There's no way to convince a vegan to

have bacon and extra breakfast and vice

versa. There's other things obviously we

work with US foods large kind of

actually food delivery food service is

truck drivers their concept of a lunch

is McDonald's

>> we can't tell them oh here's the list go

shop whole food so airone and then go

home and cook at homes it's like okay

McDonald's it is we're going to reverse

your diabetes on McDonald's diet and by

the way we do that

>> okay I don't want that to get buried

>> what are some sample meals that people

might get out of McDonald's or something

like Uh,

I will start I suppose with something

that I can potentially use immediately

or some variant thereof. Do you still

schedule your week or at least workouts

each Sunday? And I'm reading here, this

is from a blog post. Schedule

everything. This is top five tips

getting and staying in shape for people

who are busy. I spend 10 to 20 minutes

every Sunday scheduling most of my

workouts in details similar to any other

appointments in my calendar. Like with

most unscheduled tasks and to-dos,

they'll fall between the cracks. On the

other hand, with proper scheduling,

you've managed to get in your workouts

with 150 plus annual travel days,

changing cities, super early wakeups and

delayed flights, etc. So, this is kind

of a micro question that edges into the

macro just around planning and

scheduling, but do you still take time

out each Sunday to go through these

things?

>> 100%. 100%. It's every Sunday. I just

find that structure allows flexibility

and spontaneity.

>> If you don't have structure, nothing

gets done. At least in my life. And not

that my life is super special, but you

know, two pretty young kids, happily

married, running a company, growing

that's dozen employees, and then trying

to be a kind of semi athlete in the

process. If I don't schedule, it's not

going to happen. So, I I spend about 15

minutes at the end of each week that

Sunday.

>> Mhm.

>> Professionally, kind of list the three

things that absolutely have to get done,

and then I schedule a few things,

including workouts, and it works very

well. When do you do that on Sunday?

>> Well, this could be a longer

conversation, but it's either early

morning before the kids wake up and kind

of Sunday gets going or if I don't have

it done by Sunday afternoon, then it's

after 7:00 p.m. when everybody else kind

of quiets down and

>> Mhm.

>> I take my own time.

>> How many employees? Could you remind me,

Verta, how many employees do you have

right now?

>> Yeah, Vert Health. So, we we're about

thousand employees. And the caveat these

days of course is don't brag about

employees cuz the more employees you

have less you leverage AI but I guess

mentioning thousand employees it's a

real company and obviously growing fast

so it it takes fair amount of effort so

about thousand people. Well, the good

news is like so many companies in the

news these days, if you did end up

overhiring during COVID or something,

you can not say we made a mistake. You

can just say we're using AI to improve

efficiency when you have layoffs,

but we won't dwell on that. The question

I had is what type of training in your

life right now are you currently

scheduling each week?

>> Good question. Well, we're talking about

training. So this is sort of physical

training.

>> Physical training

>> is really in two buckets. The primary

focus is is really endurance sports

around cycling.

>> So I do a lot of mountain bike racing as

well as road bike racing. So that's

essentially endurance training. So I'd

say 90% is is cycling related and that's

my core workout that essentially happens

in the morning every day. 99% of the

time it's one of the first things. It's

not the very very first thing in the

morning. So that's one. We can go into

morning routines and stuff like that in

a second if that's interesting. But I do

a little bit of just sort of core work

pretty much first thing after waking up.

So I don't even have to schedule that.

That's sort of a non-negotiable before

the brain even boots up. I've done my

kind of core work. But cardiovascular

work is the main. Yeah.

>> Yeah. Let's not tease. Let's just hop

right into it. So what what does the

morning look like upon waking up? And

what time are you getting up?

>> Okay, let's separate into traveling and

not traveling. Traveling for work and

not traveling. Let's do non-traveling.

>> Yeah, non-traveling.

>> I wake up 5:00 a.m. latest. This morning

alarm was 4:45. So I wake up pretty

early. And I have the amazing privilege

and luxury that the second I roll off

the bed, I jump into a lake.

>> Mhm.

>> Or pond. And you know, it's not a long

time, maybe like a minute, just cold

water. Couple of strokes, but it's

essentially it's like a freezing cold

shower. And this is a mountain lake, so

we're talking like 40°

>> Mhm.

>> weather pretty much straight off the

bed. And after that, maybe just like a

minute or two of some air squats and

jumps and core, literally core work,

nothing too special. So that's like some

supermans and leg raises and stuff like

that. And I do it because again, I raise

bicycles quite a bit and I have some

lower back issues and core work. It just

never gets done unless it's the very

very first thing in in the morning. And

then I'll throw in a couple of push-ups

there. So it's it's you know that's 5 to

10 minutes straight off the bed jump

into the lake tripping wet little bit

core a little bit jumps a little bit

this and that and I'm just a huge not

just a believer but the practical

experience I've had is kind of mood

follows movement emotion so before I

even ruminate or think anything I've

already been in a lake and done five or

10 minutes of core work and some jumping

and get the heart rate up for a little

Mhm.

>> And that's pretty much the first 5 10

minutes. And then the other thing I I

try to do always right after is do

something useful for other people. Do

something useful for other people. And

what is that in practice when I'm not

traveling? It's preparing coffee for my

wife

>> and emptying the dishwasher. It may

sounds very simple, but that's like 15

minutes after I've woken up. I haven't

had a second to think about or ruminate,

oh my back's hurting, or oh my god, so

much work or whatever that is.

>> It's like a 15minute sort of boot up

sequence

>> and it's like life's rocking and then

kind of I'm ready to go and and do the

other things. Don't worry, I won't have

you give the minuteby minute for your

entire day. But after you have done

that, so you've made made coffee for

your wife, you've emptied the

dishwasher,

then what are you having your first

intake of coffee, what does the next

kind of 30 to 60 minutes look like for

you,

>> man? Sounds like a mind readader. So, I

do drink coffee, so that's time for an

espresso or cup of coffee at that point.

and that everybody else is still

sleeping in the house. I sit down and

basically I write down kind of my sleep,

how many hours I slept and I kind of

have a little diary. It's a spreadsheet

online,

>> 16 years of data now. And I also write

three things I'm grateful for. So this

kind of little gratitude journal, super

super simple things. And I try to focus

on the mundane such as you know leaves

in the aspen trees or warm temperature.

It's just simple things very very simple

things. So I do that and write down a

few things and then I usually work for

about an hour. So like clean email and

slacks or maybe I have like a 20 minute

writing thing. So this is kind of my CEO

job. So I try to do about hour of that

and then whenever my wife wakes up then

we have sort of a 15 20 minute couples

moment drink coffee and talk about life.

It's a really wonderful moment there. So

that's kind of the very morning and then

my real workout usually happens between

sort of 6:30 and 8:30 exercise.

>> Got it.

>> And then after that get to office.

exception would be if I have any

meetings that are across time zones,

then could be a 6 a.m. Zoom or something

like that. But before that, I've always

done my swimming in a lake and a little

bit core and maybe a cup of espresso.

That's the routine. And pretty much

repeated that for more than a decade.

And there's nothing too special. I

always say people ask like what's the

science behind I say, listen, if it

doesn't feel good, it's not right for

you. If it feels good, repeat it.

So, I mean, I suppose there are

different types of fun, right? There's

type one, type two, maybe type three

fun, which is God, I can't remember who

sent this to me.

It was a friend of mine. Maybe you

recall who this is because I'm sure I

pinged you about it, but they were

driving up some windy, incredibly steep

road in the mountains and they were

taking a video from their car of some

lunatic who I think they call a lunatic.

