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Health & Fitness

Return on Health

Niko Hems and Miguel Medina

Health is full of strong claims, conflicting voices, and bold promises. Most people end up overwhelmed and unsure who to trust. Return on Health aims to bring clarity by listening to every side, asking hard questions, and keeping science and common sense at the center.

Hosted by Niko Hems and Miguel Medina Stanivukovic, the podcast takes a clear look at longevity, prevention, performance, and the future of health. We invite researchers, founders, clinicians, skeptics, and innovators, then pressure-test their ideas. Some viewpoints will align. Others will clash. That is the point.

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  • 14 episodes
  • fortnightly
  • Avg 54 min
  • English

Episodes 14

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  • Sunday · 1 hr 2 min

    The First Person to Live to 1,000 Is Already Alive? | Aubrey de Grey

    What if aging is less like an inevitable biological process.. and more like damage that can eventually be repaired? For more than two decades, Aubrey de Grey has argued that aging should be treated as a medical problem driven by the accumulation of molecular and cellular damage. His most famous idea, longevity escape velocity. In this episode of Return on Health, hosts Niko and Miguel challenge Aubrey on how realistic that vision actually is, what his latest mouse rejuvenation experiments can tell us about humans, why his first major study fell short of its ultimate goal, and what would have to happen before rejuvenation becomes real medicine. Aubrey also explains why he believes aging can be approached through repair, why combining interventions may matter more than testing them one by one, why current biological age clocks are still limited, what he thinks the Hallmarks of Aging get wrong, and why he believes the first person to live to 1,000 years has probably already been born. ━━━━👤 ABOUT THE GUEST━━━━━ Aubrey de Grey is a biomedical gerontologist and one of the most prominent voices in longevity science. He is the founder and President of the Longevity Escape Velocity Foundation, where his work focuses on developing and testing combinations of rejuvenation therapies aimed at repairing different forms of age-related damage. He is also known for developing the SENS framework and popularizing the concept of longevity escape velocity: the idea that sufficiently effective rejuvenation therapies could extend healthy life long enough for progressively better therapies to arrive. ━━━━🎙️ ABOUT THE HOSTS━━━━ Niko Hems is a longevity expert and Head of Growth at YEARS, a company building a longitudinal, multi-modal health dataset to make prevention personal and data-driven. Miguel Medina is co-host of Return on Health, a podcast built on a simple idea: a system always produces the outcomes it's incentivized to produce. ━━━━⏱ CHAPTERS━━━━━ 00:00 Is Aging Actually A Disease? 02:17 Aubrey's Latest Mouse Rejuvenation Study 08:23 What Actually Counts As Age-Related Damage? 13:59 Can Mouse Longevity Research Translate To Humans? 16:25 How Do We Measure Anti-Aging Effects In Humans? 20:36 Can The First Person To Live To 1,000 Already Be Alive? 23:18 Longevity Escape Velocity Explained 28:16 Did Aubrey's First Mouse Rejuvenation Study Work? 32:11 How Do You Choose Which Longevity Interventions To Combine? 37:37 SENS vs The Hallmarks Of Aging 43:32 What Has Aubrey Changed His Mind About? 45:39 What Should People Actually Do Today? 47:54 Why Longevity Research Struggles To Get Funded 53:32 Prevention vs Rejuvenation 55:35 What Aubrey Would Change About Science 57:16 The Strongest Argument That Aging Can Be Repaired 58:08 Aubrey's Personal Longevity Protocol 58:41 Are Biological Age Clocks Actually Useful? 01:00:18 How Should Healthcare Change? ━━━━━💡 KEY QUESTIONS ANSWERED━━━━━ • Is aging actually a disease? • What does Aubrey de Grey mean by accumulated biological damage? • Can age-related damage actually be repaired? • What is longevity escape velocity? • Could the first person to live to 1,000 already be alive? • What happened in Aubrey's first robust mouse rejuvenation experiment? • Why is he now testing a combination of eight interventions? • Can longevity results in mice realistically translate to humans? • How can we test rejuvenation therapies without waiting decades for mortality data? • What is the difference between the SENS framework and the Hallmarks of Aging? • Are biological age and epigenetic clocks reliable enough for clinical trials? • What has Aubrey changed his mind about after more than two decades? • Why does he think current research funding creates the wrong incentives? ━━━━━━━━━━━━━━━ Connect with Aubrey: Longevity Escape Velocity Foundation: https://www.levf.org/ X / Twitter: https://x.com/aubreydegrey LinkedIn: https://www.linkedin.com/in/aubrey-de-grey-24260b/

  • S1 · E13
    August 9 · 51 min

    Cancer Scientist: What Actually Causes Cancer? (The Internet Got It Wrong)

