exactly rushing to hand out the blueprints. For good reason.HIMSS looks like it does pretty much every year, I even went and checked for the 10 minutes I had before running to catch my plane. Quite frankly, it’s why I don’t go to HIMSS and only went because I had an invite to a Most Interesting Person Black Tie that was a sidecar since so many people were at HIMSS. For me, it’s not the big health systems redesigning themselves. It’s not the payers deciding to play nice with patient data out of the goodness of their hearts. It’s the convergence of two things happening simultaneously: AI making information instantly and personally actionable, and a generation of patients who have simply run out of patience with a system that’s been charging them for opacity.The moat of incumbent healthcare isn’t impenetrable anymore. David Banks, CEO of Advent Health, one of the biggest health systems in the country even said it on stage. I’ll publish that soon, don’t worry. Healthcare, while amazing at keeping us alive, vital for acute care needs, has become the medieval overlord. The one who’s been collecting taxes on the peasants for decades - and could, because the system was opaque enough to keep them confused and disempowered. One that is suddenly facing a situation where the peasants have the same information he does.AI is the equalizer. Not because it’s magic. Because it removes the information asymmetry that was the entire basis of the power structure.As Far As Tuesday GoesCarter and I have both done versions of this on our own. I’ve shown mine on livestream, Carter’s done it with Claude CLI in ways that frankly still make my brain hurt a little. But Gene is the first person we’ve found who has done this at a level with an eye towards making it accessible and safe, and who has the deep interoperability chops to explain why the data is structured the way it is and what you can actually unlock with it.Carter’s framing, which I love: “This is about agency. Not about becoming your own doctor. About becoming a more effective consumer of your health span.”The distinction matters. Diagnosing yourself is not the point. Understanding your own longitudinal picture - what’s been happening to your body, what it’s cost you, what the signals are - and being able to walk into any healthcare encounter with that context loaded and ready? That’s the point.Come with your questions. Come with whatever bill confused you. Come with the thing your doctor never had time to explain. Get full access to Food is Health at foodishealth.substack.com/subscribe

A few weeks ago on our weekly Food is Health Livestream, we sat down with Pryce Ancona, an industry leader in healthcare interoperability (and friend!) who has spent the last decade connecting the disconnected systems of American healthcare (or at least trying). What started as a conversation about frozen olive trees in Texas turned into an hour-and-a-half deep dive into how AI is about to fundamentally change the relationship between you and your health data. Whether healthcare believes it or not. And guess what… our guest walked away rethinking the true implications.Here’s the full video. If you somehow find this TV worthy, you can now access our content on the Substack TV app on your smart TV. FYI, it took a hot second in our house, one TV let me download the app and one didn’t. Because some folks prefer the written word, we have a recap below.If you are new here - WELCOME! And thank you, there are thousands of you as of February. Just a little context for those who have just jumped in…when we talk about Food Is Health, we’re talking about a full systemic redesign where nutrient density and nutrition becomes affordable. From soil, through ingredients, through packaged goods, all the way through distribution, retail, restaurants, and into healthcare itself. To break it down, we created a framework we call System A (inherent health - evolution - pre-20th century - not scalable), B (current state - cheap calories fueling a chronic disease epidemic leading to a crippling healthcare cost burden). And System C - our mission - a new system built on first principles, designed around human outcomes and human health. Our current healthcare system still handles what it was meant to do (acute care), but a parallel system emerges that’s focused on keeping people healthy in the first place starting at the root through food. Fully upstream with primary prevention.Meet Pryce: The Guy Who Connects Healthcare DataI first met Pryce Ancona when I pretty much forced him to share an UBER to the airport for when we were both leaving the first HHS/CMS Digital Tech Bootcamp in DC and became an immediate fan of System C. He’s now that friend who texts me randomly when he sees something that fits into the future state we aim to build and brings me a massive smile. Pryce started his career at 21, fresh out of college, working for a massive electronic health records company in Wisconsin - one that everyone in health tech has heard of - you know the one. Over the past decade, he’s become one of the sharpest minds in healthcare interoperability - which is a fancy way of saying he figures out how the hundreds of thousands of disconnected healthcare data silos in this country can actually talk to each other. Or at least tries REALLY hard.He’s now at HTD Health, lured there by our friend, the man, the myth, the legend, Brendan Keeler - who writes a brilliant Substack (Health API Guy). The firm consults with payers, providers, and software vendors on how to connect systems, interpret info-blocking regulations, and build strategies for data mobility. When he describes his work, Pryce puts it simply: we made all these software systems, and now we’re trying to make them talk to each other.And that brings us to the big news.What Actually Changed: AI Meets Your Health RecordsHere’s the shift that Pryce highlighted: OpenAI and Anthropic have both announced that their AI systems can now talk directly to your doctor’s systems. OpenAI is using b.well, and Anthropic is using HealthEx.Think of it like Plaid for healthcare. The same way your budgeting app uses Plaid to connect to your bank accounts, companies like HealthEx and b.well allow apps - and now AI tools - to ping your health system’s API and say, “I have one of your patients here. I can prove it’s them. Can I have their chart?” And thanks to government mandates around info-blocking, certified electronic health records have to respond.This is the foundational infrastructure shift. Your health data is becoming mobile.Now, in practice, we’re still in the early innings. When I connected through HealthEx, it only pulled a tiny sliver of my actual health data AND that was separate from the Connector via Claude which found nothing. But according to HealthEx that will be changing quickly - and after chatting with their bada$$ CEO I believe her/them. In my case, during these early innings, I still had to go to Quest, LabCorp, and almost every other provider to manually download PDFs. It took me three to four hours to pull together ten years of data across 40 documents. I was a dog with a bone once I got started.But here’s the thing: that friction is temporary. The data pipes are being built right now.The “Who Owns the Data” QuestionCarter pushed Pryce on a key architectural question: Are we moving toward a world where you own your data and share it back to the system, rather than the system owning it and giving you access? Case in point - my own experience. It’s why I was willing to dedicate the 3-4 hrs because I knew it would always be there.Pryce’s answer was unequivocal: Yes. That’s literally what we’re working on.The government is going all-in on patient empowerment. CMS launched the Health Tech Ecosystem initiative, asking networks, EHRs, payers, and patient-facing apps to pledge toward data mobility. The whole policy direction is making it so that if a provider blocks the exchange of your healthcare information, there are financial penalties.And just last Friday CMMI (Centers for Medicare and Medicaid Innovation) leadership was quoted as saying": Develop NOT for RPM economics, but leverage LLMs to help patients self-manage. If you've already got something built, think about the automation and self-management side. - CMMI LeadershipBut Pryce also named the tension honestly. There’s still not a clear economic incentive for many providers to actively help patients take their data elsewhere. An object not in motion tends to stay not in motion, as he put it. The incentives are changing, but slowly. Again I’m brought back to the new CMMI/CMS ACCESS program (first round applications due in April for July 1st Go-live). ACCESS is an Outcomes Based Payment, Direct to Consumer, Original Medicare program intended to aid eCKM (early cardio kidney metabolic) and CKM (cardio kidney metabolic) along with MSK (musculoskeletal) and BH (behavioral health). Once the rates were released last Thursday it became clear via tech, not humans. BUT interestingly enough, the figures are also enticing to CPGs and grocery and there are some great white label options to meet the tech/Part B requirements. I’m not ready to let the fat lady of tech bros sing on this one yet. We can do better than those inevitable dumpster fires. Carter’s reframe was sharp: if Epic is focused on acute care, and standard care is deficient 80% of the time, then there’s a massive population of people who could take proactive steps to never develop chronic disease. Who has pole position in that story? Nobody has an incumbent advantage there. It’s wide open.But I always say, the food industry could take a TON of marketshare from healthcare if they so choose.The Oura Ecosystem: An Alternate Healthcare UniverseBefore we dove into the Claude reports, I wanted to make a point about OURA that I think the whole healthcare industry needs to hear.I’ve gone deep as a power user myself of the OURA ecosystem, and what I found is that they have quietly built an alternate healthcare delivery system. This isn’t just a fitness tracker for the worried well. Look at what’s inside the app: you can order a continuous glucose monitor (Stelo - delivered in some places same day via Amazon), track your blood sugar data alongside your sleep and heart rate variability, order health panels through Quest (schedule the appointment, pay for the labs, get results - all within the Oura app), and receive personalized health recommendations based on your data.They’ve built a direct-to-consumer healthcare ecosystem that controls the patient relationship the same way a health system does. And if we look at the ACCESS program once again, come July if they become an ACCESS participant, have patients attributed to them.Unfortunately, the general consensus is that their health nudging is generalized LLM at best. A far cry from what I was able to generate with a $20/mth subscription to Claude Pro which is a bit humorous given the monthly OURA subscription is almost half of the cost of Claude Pro ($20/month).Is OURA perfect? No. I think their behavioral nudging needs serious scientific rigor - they should partner with someone like our friends Marten den Haring & Dr. Amy Bucher over at Lirio. But the infrastructure is there. And here’s my prediction: I think they’re going to put rings on every senior’s finger come July 1st and pull as many people as possible into this ecosystem. When I saw the rates on Thursday night, it felt like Tom Hale wrote up what he needed and handed to Oz over dinner one night.And the behavioral piece? It works. I shared my own OURA data on the stream - how I’ve been struggling with sleep and nervous system recovery, how installing a home sauna finally allowed me to nail my evening routine, and how one night of doing it right brought my resting heart rate back down to normal, delivered my best sleep score in weeks, and produced an all-time high heart rate variability for the year.Although our Unconference last week and my time leading up to it at altitude climibing mountains seem to have sent my resting heart rate into a uproar.That’s the behavioral nudge loop in action. You measure, you learn, you change, and the ring tells you it worked (or it didn’t). Even our favorite doc - Graham Walker, MD shared with me yesterday that his early experience with his OURA so far is favorable. And yes, OURA is completely inaccessible for the majority of the population. But if my prediction is accurate, not for long. I mean, they’ve already operationalized deals with Medicare Advantage plans like Essence.I go deep because I learn by doing and I’m determined the components of System C exist they just need to be identified and integrated with their long lost missing pieces.Claude for Healthcare: The Reports That Blew My MindNow the main event. I loaded 40 .pdfs & .pngs into a Claude Project - 10 years of health records from Quest, LabCorp, my OB-GYN, a DEXA scan, brain imaging data, EEG reports - i also loaded biopsy results but those didn’t seem to be picked up. My project instructions were one sentence: “I am using this project to understand how to optimize my health by leveraging my actual health data that is shared with Claude and my desire to focus on healthspan using the definition Peter Attia uses.” That’s it. (Note - despite the controversy surrounding Attia currently, I still think the healthspan framework is brilliant)Report 1: The Four Horsemen Assessment & Health Optimization ReportMy first prompt was simple: “using what you know about my health data can you give me an overview of what I should do to be the healthiest version of myself”. Claude took all of my data, cross-referenced Peter Attia’s framework, and produced a comprehensive report organized around the Four Horsemen (cardiovascular disease, metabolic dysfunction, neurodegenerative disease, and cancer).I didn’t ask it to use that structure. I didn’t ask it to rate me. It figured it out on its own. It gave me an executive summary, told me flat out that I have a thyroid problem that needs urgent attention, connected the dots between my thyroid and cognitive test results, and suggested that before I consider something like a hyperbaric chamber for my brain concerns, I should get my thyroid sorted out first.But the detail it provided beyond that, the biometric by biometric break down was brilliant. It didn’t use the “proprietary” algorithm of biological age to hold me hostage to a monthly subscription, instead it gave me the brass tacks break-down. It gave me detailed intel into my health and even produced a protocol that tied directly to the four horsemen and healthspan. It began to finally give me a roadmap of (genetics aside) how to be able to be climbing mountains and lifting suitcases into the overhead bins at 80 instead of waiting for wheelchair assitance. But it did create a level of concern about my brain health. And instead of doing what many are doing right now and running to my doctor to get clarity (Graham had his own experience with this with DexaFit recently), I decided to have it dig deeper.Report 2: The Deep Dive on Brain HealthBecause the first report flagged neurodegenerative concerns (my mom is dying prematurely from dementia so it sent shockwaves of fear), I went deeper. One prompt: “an you go back through all of the files i uploaded and take into consideration all of the new labs, the beam report about brain compared to the MRI from prenuvo, add the dexa and also consider the vo2 max report and update thing”Claude pulled together my Pranuvo full-body MRI data, EEG results from a 2018 scare, and cognitive test scores, and produced an executive summary that no neurologist has ever delivered to me - connecting verbal memory patterns, reaction time deficits, and thyroid dysfunction in a way that actually made sense.The level of insight was mind blowing. Of course I sent it over to our friend Dr. Dan Durand over at Prenuvo and we are scheduled to dig in with his team in a few weeks. Don’t worry we will try to get them to come onto a Livestream.Report 3: The Brain Optimization ProtocolThen I asked it to take that scary brain report and tell me how to fix it, incorporating the work of some of my favorite Neurologists. One prompt: "what are suggestions especially from the Sherzai’s, Dr. Dale Bredesen and Valter longo about how to specifically improve brain size and health taking into consideration my specific weaknesses above". I warned you it was basic!Claude produced an integrated protocol that showed what each doctor would prioritize, flagged that fasting-mimicking diets are tricky with a thyroid problem (I already knew this, but it independently caught it), and ended with a unified action plan. It was like assembling a panel of three world-renowned clinicians and having them review my case together.Three prompts. Three reports. The kind of analysis that would cost tens of thousands of dollars in specialist consultations - if you could even get them to talk to each other.“This Is the Worst It’s Ever Going to Be”Back to the phrase that stuck with all of us: This is the worst it’s going to be.The data accessibility will only get better. The AI will only get better. And the people using these tools - especially Gen Z, who are essentially LLM-first in how they understand the world - will only get more sophisticated with their prompts.If a perimenopausal woman like myself who can’t find a doctor to help can produce these reports with three one-line prompts using today’s tools and today’s clunky data collection process, imagine what this looks like in a year or 2 or 5. Imagine what it looks like when your complete health record flows seamlessly into an AI that knows every published protocol and can personalize it to you - which if HealthEx keeps after it and TEFCA helps us out, should be much sooner than we thought possible.Pryce, who started the conversation as a self-described AI skeptic who “still rolls his eyes at LinkedIn posts,” left the stream saying this was one of the first AI applications where he thought: Okay, this is not just a better search engine. This is something fundamentally different.His analogy was beautiful: as an avid gardener, he’s always noticing how similar humans are to plants. Your circulatory system is your root system. If you keep feeding it crappy soil, you might not see it in the plant right away, but it’ll be less prepared for the next cold snap. What I’d done with Claude, he said, was:Make the root system visible - and then bring in the world’s best gardeners to help me tend it.The Big Question: Where Does the Disruption Land?We don’t know yet exactly where the disruption will show up. Right now Adam Carewe MD would tell you it’s landing in his virtual care waiting room, currently full of patients who just got their latest Function Health results and are in a tizzy. Carter Williams raised the grocery store example - pharmacy teams within grocery chains who know food matters but still think in pharmaceutical terms, who want to reimburse patients through pharma rather than reimagining the food delivery system itself. Nobody’s even talking to the CPGs about reducing diabetes risk through better products.It’s all swirling. And in that swirl, there’s a wormhole for the good guys - the people who want to make this about human outcomes, not continuing to monetize disease. That’s what we are building in System C.Maybe OURA’s data will expose a market of 50 million people who care about their health, and grocery stores will realize they should redesign their shelves so that it’s hard to make a bad decision. Maybe the system reshapes itself so that all the bread is good, all the brownies are good for you, and all the vegetables have better nutrition.As Carter put it: everybody’s above average. That’s the Lake Wobegon effect at the grocery store. And that’s what System C could look like.As Pryce said at the end: “I’m tired of payers being the purser and everything being preventative or acute instead of just actually taking care of the body.” He came in skeptical (well as skeptical as the ever chipper Pryce can be…). He left asking whether he should get a glucose monitor and an MRI.That’s the shift. And it’s just getting started.Cliff NotesFor those who prefer the highlights:* AI + Health Records = Now: OpenAI (via b.well) and Anthropic (via HealthEx) can now connect directly to your health records through interoperability infrastructure. The plumbing is real, even if it’s still early.* Data Ownership Is Shifting: Government policy is pushing toward patient-controlled data. Info-blocking penalties are real. The momentum is toward you owning your health data and sharing it back to the system.* Oura Built a Healthcare Ecosystem: Beyond sleep tracking, Oura has glucose monitoring, lab ordering through Quest, health panels, and behavioral nudging — all in one app. They’ve quietly built a direct-to-consumer alternative to traditional healthcare delivery.* Claude + Your Data = Your Own Medical Panel: With 40 PDFs and three simple prompts, I generated integrated health reports that rival (and in some ways surpass) what specialist consultations costing tens of thousands of dollars have produced.* “This Is the Worst It’s Going to Be”: Data access will improve, AI will improve, and user sophistication will improve. What’s possible today with manual effort and basic prompts will be seamless and ubiquitous within five years.* System C Needs People at the Table: The Unconference in Denver (Feb 11-13) gathered the right minds together - food, health tech, policy, AI — to design the system that puts human outcomes first. Come with your health data downloaded. Get full access to Food is Health at foodishealth.substack.com/subscribe

(Quick note for our livestreams: You can now watch all our videos on your actual TV now (like YouTube) via the new Substack TV app - you just have to add it to the apps on your TV via Google apps or Apple tv apps. I’ve had success on one of our 2 tvs. Once in the app, just search up The Food Is Health Revolution and voila. It’s a great alternate if you prefer the full video experience over reading and you can handle us on the big screen - I might need to start focusing more on hair and makeup... Just kidding, no time for that.)If you watched our livestream last week, you already know it was a bit of a wild ride. First and foremost, I would like to thank my husband Brian for his contribution to this week’s recording as he made his first Food Is Health cameo which was also his first “unboxing video” of our first Chef’s Garden produce box. On this episode, what started as a backup plan when Carter got stuck in travel chaos turned into a guest appearance one of my favorite farmers - Bob Jones Jr. of Chef’s Garden.Bob joined us with about 90 minutes notice. And what he shared, about regenerative farming, nutrient density, and the real economics of our broken food system, gave me the opportunity to share in my typical N of 1 style, how in our house, we treat food expenses as part of our healthcare budget. We also recognize we are extraordinarily grateful we have the financial means to make that choice. Then we pivoted to the congressional hearing where five health insurance CEOs got grilled about why premiums are so high. As someone that has spent 34 years in healthcare, it was an absolute embarrasment, yet in no way suprising. In some ways it was deeply satisfying.Let’s dig in. (Pun intended of course). And a Cliffs notes version at the bottom.“She Doesn’t Care What They Cost”Bob Jones is part of a family vegetable growing operation in Northern Ohio. His parents started in the 60s. At their peak, they were farming over a thousad acres of wholesale vegetables, shipping anywhere east of the Rockies.Then came the farm crisis of the 1980s.Here’s how Bob explained it:“My Dad’s last operating note was 24% interest. Borrowed money at 24%, we loaned it out at zero, and we wondered why it didn’t work. It was economics 101.”They were working with a large grocery chain on 120-day payment terms. Borrowing money to grow food, giving it away on credit, and hoping it all worked out. Their bank encouraged them to “find a different advocate.” Here’s where the story gets interesting.While selling at a farmers market in Cleveland, they kept encountering this European-trained chef who wanted baby zucchini with the blossoms still attached. Bob’s dad kept saying no - they were harvesting at eight inches, packing 24 in a basket for $3, and thought they were doing great.The chef kept coming back. Week after week. And as Bob tells it, if you knew his dad, when he said no, that was the end of it. You didn’t bring it up again.But Bob’s brother finally said: “Dad, she really wants these baby zucchini with the flowers. And she said she doesn’t care what they cost.”Bob’s dad’s response? “How many does she want?”That was the beginning of The Chef’s Garden as it exists today.Latent Demand Is Real (We Just Keep Missing It)Carter and I talk a lot about latent demand. Spoiler alert, Carter Williams is in full engineer mode this week solving for how to show it as a collective (more to come). People do want to eat better, they just don’t have access to what “better” actually looks like.Bob’s story is proof.They took those baby zucchini to market hidden under a paper towel, tucked under the table, because they didn’t want other farmers making fun of them for bringing “squash that wasn’t ready.”When the chef saw them? She lost her mind with excitement. Clearly we would have been friends.“Oh my God, this is exactly what I wanted! I haven’t seen something like this since I left France! I love you! I love you!”Bob’s brother was mortified. But that moment? That was the beginning of an epiphany - teaching “a bunch of dirt farmers about the food business,” as Bob put it.Here’s what Carter nailed during the conversation: * There’s latent demand for something different. People say consumers don’t want to eat better - that’s not true. They want it. They just can’t find it. * They were willing to pay more. In a world where we’ve commoditized food to the point of nutritional bankruptcy, there’s a way to differentiate product that people will pay for.Today, The Chef’s Garden ships to restaurants and homes in all 50 states and 17 countries. They have over 800 varieties of plants available in six different sizes. Disney is their biggest customer. They went from hiding baby zucchini under a table to feeding the Magic Kingdom.The Nutrient Density Research That Stopped Me ColdBob has been working with researchers including Dr. Nasha Winters (a holistic oncologist I’m a huge fan of who also happens to know one of my favorite friends in Durango - we figured that out thanks to a necklace!) and Dr. William Li. They’ve actually published peer-reviewed research with the American Society for Nutrition.Here’s what Dr. Li found when he looked at five years of their data: As they’ve improved their regenerative practices, mineral density in their vegetables has increased while sodium has decreased.Think about that for a second. Most people who need nutrient-dense food also need to reduce their sodium. Bob wasn’t even looking for this - he was focused on increasing mineral content. But because they stopped using salt-based fertilizers, they got both.The food is getting more nutritious over time because of how they’re growing it.Bob also dropped this stat that I can’t stop thinking about:“USDA says that grocery store produce on average is two weeks old before it hits the shelves because of the distribution models. USDA also says that produce on average loses 10% of its nutritional value every day post harvest.”Do the math on that. By the time most produce hits your grocery cart, it’s lost 70%+ of its nutritional value. We’re paying for food that’s already nutritionally bankrupt before we even buy it.We talk about this alot as does our bestie Erin Martin and our friend Eric Smith with his technology at Edacious that makes it possible to easily test this.The Unboxing Video (Shout out to my husband)I had to share my actual unboxing video during the livestream because it captures something I couldn’t explain in words.Quick context: I subscribed to The Chef’s Garden’s seasonal box without telling Bob. No special treatment. This is what anyone gets when they order.When that box arrived, my husband Brian and I opened it together like kids on Christmas morning. I somehow convinced him to do this on camera with me (he normally wants nothing to do with my content). But he’s awesome so of course he got into it and stole the show…What was in the box:* All sorts of varieties of sweet potatoes (if you’ve never had a purple potato, you’re missing something in life)* Watermelon radishes with that gorgeous pink interior* Carrots that taste like candy - and I don’t say that lightly* Mashed potato squash (yes, it tastes like mashed potatoes - I used it for dinner last Thursday night with buckwheat, some of Bob’s spinach and more)* Romaine and Spinach that had actual taste profiles* Beats, red potatoes and a few cucumbersBrian tried a carrot straight out of the box. His reaction: “You know the really sweet one from the bag? That’s what this is.”I tried a watermelon radish. Super sweet and spicy, but nothing like the sharp bite you expect from a grocery store radish.Is it more expensive than the grocery store? Yes. But here’s what Bob said that nails it:“As Americans, we have become wonderfully accustomed to cheap food. But now what we’re recognizing is we’re paying for that cheap food. The cheapest per capita spending on food of any industrialized nation in the world - and the highest per capita spending on healthcare. There’s a connection between those two.”There it is.If you want to try it yourself, go to The Chef’s Garden website. You can choose between a “best of the season” box (where their team picks what’s peak that week) or order à la carte. We are doing Best of Season ourselves.Now, About Those Health Insurance CEOs...Last week, five of the biggest health insurance CEOs in the country testified before Congress about why health insurance costs are so high. They had two back to back hearings. I plan to do a full post on it under separate cover.The CEOs represented CVS (which owns Aetna), Cigna, UnitedHealth, Elevance (formerly Anthem), and Blue Shield of California.I recorded the whole thing and read the transcript. And while watching insurance executives squirm has a certain cathartic appeal for someone who spent 30 years in healthcare, what struck me most was what wasn’t said.Here’s my grading:David Joyner (CVS): C-“We believe that the single biggest issue is the health status of the population.”Okay, we’re getting somewhere! But then: “Our focus is on wellness prevention... keeping people on low-cost therapies that will ultimately manage your overall health costs.”And we’ve lost him. Still stuck in the therapy/management paradigm.David Cordani (Cigna): D+“We must focus more resources on the patient earlier in the care journey, especially programs that prevent chronic disease and support long-term health.”Still stuck in the “care journey.” Still not asking what’s causing the chronic disease in the first place.Stephen Hemsley (United) and Gail Boudreaux (Elevance): DMore of the same: “preventative care so people get care before a condition worsens” and “preventative care so problems can be caught early.”Catching things early isn’t prevention. It’s early detection. There’s a massive difference.Paul Markovich (Blue Shield of California): B-He was my favorite (always has been - he has been talking systemic failure for a few years now), only because he at least acknowledged the systemic failure:“Too many times the participants in the healthcare system - health plans, hospitals, physicians, pharmaceutical companies, and others - put profits ahead of patients and are complacent about how complex, inconvenient, and inefficient our current system is.”He also specifically criticized fee-for-service medicine. He was the only one who called it out by name.But here’s the thing - nobody talked about food. Nobody talked about why people are getting sick in the first place. Not one person in that hearing mentioned the word “nutrition” or “food” or anything related to the actual upstream causes of chronic disease.The Problem Nobody NamedHere’s what’s missing from this entire conversation - and honestly, from most conversations about healthcare costs:We use the word “prevention” to mean completely different things.I learned this full framework at the American College of Lifestyle Medicine conference last fall, and it changed how I think about everything:Primary Prevention: Stopping disease before it ever occurs. Nutrition and diet. Physical activity. Reducing environmental exposures. Food policy. Food access.This does not exist in our current healthcare system OR ANYWHERE. People have to create it for themselves. There’s no reimbursement code for “helped patient not get diabetes in the first place.”Secondary Prevention: Early detection and intervention once a disease process has begun but before symptoms appear. Screenings. Catching pre-diabetes before it becomes diabetes.This is what insurance companies call “prevention.” But the disease process has already started. We’re just catching it earlier.Tertiary Prevention: Managing existing disease to slow progression and prevent complications. Diabetes management programs. Cardiac rehab.This is the monetization of disease.When those CEOs talk about “prevention,” they mean secondary and tertiary. They’re talking about catching you earlier in your “care journey” and managing your conditions better.They cannot offer primary prevention because they don’t have the assets. Food and lifestyle are the massive components - and healthcare doesn’t control those. Nor should it, probably.The system is literally designed to wait until you’re sick.This is where food can BECOME health”care” by offering the care of health, something that truly does not exist today.The Vision That Keeps Us GoingCarter said something during our conversation that I’ve been thinking about ever since:“You should be able to walk into a grocery store and it should be hard to make a bad decision.”That’s it. That’s the north star.Not another app that nudges you. Not another device that tracks your sleep and makes you feel guilty when you ignore it (I literally let my Oura ring die this week because I didn’t want to be reminded of how bad my sleep was during a work bender). A system designed so that healthy choices are the easy choices.We’re not there yet. But conversations like the one we had this week - with Bob showing what’s possible with food, and with us wrestling with what’s broken in healthcare - these are the building blocks.What’s NextThis week: Pryce Ancona from HTD Health is joining us to talk about AI for healthcare and the technical infrastructure side. If you’re curious about TEFCA, interoperability, and where this is all heading - you won’t want to miss it.The ACCESS program prediction: I shared on the livestream what I think companies like OURA might do with this new CMS program. It involves free Oura rings for seniors and a complete disintermediation of traditional healthcare. The more I think about it, the more convinced I am. Stay tuned.The Cliff NotesFor those who need the quick hits:* Bob Jones and The Chef’s Garden went from 1,200 acres to 6 during the 1980s farm crisis, then rebuilt by listening to a chef who “didn’t care what it cost” for baby zucchini with blossoms. Today they ship to 50 states and 17 countries. Disney is their biggest customer.* Latent demand is real. People want to eat better - they just can’t find it. And when they find it, they’ll pay for it.* Nutrient density matters. Bob’s research with Dr. William Li shows mineral density increasing while sodium decreases through regenerative practices. Meanwhile, USDA says grocery store produce loses 10% of nutritional value per day post-harvest.* Five health insurance CEOs testified before Congress about why premiums are so high. My grades: mostly Ds. Nobody mentioned food. Nobody mentioned upstream causes. Nobody distinguished between real prevention and early detection of disease that’s already started.* Primary prevention doesn’t exist in healthcare. What they call “prevention” is really early detection (secondary) or disease management (tertiary). Primary prevention - stopping disease before it starts - requires food and lifestyle, and healthcare doesn’t have those assets.* The north star: You should be able to walk into a grocery store and it should be hard to make a bad decision.* Try it yourself: Go to The Chef’s Garden website and get a seasonal box. Experience what food is supposed to taste like. Get full access to Food is Health at foodishealth.substack.com/subscribe