Like, look at this [ __ ] guy. He's

crazy on what you could envision

listeners or watchers as incredibly long

rollerblades. They're basically skis

with a single track of wheels on them

and poles doing uphill, I suppose,

Nordic skating, let's just call it going

up this unending

incline. And they're like, "God, who is

that lunatic?" And of course, who did it

end up being ended up being Sami, right?

So fun means different things or feeling

good means different things in different

contexts. But the reason for people who

are wondering why am I digging all into

all these details. Number one, I like

the details and the details matter. But

you have always impressed me with the

number of important pillars that you're

able to methodically schedule into your

life and furthermore within those

pillars how you're able to operate at a

very high level in multiple domains. So

that's why I'm asking about the

specifics because

these things much like workouts tend not

to happen accidentally

>> if you don't schedule them particularly

with the number of moving pieces that

you have and frankly the number of

moving pieces that any person probably

has things will not manifest magically.

And I'm curious we talked about the

single day. Do you have any type of I

know for training you almost certainly

do have like weekly and monthly

architectures particularly with

competitions but from a work could be

work could be physical perspective do

you have a consistent weekly

architecture of any type where say you

might batch certain types of tasks or

meetings or otherwise on certain days or

anything like that or is it pretty much

Monday to Friday more or less the same

daily routine? I do have a system.

Well, a couple of things. First, kind of

I think it's good to remind myself for

anyone's like, "Oh, here's the system."

And the reality is life happens all the

time. So, let let's just remember that

you're running a company, you have kids,

crap hits the fan all the time or at

least frequently. So, obviously, you

have to be flexible. So, what I'm going

to share next is the kind of beautiful

clean scenario where you can kind of

live with your structure. But the

reality is you're running a company.

>> The platonic ideal gets smashed.

>> Yeah. Exactly. A lot.

>> It's 24/7 and the Sunday afternoon walk

with your kids or or your spouse may not

happen cuz you need to address the

crisis. But you mentioned like, oh, I'm

kind of impressed how how many things

you can do.

Honestly, the biggest secret is saying

no to 99%

of the things that many people consider

quoteunquote normal. So what you care

gets done. And sometimes people ask me

like, "Wow, it's so many sacrifices. You

trying to be an athlete and a CEO and a

founder and trying to be a parent as

well and you even travel with your kids.

Like you must have so many sacrifices."

I actually find that saying no is

incredibly liberating in life. I'm way

happier that I'm married to one person

versus five. It's awesome. There's no

way I could be a CEO of many companies.

I I love the kind of focus.

And so I actually find it personally in

life when you find something that kind

of fills your cup and is satisfying and

gratifying, just having the one or two

things that I focus on and then go all

in rather than a sacrifice. It's like a

happy place for me. So anyway, so I

would say that's my biggest secret. I

think a lot of people will hear what

you're saying and theoretically agree

with it and yet most people are unable

to embrace that in practice, right? For

whatever reason and doesn't mean they're

not capable of doing it, but they don't

do it. Why do you think people have

trouble

saying no or the default is people are

inclined to overcommit or that they do

the 99% of things that are quote unquote

normal that you say no to? Why do you

think not more people do what you're

describing?

>> Honestly, if I had a perfect answer, I'd

probably write a book about it

>> with all your spare time.

>> Here's my guess. I think one might just

be a narrative. I can't tell you how

many times someone has said, "Oh my, you

must be sacrificing so much to be able

to do what you do." And I'm sure you

could say the same for an Olympic

athlete. Like, "Oh my god, so many

sacrifices." But if you're an Olympic

athlete, focus on your sport and your

craft.

Sure, you can't do 99% of things quote

unquote normal people do, but it's

probably incredibly satisfying to be

able to do that one thing for the five

or 10 or 15 years of your life. So

that's why I meant so maybe it's a

narrative that oh if if I say no to all

these whatever that is movie night every

night or some distraction whatever

staying on social media and watching

Netflix for hours a day that oh it's a

sacrifice not to do that. So that's my

guess one thing that's a narrative in

our minds like oh you want to do all

these consumption things that maybe take

time away from the thing that could move

your life or profession forward. So, so

that could be one. And then the other

thing is I think this sort of life

structure that if you don't have a

basic,

we can go back to your original question

that what's kind of your architecture

and what's your structure. If you've

never taken the time to take a step back

and say, "Hey, how am I allocating my

time?"

>> Mhm. It's very easy to let the universe

or the entropy to kind of take control

of of your time, whether that's your

inbox or text messages from others or

phone calls. It's actually very very

easy. Let the world run your life as

opposed to you running your life.

>> Well, let's talk about the weekly

architecture and then I am going to come

back to this particular

question that I asked. But let's let's

take a breather on that and would love

to hear more about the weekly

architecture or other architectures

outside of the daily.

>> So again, this is sort of in an optimal

world, but I would say professionally I

do try to group similar type of tasks

into specific days. So just to give you

an example, Monday is filled with a lot

of kind of group and leadership meetings

and stuff like that. So there's one kind

of context switching that it's meetings

in front of the whole company and in

front of leadership team and so forth.

So so that's Monday. Tuesday I try to

have all my one ones again one type of

context switching and as an introvert

that takes a lot of energy by the way as

important it is and sometimes very

enjoyable but the kind of one person

after another it's pretty draining for

me personally. How many direct reports

do you have?

>> Well, I should say this has changed all

the time.

>> Yeah,

>> there's been 15, there's been 10, and I

had eight for a long time, but for the

last couple of months, I've had two.

>> Only two, which is a very small number.

And again, that could be another 1 hour

conversation. But when you're building a

grow company,

you always have to ask yourself what's

most important for this year. And

there's not really kind of a school book

perfect

>> kind of approach. But anyways, he's two

right now. So Tuesday is that Wednesday

I actually try to reserve for thinking

and writing thinking and writing. So the

default is no meetings.

>> Mhm.

>> And one example of writing that I do I

write a team letter for the whole

company from the CEO. So I've now

written 553

of

>> Wow. So you do that every week? every

week and there's like a one topic and

again another topic we could dive into

but what I find is that it's as the

company has scaled there are a few

things that are very scalable like

whether my email hits five inboxes or

thousand obviously doesn't take any time

away from me but I can give context

explain what's happening what's

important what's happening in outside

world what's happening inside the

company and then every employee feels

hopefully some level of connection

that's one example there's couple of

things that I've kind of repeated ever

since day one and now at thousand

employee scale still very scalable but

that's just one example it could be

preparing for board meeting or thinking

about strategy which sounds very

high-flying but I I would say one thing

that's very very easy

as a CEO of a grow company is to fool

yourself that you're productive and

useful by being busy

>> Mhm. But if you miss a decision,

something around a corner, no amount of

knocking tasks off the to-do list is

going to compensate that.

>> Mhm.

>> And it's almost like managing your own

brain and feelings.

It's hard not to have a tightly

scheduled calendar, but in fact having

that time open for like you can go for a

walk and think about the problem. So

anyways, that's kind of my Wednesday.

And then Thursday and Fridays is a lot

of internal client work and those kinds

of things. But I usually that's not too

structured. But that's that's a little

bit of a typical week.

>> On Wednesday, when you're doing the

writing and thinking, what are some of

the ways that you structure your

thinking? There's unstructured thinking.