    What if one of the most popular ideas about cancer is simply wrong? For years, social media has promoted the idea that cancer is primarily a metabolic disease - one that can be starved, hacked, or even reversed through diet. But cancer geneticist Dr Moritz Przybilla argues that decades of genomic research tell a very different story. In this episode of Return on Health, hosts Niko Hems and Miguel Medina explore why cancer is fundamentally a disease of DNA, why aging remains its greatest risk factor, what the evidence really says about ketogenic diets and sugar, and where cancer research is genuinely moving next. Moritz also explains why most people misunderstand cancer prevention, why early detection may save far more lives than chasing miracle cures, how healthy tissues quietly accumulate mutations throughout life, and why the future of cancer medicine may lie in predicting risk decades before a tumor ever appears. ━━━━👤 ABOUT THE GUEST━━━━━ Dr. Moritz Jakob Przybylla is a cancer researcher at the Wellcome Sanger Institute in Cambridge. His research focuses on cancer genomics, early cancer evolution, and developing new approaches for cancer risk prediction, prevention, and early detection. Alongside his research, Moritz is passionate about making cancer science accessible and combating misinformation with evidence-based education. ━━━━🎙️ ABOUT THE HOSTS━━━━ Niko HemsNiko Hems is a longevity expert and Head of Growth at YEARS, a company building a longitudinal, multi-modal health dataset to make prevention personal and data-driven. Miguel MedinaMiguel Medina is co-host of Return on Health, a podcast built on a simple idea: a system always produces the outcomes it's incentivized to produce - so if we want better health outcomes, we need better incentives. ━━━━⏱ CHAPTERS━━━━━ 00:00 The Biggest Cancer Myth 00:57 Meet Cancer Geneticist Dr. Moritz Gerstung 02:04 Why He Left The Lab To Build A Public Voice 07:58 What Cancer Actually Is (Explained Simply) 12:21 Can You Really Prevent Cancer? 15:32 Which Infections Increase Cancer Risk? 17:15 Driver vs Passenger Mutations Explained 19:57 Thomas Seyfried's Metabolic Theory Of Cancer 28:49 Do Ketogenic Diets Help Treat Cancer? 32:59 Are 60% Of Cancers Really Unpreventable? 41:18 Metformin, Aging & Cancer Prevention 43:07 If We Could Slow Aging, Would We Prevent Cancer? 46:14 The Most Overhyped Cancer & Longevity Trends 47:11 Which Cancer Screening Test Should You Actually Get? 48:16 Moritz's Dream Cancer Research Project 49:35 How Healthcare Should Change ━━━━━💡 KEY QUESTIONS ANSWERED━━━━━ • Is cancer really a genetic disease?• Is the metabolic theory of cancer supported by current evidence?• Can sugar actually "feed" cancer?• Does the ketogenic diet help treat cancer?• Why are around 60% of cancers currently unavoidable?• Why is aging the biggest risk factor for cancer?• What are driver mutations and passenger mutations?• Can we predict cancer decades before it develops?• Which cancer screening tests are actually worth doing?• What is the future of cancer prevention?• How should healthcare shift from treating disease to preventing it? ━━━━━━━━━━━━━━━ Connect with Moritz: Linkedin: https://www.linkedin.com/in/moritz-jakob-przybilla/?locale=en Instagram: https://www.instagram.com/dr.moritzprzy/?hl=en

  • S1 · E12
    July 26 · 1 hr 3 min

    You Can't Stop Aging! Here's What Actually Matters… | Prof. Suresh Rattan

    Most people think aging is a disease. Professor Suresh Rattan thinks that's one of the biggest misconceptions in modern medicine. The anti-aging industry has never been bigger. Every week there's a new supplement, a new biomarker, a new longevity protocol, or another promise that you can slow, reverse, or even cure aging. But after more than 40 years studying the biology of aging, Suresh has reached a very different conclusion. Aging isn't something to cure. It's something to understand. In this episode of Return on Health, hosts Niko Hems and Miguel Medina sit down with one of the world's leading biogerontologists to challenge everything we think we know about aging, longevity, and health. We explore why Suresh believes there are no genes programmed to make us age, why the anti-aging industry is selling false promises, what he really thinks about Bryan Johnson, David Sinclair, and longevity escape velocity, and why living well may matter far more than simply living longer. ━━━━━👤 ABOUT THE GUEST ━━━━━ Professor Suresh I.S. Rattan is one of the world's leading biogerontologists, with more than four decades of research into the biology of aging. He founded the Laboratory of Cellular Ageing at Aarhus University in Denmark, coined the term "gerontogenes", founded the journal Biogerontology, and has published hundreds of scientific papers exploring why we age and what healthy aging really means. His work challenges many of the assumptions driving today's longevity industry, arguing that aging is a natural consequence of life - not a disease to be cured. ━━━━━━🎙️ ABOUT THE HOSTS ━━━━━━ Niko Hems Niko Hems is a longevity expert and Head of Growth at YEARS, a company building a longitudinal, multi-modal health dataset to make prevention personal and data-driven. Miguel Medina Miguel Medina is co-host of Return on Health, a podcast built on a simple idea: a system always produces the outcomes it's incentivized to produce - so if we want better health outcomes, we need better incentives. ━━━━━⏱ CHAPTERS ━━━━━━ 00:00 Aging Is Not a Disease 01:39 Why the Longevity Industry Is Selling Products 03:32 Do We Actually Understand Aging? 08:40 Why Aging Isn't a Disease 18:22 The Truth About the Hallmarks of Aging 19:12 How Humans Already Doubled Their Lifespan 23:15 Bryan Johnson, David Sinclair & Living Forever 27:52 What Actually Helps You Age Better? 35:59 What Does It Really Mean to Be Healthy? 40:40 Why We Age in the First Place 48:05 Suresh's Definition of Health 57:26 Rapid Fire: Can Humans Reach 150? 58:08 The Best Form of Hormesis 1:02:07 How Healthcare Needs to Change ━━━━━💡 KEY QUESTIONS ANSWERED ━━━━ • Is aging really a disease? • Are there actually genes that make us age? • Why do we age if evolution favors survival? • Does the longevity industry focus on the wrong problem? • What does Suresh really think about Bryan Johnson, David Sinclair and longevity escape velocity? • Can supplements or biohacks meaningfully slow aging? • What is the real definition of health? • Why is hormesis one of the most important concepts in healthy aging? • Can humans realistically live to 150 years old? • How should healthcare shift from treating disease to promoting health? ━━━━━Connect with Professor Suresh Rattan LinkedIn: https://www.linkedin.com/in/suresh-rattan-7951804/