This week’s Livestream - January 27th 11am ET (Livestream Link)Three weeks ago, I mentioned my buddy Pryce Ancona from HTD Health on our 2026 predictions episode—talking about how Gen Z is already using AI and wearables to take control of their own health.Two weeks later, I promptly forgot that I made that prediction and after the Anthropic Announcement about Claude for Healthcare, I tried it myself.If you misssed it, there is a special edition livestream the day I blew my own mind with the AI-powered health analysis I generated on myself. We promised that the episode would be Part I.Tomorrow is Part II - Pryce is joining us LIVE to go deeper: What does DIY AI healthcare actually look like? What are the opportunities—and the guardrails? Pryce is also one of the coolest tech guys ever. We had the best introduction and riff ever during an unexpected shared Uber ride (I basically invited myself to share his and gave him no good option to say no) and airport lounge hangout in D.C. after the titillating first-ever HHS Digital Tech Bootcamp last fall. He also happens to be close buddies with one of my other favorites - non other than the Health API Guy - Brendan Keeler. Despite popular opinion, there are a bunch of really good, really cool tech guys in healthcare - they just don’t generally live in Silicone Valley… Get full access to Food is Health at foodishealth.substack.com/subscribe

TOMORROW (1/23) AT 11AM ET WE WILL HOST OUR LIVESTREAM FOR THE WEEK - (LINK). IT WILL BE A PART II OF CLAUDE FOR HEALTHCARE (AND OTHER FOOD IS HEALTH RABBIT HOLES).PreambleThis is a completely transparent recording and post. Some of our readers love it when we get real, others prefer to stick to our pieces about restructuring healthcare. If you prefer the latter, you should skip this one. Here’s the thing, I’m not just obsessed with redesigning 3 industries simultaneously, I’m also a 53 year old woman, and anyone with basic science knowledge knows what that generally entails. I’ve also determined that on this Food Is Health crusade, if my own willingness to be vulnerable and open to being an N of 1 experiment for others is helpful, then I’m in. So here goes, this one is going to be FUN.I highly recommend you watch or listen to the recording as my quick summary below does not give the energy of this one justice. Dr. Robert Ferguson is truly a gem! A Little BackgroundIf you’ve been following my “Claude for Healthcare” journey (still in process - note I’m looking for a few docs to join me to weigh-in on the findings either via livestream or pre-recorded), you know I’ve been on a deep dive into my own health - particularly my brain health. We have a family history of brain health issues that is accompanied by premature and mismanged hormones. After everything I’ve learned about the connection between hormones and brain health, I can’t ignore this for myself.I don’t want an end of life with Dementia if I can prevent it.So a few weeks ago, I put up a LinkedIn post saying I was ready to start HRT. I’d asked friends who they were seeing, compiled a list, and found that only one provider even met my basic criteria. When I looked them up? They were also a Botox clinic. A MedSpa.Nothing wrong with that business model. But it wasn’t the right fit for me.Then Robert Ferguson responded to my post with words that stopped me: “I wish you’d asked me first.”Robert is a clinical nutritionist with 31 years in practice. He’s worked with thousands of women navigating perimenopause and menopause - using food. His mother survived breast cancer and he believes they were connected to hormonal therapies of the late ‘70s and early ‘80s. That personal history drives his work.I immediately took him up on his offer. Here’s the thing: I’m not in crisis mode. My symptoms are manageable. I’m lucky. But I know that the hormonal dysregulation happening in my body isn’t healthy for my systems long-term.So we to kick things off, Robert, Carter Williams and I recorded a conversation, here are the highlights. The Foundation Nobody’s Talking AboutRobert’s approach starts with something most doctors skip entirely: inflammation.“All chronic disease - all of it - the base for all is inflammation,” he told us. I’m not here to validate, but based on all that I’ve learned, I tend to agree and Carter is in the same camp.Robert’s been having this conversation with OBGYNs from Harvard and Stanford. Now he has them on board. And he pointed us to Dr. Artemis Simopoulos, a 92-year-old endocrinologist and nutrition researcher who is the most cited physician in the world on inflammation and lifestyle.In some ways this is the core thesis of Food Is Health and We spend so much time chasing hormone levels without addressing why the body can’t regulate those hormones properly. Robert’s argument is that if we fix the root cause - inflammation - he body can do what it’s designed to do.Carter summed it up perfectly: “Your body knows how to regulate estrogen. Putting exogenous estrogen in isn’t necessarily helpful, and you’ll never get it right. What you really need to do is make sure the regulatory mechanism isn’t screwed up by too much inflammation.” Who knew engineers would also be such good clinicians?Three Things You Generally Never Hear1. The Omega-6 to Omega-3 RatioMost doctors order standard omega-3 tests that measure what’s in your plasma - which basically tells you what you ate two days ago. Robert uses a dried blood spot test that looks at the cell membrane, giving a picture of what’s happening over 120 days (similar to an A1C for blood sugar).The ratio between omega-6 and omega-3 fatty acids is a critical inflammation marker. In Europe, this is standard. At Harvard’s research department, they do it. But almost no practicing physicians in the U.S. look at this.2. Cell Membrane FluidityThis one blew my mind. I’ve had hundreds of tests run because of an immune system malfunction - some that had to be sent to a specialty hospital and were only done for my particular Immunologist but it doesn’t appear he did this one.Every cell in your body has a membrane that’s both protective and selective - it controls what gets in (oxygen, nutrients) and what gets out. If that membrane is rigid instead of fluid, cell signaling breaks down. Estrogen can’t do its job. Insulin can’t work efficiently.Robert asked a question that reframed everything: Why are we pushing 25,000 milligrams of vitamin D on people? Because the cell membrane isn’t fluid enough for normal amounts to work. We’re forcing nutrients into cells instead of fixing the cells’ ability to receive them.Think about people with neuropathy taking medication for pain. What if early on they had improved their cell membrane fluidity so oxygen could actually reach those cells?3. What Happens in Your Gut Shows Up in Your BloodThe most potent antioxidant in the human body isn’t glutathione (though that’s what most people would guess). It’s something called indole-3-propionic acid (IPA), produced by bacteria in your gut.When your gut is inflamed, your body produces higher levels of kynurenine, which robs tryptophan. That means less IPA, less serotonin, less melatonin, and more aggressive behavior, depression, and anxiety. What’s happening on one side of your health is robbing the other side.A key area to be addressed - are you getting enough dietary fiber? Enough variety of fiber? Any fermented foods?The Plan: What We’re Actually Going to DoRobert is sending me a discovery questionnaire and lab tests - including that cell membrane fluidity marker that nobody else looks at. We’ll establish a baseline.Then he’ll create a customized food-based protocol. Not supplements (though those may play a role). Real food.Over the next four months, we’ll meet weekly for 10-minute check-ins. I’m committing to complete compliance - I’ll do exactly what he tells me to do. And I’ll share the whole process here via the Substack.We’ll make sure to put up a Livestream when we review my labs and he builds the protocol. I want you to see what we learn. I want you to be able to ask questions.Because here’s what I keep thinking about: We say personalized medicine isn’t scalable. After my experience with Claude last week, I don’t think that’s true anymore. With AI, with accessible testing, with practitioners like Robert willing to share their knowledge - N of 1 care is becoming real so rapidly it’s jarring.I’m going to be your guinea pig. If my data can help you understand what’s possible, then there’s no shame in any of it. We all need to figure this out collectively.A Note on What I Was Eating During This ConversationYes, I was snacking on camera. I’m not a processed food person, but when I hit days like today where I end up at 3pm recording without lunch, I need something. It used to be protein bars but I don’t like how processed they are and the lack of transparency about chemical load. I’ve found these awesome crackers called Better Buckwheat. And no we aren’t sponsored, I just stumbled onto them through Thrive. The ingredients are pretty darn amazing for crackers - buckwheat flour, dried figs, walnuts, organic maple syrup, hemp hearts, flax seed, thyme, balsamic vinegar, baking soda, sea salt, and black pepper. 6 crackers - 60 calories, 0g saturated fat, minimal sodium, 9g carbs and 2g protein - I’d say no added sugar but as Carter pointed out, there is maple syrup in them so that’s a reflection of labeling standards that we all know need improving. Maple syrup is still sugar to your liver.The point of all of this isn’t perfection. The point is understanding what actually moves the needle.This is going to be FUN!What do you want to know and learn? How can we make this impactful for you? Get full access to Food is Health at foodishealth.substack.com/subscribe

We promised last week to dive deeper into the newly flipped and revised Food Pyramid including sharing insights. Wednesday we did it live here on Substack and over on LinkedIn. You can watch and/or listen to a recording of that here or find it where you go for your regular podcast and video content.For some, watching or listening just isn’t a format that works, so we have put together a bit of a smorgarboard of a few highlights of the discussion, the deeper first principle design and human outcomes focused framework, as well as the detail we pulled together in advance of the session, some of which wasn’t explicitly covered.Ellen: Friends, we had quite the conversation this week. And I came prepared—believe it or not. I even successfully streamed on two platforms simultaneously without spending an hour troubleshooting. Growth, people.But here’s what kicked off the whole discussion, and I need you to appreciate this: The South Park episode we opened with? It’s from 2014.Season 18. Episode called “Gluten-Free Ebola.” It shows the food pyramid getting flipped upside down, fire-hosing grain fields, removing ultra-processed snacks. There’s even an inference to removing high fructose corn syrup. These guys weren’t just making jokes—they were predicting our present reality. (You can watch it below the link is on the image)Carter: So there’s nothing new about flipping the pyramid. It’s not that radical. It takes decades to change perspective. We had a food system that worked for us for 350,000 years. Our bodies were tuned to it. That’s System A.Then we dove into the idea that we wanted to boost yield. We ended famine. We decided we were going to have hero healthcare to solve awful diseases and eliminate pathogens. That’s System B. It worked—for what it was designed to do.But then we thought System B could fix food. We took the signal out of food. Getting yield up took out micronutrients and took the signals out. Signals program our bodies. Our bodies were trained for 350,000 years how to adapt to the signals they saw. We muted them. We confused our bodies.It takes 40,000 years for us to evolve to a new system, but we tried to evolve in 70 years.Ellen: And now we’re paying for it. But we promised everyone we’d talk about the food pyramid, so let’s get into what it actually says—because 75% of the criticism I’ve seen comes from people who didn’t read the actual guidelines.What the New Food Pyramid Actually SaysCarter: The pyramid is sort of pointed—it’s focused on you. I’d almost like it to say “human-based outcomes” as a first principle. Human-based outcomes. You’ve got to get the food signal programming you. Your body is programmed to be healthy when it gets the right signalsEllen: Here’s what’s getting lost in all the clip art debates. If you go to realfood.gov, you can download three PDF documents with the specifics. This is what it actually says.The Great Divide: Who’s Cheering, Who’s ScreamingEllen: So here’s what people are saying. I pulled together a lot on this.Supportive voices:* AMA president said these guidelines affirm that food is medicine* Dr. Huberman publicly praised the pyramid on X (publicly on X, publicly on X—sorry, my brain is doing things today)* Our friend Dr. Dariush Mozaffarian from Tufts noted that both low-fat and whole dairy are linked to lower cardiovascular disease* National Cattlemen’s Beef Association (NCBA):* “Pleased” with nearly doubled protein recommendations* Kim Brackett: “Beef provides high amounts of protein plus nine other essential nutrients like iron and B vitamins”National Pork Producers Council:* Rob Brenneman: “America’s pork producers appreciate the 2025 Dietary Guidelines putting pork front and center on the plate”* “Quintessentially American foods like pork chops and Easter hams can remain a staple”* National Chicken Council:* Ashley Peterson: “Chicken is back at the top of the new food pyramid – where it belongs”* International Dairy Foods Association (IDFA)* CEO Michael Dykes: “The new Dietary Guidelines send a clear and powerful message to Americans: dairy foods belong at the center of a healthy diet”* “An important victory for consumer choice and public health”* National Milk Producers Federation (NMPF):* CEO Gregg Doud: “NMPF thanks HHS and USDA for recognizing dairy’s critical role”* “Recognition of dairy’s benefits at all fat levels”* American Heart Association (AHA):* “Commends” emphasis on fruits, vegetables, whole grains, cutting added sugars and processed foods* BUT: “Concerned that recommendations regarding salt seasoning and red meat consumption could inadvertently lead consumers to exceed recommended limits for sodium and saturated fats”Critical voices:* Academy of Nutrition and Dietetics:* President Deanne Brandstetter: “Some of the recommendations in the DGAs are not aligned with the current body of evidence and will create challenges for implementation”* Specific Concerns:* Saturated Fat emphasis inconsistent with 10% limit* Doesn’t consider those who can’t/won’t consume dairy* Low-calorie sweeteners: guidelines emphasize moderation despite evidence they’re “generally considered safe”* Dr. Christopher Gardner from Stanford: “I’m very disappointed in the new pyramid that features red meat and saturated fat sources at the very top, as if that’s something to prioritize. It does go against decades and decades of evidence and research”, criticized bypassing of standard scientific review process* Dr. Marion Nestle (we have signed books from her now btw) wrote up her early take here: “Muddled, contradictory, ideological, and retro…A mixed bag. These guidelines are big wins for the meat, dairy, and alcohol industries (alas). The loser: ultra-processed foods (yes!). The recommendation to reduce highly processed foods (a euphemism for ultra-processed) is the one great strength of these recommendations. Following that advice might help Make America Healthy Again. But the rest must be viewed more as ideology than science, and also must be interpreted in the light of this administration’s destruction of what was once a reasonably effective public health service (CDC, FDA, NIH) and system. Eating more meat and fat is unlikely to help people resist measles and other illnesses preventable by vaccination.” * Dr. Eric Topol posted “a summary of data supporting more meat” with a blank box—okay, it’s funny* Dr. Neal Barnard (Physicians Committee for Responsible Medicine) - “The guidelines have unjustly condemned highly processed foods and exonerated meat and dairy products. They should have done the reverse.” Filing petition to recall guidelines due to conflicts of interest.From LinkedIn Comments:* “No fiber mention? Hello, skyrocketing cancer”* Was the new food pyramid created by people at USDA and HHS who stole the idea from South Park? LOL! (spoiler alert - the episode is from 2014!!! The link below is active to take you to the clip from episode it’s classic)* Is the new Food Pyramid really that controversial? (Not a political post.) OK, so it’s not really a pyramid. That’s the most controversial part of it. But America has been trending in this direction. Yes, it may be a case of the haves and have nots. Yes, there is a portion of America going the wrong way. But consider: 1. U.S. egg consumption is up, from 250 eggs/person in 2010 to 288 eggs/person in 2022. 2. U.S. beef consumption is up, from 55.4 lbs/person in 2015 to 59.1 lbs/person in 2021. 3. Full-fat yogurt share is up, from 49% of U.S. yogurt sales in 2013 to 70% in 2022. 4. Ultra-processed food intake among U.S. adults is down, from 55.8% of calories in 2013–2014 to 53.0% in 2021–2023. 5. Ultra-processed food intake among U.S. youth is down, from 65.6% of calories in 2017–2018 to 61.9% in 2021–2023. 6. Soft drink availability is down, from 45.5 gallons/person in 2000 to 36.1 gallons/person in 2021. 7. Added sugar availability is down, from 111 lbs/person in 1999 to 94 lbs/person in 2021.* The only news I see with this new food pyramid? We’re 30 years late teaching kids they need to eat real food.* This isnt radical. This is a well overdue course correction. Because the old food pyramid didn’t make us healthier. It made us sicker, heavier, and metabolically broken. Real food was never the problem. Ignoring human biology was.* Have they acknowledged the load of pesticides we’re ingesting, and recommend clean organic?* The question is: how much lobbying influenced the new guidelines?* Where do the peptides sit in the new pyramid?* Why are whole grains at the bottom? Why aren’t beans/lentils higher up? I think I see a tiny clip art that might be a bean. Why are red meat/saturated fats, at the top? This is terrible. Very confusing and expensive* Feels like the 90s are back, and not in a good way. Did they just decide to ignore the existence of MyPlate? To me, that framing was more easily understood and much more digestible (pun intended) for the average person.* I’ll leave it the experts in nutrition science to comment on the make-up of the new Dietary Guidelines for Americans, but a friendly reminder that the DGA isn’t worth much if we don’t increase supports like SNAP, boost funding for child nutrition programs, raise wages, and bring down prices. The well off always have access to whole foods and dietary advice is they want it. The poor do not.* I don’t think I’ve ever met an adult who plans their diet based on gov’t nutritional guidelines. It seems like something you spend a lot of time learning in grades 4-6 and then forget about.* Interesting that there’s no mention at all of sweets or pasta etc. Or even serving size. It doesn’t seem very realistic, but rather all or nothing.* It matters more what is fed in the school choice programs. This is where habits are formed. Nutritious food requires zero plastic packaging, more plant based foods for better lifelong habits (lower meat and diary percentages in keeping with its detrimental effects on health - individual and planetary). We are otherwise teaching bad behaviors, tastes and habits.* Some day perhaps we can all go back to common sense and just eat all things in moderation and most things sourced locally and from farms rather than factories (or better yet your backyard garden!). There’s no magic solution out there with slick and sexy graphics or lousy clip art.* Given how they flipped the triangle, I think this can now be accurately called “The pizza slice diagram” given how prominently saturated fats are featured within this. Seems fitting. An absolute joke of an updateThe Uncomfortable Truth About Scale and AffordabilityEllen: Two things hit me immediately after reading through the pyramid last week.First: We aren’t ready to deliver this food pyramid at scale—not in a way that isn’t going to just make people sick. It’s like healthcare trying to scale up a broken thing.Second: Who can afford this? When you read the actual dietary guidelines, you start to see you could eat along the food pyramid with SNAP. But it feels disingenuous to recommend something we haven’t made affordable or scalable yet.Carter: Well, it’s a big system. You’ve got to start somewhere.The practical question is: where does this data get used? The food pyramid informs school lunch. It informs SNAP. It informs FDA policy. There are downstream triggering events—labeling standards, marketing claims. Cheerios can get a marking that says “heart healthy” but grass-fed beef can’t. Those kinds of things can change now.But nobody in the real world looks to the FDA to be the leading voice on things. That’s not a criticism. The purpose of government is to take decisions that have been made in the market and stabilize them. Like when the railroads were all different gauges, and finally someone said this is what the gauge will be. That’s government’s job.Ellen: So this is validation for the early adopters. They were right.Carter: Yes. And the question is how do we build on it. Musk developed his spacecraft by saying: if I can make a rocket reusable, I can cut the cost of launch to orbit by a factor of a thousand. He started from first principles instead of saying “that’s too hard.”Human-based outcome. Getting the right food to have the right signals in your body. That’s the first principle. 2026 is the year to lane-change from working within the existing system to saying: humans want to be healthier, that’s the market, lean in and figure out how to do it.The Nursing Home OpportunityEllen: Mike Canji (FareRx) made a great point in the chat: the food pyramid touches nursing homes. If they accept Medicare and Medicaid, they need to adhere to the new guidelines. And who owns those contracts? Aramark, Sodexo. Push for change upstream.Carter: Let me walk through this because I think it’s interesting from a first-principle standpoint.What are you trying to do with a nursing home? You’re trying to persuade people that mom and dad are better off at this nursing home rather than another one because you feed them the right stuff. That’s a marketing message.If they’re making $50,000-60,000 a year off mom and dad, and there’s an incremental 20% cost on food to reduce customer acquisition costs—that’s interesting math.Now, who owns nursing homes? BlackRock owns something like 400,000 lives in various nursing homes. BlackRock would also have an interest in underwriting the supply chain infrastructure.So now you can start saying: here’s a system serving a distinct group of customers with a distinct interest. We’re going to build out infrastructure to allow farmers to franchise themselves and deliver into this system. There’ll be some price premium, and we can operate in a different supply chain—like Fairlife—that’s protected from being destroyed by commodity crops.Ellen: I want to add—it’s not just nursing homes. It’s hospitals too. I have a friend whose mother-in-law is in the hospital right now. She needs to heal. She’s not getting fed food that will heal her quickly. That’s a design flaw. We’re not feeding people to heal them for acute incidents.Carter: I agree. It’s an important point. But we don’t have a supply chain that meets the new pyramid. If everybody tomorrow started eating real food, we would stock out immediately.The Economics: Food + Healthcare = ConstantEllen: Let me back up to something we talk about all the time. There was a graph in a New York Times article last summer showing that over 100 years, consumers have consistently spent about 24-27% of their income on food and healthcare combined.In the early 20th century, 90%+ of that bucket went to food, with the rest on healthcare. Now it’s completely flipped—most goes to healthcare.Carter: So the externalities are centered on the person making the decision, which is helpful. And there’s a time component—you make bad decisions in your 30s that affect you in your 60s.But here’s the thing: you see your parents and grandparents deteriorate. That’s a time machine built into families. We process that 20 times a day, often privately.Ellen: My mom is the perfect example. She has late stage dementia. She’s only 78, I’m only 53. She’s got 25 years on me, and I’m watching this thinking: I do not want that to happen to me. How do I stop it?Carter: There’s a time machine on those externalities that influences behavior. Doctors say patients don’t care enough about themselves—I don’t think that’s true.When my mother was dying, the last thing she said to us was: “I shouldn’t have smoked.”We’d been saying that for 50 years. But she knew.The HSA/FSA QuestionEllen: Kendall Callahan Kendall Callahan (I think I tagged the proper one - if not, please let me know!) raised an important point: What about FSA/HSA dollars for whole ancestral foods? It would immediately lower prices 20%+ by removing the tax.And Laurie Kortowich PLANTSTRONG pointed out the current requirements. For foods to be covered by HSA, they must:* Not satisfy normal nutritional needs* Treat or manage a specific illness* Have use substantiated by a licensed medical providerCarter: That’s the same structure as a drug.Ellen: Exactly. And Richard Chamberlain (please message me your handle so I can tag you!) expanded on this beautifully in the comments: Imagine a regenerative beef product with soil nutrient profile, amino acid density, omega-3 ratio, inflammatory markers, heavy metal absence, verified metabolic impact. Pair that with a CGM showing reduced glucose spikes, HRV improvement, inflammation reduction. Then a doctor writes: “This food is prescribed for insulin resistance, metabolic syndrome, and inflammation.”That’s food as medicine with real infrastructure.Carter: Look, from a policy standpoint, I’ve had direct conversations with senators working on this. Their general attitude is: let’s give a carrot to the corporates to lean in this direction.The challenge is legislators don’t want to pay for food. They’re afraid lobbyists and rent-seekers will show up and it’ll become a new problem. The right won’t support funding food directly. The left may demand it. It’s complicated.But here’s what’s different right now: lobbyists are getting nowhere in DC. That’s a huge shift nobody’s reporting.The System C Grocery StoreLaurie Kortowich was on fire and described something that stopped us both: A new type of grocery store where all traditional slotting and digital marketing fees are not in play. Where all products are 100% focused on promoting health. Where food is prescribed, tastings are provided, cooking is demonstrated, and people leave with meals that feed their family in line with their health goals.Carter: That’s the System C grocery store. Let’s define it.Here’s the thing about grocery economics. The first order of profit comes from slotting fees—they charge CPGs to put products on shelves. The second is digital advertising. The third is you actually buying food.Costco figured this out. You pay your membership fee, that covers the slotting fee issue. So Costco has 6,000 SKUs compared to Walmart’s 60,000. They’re not dependent on CPGs paying for shelf space.When people move to a digital platform without slotting fees, the whole “I’m walking down the aisle, I see this, I buy those potato chips” thing goes away. That’s a marketing technique. CPGs spend $15 billion a year marketing to you. Whole Foods spends $400 million. There’s a reason one is easier than the other.Ellen: H-E-B (Stacy Bates) is probably closest to delivering this right now. Hy-Vee has dietitians on staff dedicated to food as medicine. And Andy Beckman from Garmin told us Albertson’s offers discounts on healthy food products based on activity through their Sincerely Health app.Carter: Why don’t we do this: define the System C grocery store as a reference architecture. Put it out there. Go through all the grocery stores and score them. Put it on GitHub so everybody can download it.Laurie poinetd out that Whole Foods has ingredient standards. We need a store with health standards.Ellen: We need a new food pyramid image that points down to health outcomes. That’s the new grocery store.Carter: We can have it pushing its way down like a wedge.The Capital Markets ProblemCarter: This goes back to capital allocation. We know there are CPGs very focused on human-based outcomes. They’ve been investing for two or three years. They’ve persuaded their boards. They’re looking more like pharma companies—building differentiated products with moats around them.The reason protection matters is investors say: you have a protected interest, you can enter this market and deal with the three-to-five-year timeline because someone won’t just steal it from you.We still have a capital markets problem. Capital markets understand how to do pharma. They have zero idea how to do food.JPM Healthcare Conference is this week. Quick history: it was originally the Hambrecht & Quist Conference. In the 90s, H&Q was the only investment bank that could articulate what the internet meant. Nobody knew what Netscape or Amazon was in 1995. H&Q hired journalists as analysts to tell the story and explain to people what was going on.Every single deal from ‘94 through the early 2000s had Hambrecht & Quist on the book because they were the ones who understood. JPM bought them, and the healthcare conference is the byproduct.The point is: capital markets don’t understand this yet. We have to re-educate them.Ellen: And part of assembling capital is showing this can be orchestrated. All the parts are in place. The problem is they’re cross-sector and cross-industry. People aren’t aware of what’s going on or how things could be realigned with existing assets.That’s on us. This tribe of folks that’s growing.2026: The Tipping Point YearCarter: I’ve been saying there would be a tipping point. I thought it would be later, but it’s earlier—because of AI, because of Claude Code, because everything is accelerating.I was at Farm Con last week—1,300 farmers. When I asked how many are using Claude Code, 30 hands went up. These farmers spent Christmas coding to do better agronomy and integrate all their reports to improve nutrient density.This is happening.There’s a large group—20 million, 30 million, 40 million people in the US—who get Function Health as a Christmas present and check their blood levels. Who load their medical data into ChatGPT. They’re early adopters trying to figure this out.Ellen: And don’t get me started on the AI side. We’re allowing consumers to create their own healthcare, disintermediate healthcare the way we know it. At the same time, we’re pricing them out of healthcare. The first place people go is the grocery store, their pantry.They can’t just go to the pharmacist and get six prescriptions. They’re looking for solutions they can do on their own. Now is the time for food to step up and take share from healthcare.The Big Picture: Why System C Changes EverythingFor those newer to our work, here’s the framework we keep coming back to—and why we think 2026 is the year it all shifts.System A: The Original Design (350,000 years)For most of human history, food and health were the same thing. Our bodies evolved to read signals from what we ate—micronutrients, compounds, the whole symphony of information in real food. Those signals programmed our metabolism, our immune systems, our ability to heal. Food was the operating system. There was no separate “healthcare” because the food was the care.System B: The Great Decoupling (1950s–present)We made a trade. To end famine and feed billions, we optimized for yield. It worked—we ended mass starvation in much of the world. We also built hero healthcare to eliminate pathogens and solve acute diseases. Life expectancy jumped.But then we made a mistake: we thought System B could fix food too.We stripped the signals out. Industrial agriculture muted the micronutrients. Ultra-processing removed the information our bodies were trained to read. We confused our metabolic systems—asking them to adapt in 70 years to changes that would normally take 40,000 years of evolution.The result? Chronic disease exploded. Healthcare costs consumed an ever-larger share of household budgets. We now spend roughly the same percentage of income on food + healthcare as we did 100 years ago (~25%), but the ratio completely flipped: what used to be 90% food / 10% healthcare is now the reverse.System B gave us cheap calories and expensive disease.System C: The Reintegration (emerging now)System C isn’t about going backward. We keep the wins from System B—hero healthcare for acute problems, the ability to feed billions. But we redirect the chronic disease burden back to where it belongs: food.The first principle is simple: human-based outcomes.Not yield optimization. Not shareholder returns. Not regulatory compliance as an afterthought. Human-based outcomes as the starting point for every decision in the food system.What does System C look like in practice?* Food with signals intact. Nutrient density measured, verified, and valued. Regenerative practices that restore the micronutrient profile our bodies expect.* Grocery stores built around health outcomes. No slotting fees distorting what gets shelf space. Dietitians on staff. Food prescribed based on your metabolic data. You walk out with meals aligned to your health goals.* Economic realignment. The 25% of income we spend on food + healthcare doesn’t change - but it shifts back toward food. You pay a premium for real food; you save multiples on healthcare you no longer need.* Capital markets that understand the thesis. Investors backing food companies the way they back pharma - with outcome data, protected differentiation, and long time horizons.* Supply chains redesigned for humans, not commodities. Farmers verticalized into nutrient-dense production. Local infrastructure reducing waste and preserving quality. Parallel systems that don’t get destroyed by commodity pricing.The food pyramid pointing down to health outcomes isn’t just a cute visual - it’s the whole philosophy. Start with the human. Work backward to the food. Let everything else reorganize around that.Why 2026?Three things are converging:* Validation from above. The new dietary guidelines - whatever their flaws - put “real food” in the government’s vocabulary. That’s regulatory cover for everyone ready to move.* Tools from the side. AI is letting consumers take control of their own health data. Farmers are coding their own agronomy systems. The infrastructure for personalized nutrition is being built in garages and on kitchen tables.* Pressure from below. People are watching their parents deteriorate. They’re getting CGM data and Function Health panels as Christmas gifts. They’re doing the math on what chronic disease will cost them. The demand is there - visceral, personal, and growing.System B took 70 years to build. System C won’t take that long. The question is whether we build it intentionally—or let it emerge chaotically while the wrong players capture the upside.That’s why we’re here. That’s what Food is Health is about.The Bottom LineEllen: We have two choices with this food pyramid. We can pick it apart and dismiss it like we’ve done before. Or we can recognize that 75% of what sits in grocery stores is ultra-processed cheap calories—and we now have a food pyramid that sends you to a website called realfood.gov.Carter: This is validation for all the early adopters. They were right.Ellen: Private industry can take this and run with it. Turn it into affordable nutrition, nutrient density, a complete redesign. We don’t have to wait. We can be the ones to take the good parts and build.Carter: Or someone else takes the bad parts and builds with those instead.Ellen: Exactly. So—what do you think? Are you ready to help define the System C grocery store?Carter: Let’s do it. Here’s the architecture. Different grocery stores can say they’re moving in this direction. We define it, evolve it, put it out there.Ellen: Tell your friends. If you came today and you learned something, tell them to subscribe. We’re going to do some cool stuff this year.Carter: 2026. This is the year. Get full access to Food is Health at foodishealth.substack.com/subscribe

