Founder @truemed, @kettleandfire, @drinksurely, others. Venture partner @LongJourneyVC. Sign up for my newsletter on health and startups:
Austin, TX
- Tweets 6,142
- Following 838
- Followers 46,649
- Likes 11,372
Pinned Tweet
Today, 90%+ of healthcare spend (all $4.5T of it) goes towards treating chronic conditions after someone is sick.
Less than 3% of that spend goes towards prevention.
@Truemed exists to get more people investing in True Medicine. Exercise, food, supplements, movement, sleep, toxin removal… lifestyle interventions that help people treat and prevent disease, not just treat the symptoms of underlying sickness.
We’re building tools that allow qualified individuals to unlock the $160B in tax-free HSA/FSA funds, and use them on these root-cause interventions.
Since launching just 2.5 years ago, we’ve helped almost a million individuals pay for these interventions, and we’re just getting started.
If we want to fix healthcare in America, we fundamentally have to help Americans get healthier.
I’m extremely proud to announce our $34M Series A led by a16z, and am excited to continue our work to end the chronic disease crisis.
158
81
1,134
502,440
Singapore created the world's most efficient healthcare system from scratch in one generation.
They spend $4,000 per person on healthcare. We spend $15,000.
Their secret?
The exact opposite of what American "experts" recommend: 🧵
659
5,172
27,826
3,714,595
1990: zero states with obesity rates above 20%
2018: zero states with obesity rates below 20%
Not to mention an explosion in chronic disease, cancer, ADHD, inflammation...
Something has to change. And that something is our broken food system.
283
1,415
7,430
1,906,565
Why do the French eat cheese, butter, and drink wine—but still have lower rates of heart disease than Americans?
After some digging, I found out what was going on...
The “French Paradox”—explained: 🧵
179
761
4,851
996,720
Here's a cheery Friday fact.
An average 22 year-old male today has roughly the same testosterone levels as a 67 year old had in the year 2000.
Average testosterone has fallen close to 50% in the last 2 decades, and nobody is talking about it.
315
1,115
4,414
Italians aren’t counting calories at all. They eat pasta, cheese, gelato and stay thin.
When Americans eat similarly, they get morbidly obese and sick.
What on Earth is going on?
The flavor-nutrition disconnect, explained: 🧵
192
577
4,619
683,677
I'm seeing a big shift in friends moving away from:
- alcohol
- caffeine
- nicotine
and towards
- cannabis
- psychedelics
We don't want our parents' drugs.
612
218
3,687
The FDA literally has a 10-second rule.
If a company fries something in oil for less than 10 seconds, there's no requirement to add the oil to the ingredient label.
Reform can't come soon enough.
63
518
3,702
247,145
I think a lot of people are sleeping on just how big the "Boomer's retiring and selling their business" is going to be in the next decade
Something like $30 trillion of SMB equity is going to change hands (or... not and shut down)
Massive generational shift going on
138
311
3,063
1/n A quick tweetstorm about why I think Beyond Meat ($BYND) and Impossible Foods are the trans fat purveyors of our generation.
139
832
2,952
It's crazy to me that school today:
- put kids inside all day
- feeds them terrible foods
- make them sit 6+ hours
- pretends they can pay attention to not-that-interesting topics for 6 hours
And when they can't do the above, we medicate them.
75
321
2,631
9/ The price transparency experiment is fascinating:
All healthcare providers in Singapore must display their prices and outcomes so that buyers can assess the cost and quality.
Why? MOH published all hospital prices online.
Markets work when consumers have information.
20
176
2,575
150,729
4/ They ranked healthcare 5th in priority, after:
• International recognition
• Defense capabilities
• Economic development
• Housing
Why? Building wealth creates resources for healthcare.
3
147
2,325
217,963
~60 years after Singapore's independence from the UK, they are:
- wealthier than the UK (per capita)
- have better education + health outcomes
- higher growth than the UK
Likely a lot to learn from looking at Singapore's rise!
