A viewer accused us of promoting drugs.

Carter answered before I could.

“We’re promoting the use of agency.”

That became the episode.

The GLP-1 argument has become so moralized that we keep missing the market signal underneath it. We were not arguing that the drugs have no risks. We were not arguing that everyone should take them. We were arguing that millions of people have demonstrated a willingness to spend money to change their metabolic health.

That matters because prevention did not have a visible price before.

Now it does.

Once consumers started changing what they ate, drank and bought, other companies had a reason to build for the person trying to stay well. Food companies. Diagnostics companies. Wearables. Life insurers. Fitness platforms. The drug did not finish the job. It revealed the customer.

That is a very different claim from “take the magic pill.”

The deeper conversation was about what happens after demand appears.

I made it personal, as usual.

I have an underactive thyroid. I have nodules that have been biopsied. I take medication and follow a monitoring schedule. The standard model says a primary care physician or endocrinologist “manages” this condition.

But what part actually requires a clinician?

I can see whether my thyroid-stimulating hormone is moving up or down. I can track symptoms. I can follow the established schedule for labs and imaging. I do not need to pay a specialist to read a trend line back to me.

I do want clinical expertise for the hard question: What options exist if I want to change the underlying condition or reconsider the treatment? What is known? What is uncertain? What is worth trying safely?

Those are not the same service.

We have bundled them together because healthcare was designed around gatekeeping. The primary care physician was once openly called the gatekeeper. The theory was that somebody had to control the faucet or people would consume care the system considered unnecessary.

Consumer diagnostics, wearables and AI are dismantling that arrangement from the outside. Not cleanly. Not without mistakes. But unmistakably.

That does not erase the case for medical training. Carter drew the line clearly: acute and highly complex disease can require intense human expertise. The opportunity is to stop spending that scarce expertise on mechanical work a person and a tool can handle. If we remove friction from the routine layer, clinicians have more room for the decisions where judgment, examination and accountability actually matter.

The next fight is over interpretation.

An Oura score is an algorithm. A consumer lab company’s green, yellow and red ranges are an algorithm. A clinical reference range is also an interpretation built from assumptions and evidence. None of them is an agnostic source of truth.

This is where people get nervous. If consumers can see all the data, what happens when they misunderstand it?

The answer cannot be to keep them from seeing it.

The answer is to make the feedback layer better.

Carter and I started sketching what we mean by a System C stack for the consumer. First, collect the data you can reasonably use. The number matters more than the company’s score. Second, put it beside your own history. A trend across time is more useful than one color on one day. Third, connect the change to what you did. Did sleep improve after the intervention? Did ApoB move? Did the behavior change actually produce the outcome you wanted?

Then decide where a human belongs.

Sometimes the answer is nowhere. Sometimes it is a registered dietitian. Sometimes it is a primary care physician. Sometimes it is the most specialized clinician you can find. Agency is not pretending those people are interchangeable. It is refusing to pay the most expensive person in the system for every step.

This is not a finished stack. We said that on air.

We need to hear from the people already trying to build it around themselves. What data are you collecting? What can you not connect? Which score do you distrust? Where did you need a human? What did you learn only because you could see the trend?

The old system asks whether you have permission.

The new one starts with a different question: What are you trying to change?

Then it gives you the data, the feedback and the right level of help to find out whether it worked.

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After a long hiatus of livestreams - Ellen was waiting for this one. This one opened with RFK Jr.’s Real Food Show $5 meals, celebrity chefs, salmon cakes - and immediately hit the structural tension underneath it: real food is great, but time poverty is the actual barrier, and a show about cooking doesn’t solve the distribution problem. Carter’s sharper frustration was the current fight crowding out the chronic disease conversation. 280 Americans die every day from type two diabetes. It’s a human-created event. We can reverse it. It gets essentially none of the attention.

The second half went personal to Ellen’s hormone panel, the 30-day cycle mapping DUTCH test vs. what standard of care for a perimenopausal woman actually looks like (one blood draw on one day of a cycle, estrogen assumed low, progesterone the actual problem), and the health context library she’s been building inside Claude. 15+ years of health data, biomarkers, hormone results, all of it - as her argument that end-of-one personalized medicine is now entirely scalable if you’re willing to do the work. Carter asked Ellen’s self-built personal health agent Thomas on air what he’d charge as a health coach. Thomas came back with $500/month, a clear scope of work, and a note about avoiding anything that sounds clinician-like. Carter immediately asked what he’d spend it on and whether they’d need to issue a W-2. Ellen didn’t ask Thomas.