  • S1 · E11
    July 10 · 53 min

    Longevity Expert: Everything We've Been Told About Living Longer Is Wrong

    Most people think longevity is about living longer. Dr. Jack Kreindler thinks that's exactly where we've gone wrong. The longevity industry has never been bigger. Every week there's a new supplement, a new biomarker, a new biohack, or a new promise that you can slow aging. But after more than 25 years working with elite athletes, founders, CEOs and patients facing life-threatening disease, Jack has reached a very different conclusion. The goal isn't to live longer. It's to stay fully alive for as long as possible. In this episode of Return on Health, hosts Niko Hems and Miguel Medina sit down with one of the world's leading physicians in preventive medicine and human performance to separate evidence from hype. We explore why Jack has become one of the biggest critics of the word longevity, what he really thinks about Bryan Johnson and David Sinclair, whether NAD boosters actually make sense, and why purpose, relationships and resilience may be more powerful than the latest biohack. ━━━━━👤 ABOUT THE GUEST━━━━━ Dr. Jack Kreindler is a physician, physiologist and entrepreneur specializing in preventive medicine, human performance and healthy aging. He is the Founder & CEO of WellFounded and previously founded the Centre for Health and Human Performance (CHHP) in London, where he pioneered a model combining elite sports science with clinical medicine. Over the past two decades, he's worked with Olympic athletes, military personnel, founders, CEOs and patients with complex medical conditions - helping them maximize health, performance and resilience rather than simply adding years to life. ━━━━━🎙️ ABOUT THE HOSTS━━━━━━ Niko Hems Niko Hems is a longevity expert and Head of Growth at YEARS, a company building a longitudinal, multi-modal health dataset to make prevention personal and data-driven. Miguel Medina Miguel Medina is co-host of Return on Health, a podcast built on a simple idea: a system always produces the outcomes it's incentivized to produce - so if we want better health outcomes, we need better incentives. ━━━━━━CHAPTERS━━━━━━ 00:00 Why Jack Rejects the Word "Longevity" 01:33 What People Are Really Asking For 03:29 Healthspan vs. Lifespan 08:42 The Pillars That Actually Matter 12:02 What Happens Inside a Longevity Clinic 17:56 The Biomarkers Worth Paying Attention To 19:45 Why Human Connection Might Be the Ultimate Biomarker 28:25 Environmental Toxins & Modern Living 32:50 Are Toxins Really Making Us Sick? 36:14 Bryan Johnson, David Sinclair & Longevity Escape Velocity 40:03 What Founders Can Learn From Elite Performers 44:06 Burnout, Stress & High Performance 47:27 Can We Really Make 90 the New 60? 48:30 The Longevity Supplement Jack Would Never Take 49:40 The Supplements He Actually Recommends 51:15 Will AI Replace Doctors? 52:51 The Biggest Problem With Modern Healthcare ━━━━━💡 KEY QUESTIONS ANSWERED━━━ • Is the longevity industry focusing on the wrong goal? • Can you actually extend your lifespan - or just your healthspan?• Are expensive longevity supplements worth the money? • What does Jack really think about Bryan Johnson's Blueprint? • Which supplements have the strongest evidence today? • Why is VO₂ Max one of the most powerful predictors of long-term health? • Are environmental toxins a bigger problem than we realize? • Can AI become a better doctor than humans? • Why might relationships, purpose and meaning outperform the latest biohacks? • What would Jack change about modern healthcare if he could? Connect with Jack 🌐 WellFoundedhttps://wellfounded.health 🏥 Centre for Health and Human Performance (CHHP)https://chhp.com 💼 LinkedInhttps://www.linkedin.com/in/jackkreindler/

  • S1 · E10
    June 29 · 58 min

    Best Selling Author: This Diet Will Betray You!

