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Colossus (Invest Like the Best / Business Breakdowns)Podcast20 Jun 2023Source: joincolossus.comHost: Patrick O'Shaughnessy

Justin Mares - The US Health Crisis - [Invest Like the Best, EP.333]

In plain words

This interview argues that the US health crisis stems from a broken incentive system: everyone in food and healthcare makes more money when you're sick, so 97% of spending goes to treating disease and only 3% to prevention. Mares warns against Ozempic, noting 30-40% of weight loss comes from muscle and bone loss, and weight returns after stopping. He also flags glyphosate (a weedkiller) in US drinking water at 7,000 times the EU limit, calling environmental toxins a major future risk.

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Justin Mares, in episode 333 of Invest Like the Best, points out that the United States is facing a health crisis that could ultimately lead to national bankruptcy. The three health food brands he founded, along with TrueMed, generate a combined annual revenue of over $100 million. His core argument

~13 min full read · 9 sections
Deep Analysis

Justin Mares - The U.S. Health Crisis - [Invest Like the Best, EP.333]

At a Glance

Justin Mares is the founder of TrueMed, having previously launched three health food brands with combined annual revenues exceeding $100 million. The core theme of this episode: the U.S. health system suffers from systemic incentive misalignment, exacerbating chronic diseases, declining mental health, and infertility issues, potentially leading to national bankruptcy. Key takeaway: Mares argues that the incentive structure within the U.S. food and healthcare system makes all participants earn more when consumers are sick, which is the root cause of the health crisis—97% of medical spending goes toward treating those already ill, while only 3% is allocated to prevention.


I. The Scale and Root Causes of America’s Health Crisis: From “Default Health” to a “System That Causes Disease”

Mares argues that over the past 50–60 years, the health of Americans has fundamentally deteriorated, with chronic diseases evolving from near non-existence to accounting for 20% of GDP.

  • Historical comparison: 50–60 years ago, chronic diseases were “basically not a thing”; today, 40–50% of children have diabetes or prediabetes, with cancer, obesity, infertility, and depression exploding across the board.
  • Economic threat: Healthcare costs have outpaced inflation by 200% and are approaching 20% of GDP. Mares warns: “You don’t have to fast-forward very far to see healthcare costs growing at this rate to the point where they essentially bankrupt the country.”
  • Human capital loss: Six in ten adults have at least one chronic disease, with the average person taking 17 prescription drugs per year. Mares notes: “If you don’t feel well health-wise, you cannot work at your best, at your highest efficiency.”

Mares emphasizes that the root cause lies in the structural incentive distortions within the food system:

  • Misaligned subsidies: Since 1995, the U.S. has spent nearly $210 billion in subsidies on just three crops: corn, soybeans, and wheat. Government subsidies for tobacco (about 2%) are four times the total subsidies for fruits and vegetables. Mares points out: “The USDA says Americans should get 50% of their calories from fruits and vegetables, yet over 80% of subsidy dollars go to corn, soybeans, and wheat, with only about 0.45% going to fruits and vegetables.”
  • Industrialization of food: In 1960, nearly 0% of American calories came from soybean oil; today, that figure is close to 20%. Mares argues these soybean oils are “unprecedented in human dietary history.”
  • Addictive design: Large food companies spend hundreds of millions of dollars to “weaponize” human evolutionary senses, much like Facebook/TikTok, creating ultra-processed foods that are irresistible.

Mares specifically notes that the “cognitive tools” of nutrition research have been systematically weaponized: In the past two years, 50,000 nutrition studies have been published, many funded by large food companies. For every $1 the NIH spends, large food companies spend $11 funding nutrition research. “They are replicating the tobacco companies’ strategy from 40–50 years ago—funding every study that could blur the lines of causality.”


2. Ozempic and the Trap of "Engineered Solutions"

Mares remains highly cautious about GLP-1 agonists such as Ozempic, viewing them as a quintessential example of "symptom engineering" rather than addressing root causes.