First things first - quick reminder, we have a livestream scheduled today (January 14th @11am ET to dive into the flipped food pyramid) - here is link.Last week ChatGPT stole the show announcing ChatGPT Health - only to take the wind out of everyone’s sails by simply offering a wait list.But alas, it’s JPM Healthcare week in San Francisco, and as is typically the case, a big announcement was timed with the event. Anthropic sent a counterstrike. The headline read "Anthropic joins OpenAI's push into health care with new Claude tools." The kicker? Claude’s healthcare features are live NOW.Let me just say my mind is officially blown. So much so that Carter Williams and I went live last night to debrief more about what I learned when I used myself as the guinea pig and went down the rabbit hole.If it weren't for being Carter Williams' sidekick I would be blissfully ignoring all things AI and still convincing myself we could “fix healthcare” out flitting around San Francisco talking about how we could fix it. That was then, this is now and since we want to unlock the market that ends the chronic disease epidemic, I have no choice but to embrace AI and learn to code in it.For those that don’t have time to listen to the recording or watch the video, below is a quick synopsis. We will save you from the full transcript.Preamble & Context-Per announcement "you can integrate all of your personal information together with your medical records and your insurance records, and have Claude as the orchestrator and be able to navigate the whole thing and simplify it for you" -You have to be a Pro or Max subscriber, thanks to Carter's recent Claude coding bonanza, I upgraded to Max last week -Once connected, Claude will "summarize your medical history across providers, explain lab results and test findings in plain language, detect patterns across fitness metrics and health data over time, help you prepare questions for doctor appointments and identify trends you might want to discuss with your provider"-The Consumer health integrations are all beta and are done through the Connector setting (you have to browse connectors to find them) some are rolling out this week - HealthEx, Function Health and Apple Health / Android Health - you have to add the connectors but it's easy. Supposedly Apple Health will be via app and as of this post it's now showing for me-I went into HealthEx separately and set things up - if I wasn't hellbent on getting through it, I probably would have stopped the setup as it was annoying to me to have to find providers in HealthEx and then provide separate login details for each portal, many of which I haven't accessed in over 5 years. Unfortunately the beta version of the connector failed to work and I’m actively troubleshooting with HealthEx to resolve.-I've tried multiple similar platforms that seek to integrate and automatically find my EHR data but it's a nightmare because my providers aren't part of big health systems so they are part of the smaller ambulatory EMRs that aren't integrated into platforms like HealthEx. But I decided Claude is here to stay so I might as well invest the time.-As for aggregating everything into HealthEx - my biggest frustration is that the majority of my recent health data isn't available, especially labs - WHY IS Labcorp STILL NOT PLAYING?! THANK GOODNESS QUEST IS!!! Talk about differentiation, Quest Diagnostics now has a loyal customer. I'm so annoyed that my recent Prenuvo enhanced scan labs and my Superpower labs aren't integrated through connectors. It's a true differentiator for Function Health. Thankfully ŌURA is partners with Quest, so the labs I'm having drawn Wednesday via my OURA app theoretically should sync with Claude.-I ended up doing it all the old fashioned way and spent about 3-4 hours broken up over the last two days to integrate of my health data, which is my case is A TON. Hundreds of tests, etc.We Skipped JPMWhile the healthcare industry gathered at JP Morgan this week, Ellen and Carter stayed home. Not because they couldn’t go—Ellen has attended the last two years—but because they’re building System C, and JPM is quintessentially System B. As Carter put it: “You can’t simply re-engineer System B to be better at this point. You have to engineer the right answer from first principles.”They have “spies” at JPM feeding them intelligence. But the real action this week? Ellen went down a rabbit hole with Claude for Healthcare that left her calling Carter twice in one afternoon.To all of our friends out there - our hearts go out to you. TRY TO STAY WELL! The Experiment: 60 Files, One Simple PromptI created project in Claude named Health Optimization. I load about 60 files from the last 10 years that included:* LabCorp results dating back to 2016 (277 biomarker elements)* Quest diagnostics* Various physician portal records* HealthEx aggregated data* DEXAfit scan from San Francisco* Pranuvo full-body MRI and enhanced EEG* Beam brain EEG report* Functional medicine records from her 2018 mold exposure crisis* And a more and yes it was a royal pain in the you know what, if it weren’t for the substack I likely would have bailedI created bare bones project instructions were bare bones focused on healthspan optimization using Peter Attia’s framework.Then I used a super simple prompt for the first output”“Using what you know about my health data from the project files, can you give me an overview of what I should do to be the healthiest version of myself?”After reading what it produced I asked it to create a formal report.Mind blown: A 12-Page Personalized Health ReportWhat Claude generated stunned me. It produced a comprehensive report that followed Peter Attia’s Four Horsemen of Health using my 10 years of history distilling it down to the type of comprehensive report I have yet to receive after tens of thousands of dollars spent on clinicians ranging from basic primary care to world-renowned specialists to concierge docs to TCM clinicians to functional health docs to natruopaths with some chiropractors and energy workers in between. I shared the report on the video.Executive Summary - Four Horsemen Assessment:* Cardiovascular: Low risk* Metabolic: Exceptional* Neurodegenerative: Monitor* Cancer: Low riskIt even created a “Good News” highlights:* ApoB improved 21% (94→74), moving from borderline to optimal* Visceral fat in the 5th percentile (near zero)* Fasting insulin of 3.7 indicating excellent insulin sensitivity* A1C of 5.0%—”essentially zero risk of type 2 diabetes”* VO2 max of 45.8—highest category for a 53-year-old womanThen it took my history and lab results and created a critical finding…“Your severely undertreated thyroid is the single most important modifiable factor affecting your health span. This requires urgent attention and is likely contributing to your cognitive symptoms, slow reaction time, verbal memory deficit, and may be accelerating brain aging despite your otherwise exceptional protective factors.”Claude didn’t just flag isolated issues. It connected the dots between my thyroid dysfunction and the brain findings.My immediate response to the thyroid finding? Since I’ve known I have an issue for over 20 years and know the drill, I went online and discovered I could get Armour thyroid (which for me works better than synthroid) prescribed for $22 (prescriber approval) plus $60 for the medication - no doctor visit required.Carter even questioned my own healthcare consumption and I admitted - “I am completely outside the incumbent System B healthcare revenue system now.”* Time invested: ~5 hours* Compute cost: Approximately $0.20-$0.50* Result: The most robust, personalized health plan I’ve ever receivedThe Disruption FrameworkCarter drew the Uber parallel: When Uber launched, people assumed the San Francisco taxi market was $400M. Turns out it was $700M—$300M of demand wasn’t being captured because of friction (convenience, timing, price, availability).Ellen represents the healthcare equivalent: consumers who want to stay pre-chronic, who want to stay out of the system, who are willing to invest in prevention but have been priced out or friction-ed out of traditional healthcare.The tools doctors use are becoming readily available. The friction is disappearing. And as Carter noted: “We need a lot less doctors.”What’s NextPart II will cover:* My deep dive into my brain findings (the scary part that had me considering a hyperbaric chamber)* The protocol Claude generated based on the Sherzai’s research, Dr. Bredesen’s work, and Walter Longo’s longevity framework* How Claude synthesized multiple expert frameworks into personalized recommendationsThe InvitationCarter offered to help any of our tribe do the same thing by scheduling time with us. We are putting together a link for that but in the meantime, feel free to reach out to schedule. Your assignment in the meantime is to collect all of your health data from the various EMRs on which they reside. Bottom Line: While System B gathered at JPM to discuss incremental improvements to a broken system, I stayed home and built a personalized health optimization plan using AI that outperformed anything I’ve ever received, for less than the cost of a latte.It’s not perfect, full of terrifying flaws and lacks tons of what I want from clinicians but it’s important we all understand what consumers have at their fingertips!This is System C. And it’s live now. Get full access to Food is Health at foodishealth.substack.com/subscribe

One of us had a wicked head cold last week and ended up getting nothing planned for the week done except becoming a professional ginger tumeric peeler and tea maker. Meanwhile the other of us made up for it by programming an entire app that will power the Crusonia venture we are launching.We decided Friday we would formally kick off the new year for the Substack with a live conversation that started as an attempt at structure and ended, predictably, somewhere between Tom Sawyer and economic theory. The most exciting part for Ellen is that she went an entire hour and a half without a sneeze. As for our ramblings, quite frankly, I think everyone expects that from us and would likely be surprised if it were different. But here’s what matters. We don’t think 2026 will be another year of incremental change. We think it’s the year the pieces finally converge.We’re done pre-gaming. The infrastructural forces are aligned. The question isn’t whether healthcare transforms, it’s who dives into System C transformation and what happens to the incumbents who don’t. And the same holds true for food. With GLP-1 now becoming close the cost of some cell phone monthly bills, we expect the food industry will have no choice but to pivot very quickly.If you want the cliff notes version (Andy Beckman - hopefully you see this) - we added a section at the bottom.The PredictionsThe Gen Z WildcardThe first prediction. At the end of 2026, we’ll look back and see that Gen Z changed the equation.Not because they’re better or smarter than other generations. But because they have a fundamentally different relationship with healthcare, information, and self-determination. They’re also the core of pre-chronic cohort - under 40, healthy enough to opt-out of the incumbent healthcare system, tech-native enough to figure out their own solutions.They’re not buying insurance. They’re using Mark Hyman as their doctor. They’re taking their Function Health data, throwing it into ChatGPT, and building protocols that would take a physician weeks to research. They’re microdosing GLP-1s they bought on the gray market for $25/week while Lilly charges $1,000/month to employers willing to pay the price.Here’s what matters: They’re predictable in their unpredictability. They’ll do what’s necessary to stay alive in an affordable, manageable way. To them, this looks normal. To those of us over 50, it looks like noise. Especially those over 50 in healthcare. But noise has a way of becoming signal when enough people generate it.The Minnesota daycare fraud story reached 100 million people, more than 10x what 60 Minutes gets on a good day. Young people moved elections that boomers can’t quite understand. They’re influencing family units upward, the typical matriarch/patriarch structure inverts when Gen Z enters because they actually might know more about navigating this new landscape than their elders.The GLP-1 CascadeThe second prediction: 2026 is the year GLP-1s hit critical mass. They could easily hit $100 and result in a 25%+ weight loss outcome. The gray market’s already there with next-generation peptides at $25/week, functionally equivalent to what Lilly hasn’t even gotten FDA approval for yet.This matters because it triggers a cascade:Q1 2026: Food industry feels it first. We’re already hearing from CPG executives about sales disruption. When you’re not hungry, you buy differently. Think share of stomach instead of selling calories. When 20-30 million Americans are on semaglutide variants by year-end, the grocery cart changes at scale.Q4 2026: Lilly (and Novo Nordisk) hit their Clayton Christensen moment. They’re losing 30% of sales to gray market peptides. The music industry had to deal with MP3s. Pharma now has to deal with the fact that people are comfortable enough to biohack, mainline, and gray-market their way to outcomes.Q4-Q2 2027: Healthcare starts seeing it in the data. Health system CEOs are already reporting minimal but noticeable inpatient reductions from people whose A1C dropped from 13 to 7. That’s at $1,000/month. At $200/month? The floodgates open. Not so many “heads in beds”.They’ll either become Tesla - selling direct, owning the whole value chain including food. Will be curious to see who becomes Blockbuster. It’s likely pharma is virtually forced to stop rent-seeking from healthcare and start building parallel infrastructure.The Fatal Blows (Or At Least the Dismemberment)Ellen spoke about this as both fatal blows and death by a thousand cuts, favoring the latter. 2026 is the year healthcare takes enough serious hits that either factions begin to cruble in 2027-2028, or things pivot so fast they won’t know what hit them.The blows aka tailwinds for System C:From policy: * CMS ACCESS unlocks the entire Medicare FFS market (30 million Americans) to technology-enabled chronic disease management. This isn’t incremental. It’s 350+ organizations that have never had direct Medicare access suddenly getting paid for outcomes, not forced to demonstrate an ROI to a middleman who profits from sickness. * CMS ELEVATE further invests in the interventions that have demonstrated the ability to eliminate/prevent costly chronic disease through lifestyle modification. * The administration continues to show strong signs of PBM disruption* The Rural Transformation funding program is putting real dollars into food-as-medicine infrastructure (as well as other chronic disease reversal infrastructure). State pilots accelerate because the federal government just gave them permission and funding.* The possibility that the projected $100B+ in Enhanced ACA subsidies for FY2026 truly end and the redistribution includes some portion being allocated to increased HSA funding along with the availability of true catastrophic plans.* The laundry list of new CMMI models beyond those above that appear to have been conconcted during a drinking game of kombucha and wellness tonics that are meant to disrupt the incumbent healthcare delivery system: BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth), GENEROUS (GENErating cost Reductions fOr US Medicaid), GLOBE (Global Benchmark for Efficient Drug Pricing), GUARD (Guarding U.S. Medicare Against Rising Drug Costs), LEAD (basically the ACO REACH model replacement - it’s underwhelming), TEAM (Transforming Episode Accountability Model) and WISeR (Wasteful and Innappropriate Service Reduction)* $700M earmarked to support Regenerative AgricultureFrom markets: * PBMs are in the crosshairs between policy above and Mark Cuban’s warpath that is focused on destroying their margin arbitrage, private industry doesn’t need the federal government to finish this off. Amazon’s still selling to employers but the direct-to-consumer model is coming. When insurance becomes optional for the healthy and unaffordable for everyone else, the system breaks.* Health insurance design is ripe for the picking. As soon as there is another option like Crowd Health and employers start to jump onboard, watch out.From consumer behavior: * Gen Z doesn’t want to age into chronic disease. The Death Star won’t keep getting fed new patients with AI and DIY healthcare on offer. Especially with the forces above. * Food industry shifts with GLP-1 impacts. Healthcare’s customer acquisition strategy is society feeding people wrong. What happens when that stops?ResolutionsThe First Piece of Crusonia UnveiledIt’s no secret we are serious about building System C in 2026. It’s game on and Crusonia is the core, based on self-reinforcing capital accumulation with continuous, compound growth and sustainable output without negative environmental impact through health improvement and outcomes and creates it’s own economic flywheels. Not the perpetuation of the current model where cheap calories which fuel chronic disease, where disease perpetuation funds everything.* The $100M Food Is Health fund focused on strategic corporate partnerships with early commitments already secured* The Crusonia Syndicate which will create the cross-sector use cases focused on human outcomes bringing together incumbents and start-ups will open up for membership in the coming weeks. Members will of course get a paintbrush. Think Tom Sawyer meets the Rebel Alliance meets Robinson Crusoe meets Crusonia economis (Frank Knight/Tyler Cowen).* And the latest component - Hayek. Carter spent the last week coding instead of talking to humans because it was easier to articulate in code. He built something called Hayek (yes, after the economist, because Claude is named after Claude Shannon, and these are the fathers of information theory and entrepreneurial thinking). Carter shocked Ellen by dropping live on the call that he would be inviting some of this tribe to test the protoype: crusonia.io:* A partnership discovery tool. We have CRMs to figure out who to sell to in established systems. But how do you figure out who to partner with for a supply chain that doesn’t exist yet? That’s what Hayek solves—it’s a referral agent that connects half-baked ideas to the companies and people who can make them real.* A CIA analyst function. If you’re good at connecting dots, you can operate inside Crusonia like an intelligence analyst - seeing patterns across 6,000+ startups evaluated over 10 years (with thousands of incumbents and startups being added), identifying what’s emerging before others see it.* A collective action mechanism. If you’re Kroger and you know you need nutrient-dense food, you only know how to call CPGs. But maybe you need to talk to farmers first. Crusonia removes that friction.By end of Q1, we’ll have launched Crusonia formally: the app, a ~$100M fund focused on strategic corporate partnerships, and the syndicate (invitation-only architects plus the broader collective who want to roll up their sleeves on use cases).We committed on the call to a live design session where we mock up a System C use case with the cross-section of people who actually showed up for this conversation. EMR people, tech people, clinicians, food-as-medicine practitioners, ag, CPG. We have everyone we need. We just need to paint the fence together.Who We Need at the Table... If you’re reading this and you see yourself in one of these categories, we’re looking for you:* Ag/regenerative: If you’re producing nutrient-dense food and want direct pathways to outcome-based reimbursement* Ingredients/CPG: If you’re tired of the street giving you no credit for investing in what’s technically right but won’t show revenue for years* Retail/distribution: If you’re ready to connect food purchasing to health outcomes in real-time* Wellness/longevity: If you’re building measurement, feedback loops, CGMs, wearables, biomarker tracking* Healthcare delivery: If you understand you can’t deliver primary prevention alone and want new partners OR maybe you just want to see the system change* Capital: If you see the $10 trillion human health economy emerging and want to fund what replaces the $4 trillion chronic disease treatment/management systemWhile we don’t have the date for this just yet, the date we do have is for our first physical convening - April 29th - 30th, in Nashville at the Food Health LIVE event. We will be holding a half-day Innovation Lab the morning of April 29th, which is the day the full conference kicks-off in the afternoon. There will also be a 2nd track announced soon that is cross-sector and what we will call a “How To”. Here is the subscriber 10% discount code (HEALTHCAREACTUALLY10). We will talk more in the coming days when we hosti a live session on our Food Is Health channel on FoodHealth Live to talk about the event and get feedback. Pej and Tom have a fantastic event planned this year.RamblingsTom Sawyer Chapter 2Ellen ended up reading part of Carter’s favorite passage from Chapter 2 of Tom Sawyer, because sometimes you need Mark Twain to explain market transformation.Tom Sawyer had to paint a fence. He started alone, felt overwhelmed, couldn’t convince anyone to help. Then he had a perspective shift: What if painting the fence wasn’t work—what if it was an opportunity so rare that people would line up for it?By the end, everyone wanted to paint the fence. They brought him apples. They begged for a turn with the brush.That’s 2026.The Tom Sawyer System C reality means getting agriculture, food, healthcare, wellness, and pharmaceuticals to see they can paint the fence together. We’ve articulated what System C looks like. Now we need the cohort that understands how to orchestrate it cooperatively rather than each trying to own the whole thing.Ellen even included a paintbrush in her Christmas package to Carter.The Uncomfortable Truth About What Insurance Should CoverEllen made the controversial statement: We can’t cover chronic disease the way we do today and have insurance remain sustainable.Adding that healthcare isn’t capable of delivering primary prevention because food and lifestyle are such massive components and healthcare doesn’t have those assets (at scale), nor should it. We discussed briefly what the future structure should contain (we outlined just before the holidays in a detailed substack):* Catastrophic insurance for true acute care* Capped benefits for disease reversal (e.g., $50-100K for a type 2 diabetes reversal program, then you’re done)* End-of-life annuity so families can plan with dignity instead of bankrupting themselves on ICU care that extends death by days instead of life by years* Supplemental policies you can buy if you want chronic disease coverage, but you pay the premium that reflects the true costThis isn’t cruel. It’s honest. Right now we’ve built a system where it’s less expensive to get chronic disease and have it treated, than to avoid it. That’s backwards. System C makes it hard to make bad decisions at the grocery store, makes nutrition affordable, makes nutrient density the norm, biforcates acute care and health, yields primary prevention and disintermediates the incumbent healthcare system.The 2026 RoadmapChristo B Vermeulen challenged us in the comments on the livestream for a quarter by quarter roadmap which was admittedly not easy on the fly but we did our best:* Q1: GLP-1 disruption accelerates in food. ACCESS applicants are announced—we see who’s jumping in. Rural Transformation awards flow. State pilots launch. Crusonia launches with early fund commitments.* Q2-Q3: Food industry feels the tides shifting first, possibly in the magnitude of a reckoning - when 20M+ people aren’t hungry the same way, grocery changes. The use cases start: real examples of soil-to-cell-to-outcome value chains with measurement and feedback loops.* Q4: Pharma hits their Blockbuster-or-Tesla moment. The healthcare incumbents willing to read the tea leaves face the question: are we facing a sentinel moment? By year-end, we have 1-3 functioning System C use cases with cross-sector partnerships proving the model works supported by Cursonia. And it’s possible a few healthcare incumbents will begin to see the early signs of GLP-1 uptick in their admissions data.Bottom Line2026 isn’t about whether System C happens. The forces are converging. Gen Z behavior change, GLP-1 price collapse, policy unlocking new markets, incumbents facing margin pressure, and customer signal getting louder.The question is whether we architect it intentionally or let it emerge chaotically.Our resolutions for the Substack?* Get more people painting the fence.* Have 2-3 functioning use cases by year-end that prove System C works at scale.Question we have for all of you. Will this group of rebels mobilize with paint brushes to accelerate things or grab the apple and watch?If you want a paintbrush, you know where to find us.Want to join the Crusonia collective or the design challenge? Reply to this post or reach out directly. We’re building the infrastructure for what comes next. The only question is whether you’re building with us or watching from the sidelines.The Cliff Notes* Gen Z is about to flip the script—they’re using Mark Hyman as their doctor, throwing Function Health data into ChatGPT, and microdosing $25/week gray market GLP-1s. To them this looks normal. To healthcare executives, it looks like noise. Noise becomes signal when millions generate it.* GLP-1s hit $100 by year-end and trigger the cascade: Food industry feels it first (Q1), (Q4) pharma hits their Blockbuster-or-Tesla moment and when healthcare might start to see it in the data. * Healthcare takes multiple fatal blows in 2026: CMS ACCESS unlocks Medicare for 250+ tech-enabled orgs, PBMs face extinction, and the Death Star stops getting fed new patients because fewer people are aging into chronic disease.* We launch Crusonia (named after self-sustaining economics), including $100M fund, Crusonia Syndicate membership and Hayek app (crusonia.io). It’s a compehensive collective action mechanism. * The uncomfortable truth: Insurance can’t sustainably cover chronic disease the way we do today. We need catastrophic coverage, capped disease reversal benefits, and supplemental policies priced to actual cost. System C makes it hard to make bad decisions instead of profitable to treat them.* Resolutions: Get more people painting the fence. 2-3 functioning System C use cases by year-end that prove the model works… If you want a paintbrush, you know where to find us. Get full access to Food is Health at foodishealth.substack.com/subscribe