We dove into the viral chart that started it all (and the corrected one). Clinicians warning about false positives, CEOs of the companies named in the chart correcting the numbers, and consumers who’d never heard of any of these services realizing a comprehensive biomarker panel is now a commodity. Carter’s read on all of it was immediate: the cost of running your own assays on your body is going to zero, and no amount of institutional resistance is going to stop it. The question isn’t whether people will do this. It’s about what happens next.

Dr. Nupur Garg jumped in live - an MIT-trained ER physician who now runs a solo lifestyle primary care practice in North Haven, Connecticut with a whiteboard behind her desk and no staff. Her answer to the “what happens next” question was what made Ellen want to have her as her doctor. Labs are the feedback loop / outcomes data for the experiments people are already running on themselves. The problem isn’t the false positives. The problem is that nobody built the feedback layer between the result and the behavior. That’s the gap AND the whole opportunity. That’s Sytem C.

It’s July 2nd. As of yesterday Seniors who have a Part D plan (prescription drug plan) who want to lose weight can choose from three GLP-1s for $50/month for the next 18 months (as long as they meet the BMI/health condition gates which we will dive into below and aren’t excluded for specified reasons).

Yesterday I went on national news again to make sure the information provided was accurate. Bianca de la Garza - Emmy nominated and award winning TV host, anchor of Bianca Across the Nation daily on Newsmax (12-2pm ET) has a fantastic new Living Longer segment that aligns with our Food Is Health work. And we’re excited to be collaborating when helpful to bring timely and relevant insights to her audience.

I know, it is scary to jump off a cliff without a parachute when it comes to GLP-1 use aka without lifestyle (nutrition/strength and more) support. A $50 drug without a food system is not a health structure. It is a temporary discount on a downstream intervention.

But when ~50% of Seniors have a metabolic condition the saying “desperate times call for desperate measures” comes to mind. Loudly.

And the glaring Bridge program gap is what the BALANCE program is for. And I heard some reassuring news firsthand earlier this week. A few of the brilliant folks I’d want to be involved have indeed been summoned to work on the program design.

The Bridge Program

Medicare has never been allowed to cover GLP-1 drugs for weight loss. That changed yesterday by utilizing the Section 402 demonstration authority (42 U.S.C. \mathsection 1395b-1), which allows CMS to test temporary, short-term pilot programs outside of the standard Medicare Part D system.

It’s important you remember that because knowing that authority exists for System C innovation should give EVERYONE hope. It’s not about asking for handouts, it’s about creative, innovative system design.

This program does not cover Ozempic. Not Mounjaro. Not the drugs people casually name at dinner parties because the brand recognition got there before everything else did. The new Medicare GLP-1 Bridge covers a specific list of obesity medications, for eligible beneficiaries, at $50 a month, from July 1, 2026 through December 31, 2027.

Obesity is not a character flaw. It is not a failure of discipline. It is biology, food environment, stress, medication history, sleep, poverty, trauma, hormones, marketing, and a thousand other things that get flattened into a before-and-after photo.

So if a senior who has been metabolically stuck for years can finally access a medication that helps, should we shame them and/or scold them?

What if instead we build something BEFORE the Balance program is up and running that ensures they don’t end up plagued by frailty, sarcopenia, etc. And that the success they might achieve on the drug is sustained.

I am also interested in asking the question we overlook.

What happens after the appetite signal changes?

Because that is where the real story begins.

Program Details

* Eligible Medicare Part D beneficiaries can get these three specific GLP-1 weight-loss medications for a flat $50 monthly copay.

* The approved drugs are Foundayo tablet, Wegovy injection or tablet, and Zepbound KwikPen only.

* The $50 DOES NOT cover the cost of obtaining the prescription.

* The program runs through the end of 2027.

* It operates outside the normal Part D coverage and payment flow, with pharmacy eligibility confirmation and Medicare approval.

* The prior authorization required from a prescriber will last the entire 18 months, but the scripts can only be filled for 30 days at a time.

* Prescribers don’t need to be Medicare eligible or accept Medicare, seniors do not need to go to their current doctor, however they should ask whether the prescribing is going to be submitted to Medicare or Medicare Advantage plan (not their MA Part D plan) so they don’t end up stuck paying unexpectedly to get the prescription.

* Current Part D health plans are completely separate from the program.