  • Business Model Analysis: Ozempic is a once-weekly injectable drug requiring lifelong use, with all weight regained upon discontinuation. Mares notes: "There are already pushes to prescribe this to 12-year-old overweight children—they will take it for life."
  • Underappreciated Side Effects: Early studies show that 30-40% of weight loss comes from loss of muscle mass and bone density. Mares explains: "Muscle is a 'sink' for glucose—if you eat poorly and your blood sugar spikes, muscles can absorb that energy. If people become weaker and their bone density declines, they will be even less able to withstand the glycemic shock of their current diet."
  • Root Problem Unaddressed: Mares argues that obesity is a symptom of metabolic dysfunction, not the cause. "Using a drug that must be taken for life to address the symptoms of metabolic dysfunction does nothing to help with chronic disease, inflammation, mental health, infertility, and other issues linked to a toxic food system."

Mares places Ozempic alongside other historical "engineered solutions": Heart disease rates are rising, yet statin prescriptions are at an all-time high—heart disease continues to climb; depression rates are rising, and SSRI prescriptions are at record levels—still climbing. "Core health metrics continue to deteriorate."


3. The Unity of Physical and Mental Health: The Gut-Brain Axis and Emerging Evidence

Mares argues that physical health and mental health are "the same thing," closely linked through the gut-brain axis.

  • Key data: Male sperm count has declined by 50% over 50 years; 26% of women suffer from polycystic ovary syndrome (PCOS), the leading cause of infertility, which was "almost nonexistent" in the 1970s; miscarriage rates have risen by 10% over the past decade; adolescent girls are experiencing menarche 1-2 years earlier than historically.
  • Gut-brain connection: Over 90% of the body's serotonin is produced in the gut. A literature review shows that for patients with treatment-resistant depression, pure nutritional intervention (improving diet, altering gut microbiome composition) is more effective than talk therapy alone.
  • Mares' "seesaw" model: "You can think of physical health as a seesaw—if it tilts in one direction (unhealthy), it will slightly bias your mood toward negativity, making it easier to fall into a negative feedback loop. And vice versa."

Mares acknowledges that this field is still in its early stages: "Our understanding of the gut-brain axis is very preliminary. But if you believe obesity is a symptom of metabolic dysfunction, then using drugs to address the symptom without solving the root cause does nothing for chronic disease, inflammation, mental health, and so on."


4. Environmental Toxins: The Overlooked "Forever Chemicals" Crisis

Mares believes that environmental toxins (PFAS, glyphosate, etc.) will be one of the most important health trends over the next decade, with their dangers potentially far exceeding current understanding.

  • Regulatory divergence on glyphosate (Roundup): 28 countries worldwide have completely banned glyphosate; the EU is set to ban it within the next few years. The allowable level of glyphosate in U.S. drinking water is 7,000 times higher than in the EU (700 ppb vs. 0.1 ppb). The Detox Project study found that 0.1 ppb of glyphosate can alter gene function in rats and cause severe organ damage.
  • Ubiquitous contamination: 93% of streams contain PFAS; 100% of supermarket cereal products tested positive for glyphosate levels exceeding tap water standards—Cheerios samples averaged 1,125 ppb.
  • Differences in regulatory philosophy: Europe applies a "guilty until proven innocent" principle to new chemicals—"assume these compounds may be harmful until proven safe"; the U.S. adopts an "innocent until proven guilty" approach—"chemicals are basically good until found unsafe," relying on corporate self-reported safety studies.

Mares argues that the bioaccumulation and interactive effects of these chemicals represent the greatest unknown risk: "We are conducting a massive experiment—what happens when all these toxins and chemicals interact? We have absolutely no idea."

Avoidance strategy (80/20 rule):

1. Check everyday products (shampoo, hand soap, lotion, face cream)—ensure they are PFAS-free

2. Use non-toxic cookware (ceramic or stainless steel)

3. Invest in a high-quality water filtration system (reverse osmosis + remineralization)

4. Help eliminate toxins from the body through saunas, sweating, and drinking clean water

Mares predicts: "If someone could create a water brand free of PFAS or microplastics, it would be an absolute success."


5. "Edge Cities" and the Rise of Multi-Company Founders

Mares introduces the concept of the "Edge City"—the frontier of a given field, where what you encounter today will become mainstream in 5-10 years.

  • How to identify whether you are in an "Edge City":

1. When friends and acquaintances frequently ask you questions on a certain topic, yet you rarely receive deep insights from them in return.

2. When you speak with a well-known figure in a field, and the conversation centers not on what made them famous, but on the topic you have deeply researched—you become the "high-status" party in that dialogue.