    Is the longevity supplement hype real - or are you wasting money? Bestselling author Bas Kast breaks down what actually works in nutrition, supplements, and slow aging. Most people don't suffer from a lack of health advice. They suffer from too much of it. One expert says eat more protein, the next says cut animal foods. One says supplements are useless, the next sells a 100-pill longevity stack - and all of it sounds convincing. In this episode of Return on Health, hosts Niko Hems and Miguel Medina sit down with Bas Kast - the science author whose book The Diet Compass (Der Ernährungskompass) sold over 1 million copies - to separate evidence from noise. We cover what still holds up in nutrition science, which supplements are worth taking (and which are pure marketing), why you are never the "average" person in a study, and Bas's new project SlowAger. ━━━━━━━━━━━━━━━ 👤 ABOUT THE GUEST ━━━━━━━━━━━━━━━ Bas Kast is a science journalist and bestselling author known for translating complex nutrition and longevity research for a general audience - without academic jargon or wellness hype. His book "The Diet Compass" (Der Ernährungskompass) became an international bestseller with 1M+ copies sold, grounded in thousands of peer-reviewed studies. His newer work focuses on vitamins and supplements (the "Vitamin Compass" / Der Vitamin-Kompass), and his current project, SlowAger, explores the messy intersection of nutrients, supplements and healthy aging. ━━━━━━━━━━━━━━━ 🎙️ ABOUT THE HOSTS ━━━━━━━━━━━━━━━ Niko Hems is a longevity expert and Head of Growth at YEARS, a company building a longitudinal, multi-modal health dataset to make prevention personal and data-driven. Miguel Medina is co-host of Return on Health, a podcast built on a simple idea: a system always produces the outcomes it's incentivized to produce - so if we want better health outcomes, we need better incentives. ━━━━━━━━━━━━━━━ ⏱️ CHAPTERS ━━━━━━━━━━━━━━━ 00:00 Too much health advice — the real problem with health information 01:18 How Bas Kast got into nutrition: headaches, low-carb & a personal wake-up call 05:15 Where health communication goes wrong: incentives & the Brian Johnson effect 12:19 The 3 principles of healthy eating (Michael Pollan's rule explained) 15:04 What Bas changed his mind on: whole grains, the gluten myth, cheese & intermittent fasting 21:01 Population data vs. personalization: why nutrition averages mislead you 28:28 A data-driven future for nutrition, CGMs & the 10-year Diet Compass update 33:25 The supplement hype: do we really need supplements? (NMN, NR, spermidine, taurine) 44:48 SlowAger, low-dose lithium & how to weigh risk vs. caution 51:06 Lightning round: 3 steps to use supplements intelligently 52:39 The most underrated supplement category (AREDS, lutein & zeaxanthin for eye health) 57:20 Return on Health: the one thing to fix in medicine — treat your body like your teeth ━━━━━━━━━━━━━━━ 💡 KEY QUESTIONS ANSWERED ━━━━━━━━━━━━━━━ - Do longevity supplements like NMN, NR and spermidine actually work? - What are the 3 simple rules for a healthy diet? - Is gluten bad for you if you're not sensitive? - Why does the same diet work for one person and fail for another? - Which supplements are actually backed by strong evidence? - Is low-dose lithium safe as a supplement? - Why is the medical system "too reactive" — and how do we fix it? ━━━━━━━━━━━━━━━ 🔗 LINKS ━━━━━━━━━━━━━━━ 📚 Bas Kast - The Vitamin Compass: https://vitaminkompass.com/ 🔔 Subscribe for a new episode every week

  • S1 · E9
    May 31 · 58 min

    Functional Medicine MD: What 5,000+ Patients Taught Him About Root Cause Medicine