A Future Cast Narrative: 2025-2040Disclaimer: This is a “future cast,” a fictional exploration of one possible future based on current trends and emerging technologies. While the companies and technologies mentioned are real, the events described are speculative fiction intended to help visualize potential outcomes. Like any forward-looking statement, actual results may vary significantly. This is not investment advice, predictive analysis, or a guarantee of future events. Consider it a thought experiment in what could be possible if current innovations in food, agriculture, and health converge in transformative ways.PROLOGUE: THE VIEW FROM 2040April 12, 2040. Rochester, Minnesota.Dr. Marcus Chen stood at the podium in Mayo Clinic’s Gonda Building, looking out at 3,000 physicians, researchers, and healthcare executives who had gathered for the 15th Annual Metabolic Health Summit. The irony wasn’t lost on him. Fifteen years ago, Mayo’s cardiology department had nearly fired him for suggesting that food could do what pharmaceuticals couldn’t.Now they were giving him their highest honor: the Distinguished Achievement in Healthcare Transformation Award.“They’re calling it the greatest shift in American healthcare since the discovery of antibiotics,” the host announced. “Under his leadership, we’ve seen Type 2 diabetes incidence drop 67% nationally. Cardiovascular disease mortality has fallen 54%. And the Medicare trust fund, which was projected to be insolvent by 2035, now holds a surplus of $847 billion.”Marcus adjusted his glasses. At 62, he still found mornings difficult, though for different reasons now. Not because of the chest pain that had awakened him that February night in 2025. Not because of the depression that followed his diagnosis. But because there was so much left to do.“The greatest discovery I ever made,” Marcus began, his voice carrying through the silent auditorium, “wasn’t in a lab. It wasn’t in a peer-reviewed journal. It was in a grocery store parking lot in Tulsa, Oklahoma, where a woman in a cowboy hat named Erin Martin handed me a bag of locally grown carrots and told me to stop being an idiot.”The audience laughed. Those who knew the story smiled knowingly. Those who didn’t lean forward.“This is the story of how we stopped treating chronic disease and started eliminating it. It’s a story about food, about farmers, about a healthcare system that had to break before it could heal. But mostly, it’s a story about what happens when you stop asking ‘how do we manage this?’ and start asking ‘why does this exist at all?’”CHAPTER 1: THE ORDINARY WORLDFebruary 2025, Rochester, MinnesotaMarcus Chen had been practicing cardiology for twenty-three years. He was good at it. His patient outcomes ranked in the top 5% nationally. His research on statin optimization had been cited over 2,000 times. He served on three FDA advisory committees and had trained more cardiology fellows than anyone else at Mayo.He was also, by every clinical measure, a walking time bomb.The chest pain started at 2:47 AM on a Tuesday. He knew the time because he’d been tracking his sleep with an OURA ring, part of an ongoing study on physician wellness and integrating wearables into clinical workflows for patients. The data would later show his heart rate variability had been declining for months. His resting heart rate and respiratory rate, had been creeping upward since Thanksgiving. Even his glucose levels were on the rise as documented by the Continuous Glucose Monitor he had been wearing as part of the study.He sat up in bed, analyzing his symptoms with the clinical detachment of a man who had seen ten thousand cardiac events. Substernal pressure. Radiation to the left arm. Diaphoresis. He knew exactly what was happening. He just couldn’t believe it was happening to him.His wife, Jennifer, found him sitting on the bathroom floor, Googling “atypical MI presentation in physicians.”“Marcus,” she said quietly. “You’re having a heart attack and you’re doing research?”“The data doesn’t fit,” he muttered. “My LDL has been under 70 for eight years. I take rosuvastatin. I exercise three times a week. My coronary calcium score was 12 last year. This shouldn’t be happening.”But it was.The cath lab confirmed a 90% occlusion in his left anterior descending artery. A stent restored blood flow. His ejection fraction, measured the next morning, was 48%. Not catastrophic, but damaged. Measurably, permanently damaged.For three days, Marcus lay in a hospital bed, surrounded by colleagues who didn’t know what to say. He was the doctor who fixed hearts. Now his own was broken.“The protocols I’d spent my career perfecting had failed me,” he would later tell congressional investigators. “I did everything right according to the guidelines. I optimized every biomarker we measured. And I still ended up on that table. That’s when I realized we weren’t measuring the right things.”CHAPTER 2: THE CALL TO ADVENTUREMarch 2025, The RecoveryThe depression arrived exactly when the textbooks said it would: three weeks post-procedure, right as the initial crisis faded and the reality of chronic illness settled in. Marcus knew the statistics. Thirty percent of MI patients develop clinical depression. He knew the treatment protocols. He’d prescribed them a thousand times.Knowing didn’t help.What helped was an email from a name he didn’t recognize: Carter Williams, managing partner at something called iSelect Fund.“Dr. Chen,” the email began. “I heard about your situation from a mutual colleague. I’m sorry. As you know so well, what happened to you happens to six hundred thousand Americans every year. Most of them don’t have your training, your resources, or your access to world-class care. And like you, most of them were doing ‘everything right’ according to current guidelines.”“I’m an investor. My firm focuses on companies that are trying to fix what I call ‘System B,’ the sick care system that failed you, even though it employs you. The system that diagnoses disease once present and treats your symptoms in lieu of the underlying root cause. We see the $5 trillion healthcare burden differently than most. We believe the $4 trillion America spends annually on treating chronic disease, at least $1.9 trillion due to poor nutrition, represents the largest market opportunity in human history. Not by perpetuating the monetization of sickness but because it represents an unconscionable failure of systems thinking.”“My partner Ellen Brown spent thirty years building healthcare systems from the inside, working with hospitals, health plans, and managed care organizations. Six months ago, she called me and said, ‘Carter, I’ve spent my career optimizing a machine that makes people sicker. I’m done.’ She’s now helping us build what comes next.”“I’d like to introduce you to some people who are building what we call System C. They’re farmers and gerontologists and food scientists and entrepreneurs who believe that your heart attack, like most chronic disease in America, was preventable. Including Dr. Ajay Joseph, an interventional cardiologist who doubles as a Lifestyle Medicine doctor. Fixing the results of the diseases he also eliminates. Not through better pharmaceuticals. Not through earlier diagnostics or interventions. But through food and lifestyle.”Marcus almost deleted the email. It sounded like a pitchslap and wellness industry nonsense, the kind of thing he’d spent his career debunking. But something in the provocative accuracy caught his attention. He’d never seen anyone quantify the healthcare cost of poor nutrition with such precision.He Googled Carter Williams. What he found surprised him.Williams wasn’t a wellness guru. He was a former Phantom Works engineer who had helped build stealth aircraft before moving into venture capital. His fund had invested in agricultural technology, food science, and healthcare delivery companies. His testimony before the Senate HELP Committee had been cited by researchers at Tufts and UCSF.Then he looked up Ellen Brown. Thirty years that spanned from leading strategy for a $3B Blues plan, creating a strategy arm for a formidable consulting firm that had a successful exit and most recently founding her own consulting firm that was responsible for leading payment transformation and value-based care engagements with some of the most formidable health care companies in the country. She knew the healthcare system’s underbelly better than almost anyone alive. And she all but walked away from it.Marcus replied with a single question: “What causes aren’t we addressing?”The response came within an hour: “All of them. When can you fly to Tulsa?”CHAPTER 3: REFUSAL OF THE CALLApril 2025, The SkepticMarcus didn’t fly to Tulsa. Not immediately.Instead, he returned to work. His colleagues had cleared his schedule for six weeks, but by week four, he was back in the cath lab, back in the clinic, back in the familiar rhythms of intervention and management and disease progression. The hospital had a new Chief Medical Officer position opening. His name was on the shortlist.“You could shape care delivery for the system,” Jennifer said one evening. “Change the entire approach and experience for patients.”“I’m a clinician,” he replied. “I help individual patients. That’s what I’m good at.”But the numbers haunted him.He started tracking them obsessively. The 600,000 MIs per year. The 1.4 million Americans on dialysis for diabetic nephropathy. The 8 deaths per minute from Type 2 diabetes globally. The $5.6 trillion annual healthcare spending in 2025, the most recent figure from the CMS Office of the Actuary . The fact that 94% of Americans were metabolically unhealthy by at least one measure.He calculated his own contribution. In 23 years, he had performed approximately 8,000 cardiac interventions. Each one represented a failure, the majority of them from human bodies so degraded by chronic disease that they required mechanical repair. Thousands of failures. Not his failures, exactly. System failures.One night, unable to sleep, he pulled up the email from Carter Williams again.“What if we started small?” he typed slowly, “what if we could eliminate even 10% of these cases? What would the numbers look like?”The reply came in the wee hours shortly thereafter. Williams was apparently also an insomniac.“10% prevention would save 60,000 MIs annually. It would save $480 billion in direct healthcare costs. It would add approximately 1.2 million life-years to the American population each year. But here’s the thing, Dr. Chen: we’re not aiming for 10%. We’re aiming for 60%. Because the data shows that’s what’s actually achievable. Ellen and I can prove it. Come to Tulsa.”Marcus stared at the number. Sixty percent. Three hundred sixty thousand prevented heart attacks per year. From his own specialty alone.He booked a flight for the following week.CHAPTER 4: MEETING THE MENTORSMay 2025, Tulsa, OklahomaThe FreshRx Oklahoma warehouse sat on the edge of Tulsa’s medical district, a low-slung building that had once been an auto parts distribution center. The transformation was immediately apparent: loading docks now received wooden crates of vegetables from local farms instead of catalytic converters from China. The smell of cardboard and machine oil had been replaced by the earthy scent of freshly harvested produce.Erin Martin met Marcus in the parking lot. She was smaller than he expected, barely five feet tall, wearing a black cowboy hat that seemed too large for her frame. She was eating a carrot, holding a Tulsa FreshRx flyer in her other hand. Next to Erin stood Dr. Ajay Joseph, an interventional cardiologist and Lifestyle Medicine Diplomate who practiced in Tulsa, leading a small but mighty lifestyle medicine clinic serving patients from across the country, helping them end the diet & lifestyle-related chronic diseases they had been told prior were a life sentence. Marcus was stunned. How did he not know there was another way until today!“You’re the cardiologist who had a heart attack doing everything right,” Erin casually stated. “Carter told me about you. I’m not a doctor. I’m a gerontologist. I spent years watching elderly people die from diseases they didn’t have to have. Then I got tired of watching.”She handed him a carrot from the crate beside her. “Eat this. Tell me what you taste.”Marcus bit into it skeptically. The flavor was unlike any carrot he’d had from a grocery store. Sweeter, more complex, almost buttery.“That’s what food is supposed to taste like,” Erin said. “Grown in living soil by farmers who care about nutrition, not just yield. We test everything through Edacious. That carrot has three times the beta-carotene of a commodity carrot. Your body knows the difference even if your mind doesn’t.”She led him inside, past stacks of produce boxes labeled with farm names and harvest dates, past a teaching kitchen where a group of patients was learning to prepare a simple vegetable stir-fry, past a small clinic where a nurse practitioner was reviewing lab work with a middle-aged man.“We’ve enrolled 847 patients since 2020,” Erin explained. “All diagnosed with Type 2 diabetes. All were referred by local physicians who were running out of options. The standard of care wasn’t working for these people. Many were on maximum doses of metformin, some on insulin, some on GLP-1 agonists that cost $1,500 a month.”“What do they get from you?” Marcus asked.“Vegetables, knowledge, and self-worth.” Erin smiled at his expression. “Sounds ridiculous, right? But not just any vegetables. Produce grown by local regenerative farmers who optimize for nutrient density, not yield. I started this program because I watched too many people in senior care facilities waste away on institutional food. A master’s degree in gerontology taught me how people age. Five years running FreshRx taught me that aging doesn’t have to mean declining.”She handed him a tablet displaying patient outcomes. Marcus scrolled through the data, his skepticism eroding with each chart.Average A1C reduction: 2.1 points. Average weight loss: 23 pounds. Average medication cost reduction: 67%. Percentage of patients achieving A1C below 6.5 without medication: 34%.“Your greatest A1C reduction?” Marcus asked.“13.6 to 5.4 in six months. That patient had been diabetic for eleven years. Three different endocrinologists had told her she’d be on insulin for life. Our record weight loss is 111 pounds.”“That’s not possible,” Marcus heard himself say. “That level of reversal would require complete beta cell regeneration. The literature doesn’t support it.”Erin pushed her cowboy hat back and looked at him the way a patient grandmother looks at a child who insists monsters live under the bed.“Dr. Chen, the literature is based on research done with commodity food. Nobody’s published studies on what happens when you feed people real food because nobody’s scaled real food until now. You’re a cardiologist. You understand that the heart is a muscle that can be strengthened or weakened. Why would metabolic function be any different?”Ajay shared a similar story full of patient success stories, the same levels of magnitude from his lifestyle medicine clinic. Explaining their future plans for integrative pilots.Before Marcus could respond, Carter Williams appeared at the warehouse entrance, accompanied by two others. The tall man in jeans and work boots looked like he’d spent his morning wrestling cattle. The woman beside Carter looked more like she walked out of a hospital boardroom as opposed to the produce warehouse.Jesturing towards the man in jeans, “Marcus, meet Kelly Garrett. He farms 8,000 acres in northeast Iowa using methods that most agricultural scientists told him were impossible. His yields match or exceed conventional farms, while his input costs are 40% lower. More importantly, his crops test consistently higher for micronutrients.”Kelly extended a hand that felt like it was made of leather and bone. “Heard you had a health crisis. Sorry about that. A lot of good people end up in your situation these days. Most of ‘em are eating food that was grown to be cheap, not to be nutritious.”“And this,” Carter continued, gesturing to the woman, “is Ellen Brown. She’s spent thirty years in the belly of the beast, she knows exactly how the current system works because she helped build parts of it.”Ellen shook Marcus’s hand firmly. “I also know why it’s failing. I spent three decades optimizing a machine that profits from keeping people sick. I didn’t believe that at first, and it’s still hard to stomach the idea. Risk stratification, care management, and population health make disease management profitable, not its reversal. I thought if we paid health systems to improve health, things would change, but instead, we got really good at managing chronic disease. There was no incentive to end it or prevent it.”“What changed?” Marcus asked.“I did the math,” Ellen said simply. “I calculated how many diabetics I’d helped manage into kidney failure. How many heart patients I’d helped manage into bypasses. The system I built wasn’t fixing anything. It was processing disease. Efficiently. Profitably. And pointlessly. When I found Erin and Ajay amongst others I realized we had the tools to end the chronic disease and when I met Carter and he said “I want to redesign the system so it becomes hard to make a bad decision at the grocery store, I realized I’d spent my career trying to fix a system that is designed just the way it was meant to operate.”Marcus spent three more days in Tulsa. He toured Kelly’s operation via video link with a soil scientist from Ohio State who explained the microbial dynamics. He sat in on FreshRx patient consultations. He reviewed published literature on nutrient density variation in vegetables. He joined Dr. Joseph for a day with patients in the office, as well as participating in the sessions that were part of the Intensive Therapeutic Lifestyle Change program that was producing similar results.On his last evening, sitting in a beloved Tulsa farm-to-table restaurant that sourced from the same farmers as Erin, with Carter, Erin, Ellen, Ajay, and Kelly, Marcus finally asked the question that had been forming since he arrived.“Why isn’t everyone doing this? If the results are this clear, why isn’t it standard of care?”Carter set his glass of water down. “That’s the four trillion-dollar question. Literally.”Ellen leaned forward. “Because the current system is optimized for disease management, not disease reversal. I spent thirty years watching it from the inside. Every stakeholder profits from the chronic illness continuing. Pharma sells drugs. Hospitals fill beds. Insurance companies collect premiums. Food companies sell cheap calories. The incentives all point the wrong direction.”“Nobody in the existing system makes money when people get better,” Carter added.“Except the patients,” Marcus said.“Except the patients,” Ellen agreed. “And the employers who pay for their insurance. And the food industry that sells the food that causes the disease. And the taxpayers funding Medicare. And the children who inherit healthier parents. If you take food and wellness into the equation, there’s $9 trillion a year on the table. The people who benefit from the current system control about $3 trillion of that. The people who would benefit from a new system control the other $6 trillion. The math is obvious. The politics is hard.”Marcus flew home the next morning with a USB drive containing three years of FreshRx outcomes data, contact information for eighteen farmers and food scientists, and a decision he hadn’t expected to make.He withdrew his name from the CMO search.CHAPTER 5: CROSSING THE THRESHOLDJune 2025, The LeapThe announcement came as a shock to everyone who knew Marcus Chen. One of Mayo’s most respected cardiologists was leaving to join something called the Food is Health Collective, a newly formed organization backed by iSelect Fund and a consortium of health systems, insurers, and food companies.“You’re giving up your practice to sell vegetables?” his department chair asked, genuinely confused.“I’m giving up treating symptoms to address systemic root causes,” Marcus replied. “Every patient I see in the cath lab represents a failure of primary prevention. I can spend the next twenty years intervening in those failures one at a time, or I can spend those years trying to prevent the failures from happening.”The Collective launched with an audacious goal: prove that a fully integrated food-as-health approach could reduce chronic disease incidence by 50% in pilot populations within five years. The founding partners included three regional health systems, two Medicare Advantage plans, a major self-insured employer, a retail grocer, an innovative CPG, and a coalition of regenerative farms spanning six states.Marcus’s role was Chief Medical Officer. Ellen Brown oversaw the Collective, bringing her decades of healthcare system expertise to design the payment models and partner agreements. Her job was to design the use cases and make the new system economically viable within the existing healthcare infrastructure.“We need to work within the system to change it,” Ellen explained at the first board meeting. “That means leveraging all of the outcomes based tools. It means getting creative about making nutrition affordable, sometimes covering food as a pharmaceutical benefit, other times offering retail incentives while also taking SNAP into consideration. It means having the entire value chain from soil to cell at the table to redesign. It means building the economic case that will make health plans want to participate.”“We need randomized controlled trials,” Marcus added. “We need peer-reviewed publications in major journals. We need FDA acknowledgment that these interventions meet efficacy standards. Without that, we’re just another wellness fad.”“That could take a decade,” someone objected.“Then we’d better get started.”The first pilot site launched in September 2025 in a former coal mining region of Appalachia. The population was among the sickest in America: obesity rates above 45%, diabetes prevalence over 20%, and cardiovascular mortality nearly double the national average. Standard healthcare interventions had been tried for decades with minimal impact.The Collective’s approach was different. Instead of parachuting in with prescriptions and lectures, they started by listening. What did people eat? Why did they eat it? What would they eat if they had different options? What drove their daily lifestyle choices?The answers revealed a system problem, not a behavior problem. Fresh produce was available only at a grocery store 45 minutes away. Local convenience stores stocked chips, soda, and processed meat. The Dollar General offered canned vegetables with more sodium than nutrition. People weren’t making bad choices; they were making the only choices available. Meanwhile, their insulin was delivered to their doorstep.The intervention began with infrastructure. The Collective partnered with regional farmers to establish weekly produce distribution at community centers. They trained local residents as “food coaches” who could help neighbors navigate cooking and meal planning. The community organized weekly food prep group meetups. Ellen worked with the Collective members to create an outcomes-based program for their employees with Type II Diabetes and Heart Disease that focused on lifestyle change and produced results in which the disease was reversed, not simply treated. Framing it as a true incentive for health. “We’re not asking people to change their behavior,” Marcus explained at a community meeting. “We’re changing their options. Right now, the healthy choice is the hard choice. We’re going to make it the easy choice.”CHAPTER 6: TESTS, ALLIES, AND ENEMIES2026-2027, The ResistanceSuccess bred opposition.As the Appalachian pilot showed promising early results, the Collective attracted attention from unexpected quarters. A pharmaceutical trade group published a white paper questioning the methodology. A major hospital system that had initially expressed interest quietly withdrew after pressure from device manufacturers. An op-ed in a medical journal warned of “nutritional pseudoscience” infiltrating evidence-based medicine.The most dangerous threat didn’t come from the opposition. It came from imitation.In early 2027, NorthStar Health, one of the largest integrated delivery networks in the Midwest, announced its own “Food Forward” initiative. The press release cited the Collective’s pilot results. The CEO praised “the pioneering work being done in Appalachia.” They hired a former Collective advisor as their program director.Ellen saw it coming before anyone else. “They’re going to strip the model for parts,” she warned at a strategy meeting. “I’ve watched health systems do this for thirty years. They take an innovation, remove everything that makes it effective, and wonder why it doesn’t work.”She was right.NorthStar’s version looked similar on paper: produce prescriptions, health coaching, and patient enrollment. But they sourced their vegetables from the same commodity distributors that supplied their hospital cafeterias. They told their own Primary Care Physicians they had to support patients in changing their lifestyle with no training and the same 7 minute office visit schedule leading to burnout. No regenerative farms. No nutrient density testing. No partnership with local growers. No retail grocer or CPG supporting redesign. The cost per patient was 50% lower than the Collective’s model.“We’ve optimized the program for scale,” NorthStar’s CEO told healthcare media. “The original approach was too boutique. We’ve made it enterprise-ready.”Six months later, the results came in. NorthStar’s engagement rates were abysmal, and their patients showed it. A1C reductions of 0.2 points, less than 10% of what the Collective achieved. Weight loss averaged But the damage was done. Critics pointed to NorthStar’s failure as evidence that food intervention didn’t work at scale. “Another wellness fad exposed,” one healthcare analyst wrote. “The Collective got lucky with a self-selected population. Real-world implementation proves the model is fundamentally flawed.”Erin was furious. She called Marcus from Tulsa, her voice tight. “They fed people garbage and blamed the concept when it failed. That’s like testing a car without an engine and concluding that transportation doesn’t work.”“We need to name what happened,” Marcus replied. “Publicly. Before the narrative sets.”Carter disagreed. “Don’t punch down. Don’t get into a war with a health system. Just keep producing results. The data will speak.”It was Ellen who found the middle path. She wrote a detailed case study, published in Health Affairs, titled “The Nutrient Density & Lifestyle Gap: Why Food Quality & Lifestyle Modifications Determine Outcomes.” Without naming NorthStar directly, she documented exactly what happened when programs substituted commodity produce for regeneratively grown food. The paper was downloaded 50,000 times in its first month.The lesson was clear: the model couldn’t be stripped for parts. The soil mattered. The farmers mattered. The training mattered. The clinicians mattered. The vertical integration from ground to patient mattered. Anyone who tried to shortcut the system would fail, and their failure would be mistaken for the concept’s failure.It was a warning Marcus would remember eighteen months later, when the Collaborative faced its own supply chain crisis.The attacks were predictable. What surprised Marcus was where they came from.“It’s not pharma,” Carter explained during a strategy call. “They’re actually watching with interest because they see the GLP-1 disruption coming and want alternatives. It’s the traditional healthcare delivery system. Hospitals that need filled beds. Specialists who need chronic patients. The revenue model depends on the disease continuing.”Ellen added the financial perspective. “I used to sit in rooms where hospital executives celebrated ‘heads in beds’ because it meant more revenue. They’d never say it that way, but the incentives were clear. Our program threatens that entire model. Remembering the story of the lifestyle medicine disease reversal program that couldn’t publish their actual results because their hospital partner feared board members being concerned about revenue disruption.”The most sophisticated opposition came from within medicine itself. A respected endocrinologist published a critique arguing that food interventions were “blame shifting,” which implied patients caused their own diseases through poor choices. The critique went viral on medical Twitter.Marcus responded with data. He published the first six-month outcomes from Appalachia: average A1C reduction of 1.8 points, average medication cost reduction of 52%, zero emergency room visits for diabetic complications among enrolled patients compared to a regional average of 8.3 per 100 patients, and hospital admissions half of what they were previously for those same people.The endocrinologist dismissed the results as selection bias. The medical establishment largely agreed.But something else was happening that the critics couldn’t dismiss: consumers were voting with their feet.The direct-to-consumer health companies that Carter had identified as “Force One” of the chronic care disruption were exploding in popularity. Hims & Hers had grown to 4 million subscribers seeking alternatives to traditional healthcare. OURA and Levels popularized continuous monitoring, showing users in real-time how food affected their bodies. A generation of millennials and Gen Z consumers were bypassing the healthcare system entirely, building health habits through apps and wearables and food choices that their doctors never discussed.“The market is moving faster than the institutions,” Marcus observed at a board meeting in early 2027. “We don’t need to convince the AMA. We need to build a system that works better than the one they’re defending. The evidence will speak for itself.”The board approved a major expansion. Within six months, the Collective operated pilot programs in 12 states serving over 50,000 patients. They decided to launch a companion HSA marketplace and stripped down actual catastrophic product options to support those patients.CHAPTER 7: THE ORDEAL2028, The CrisisThe Medicare pilot approval should have been the turning point. After three years of lobbying, the Collective had convinced CMS to authorize a demonstration project: 100,000 Medicare beneficiaries in 15 states would receive food intervention coverage as a pharmaceutical benefit in concert with retail incentives and SNAP. The study would run for three years and determine whether the approach warranted national rollout.Implementation began in January 2028. By March, everything was falling apart.The problem wasn’t medical. It was logistical. Scaling from 50,000 patients to 100,000 required a supply chain that didn’t exist. Regenerative farms produced higher-quality food, but they couldn’t produce enough of it fast enough. The Collective had assumed they could supplement with conventional produce when necessary. They were wrong.Testing from Edacious showed that conventional produce delivered, on average, 40% fewer micronutrients than the regenerative produce used in successful pilots. Patients receiving conventional produce showed less than half the improvement of patients receiving regenerative produce. The carefully constructed evidence base was collapsing.“We scaled too fast,” Marcus admitted at an emergency board meeting. “We prioritized access over quality. And now we’re proving our critics right.”Ellen, who had spent months designing the demonstration model, looked devastated. “If this fails, we won’t get another chance for a decade. CMS will point to our results and say food intervention doesn’t work.”The board debated withdrawing. Some members argued that continuing with suboptimal results would do more harm than good, giving ammunition to opponents who wanted to kill food intervention entirely.Carter Williams disagreed. “We don’t have a medical problem,” he argued. “We have a supply chain problem. Solve the supply chain, and the medicine works. That’s what entrepreneurs do. We fix constraints.”What happened next would later be called the “Regenerative Sprint,” an eighteen-month crash program to transform American agriculture. The Collective partnered with major food companies, including Ingredion and Cargill, to accelerate regenerative transitions on conventional farms. They deployed Kelly Garrett’s methods through a network of trained consultants who worked directly with farmers. They invested $280 million in soil-biology testing infrastructure to verify regenerative outcomes at scale.The results defied expectations. By late 2029, over 400,000 acres had transitioned to regenerative practices, with verified improvements in nutrient density. The Medicare pilot recovered. Final three-year outcomes showed exactly what the smaller pilots had predicted: 47% reduction in diabetes medication costs, 34% reduction in cardiovascular events, 28% reduction in all-cause hospitalizations.“We almost gave up,” Marcus told a journalist years later. “At our lowest point, I thought we’d proven that this approach couldn’t scale, that it would always be boutique medicine for wealthy consumers who could afford premium food. What I learned is that you can’t scale by trying to scale. You scale by building the infrastructure that makes scaling inevitable.”CHAPTER 8: THE REWARD2030, The Tipping PointCMS announced a national rollout in February 2030. Effective January 2031, all Medicare FFS beneficiaries with Type 2 diabetes, cardiovascular disease, or obesity had access to food intervention w/lifestyle change support benefits, and the required benefits for Medicare were updated to reflect the change. The coverage structure mirrored pharmaceutical benefits: copays for produce, deductibles for coaching services, and prior authorization for intensive programs.The announcement triggered a cascade of corporate repositioning that transformed multiple industries simultaneously.Kroger, the nation’s largest grocery chain, announced a $2 billion investment in metabolic health services. Every store would include a clinic staffed by certified lifestyle medicine practitioners who could prescribe food interventions covered by insurance. The company hired 12,000 health coaches and partnered with 3,000 regenerative farms to guarantee a nutrient-dense produce supply.CVS merged its MinuteClinic division with Aetna’s care management platform to create what they called “Continuous Care,” a service that combined pharmacy, food prescription, and ongoing monitoring into a single subscription. Early pilot results showed 40% better adherence than traditional care models.Novo Nordisk, reading the market signals, announced a strategic partnership with Season Health, a food-as-medicine startup. GLP-1 prescriptions would now include automatic enrollment in a food coaching program. The company’s CEO acknowledged publicly that pharmaceutical interventions alone were insufficient for sustainable weight management.“The business model has flipped,” Carter explained at a healthcare investor conference, Ellen beside him, presenting the financial projections. “Five years ago, sick patients were the most valuable customers. Now healthy patients are. The companies that help people stay healthy capture lifetime value. The companies that profit from illness are watching their customer base disappear.”The numbers told the story. Medicare spending on diabetes medications fell 23% in the first year of national rollout. Hospital admissions for diabetic ketoacidosis dropped 31%. The actuaries at CMS projected $340 billion in savings over the next decade.For Marcus, the reward was more personal. His own health had continued to improve throughout the years of building the Collective. His ejection fraction had normalized. His coronary calcium score had stabilized. His continuous glucose monitor showed the flat, stable readings of someone with excellent metabolic function.His cardiologist, bemused, reviewed his latest labs and imaging. “Whatever you’re doing, keep doing it. I’ve never seen this kind of regression in established disease.”“I’m eating vegetables,” Marcus said.“Real ones.”CHAPTER 9: THE ROAD BACK2032-2035, The TransformationThe next five years saw changes that even the most optimistic projections hadn’t anticipated.In agriculture, regenerative practices went from a niche movement to an industry standard. The economics had become undeniable. Farms that had transitioned showed 35% higher profit margins due to reduced input costs and premium prices for verified nutrient-dense crops. The USDA, reversing decades of commodity-focused policy, began offering transition grants covering the 3-5-year period required for soil biology restoration.Kelly Garrett’s methods, once dismissed as unscalable idealism, were now taught at land-grant universities. His consulting firm had trained over 4,000 farmers representing 12 million acres. A new generation of agricultural technology companies, backed by venture capital that once flowed exclusively to software startups, developed precision tools to measure and optimize soil health.In food manufacturing, the reformulation wave that Carter had predicted became a competitive imperative. Major CPG companies discovered that products engineered for nutrient density actually tasted better, creating brand differentiation in categories that had been commoditized for decades. The Fairlife model, once an anomaly, became the template. Vertical integration around health outcomes replaced horizontal cost optimization.In healthcare, the traditional system is fragmented along predictable lines. The redesign so desperately needed was finally underway. Acute care thrived with hospital systems investing heavily in trauma, cancer, and complex surgical capabilities. Chronic care collapsed, as patient volumes for diabetes management, obesity treatment, and cardiovascular maintenance plummeted year over year. And health became it’s own service line on the farm and in the retail grocery store. The hospital system that had withdrawn from the Collective years earlier now filed for bankruptcy. Their CEO, in a remarkably candid exit interview, acknowledged that the organization had bet on chronic disease and lost.“We optimized for the wrong outcome,” she said. “We built infrastructure to manage chronic disease when we should have been building infrastructure to reverse it and prevent it. We should have looked beyond the hospital and clinic walls. By the time we recognized the shift, our competitors had already captured the healthy patients. All we had left were the people too sick to be helped by food alone.”Erin Martin’s FreshRx model, scaled nationally and internationally, served over 8 million patients by 2035. The program had evolved beyond simple produce prescription to include comprehensive metabolic coaching, continuous monitoring integration, and food-drug interaction optimization. Her cowboy hat was seen more giving conference keynotes while living on the farm with her own kids. Outcomes data now included twenty-year longitudinal tracking showing sustained disease reversal rates above 70%.“We didn’t cure diabetes,” Erin explained at the tenth anniversary celebration. “We eliminated the conditions that caused it. There’s no medication that treats what happens when you feed a human body food designed to nourish it. There’s no pharmaceutical intervention for health.”CHAPTER 10: THE RESURRECTION2036-2038, The New SystemThe American College of Lifestyle Medicine achieved something unprecedented in 2036: its board certification became required for primary care licensure renewal in 23 states. Physicians who had spent careers prescribing medications for metabolic disease were now required to demonstrate competency in whole-person health, food intervention, behavioral coaching, and outcomes-based care. And compensation changed accordingly.The backlash was immediate and short-lived. Within two years, physician satisfaction surveys showed the highest levels in decades. Doctors reported that treating root causes instead of managing symptoms restored the sense of purpose that had drawn them to medicine in the first place.“For thirty years, I felt like I was bailing water from a sinking ship,” one internist told researchers. “Now I’m patching the holes. My patients actually get better. They thank me for helping them live instead of just helping them not die.”Williams and Brown accomplished their objective. A redesigned system aligned for human outcomes, where it was hard to make a bad decision at the grocery store. Sure, there were books and TED Talks, but it was their impact on ending the chronic disease pandemic that mattered most.“I know exactly how the old system worked because I helped build it,” Brown told audiences. “Risk stratification. Care management. Population health analytics. We got really sophisticated at “managing care”. What we never asked was why so many people were getting sick in the first place. That was the blind spot. And it cost us trillions.”The insurance industry restructured around what they called “health optimization contracts.” Premiums dropped for subscribers who maintained metabolic health benchmarks. Some plans excluded cardiometabolic disease care altogether in lieu of reversal programs. Insurance became insurance again. The care of health became it’s own new product line with grocers becoming the type of clinic they were always designed to be, not the insertion of sterile clinics next to cereal boxes.Life insurance companies, always the earliest actuarial signals of population health shifts, began offering premiums 40% below 2025 levels for applicants who demonstrated sustained metabolic health. The demographic that had once been most expensive to insure, middle-aged Americans with family histories of chronic disease, became profitable customers through prevention.Employers, facing continued workforce shortages, competed on health rather than health insurance and salary alone. Companies that invested in employee metabolic health reported 23% lower healthcare costs and 18% lower turnover. “Our whole person health program is our recruiting program,” one tech CEO explained. “Gen Z won’t work for companies that make them sick.”Food, wellness, and healthcare merged into a new industry centered on human outcomes, and investors had a field day as a $9 trillion market emerged. The political alignment that had seemed impossible in 2025 had become reality by 2038. Conservatives championed food-as-health as a free market alternative to government healthcare expansion. Progressives embraced it as environmental policy and health equity in one package. Rural communities that had been decimated by chronic disease became showcases for regenerative agriculture and community health innovation.The Make America Healthy Again initiative that had launched amid controversy in 2025 achieved its stated goal eight years ahead of schedule. Childhood obesity rates had peaked and were beginning to decline. Type 2 diabetes incidence in adults under 45 had fallen 58%. The chronic disease burden that had threatened Medicare solvency was no longer growing, and projections showed continued decline for decades.CHAPTER 11: RETURN WITH THE ELIXIRApril 2040, Rochester, MinnesotaMarcus finished his acceptance speech to a standing ovation. The award ceremony was followed by a reception where he encountered faces from every chapter of his journey: the cardiologist who had performed his stent procedure, now head of Mayo’s Lifestyle Medicine department; the endocrinologist who had criticized his work, now a collaborator on metabolic research; the hospital administrator who had questioned his sanity, now running a health system built on the principles he’d championed.He found a quiet corner and pulled out his phone to text Jennifer, who had stayed home to prepare for the grandchildren arriving tomorrow.“Speech went well. Lots of people pretending they always believed in this. Lots of people genuinely surprised it worked. Coming home soon.”Her reply came immediately: “Proud of you. Your heart rate looks good on the monitor. Vegetables for dinner.”He laughed quietly. Some things hadn’t changed.Carter Williams appeared at his elbow, Ellen Brown beside him, both looking older but still carrying the energy that had characterized them fifteen years earlier.“We did it,” Carter said simply.“We did something,” Marcus corrected. “The job isn’t done. There are still three billion people globally living with chronic diseases that could be prevented. The American model works, but we haven’t scaled it worldwide yet.”Ellen smiled. “That’s why India is my second home these days. That’s what I love about this team. We spent years learning how to break the old system. Now we get to spend years building the new one everywhere else.”They stood in comfortable silence, watching the reception wind down. Medical leaders who had built their careers on managing disease were now celebrating its prevention. Food company executives who had once optimized for addiction were now competing on nutrition. Farmers who had been told their methods couldn’t scale were now training the next generation.“You know what changed?” Carter asked finally. “Not the science. We had the science in 2025. Not the technology. We had that too. What changed was the story. We stopped telling people what to fear and started showing them what to build. Fear creates resistance. Vision creates collaboration.”Marcus nodded slowly. The hero’s journey, he reflected, was never really about the hero. It was about what the hero brought back. The elixir wasn’t a cure or a treatment or even a system. It was proof that the impossible was possible.He had left Mayo fifteen years ago as a broken cardiologist searching for answers. He returned as living evidence that chronic disease wasn’t inevitable, that the food system could nourish instead of poison, that the healthcare system could heal instead of manage.That was the elixir.That was always the elixir.EPILOGUE: THE NEW ORDINARY WORLD2045, The Next GenerationMaya Chen graduated from medical school the same year her grandfather stepped down from the Food is Health Collective. She had grown up hearing his stories, watching the transformation unfold, eating vegetables from regenerative farms before she knew there was any other kind.Her specialty was preventive cardiology, a field that hadn’t existed when Marcus began his career. Her patients came to her not because they were sick but because they wanted to stay healthy. Her tools weren’t stents and statins but continuous monitors and food optimization algorithms. Her outcomes weren’t measured in survival rates but in vitality scores.“What was it like?” she asked her grandfather one evening, visiting him in the Rochester home where he and Jennifer had raised their children. “When chronic disease was normal? When most people just... got sick and stayed sick?”Marcus considered the question. He was 87 now, still sharp, still walking daily, still eating the vegetables that had saved his life forty years earlier. The ejection fraction that had dropped to 48% after his heart attack had recovered to 62% and stayed there for decades.“It felt inevitable,” he said finally. “That’s what made it so hard to change. Everyone assumed that aging meant declining. That chronic disease was natural. That the best we could do was manage the damage. We couldn’t imagine a world where health was the default.”“But you imagined it.”“I saw it,” Marcus corrected. “Other people had already built pieces of it. Farmers like Kelly Garrett. Program builders like Erin Martin with her cowboy hat and her carrots. System thinkers like Carter Williams. Healthcare thought leaders like Ellen Brown knew the old system was broken from the inside. Researchers who knew the science. Entrepreneurs who built the tools. We just helped connect them. The hero’s journey isn’t about one person conquering obstacles. It’s about each person recognizing that the obstacles were illusions all along.”Maya reached for her grandfather’s hand, the same hand that had performed thousands of cardiac interventions, that had signed the papers launching the Collective, that had steadied itself on that bathroom floor decades earlier.“So what’s next?” she asked. “What’s the next illusion we need to see through?”Marcus smiled. “That’s your journey now. Mine was showing that chronic disease could be prevented and stopped in its tracks. Yours might be showing that aging itself can be optimized. Or that mental health follows the same patterns. Or something we can’t even imagine yet.”He looked out the window at the garden Jennifer still maintained, rows of vegetables growing in soil rebuilt over decades of regenerative practice. The same soil-to-cell connection that had defined his life’s work, visible from his living room window.“The only constant,” he said, “is that someone will always insist the impossible can’t be done. And someone else will always prove them wrong. Be that someone, Maya. Be that someone.”The future described in this narrative is speculative, but every element is grounded in work already underway. The question isn’t whether this transformation is possible. The question is whether we will make it inevitable. Get full access to Food is Health at foodishealth.substack.com/subscribe

