In the last decade of a person’s life, we spend 7x what we spend on taking care of them in all the years that came before.

SEVEN TIMES!

That’s not only unbelievable, it’s unsustainable, particularly as our aging population grows and life span increases. So, if it’s not just about increasing life span, or the number of years someone lives, what is it about? For Dr. Tzipi Strauss, Founder and Director of the Sheba Longevity Center, it’s about increasing health span, that is the number of years a person lives healthily, without the need for significant intervention.

The work Dr. Strauss and her team are doing focuses on longevity. It’s a step beyond lifestyle medicine in that they look across all body systems, and at the individual as a whole, to identify their biggest risk factors and what interventions they actually need, not just what the latest fad says. The emphasis on behavior change is significant, and that may be the holy grail, getting people to adopt these healthy changes permanently, but Dr. Strauss finds that when patients see their biological age and the impact of the decisions and choices they’ve been making, their motivation to change is different. It’s data driven.

Professor Strauss is a physician-scientist, pediatrician, and neonatologist, and a leading voice in the emerging field of longevity medicine. She is the Founder and Director of the Sheba Longevity Center—one of the first academic longevity centers embedded within a public healthcare system. Her work combines clinical innovation, research, and policy, aiming to transform longevity from a privilege into a scalable, evidence-based public health model.

Without intervention, in 2050, everyone in the US population will either have Alzheimer’s disease or be caring for someone with Alzheimer’s disease.

That’s the state of where we’re at with cognitive decline. Right now, if you reach the age of 85, your chances of developing cognitive decline are 1 in 2. That’s right, 50%. But, BUT, new research is helping us understand the hidden drivers of cognitive decline and creating hope at the same time. Because now that we understand the origin of risk for an individual, we can prescribe specific interventions to circumvent that risk and prevent the disease altogether.

This is the amazing work of James Maskell and Dr. Kristine Burke, my guests on the show today. Dr. Burke is Co-PI of the EVANTHEA Study, a clinical trial designed to look at the impact of a precision medicine approach to Alzheimer’s disease. The initial results are astounding – with intervention, 91% of participants saw improvement in cognitive function. That’s better than any drug, lifestyle medicine, or treatment protocol we have to date by a long shot. These two join me today to talk about what those hidden drivers are, how precision medicine can help, who’s going to pay for it, and why this is so critically important to society at large.

Dr. Kristine Burke is a triple board-certified precision medicine physician and the Founder and Executive Medical Director of True Health Center for Precision Medicine in Northern California. She is also the Co-Founder and Chief Medical Officer of TruNeura who is advancing a scalable model for brain health that integrates clinical insight, data, and AI-supported decision tools.

James Maskell has spent the past decade innovating at the cross section of functional medicine and community. To that end, he created the Functional Forum, the world’s largest integrative medicine conference with record-setting participation online and growing physician communities around the world.

“Health doesn’t just happen within the four walls of the hospital.”

Or, at least, it shouldn’t have to. The work of our guest today, Dr. Eve Cunningham, and her team at Cadence, ensures that patients with chronic conditions can continue to live and thrive at home. Through remote patient monitoring but also behavioral support, medication titration, and relationship building, they ensure that patients understand their condition, are able to manage it effectively at home, and have another set of eyes looking out in case something starts to go awry. It’s technology driven, but it’s human focused.

Eve is the Chief Medical Officer of Cadence, a medical group and remote care delivery system that supports health systems, clinicians, and patients in delivering care beyond the four walls of a hospital or clinic. Dr. Cunningham has spent the last 20 years deploying transformational health system programs at scale, leading large multidisciplinary medical groups, and integrating AI into clinical care at some of the largest non-profit health systems in the country. She is a board-certified OB-GYN and leader in virtual care, clinical AI, and clinician burnout.

We’re quick to blame genetics for our health and wellness issues, but the reality is that genetics only makes up 18% of our health destiny. That means the rest is up to us.

Our guest today, Dr. Grant Zarzour, has seen that first hand in his own family. When his son was diagnosed with moderate autism, he and his wife refused to accept the predictions for his future. They dove head first into the data and in so doing, revolutionized not just their son’s life, but their own. Now a relentless proponent of diet, sleep, and exercise for physical and mental health, Dr. Zarzour feels like we all have a hand in our own destiny. We just have to commit.

Dr. Zarzour is a practicing hip and knee surgeon in Mobile, AL. He is the president of the largest orthopaedic practice in Alabama. While treating thousands of patients a year, Grant has developed a passion for preventive medicine. In 2024, he founded Sperity Health, which offers personalized longevity coaching to help its members improve their diet, exercise, and sleep with expert MD guidance. Sperity Health’s mission is to lower its member’s risk of cancer, cardiovascular disease, and dementia by up to 50% based on data and science.