73
1,060
2,167
5/ Here's their secret weapon most analysts miss:
The "outpatient dispensary" network.
They built satellite clinics (small healthcare facilities that are extensions of larger hospitals or healthcare centers) offering immunization, health screening, family planning, and psychiatric counseling.
All before investing in expensive hospitals.
30
182
2,077
247,934
6/ The data proves this worked. Success metric?
They moved most primary care away from expensive hospitals to these clinics that former Health Minister Khaw Boon Wan called "low-hanging fruit."
High return on low investment.
6
118
2,053
186,671
It takes 280 gallons of water to make a pound of beef.
That goes down to 50-100 gallons when grass-fed.
It takes 339 gallons to produce a pound of walnuts, and 503 gallons for a pound of almonds!
But which one does the media tell you to stop eating?
165
277
1,994
274,718
My 16 year old brother wants to be an entrepreneur, but is stuck and has "no ideas".
What's the best way for a teenager to start their own thing and get a taste of entrepreneurship?
657
184
1,994
10/ They solved the "free rider" problem with this solution:
• Basic clinic visit: 50 cents
• Doubled on holidays
(It's pricier now)
Small co-pays prevent abuse while maintaining access. When people paid for antibiotics, they finished the course instead of wasting them.
11
119
1,921
143,843
3/ Lee Kuan Yew's key insight (from his Cambridge days studying Britain's NHS):
Free healthcare sounds civilized, until you understand human behavior and system incentives.
So, the government made a counterintuitive choice in 1960s:
5
91
1,871
219,618
I wish there was a WeWork for deep, focused work.
I'd love a spot I could hit for 3-4 hours that'd have:
- library rules (ie silence)
- no cell phone signal
- caffeine + nootropics to help get in flow state
- sauna / cold plunge
.. whatever makes me my most productive self
168
78
1,863
Curious who will be the first VC to fund a religion:
- massive TAM
- strong network effects
- huge customer LTV
- tax advantaged structure
- most competitors are hundreds of years old
- addresses lots of problems of modernity (meaning, community, etc)
189
213
1,731
8/ What makes their hospital system unique?
Public hospitals have autonomy like private ones.
Their prices set a benchmark for private hospitals, and the government keeps control through MOH Holdings.
Result: Competition without chaos.
2
108
1,675
157,257
Nattokinase is the #1 supplement for cardiovascular health.
It reduces plaque, dissolves clots, and lowers blood pressure. In trials, it reduced arterial plaque 36.6% (vs 11.5% for statins).
Here's everything you should know: 🧵
60
363
1,662
315,263
7/ 1983 was the inflection point. The first National Health Plan introduced Medisave.
Every employee contributes a portion of their monthly salary to a personal account.
After age 50, rates decrease. This creates individual responsibility without abandoning collective support.
5
100
1,608
175,182
14/ The outcomes speak for themselves.
SGP has the world's highest healthy life expectancy (all while spending a fraction of GDP).
Not magic, but careful system design over 40+ years.
12
118
1,511
102,327
I've started 2 consumer brands (@kettleandfire and @perfectketones) that each have done $100mm+ in sales in less than 5 years.
If you’re starting a consumer brand, here are the 7 key areas to focus (thread):
41
191
1,486
20/ Critics will scream "socialism!" but they're missing the point.
Singapore's system is more capitalist than ours.
They just understood you need rules for markets to work.
Their healthcare costs 5% of GDP versus our 17%. That's not politics, that's math.
12
132
1,506
60,419
Company I wish existed - hard sciences classes for the intellectually curious.
Like, I'd love to spend 2 hours a week learning physics purely for intellectual curiosity reasons.
College classes are too much (time / $$ / inefficient) + most students don't care.