* Those that believe they are eligible and still have questions should call 1-800-MEDICARE, NOT THEIR CURRENT PART D PLANS.

The Human Story

KFF estimates that more than 13 million Medicare beneficiaries met the BMI thresholds for obesity or overweight in 2023, and about 3.8 million may meet the fuller Bridge eligibility criteria once the program’s exclusions are applied (and we KNOW that number has changed dramatically - when I ran some figures earlier this week I came back with the potential of 20-25 million qualifying).

And someone who knows this space better than anyone I know said there isn’t anywhere close to enough supply of the drugs to meet the likely demand.

The risk? Bridge is drug-only.

The lifestyle, nutrition, coaching, and behavior-change infrastructure that was supposed to come through the broader BALANCE model is not arriving with it on the Medicare side. That portion has been delayed. As of now until January 1, 2028.

Lifestyle later. Nutrition later. Food later.

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The System Design Opportunity

GLP-1s may change the appetite signal. They do not build the lifestyle support and food system that has to meet the person on the other side of that signal.

That is the missing sentence in almost every discussion of these drugs.

The medication can reduce hunger. It can help people lose weight and can affect blood sugar, cardiovascular risk, and the economics of obesity care.

But it does not decide what food is available when someone’s appetite drops. What lifestyle changes are made to prevent muscle loss. Frailty enmass is a true risk.

One that I for one am hellbent on trying to protect against.

How do we make nutrition support affordable?

How do we make protein affordable?

How do we make strength attainable?

The drug would not have taught someone like my Mom how to protect muscle while losing weight. She would have qualified before vascular dementia robbed her of her dignity. I’m fairly certain we would have gone for the drug if it meant she could have reversed the metabolic syndrome that plagued her for years.

How do we redesign the grocery aisle for the coming demand?

How do we make nutrient density the default?

We don’t need to wait for the BALANCE program to build the rails between the prescriber, the food environment, the strength plan, the wearable, the caregiver, the pharmacy, the meal provider, and the person trying to avoid the end of life my own Mom is facing.

Damn straight this is personal.

These things matter because for older adults, weight loss is not the same thing as health.

This is where we have to be grown-ups.

Older adults on GLP-1s are not just losing fat. They lose lean mass, something they are already losing. That means muscle. That means strength. That means balance, walking speed, the ability to get out of a chair, the difference between independence and frailty.

The clinical word is sarcopenia. The lived experience is: I can finally wear those clothes from years ago, but I am weak. Or worse, I became frail.

That is not a win.

For a senior, the goal cannot be “make the number on the scale go down.” The goal has to be function. Strength. Stability. Blood sugar. Blood pressure. Sleep. Digestion. Medication interactions. Food tolerance. Protein adequacy. Actual life.

Let’s Do Something More Than What System B Does

I do not mean this as an insult. It’s reality.

System B is very good at downstream intervention. It is good at codes, claims, formularies, pricing mechanics, prior authorization, centralized processors, guardrails, rebates, and all the machinery required to move a drug through a payment system.

It is very good at demanding reimbursement and saying without it there is no business case. It is good at staying entrenched within the current delivery design and reimbursement structure.

Rockets ended up in the ocean after one use making them extraordinarly costly too until Falcon 9 came along.

The Medicare GLP-1 Bridge is a perfect example of the world we live in now. The federal government can move quickly to stand up a drug-access pathway for seniors because the drug has a billing architecture. It has a manufacturer. It has a pharmacy channel. It has a price. It has a claim. And Medicare went to bat with the pharma industry to get a drug to an unheard of price of $299, absorbing $249 of it themselves. Getting the out-of-pocket cost below that magic $99 threshold Carter Williams and I wrote about over a year ago. Kudos to Chris Klomp and the Medicare team.

The system can see the drug because the drug knows how to send a bill.

The rest of health is still standing outside the building, knocking.

That is the structural problem. Or opportunity. Depending on how you see it.

That means food, strength, nutrition, behavior change, nutrient density, affordability, education and so on.

We keep asking whether Medicare should pay for GLP-1s. Fine. Have that argument.

But the better question is: why is the only thing ready for national scale the downstream intervention?

Why is there not a parallel pathway that says:

* If we are going to change appetite, how do we change the food environment?

* If we are going to finance weight loss, we are also going to finance muscle preservation.

If we are going to open access to pharmacology, we are also going to build the direct-to-consumer support system that helps older adults use it safely, intelligently, and affordably.