    Functional Medicine MD: What 5,000+ Patients Taught Him About Root Cause Medicine In this episode of Return on Health, we speak with Dr. Peter Martin, physician, former CNS pharmacology researcher, and founder of FunMed, one of Europe’s leading functional medicine clinics. Peter spent around 15 years in pharmacology research before his own burnout pushed him to look beyond the conventional model of symptom control. What started as a personal search for recovery became a data-driven clinical model built around root cause medicine, extensive biomarker testing, gut health, metabolism, and chronic disease prevention. We talk about what functional medicine actually means, why chronic disease often needs a different care model, and what Peter has learned from treating more than 5,000 patients. He explains why fasting insulin may be one of the most overlooked markers in modern healthcare, how low-grade inflammation is often connected to gut health, and why normal lab results do not always mean someone is truly healthy. We also get into the controversial parts: large biomarker panels, false positives, red meat, vegan diets, anti-nutrients, carnivore diets, and the weakness of much nutrition research. Peter also shares why he believes functional medicine could become part of the European healthcare system, especially if reimbursement shifts from visits and procedures toward actual health outcomes. This episode covers: What 5,000+ patients taught him Why fasting insulin is often missed How root cause medicine could change care Topics discussed: 00:00 Introduction 01:00 What FunMed does differently 02:00 Real-world data from 5,000+ patients 03:30 From CNS pharmacology to functional medicine 07:00 Root cause medicine vs symptom control 10:30 Precision health in Sweden and Germany 15:30 Why FunMed tests around 200 biomarkers 21:00 False positives and the problem with large panels 28:00 Fasting insulin and insulin resistance 31:00 Low-grade inflammation and gut health 35:30 Low-carb and ancestral nutrition 41:00 Vegan diets, nutrient deficiencies, and bio-individuality 49:30 Red meat, nutrition research, and epidemiology 56:00 Functional medicine and insurance coverage 59:00 Rapid fire: biomarkers, magnesium, carnivore diet, healthcare reform Guest Dr. Peter Martin Physician, former CNS pharmacology researcher, founder of FunMed, and one of the leading voices trying to bring functional medicine and precision health into European healthcare. Guest links LinkedIn: https://www.linkedin.com/in/peter-martin-31b23342/ FunMed: https://www.funmed.se/?srsltid=AfmBOorlgUNnEK1ba7p_zIxug35sx3YMSq6PmYiufq6xJH1VAQ-EiQc0 Return on Health is available wherever you get your podcasts. If you enjoyed this episode, leaving a 5-star rating on Spotify helps us bring more honest conversations about health, longevity, and medicine to more people.

  • S1 · E8
    May 6 · 58 min

    Harvard MD: The Truth About Peptides And Longevity Medicine

    Harvard MD: The Peptide Boom Is Here.. But Is Medicine Ready? In this episode of Return on Health, Niko and Miguel speak with Dr. Anand Vinjamoori, Harvard Medical School and Harvard Business School trained physician, former founding Chief Medical Officer at Modern Age, advisor to Superpower, and founder of Next Generation Medicine. Together, they discuss why longevity medicine is booming while many companies still struggle to build sustainable businesses, why peptides may become one of the next major waves in health optimization, and why the future of biomarkers will likely require a much more individualized and data-driven approach. This episode covers: The peptide boom and why it matters Why longevity businesses often fail What biomarkers can and cannot tell us Dr. Anand explains why the current medical evidence system may be too slow for the next generation of therapies, how real-world data and patient registries could help close the evidence gap, and why biomarkers should be used with nuance rather than treated as absolute truth. He also shares his view on overhyped interventions, the role of exercise, and the cultural differences between American optimization culture and European lifestyle rhythms. Key topics Longevity medicine and market timing The business challenges behind longevity clinics Customer acquisition and why messaging matters The rise of peptides in health optimization Evidence gaps, real-world data, and patient registries Personalized medicine and individual risk assessment Biomarkers, multi-omics, and biological individuality Why HBA1c can be overinterpreted Exercise as one of the strongest health interventions Cold plunges and the problem of overapplied hormesis European lifestyle culture vs. American optimization culture Chapters 00:00 The Longevity Paradox 01:03 Building Modern Age and the Early Longevity Market 05:04 Personal Motivations Behind Longevity Medicine 07:57 What Patients Actually Want From Longevity Care 11:39 Why Many Longevity Businesses Struggle 15:12 How Customer Preferences Have Changed 18:21 Peptides as the Next Big Wave 19:07 Peptides, Regulation, and Medical Experimentation 24:24 The Evidence Gap in Peptide Use 30:58 Why Medicine Needs Better Risk Assessment 36:59 Biomarkers and Biological Ground Truth 44:20 Multi-Omics and the Future of Measurement 48:35 Which Biomarkers Are Useful — And Which Are Noise? 52:42 Culture, Lifestyle, and Health Optimization 55:45 Lightning Round: Metrics, Interventions, and Healthcare Reform Guest Dr. Anand VinjamooriHarvard Medical School and Harvard Business School trained physician, former founding Chief Medical Officer at Modern Age, advisor to Superpower, and founder of Next Generation Medicine. Guest links LinkedIn: https://www.linkedin.com/in/vinjamoori/ Next Generation Medicine: https://www.nextgenerationmedicine.co/ Superpower: https://www.linkedin.com/company/superpower/posts/?feedView=all Listen now Return on Health is available wherever you get your podcasts. If you enjoyed this episode, leaving a 5-star rating on Spotify helps us bring more honest conversations about health, longevity, and medicine to more people.