84
107
1,464
2/ First, the stats that matter for context:
• Pre-1960: Singapore had <50 medical specialists for 2M residents
• 1964: GDP of $0.89B
• 1983: GDP grew to $18B
• 2011: Nearly $279.4B
This economic foundation was crucial. Here's why:
4
74
1,420
228,548
11/ Modern polyclinics are one-stop centers handling:
• Acute illnesses
• Chronic disease management
• Clinical laboratory services
• X-ray facilities
• Pharmaceutical services
All with coordinated care teams.
3
60
1,300
116,480
17/ We need price transparency with teeth.
Singapore's MOH publishes every hospital's prices online and costs dropped immediately.
But they understood the key thing: you need both standardized coding and real-time price databases.
Half measures won't cut it.
7
76
1,277
73,574
13/ Singapore's current system uses 3 layers of protection:
• Medisave (mandatory savings)
• MediShield (catastrophic insurance)
• Medifund (safety net for the poor)
Each layer has a specific role, preventing gaps while maintaining incentives.
3
94
1,269
92,336
I was homeschooled until 5th grade. 2 hours a day of formal "school", 4 days a week (we had Fridays off).
I was shocked when I entered 5th grade that I was ahead of many kids who spent 5x more time in class.
Establishment culture: NYC parents paying huge sums to send two year olds to private preschools, while advocating public for others
Emerging culture: homeschool your kids, let them read books & play games, then set them up as contract programmers on Upwork once they can code
31
132
1,144
18/ The hard truth about insurance reform: First-dollar coverage must go.
Instead, we need:
• High-deductible catastrophic coverage for all
• Income-based co-pays
• Price caps on basic services
The insurance lobby will fight it, but Singapore proves it works.
15
72
1,135
67,124
Ozempic isn't a miracle weight loss drug.
It’s medically induced anorexia.
Most doctors won't tell you this, but this weight loss comes with a terrible price.
Here's the real truth about Ozempic: 🧵
63
185
1,123
478,776
I think 2x/year psychedelic therapy with my partner has been the best thing we've ever done for our relationship.
When/if psychedelics are normalized, they will almost certainly impact the national divorce rate
55
26
1,065
Something I've found true in the last month - "A person's success in life can usually be measured by the number of uncomfortable conversations they're willing to have."
I've since made this something I reflect on every Monday. What hard conversation am I avoiding right now?
21
133
1,063
fin/ Could the U.S. implement these reforms?
Politically, it would be incredibly difficult. But with healthcare bankrupting families and crippling businesses, we're running out of alternatives.
The Singapore model isn't perfect, but it's better than what we have now.
32
63
1,058
54,206
16/ Mandatory health savings accounts that actually work.
Not the HSAs we have now (though those are great), but real accounts with:
• Higher caps
• Government matching for low-income workers
• Direct payment to providers
10
59
1,046
74,828
The average 22-year-old male has the same testosterone as a 67-year-old male...
In the year 2000.
Just 23 years ago.
Why is this happening, and what can be done about it?
77
96
944
476,534
19/ The most crucial piece: Government as system architect, not just payer.
This means regulating hospital expansion, managing doctor supply, controlling medical school seats, and setting price ceilings.
Not full control, but smart oversight.
15
61
980
61,049
15/ So what would it take for the US to implement Singapore-style reforms?
We'd need to completely restructure incentives across the entire system.
Stay with me for just one more minute, and let me break it down 👇🏽
8
55
967
78,589
12/ They also solved workforce development systematically.
In 1970, they created Committee for Postgraduate Medical Education.
A decade later, they launched Healthcare Manpower Development Programme.
By 2009, they had 1,750 foreign-trained doctors integrated into system.
2
62
950
109,838
Just came across this weekly sprint update template from @ycombinator
Feels like this sort of fast, informal accountability + reporting would be suuuper useful to a lot of people who have just started working on something new
26
79
960
A hire I'd love to make: Chief Automation Officer.
Come in, help me + the team save time by leveraging:
- Zapier
- Retool.com
- virtual assistants
- Airtable
- anything else I'm missing
Does this exist?