This is our call to action

So here is what I want this community to hear the day after this program launched:

The Bridge is real. The gap is real. And we do not need to wait for the existing system to finish thinking about it.

Here, in our rebel alliance network, we are working on a more comprehensive option for seniors that starts with the person, not the claim.

Direct to consumer.

Affordable.

Customizable.

Built around food, strength, data, medication reality, and the actual life of an older adult trying to stay metabolically healthier without becoming a full-time project manager of their own decline.

That last part matters.

People do not need a siloed app yelling at them. They do not need a PDF meal plan. They do not need moralizing. They do not need a $400-a-month concierge fantasy dressed up as access.

They need a system that can meet them where they are and help them build the next right layer:

* What should I eat when my appetite is lower but my protein needs are higher?

* How do I protect muscle without pretending I am training for the Olympics?

* What labs, symptoms, and signals should I actually watch?

* What should I ask my prescriber?

* What do I do when food tastes different?

* What if I am on five other medications?

* What if I live alone?

* What if I cannot afford boutique wellness?

* What if I do not want to be optimized, I just want to feel steady again?

That is the beta we are building toward.

Not a diet.

Not a wellness challenge.

Not a drug companion brochure.

A System C beta for seniors.

Because System C is the part our current economy still does not know how to price: the infrastructure that produces health before the hospital has to manage what broke.

That is the bridge we ARE building. Let us know if you want to be part of that. We aren’t waiting for handouts.

Heck, maybe we can actually help Medicare by figuring a few things out NOW within the private sector.

I assure you there are plenty of folks seeing this pot of gold, scheming up plans to simply make money without any inkling of focus on the health of seniors.

The Opportunity

The Medicare GLP-1 Bridge is important because it reveals the future before the future is ready.

It shows us that the demand is here.

It shows us that seniors are going to be asking different questions.

It shows us that food, healthcare, retail, benefits, caregivers, and personal biology are no longer separate conversations.

The drug wave has forced them into the same room.

Now we have to decide what gets built in that room.

If the answer is only cheaper access to medication, we will have missed the moment.

If the answer is processed food with better protein claims, we will have learned nothing.

If the answer is another layer of expensive coaching for people who already have resources, then we will have recreated the same access problem in a prettier font. And on a practical level, we risk replacing millions of obese seniors with millions of frail seniors.

But if we use this moment to build the rails between pharmacology and food, between weight loss and strength, between personal data and daily decisions, between affordability and customization, then the Bridge can become more than a temporary CMS workaround.

We do not need to wait for BALANCE.

We can become the forcing function.

The drug is downstream.

The food behavior it triggers is upstream.

The market that connects them is what we have to build.

If you are a clinician, dietitian, senior, caregiver, technologist, food operator, farmer, payer, investor, or just one of the people who has been sitting here with us saying, “Yes, this is the missing layer,” I want you in this conversation.

Reply to this. Send us an email.

* Tell us what seniors need that the current system will not build.

* Tell us what you have seen work.

* Tell us where the friction is.

* Tell us what has to be affordable from day one.

* Don’t tell us you need capital to make it work

* Don’t tell us you need it to be reimbursed

We are gathering the operators, the signal, and the lived reality now.

Because the GLP-1 Bridge has been built.

And the real connection still has to be built.

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Source And Notes

- CMS says the Medicare GLP-1 Bridge runs from July 1, 2026 through December 31, 2027, operates outside Part D, and covers eligible Part D beneficiaries for certain GLP-1 drugs at a $50 monthly copay. Source: https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge

- Covered drugs per CMS/Medicare public materials: Foundayo tablet, Wegovy injection or tablet, and Zepbound KwikPen only. Not Ozempic, Mounjaro, Rybelsus, Zepbound single-dose pens, or Zepbound vials.

- Medicare fact sheet: https://www.medicare.gov/publications/12234-medicare-glp-1-bridge-glp-1-drugs-for-50-a-month.pdf

- KFF, June 29, 2026, estimates 13.3 million Medicare beneficiaries had BMI 27+ in 2023, but about 3.8 million Part D enrollees could be eligible after Bridge clinical criteria and exclusions. I used the tighter 3.8 million figure rather than the writer brief’s broader 20-25 million estimate. Source: https://www.kff.org/medicare/nearly-four-million-medicare-beneficiaries-met-the-eligibility-criteria-in-2023-for-the-medicare-glp-1-bridge/