You can go for a walk and kind of ponder

and allow the void to invite hopefully

some type of insight. But then there's

structured thinking. And I guess to the

extent that I know you at all, I would

say I'm inclined to think you probably

have some prompts or structure or an

approach to doing thinking. What does

that look like or how would you speak to

that?

>> Typically, the way my brain works is the

actual thinking and problem solving

happens 24/7. And I'll give you a

specific example. my workouts every

morning which is is about an hour hour

and a half unless it's a very very very

high intensity that's one of the best

times where my thinking happens and sort

of problem solving and new ideas and

creativity happens there and then for

the Wednesday I actually just block like

an hour and say it's almost like the

time to get the words and the thoughts

and whatever that might be off my brain

to a paper or obviously in the cloud. So

unless I have to do a very kind of

leftbrain mathematical

deterministic problem solving thing like

literally like okay let's look at how do

we improve crush margin orism like that

>> the creative work does not happen at the

desk

>> for me

>> and I'll give you one thing that I

noticed this was especially during co

when covid hit I was listening a lot of

podcasts and music and audio books on

100% of my workouts was maybe like a

here

and I realized that the problem solving

and the creativity almost like stopped.

So now I have a rule that maximum of

half of my workout I can listen to Tim

Ferris.

I said sorry. So if your download

numbers are going down or or listen

numbers,

>> damn it, Sammy, I need all the help I

can get.

>> So if the brain is in a consumption

mode, you're kind of just filling the

cup. And I I've noticed the creative

thoughts and the problem solving that's

happening kind of in a background

processing is is not happening. So

anyways, that's a tactical thing that

I've noticed that too much audio book uh

podcasts kind of filling the brain and

it stops creating stuff. It's it's very

interesting. That's at least my personal

experience. So I'm very conscious of on

those moments when I'm you know

exercising or walking or driving

somewhere that there's kind of like a

cut off point. No more listening. Just

let your brain do its thing. And then

the Wednesday comes in. It's more like,

okay, now I kind of have the framework

in my head, take an hour and a half to I

don't know, write about next year's

priorities. So this going to the new

product we're going to launch and or

even these team letters that I write. I

actually write them in my brain when I'm

away from the desk and then when I sit

down, it just it comes up.

>> That actually leads into my follow-up

question. And I can't imagine I'm the

only person wondering this, which is

when you're doing these workouts, let's

just say it's an hour and a half to two

hours, the real workouts, right, in the

morning. I would imagine quite a lot

percolates and comes up and if you're

doing that Monday, Tuesday, maybe also

Saturday, Sunday, etc. By the time you

get to Wednesday, if I have not taken

some step to maybe verbally record some

of that or make short notes in a

notebook for cues for later, I would be

doubtful that I would be able to recall

the good ideas that I had earlier in the

week. Do you just have a pre-ternatural

sort of inclination to be able to

remember all that stuff or do you take

some type of shortorthhand

after the workouts so that you can use

those then on Wednesday as prompts? How

does that work?

>> Essentially, I write emails to myself

>> or store notes. It's the same thing. So

there's tidbits along the week and then

I have it

>> for Wednesday and then you know half

maybe in the in the brain and half is

written somewhere so I don't forget it

all

>> and you just send yourself an email

after the workout with some type of

note.

>> Yeah. Yeah.

>> What is an example of what you might

cover in a team company email on a

Wednesday and how long is that? That is

like you mentioned earlier one of the

things you've repeated since day one.

What would be an example that you can

share? I mean it could be hypothetical

but just like what might you put into

that and how long is it?

>> Half is standard structure. So there's a

quote from again we can go into details

but you know we're in a business of

reversing metabolic disease and helping

people get healthy with nutrition. So we

treat patients like real humans hundreds

of thousands. So half of it is just

existing structure. There's a quote from

a patient. So we always kind of lead

with this is why we're here and here's

kind of a positive feedback from a

patient. Then there's some business

metrics like how much we've grown and

what are the priorities and just a

reminder of this year's kind of key

objectives. And so half is like that and

then the most important other half is

topic of the week. So topic of the week

is essentially my as a CEO founder essay

and I think that's what you were asking.

I would say they're rling in two or

three categories. One is what has

happened in external world. What's the

context there and how does that affect

us? You know, one example, this is a

real world example that I' I've written

quite a bit about since we use nutrition

as the core tool,

but obviously our providers use all the

tools in a toolkit. One of the things

that has really changed in addressing

obesity and metabolic disease over the

last couple of years is the GLP-1 drugs.

So these are the ompics of the world.

And so I've had number of letters

discussing how do these drugs

potentially affect how we take care of

our patients and what's the impact on

our business. So that would be

externality and how is that affecting

our strategy. So that's one example. The

other category is career and personal

advice to our team members like how to

make most out of your experience working

at Verta and around that kind of stuff

that we discussed we've discussed now

like personal productivity and how do

you make most out of so that's I would

say is is the second category

and then third is just internal this is

what happened this is what it means for

us so honestly it's I kind of like it

it's my personal outlet and sometimes um

said, "Hey, 530 plus

essays. There's a book in the making.

All we need to do is upload it to Chat

TPT and we have a book ready to be

published."

>> So, I I promised I would come back to a

thread, which I realized is probably a

misworded question. And the question I

asked was

why people have trouble doing what you

do, which is saying no to 99% of the

things that that normals do or feel

compelled to do. To your point about the

narrative and I and I realize that's

perhaps not the right question. the the

the right question might be what advice

would you give to someone who is having

trouble saying no or focusing on just a

few things but I can make it much more

specific because I think the more we can

imagine it uh perhaps the the easier it

is to dig into this so let's say that

you had a relatively new hire right who

is on the younger side but you know a

10x engineer or some equivalent of that

someone who is clearly a superstar but

who has not established the type of

architecture

and routine that you have in your life.

And let's just say you sense that they

are on the path to burnout, which is

going to be bad for them. It's going to

be bad for the company. It's going to be

bad for the patients you serve.

>> And and you want to stage an

intervention to help them

correct course. I imagine you may have

even had these conversations. What might

that conversation or coaching look like?

>> Well, funny enough, this has been one of

the topics of my team letters, one of

the 530.

So, I would separate it into two things.

My my advice, one would be this sort of

planning. I literally it would be very

simple. sit down for five minutes on a

on a Sunday evening before the week

starts and write down what absolutely

completely needs to get done next week.

Super duper simple, professionally or

personally, and schedule it into your

calendar like literally. And if you have

the flexibility, then like block two

hours in the mornings to get those two

or three things done. And then when life

happens or work happens, everything else

kind of comes after that. So that to me

would be the number one thing. And then

I would couple that when Monday comes or

Tuesday comes, it's, you know, whether

you work in an office or in a remote

setting, do not let the universe

control your time. So this means

absolutely no notifications.

Maybe if you have to get text message

for I don't know family emergency or

something but like take everything else

out and you kind of create that sacred

space where you can do that work whether

that's writing or coding or calling 15

cold calling 15 prospects or whatever

that is. It's it's super duper simple

but it's so easy to then sort of again

Monday comes Tuesday comes and then the

world takes over and you're like oh my

god it's 4 p.m. I haven't done the

thing.

>> So I'd say that would be the one

category.

>> Can I pause for one second?

>> Yeah sure. Okay. So, before we get to

the second, for some people listening,

if if they were sit down for 10 minutes

on Sunday to write down the things that

must get done

professionally and personally, they

might have a list of 20 things in each

category.

So, are we talking about one thing,

three things in each category? I know

this seems like very

personnicity, but this seems like a

possible failure point for people,

right?