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It’s a holiday week. We just wrapped three intense days at the American College of Lifestyle Medicine conference - 2,200 practitioners, researchers, and changemakers gathering around a board certification that could eliminate 60-70% of established chronic disease costs. The crowd was significantly larger than last year, which tells you something about momentum. But as always with healthcare transformation, the picture is complicated. We thought this video would be a fun during and after from the American College of Lifestyle Medicine Conference. The Core Tension: Healthcare Can’t See Food (Unless It’s a Drug)Our conversation with Dr. Sachin Jain crystallized something we’ve been wrestling with: it’s incredibly difficult to get our minds out of the economics of one industry versus the other and think about it as a system design challenge of chronic disease.Healthcare wants to keep people sick - that’s how the engine runs. Food, on the other hand, is neutral. Food just wants to keep people happy and buying product. They don’t have a vested interest in whether you’re sick or healthy. If you could feed somebody the same calories in a much healthier configuration for the same amount of money, food wouldn’t care. They’d just redesign to match demand.That’s why we increasingly believe food needs to lean into healthcare, not the other way around. There’s less friction. Food has less skin in the game of staying entrenched in the current system. Healthcare is reimbursed, it’s regulated - food’s not. You can change your diet tomorrow. Nobody’s going to step in and say that’s not allowed.The Practitioner’s Dilemma: When the CEO Won’t Expand the ProgramThere was a revealing moment during Dr. Joseph’s keynote—the cardiologist who launched the lifestyle medicine program at St. Francis in Tulsa. Someone from the audience asked: “How did you get your CEO to buy into this?”That question is endemic of what’s happening. The majority of lifestyle medicine assets today are those clinicians. About half are independent practitioners who could potentially deploy differently. The other half? They’re employed by incumbent legacy health systems operating under the current healthcare finance model. Systems that see lifestyle medicine like primary care—it doesn’t make money. It’s much better to do more joints, have more beds, deliver more acute care.There’s still political discourse about how that program fits in. It was the perfect epitome of what we’re up against: over 2,000 people came together around something so simple in it’s delivery that could take 60-70% of chronic disease costs out of the system. Yet we still monetize sickness to keep the engine running.Five Forces Converging (Finally)Despite the friction, we see five powerful forces all moving toward transformation:* The sickest patients on GLP-1s now generate less revenue for hospitals - the economic model cracking* Patients without chronic disease are taking control - they’re avoiding the system entirely* Geopolitical pressure - when you look at US and China, both spend heavily on healthcare and military. When GLP-1s go off patent in China in 2026, they can spend more on defense. The US government has interest in making Americans healthy from a national security standpoint* Enhanced benefits and HSA funding potential - we posed the question of what happens if HSAs were well-funded, if there was more cash in consumers’ hands. That was a market force people hadn’t considered* Next-generation GLP-1s and innovation in lifestyle medicine - from frontline practitioners creating new business models all the way to WashingtonLily Goes Direct: Getting Closer to the SignalSince ACLM, Eli Lilly announced they’re going direct to corporations with GLP-1s -bypassing PBMs, bypassing the traditional systems. They’re getting closer to the consumer signal. And this matters because the disintermediation of healthcare - how we’ve disconnected people’s license to choose from the funding of it - has made it so that latent consumer demand can’t be felt. Those signals are getting lost.Anyone who gets closer to the consumer has the opportunity to build a better product. If Lilly can integrate food and nutrition into their approach, if they’re delivering value to consumers while competition remains open - that’s productivity. That’s progress.The consumer already sees food and healthcare as integrated. They’re spending on both. The rest of the system may not see it, but at the end of the day, it’s all integrated at the consumer level.The Middle Ground We’re MissingWe kept coming back to this: there’s always going to be a need for acute care. But we don’t have the middle care figured out. The interventions that keep you from needing that expensive diagnostic panel to find something - or better yet, keep you from developing the condition in the first place.Companies like L-Nutra with their fasting-mimicking diet (Prolon), the innovations happening at places like Eudemonia, the evidence around autophagy and cellular renewal—these are the middle-ground interventions we currently consider “woo-woo.” But they’re what keep you from sliding into System B. And the younger generation is willing to pay cash for them because they don’t expect much from traditional healthcare.System C: Where Two Trains Need to MergeWe keep framing this as three systems:* System A: Inherent health, food systems we were designed with* System B: Our effort to scale food and the healthcare we needed because we were making people sick faster than we wanted them to die* System C: What we need and are building - taking the best of A and B, getting back to human-based outcomesThe problem is we have two trains running—food running off one cliff, healthcare running off another. They need to come together, which is never easy. But if we focus on first-principle human-based outcomes and start working on those economic models, we’re looking at about a 20-year correction for a problem that took 50 years to create.What We’re Taking ForwardThe crowd at ACLM? Ninety percent are already converted. They’re the choir. Our job is to find the conductors - the people who have a place in actually transforming this system. We need to help Wall Street and capital providers understand that the merging of these trains is happening, whether the incumbents like it or not.The forces at play here, the way we’ve lined up the world, the pressure from every tier - from frontline practitioners to Washington - it’s all moving in the direction of food itself becoming healthcare.When we redesigned computers, the revolution came from outside - Gates, Jobs, the people IBM forgot. It’s often very difficult for insiders to drive transformation. But the ethical impact matters. Food has a responsibility to think about its off-target effects. Either they change what they do, or someone slightly outside sees the opportunity to fix it.Our goal: Make sure the vision is clear. Make sure we bring the players to the same table. Make sure we create convenings and use cases. Make sure the capital’s there to fund what needs to happen next. That’s 2026. Game On. Get full access to Food is Health at foodishealth.substack.com/subscribe

As you all know by now, CMS has launched one of the most ambitious rural-health initiatives in decades. The Rural Health Transformation (RHT) Program will distribute up to $50 billion through FY 2026-2030 to help states redesign how rural care is delivered—funding prevention, workforce pipelines, and digital access.We’ve been digging into the details and getting as much insight to share as possible. On Friday of last week (10/10/25) we had a live Zoom call that included a slew of stakeholders from ag, food and healthcare. We have included the Zoom above. We plan to hold one more zoom this week.In the meantime, we’ve created a shared drive where we will be updating information as it is received Google Drive. In addition to the program materials and state links and more, we have added a document DRAFT “State Language Framework - Crowd Source Document” that is designed to become a succinct set of language to be used to provide to your state officials or any other contacts helpful. We welcome this group to “crowd source” this document but have some ground rules (some are redundant to details in the How To Engage section):* MUST BE VENDOR AGNOSTIC* Clearly articulate the scoring impact, specifying each measure and points* Make it quantifiable (we are revising what we have created to do just that)* MUST be sustainable without grant $$ * Please enhance and/or add new bullets/sections, don’t delete what is thereThe specifics of what we suggest are found in the How To Engage Section below.Who’s driving itHealth and Human Services (HHS) is leading the charge via Centers for Medicaid and Medicare (CMS), the HHS department responsible for program funding decisions and program oversight * Alina Czekai, Director, Office of Rural Health Transformation* Kate Sapra, Acting Deputy Director, focused on cross-state coordination* Emily Chen, Senior Advisor, who urged evidence-based innovation, not pilot fatigue* Christopher Clark, Grants Management Officer, who explained funding and complianceContact: [email protected]“Rural transformation must move beyond keeping hospitals open. We’re building systems that keep people healthy where they live.” - CzekaiThe timelineAwards are expected by December 31, 2025.Funding begins January 2026, with five one-year budget periods running through FY 2030.Unspent funds can roll forward for one fiscal year before redistribution.Key dates:* Letter of Intent (optional) - Sept 30 2025* Application deadline - Nov 5 2025 (11:59 p.m. ET)* Awards announced - Dec 31 2025* Budget Period 1 starts - Jan 2026What states must deliverOnly states can apply directly, but CMS expects them to braid public and private resources. Each application must include:* Needs Assessment – baseline data on rural access, chronic-disease burden, and facility status.* Transformation Plan – clear goals and a sustainability model beyond federal dollars.* Implementation Timeline – milestones through 2031.* Stakeholder Engagement – Medicaid, tribal health, community providers.* Evaluation Metrics – at least four measurable outcomes such as hospital readmissions, telehealth uptake, or A1C improvement.“We’re not funding activities - we’re funding outcomes.” - SparaWhere Innovators FitStartups can’t apply directly, but CMS expects them to power execution through sub-awards and state partnerships. Five “use-of-funds” categories create multiple entry points:Technology Innovation - broadband, telehealth, remote monitoring, cybersecurity, and data integration. Emily Chen stressed that CMS wants digital infrastructure that lasts beyond grant cycles.Innovative Care Models - produce-prescription programs, lifestyle or behavioral-health integration, and “food as medicine” pilots. These align perfectly with Food is Health thinking.Workforce Development - rural residencies, tele-EMS, community-health training, and loan-repayment tie-ins. Kate Sapra linked this to CMS’s new workforce data initiative.Prevention and Consumer Health Tech - nutrition apps, wearables, and farm-to-clinic supply chains. Alina Czekai invited proposals that “connect agriculture and health.”Data and Evaluation Systems - cross-state data hubs and AI-based outcome tracking. Christopher Clark reminded applicants that all systems must meet federal privacy and interoperability standards.How to help your state prepareStartups:* Create a one-page brief showing how your technology improves access, quality, or cost. Map it to one of the five funding categories. Contact your State Office of Rural Health or Department of Health this summer to be added as a partner.Universities and nonprofits:* Offer to manage evaluation and metrics - every state must prove measurable impact.Investors and corporates:* Align co-investment or in-kind support with the 25 percent non-federal match requirement.How to Engage: Turning Rural Innovation into State-Ready LanguageThe Rural Health Transformation (RHT) Program isn’t just another grant cycle. It’s a five-year framework where states must design working systems, not pilots.That means startups, community programs, and local innovators will shape the real implementation work - if they show up early enough.Here’s how.1. Understand what states are being asked to buildEach state must produce a comprehensive transformation plan, not a single project.They’ll need to demonstrate measurable improvements in access, quality, and cost—especially around chronic disease and hospital dependence.That means they’re looking for partners who can deliver ready-to-insert programs that fit inside their proposals.CMS made it clear:“Show us ideas that a governor can stand behind and a hospital CEO can implement.”The RHT categories are deliberately broad - digital health, prevention, workforce, and innovation—because CMS expects cross-sector participation.If you have a working model (say, a produce-prescription program, wearable-driven nutrition app, or tele-behavioral network), treat it as a component the state can adopt and scale.2. Write “plug-and-play” proposal languageDon’t send a deck; send words states can drop directly into their grant narrative.Officials are under pressure to hit submission deadlines and will naturally use clear, pre-written content that aligns with CMS scoring criteria.Structure your draft contribution like this (in case you want to create your own in addition to what we are creating):Section Title: Use of Funds – Innovative Care Model: Produce Prescription ExpansionProblem: High rates of diet-related chronic disease in rural counties; limited access to affordable produce.Solution: Partner with FreshRx or a comparable provider to implement a produce-prescription model reaching 500 patients in Federally Qualified Health Centers.Expected Outcomes: 10% reduction in A1C; 15% improvement in food security scores; measurable reduction in per-member per-month costs within 18 months.Metrics: Number of patients served, change in HbA1c, hospitalization rates, program retention.Sustainability: Program funded through Medicaid Section 1115 waiver in Year 3.That language fits the CMS template and makes it easy for a state health department to say “Yes - insert this.”3. Find the right people in each stateEvery state has a State Office of Rural Health (SORH) and often a Rural Health Advisory Council reporting to the governor.These offices will coordinate the RHT response with Medicaid, public-health, and workforce agencies.Start here:* Visit nosorh.org/states - click your state for director contact info.* Search “Office of Rural Health Transformation” or “Rural Health Policy Council” on the state health-department site.* Reach out to the Governor’s Health Policy Director or State Medicaid Innovation Office (often leads these cross-agency efforts).* Ask: Who is leading your state’s CMS RHT application process, and how can we share draft program language for consideration?Several states - Oklahoma, Missouri, North Carolina, and Maine - already have dedicated transformation offices that will anchor their proposals.Others will build task forces this summer; being early means you can help shape the scope.4. Anchor your pitch in metrics and sustainabilityThe biggest mistakes CMS sees are vague claims and no plan for what happens after federal funding ends.Each idea needs both a numerator (how many people it reaches) and a denominator (the total population affected).If you can’t quantify it, it won’t make it into a state plan.Propose clear measurement methods:* Link to existing CMS quality metrics (readmissions, blood pressure control, depression screening, telehealth access).* Identify data sources (claims data, EHR extracts, or program dashboards).* Outline the path to sustainability - Medicaid waivers, value-based care contracts, employer partnerships, or insurer pilots.5. Focus on what states need help with mostFrom the webinar Q&A, CMS officials said states are especially seeking help in five areas:* Data integration and reporting - systems that track outcomes across multiple health networks.* Nutrition and lifestyle programs - initiatives that tie food access to measurable health improvement.* Workforce retention - solutions that keep clinicians in rural communities via remote learning, tele-supervision, and loan-forgiveness alignment.* Behavioral health access - models combining tele-mental health, addiction treatment, and local peer support.* Sustainability and payment innovation - economic models that convert grants into lasting revenue streams.6. Think systems, not silosAlina Czekai summed up the program’s philosophy:“The goal isn’t a better clinic - it’s a better community ecosystem.”Startups that connect the dots between food, tech, workforce, and health outcomes will stand out.If your solution helps states measure, scale, or sustain that ecosystem, you belong in their plan.Quick checklist for startups* Identify your state’s RHT lead (start with the SORH).* Map your product or program to one of the CMS “use of funds” categories.* Draft one-page RHT-ready narrative text for state insertion.* Define 2–4 measurable outcomes tied to CMS metrics.* Describe how the model sustains itself post-grant.The bottom line* Don’t wait to be asked to provide language, help write it proactively.* Every RHT proposal will need proof-ready programs that deliver measurable results.* If you can hand a state a clean paragraph that fits their submission template, you’re not a vendor; you’re part of the plan.Why it mattersAlina Czekai closed with a challenge:“If rural America is to thrive, it needs a health system designed around prevention, data, and dignity - not scarcity.”This is that moment.This is a first pass at providing States with the resources to connect food, health, and technology into a coherent rural strategy if they so choose. They’ll need implementers who can show them the path and then help them execute. Right now they don’t know what they don’t know and it’s imperative we do all we can to get the message out that we can take actions that will lead to the end of the Chronic Disease Epidemic!Resources* 📄 CMS Webinar Replay: (link to video)* 🏛 Program Details: (link to website)* 📬 Email: [email protected]* 📅 Funding Notice: Grants.gov ID CMS-RHT-26-001 Get full access to Food is Health at foodishealth.substack.com/subscribe