- KFF, January 2026, reports gross Medicare Part D GLP-1 spending reached $27.5 billion in 2024 before rebates. I did not include this number in the body to keep the piece consumer-forward. Source: https://www.kff.org/medicare/recent-trends-in-glp-1-use-and-spending-in-medicare/

- AAMC reporting on GLP-1s in older adults supports the caution around sarcopenia, frailty, and the need to prioritize muscle, strength, protein-forward nutrition, and individualized prescribing in older patients. Source: https://www.aamc.org/news/are-glp-1-weight-loss-drugs-safe-older-adults

- BALANCE wording is intentionally cautious: https://www.kff.org/medicare/what-to-know-about-the-balance-model-for-glp-1s-in-medicare-and-medicaid/

Thank you to everyone who tuned into my live video! Join me for my next live video in the app.

Thank you Chandermanik Thapar, Online Learning Collaborative, and many others for tuning in!

Rip Esselstyn - former pro triathlete, Austin firefighter, the guy who got a station full of Texas meat-eaters to go plant strong and turned it into the Engine 2 Diet, a NYT bestseller, and a CPG brand that’s been on Whole Foods shelves since 2011. (And yes, I fangirled. I bought his Seven-Day Rescue book three years ago when my mom almost died and we found out she had type 2 diabetes. So this one was personal.)

We started where every System C conversation has to start: trust. Rip walked through the 10-second label test anyone can run - check the fat (no palm, palm kernel, hydrogenated, or the animal stuff), check the sodium (Americans are getting pickled - half of us blow past the 1,200–1,500mg daily target), and check the added sugar (more than 4 grams per serving and he says run for the hills - and remember, 4 grams is one teaspoon). The point isn’t fear. It’s that once you know the trick, reading a package takes ten seconds.

Carter pushed into the harder question - the one we keep circling. The $15 billion a year CPGs spend keeping you in the potato chip lane. The Kroger data showing customers index 8% toward whole food the second you move them from in-store to online, away from the endcaps and the signaling. His thesis: maybe people aren’t addicted to processed food so much as they’re trapped by friction and a marketing machine telling them to stay put. Rip didn’t fully cosign - he thinks there’s real engineering happening to hit the “bliss point” (salt on sugar on fat, lighting up the brain like a pinball machine) - but he made the case that healthy eating becomes its own kind of addictive once your numbers get sexy and you actually feel the difference. As he put it: nobody comes out of the womb craving black coffee or cigarettes. Those are learned. So is this.

The richest stretch was on what Rip’s actually building. Plant Strong as the “easy button” - foundational products you dress up yourself (he called it the Geranimals model, and Carter ran with the Betty Crocker / “now you feel like a chef” angle). Clean label first, plant-based second - because, as Rip said, plant-based lost its health halo when everyone started using the same refined-grain, sugar, and oil tricks. His new motto: real that you can feel. The milks are almonds and water, no gums or emulsifiers, run on a hydro-release process powered by Niagara Falls. And the business reality nobody romanticizes: D2C is his deepest channel (close to 200K newsletter subscribers), retail slotting fees can take two and a half years to break even, and his advice to anyone entering CPG is to not start in retail - prove it on Amazon and DTC first, because the retail playground is brutal and full of bullies.

I brought the room into the upstream conversation: the CMS ELEVATE program, up to 30 entities over two years, up to $3.3 million per grant for formal controlled research on lifestyle and functional interventions. The government will fund the research but explicitly won’t pay for the food. So the play I floated to Rip - and to Bob Jones at Chef’s Garden the night before - is to put a grant in next year with Plant Strong and regenerative ag in it, and solve the food-funding piece through another mechanism. Stop fixating on downstream reimbursement once someone’s already sick. Pull it upstream, before the chronic disease.

The thing that landed for me was something my husband said on his birthday last week: he’s just going to stay fit now, because he knows how much better he feels. That’s the buffer against the Twinkie. The problem is most people are so deep in chronic inflammation they’ve forgotten what “good” even feels like. A challenge can’t just be about what the CGM says - it has to be about whether you slept better, moved better, felt better.

And we may actually run that challenge. Rip has a two-week bundle (planstrong.com) - baseline your numbers, eat PlantSTRONG for breakfast, lunch, and dinner, retest. His data across 919 data points: roughly 22 points off total cholesterol, 12 off LDL, 20 off triglycerides, ~3 pounds in a single week, dose-responsive. We’re scheming a Food Is Health Substack version with our 25K readers.