  • S1 · E7
    April 19 · 56 min

    Geriatrician: Most Aging Is Preventable (But We Start Too Late)

    Most people think aging is something that happens later. In reality, the processes that determine how you age — and whether you stay functional — start decades earlier. In this episode of Return on Health, we sit down with Roberta Vella Azzopardi, a geriatrician and geroscientist with a PhD in cognitive frailty, to break down what aging actually looks like in clinical practice. Instead of focusing on single diseases, this conversation zooms out: Why do people lose independence? What really drives decline? And where are the biggest missed opportunities in prevention? What this episode covers Why modern medicine often intervenes too late What frailty really means — and why it matters more than age How loss of muscle drives metabolic and cognitive decline The concept of peak span and why function beats lifespan Why hearing loss is one of the biggest overlooked dementia risk factors The massive gap in menopause and women’s health care What actually works vs. what’s just hype in longevity Key takeaways Frailty is best understood as loss of physiological reserves. When those reserves drop below a certain threshold, even small stressors can lead to long-term decline. This is why two people at the same age can look completely different clinically — one independent, one dependent. A major driver of this process is muscle loss. Muscle is not just about movement. It directly affects metabolic health, insulin sensitivity, and even brain function. The good news: even later in life, resistance training and sufficient protein intake can still improve outcomes. One of the most underestimated risk factors discussed in this episode is hearing loss. It contributes to cognitive decline through increased cognitive load, social isolation, and shared vascular mechanisms — yet remains widely underdiagnosed and undertreated. Another critical blind spot is women’s health, especially around menopause. Many symptoms are treated in isolation instead of addressing underlying hormonal changes, leading to years of missed intervention opportunities. Timestamps (00:00) Introduction & Roberta’s background (04:30) Frailty explained: vulnerability vs. age (11:00) Why prevention starts decades earlier (16:50) Reversing decline: muscle, protein, training (21:00) Peak span vs. lifespan (28:30) Menopause and missed diagnoses (36:30) Dementia prevention & modifiable risks (37:00) Hearing loss and cognitive decline (50:00) Busting common aging myths (55:00) Lightning round insights Takeaways Start investing in your health early — not when problems appear Maintain muscle mass through resistance training and protein intake Don’t ignore hearing health — it directly impacts brain health Look at root causes, not isolated symptoms Prevention is not one intervention — it’s a system Roberta: https://www.linkedin.com/in/roberta-vella-azzopardi-md-phd-8235878a/ Return on Health: https://returnonhealth.de/ Niko: https://www.linkedin.com/in/niko-hems/ https://www.instagram.com/niko_hems https://nikohems.de/ Miguel: https://www.linkedin.com/in/miguel-medina-stanivukovic-857b9720b/ https://www.instagram.com/miguelmedinastanivukovic/?hl=en

  • S1 · E6
    April 4 · 1 hr 1 min

    Karolinska MD PhD: The Hidden Phase Before Disease

    Karolinska MD PhD: You Feel Healthy. Your Data Disagrees Most people think they’re healthy. But biology doesn’t care how you feel. Long before symptoms show up, your physiology is already shifting.. and most check-ups won’t catch it. In this episode, we sit down with Natalia Trpchevska (MD, PhD Karolinska, Medical & Scientific Director at AYUN) to break down what longevity medicine actually looks like when applied properly. We go beyond surface-level optimization and talk about what actually drives risk: mitochondria, metabolic flexibility, genetics, and why most people are already off track without knowing it. This episode covers: Why longevity medicine still struggles in practice Mitochondria, NAD+ and optimization myths Biohacking and the future of healthcare Key takeaways: Health declines silently — symptoms come late Longevity medicine asks: where are you heading biologically? The basics still dominate outcomes — most people underestimate them The next level is personalization, not more hacks Two “healthy” people can have completely different risks Mitochondria adapt first — then they start driving dysfunction Most mitochondrial interventions are misunderstood Genetics gives probabilities, not certainty Real optimization = prioritization + sequencing About Natalia: Natalia Trpchevska is a medical doctor and holds a PhD in genetics from the Karolinska Institutet. She is the Medical & Scientific Director at AYUN in Zurich, where she focuses on applying systems biology and layered diagnostics to detect early shifts in physiology — before disease develops. Her work bridges clinical medicine and research, with a strong emphasis on translating complex biology into actionable interventions. Timestamps: 00:00 – Introduction & Natalia’s background (Karolinska, genetics → clinic) 03:30 – Why genetics naturally leads into longevity medicine 05:00 – What longevity medicine actually does differently 07:30 – “Physiology before pathology” explained 09:30 – The basics vs. the real next level 11:30 – Same lifestyle, completely different risk profiles 13:30 – APOE4, Lp(a) and personalized strategy 15:00 – Mitochondria: what actually happens as you age 18:30 – When mitochondrial dysfunction becomes clinically relevant 21:00 – Cause vs. consequence: where mitochondria fit in aging 23:30 – How mitochondrial function is actually measured 26:30 – Why isolated tests don’t work (layered diagnostics) 29:00 – What happens after testing: prioritization & sequencing 32:00 – Why “doing everything” doesn’t work 35:00 – IHHT explained: mechanism, benefits, limitations 38:30 – Risks, contraindications & when it backfires 41:00 – Environment vs. lifestyle: what really drives dysfunction 44:00 – The hierarchy: metabolism → inflammation → toxins 47:00 – Why most people focus on the wrong layer 49:30 – What genetics got wrong over the last decade 53:00 – Polygenic risk, probabilities & real-world use 56:00 – Gene–environment interaction: what actually matters 58:30 – Final thoughts: what people still misunderstand about health Links: Natalia: https://www.linkedin.com/in/natalia-trpchevska/ https://www.ayun.ch/ More about Return on Health: https://returnonhealth.de/ Niko: https://www.linkedin.com/in/niko-hems/ https://www.instagram.com/niko_hems https://nikohems.de/ Miguel: https://www.linkedin.com/in/miguel-medina-stanivukovic-857b9720b/ https://www.instagram.com/miguelmedinastanivukovic/