82
63
913
I'm surprised startups + founders don't share resources across key areas:
- legal
- accounting
- bookkeeping
I'd much rather split a full-time lawyer/CPA with 4 other friendly companies than work through a firm.
Does anyone do this? Or why is this a bad idea?
101
44
834
But at least it hasn't seemed to impact anything besides:
- historically low marriage rates
- historically low birth rates
- historically low youth sexual activity
Nope, nothing to see here..
28
114
759
David Protein Bar.
At first glance, their marketing might convince you that it's healthy.
In reality—it's a nuclear bomb for your gut, metabolism, and overall health.
Here is a breakdown: 🧵
112
53
793
609,285
1/n A tweetstorm about a little-discussed factor that’s destroying American health: vegetable oils.
34
119
753
I've had consistent neck + upper back pain for years.
5 mo ago, I got a movement coach to help me with mobility + movement.
Today, I realized I literally never think about neck or back pain anymore.
Makes me wonder how many ppl get surgery when they just need to.. move
63
30
750
5/ When you eat a $BYND burger, you’re effectively consuming a pea protein and canola oil smoothie.
Deconstructed, nobody thinks this is good for you. Put it in patty form, and people will apparently consider it healthy. Nuts.
23
121
643
5/ When Americans say "cheese" and when the French say "cheese," we're talking about different substances.
American cheese undergoes 18+ processing steps including emulsifiers, preservatives, and artificial colors.
French cheese? Milk, cultures, salt, time. That's it.
20
78
646
62,787
Between 1950 and 2007, melanoma rates skyrocketed. Ironically, during the same period, sunscreen use went through the roof.
Could the very thing meant to protect us be contributing to the problem?
Let’s explore the connection: 🧵
42
72
634
214,086
RT the thread if you found it valuable.
A bit about me:
I founded @truemedpayments, @kettleandfire, and @drinksurely. Follow me to read more about health and startups.
Singapore created the world's most efficient healthcare system from scratch in one generation.
They spend $4,000 per person on healthcare. We spend $15,000.
Their secret?
The exact opposite of what American "experts" recommend: 🧵
53
109
605
80,142
People are so unwilling to blame our food system as the reason for our poor health in the US vs other countries.
It’s obviously the food. American food is uniquely poisonous.
41
89
569
55,835
The most interesting thinkers I interact with are those who are technological progressives but Paleo conservatives from a health, wellness and happiness standpoint.
I have no idea what to call this subculture.
51
27
550
I'm starting a new company - truemedicine.care - that puts food + exercise at the center of health.
Today, less than 3% of all healthcare $$ goes towards prevention. That has to change.
We just closed our seed round + are looking for founding engineers to join the team
49
30
576
6/ The same pattern emerges with meat.
Most American beef is fed corn and soy, treated with hormones, processed with ammonia, and preserved with nitrates.
But most French beef is grass-fed, ages naturally, and butchered locally.
3
51
534
58,211
In 2005, YC began investing in the uninvestable. That meant funding young, inexperienced, highly technical founders.
Early YC was one of the best funds ever.
Makes me wonder - what are the uninvestable asset classes of today that will drive huge returns over the next decade?
127
38
518
293,290
I want to hire a new kind of PR firm.
One that pitches niche podcasts, YouTubers, influencers and newsletters for features. Not Forbes.
New media needs new PR.
41
31
508
American farms pump 6.1 million kg of antibiotics into HEALTHY animals each year, DOUBLE what Europe allows.
This is the meat Americans eat every day.
Here is what this means for your health: 🧵
31
117
504
204,580
Today I learned that we're likely 2-3 years away from short-route electric airplanes that literally cut the cost of flying by 10x. Ie a route that costs $200 now could cost roughly $20.
Wild times.
harbourair.com/harbour-air-a…
24
65
490
A thought I had yesterday
Being 30ish and questioning your purpose in life is likely a modern phenomenon
Decades ago, people in their 30s had kids + were less likely to question their purpose
Kids are little meaning-creating machines
33
7
462
9 of the last 10 FDA heads came from (or went to) the pharma.