Do This One Thing

Rip’s - start tomorrow with one whole-food, plant-strong breakfast. Doesn’t have to be Rip’s line - steel-cut oats, whole grain toast with avocado, a tofu scramble. And learn the only five words that make a grain whole: whole, sprouted, cracked, rolled, or stone ground. Everything else is processed.

Carter’s - if you’re formulating or bringing a brand to market, prove it direct-to-consumer before you ever pay a slotting fee. And think about the “stack” of trust - package, education, customer experience - because scaling System C means simplifying that explanation for marketers, doctors, and grocers.

We started this one with a confession — I (Ellen) have been awake since 3:30am working on the MAHA Elevate grant — a $3 million intervention for federally qualified health centers that, if it lands, would put 246 people through a full year of therapeutic lifestyle medicine designed to put their cardiometabolic disease into remission. Not manage it. Remit it. 35% of enrollees. Type 2 diabetes, hypertension — gone.

Carter hit the nail on the head, “That three million might save a million lives”. That’s why I haven’t slept.

But we also had a live stream to run and a real question to answer — is it better to change the food or change the retail?

Carter wrote a piece this week about what the capital markets are already telling us. General Mills at an all-time low. UnitedHealthcare at an all-time low. GLP-1s eating commodity demand. The next generation of Zepbound is coming with 24% weight reduction, less resistance, and it doesn’t appear to stop. None of this is a mystery. As Carter put it, “There’s an asteroid coming in at us. It’s predictable. We see it coming.” And yet CPGs are largely in wait-and-see mode. The boardroom is hoping next quarter looks different.

We brought in two phone-a-friends to pressure-test this. Carmen Brace, who does the kind of strategic CPG advising that actually accounts for human outcomes — not just margin — joined us first. Then Ellis McCue jumped in, and Carter made her CEO of General Mills on the spot which is exactly where the conversation needed to go.

What would you actually do, right now, if you understood the threat clearly?

The System C answer to the food vs. retail question is that it’s the wrong frame. Both moves — reformulate the product, fix the shelf — are still System B+ plays. You’re optimizing inside an incentive structure that was never organized around health. The organizing question underneath both is — who gets paid when the food actually builds health?

Right now? Nobody.

Retail is paid for volume. CPGs are paid for repeat purchase. Neither of those signals has anything to do with whether the person eating the food is better off.

What would change it? Carter laid out the real options math: you can price the cost of not acting. General Mills has lost far more market cap than it would have cost to invest early in the technology and sourcing practices that would have gotten ahead of this. That’s not a nutrition argument, that’s a finance argument. The tragedy is that the science and the economics point in the same direction — and most boardrooms are still treating it as a values conversation instead of a strategic one.

Carter’s do-one-thing for anyone producing a SKU — ask yourself how many people are getting chronic disease because of your product — and what you can do to make it one step better.

Not a full platform rebuild. Engine 1 to Engine 2.

My do-one-thing? If you’re a retailer, look at the new CMMI programs and ask how your grocery business — not your pharmacy — could become a direct partner in disease reversal reimbursable through Medicare. The infrastructure is already there. The permission is already there. It just requires someone willing to stop thinking of themselves as a food store.

Next week Rip Esselstyn from PlantStrong joins us on Friday at 1:30pm ET — someone who actually built the other thing.

See you then.

Kelly Ryerson joined us live this week, and the timing couldn’t have been scripted better. The House had just voted 280-142 to strip a pesticide liability shield from the farm bill - with 73 Republicans breaking from leadership. That’s not a MAHA moment. That’s a population renegotiating a 60-year-old contract on how society handles the externalities of innovation. The contract was built for a world where you couldn’t measure the harm. We can measure it now. (And Carter wrote a banger piece on this yesterday morning - outstanding. Go read it if you haven’t.)

Kelly walked us through her own root cause story, which until last Friday at Ryland’s I somehow had never heard - even though she’s one of my besties (how did we not meet nine years ago at the IFM conference huddled in the root-cause corner together?? Carter says us together would’ve been trouble. He’s probably right.). Mysterious illness. Every specialist at Stanford and UCSF. Diagnosis: she must be crazy. The intake bloodwork - done at Theranos, you can’t make this up - eventually confirmed she was a starving person nobody had thought to check. Zero vitamin D. Zero vitamin C. B12 of 50 when it should be 500. Full gut dysbiosis. She went gluten-free, started feeling better, and at a Columbia conference asked a question nobody had answers to: is something happening on the farm? A General Mills insider found her afterwards and dropped the bomb - farmers spray Roundup on grain right before harvest as a desiccant. It goes straight into the food supply. Glyphosate acts like an antibiotic that selects against beneficial gut bacteria. The stuff you’re paying for at Whole Foods in probiotic bottles. We’re eating an antibiotic every single meal.