  • S1 · E4
    March 21 · 52 min

    Medical Doctor: Primary Care Is Broken!

    Rethinking Primary Care and Longevity: Insights with Dr. Takhar. In this episode, Dr. Takhar, UCLA and Harvard trained physician-scientist shares his journey from emergency and internal medicine to building a groundbreaking primary care model focused on human connection, longer physician-patient times, and personalized longevity strategies. We explore how systemic issues hinder patient-centered care and what reforms could make healthcare more effective, preventative, and humane. Key topics: The limitations of conventional healthcare: burnout, bureaucracy, short visits The unique model of Primary MD: small panels, extensive diagnostics, longer consultations Human connection as a pillar of effective medicine The importance of listening and communication skills in healthcare Ethical considerations of concierge medicine and access equity The role of diagnostics: lipid panels, advanced markers, and their clinical relevance Risks, hype, and evidence in emerging longevity interventions Future pathways for systemic reform: data, evidence, insurance, and policy shifts Lessons from infectious disease training applied to longevity and longevity safety The "Mixed Medical Arts" approach: integrating diverse fields for optimal patient outcomes Timestamps: (00:00) - Introduction to Dr. Takhar and the care collision in modern medicine (02:07) - Clinical experiences shaping innovative primary care (07:12) - The human component in healthcare and systemic barriers (10:53) - What primary MD does differently to foster patient trust (13:20) - Teaching patients the 'why' behind health decisions (14:17) - The vital role of health coaches in adherence and engagement (15:32) - The holistic approach combining diagnostics, trust, and relationship (18:07) - Addressing ethics and access in concierge-like models (19:36) - How to demonstrate value and scalable models (22:37) - Overcoming telehealth technical issues in podcast interviews (23:58) - The importance of comprehensive, integrated care strategies (26:32) - Membership-based care: structure and patient experience (27:33) - Ethical considerations of luxury care and future access (36:36) - System change: from volume to value and prevention (42:48) - Infectious disease background shaping longevity skepticism (46:55) - The dangers of hype and unproven interventions (50:32) - Bottom-up demand and the future of preventative medicine More about Return on Health: https://returnonhealth.de/ Dr. Sukhjit “Sarge” Takhar: https://www.linkedin.com/in/sukhjit-takhar-md/ https://www.primary-md.com/ Niko: https://www.linkedin.com/in/niko-hems/ https://www.instagram.com/niko_hems https://nikohems.de/ Miguel: https://www.linkedin.com/in/miguel-medina-stanivukovic-857b9720b/ https://www.instagram.com/miguelmedinastanivukovic/?hl=en This episode underscores the critical need for systems that prioritize genuine human connection, personalized diagnostics, and thoughtful health promotion to advance longevity and overall well-being.

  • S1 · E4
    March 7 · 56 min

    Stanford MD: The Longevity Industry Is Lying To You

    Longevity science is advancing quickly. Healthcare systems are moving much slower. In this episode, Stanford-trained physician Dr. Hillary Lin explains why prevention, biological age testing, mitochondria, and health optimization often struggle to translate into real clinical practice. We discuss the limits of NAD+ supplementation, the risks around peptides, and why behavioral change still drives most health outcomes. The conversation also looks at decentralizing healthcare, continuous monitoring, and why many high performers struggle with recovery despite doing “everything right.” What you’ll learn • Why longevity science and healthcare are misaligned • The role mitochondria play in aging and energy • When NAD+ supplementation can backfire • Risks around peptides and self-experimentation • Why behavior change drives most longevity gains • The future of continuous health monitoring Topics 00:00 The gap in longevity care 02:17 Hillary Lin’s path into longevity medicine 05:28 Decentralizing healthcare 08:13 Mental health navigation 14:05 Mitochondria and mitophagy 16:45 The NAD+ problem 22:33 High performer bottlenecks 27:20 Behavior change and longevity 30:31 Peptides in longevity medicine 35:02 Continuous healthcare models 46:19 Biological age testing 51:32 The future of healthcare monitoring Follow Hillary: https://www.hillarylinmd.com/ https://www.linkedin.com/in/hillarylinmd/ https://www.instagram.com/hillarylinmd/?hl=en More about Return on Health: ⁠https://returnonhealth.de/⁠ Niko: ⁠https://www.linkedin.com/in/niko-hems/⁠ ⁠https://www.instagram.com/niko_hems⁠ ⁠https://nikohems.de/⁠ Miguel: ⁠https://www.linkedin.com/in/miguel-medina-stanivukovic-857b9720b/⁠ ⁠https://www.instagram.com/miguelmedinastanivukovic/?hl=en