After diving into the $50B Rural Health Transformation funding opportunity in this recording, we determined we should offer a live discussion.We only have 30 days until these submissions are due. Join us TODAY for a LinkedIn Live at 11:15am ET for at least an hour to talk about the opportunity. (Link to Register/Join)Who knows, we may phone a friend (like we did in the video above with Erin Martin) or offer for a few folks to join us on the fly. That’s what the comments section is for during the session. And of course, feel free to text us directly during the session or ahead of time as many of you have our info.We will dig into the scoring methodology for proposals.The objective is to help create a list of all of the line items these programs should be thinking about. The line items that will score the best based on the criteria outlined to markedly improve the chances of the state being awarded funding.We want Food Is Health to help shape the message to Governors of what is possible in Making Rural America Healthy Again. Reminding everyone that food is a fundamental to the root cause of chronic disease and prevention, and therefore should be part of the transformation to be funded. Carter Williams and I want to arm everyone with what they need to send to their Governors. This $50B is an opportunity to use funding towards System C focused on restoring human health and ending the chronic disease epidemic that is largely diet-related.Even if you can’t join, we want your input and your suggestions for outreach. I will once again reference none other than Eminem and his infamous lyric “You only get one shot, do not miss your chance to blow. This opportunity comes once in a lifetime, yo.”Here are the show notes from the recording:The conversation delves into the recent $50 billion funding opportunity aimed at transforming rural health care. Ellen and Carter discuss the implications of this funding, the challenges faced by rural health systems, and the potential for innovative health solutions. They explore the eligibility criteria for states, the importance of grassroots advocacy, and the scoring methodology that will determine funding allocation. The discussion emphasizes the need for collaboration and strategic planning to ensure that the funds are utilized effectively to improve health outcomes in rural communities.Takeaways:* The $50 billion funding is aimed at transforming rural health care.* Eligibility for funding is based on state applications and approval.* Grassroots organizations face challenges in accessing state-level support.* Innovative health solutions are needed to address rural health disparities.* The scoring methodology will impact how funds are allocated to states.* Collaboration with state governors is crucial for funding success.* Food is Medicine is a key component of health transformation.* The importance of preventative health in funding proposals is emphasized.* There is a need for a strategic approach to mobilize resources.* Time is of the essence as grant applications are due soon.Chapters:00:00 Rural Health Transformation Overview02:32 Funding Opportunities and Challenges05:24 Innovative Health Solutions and Root Causes08:24 Strategic Partnerships and Grassroots Involvement10:25 Scoring Methodology and Technical Factors14:55 Implementation and Future Planning18:02 Connecting with Experts: A Live Call19:46 Funding for Rural Health Initiatives21:12 Mobilizing for Food is Medicine23:49 Collaborative Strategies for Health Advocacy24:43 Innovative Health Tech Conversations Get full access to Food is Health at foodishealth.substack.com/subscribe

Sometimes you just have to laugh. The last two weeks have been impossibly long but equally as fascinating. Yet in the midst of chaos, Carter Williams, Erin Martin and I found ourselves on Ryland Engelhart and his sister Mollie’s regenerative Sovereignty Ranch for a Food Is Medicine weekend for real people. It was the first time we’ve been part of something geared towards consumers and not just industry. Also there was Kelly Ryerson and regen OG’s like Will Harris (White Oak Ranch), AJ Richards and many others.We enjoyed amazing food, fantastic speakers and spending time with each other.I’m still digging out from a week of travel that took me from DC, NYC, FL, OK and TX and that included global discussions. So a fun video was about all my brain could muster. There are some photos from the farm and a funny recording that the three of us made as a follow-up to Carters more formal piece sharing his disdain for the Reese’s / Oreo collab that was announced a few months ago. Since the new products have hit grocery shelves I thought now this will be fun…In the meantime, here is a quick story of Braveheart the pig that Mollie shared on our farm tour this weekend. Let it be a reminder that we have to keep fighting to end this chronic disease epidemic and heal our soil.You see the day she was set to be sent off, this typically peaceful girl lost her ever living mind. She fought leaving the farm hour after hour, finally wearing the crew down enough to let her stay. She used her instincts to do what she needed to do to save her own life. Mollie subsequently named her Braveheart.That’s how voices can be heard. When our instincts tell us what to do to save human health, follow them. Don’t be quiet, say your truth. Be like Braveheart.And stay tuned for a piece on the Rural Health Transformation funding opportunity for which the clock is ticking… Get full access to Food is Health at foodishealth.substack.com/subscribe

As we navigate multiples cities and juxtapositions of industries and attendees this week and last, we toke 30 min. today to compare notes and had a few aha’s real-time. This was a very efficient way to keep sharing timely insights amidst our time shortage. Crazy as it may seem, we are going to find ourselves in the SAME PLACE along with our friend Erin Martin at our mutual friend Ryland Engelhart Sovereignty Ranch down in Texas for his Food Is Medicine event starting tomorrow - (Tickets) for a “weekend of homestead-skill-building, legislation-changing, self-healing discussions and workshops. We’ll spend 4 days challenging the systems that keep us sick and dependent, and emerge a healthier, more food sovereign community, and we’ll do it together.” JOIN US!I must admit when you pair this with a dinner Monday night in DC full of CMS officiaLs, a day in NYC that included foreign royalty, followed Thursday night by a dinner meeting with a middle Eastern leader about Lifestyle Medicine… ending it on a world renowned regenerative ranch with my peeps will be a relief AND go down as the craziest week yet. Notice how I say yet. Attached is our recording and below is a rough summary of what we covered.The DIY Health CrisisHere’s what hit me during Carter’s debrief from the Canaccord Genuity wellness conference in New York: 320 million Americans are essentially DIYing their health span and lifespan. They’re pulling from three separate, poorly coordinated buckets - food, supplements, and pharmaceuticals, to achieve something that should be integrated.Think about it. You eat food. You take supplements. You consume pharmaceuticals. Each has its own “experts,” its own delivery system, its own economic model. But inside your body? It’s all one chemistry experiment, and you’re the unlicensed lab technician trying to figure out the recipe.The Apple Analogy That Changes EverythingCarter made a comparison that stopped me cold: “Can you imagine Apple saying, ‘oh, you know what, we’ll give you the hardware, but you got to go to these other people to get the software’?”We accept this fragmentation in health because... well, because we always have. But somebody at Apple sat down and said, “we can make more money if we integrate these things.” The result? They became one of the most valuable companies in the world by eliminating customer friction and taking responsibility for the entire user experience.When Pharma Starts Thinking Like AppleHere’s where it gets interesting. Novo Nordisk showed up at this wellness conference announcing they’re developing a high bioavailable protein supplement to go with their GLP-1 drugs. Why? Because they’re seeing massive drop-off after 12 months when patients should ideally stay on for 24-36 months.This isn’t just about being “capitalist” - though it certainly is that. This is pharma recognizing they need customer success. In software, customer success teams replaced support teams when companies realized they wanted customers to actually succeed with their products, not just troubleshoot problems.The Missing Customer Success LayerThere’s a company with a supplement that matches a $40,000 biologic pharmaceutical for IBS. When patients struggle with complications from the expensive drug, they often quit. This supplement keeps them on the therapy. The pharma company suddenly got very interested when they realized: “Oh wait, you have a supplement that keeps people using our $40,000 drug AND you have digital information about our consumers that we don’t have.”Tesla has customer success. Apple has customer success. Pharma doesn’t. Food doesn’t. Healthcare doesn’t.You walk into an Apple store with iPhone problems, and an attentive Gen Z employee makes your problems disappear. You go for an ultrasound, they forget to tell you not to drink liquids, then act like you should have known better when you show up with coffee in your system.The $10 Trillion Market RestructuringWhen you add food ($1.7T), healthcare ($1.9T due to poor nutrition), and wellness together, you’re looking at a $10 trillion market opportunity. Not separate markets - one restructured market.The wellness layer isn’t just spa trips and vitamin supplements. It’s the missing healthcare layer that should be true prevention. When you reformulate food properly, you can integrate many of those wellness tools as part of a redesigned prevention system.Prevention 3.0We came up with a new framework around prevention thank’s to my healthcare’s narrow lens that defines it today":* Prevention 1.0: Doctor tells you to eat your peas* Prevention 2.0: Noom coaches you* Prevention 3.0: The system is designed so you don’t have to make the decisionIn Prevention 3.0, no matter what bread you buy, it won’t affect your health negatively. No matter what meat you buy, it won’t affect your health negatively. The system removes the friction of having to be a health expert just to grocery shop.The Healthcare Reality CheckFresh from a healthcare dinner in DC, and I have to be honest - I’m growing exceedingly impatient with that room. CMS leaders, health tech executives, policy folks - all having the same myopic conversations.On the food side, decision-makers are genuinely curious about meeting consumer health demands. They’re scared, unsure, worried about following false trends, but they’re in the conversation. They’re willing to engage.Healthcare? It’s like an empire that will continue doing what it does. The sentiment had the same themes * Food is for somebody else to solve.* We can’t pay for food for everyone (yet that wasn’t even implied…)* Let’s take soda away from SNAP recipients and get rid of corn syrup that is more important than reformulation.* People don’t care, people won’t try. * How can we care about food when rural healthcare funding just got cut?And then the conversation returned to build the next shiny object that makes something 2% more efficient.Nobody’s talking about reversing disease. They’re talking about managing it more efficiently.The Frequency Mismatch ProblemCarter raised a concept from physics - impedance matching (not something I think I’ve ever referenced btw). You need to transmit on the right frequency and receive on the right frequency. Sometimes you don’t see technology adoption because you’re not on the same frequency.CPG companies get accused of not understanding health, but maybe nobody’s transmitting on their frequency. No startup walks into the General Mills C-suite and says, “What you need to do is launch a reformulation exercise across 100 SKUs in the next six months, report it to the street like you did with Lean Six Sigma, and have central procurement build suites of better ingredients for your product teams.”The ingredients companies are calling line managers about individual sweeteners. The C-suite is thinking about portfolio transformation. Different frequencies entirely.The Open Field OpportunityHere’s what’s wild: this customer success layer for health is an open field. Costco’s Kirkland brand touches 20 million brand-loyal people, but even they haven’t fully captured this integrated health experience.The opportunity is to make health span and lifespan not DIY. To own that integrated experience where consumers don’t have to be experts in biochemistry, nutrition science, and pharmacology just to take care of themselves.Consumers spend 25% of their household income on food and health. They’re optimizing for health span and lifespan whether they call it that or not. They’re willing to pay more if you can stop them from having to DIY it all.Breaking Healthcare Into ChunksWe need to be careful how we talk about this transformation. Healthcare needs to be broken into chronic and acute care. The acute function - cancer, sickle cell anemia - has its own distinct challenges and deserves the complex system we’ve built. We shouldn’t make it seem we don’t think that needs to remain.But chronic care - Type 2 diabetes, hypertension, metabolic syndrome, inflammatory conditions - that’s where this integrated model makes sense. That’s where Prevention 3.0 could conquer 70% of what’s making us sick.The Bottom LineConsumers are DIYing their health because the system forces them to. Food, pharma, healthcare, and wellness are all operating below their potential because they’re not thinking about customer success.There’s an economic opportunity for someone to own this integrated experience. The question isn’t whether it will happen - it’s who will figure out the right frequency first.The $10 trillion market is there. The consumer demand is there. The technology exists.Someone just needs to stop making customers be their own systems integrator.And now to try to get one good night sleep in my own bed and change out what’s in my suitcase. I’ll share my crazy day with royalty and celebrities in NYC soon. Want a preview? See my LinkedIn post from Wednesday…Oh and if having us in the rooms to share our insights and related design thinking is useful for you, please convert to a paid subscription. Travel costs don’t seem to be getting any cheaper anytime soon… Get full access to Food is Health at foodishealth.substack.com/subscribe

GLP-1 demand shock, pre-chronic shoppers, and the capital gapWe broke last week’s D.C. download into three pods because there was too much signal for one sitting. Episode II picks up where the article left off, connecting policy scaffolding to real consumer behavior and near-term moves for CPG, retail, ag, and investors.🎧 Listen on the Food Is Health Revolution podcast on Spotify, Apple, and YouTube.The through-line from the articleIn the piece “The Week the Path Came Into Focus” we argued the concrete is wet, consumers are outpacing institutions, and “measurement is the new weigh scale.” Episode II puts meat on those bones: what shoppers are actually doing, why big companies feel stuck, and where capital should go first.What we cover in this episodeIf you run a portfolio, a brand, or a banner, this one is worth the commute. Then share it with the person in your org who owns reformulation or retail health. 🎧 Find Episode II on Spotify, Apple, and YouTube.Consumer trends outpacing institutions in healthcare and nutritionIn recent years, a seismic shift has occurred in the healthcare and nutrition landscape. Consumers are no longer passive recipients of services; they are active participants, driving trends that often outpace traditional institutions. This transformation is reshaping how we approach health and wellness.Consumer Empowerment: Today's consumers are more informed than ever, thanks to the internet and social media. They demand transparency, personalized care, and innovative solutions. As one expert noted, "The power has shifted to the consumer, who now dictates the terms of engagement."Technology and Innovation: Wearable technology, telemedicine, and personalized nutrition plans are just a few examples of how consumers are leveraging technology to take control of their health. Institutions are struggling to keep up with this rapid pace of innovation.The Rise of Alternative Solutions: With a growing interest in holistic and preventive care, consumers are exploring alternative solutions such as plant-based diets, supplements, and wellness apps. This trend is challenging traditional healthcare models to adapt or risk becoming obsolete.As consumer trends continue to evolve, institutions must embrace change and innovation to remain relevant. The future of healthcare and nutrition lies in collaboration between consumers and institutions, where both parties work together to achieve optimal health outcomes.Challenges and opportunities for startups in the current capital marketNavigating the capital market is a daunting task for startups, especially in today's volatile economic climate. While challenges abound, there are also unique opportunities for those willing to adapt and innovate. This post examines the challenges startups encounter in securing funding and achieving growth.Challenges in the Capital Market: Startups today face a myriad of challenges, from tightening venture capital to increased scrutiny from investors. As one industry insider puts it, "The bar has been raised, and startups must demonstrate not just potential, but proven traction and a clear path to profitability."Opportunities for Innovation: Despite these hurdles, the current market presents opportunities for startups that can offer innovative solutions and demonstrate resilience. Niche markets, sustainable practices, and technology-driven efficiencies are areas ripe for exploration and investment.The Role of Strategic Partnerships: Forming strategic partnerships can be a game-changer for startups. By collaborating with established companies, startups can leverage resources, gain market insights, and enhance credibility. This approach can open doors to new funding avenues and market opportunities.While the capital market presents significant challenges, it also offers opportunities for startups that are agile and forward-thinking. By focusing on innovation, strategic partnerships, and clear value propositions, startups can thriveBig Ag and CPG's struggle with consumer demand for healthier optionsIn recent years, consumer demand for healthier food options has surged, challenging Big Agriculture (Big Ag) and Consumer Packaged Goods (CPG) companies to adapt. This shift is reshaping the food industry, as companies strive to meet new expectations while maintaining profitability.The Health-Conscious Consumer: Today's consumers are more health-conscious than ever, seeking transparency and quality in their food choices. They demand products that are not only nutritious but also sustainably sourced and free from artificial additives. As one industry analyst observed, "Consumers are driving a revolution in the food industry, and companies must evolve or risk being left behind."Challenges for Big Ag and CPG: For Big Ag and CPG companies, adapting to these demands is no small feat. The transition to healthier options often requires significant changes in sourcing, production, and marketing strategies. Additionally, these companies face the challenge of balancing cost with quality, as healthier ingredients can be more expensive.Opportunities for Innovation: Despite these challenges, the demand for healthier options presents opportunities for innovation. Companies that can successfully reformulate products, invest in sustainable practices, and communicate transparently with consumers stand to gain a competitive edge. As one CPG executive noted, "Innovation is key to staying relevant in this rapidly changing market."The struggle to meet consumer demand for healthier options is a defining challenge for Big Ag and CPG companies. By embracing innovation and prioritizing transparency, these companies can not only meet consumer expectations but also thrive in the evolving food landscape.Potential for new investment categories in food as health and regenerative practicesThe intersection of food, health, and regenerative practices is creating exciting new investment opportunities. As consumers increasingly prioritize health and sustainability, innovative categories are emerging, offering promising opportunities for investors seeking to make a positive impact.The Rise of Food as Medicine: The concept of food as medicine is gaining traction, with consumers seeking products that offer health benefits beyond basic nutrition. This trend is opening up investment opportunities in functional foods, supplements, and personalized nutrition solutions. As one investor noted, "The potential for growth in this sector is immense, as people become more proactive about their health."Regenerative Agriculture: Regenerative agriculture is revolutionizing the way we approach food production. By focusing on soil health, biodiversity, and ecosystem restoration, this approach not only enhances food quality but also addresses climate change. Investors are increasingly drawn to companies that prioritize regenerative practices, recognizing the long-term benefits for both the planet and their portfolios.Innovative Food Technologies: Advancements in food technology are paving the way for new investment categories. From lab-grown meats to plant-based alternatives, these innovations are reshaping the food landscape. As one tech entrepreneur stated, "We're on the cusp of a food revolution, and the opportunities for investment are vast."The potential for new investment categories in food as health and regenerative practices, is significant. By aligning with consumer values and embracing innovation, investors can capitalize on these emerging trends and contribute to a healthier, more sustainable future.Role of grocery stores in promoting nutrition and healthGrocery stores are more than just places to buy food; they are pivotal players in promoting nutrition and health. As the primary source of food for most households, grocery stores have a unique opportunity to influence consumer choices and foster healthier communities.Educating Consumers: Many grocery stores are stepping up to educate consumers about nutrition. Through in-store dietitians, cooking classes, and informative labeling, they provide valuable resources that help shoppers make informed decisions. As one store manager noted, "Our goal is to empower customers with the knowledge they need to make healthier choices."Promoting Healthy Products: By strategically placing healthier options at eye level and offering promotions on nutritious foods, grocery stores can nudge consumers towards better choices. This approach not only benefits public health but also aligns with the growing consumer demand for healthier products.Community Engagement: Grocery stores are increasingly becoming community hubs, hosting events and workshops that focus on health and wellness. These initiatives foster a sense of community and encourage healthier lifestyles. As one participant shared, "These events have transformed the way I think about food and nutrition."The role of grocery stores in promoting nutrition and health is crucial. By educating consumers, promoting healthy products, and engaging with the community, they can drive positive change and contribute to a healthier society. 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Last Friday we published a short summary on key policy trends we observed during our week in Washington, DC. Each one of those points is probably at least a billion-dollar opportunity. The post on Friday was too short to represent everything we learned. We are doing a series of follow-up podcasts to go into more depth. This is Part 1. Please listen here, Apple, Spotify or YouTube. Provide any comments or questions below.A brief summary of the discussion…..Regenerative Agriculture and Its Impact on HealthRegenerative agriculture is more than just a farming practice; it's a movement towards a healthier planet and healthier people. Imagine a world where the soil is alive, ecosystems thrive, and our food nourishes us in ways we've never experienced before. This is the promise of regenerative agriculture.The Principles of Regenerative Agriculture: Regenerative agriculture focuses on restoring soil health, increasing biodiversity, and improving water cycles. By minimizing soil disturbance and promoting plant diversity, farmers can create resilient ecosystems that support both the environment and human health.Impact on Human Health: The benefits of regenerative agriculture extend beyond the environment. Healthier soil leads to more nutrient-dense crops, which can improve our diets and overall well-being. Studies have shown that food grown in regenerative systems contains higher levels of vitamins and minerals, contributing to better health outcomes.A Case Study: Consider the story of a small farm in Iowa that transitioned to regenerative practices. Within a few years, the farm saw a dramatic increase in soil fertility and crop yields. The local community benefited from fresher, more nutritious produce, leading to a noticeable improvement in public health.Conclusion: Regenerative agriculture offers a path to a sustainable future, where the health of our planet and its inhabitants are intertwined. By embracing these practices, we can ensure a healthier, more resilient world for generations to come.Consumer Behavior and the Influence of Social Media on Food ChoicesIn today's digital age, social media platforms have become powerful influencers of consumer behavior, especially when it comes to food choices. Imagine scrolling through your feed and being captivated by vibrant images of gourmet dishes or the latest food trends. This is the new reality of how social media shapes our eating habits.The Power of Visual Appeal: Social media thrives on visual content, and food is no exception. Platforms like Instagram and TikTok are filled with eye-catching food photography and videos that entice users to try new recipes or visit trendy restaurants. This visual appeal can significantly impact consumer decisions, often leading to impulse purchases or dining experiences.Influencers and Their Impact: Food influencers and bloggers have become key players in shaping consumer preferences. With their large followings, they have the ability to introduce new products, cuisines, and dietary trends to a wide audience. Their recommendations often carry more weight than traditional advertising, as they are perceived as authentic and relatable.The Role of User-Generated Content: User-generated content, such as reviews and personal food experiences shared on social media, also plays a crucial role in influencing food choices. Consumers trust the opinions of their peers, and positive reviews can drive interest and sales for food brands and restaurants.Social media has transformed the way we discover and choose food, making it a powerful tool for influencing consumer behavior. As platforms continue to evolve, their impact on our food choices will likely grow, offering both opportunities and challenges for the food industry.Policy Shifts in Nutrition Science and Dietary GuidelinesThe landscape of nutrition science and dietary guidelines is constantly evolving, reflecting new research and societal needs. Imagine a world where dietary recommendations are not just about what we eat, but how our choices impact the planet and future generations. This is the direction in which policy shifts are taking us.The Evolution of Dietary Guidelines: Over the years, dietary guidelines have shifted from focusing solely on individual nutrients to a more holistic approach that considers overall dietary patterns. This change reflects a growing understanding that the synergy of foods consumed together can have a greater impact on health than individual nutrients alone.Incorporating Sustainability: Recent policy shifts have begun to incorporate sustainability into dietary guidelines. This means considering the environmental impact of food production and encouraging diets that are not only healthy but also environmentally friendly. This approach aims to promote food systems that support both human health and the health of the planet.The Role of New Research: Advancements in nutrition science continue to inform policy changes. For example, emerging research on gut health and the microbiome is influencing guidelines to include more fiber-rich and fermented foods. These updates aim to address modern health challenges such as obesity and chronic diseases.Policy shifts in nutrition science and dietary guidelines are paving the way for a more comprehensive approach to health and sustainability. By embracing these changes, we can work towards a future where dietary recommendations support both individual well-being and the health of our planet.The Role of Soil Health in Sustainable FarmingSoil health is the cornerstone of sustainable farming, playing a crucial role in the productivity and resilience of agricultural systems. Imagine a world where the soil beneath our feet is teeming with life, supporting crops that nourish us and ecosystems that thrive. This is the vision of sustainable farming driven by healthy soil.Understanding Soil Health: Soil health refers to the soil's ability to function as a living ecosystem that sustains plants, animals, and humans. Healthy soil is rich in organic matter, teeming with microorganisms, and capable of retaining water and nutrients. These characteristics are essential for sustainable farming practices that aim to produce food while preserving natural resources.Benefits of Healthy Soil: Healthy soil contributes to increased crop yields, improved water retention, and reduced need for chemical inputs. It also plays a vital role in carbon sequestration, helping to mitigate climate change. By maintaining soil health, farmers can enhance the resilience of their crops to pests, diseases, and extreme weather events.Practices to Promote Soil Health: Sustainable farming practices such as crop rotation, cover cropping, and reduced tillage are key to maintaining soil health. These practices help to prevent soil erosion, improve soil structure, and promote biodiversity. By adopting these methods, farmers can create a more sustainable and productive agricultural system.Challenges and Opportunities for Small and Organic FarmsSmall and organic farms are at the forefront of sustainable agriculture, offering unique benefits to consumers and the environment. However, they also face distinct challenges in a rapidly changing agricultural landscape. Imagine a world where these farms thrive, providing healthy food and preserving biodiversity. This is the potential future we can work towards by understanding their challenges and opportunities.Challenges Facing Small and Organic Farms: One of the primary challenges for small and organic farms is access to markets. Competing with larger, conventional farms can be difficult due to economies of scale and distribution networks. Additionally, organic certification can be costly and time-consuming, posing a barrier for many small farmers. These challenges are compounded by the need for specialized knowledge and labor-intensive practices.Opportunities for Growth and Innovation: Despite these challenges, small and organic farms have unique opportunities to innovate and grow. The increasing consumer demand for organic and locally-sourced products provides a niche market that these farms can capitalize on. Direct-to-consumer sales models, such as farmers' markets and community-supported agriculture (CSA), offer ways to connect with consumers and build loyal customer bases.The Role of Technology and Collaboration: Technology can play a significant role in overcoming some of the challenges faced by small and organic farms. Innovations in precision agriculture, mobile apps for market access, and online platforms for direct sales can enhance efficiency and reach. Collaboration among farmers, through cooperatives or networks, can also provide shared resources and collective bargaining power.While small and organic farms face significant challenges, they also have unique opportunities to lead the way in sustainable agriculture. By embracing innovation and collaboration, these farms can thrive and contribute to a healthier, more sustainable food system. Get full access to Food is Health at foodishealth.substack.com/subscribe