I shared my own version - the diagnostic rabbit hole from hell, thinking I had MS, the ER doctor telling me I was having a panic attack and sending me home, the eight months of nobody diagnosing me with anything. What got me better? Food. The Wahls protocol. Six months. And the icing on my cake: my husband had penetrated our entire Florida lawn with Roundup while I was working from home with the air handler pumping it back at me. (I love him anyway.)

Carter pulled the lens up to the structural question - companies build things, those things have externalities, and we granted liability shields decades ago because we couldn’t really measure harm. Now we can. In silico testing. Animal models. AI sitting next to Dr. Joe Pizzorno at dinner in Nashville last week, holding its own on diabetogens - and Joe, the most skeptical AI critic at the table, conceding it was actually pretty right. The visibility era has arrived. The System B architecture was never designed to survive it.

Kelly’s point that’s been sitting with me since: 57,000 pesticide products were sitting under that liability shield, the vast majority manufactured by ChemChina and foreign chemical corporations. We’re not protecting American companies anymore — Bayer is German, Monsanto got absorbed. There’s no national security defense left to make. Meanwhile rural red communities are getting the rawest end of it: well water contamination, air spray, the cancer that hits everyone in town. Kelly lost her father-in-law to ALS that Duke attributed to pesticide exposure, her mother-in-law to cancer, both in their early 70s in rural North Carolina. Those constituents are the ones who flipped this vote. Personal experience. Celiac. Kids who can’t focus until you take them off gluten and dyes. Pregnancies that won’t take. That’s what’s moving the Republicans, not a press release.

The whole conversation kept circling the System C through-line. This isn’t about banning glyphosate into submission - it’s about making it so you don’t need it. Fix soil health, fix nutrient density, fix the feedback loop between food input and human outcome, and the chemical treadmill becomes economically irrational. Carter’s line that landed for me: the goal isn’t a grocery store where you have to pull out an app to figure out what’s safe. It’s a grocery store where you don’t have to ask the question at all. Pretty much anything you can buy is good for you. That’s the reusable rocket. And just like SpaceX, we get there by working backward from the first-principles outcome - not forward from where we’re stuck.

We had to bring it in early because Bristol the German Shepherd was losing her mind over what may have been Kermit the Frog. Worth it.

By 2050, it should be hard to make a bad decision in the grocery store. That’s the goal. What happened in this room was a step toward making it real.

This week at Food Health LIVE, our Innovation Lab brought together over 50 cross-sector industry leaders representing the full chain of soil to cell. Farmers, seed geneticists, food banks, clinicians, ingredients companies, advanced diagnostics, CPG founders, health insurers, community food organizers, measurement technologists and many others, and asked them to do something rooms like this don’t attempt often. We asked them to build the system in real time, with real people, in the room.

We threaded the needle from soil to cell and here are a few things I took away.

P.s. keep an eye out for a soon to come list of exclusive discounts from the companies delivering System C for paid subscribers.

The Pieces Exist. The Loop Doesn’t.

One of the most important things that happened in that room wasn’t just a single conversation, it was the accumulation of all of them.

At the end of the 3 hours, you could trace a line from the farmer who knows exactly how his growing practices affect the glucosinolate content of his broccoli, through the ingredient company that’s spent a decade developing a fiber profile that heals the gut, through the CPG brand whose products show a 21-point cholesterol reduction in clinical data, through the insurer who’s already covering food as medicine and showing a 3-to-1 return on investment, through the technologist who’s figured out how to measure metabolic health in under two minutes simply using an ultrasound and another innovator who is doing the same via cellphone.

Every node in that chain was in the room but the loop doesn’t close here. Not yet.

The Market Signal Is the Whole Game

People miss this when they assume the problem is supply. Better seeds, cleaner ingredients, more regenerative farms. Yes. All of that matters but supply is not the real constraint.

Consumer demand is the trigger that matters.

Right now, food is priced on features – grams of fiber, sugar content, organic certification – not on outcomes. A farmer who grows broccoli with twice the glucosinolate content gets paid the same as the farmer who doesn’t, because no one downstream is asking for it. In large part because consumers can get that information. A CPG company that can demonstrate that its product reduces inflammation in a measurable, personalized way can’t communicate that without going through a pharmaceutical-grade FDA claims process it can’t afford. Yet the technology to measure human outcomes at the individual level is collapsing in cost with $80 blood panels, CGMs on instant order, and AI-powered metabolic imaging, but that data isn’t connected to the supply chain. Not yet.