>> Yeah. So what is your suggestion there?

>> So it's probably one or two things but

this again we could launch into another

part which is obviously you need an

architecture of annual thinking

planning.

>> Sure.

>> What is the business need for example in

fact I just have a text file as file on

on my computer here's the four things to

remember as a CEO now and 20 years from

now. Here's the three things for this

year and here's the three things for

this week. I literally have a text file

and I just update it every Sunday. And a

whole another topic which I'm sure some

people think I'm crazy is I have a

15-year plan for myself which I kind of

accidentally stumbled that it actually

could be useful and I updated every year

and again we can take that offline or

take a bookmark how that came about.

It's been incredibly helpful. And again,

I want to highlight structure allows

spontaneity and flexibility. But if you

don't have that architecture, then

obviously on a Sunday evening, it's

like, oh, should I write a book or get a

new job or just do this project that my

boss was asking? So, it's like if you

don't have that north star, you could be

kind of spinning like a compass. Yeah.

Run a magnet. I did take you off track

because you were saying block these

things out in the calendar like Sunday 5

to 10 minutes.

>> Block those things out in your calendar

if you can. 2 hours first thing in the

morning. Do not let the universe

>> dictate how you use your time. Block out

notifications. And then you said the

second thing and then that's when I

interrupted you. Second bucket. This is

probably the most important as it

relates kind of like a burnout and you

just kind of you're falling apart and

I'm going to knock here on my wood my

table. Not too hard to create any any

noise. But I founded my first software

company in April 2000. So now it's we're

here in 2026. So that's 26 years running

building fast growth companies. And I I

haven't cracked yet. And again, caveat

is it could happen tonight. So but

there's a few things I've learned. I

think these are applicable to especially

any knowledge worker where kind of like

everything's just coming to your brain

and it's it's very easy to you know get

stressed and anxious and cracked and I

written about this as well. Here's my

formula that has worked for me very

well. One you have to take care of your

sort of foundational metabolic health.

What is it? It's sleep, nutrition,

exercise. So that's kind of one. If you

are metabolically very very unhealthy

it's very very likely that you're going

to crack under pressure. So that's one.

Second one is it's very helpful to have

especially for kind of founder CEO types

but for anyone have at least two or

three identities or outlets. For me it's

parent husband one CEO two and then

wannabe athlete. And so if one's

failing, hopefully at least two other

are the areas outlets in my life where

it's like a it's going okay. And by the

way, it's never that I'm rocking and

winning and ringing the bell in all

three at the same time. And it's very

helpful. It's it's almost like a Jedi

mental trick like, "Oh my god, work

sucks, but at least my kids love me

today." So, so having that outlet and

particularly founder types, younger

ones, it's often the opposite that

they're sort of proud of the fact that I

only have one thing and I'm ready and

willing to die for my company. Well,

that's all well and good when

everything's going well, but you have

the first kind of speed bump and then

everything falls apart. So, that's the

second thing I would say. Third one is

have peers outside of your company that

you can kind of let your hair down.

Sorry, sorry that I know. let your head

down and relax. For me, it's a group of

CEOs. Other CEOs was, "Oh my god, can

you believe? Can you believe this

employees are bitching again?"

Obviously, you can't say that in front

of the company. Personally, for me, it's

been YPO, the young president's

organization since I guess 2008. So, now

it's for me, it's not anymore the why

the young, it's just PO. I'm old enough.

So, I have that. And then the fourth one

I would say is you know everyone has

their own tools but just understanding

how your mind work. It could be

meditation, could be some other tools

but that's been a process for myself to

just realize that if you are just

attached to your thoughts eventually

they're going to get you and you can't

really think yourself out of the hole

that you thought yourself into. So

unless you can take a step back and kind

of like observe like oh my god my

brain's having a life of its own. So

that's kind of the toolkit I would not

to crack. So foundational health have

different outlets, identities, have

peers you can talk. It could be friends

as well and then some sort of

understanding and kind of way of taming

your mind if you will or being able to

see that the mind has the life of its

own. That's been helpful for me and I

will say again could happen tonight but

I I haven't touched any prescription

drug for anything sort of mind related

and that toolkit has kind of kept me

head above the water so far for 25 26

years.

>> I have a very left turn question for

you. Hopefully it won't be incredibly

offensive but I was just thinking when

you were like I would knock on wood but

I don't want to make any noise and then

you're like you can let my hair down,

you know, no offense. Sorry. and you're

very polite and I've only been to

Finland once. I was walking around and

of course went to the obligatory saunas

and so on which I actually can tie into

my story. But I was walking around and

in the maybe two days that I was in

Helsinki, I thought to myself cuz I've I

lived in Japan. I speak Japanese. I'm

still close to my host family who I

stayed with when I was 15. And I thought

Finnish people feel like white Japanese

people. That was my feeling there. And

the reason it ties into the sauna,

different context, but if you go to

Japan, it's like everything is is very

restrained. It's very polite. People

don't stare you in the eye when you're

walking down the street. And in Japan

though, if the boss says, "We need to go

out and drink."

When you drink, okay, and if the boss

says you have to drink, you have to

drink. But you go out and you can get

really loud and you can get really

boisterous. You're allowed to say things

when you've had some alcohol that

basically everyone agrees they're going

to forget the next day like it never

happened. Now, I can't take it that far

with Finland, but when I went to the

saunas, one thing that I was very

surprised by is that they sell huge like

Stein glasses of beer that people bring

into the saunas. And I was like, "Oh,

this is where they let their hair down."

Okay. Am I totally off base? I don't

know if you've spent time in Japan, but

culturally, I felt like in my 48 or 72

hours of exposure, I was like, "Wow,

even Finnish itself has some of like the

phone, some of the sounds of Japanese."

I mean, it sounds like I'm really

overreaching now, but am I just an

insane person or do you feel like

there's something possibly there? I

think there's similarities and you're

definitely the connoisseur of a Japanese

culture versus me having just been to

Tokyo and a few other places a couple of

times, but that kind of space and

distance and politeness that people

Well, actually, there's no distance in

Tokyo obviously, but the sort of

emotionally there is a kind of distance

>> Mhm. in Finland and Japan versus

when I came to America 2003, moved to

California, it's like everyone's on your

face and everything's freaking awesome

and it took a couple of years to it's

like wait just come on like give me

space and everything's not awesome. So

yeah, maybe there are similarities and

then yeah, alcohol I'm sure has been a

mental health tool not very effective at

that in Finland for many many decades.

But sauna I have to well first of all

there's 5 and a half million people in

Finland and there are more than 3

million sauners more than 3 million

saunas.

>> It's a crazy number.

>> So on average you have one to two people

per sauna in Finland.

Babies used to be delivered in sauna

>> really

>> in Finland because the clean bacteria

dies in a heat

>> sterilized right

>> there warm water I think my mom was

delivered in sauna I was in a hospital

just to be clear so sauna is beyond

being part of the culture it's part of

the DNA and it's culturally it's an

amazing place actually not just kind of

let loose and your hair down but you

don't have your uniform you don't have

your titles you don't have your whatever

social economics signals, symbols, fancy

waters and everyone comes together

whether that's family or your friends or

your community and s is definitely a

place where a lot of things happen in

Finland and we can talk about saers and

its role in a culture but it's something

way beyond cold bars and sauna.

>> Well, let's talk about it. Why is that?

Why is it so prevalent in Finland?