3. Maintaining extreme openness to being proven wrong.

  • The trend of multi-company founders: Mares believes that with the rise of productivity tools like GPT, multi-company founders will become more common. "People talk about power-law distributions in company outcomes. I believe the same power-law distribution exists among individuals, but almost no one explicitly says so."
  • Key shift: In 2008, knowing how to code was more important than understanding the industry. Today, deep domain expertise combined with the ability to use software as a tool is the key to creating enormous value.
  • A new model of capital formation: Mares argues that rather than building systematic "company factories," it is better to invest in "power-law individuals" who can continuously create new companies—such as Elon Musk, Sam Altman, and Jack Dorsey. "By building something truly unique and massive, you acquire an ability that cannot be learned from books or podcasts. Now, this leverage makes repeat entrepreneurship possible, which was historically impossible."

Mares cites Flagship Pioneering in the biotech sector as an example: "Over the past 20 years, they have created companies like Moderna and Indigo Bio, achieving one of the best returns in investment history. They turned a fundamental insight into a system or infrastructure, enabling them to continuously convert insights into companies."


Mentioned Positions

Position Guest Stance Key Data
Kettle & Fire Founder (successfully exited) #1 bone broth brand in the U.S.; first bone broth brand to receive glyphosate residue-free certification
Perfect Keto Founder Ketogenic diet food and supplement brand
Shirley Founder Non-alcoholic wine brand
TrueMed Founder (current project) Helps consumers use HSA/FSA tax-free funds to purchase health products; total HSA/FSA account balance approximately $150 billion, with 91% sitting idle as cash
Ozempic (Novo Nordisk) Risk warning 30-40% of weight loss comes from muscle and bone density loss; could become one of the most profitable drugs in history
Campbell's Neutral (mentioned as competitor) Annual revenue approximately $8 billion
Mindbloom Positive mention (founded by friend) First ketamine-assisted therapy company in the U.S.
Flagship Pioneering Positive case Created companies such as Moderna, Indigo Bio, etc.
Atomic Positive case Has incubated over 50 companies
8Sleep Positive mention (TrueMed partner) Smart mattress, purchasable via HSA/FSA
Peloton Positive mention (TrueMed partner) Fitness equipment, purchasable via HSA/FSA

Judgments Worth Remembering

1. "All participants in the U.S. food and healthcare system earn more when consumers are sick" (Mares) — 97% of medical spending goes toward treating those already ill, with only 3% allocated to prevention. This is the core misalignment of system incentives.

2. "30-40% of the weight loss from Ozempic comes from muscle and bone density loss" (Mares) — Muscle acts as a glucose "sink"; losing it means the body is less able to withstand the blood sugar shocks of an unhealthy diet. All weight is regained after discontinuation, and long-term safety data are lacking.

3. "The allowable level of glyphosate in U.S. drinking water is 7,000 times higher than in the EU" (Mares) — 0.1 ppb can alter rat gene function and cause organ damage, yet the U.S. permits 700 ppb. A total of 28 countries have completely banned glyphosate.

4. "If you rely on school lunch as your primary source of nutrition, that itself is a risk factor for childhood diabetes" (Mares) — It carries the same level of risk as "being born into a family where a parent has diabetes." 25% of children have prediabetes, and 45% are overweight or obese.

5. "Edge City" framework (Mares & Dylan Bynon) — If you are on the frontier of a given field, what you encounter today will become mainstream in 5-10 years. Identifying sign: friends often ask you questions about a topic, while you rarely receive deep insights from them on it.

6. "The power-law distribution among people also exists, but almost no one explicitly states it" (Mares) — Elon Musk is more likely to found five important companies than five different people each founding one. Multi-company founders will become more common as AI tools and capital formation create new patterns.

7. "In 2008, knowing how to code was more important than understanding the industry; today, deep domain expertise combined with software tools is key" (Mares) — Huge returns are increasingly coming from those with deep domain knowledge who can use software as a tool.

8. "Terrain theory may be partially correct: a person who is more prone to inflammation is also more susceptible to disease" (Mares) — While the specific formulation of the theory may be inaccurate, its core insight—that the environment ("terrain") matters more than the pathogen itself—is worth keeping an open mind about.