When a consumer can measure what a food does to their body, share it, and have that data feed backward through retail into CPG into ingredient sourcing into seed genetics, that’s the market signal that rewrites the economics of the entire food system. That’s the flywheel. The diagnostic infrastructure is the crank.

The room saw this unfold over the course of the morning. The question then became how quickly and with what combination of existing measurement tools can this infrastructure to deliver the missing that outcome layer.

Reimbursement Is Not the Solution

A lot of the work happening in food as medicine right now is focused on reimbursement. Getting medically tailored meals covered. Getting produce prescriptions into Medicaid. Getting food written into value-based care contracts. All of it matters and is important. All of that cost burden is downstream once disease is already established. It operates in System B (as B+). We need to expand this upstream so it isn’t reliant of downstream funding which is fundamental to System C.

Downstream reimbursement as an intervention is System B+. It’s the best version of the current system and we should pursue it, because it funds the transition to System C and proves the outcomes. But, reimbursement still sits on top of a broken economic architecture. You haven’t changed the system when you’ve convinced it to pay for a workaround.

Ellen pushed on this hard in the room. She asked one of the medically tailored meal founders point-blank, “if you could wave a magic wand, would you want to be upstream of all this where people never develop the disease that requires your intervention in the first place?” He said yes. So did almost everyone else when pressed.

The goal is food that is so affordable, accessible, and nutritionally dense that chronic disease becomes rare. Not simply managed. Rare. That’s the engineering challenge and reimbursement is a funding mechanism on the way there, not the place you’re trying to get to.

This distinction matters because it determines where you invest your energy. System B+ is about negotiating better terms inside a broken system. But when you add System C as the long game you can build it using System B to fund it.

The Access Problem Is Built Into the Architecture, or It’s Not Real

A food bank director stood up and said what is often avoided – if your solution requires people to be able to afford to shop differently, it’s not a new system, it’s a premium tier.

And she was right.

Ellen shared a story about a woman who graduated from a Food Is Medicine program. In 8 months she learned to cook – she and her son made eggplant together – and her relationship with food had been transformed. And then she shared – I’m going to have to go back to eating what I was eating before. I can’t afford anything else. The food bank doesn’t have eggplant.

That’s not someone “unwilling to change”. That’s what it looks like when the system is designed from top to bottom for the wrong outcome. The economic model of System C isn’t “healthy food for people who can pay for it.” It’s “fix the cost structure upstream so that nutritionally dense food is the affordable default everywhere – in the grocery store, the food pantry, the hospital cafeteria, and the corner store.”

That’s not simply charity, it’s engineering, and a complete system re-design.

And it really comes back to outcomes data.

AI Is The Reusable Rocket of Healthcare.

Ellen made a point that I want to echo here, “AI primary care is effectively free already. For $20 a month you can access something better than most physician consultations for general health questions. The reusable rocket has landed.”

What that means for the future design specifically is that the cost of knowledge – personalized, synthesized, acted on – is approaching zero. The “n of one” medicine that used to require a $500 blood panel at minimum, interpreted by a concierge doc charging $1000 to review, is moving towards less than $100.

That changes the measurement economics, the clinical workflow, and who can access personalized nutrition guidance. At the same time, it creates a new problem – all that intelligence and information is worthless if it’s not connected to a food supply that can actually respond to it.

The knowledge layer and the supply chain layer have to close the loop on each other. AI accelerates the knowledge layer. The supply chain transformation still needs work. And a new system.

So What?

The food and health system is not going to be reformed from the inside. The organizations embedded in the current state - the food companies, the insurance companies, the hospital systems – are doing exactly what they were designed to do. So much so that Ellen and Carter have named their first book “Nobody Did Anything Wrong”. These companies are not villains. They are optimizing for the metrics they were built around. The metrics that produce and monetize chronic disease.

What will actually change the system is a parallel architecture that makes the old one irrelevant. That’s what System C is. Yesterday you could see all the pieces of it – the soil science, the measurement technology, the clinical proof points, the reimbursement innovation, the community infrastructure, the AI layer – come together.

The reusable rocket doesn’t become reusable until launch. System C is doing its final pre-launch checklist.

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