Because it seems like, and I'm sure

you've seen this, but like there are

certain studies in the world of

psychedelics where it's like they did

brain imaging and one study that they've

been slicing over and over again and

torturing the data again and again to

just produce more and more papers on

this one study that was done so long

ago. It seems like the same group of

like 140 fins has been dissected

5 million times in various announcements

around saunas. But why is it so

prevalent there versus other places? I

don't know the origin story.

>> Hopefully there's a historian who will

check me on this, but it definitely goes

back hundreds, let's say, many hundreds

of years where it was sort of necessary.

So, you know, Finland, four seasons,

incredibly cold winters. So, sana was a

place to basically heat and warm up in a

winter. It was also a place where, you

know, you could dehydrate food. That's

kind of how it goes way back when, and

obviously now, you know, it's not

necessary to stay warm and it's not

necessary to dry your food, but I think

that's kind of where it started. And the

initial sound as well kind of duck into

a side of a mountain and then you burn

wood on top of rocks and then you

extinguish the fire and then you make

sure that the smokes goes away and you

know the rocks stay hot for a long time

and you go in. That was the original.

People still have that kind of soundness

today. It's called smoke sauna.

>> Mhm.

>> Essentially you don't have a way to get

the smoke out other than open the door.

So there's no fireplace where the smoke

just goes through a chimney. So that's

called smoke sauna and it's a special

sauna experience and obviously it takes

much more time to heat it and make it

safe and because you don't want to go

there where the smoke but I think that's

kind of the history and then somehow I'm

I'm missing the link how it became sort

of like a culture but now nobody will

build a house without a sound like

literally first is where the sauna and

then let's figure out if there's space

for a bathroom like that's kind of the

order in Finland. I went to this

public sauna.

It's pretty fancy. And there's a word.

You could probably tell me what it is.

It's like lea or something like that.

>> Oh,

>> yeah. There we go. There we go. So, this

is what the act of throwing water on the

stones. Is that what that refers to? Or

the sound that it makes? I don't know

what the name of the actual location

means, but you can tell me in a second.

But the reason I bring it up is I have

never experienced so many varieties of

sauna and they had a smoke sauna room

and in my mind looking at the menu of

options before going in I'm like okay I

get it. It's a hot room. How different

could it be? But the experiences in the

feeling in the body and the way it

penetrates your

sort of being is very different. I was

shocked because I've spent so much time

in dry saunas in the US and I've also

done steam rooms and so on, but I did

not expect there to be such a broad

pallet of experience in saunas. So that

place was amazing.

>> Yeah. So I guess Eskimos have dozen or

so words for snow.

>> Yeah. because they know every nuance and

you know kind of detail and and fins

have dozens of words for different

things around sauna that you can't even

in translate. Lolu is probably the most

important. You judge the sauna and its

quality based on lulu and lolu is

essentially it's after you throw water

into the rocks the fireplace the rocks

and then the steam comes up. It's not

the steam. It's not the heat. It's the I

guess you could say the spirit of the

steam, but how it feels, how it lands.

And let me tell you, there's million

different variations how it happen. Is

it too hot? Is it too kind of sharp? Is

it soft? Does it sort of linger around?

And how does it feel on your body? That

is Lulu. And you judge the quality of

the sound based on a Lulu. And there's a

whole science to it. kind of like how

big is the space to get the loader right

in a barrel sound which by the way I

have at my house is very very hard

because it's too small the fireplace you

can't get high enough and you should be

sitting kind of above the fireplace so

so yeah Lulu is if you know one word

lulu and you want to impress fins you go

to a say what a fantastic Lulu

>> I feel like I need to reach out to the

the Finnish tourism board to sponsor

this episode

get people headed over to Finland. I

really enjoyed it. It was a very short

trip, but hopefully I'll I'll have a

chance to get back.

Let's let's talk about metabolic health

because certainly Verta, we can talk

about Vera. And a part of the impetus

for this conversation was tons and tons

of text messages back and forth. And

some of them I'm sure we can't talk

about publicly necessarily because it's

internal data or whatever. But I would

have say a conversation with Dominic

Dagustinino who some long-term listeners

will know synthesizes novel exogenous

meaning supplemental ketones and so on.

And I was, for instance, I'll give one

example, facing a bit of an enigma in my

own experience, which was I've I've gone

into ketosis, and I know that's a very

kind of sloppy way of putting it, but

let's just say getting into ketosis. So,

eating a predominantly fat-based diet or

even doing it through fasting, getting

to a point where I feel like my brain

has switched over to ketones. And I was

lamenting to Dom Dominic that my devices

were telling me I was not in in ketosis.

And I found this implausible because

after so many years of experimenting

with it, I feel like I have a very good

bead on when my cognition clicks over

and is actually operating at a much kind

of faster CPU capacity. But my finger

pricks with say a precision extra device

or the Keto Mojo were telling me I was

basically not ketosis. And very

confusingly, even with a breathbased, I

think it's ketone air or something like

that. Pretty primitive device. But even

with that, I was being given a negative.

and you sent me a text showing your like

bar graph over the last 10 years or

something of measurable ketone levels

going down over time even though

presumably you're increasingly and

increasingly fat adapted and I was like

of course Sami has this data and then

you have some fascinating fascinating

data I have certainly never seen

anywhere else

looking at different cohorts with

various combinations of things with or

without say dietary ketosis. That is

part of the reason I wanted to have you

on. You're such a meticulous thinker

around these things and data cruncher.

But let's let's maybe just define some

terms before we get into things.

What is metabolic health? And maybe you

could tell your personal story because

my understanding is at some point yours,

you know, sub 10% body fat, but your

report card in terms of biomarkers and

so on came back and you're pre-diabetic

is my recollection. But perhaps you

could take that TED talk I just gave and

use it as a leaping off point for

discussing defining metabolic health and

then talking about your own personal

journey maybe as a starting point.

>> Yeah, absolutely. And first the the

caveat which is that I I do have two

master's degrees but I'm not a medical

doctor and I don't play one on the

internet and I'm sure in this

conversation we'll kind of go into that

area. So I just want to be clear I'm not

giving medical advice to anyone and I'm

not a medical doctor but obviously have

a lot of experience with the topic that

you just asked. But in terms of I guess

the personal story, so just rewind not

quite all the way back to to Finland,

but again my background is not in

medical field. I'm a physicist by

training and in fact started my career

in a nuclear power plant way back when

in Finland when it was still fashionable

and I guess nuclear power plants coming

back to fashion now now again which is

just to show that my background is in

sort of science and technology not in in

healthcare. However, I've been

essentially an athlete all my life.

Cross country skier bath althlete came

to America, started doing triathlons and

>> Well, you had to ski to school at one

point, right?

>> Yeah. Sounds very idealic. Maybe that

was a punishment by my parents. So,

Nordics came to school indeed. First

grade through sixth

>> sounds terrible actually.

>> So quite something. And the biatlon came

handy. So carrying a rifle so I could

shoot the bears when they were attacking

along the way, which may or may not be

true. I was an athlete and have been an

athlete all those years and then after

coming to America started doing

triathlons and a pretty high level

athlete again we're not talking about

Olympic gold medals but as an amateur

and did many many Hawaii iron mans I

think seven of those world championship

races and even won the world

championships in my age group as a

triathlete

2012 I believe and I I give that all as

a background context because my view on

metabolic health and sort of chronic

disease type diabetes and obesity was

this is very embarrassing to admit was

the following which is it's ridiculous.