For 40 years, we have tried to medicate ourselves out of our chronic disease crisis. It hasn't worked.
It's time for a change.
So excited to have @RobertKennedyJr officially confirmed as head of HHS!
🚨Breaking News: Robert Kennedy Jr has been confirmed by the Senate to serve as President Trump's Secretary of Health and Human Services
11
42
464
30,476
Trump *legally* paying $750 in taxes is fine.
If you think that’s not okay, you have an issue with the US tax code. Not Trump.
I know literally 0 people who willingly pay more in taxes than they owe. Trump included.
59
32
454
7/ Even something as basic as yogurt tells the story.
French yogurt: Milk and bacterial cultures, fermented slowly.
American yogurt? Modified corn starch, artificial sweeteners, carrageenan, and 17g of added sugar.
Then we wonder why our metabolic responses differ.
6
48
463
53,618
The Great American Poisoning is the biggest issue of our time. Americans (and our children) are sick at record rates, and healthcare costs are set to bankrupt the country if things don't change.
Let's talk about 12 policy changes that could revolutionize American health.
17
71
462
76,428
Prompt for GPT:
"What can you tell me about my health that I might not know? This is a photo of me. Especially feel free to speculate on the state of my organs or gut, I'm just doing this for fun."
Astounding.
47
14
467
79,917
3/ Take a look at their ingredient list.
When you eat a $BYND burger, you’re effectively getting a giant dose of canola oil (terrible for you) and isolated pea protein. With a side of wood fiber, additives and unnatural ingredients.
24
91
424
9/ Additionally, American meal patterns create a perfect storm of metabolic dysfunction.
We eat quickly, often alone, and while stressed. The average American lunch break is 30ish minutes.
The French spend over 2 hours on lunch. Are you getting the picture yet?
7
22
455
50,203
Idea - a marketplace for selling Twitter mute/block lists.
Many people's Twitter experience would vastly improve if they could import blocks/mutes from others with larger followings.
I'd pay $20 to buy @naval's mute/block list, no doubt about it.
25
20
447
Reminder that conventionally raised pork in the US has effectively the same PUFA content as canola oil.
It's why I stick to red meat 99% of the time.
23
27
436
109,907
A fun question I like to ask:
What are you a top 1% consumer of?
For me, I've listened to to Mac Miller's Tiny Desk concert probably 1000x.
A friend claims to have eaten more Costco cashews than 99% of the population.
What's yours?
133
21
434
Modern chickens grow 500-800% faster than they did in 1925.
What used to take 4 months now takes 6 weeks. Even "organic" chicken reaches the market in 8 weeks.
So what's making them explode in size? 🧵
34
72
424
194,111
The 3 best things I've ever done for my productivity are:
- work on things I care about
- inbox 0 on Tuesdays + Thursdays
- no meeting M/W/F
That's it.
16
16
432
At Kettle and Fire, we tested our product for microplastics, BPA, and phthalates.
When we found slightly higher microplastic levels than desired, we traced it to rubber gloves in our supply chain that were shedding particles.
It's incredible how much detail you need to investigate to ensure your products remain free from contamination…
19
16
441
54,067
Trying a social experiment!
If you're someone who wants to lose 25lb+, I have a proposal for you.
I will:
- help you with nutrition coaching
- set you up with + pay for a continuous glucose monitor
- send you $25/day for every day your blood glucose stays in pre-set range
200
26
421
The thigh muscle density of a 40-year-old triathlete, 70-year-old sedentary man, and a 70-year-old triathlete.
Healthspan doesn't depend on miracle drugs or quick fixes.
It depends on exercise, diet, and lifestyle.
6
45
404
52,592
fin/ I'm testing out doing some tweetstorms since my writing has fallen off.
Tomorrow, assuming I don't get taken out by an intnernet rage mob, I'll dig into the health of $BYND and Impossible's businesses.