THE LAST PRESCRIPTION: PODCAST SHOW NOTESEpisode SummaryA revolutionary future cast exploring how the American healthcare system transformed from treating disease to preventing it entirely. Set in 2038, this narrative traces the collapse of pharmacy benefit managers (PBMs), the merger of pharmaceutical companies with food producers, and the rise of "Heartland Marts" - grocery stores where every product promotes health. Follow the journey from Trump's 2025 pharmaceutical pricing ultimatum to a world where chronic disease has become obsolete.Key Themes• The Great Convergence: How pharmaceutical, food, and agricultural industries merged to create a prevention-based health system • Indigenous Wisdom Meets Modern Science: Traditional medicinal plants validated and scaled through pharmaceutical rigor• The Death of Middlemen: How PBMs and insurance companies collapsed when direct-to-consumer models emerged • Food as Prevention, Not Treatment: The shift from prescribing medications to engineering nutritious food • Technology as Invisible Support: AI and apps that guide health choices without conscious effortTimeline of Transformation2025 - The Catalyst • White House demands pharmaceutical companies match international pricing • GLP-1 drugs devastate ultra-processed food sales • Farmers face bankruptcy as commodity crop demand collapses • Pfizer's Albert Bourla asks: "What if we're in the wrong business?"2026 - The Recognition • Brightseed identifies 10,000 bioactive compounds in foods • Edacious reveals 50% nutrient decline since 1950 • Pharmaceutical companies partner with indigenous communities • FDA announces revolutionary safety-only regulations for chronic disease treatments2027 - The First Heartland Mart • Jake Wilson opens revolutionary grocery store in Seward, Nebraska • Monthly membership model: $99 individual/$249 family • Every product optimized for health • Insurance claims drop 60% in first year2028 - The Collapse • CVS Caremark, Express Scripts, OptumRx file bankruptcy • 7,000 pharmacies close in six months • Healthcare sector loses $2 trillion in market value • Life insurance companies pivot to "longevity services"2029-2030 - The Scaling • Apple launches invisible "Nutritional Support" in iOS 18 • USDA restructures subsidies around nutrient density • McDonald's becomes "McHealth" - "Billions Healed" • 10,000 new functional food products launched2031-2033 - Global Revolution • Japan achieves 92-year life expectancy • China mandates therapeutic food standards • Africa leapfrogs traditional healthcare entirely • WHO declares "The Year Health Won"Key PlayersVisionaries Jake Wilson → Nebraska farmer who created Heartland Mart Sarah Chen → CEO of HealthShift Markets Albert Bourla → Pfizer CEO who questioned pharma's purpose Maya Thompson → Walmart executive who spotted the trendScientists & Innovators Dr. Joseph Pizzorno → Discovered soil-health-human connection Jim Flatt → Brightseed CEO mapping food compounds Eric Smith → Edacious CEO exposing nutrient crisis Tom Mitchell → Insurance actuary turned health revolutionaryIndigenous Leaders Shawn Terry → Muscogee Creek Nation Health Secretary Various Lakota, Peruvian, and Amazonian medicine keepersRevolutionary ConceptsBusiness Model Innovation • Outcome-based pricing instead of volume • Membership groceries with health guarantees • Direct-to-consumer pharmaceutical sales • "Life extension services" replacing health insuranceScientific Breakthroughs • Mitochondrial health as foundation • Synergistic compounds in whole foods • Fermented foods producing natural peptides • Soil microbiome affecting human healthRegulatory Revolution • FDA focuses only on safety, not efficacy • Market determines what works through outcomes • 95% reduction in development costs via AI • Six-month approval instead of six yearsNotable Quotes"We spent billions developing drugs to treat diseases that could have been prevented with better nutrition. What if, instead of competing with food, we partnered with it?" → Albert Bourla, Pfizer CEO"We're not facing a healthcare crisis. We're facing a nutrition crisis that's creating a healthcare crisis." → Eric Smith, Edacious CEO"You spent fifty years profiting from reversible conditions. You can't just buy your way into wellness." → Jake Wilson to UnitedHealth Group"The best technology is invisible. You shouldn't have to think about health. It should just happen." → Tim Cook, Apple CEOTransformative OutcomesHealth Metrics Chronic disease prescriptions: 4.2 billion (2025) → 47 million (2038) Diabetes rates: 12% → 2% in four years (China) Cancer survival: 85% achievement rate Healthcare costs: 50% reduction in US GDP spendingIndustry Changes PBMs: Complete collapse and obsolescence Pharma: Split into acute care and food-health hybrids Agriculture: Shift from yield to nutrient density Grocery: Every store becomes a health centerSocietal Impact Crime reduction: 40% in areas with medicinal gardens Life expectancy: Increasing faster than time passing Education: Medical schools add culinary degrees Employment: Thousands of new jobs in food-health sectorKey Partnerships & Mergers• Pfizer + Unilever = "Vitality Foods" • Novo Nordisk + Yakult (fermented foods) • Johnson & Johnson splits into three companies • Indigenous tribes form top medicinal plant venture • Harvard Medical School + Culinary Institute of AmericaLessons for Today1. Prevention is more profitable than treatment 2. Ancient wisdom validated by modern science works best 3. Removing middlemen reduces costs and improves outcomes 4. When industries collaborate instead of compete, everyone wins 5. The best health interventions are invisible to the user 6. Food and medicine were never meant to be separateResources Mentioned• Brightseed AI platform for bioactive compounds • Edacious food testing and nutrient density data • HealthShift distribution model • Lumeris AI primary care system "TOM" • Indigenous medicinal plant knowledgeCall to ActionThis future cast challenges us to reimagine healthcare not as treating disease but as optimizing human potential. The question isn't whether this transformation will happen, but who will lead it and how quickly we can achieve it."The last prescription had been written not because medicine had failed, but because it had finally succeeded in making itself unnecessary." 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Episode OverviewThis episode features a "future cast" - a work of speculative fiction that explores one possible future based on current trends and emerging technologies in regenerative agriculture, public land management, and rural economics. While the companies, technologies, and political figures mentioned are real, the events described are fictional scenarios designed to help visualize potential outcomes if current innovations in ranching, soil health, and carbon markets converge in transformative ways.Story SynopsisSet between 2026-2040, this future history follows the transformation of America's 245 million acres of Bureau of Land Management (BLM) grazing land into the world's largest regenerative agriculture experiment. The story centers on RC Carter, an experienced rancher locked out of land ownership by inflated prices, who becomes a pioneer in the regenerative rangelands movement that revolutionizes American agriculture, healthcare, and rural communities.Key CharactersRC Carter - Experienced rancher who builds Carter Country Meats into a $42 billion company through regenerative practices on BLM landSenator Dr. Marcus Thompson - Small-town physician turned politician who authors the Regenerative Rangelands ActKelly Garrett - Real-life regenerative agriculture expert and "Chief Soil Officer" who becomes agriculture's most influential thought leaderNick Voss - Desert restoration specialist whose genetic innovations enable cattle to thrive on marginal landsDr. Lars Dyrud - EarthOptics scientist who develops satellite-based soil carbon measurementMajor Themes ExploredThe Land Access Crisis: How rising land prices have locked experienced ranchers out of ownership, and how BLM lease reform could democratize access to agricultural opportunityCarbon Markets & Climate Solutions: The potential for regenerative grazing to sequester massive amounts of carbon while generating revenue for rural communitiesSoil-Health-Human-Health Connection: The scientific links between soil biology, animal nutrition, and human health outcomesRural Economic Renaissance: How regenerative agriculture could revitalize struggling rural communities and reverse urban migrationPolitical & Industry Transformation: The potential alliance between environmental goals, agricultural profitability, and healthcare cost reductionTechnology Integration: How AI, satellites, blockchain, and biotech could optimize regenerative practices at landscape scaleChapter BreakdownChapters 1-2: The crisis setup and political catalyst (2026-2028) Chapters 3-5: Scientific breakthroughs and early adoption (2027-2029)Chapters 6-8: Business model revolution and consumer awakening (2029-2031) Chapters 9-10: Scaling and system-wide effects (2032-2033) Chapters 11-12: Global transformation and new industry giants (2034-2035) Epilogue: The view from 2040 - a transformed landscapeReal Companies & Technologies FeaturedEarthOptics: Actual soil sensing technology companyMiraterra: Real soil spectroscopy technologyHerddog: Virtual fencing and livestock management platformHolobiome: Microbiome research companyEdacious: Food traceability and nutrient density platformCalibrated Agronomy: Kelly Garrett's real consulting companyKey Data Points from the Future Cast245 million acres of BLM land transformed$500 billion in healthcare savings600 million tons of CO2 sequestered annuallyRural unemployment eliminated60% reduction in chronic disease rates$18 billion in annual carbon credit revenueImportant DisclaimersThis is speculative fiction, not:Investment advice or financial recommendationsPredictive analysis or guaranteed outcomesPolitical advocacy or policy prescriptionsMedical or health advicePurpose: This future cast serves as a thought experiment to explore what might be possible if economic incentives were aligned with regenerative agriculture, soil health, and rural prosperity. It's designed to help listeners visualize potential pathways forward based on technologies and trends that exist today.Discussion QuestionsCould regenerative agriculture really sequester enough carbon to meaningfully impact climate change?What would it take to make BLM land management more economically productive?How might the intersection of healthcare costs and food quality drive agricultural transformation?What role could technology play in scaling regenerative practices?How might rural communities be revitalized through agricultural innovation?Resources for Further ExplorationKelly Garrett's work: Calibrated Agronomy and regenerative farming educationAlan Savory: Holistic Management and regenerative grazing pioneerEarthOptics & Miraterra: Real soil sensing technologiesBLM Grazing Statistics: Current utilization and economics of public rangelandCarbon Market Development: Current state of agricultural carbon creditsEpisode LengthApproximately [X] minutesCreditsBased on original future cast writing exploring regenerative agriculture possibilities through speculative storytelling.Remember: This is a work of fiction designed to explore possibilities, not predictions. Actual results may vary significantly from these imagined scenarios. Get full access to Food is Health at foodishealth.substack.com/subscribe

"A Future History of the Nutrient Density Revolution"This episode features a "future cast" - a work of speculative fiction that explores one possible future based on current trends and emerging technologies in food, agriculture, and healthcare. While the companies and technologies mentioned are real, the events described are fictional scenarios designed to help visualize potential outcomes if current innovations converge in transformative ways.What This Future Cast Explores:The story follows the transformation of a struggling Dollar General store in rural Tennessee into "Heartland Mart" - a revolutionary grocery chain that becomes the catalyst for America's nutrient density revolution from 2023 to 2036.Key Themes Covered:The Grocery Store as Healthcare Hub: How transparent nutrient density scoring and metabolic testing transforms shopping into preventive medicineSoil-to-Cell Connection: The scientific discovery linking soil health directly to human cellular function and the gut microbiomeRegenerative Agriculture Economics: How premium pricing for nutrient-dense food makes regenerative farming more profitable than industrial agricultureHealthcare System Transformation: The collapse of chronic disease rates and healthcare costs when communities gain access to truly nutritious foodRural Renaissance: How the nutrient density revolution revitalizes small-town America and reverses urban migrationGlobal Impact: The worldwide adoption of the model and its effects on climate, biodiversity, and human potentialPurpose: This future cast serves as a thought experiment to explore what might be possible if we aligned economic incentives with soil health, human health, and planetary health. It's not a prediction, but rather a vision of one potential path forward based on technologies and trends that exist today.Disclaimer: This is speculative fiction, not investment advice or predictive analysis. Actual results may vary significantly from these imagined scenarios. Get full access to Food is Health at foodishealth.substack.com/subscribe

IntroductionYou may remember the first part of this story from a few weeks ago. How Heartland Mart became the epicenter of a revolution that transformed American agriculture, led to the collapse of healthcare costs by 47%, and proved that the shortest distance between soil and health runs straight through a rural grocery store. It all began with an old Dollar General on Highway 41 that was repurposed to offer affordable nutrition and prioritized nutrient density.The story began with Marcus Chen, the store's "Nutrition Navigator"—a job title that didn't exist when this was still a Dollar General—standing in front of a digital display that shows real-time nutrient density scores for the day's produce, traced back to the exact field where each item was grown. A bushel of sweet corn from the Hendricks farm twelve miles away glows with a golden "97" score. Next to it, imported corn from an industrial operation shows a dismal "31."Today's FutureCast is another important chapter in that story. The one that dives deeper into how Heartland Mart went from soil minerals to metabolic impact because once customers could see the difference, everything changed. And how this links to the story of The Healthspan Revolution and Healthspitals.But First a Disclaimer: This is a "future cast" - a fictional exploration of one possible future based on current trends and emerging technologies. While the companies and technologies mentioned are real, the events described are speculative fiction intended to help visualize potential outcomes. Like any forward-looking statement, actual results may vary significantly. This is not investment advice, predictive analysis, or a guarantee of future events. Consider it a thought experiment in what could be possible if current innovations in food, agriculture, and healthcare converge in transformative ways.Memphis, Tennessee, 2037Maria Rodriguez stands in the produce aisle of Heartland Mart, her smart cart glowing with a soft green light as she reaches for a bundle of kale. The moment her hand breaks the invisible sensor field around the vegetables, her cart display springs to life."Based on your current inflammation markers and this morning's glucose pattern, this Purple Moon kale will reduce your C-reactive protein by approximately 18% within 72 hours, Your sleep quality score should improve by 2.3 points tonight if consumed with dinner." The display notedMaria smiles, remembering her first visit here three years ago. She'd been skeptical, even scared of all the technology. But Jennifer, one of the store's Nutrition Navigators, had walked her through everything. "Think of me as your translator, The technology knows the science, but I help you understand what it means for your life.""The grocery store became our pharmacy, our nutritionist, our health coach, and our community center all at once. My doctor still oversees my clinical needs, but now she prescribes foods and lifestyle instead of pills." — Maria Rodriguez, Memphis residentAround her, the store pulses with purposeful activity. Near the entrance, new customers sit with Nutrition Navigators for their onboarding sessions, learning to interpret their metabolic data. A grandfather receives real-time coaching on reversing his pre-diabetes, his plan approved by Dr. Martinez at the Memphis Lifestyle Medicine Clinic. In the community coaching corner, a group of construction workers compare their metabolic improvements on the leader board, their employer's wellness physician stopping by weekly to review progress.This is the story of how a digital revolution in grocery stores, powered by personal health data, community incentives, and collaborative healthcare, transformed how America prevents and reverses chronic disease. How physicians evolved from prescribing pills to designing nutrition protocols. How a simple coin system aligned individual health with collective wealth. How human counselors and advanced technology worked in harmony to make the healthy choice the easy choice. How the most advanced medical insights were deployed not in hospitals or clinics, but in the place where health actually begins: the grocery aisle.Chapter 1: The Healthcare Apocalypse That Wasn'tMontrose, Colorado, January 2027Dr. James Chen stared at the projections on his screen at Montrose Regional Hospital. If current trends continued, healthcare would consume 35% of GDP by 2035. Chronic disease rates were exponential. And with the Medicare and Medicaid cuts that just kept coming, the system was collapsing under its own weight."We had access to the most advanced medical technology in human history," Chen later recalled. "MRI machines that could see individual neurons. Surgical robots with superhuman precision. AI that could diagnose rare diseases. And none of it mattered because we were treating symptoms, not causes."The Wellness Institute at MIT had just published devastating research. Their analysis of 10 million patient records showed that only 2.8% of chronic disease cases were successfully reversed through medical intervention alone. The other 97.2% remained on medications for life, accumulating side effects and costs."We were a repair shop that never fixed the root cause. Imagine a mechanic who only treats engine damage but never mentions you're putting sugar in your gas tank." — Dr. James ChenMeanwhile, in the board room, venture capitalist Sarah Kim was meeting with the hospital board. Her firm, Nutrition & Lifestyle First Capital, had a radical proposal: What if they stopped trying to fix healthcare and started "rightsizing" it?"I showed them data from our pilot programs," Kim explained. "Grocery stores equipped with metabolic monitoring, personalized nutrition guidance and lifestyle modification support were achieving 73% reversal rates for type 2 diabetes. No medications. No procedures. Just food and behavior change, guided by technology and clinical oversight by lifestyle medicine board certified clinicians (Primary Care Physicians were repurposed from draining margin to bolstering change)."The board was skeptical until Kim showed them the economics. The average diabetic patient generated $400,000 in lifetime medical costs. The average cost to reverse diabetes through precision nutrition? $12,000, mostly in technology and coaching."The numbers were so stark that keeping the current system seemed criminally negligent," reflected Dr. Margaret Wu, the hospital's CEO. "We were literally profiting from keeping people sick."By March, Montrose Regional announced a shocking pivot. They would transition from a treatment center to a prevention hub, with their first initiative being a partnership with local grocery stores to prevent the diseases they once treated.The medical establishment erupted. The American Medical Association called it "dangerous experimentation." Pharmaceutical companies threatened lawsuits. Insurance companies warned of catastrophe.They were right about one thing: It was catastrophic. For them.Chapter 2: The Quantified Kitchen RevolutionAustin, Texas, March 2028Jennifer Walsh had worn a continuous glucose monitor for two years, tracking her blood sugar responses to every meal. She thought she understood her metabolism. Then she walked into the first NutriSense Market, a converted Whole Foods that had become ground zero for the quantified nutrition movement."Let me introduce you to Sarah first," suggested Marcus, the store's lead Nutrition Navigator. "She'll help you understand what all this technology means for your specific health journey."Sarah Chen, a certified lifestyle medicine coach, greeted Walsh warmly. "First time with the full system? I know it can feel overwhelming. Think of me as your guide. The technology provides incredible insights, but I'm here to help you understand what matters most for you."After a 20-minute consultation where Sarah reviewed Walsh's health goals and explained how her physician Dr. Joseph from St. Francis Lifestyle Medicine Center would oversee her nutrition protocol, she handed Walsh the AR preview glasses."Your doctor, Dr. Joseph, has already reviewed your metabolic profile and set your optimization parameters," Sarah explained. "He'll check in monthly, but I'm here every day if you need help."The moment Walsh put the glasses on, the store transformed. Every product glowed with a personalized aura. Green meant optimal for her current metabolic state. Yellow meant neutral. Red meant inflammatory. But it wasn't just simple categorization—each product displayed real-time predictions.A package of wild salmon pulsed with data: "Omega-3 content will improve your morning cognitive function by ~15%. Optimal consumption time: 6 PM for maximum sleep quality benefit. Pairs well with items in your cart for 34% better nutrient absorption.""We don't sell food anymore. We sell future health states, precisely quantified and personalized." — David Martinez, NutriSense Market CEOThe technology stack was staggering. Her continuous glucose monitor fed data to the store's AI through her phone. Her Ultrahuman ring powered by Medikarma contributed sleep and recovery metrics. Her Viome gut microbiome test results were integrated. Even her Levels breath acetone monitor, checking fat-burning in real-time, influenced the recommendations.But the real breakthrough was the prediction engine. Using data from 50 million users, the system could forecast with 89% accuracy how any food combination would affect her energy, mood, inflammation, and even her likelihood of craving junk food later.Walsh picked up a bag of macadamia nuts. Her glasses displayed: "Warning: Your current omega-6 to omega-3 ratio is 12:1. These nuts will push it to 15:1, increasing inflammatory markers. Alternative suggestion: walnuts (will improve ratio to 8:1)."The store's AI wasn't just reactive—it was proactive. As Walsh approached the dairy section, her glasses highlighted a specific yogurt. "Based on your last three days of data, your gut bacteria populations suggest you need more Lactobacillus rhamnosus. This yogurt strain shows 92% genomic match to your optimal profile.""It was like having a team of lifestyle medicine board certified clinicians—nutritionists, PCPs, endocrinologists, cardiologists, gastroenterologists along with data scientists guiding every food choice," Walsh said. "Except it was better because it was based on my actual body, not population averages."By the time Walsh checked out, her cart had been optimized not just for nutrition, but for her specific goals: reducing inflammation, improving sleep quality, and stabilizing energy throughout her workday. The receipt showed more than prices—it showed predicted health outcomes."Total Health Impact Score: +47 (Excellent). Predicted outcomes: Inflammation reduction: -23%, Sleep quality improvement: +19%, Sustained energy increase: +34%, Craving reduction: -56%."The cost? Her grocery bill was $147, about 20% higher than her usual shop. But her employer, Dell Technologies, covered the difference through their FoodCare Benefits program, knowing that optimized nutrition meant lower healthcare costs, fewer sick days and higher productivity.Chapter 3: The Birth of Nutrition CurrencySeattle, Washington, September 2029The idea came from an unlikely source: a Reddit forum for biohackers struggling to afford quality food. User "MetabolicMike" posted a frustrated rant: "I know exactly what foods would fix my pre-diabetes. I have all the data. But organic, regenerative food that I can buy from local farmers costs twice as much as the processed crap that's killing me. The system is broken. We need affordable nutrition."The response that changed everything came from "BlockchainBrenda": "What if eating healthy earned you money? What if society paid you to prevent disease instead of waiting to treat it?"Within 72 hours, the thread had 50,000 responses. Developers, economists, nutritionists, and patients collaborated on what would become the NutriCoin protocol—the first decentralized autonomous organization (DAO) designed to incentivize healthy eating."We realized the fundamental problem: The costs of poor nutrition are socialized, but the costs of good nutrition are individualized. We needed to flip that." — Brenda Zhang, NutriCoin co-founderThe system was elegantly simple:Every healthy food purchase earned NutriCoins based on its predicted health impactCoins could be redeemed for discounts on future healthy purchasesCommunity members could donate coins to those in needEmployers and insurers could contribute to coin poolsThe unhealthier the food avoided, the more coins earnedBut the genius was in the governance. The DAO operated on transparent smart contracts. When someone chose steel-cut oats over sugary cereal, the system calculated the statistical healthcare costs avoided—$0.47 in future diabetes treatment, $0.23 in cardiovascular care, $0.18 in obesity-related costs—and awarded coins accordingly."Every purchase became a vote for personal and collective health. The invisible hand of the market finally had a conscience." — Dr. Robert Kim, Health EconomistMicrosoft was the first major employer to integrate NutriCoin into their benefits. Employees who made healthy food choices earned coins that could offset grocery costs, gym memberships, or even be donated to food-insecure colleagues. Within six months, Microsoft reported a 31% reduction in healthcare claims.The government took notice. SNAP benefits were reformed to work through the NutriCoin system. Instead of restrictions on what couldn't be bought, the system incentivized what should be bought. A SNAP recipient choosing nutrient-dense vegetables earned bonus coins, effectively stretching their benefits by 40%.Chapter 4: The Community TransformationBirmingham, Alabama, November 2030The old Piggly Wiggly on the south side had been a food desert staple: processed foods, sugary drinks, and produce that looked tired before it hit the shelves. When it reopened as a Community Nutrition Hub, the transformation was more than physical."First thing I noticed was the sound," recalled Tara Washington, a local teacher. "The store was... alive. People talking, laughing, comparing notes. It wasn't shopping; it was a gathering, something we had lost."The center of the store had been transformed into the Community Metabolic Arena, a space where shoppers could see real-time displays of the neighborhood's collective health improvement. A massive screen showed anonymized, aggregated data:"Birmingham South Side Health Score: 72/100 (Up 8 points this month!)"Average inflammation: Down 34%Diabetes reversal rate: 67%Community NutriCoin pool: 847,000 coinsAvailable for neighbors in need: 234,000 coins"We gamified getting healthy, but at the neighborhood level. Your choices didn't just affect you; they lifted everyone." — DeShawn Miller, Community Nutrition Hub managerThe social dynamics were revolutionary. Shopping parties formed spontaneously—groups of neighbors helping each other optimize their carts. The store's AI would suggest "community challenges": if 100 people chose omega-3 rich foods this week, everyone earned bonus coins.The store employed twelve full-time Nutrition Navigators, each trained in lifestyle medicine coaching. They weren't there to replace doctors but to bridge the gap between medical advice and daily food choices. Dr. Patricia Williams, who transitioned from traditional practice to become the store's Clinical Liaison, held office hours three days a week."I still practice medicine," Dr. Williams explained. "But instead of seeing patients after they're sick, I help them navigate food choices to stay well. I review everyone's nutrition protocols, adjust as needed, and coordinate with their primary care physicians. It's medicine at its most effective—prevention at the source."Peer coaches emerged organically. Robert Thompson, a retired mechanic who'd reversed his diabetes, held court near the meat section every Tuesday, showing newcomers how to read their metabolic responses. His informal classes drew dozens of participants, with Dr. Williams often stopping by to add clinical context."Big Rob saved my life," said Marcus Green, a bus driver. "Doctors gave me pills and sent me home. Rob taught me to read my body like I read my engine diagnostics. Dr. Williams confirmed my progress every month. Haven't needed medication in 18 months."The store's Meta Health Corners offered free consultations with AI-powered health coaches and human health coaches depending on need. These weren't medical professionals but trained community members who could interpret data and suggest food strategies. The AI provided the analysis; humans provided the encouragement and accountability."Medical school taught me to prescribe medications. The grocery store taught me to prescribe mushrooms." — Dr. Patricia Williams, who left her practice to become a Community Health CoachThe leaderboards became a source of pride. Families competed for the "Most Improved Metabolic Health" award. Churches organized "Congregational Health Challenges." The local high school's football team credited their state championship to optimized nutrition, with players shopping together every Sunday.But the most profound change was economic. As the community's health improved, local businesses thrived. Sick days plummeted. Energy levels soared. The virtuous cycle of health creating wealth creating more health transformed one of Alabama's poorest neighborhoods into a model of vitality.Chapter 5: The Science of NudgesPalo Alto, California, January 2035Inside the Behavior Design Lab at Stanford, Dr. Lisa Park was obsessing over shopping cart handles. Her team had spent six months perfecting the haptic feedback system that would become standard in every smart cart nationwide."We discovered that gentle vibrations at specific frequencies could influence decision-making without conscious awareness," Park explained. "A 40Hz pulse increased likelihood of choosing anti-inflammatory foods by 23%."The shopping cart had evolved from a simple basket to a sophisticated behavior modification device. The handle monitored galvanic skin response, detecting stress levels. The wheels contained weight sensors that tracked not just what you bought, but your shopping patterns, speed, hesitation, and decision-making rhythms."Every micro-behavior told us something. Hesitation in the cookie aisle while stressed? The cart would gently steer toward the fruit section." — Dr. Lisa ParkThe nudge technology was controversial but effective:Visual Nudges: Products optimal for your current health state literally glowed on the shelvesAuditory Nudges: Personalized music that subconsciously guided healthier choicesHaptic Nudges: Gentle vibrations that rewarded good choicesSocial Nudges: Notifications when friends made inspiring health improvementsTemporal Nudges: Reminders of how you'd feel in 2 hours based on your choiceThe most powerful nudge was the "Future You" visualization. Point your phone at any product, and AR would show two versions of yourself: one after a month of eating this food regularly, another after avoiding it. The visualizations were based on real data from millions of users with similar genetics and health markers."Seeing myself with clearer skin and brighter eyes from choosing wild-caught salmon over farm-raised was more motivating than any nutrition label," said tech worker Amanda Chen.The carts became so intelligent they could predict cravings before they hit. If your stress levels suggested you were about to binge on ice cream, the cart would proactively suggest frozen berries with coconut cream, displaying exactly how this swap would affect your mood and energy."We weren't controlling choice; we were illuminating consequences. Free will with full information." — Dr. B.J. Fogg, Stanford Behavior DesignCritics argued it was manipulation. Supporters countered that the previous system, where food companies spent billions engineering addiction, was the real manipulation. The smart carts simply leveled the playing field.The results spoke for themselves. In stores with full nudge implementation:Impulse purchases of inflammatory foods: Down 78%Adherence to personal health goals: Up 84%Shopping satisfaction scores: Up 91%Average health improvement: 4.2x faster than control storesChapter 6: The Healthcare EvolutionTulsa, Oklahoma, March 2035The St. Francis's quarterly board meeting was surprisingly optimistic. While traditional patient volumes had dropped 64% in three years, their new Lifestyle Medicine Partnership program was thriving."We didn't lose our purpose," explained CEO Dr. Richard Stevens. "We evolved it. Instead of treating chronic disease, we can reverse it and now even provide clinical oversight for prevention at scale."The transformation created a new healthcare model:Physicians designed and monitored personalized nutrition protocolsLifestyle medicine specialists held regular hours at Heartland MartsNurses became certified Nutrition NavigatorsPharmacists transitioned to "Farmacists," experts in food-drug interactionsSpecialists focused on optimizing treatments rather than managing disease"We went from being siloed with grocery stores to partnering with them. The results speak for themselves." — Dr. Richard StevensThe new structure included:200 physicians providing remote oversight for 2 million nutrition protocols500 lifestyle medicine counselors embedded in local stores and via wearable devicesMonthly check-ins replacing quarterly sick visitsPrevention bonuses replacing procedure feesCollaborative care teams including doctors, nutritionists, and community coachesThe numbers told the story:Type 2 diabetes diagnoses: Down 79%Medication needs: Reduced 67% (with physician supervision of tapering)Patient satisfaction: Up 91%Physician burnout: Down 73%Healthcare costs: Decreased 52%"I see 100 patients a day now, but they're all getting healthier," said Dr. James Chen, who added lifestyle medicine board certification to endocrinology. "I review their lifestyle including food choices, adjust protocols, support change and celebrate victories. It's why I became a doctor."Insurance companies evolved their models too. United Health's "Collaborative Care" program covered:Physician protocol design and oversight: $50/month per patientWeekly Nutrition Navigator sessions: Fully coveredContinuous monitoring and adjustments: IncludedTraditional sick care when needed: Still available"We were able to reimagine health insurance benefits to support health once nutrient density and affordable nutrition became the standard and personalized nutrition was part of everyday life." — Jennifer Walsh, United Health CEOMedical schools scrambled to adapt. The traditional curriculum of diagnosis and prescription became obsolete. It was through the early leaders such as Alice Walton with her new medical school in 2025 that started the shift. New programs focused on:Metabolic optimizationNutritional genomicsBehavioral transformationCommunity health designFood system architectureYoung doctors no longer dreamed of specialty practices. They aspired to become Chief Nutrition Officers at grocery chains or for CPGs, where they could prevent and reverse disease at scale rather than treat it individually.Chapter 7: The Algorithm of LifeSan Francisco, California, June 2035The breakthrough came at 2:47 AM in a small apartment above a Korean grocery. Yuki Tanaka, a former Google engineer, had been working on the problem for three years: How to create an AI that could predict optimal nutrition not just for health, but for specific life performance."Everyone was focused on preventing disease," Tanaka explained. "I wanted to optimize life itself. What foods would make a pianist play better? Help a programmer code more creatively? Enable a parent to be more patient?"Her creation, the Life Optimization Algorithm (LOA), analyzed millions of data points:Genetic markersMicrobiome compositionSleep patternsStress responsesCognitive performance metricsEmotional regulation patternsCreative output measurementsSocial interaction quality"Food wasn't just fuel or medicine. It was a programming language for human performance." — Yuki TanakaThe algorithm discovered stunning correlations:Specific mushroom compounds improved musical creativity by 34%Fermented foods enhanced emotional resilience in social situationsParticular amino acid combinations boosted coding efficiencyTimed carbohydrate intake optimized parental patienceWithin months, LOA was integrated into every major grocery platform. Shoppers didn't just scan for health; they scanned for life goals:"Preparing for job interview" generated a meal plan to optimize confidence and clarity"Training for marathon" created nutrition protocols for endurance and recovery"Studying for exams" suggested foods for memory consolidation and focus"Trying to conceive" provided fertility-optimizing nutrition plansThe personalization went beyond individual optimization. LOA learned relationship dynamics. Couples could shop for "relationship harmony," receiving food suggestions that balanced both partners' neurotransmitters for better communication."My marriage was saved by Brussels sprouts," laughed software engineer David Kim. "Turns out, when we both ate cruciferous vegetables, our arguments decreased by 70%. The sulfur compounds helped us both process stress without taking it out on each other."Chapter 8: The Shelf-Stable RevolutionKansas City, Missouri, August 2035Everyone assumed the nutrition revolution would bypass packaged foods. Big Food would resist, processed products would remain toxic, and the movement would stay limited to fresh produce. Everyone was wrong.The transformation began at Thrive Naturals, a startup that asked a simple question: "What if shelf-stable could be more nutritious than fresh?""Fresh produce loses nutrients every hour after harvest," explained CEO Dr. Priya Patel. "We realized that properly processed foods could lock in peak nutrition indefinitely."Their breakthrough was the NutriLock process:Harvest at peak nutrient densityFlash-process within 2 hoursPreserve using natural fermentationPackage with nitrogen flushResult: 94% nutrient retention for 2+ years"A two-year-old jar of our fermented vegetables had more bioavailable nutrients than fresh vegetables from most grocery stores." — Dr. Priya PatelBig Food companies, seeing their market share evaporate, pivoted hard. General Mills acquired six regenerative farming operations and launched "Ancient Future," a line of shelf-stable products that scored 85+ on nutrient density scales.Kraft Heinz shocked the industry by open-sourcing their reformulation research. Their "Project Phoenix" showed how to transform any processed food into a functional medicine:Mac and cheese with added prebiotics and resistant starchKetchup fermented with beneficial bacteriaCrackers made from sprouted ancient grainsCookies that improved gut healthThe transformation reached frozen foods. Advanced freezing techniques preserved not just nutrients but beneficial enzymes and probiotics. A frozen pizza could now be more nutritious than most restaurant meals."We kept the convenience America loved but added the nutrition America needed." — Roberto Silva, Kraft Heinz Chief Innovation OfficerChapter 9: The Super App RevolutionLos Angeles, California, October 2035Sarah Chen's phone buzzed softly. "Based on your cortisol spike 20 minutes ago and upcoming deadline, stop by Heartland Mart in the next hour for your personalized stress-response nutrition protocol."The NutriLife super app had become the control center for 100 million Americans' health. Modeled after WeChat but focused entirely on metabolic optimization, it integrated:Real-time biometric monitoringGrocery shopping and meal planningCooking classes and community mealsRestaurant ordering with metabolic matchingSocial features and community challengesHealth coaching and peer supportFinancial rewards and NutriCoin managementPredictive health alertsLife performance optimization"It wasn't just an app. It was your metabolic co-pilot, nutritionist, coach, and accountability partner in your pocket." — Sarah Chen, early adopterThe app's intelligence was breathtaking. It learned your patterns, preferences, and responses. It knew that you craved sugar when stressed, so it preemptively suggested alternatives. It recognized that your sleep suffered after late-night cheese, so it reminded you at 7 PM.But the killer feature was Metabolic Matching for restaurants. Open the app near any restaurant, and it would instantly analyze the menu, showing exactly which dishes would optimize your current state. Restaurants competed to offer the most metabolically friendly options."Date night became 'optimization night.' Couples would compete to find restaurants where they could both eat perfectly for their biology." — Marcus Thompson, restaurant criticThe social features transformed health from a solitary to a community journey. The "Metabolic Tribes" feature connected people with similar health goals and genetic profiles. Late-night craving support groups formed spontaneously. Victory celebrations when someone reversed a condition went viral.The app even integrated with dating platforms. "Metabolic Compatibility" became a key matching criterion. Couples with aligned nutrition needs reported 40% higher relationship satisfaction.Chapter 10: The New Economics of NutritionNew York City, November 2035The New York Stock Exchange had seen many historic moments, but nothing quite like this. NutriDAO was about to become the first trillion-dollar organization with no CEO, no headquarters, and no traditional structure."We're witnessing the birth of a new economic model," announced Bloomberg analyst Maria Rodriguez. "Value creation through value prevention. Profits from optimization, not exploitation."The economics were staggering:Healthcare costs: Down $1.4 trillion annuallyProductivity gains: Up $800 billion annuallyReduced sick days: Saving $400 billion annuallyIncreased healthspan: Adding $2 trillion in economic valueTotal economic impact: $4.6 trillion per year"The sick-care industrial complex fought hard, but math doesn't lie. Healthy people create more value than sick ones. Healthcare was right-sized." — Dr. James Morrison, EconomistThe transformation reached unexpected sectors:Real Estate: Properties near Community Nutrition Hubs commanded 45% premiums. Developers built "Metabolic Communities" with integrated food systems.Education: Schools with optimized nutrition programs saw test scores rise 38%. Harvard launched the first "Nutritional Excellence" admission track.Criminal Justice: Prisons implementing precision nutrition saw violence drop 67% and recidivism fall 54%.Finance: "Health Bonds" backed by community nutrition improvements became the hottest investment. Cities issued bonds to fund grocery store conversions, paid back through reduced healthcare costs.The gig economy transformed. "Metabolic Coaches" earned more than software engineers. "Nutrition Navigators" became the fastest-growing profession. "Community Health Architects" designed food systems for optimal population health.Traditional power structures crumbled. Pharmaceutical companies either pivoted to nutrition or disappeared. Insurance companies became health investment firms. Hospitals became optimization centers."We didn't reform healthcare. We made it irrelevant for 80% of what killed people." — Sarah Kim, Nutrition First CapitalChapter 11: The Global AwakeningGeneva, Switzerland, January 2036The World Health Organization's emergency session had been called to address a crisis, but a positive one. Global chronic disease rates were plummeting so fast that entire economies built on sick-care were collapsing."We face a crisis of success," admitted WHO Director-General Dr. Chen Wei. "Health is spreading faster than our systems can adapt."The American model was being replicated worldwide:India's "Bharat Nutrition" connected 800 million people to optimized food systems with physician oversightChina's "Health Harmony" program integrated Traditional Chinese Medicine practitioners with metabolic trackingBrazil's "Favela Fresh" brought Community Nutrition Hubs with local doctors to every neighborhoodNigeria's "Africa Eats" platform connected traditional healers with modern nutrition science"Every culture had wisdom about food and health. We just gave them tools to prove and scale that wisdom, while keeping their healers central to the process." — Dr. Adaora Okonkwo, Africa Health InitiativeThe global impact was transformative:Diabetes prevalence: From 10.5% to 2.1% worldwideMental health conditions: Down 64% globallyCardiovascular disease: Reduced by 71%Healthcare spending: From 10% to 4% of global GDP (shifted from treatment to prevention)Life expectancy: Increased by 11 years averagePhysician satisfaction: Up 82% globally as roles shifted to preventionBut the real revolution was in human potential. With optimized nutrition, humanity experienced a cognitive renaissance:Average IQ increased 12 pointsCreative output doubledWorkplace productivity rose 45%Social cohesion improved dramaticallyViolence decreased 58% globally"We discovered that most of human suffering and limitation was simply malnutrition disguised as normalcy." — Dr. Chen WeiChapter 12: The Store as CathedralNashville, Tennessee, December 2036I'm standing in the Heartland Mart where it all began, but it's unrecognizable from its Dollar General days. The space has become something between a grocery store, a community center, a health clinic, and a temple to human optimization. It sits across the street from the Healthspital Collective where the community gathers daily for meals and movement. Between Heartland Mart and the Healthspital, all aspects of personal healthspan are frictionless. It's about thriving, not surviving.The morning Metabolic Mass is beginning, a daily ritual where community members gather to share victories, seek support, and plan their health journeys. Elder Thompson, who reversed his diabetes four years ago, leads the gathering."We gather not to worship, but to witness," he intones. "To witness the miracle of transformation that happens when we align our choices with our biology."The store pulses with purpose. In the Optimization Chambers, individuals receive real-time biofeedback while selecting foods. The Community Kitchen hosts classes where grandmothers teach teenagers to ferment vegetables while teenagers teach grandmothers to read their metabolic data."This isn't shopping. It's communion. With our food, our community, our optimal selves." — Elder ThompsonThe Children's Metabolic Garden, inspired by Big Green and the Green Bronx Machine back in 2025, showcases the next generation. Kids as young as five understand their genetic variants, microbiome composition, and optimal nutrition strategies. They grow food, test its nutrient density, and track how it affects their performance in school."My daughter talks about her mitochondria like previous generations talked about their toys," laughs parent Jennifer Martinez. "She optimizes her breakfast for her spelling test. It's a different world."The Wisdom Wall displays thousands of testimonials:"62 pounds lost, diabetes reversed, life reclaimed""Off antidepressants after 20 years""Autoimmune condition in complete remission""Running marathons at 70""Clear skin, clear mind, clear purpose"But beyond individual transformations, the store has become the beating heart of community resilience. During the recent economic downturn, the community's NutriCoin reserves ensured no one went without optimal nutrition. Crime virtually disappeared. Teen pregnancy dropped 80%. College acceptance rates tripled."We proved that a grocery store could be the foundation of civilization." — Susan Whitfield, Heartland Mart founderEpilogue: The Choice PointMemphis, Tennessee, January 2037Maria Rodriguez finishes her shopping, her cart perfectly optimized for her upcoming week. The receipt shows not prices and products, but promises and probabilities:"This week's nutrition will likely result in:Energy levels: Sustained high throughout workdaySleep quality: 8.2 hours average, 23% deep sleepMood stability: 91% positive outlook probabilityInflammation: Continuing downward trendHealthspan impact: +3.2 days added to healthspan"She pauses at the exit, remembering her grandmother who died at 58 from complications of diabetes, her mother who struggled with depression, her brother who battled obesity. All preventable. All tragic. All ancient history now."We had a choice," Maria reflects. "Continue accepting that sickness was normal, or demand that health was possible. The technology just made the choice visible."The transformation wasn't without challenges. Old systems resisted. Some physicians felt threatened before realizing they could practice prevention instead of just treatment. But the partnership model, where doctors provided oversight while stores provided daily support, proved irresistible. Results spoke louder than skepticism."We didn't need to eliminate healthcare. We needed to redirect it upstream." — Maria RodriguezAs Maria loads her groceries, her daughter asks, "Mom, why do we still go to Dr. Chen if we don't get sick anymore?"Maria smiles. "Dr. Chen helps design our nutrition plan, honey. She makes sure what we eat keeps us healthy. It's like having a coach instead of waiting for a repair person."Her daughter nods. "So doctors keep us healthy instead of fixing us when we break?""Exactly, baby. And the nice people at the store, like Miss Jennifer, help us follow the plan every day."The future hadn't eliminated healthcare—it had transformed it. Doctors still mattered, perhaps more than ever, but their role had evolved from treating disease to optimizing human potential. The vast majority of chronic conditions that had plagued humanity were prevented at their source: the intersection of food choice and human biology.The grocery store had become our daily pharmacy. The Nutrition Navigators had become our health coaches. Our doctors had become our wellness architects. And food—real food, guided by both human wisdom and technological precision—had become our primary medicine.The revolution wasn't led by doctors or politicians or tech billionaires. It was led by ordinary people making extraordinary choices, one shopping trip at a time. They proved that the shortest distance between a sick society and a healthy one runs right through the produce aisle.Welcome to 2037. The aisles are smart. The food is affordable nutrition. The community has come together and ended the chronic disease epidemic.And it all started with a simple question: What if we made the healthy choice the easy choice?The answer changed everything. Get full access to Food is Health at foodishealth.substack.com/subscribe