It's very simple. People know exactly

what to do. Most people, most Americans,

they just don't do it. And as a result,

we have just obese people everywhere.

Everyone has pre-diabetes or type two

diabetes. By the way, it's more than 50%

of American adults. Now, the data is I

think 93% this is the published

peer-reviewed number. 93% of Americans

are metabolically unhealthy in one way

or another. American adults and you know

that's either you have a high blood

pressure or your lipids off or you're

obese or you have type two diabetes or

pre-diabetes. And my view as judgmental

as I was was always listen ridiculous.

You know what to do but you're not doing

it. You're eating too much. You're just

eating too much and you're not

exercising.

you lose her and that's why I pay too

many taxes because healthcare is five

trillion a year of which almost all of

it is metabolic culture related. So that

was my view and I'm very very

embarrassed to say that's how I was

thinking sort of judging people like

you're unhealthy for reasons that are

100% in your control and then like got

the moment where I had to eat a lot of

humble pie and I discovered that despite

you know being

yeah I don't know 10% body fat dicks or

whatever and you know exercising 15

hours a week and performing well as as a

triathlete. I was pre-diabetic. All the

numbers are off and essentially on my

way to type two diabetes. And I was

like, "Shit, wait. I'm not one of those

people with no willpower. I'm not one of

those lazy people. I'm not one of those

quote unquote middle of America 300 lb,

you know, seat belt extender.

That's not me. Seriously, what's going

on here?" And this was 2012, around the

time my previous company, Trulia, went

public. And I was like, well, first I

have to figure this out for myself

because if I can't avoid being

metabolically unhealthy, nobody can.

Well, guess what? Like, nobody can.

Like, that is the status quo in America

today with so many people metabolically

unhealthy. And that got me very

interested in this whole topic of what

is actually driving poor metabolic

health. fortunately met with amazing

scientists who kind of helped me

understand that fundamentally

obesity, type two diabetes, any other

conditions that result from poor

metabolic health, it's not a personal

choice. People don't wake up on a Monday

morning and say, "I want to gain 200 lb

and develop type 2 diabetes. That sounds

awesome. And sticking an insulin needle

to my body for the next 10 years every

day, awesome. Sign me up." No, it is not

lack of willpower. However,

nutrition and food is the number one

driver of poor metabolic health.

>> And if you know how to use nutrition, if

you know how to use nutrition to

actually improve and reverse your

metabolic health,

>> you can take an average, let's just call

it 300 lb middle of America truck driver

or average person that we people on the

coast often look like, oh, it's your

fault. and systematically reverse the

condition nutritionally.

And essentially that's what we've done

at Verta Health now with more than

quarter million patients and you know

scaling fast. But let me just pause

there. That's kind of the how did a

Nordic skier physicist from Finland get

interesting in metabolic health and and

then we can take this down to different

paths.

>> Let's hop in. I want to start with well

as you might expect question about diet.

I want to know what

looking back what the problem was with

your diet and also

this is of course a leading question so

feel free to discard it if it's not a

good question but how large a role does

high fructose corn syrup play broadly in

the US in metabolic dysfunction right if

if that just were removed from the

market what impact would that have but

let's begin with just your personal

retrospective

hindsight 2020.

What was wrong with your diet when you

were exercising 15 hours a week, roughly

10% body fat, performing well in

competition? What was wrong with your

diet?

>> Number one question I get like, oh, was

it your genetics cuz you were exercis so

much? Obviously, genes play a part in

everything, but I just want to remind

that given about 60% of American adults,

6 either have type two diabetes or

pre-diabetes today. Clearly, it's not

like our gene pool has changed. So it

can't really be genes or if 93% American

adults are metabolically unhealthy. It's

not like our genes have changed. So no

it's not that Sami was the n equals one

fin with very very bad genes. This is

happening to a lot of people. So that's

I would say one thing the first one is

there. The second thing is that it is

possible to be skinny and lean and

metabolically unhealthy. some kind of

people of certain background especially

kind of in Asia it's more common that

you don't gain 100 pounds but you're

very metabolically unhealthy

also you can out exercise the calories

and burn and not gain massive amount of

fat but you can still be elevated blood

sugar elevated insulin and be insulin

resistant and that's basically what I

was doing it's very very hard and I can

tell you that I was hungry for 15 years

as an athlete like I'm always more

hungry than I could and if I eat to my

appetite, I'm going to gain fat. I can't

do that as an athlete. So now I'm going

to answer your question. So my N equals

1, I'm absolutely convinced because I

was able to fix and improve it is I was

eating

six meals a day of essentially

incredibly high carbohydrate and

incredibly high glycemic index foods and

practically no fat.

for 10 plus years.

>> So, you weren't eating Twinkies?

>> No,

>> we're talking about rice, things like

white rice, or what are we talking

about?

>> Rice, bread, apples, granola bars, I

don't know, ketchup, pasta.

>> Mhm.

>> But, you know, anything that's has a

glucose molecule turns into blood sugar.

And sure, if it's in an apple or if it's

lots of fiber, it comes very, very

slowly. But if you're eating 4,000

calories a day, of which 3,000 is carbs.

Yeah,

>> do the math. 750 grams of carbs a day or

more. And so you're basically trip

feeding sugar into your veins

constantly. Jamber juice in the

afternoon once I get tired. I just

remember it was my diet all the time.

When you're in your 20s, you can

overdose. People say dose makes the

poison. That's true. you can tolerate

for a long time but once you get to your

30s you know it gets very hard so very

convinced that that was it.

>> What are some of the more surprising

things that you have seen within verta

health now that you have more than n

equals 1?

>> Mhm.

>> And what do the interventions look like?

>> Well let's start from the front end of

of your question. What's the most

surprising? The most surprising is that

we've been able to be successful

with literally anyone. Anyone. And I

I'll give you one example. And and why

is that surprising?

Even overcoming my own concept of it's

all about willpower. I had this like but

it's like people are maybe not as

educated as I am. Maybe they're kind of

busy lives. maybe they don't have my

willpower or kind of the willpower of

willpower Olympians.

>> So that's been one of the most

surprising. We work with Native American

tribes,

you know, 800 or so large employers,

their truck drivers. We've analyzed

outcomes based on what's called ADI, so

area deprivation index. So you take all

zip codes in America and you rank them

by average income

and exactly the same outcomes,

exactly the same outcomes. We looked at

race, ethnicities, exactly the same

outcomes. And these are like large

scale, tens of thousands, hundred

thousands of patients. So that's one

that's been very surprising, which is to

say if you fix the biology,

you fix the outcomes. This isn't, oh,

you didn't even go to high school and

you have a very busy life, so we need

some sort of extra willpower training.

No, you fix the biology, you fix the

body and the outcome. So, that's number

one. Number two is the magnitude of

improvements.

So, to give you a couple of examples,

someone may have had type two diabetes

for 15 years. They are on 100 units of

insulin a day, sticking the insulin

needle three times a day for 10 years.

And we can reverse that kind of state of

type 2 diabetes in 6 to9 months and then

sustain it for long term. 13% average

body weight loss. And this is kind of

like on an intent to treat basis, not

thousand start and then you calculate

results based on five successful ones.

No, you calculate the average results

from all the thousand. So 13%. So in our

clinical trial, that was about 30 pounds

or so.