Forty percent of the time, oncology care is not being delivered in concordance with guidelines. FORTY PERCENT!

As our guest today explains, that’s not because of bad doctors. It’s because oncology care changes rapidly and because almost eighty percent of patients are being seen by a community oncologist, a physician who is responsible for treating ALL types of cancer, instead of a specialist. How can we address that? Well, as Dr. Yousuf Zafar explains, there are really three options.

1. The patient travels to an NCI Cancer Center to seek a second opinion. This is obviously expensive and inconvenient and out of scope for many patients.
2. The patient’s provider calls another oncologist in their network consult on the case. These relationships are critical but not universal.
3. We can formalize this provider-to-provider framework and have it paid for by a patient’s employer. This is the basis for AccessHope.

Today’s guest is a practicing oncologist and adjunct professor at Duke University, and chief medical officer at AccessHope, where he focuses on expanding access to expert cancer care for patients treated outside of academic centers. While National Cancer Institute Designated Comprehensive Cancer Centers deliver superior outcomes, they treat only 20 percent of cancer patients. Dr. Zafar is working to extend that expertise to the remaining 80 percent.

It’s rare that an article title alone makes me want to stop what I’m doing and read it, but that’s what happened when I saw the title of Jess Craig’s recent article, “Why More Doctors are Billing Their Patients Like it’s the 1920’s.”

In this article, and subsequently, our conversation here on the podcast, Jess explains what she means, citing the growing number of physician practices organized around the concept of direct pay. That is, the practice or physician determines a set cash price for their services and the patient pays that price out of pocket. This model may seem like we’re going backwards, to a time when health insurance didn’t exist, but in fact, it’s starting to be seen as one of the most progressive ways of managing rapidly inflating costs and concern about quality. While there are still questions around accessibility, as Jess points out, it may be one of the first advances we’ve seen in over a decade that could actually move the needle.

Jess Craig is a health reporter for Straight Arrow News (SAN). Prior to joining SAN, Jess worked as an infectious disease epidemiologist and health security technical advisor for international research institutes and US government agencies, including the CDC, USDA, and USAID. Jess worked as a freelance journalist for eight years, covering science, health, and world news for various outlets. She also served as a reporting fellow for NPR in 2020 and for Vox in 2024.

With the recent explosion of GLP-1 drugs, the war on obesity seems to have taken a new and potent turn, but many are concerned about the recidivism, the side effects, and our reenergized obsession with being thin.

Our guest today, Dr. Laure DeMattia, is a board certified family medicine physician and obesity specialist. For her, obesity is personal, as she has struggled her entire life with this chronic condition. In this episode, Dr. DeMattia breaks down for us how GLP-1 drugs work to hyperdrive weight loss, why that loss is rarely sustainable without long term use of the drugs, and her own philosophy outside of medication that helps her patients feel seen, heard, and safe. It’s both an educational conversation and a behind-the-curtains look at the obesity epidemic from someone on the front lines.

Dr. Laure DeMattia helps women stop blaming themselves for their physiology and find lasting health for over 20 years. Her dual perspective as both a doctor and a patient makes her uniquely compassionate, challenging the myth that willpower is the solution. Author of the book, The 4 Food Cues, Dr. DeMattia hosts her own YouTube channel, Navigating Obesity with Dr. D, where she offers a compassionate, realistic viewpoint about weight and weight loss.

“It doesn’t matter what is going on in your life, nutrition is relevant.” And, at least for most Americans, getting help with their nutrition is covered by their insurance. So, why isn’t working with a dietician a normal part of every American’s care plan?

Our guest today is trying to address that question. Noah Kotlove, the CEO and Co-Founder of Berry Street, went through his own nutrition journey after spending his first thirty years clinically obese. He tried every fad diet imaginable, with great success, but like many, gained all of the weight back because of the unsustainability of so much restriction. He finally found lasting change when he met with a dietician, a step recommended by his primary care provider, and, surprisingly to him, totally covered by his insurance plan.

That personal experience led Noah to create Berry Street, an online, DTC nutrition therapy platform that helps clients access registered dieticians while taking the guesswork out of the payment part. In this episode, Noah shares how Berry Street works, why the relationship between dietician and client is such a critical part of success, and how they leverage information, expertise, and technology to improve the customer experience and increase the likelihood of sustainable outcomes.

Noah founded Berry Street after losing 60 pounds through nutrition therapy, aiming to scale insurance-covered care through technology and change the way Americans eat. A serial entrepreneur, Noah is also the Founder of Sobrietysoft, an addiction recovery app with over 6 million users. He sees technology as a tool that allows us to get creative about outcomes over products.