Just a few months ago, Casey Means, MD (Casey’s Substack) took the main stage at the biggest US healthcare conference, Erin Martin and I were there and we recorded her. We’ve shared some of the highlights in the video above.Erin ran into her, I had serious FOMO!She is now the nominee for US Surgeon General. There is debate. There is excitement, there are naysayers. She is a co-founder, of Levels which put continuous glucose monitors on the map for many pre-diabetics with easy access to CGMs and an easy interface to track the results. She is a NYT best seller - Good Energy: The Surprising Connection Between Metabolism and Limitless Health To compare, our last Surgeon General was a Dr. Vivek Murthy, an internal medicine physician by training focused on youth e-cigarette use among youth, mental health stigma, the need for social connection and the opioid epidemic. Prior to Dr. Murthy we had Dr. Jerome Adams, an anesthesiologist, focused on opioid crisis, COVID-19 epidemic, health equity and community-based health initiatives and who prior to his appointment, was the Indiana State Health Commissioner. Like I’ve said before, let’s not kill the message even if we don’t like the messenger when the message is what is needed. It’s bold and it could lead to the systemic change we write about. For most on this substack, the message is music to the ears.As for the messenger I will let her speak for herself here. She has made her message clear over the past few years. Here are a few key quotes.I like to stay neutral and listen, but on this one, I’m Team Casey.“We can’t have a healthy society without well-functioning humans. We can’t have well-functioning humans without well-functioning cells. And we can’t have well-functioning cells with mitochondrial dysfunction, oxidative stress, chronic inflammation, and cellular and hormone disruption from toxic chemicals in our food. We combat those things through nutrient-dense, unprocessed foods grown in living, thriving soil.”“More than anything, I would like to see our future White House rally Americans to be healthy and fit”“I think about metabolic dysfunction as the trunk of the tree of all these branches that are actually quite connected... erectile dysfunction is one tree, and depression is another tree, and dementia is another tree, and heart disease is another tree... Fundamentally, they’re all linked by this core process that is totally hijacked by our modern diet and lifestyles.”“What we know is that one of the key fundamental triggers of inflammation in the body is dysregulated blood sugar and metabolic dysfunction... And nine of the ten leading causes of death in the US are exacerbated by high blood sugar or metabolic dysfunction.” “We’re on track this year to have more new cancer cases than any year in human history... autoimmune diseases skyrocketing, depression, anxiety, skyrocketing... And we are somehow still buying into this idea that the more money we throw at the problem with the same approach that we’ve been doing, the better it’s gonna get — and that is totally false... they’re all fundamentally metabolic driven issues.” Get full access to Food is Health at foodishealth.substack.com/subscribe

Quick note - I have not absconded with Carter Williams, he is simply trying to avoid becoming an ice cube after the epic ice storm his community endured resulted in a loss of power that is now going into Day 4. Please send him “warm” wishes.I’ve been going through all of the episodes we recorded this past fall at the American College of Lifestyle Medicine Annual Conference and it dawned on me that although we talk alot about systemic redesign and the need for “health”care. We haven’t shared much about those tools and resources that exist today that could help us create actual by leveraging some of the current infrastructure/resources of the existing “Sick”care system. Even when we create actual “health”care, we will still need “sick”care. We just don’t need that to be our only option. We need both parallel paths. Pillars of HealthThere is no perfect care delivery model, there are just countless varieties and options. And in the end one of the biggest drivers to what will work in the future is cost vs. outcomes along with available resources. We often hear of things like Functional Health and Integrative Medicine but not as many folks have heard of Lifestyle Medicine. The concept is so simple it seems too good to be true. And regardless of the pillars, equally important is the concept of a framework to follow. Allopathic medicine is still delivered, but through the lens of managing the 6 pillars of “health”.ANY clinician can add Lifestyle Medicine board certification to their current certification. It’s about 6 months of part-time learning, attendance of the conference and passing a set of exams. Most can complete it within a year and arguably less depending on timing. There is no fancy tech or expensive meds or costly devices or procedures. It is brass tacks. When you listen to the podcast you will be reminded that lifestyle is actually the basis for pretty much every clinical guidelines.In essence Lifestyle Medicine is the foundation of healthcare. Not the other way around. It just so happens we have created an educational system that does it in reverse and an economic model that has the economic alignment backwards.Not long ago, Lifestyle Medicine had a stigma due to it’s initial conviction to exclusive plant-based eating but it has evolved, so has it’s acceptance of dietary diversity. Still however, whole food, plant heavy - which is the diet associated most with longevity regardless of specialty. So imaging adding the actual nutrient dense food to this approach and we are talking a true paradigm shift. This also lays out the basics for N of 1 / personalized medicine.The Unexpected Epicenter of a “Health”care System - TulsaMost everyone reading our substack knows Erin Martin and FreshRx Oklahoma. If you aren’t familiar, go now and learn more! She was on a previous episode of our podcast and it’s a great listen. Her program has become a national model for partnering with local regenerative farmers and using food as a true clinical intervention that improves health outcomes. She’s the only program in the country with a health plan contract that has outcomes incentives, an actual value-based care contract.Unbeknownst to Erin, Dr. Ajay Joseph, (an interventional cardiologist who carves out one day a week as a lifestyle medicine doctor) also in Tulsa, was busy at the same time she was building FreshRX, building an Intensive Therapeutic Lifestyle Change (ITLC) program over at St. Francis - one of the major health systems in Tulsa. He has built a wildly impactful Lifestyle Medicine clinic and program that has eliminated cardiometabolic disease for the majority of his program participants. It’s an 8-week program that teaches nutrition (including hands-on in a teaching kitchen), stress management, sleep hygiene, exercise/movement, importance of relationships and avoiding risky susbtances.As you would imagine once they met it was an immediate “synergy for the ages”. Let’s just say you are going to see some pretty exciting outcomes coming out of Tulsa in the next 12-18 months… It’s been so fulfulling to get to work with those two to create a sustainable economic model! The Podcast Recording with Dr. JosephI figured no better way to explain his program than for you to hear it from Dr. Joseph himself. This is the brief interview we did with him last fall at the ACLM conference. We need to get Dr. Joseph onto The Food Is Health Revolution for a full episode! Get full access to Food is Health at foodishealth.substack.com/subscribe

There has been quite a bit of chatter lately around front-of-package nutrition, the need to understand nutritional density and whether the FDA is doing enough in general. Especially in light of the fact that 75% of the “food” in grocery stores isn’t actually food at all by definition. FOOD (noun) - any substance consumed by an organism for nutritional support and energyWell what better a way to ponder the FDA’s vision than to hear it directly from the proverbial “horses mouth”. Late 2024, Erin Martin (FreshRX Oklahoma), Justin Politi (one of partners at BP2 Health) and I had the chance to sit down with the FDA’s Deptuty Deputy Commissioner for Human Foods - Jim Jones. In this role, which reports directly to the FDA Commissioner, Jones leads the unified Human Foods Program (HFP), overseeing all FDA food safety and nutrition activities. He is actually the first person to hold this role that was created in 2023. When you read his background, you realize he might be a bit of a secret weapon for Making America Healthy Again #MAHA. He spent most of his career as a federal regulator of pesticides, toxic substances, chemical safety, and pollution prevention at the U.S. Environmental Protection Agency (EPA) and spent much of his tenure involved in leadership and decision-making related to food safety. As a principal architect of the 2016 overhaul of the Toxic Substances Control Act, Jones led discussions with members of Congress, industry and environmental groups that resulted in a law reshaping how chemical safety is managed in the U.S. And these are just a few of the highlights.“My view is that we have 330 million Americans that we really want to improve their nutrition, and I want to do it for everybody. - Jim JonesCall me a pollyanna, but after our power-packed 15 minutes where Jim shared a few of the highlights of what the FDA has planned, I felt it wasn’t all doom and gloom: * A rule that will describe the parameters for when a food can say that it's healthy. And the development of a logo so that consumers can start to see on packaging some consistency around how they can be able to recognize the healthy designation. This will identify products designated as healthy across product categories and within product categories* Taking comment from all stakeholders right now, what we refer to as Phase II of sodium reduction goals. Phase I just ended last April and with a 2.5 year goal to achieve a 13% reduction in average sodium consumption by Americans. The early data that we have indicates about 40% of the categories meeting or close to meeting the first reduction* Planning to propose bringing three nutrients from the back of the label to the front of the label, in a way that's very easily understood by the consumer (Sodium, added sugar and saturated fat). Putting that on the front of the label with some descriptor related to it. (This was actually announced by the FDA a few weeks ago)* We discussed whether there is a universe where there are fewer chemicals in our foods* We talked about Eric J. Smith and Edacious and the need for nutritional density* We talked about work that includes Instacart to help them help their customers quickly understand what foods they are buying through Instacart that are good for them“At the FDA we have a lot of knowledge around nutrition, chemical safety, how that can then be translated in new technologies in the private sector to help consumers buy and get healthier food, and I think that that can play a huge role in how people get healthier” - Jim JonesDespite all of this promise, we seem to all find ways to pick things apart. We all seem to say it isn’t enough and that the evil empire of food/pharam/chemicals will find a way around.Which brings me to the question I started with…Is incremental change better than no change at all? Get full access to Food is Health at foodishealth.substack.com/subscribe

This episode features a conversation between Ellen Brown and Carter Williams about the systemic issues within the food and health industries. They discuss the interconnectedness of the food system, from soil to cell, and argue for a more holistic approach to improving health outcomes. Their conversation explores the need for systemic redesign, drawing parallels to engineering and aircraft accident investigations, to create a more nutritious and affordable food system. They highlight examples of companies successfully integrating various stages of the food chain and emphasize the potential of data-driven approaches to improve both individual and population health. Ultimately, they advocate for a comprehensive, systems-level approach to address the current health crisis. Get full access to Food is Health at foodishealth.substack.com/subscribe

Our co-hosts Katie Stebbins, Carter Williams, and Ellen Brown reflect on the past year and discussing the interconnectedness of the food and healthcare systems. They analyze the food supply chain ("soil to cell"), exploring challenges and opportunities in farming, manufacturing, distribution, and consumer behavior. The discussion highlights the need for systems thinking, addressing issues like regenerative agriculture, food safety recalls, and the evolving relationship between food companies and healthcare. They emphasize the potential for innovation and collaboration to improve health outcomes and economic efficiency. Finally, they predict future trends and identify key areas for change in 2025. Get full access to Food is Health at foodishealth.substack.com/subscribe

We recently brought together a multidisciplinary panel of experts sharing practical strategies to address critical issues at the intersection of healthcare and food policy. Drawing on perspectives from healthcare to agriculture, the discussion focuses on actionable approaches to Make America Healthy Again.The diverse expertise of the speakers provides a comprehensive view of the challenges and opportunities in transforming healthcare through a more nutritious and affordable food system. This session offers valuable insights for policymakers, healthcare providers, and stakeholders seeking pragmatic solutions. Get full access to Food is Health at foodishealth.substack.com/subscribe

Our hosts Katie Stebbins, Ellen Brown, and Carter Williams are joined by Dr. Joseph Pizzorno, an internationally acclaimed expert on science-based naturopathic medicine, to explore the intersection of nutrition, healthcare, and environmental factors influencing public health. Get full access to Food is Health at foodishealth.substack.com/subscribe

Erin Martin runs a program called FreshRx Oklahoma, which prescribes fresh, locally grown produce to individuals with type 2 diabetes. This program is aimed at addressing both food insecurity and chronic illness, showing remarkable results in reducing patients’ A1C levels, weight, and healthcare costs. The conversation emphasizes the importance of aligning economic, agricultural, and health systems to improve outcomes for individuals and communities. Get full access to Food is Health at foodishealth.substack.com/subscribe

Our hosts Katie Stebbins, Ellen Brown, and Carter Williams are joined by guest Matt Moreland of Moreland Farms. The group discusses current agricultural trends and challenges, including the integration of the supply chain and the tension between overproduction of commodity crops and the growing demand for specialized, higher-quality agricultural products. They explore the potential role of food in improving public health, especially in light of rising health care costs and the increasing use of GLP-1 medications for obesity. The podcast also covers the need for innovation in farming practices, such as integrating livestock, and the broader impact of these practices on climate and health systems. The conversation emphasizes how changes in the food system can drive better health outcomes and create new economic opportunities. Get full access to Food is Health at foodishealth.substack.com/subscribe

Get full access to Food is Health at foodishealth.substack.com/subscribe

The US spends $1.7t on food and $1.9t on healthcare due to poor nutrition annually. We need to come together to find the answers, so here we are, connecting food, health, and the economy. Get full access to Food is Health at foodishealth.substack.com/subscribe