>> Mhm. average weight loss at one a year

and sustained and mostly fat because we

did dex scans as well. I would say the

third one is the broadsp spectrum

effects and some of these are peer

reviewed. So we've been able to show not

just blood sugar down and reversing type

2 diabetes, not just weight loss, but

we've been able to show up to 75%

reduction in liver disease. It used to

be called fatty liver disease, but

scientists changed it to liver disease

and so it's called mash and massold. By

the way, it's cost hundred billion

dollars a year in America today. There's

one FDA approved drug today. One FDA

approved drug today for MASH. It's one

type of liver disease. It cost 45,000 a

year. No kidding. And it came out to

market last year, first time 2025,

billion dollars in sales. We deliver

similar results nutritionally.

>> I'm not sure. I think this is public.

This is in our texts. The paper just

accepted through peer review treating

stage four. There is no stage five if

I'm Yeah. I'm remembering correctly,

metastatic pancreatic cancer, right?

This is bad news.

>> This is super super bad news. I mean,

also if my memory serves, this is kind

of like a Steve Jobs type situation.

Okay, but this is treating stage 4

metastic pancreatic cancer with three

chemo drugs. Okay, that's one arm versus

same drugs and on verta, right? Trying

to get patients into ketosis remotely.

And do you want to describe the results

of that? So this was a very well

controlled so randomized control trial

for states for metastatic pancreatic

cancer. We ran the trial with a number

of academic oncology centers. So this

wasn't just us. So very well controlled

randomized control trial.

>> And before I talk about the results just

a reminder pancreatic cancer is number

two or number three killer depending on

the year of cancers in America. So it's

very deadly. It's usually diagnosed kind

of too late. So at stage four metastatic

stage and the life expectancy is usually

sort of 12 to 18 months. It's very very

deadly cancer. And so we had a trial

where we had one arm where we randomized

people. It was chemo three drugs and

then another arm as you mentioned same

drugs exactly same therapy plus the

verda nutrition therapy.

And we were able to show just about 35%

life extension on average in that arm.

So chemo plus verta again it's a very

deadly disease. So 35% is stunning but

of course you know we're still counting

months. It's not that you go from 12

months to 12 years on average. But I

guess going back to your earlier

question that shows the power of

metabolic health and poor metabolic

health and what might be possible like

what is absolutely possible is reversing

type 2 diabetes, losing weight,

preventing liver disease. We didn't even

talk about kidney disease and other

things. But the fact that we can drive

outcomes even with some cancers and I

will say some cancers I can't say like

oh nutrition can cure cancer. M not

quite but poor metabolic health and in

our case we didn't really define the

poor metabolic health in the beginning

but essentially it's high glucose levels

high fasting insulin levels and what you

then might call insulin resistance. Your

body is primary burning sugar and you're

constantly hungry. You're constantly

craving. So even if you're 100 pounds

overweight you're hungry and you want to

eat more of that stuff. That's kind of

the typical state of poor metabolic

health. And then it manifests itself

with type 2 diabetes,

cardiovascular disease,

fatty liver disease, often eventually

chronic kidney disease and and many

other things. And seems like many

cancers thrive in that kind of

environment in that kind of poor

metabolic health.

>> Yeah, I don't think that's

controversial. I mean, maybe look says

the non-d doctor to the non-d doctor,

but I mean certain cancers, not all, are

very glycolytic, right? I mean they're

really dependent on a steady fuel of

sugar to simplify it. Dom I think for

people who want to hear more on that

also Dominic Dugustinino has spoken

about it quite a bit in a couple of my

conversations with him. So what I want

to ask you about because we've teased it

a little bit right the Verda nutrition

therapy. I'm looking at the Verta quick

guide right now. If you don't mind, I'll

just kind of lay out some of it because

for me, this is where probably the magic

is embedded and I want to learn more

about how you guys get the compliance,

the adherence that you do, right?

Because that to me has always been this

very elusive,

I don't want to say missing link, but

challenging link with anything

approaching what we might consider a

ketogenic diet. Right? And I want you to

also dispel if I'm making false

equivalence with the ketogenic diet. But

you have curb your carbohydrates, right?

Aim to begin with around 30 g per day

just as needed. And you have some very

important stuff in here, right? Measure

total carbs, not net carbs. This is

where people try sometimes outsmart

themselves. And then you give examples

of what that can look like, right? And

then building your plate. Like what does

an actual meal plate look like? non-

starchy vegetables, moderate protein,

added fat, salt, and extras, etc. I'd

love for you to describe what you have

found to work when you're getting people

started and just what you've picked up

over time in terms of most helpful

components. I was going to say

ingredients, but not food ingredients.

>> Ingredients for for getting people to

>> adhere to these diets because my

assumption, which may be incorrect, is

okay, I Tim Ferrris, I can go to Whole

Foods and buy salmon and vegetables and

this and that. A lot of people in

economically depressed circumstances or

areas or fill in the blank buy a lot of

their what some people would consider

sort of unhealthy food because it's very

inexpensive

>> and it's readily available, right? And

like having spent time around a number

of Native American reservations, it's

like man, there are food deserts in the

United States.

>> What have you found? What have you

learned over the course? Because your

data set is so incredible, right? I

mean, it's just like such a rich and

amazing data set.

What have you learned about helping with

adherence and compliance or modifying

the diet itself?

>> Well, I I will brag because you said we

have big data set. We we absolutely have

the largest data set of metabolic

disease reversal in the world. Like

millions of patient years of data and

data points from each patient every

single day. not just kind of qualitative

information but blood by Marcus. Let me

try to peel the onion to answer your

question because a lot goes into it. So

I guess just to take a step back. Yes,

we use nutrition, individualized

nutrition as the core therapy to treat

our patients. It is our own protocol. I

say our own protocol because any kind of

generic label that you put into it,

people go to Google and they Google and

they can go wrong in 1,000 different

ways.

>> Mhm.

>> So anyway, so we use our own protocol,

but yes, to address and reverse

insurance, you do have to reduce your

total carbohydrate intake. And we have

those response curves to know that the

more and the better you do it, the

better outcomes you typically see. But

that's sort of number one thing I will

say that yes we use nutrition as a

therapy to reverse metabolic disease and

I will say that as a physicist using

nutrition as a drug or as a therapy is

harder than sort of nuclear physics.

Why? For all the reasons you mentioned

because every person makes a medical

decision three to four times a day.

That's when you eat. It's different

today versus tomorrow and then it's

different between individuals. So it is

a very very hard puzzle to solve.

Unfortunately, you know, computers and

software is is very helpful about that.

So, that's kind of one individualized

nutrition. Number two, so what does it

take and how do we approach key piece

even if you know exactly what somebody

should eat is you kind of need the

support system and I guess that's my

tech background with truly and other

things comes to play that everything we

do we do virtually. So what we can do is

we can monitor your biomarkers remotely.

We give you tools to do that. We can

track blood ketones, blood glucose, your

weight and other things. And then we

have actual real medical doctors, not

me, who are full-time employees who

monitor you and coaches who can who can

then make adjustments.

>> Is that collected through

continuous glucose monitors,

>> connected devices? Yeah.

>> Is it also blood draws or is it mostly

some type of continuous monitoring? It's

all of the above. Some patients get a

CGM and some it's a finger brick, but

not everybody gets a CGM. Depends on the

situation. We do lab draws one to two

times a year. So that's obviously

doesn't can't happen daily.

>> I got it. With the finger prick, that's

some type of Bluetooth enabled thing

that automatically syncs the data. So

they're not manually having to enter any

values.