42
9
392
8/ My larger concern on both of these burgers is that - at minimum - they are HIGHLY processed products with lots of stuff that doesn't lead to healthier humans: vegetable oils, soy, protein isolates, additives, all non-organic. They are not real foods. (cough, Soylent).
10
44
379
Singapore spends 4% of GDP on healthcare; the US burns 18%.
Yet Singaporeans enjoy some of the world’s lowest chronic-disease rates.
Prevention is baked into their daily life: from school meals to city design.
The urban-health model we should all study: 🧵
16
65
398
83,014
French kids are 60% less overweight than American kids
If we wanted to actually address the "mysterious" obesity crisis, we should copy the French approach to school lunches and food.
Instead, the APA recommends ozempic to kids over the age of 12
29
71
384
29,921
people are exercising more now than before - jeffnobbs.com/posts/what-cau…
17
12
364
35,211
I wonder to what extent sleep trackers (Oura, Apple Watch, Whoop, etc) are pushing people to drink less.
Once you start tracking your sleep, it quickly becomes obvious just how badly alcohol impacts it.
And not for the better.
32
25
392
I've started calling friends explicitly to chat for just 5-10 minutes.
Stating 5 mins up front (and giving permission for shorter future calls) makes the barrier to picking up the phone MUCH lower.
It's led to lots of short, fun calls lately. 10/10 would recommend.
16
14
397
Who could write a book that you'd happily pay $1000 to read?
Mine:
- The Last Psychiatrist on ~anything
- @slatestarcodex on ~anything
- @naval on ~anything
- @algekalipso on consciousness
- @byrneseyeview
- @Alex_Danco
- @nntaleb
Who else?
75
31
391
Most people would rather *be* something than *do* something. Rather "be" an entrepreneur than start a business.
The happiest people I know all choose action over identity.
11
35
390
Proud to announce the opening of @kettleandfire own factory!
We've been working on our own facility for over a year now, and are proud to have opened all 160k sqft of the new facility🚀
39
6
382
22,099
Just had our 5th friend buy a home within 4 blocks of our house in Austin
Progress towards building a friend-filled neighborhood is happening 💪
23
3
368
2/ Imho, the "flavor-nutrition disconnect" is the most profound nutrition discovery of our time.
For millennia, flavor signaled nutrition.
A sweet berry meant energy (sugar!), a bitter leaf meant medicine.
Today, these ancient connections are broken.
1
14
355
37,771
9/ Not only that, but I’m concerned any time I see a nutrient-dense food (like meat) being replaced by a highly processed variant. Historically, that hasn’t done good things for human health.
6
20
325
FDA has been fooling you for decades with artificial food dyes.
In 1990, they banned them in cosmetics, but kept them in your food.
West Virginia just banned them. Why?
Here's the eye-opening truth Big Food doesn't want you to know: 🧵
11
64
337
139,097
Learn in your 20s, earn in your 30s.
^ Probably the best career advice I've ever been given.
11
78
325
My predictions on the biggest health trends of the next decade:
- PFAS and other toxin exposure
- nutritional psychiatry
- treating gut health for mental health issues
- psychedelic therapy for multiple conditions
- treating the house as a source of illness
What am I missing?
60
22
322
78,610
In 1962, kids got only 7 vaccine doses in childhood.
Today, American children get 73... while Switzerland, Japan & Austria administer HALF as many.
Are other developed nations "anti-science" or is Big Pharma to blame?
A nuanced look at vaccine policy: 🧵
20
53
320
118,499
Our food system is broken and makes everyone sick.
This is *the* key bipartisan issue of our time - and I’m grateful my article in @micsolana’s newsletter spurred Jesse Watters to bring this message to his large audience.
(start at 2:34)
foxnews.com/video/6318208333…
12
46
301
108,072
Basically 1/2 my friends at this point are trying to set up communal living as we move into our 30s.
I have no idea who will figure out the communal living thing. But suspect the prize for doing so is quite large.
37
11
307