>> Goes to cloud and gets to us. And I say

that because if you say like, oh, here's

how to eat. Here's a brochure or a book

or something. It's kind of like telling

to a car driver, just hold on to the

steering wheel straight. It's going to

be awesome. And here's brake and gas

pedal. And you know what's going to

happen? The car is going to beautifully

stay on the road until the first corner.

It's like, oo, forgot to mention that we

may need to adjust. Turn left, turn

right. And so it's the same thing with

nutrition that unless you have this kind

of a platform, there's constant

adjustments. It's kind of like a

self-driving car. Then if you have the

cameras wide lane and yellow lane or

line and you kind of try to keep it in

between. So with the remote monitoring,

we can kind of try to keep you between

the yellow and and white. So that's the

second thing. The third piece for

adherence and this we start talking

about nutrition.

The most important thing early is to

understand the constraints that a person

has. Now I'll give you silly examples.

If we tell a vegan to have bacon and

eggs for breakfast, you know what

happens? They're gonna say f u c k. I'm

out, right? Yeah.

>> There's no way to convince a vegan to

have bacon and eggs for breakfast. And

vice versa. There's other things.

Obviously, we work with US foods, large

kind of actually food delivery, food

service is truck drivers. Their concept

of a lunch is McDonald's.

>> Mhm.

>> We can't tell them, oh, here's the list.

Go shop Whole Foods. So airon and then

go home and cook at home. It's like,

okay, McDonald's it is. We're going to

reverse your diabetes on McDonald's

diet. And by the way, we do that.

>> Okay. I don't want that to get buried.

>> Yeah.

>> What are some sample meals that people

might get out of McDonald's or something

like that?

>> Perfect. So that's the next step with

food. And maybe I'll give you an

example. It's like, okay, now that we

know you are a truck driver and you will

never become a vegan. You can never

become a vegan. I'm obviously I'm tongue

and cheek here, but most of them don't.

Well, I mean, I'm not a vegan either,

and I'm not sure if you're probably not

either, right? Yeah. As it stands.

>> Yeah. And by the way, we have many, many

successful vegan patients. So,

>> yeah.

>> Sorry if I started a diet war here, but

uh Okay. So, example, your truck. Okay.

So, McDonald's, it's may not be the

pinnacle of health, but we can reverse

your metabolic disease with that. And

let's forget the organics that we'll do

that later if you can. Here's what you

do. You go there, say, "All right, well,

you want your burger. Maybe you even add

extra cheese, but please ask them to

drop the bun and just have like a

lettuce strap. Get that. Then you go to

the condiments. Yeah, mayo might be

fine, but don't take the ketchup cuz

we're going to educate you and tell you

that ketchup is colored sugar.

>> Mhm.

>> You you can't have that. Yeah, you want

your soda. You really want your soda.

Water is not enough. Okay, so go for the

diet coke. Don't take the soda with the

sugar. Again, somebody's listening like,

"Oh, diet coke's bad for you." I totally

agree. I'd rather drink water, but

again, let's not let perfection be the

enemy of progress. So, that would be a

McDonald's kind of a session and off you

go.

>> Yeah.

>> So, that's kind of the second step with

food. And then the third one is is

really empowering the patients

with we talk about AI like AI based

tools. you go to a restaurant or you're

trying to cook something, you can take a

picture and we instantaneously say like,

"Hey, what kind of adjustments should

you make?" And tie that to your actual

situation.

>> Mhm.

>> So, how do you change that? And this

happens every day, two, three, four

times a day. And that's the kind of the

self-driving car analogy that the car

that goes straight is fantastic until

you have a corner. And that's 100% the

diets in America today. So, you can't do

one size fits all. And then before you

ask a follow-up question,

this is mind-blowing for people and ties

to your earlier earlier question as

well. The adherence of verta patients

again which are like real Americans not

sis real Americans

is twice as high at one year as taking a

JB1 drug. M

>> we have 83% adherence retention of

patients at one year and look at any any

of the public available data people

stick to GLP ones like 40% maybe 50% 30

to 50%.

>> Mhm.

>> Why is that? Number one reason is the

user perceived benefits. It's like I

can't believe I feel this good. I can't

believe I've lost 35 pounds. I can't

believe I don't need to stick the

insulin needle to my body. And the

stories that we hear from people is

like, I'm 65. I thought I don't see my

grandkids grow and I have so much energy

that I'm gardening the first time in 20

years or whatever that is. And you know

this, when you're feeling really, really

bad, you're sick and everything's

hurting and then that suddenly goes

away, that's like life is freaking

awesome. And so I think the number one

reason is the benefits are so strong

versus like a calorie restricted diet

where you're like this sucks but I'm

gonna look good on a beach at least for

a week.

>> How do the experience of benefits differ

from GLP1s, right? Just because we're

segueing directly from that and

certainly a lot of people listening will

either directly themselves have

experienced or know someone who has lost

35 lbs, right? and feels more energy

because the GLP1s do make you slightly

more katotic

>> for the people who are wondering why

they might feel sharper. That's actually

one very plausible piece of the puzzle.

But how do the perceived benefits differ

in a way and maybe there's more to

explain it and I'm sure there is the

sort of two times GLP1 adherence at one

year. I guess that's what you said,

right? So I'm just trying to identify

where those two interventions diverge.

>> First I will say our verd providers

prescribe both oral and injectable GLP1s

when appropriate and or necessary and

when our client the plan sponsor like an

employer health plan have them in a plan

design. So I just wanted to mention that

so that nobody thinks like oh this is

some sort of nutrition dogma. No,

there's effective pharmaceuticals and

especially JB ones in obesity and

metabolic disease context are way better

than the 1980s and '90s diet pills. So

like it's a real real innovation.

>> You guys don't prescribe fanfan to your

patients. Yeah,

>> we don't. We don't. By the way, there

are companies that do that to lower cost

of GLB ones. So absolutely we don't do

that.

>> Yeah,

>> I start from very basics. The GLB ones

100% affect your appetite. So they

change how much you eat. So you eat

less, but they alone don't change what

you eat. So that's a starting point. And

if you don't change what you eat, you're

not going to be perfectly or even

optimally metabolically healthy. And so

one example is

>> you lower appetite, you eat less. But

the second you come off these drugs, all

the data shows that your weight

skyrockets and more likely than not, you

gain fat and you've lost tons of muscle.

By the way, we've shown the patients who

come to us on GLP once and once they

discontinue the drug for whatever

reason, a personal choice or side

effects, we've been able to sustain that

weight loss. This is published and peer

review data 18 months out and soon we

will have even longerterm data, but 18

months no weight regain.

>> Why? Because we start changing what you

eat while you're on the drug

>> and if you do that. But to kind of

sharpen the point to your question,

obviously

we know the side effects of healthy

nutrition. None. Every drug has side

effects. So that's sort of one thing.

And these do ones are tolerated much

better than many, many other drugs. But

there's a lot of things.

>> Nausea and stomach issues. It's

interesting. We've surveyed the patients

who are on GLP1s in our care. 80% of

them say I either want to severely

reduce the dependence on these drugs or

get completely awful. So this idea which

is prevalent at least in the press like

Americans just want to take a pill and

keep taking the pill for the rest of

their lives most people if given the

choice if given the choice to be healthy

without they they don't want to be

taking drugs. So I guess hopefully that

answers the question of what are the

user perceived benefits? Well, there's

no use of side effects when you're

eating healthy food, but with the drug,

you usually have that.

>> I'm not the expert to talk to kind of

how

energy levels or kind of excitement or

mood and things like that change. I

think lots of data will come out when