  • S1 · E3
    February 20 · 56 min

    Longevity Doctor: The Hidden Power of Metabolic Flexibility

    Unlock the secrets to lasting health and longevity with Dr. Rhea Kotecha - a physician bridging functional medicine, longevity, and science to transform the way we age. Discover why metabolic health is the underrated pillar of a long, vibrant life, and learn practical strategies that go beyond quick fixes to create real, sustainable change. If you've ever wondered how to assess your true health potential or how personalized medicine can help you avoid the pitfalls of one-size-fits-all protocols, this episode is your essential guide. Takeaways Longevity is not just about adding years but optimizing healthspan. The gap between knowledge and action is where health interventions fail. Personalized protocols based on biomarkers are essential for effective longevity strategies. Metabolic health is a crucial pillar of healthspan optimization. Visualizing future health can motivate clients to adhere to protocols. Functional foods can be both beneficial and a marketing gimmick. A whole food approach is vital for improving health outcomes. Adherence to protocols is often hindered by overwhelming information. Medical education should emphasize holistic approaches to health. The healthcare system needs to adapt to prioritize healthspan optimization. Summary In this conversation, Dr. Rhea Kotecha discusses the multifaceted approach to longevity, emphasizing the importance of understanding healthspan over mere lifespan. She highlights the significance of personalized protocols based on biomarkers, the role of metabolic health, and the need for a holistic view in medical education. The discussion also covers the challenges of adherence to health protocols, the impact of functional foods, and the necessity of visualizing future health to motivate clients. Dr. Kotecha advocates for a shift in the healthcare system towards proactive health management, focusing on optimizing healthspan. Chapters 00:00 Understanding Longevity: A Multifaceted Approach 02:02 The Intersection of Medicine, Psychology, and Nutrition 04:06 The Role of Psychology in Health Interventions 06:03 Functional Foods: Marketing vs. Reality 08:15 Assessing Longevity: The Importance of Individualization 10:15 Key Biomarkers for Longevity Assessment 11:55 Metabolic Health: The Foundation of Longevity 14:57 Microbiome Testing: Promise and Challenges 19:22 Visualizing Longevity: Engaging Clients in Their Health Journey 23:23 Fermented Buckwheat: A Nutritional Powerhouse 27:00 The Importance of Gut Health and Fermented Foods 28:53 Creating a Balanced Fiber and Protein Blend 33:24 Client Readiness and Longevity Protocols 35:29 Improving Adherence in Medical Protocols 40:45 Navigating Evidence-Based Medicine and Experimental Interventions 45:31 Practicing Longevity Medicine in a Traditional Healthcare System 47:17 Misconceptions About Longevity and Healthspan 49:02 The Anthropological Perspective on Longevity 51:14 Bridging the Gap Between Modern Life and Evolutionary Needs 53:27 Key Interventions for Healthspan Improvement 54:08 Overhyped Longevity Interventions to Avoid 54:53 Future of Personalized Supplementation 55:27 The Role of AI in Longevity Medicine 56:03 Reforming Healthcare Incentives for Longevity Follow Rhea: https://www.instagram.com/drrheakotecha/ https://www.drrheakotecha.com/ More about Return on Health: https://returnonhealth.de/ Niko: https://www.linkedin.com/in/niko-hems/ https://www.instagram.com/niko_hems https://nikohems.de/ Miguel: https://www.linkedin.com/in/miguel-medina-stanivukovic-857b9720b/ https://www.instagram.com/miguelmedinastanivukovic/?hl=en Keywords longevity, healthspan, biomarkers, metabolic health, functional foods, personalized medicine, adherence, medical education, evolutionary health, anthropological perspective

  • S1 · E2
    February 13 · 54 min

    Stanford-Trained MD: Do This to Prevent Chronic Disease

    This episode digs into why midlife health quietly shapes your future more than most people realize - and why the healthcare system is structurally bad at dealing with that phase of life. Together with Stanford-trained MD Ali Zaidi, we talk about what actually changes in your body during midlife, which signals people tend to miss, and where medicine often reacts too late instead of setting the right defaults early on. A grounded conversation about biology, behavior, and why “doing nothing until something breaks” is still the dominant strategy in most health systems. Takeaways Midlife health is crucial Preventive care is undervalued in the healthcare system Longevity interventions Testing for mid-lifers Chapters 00:00 The Importance of Midlife Health 06:02 Physiological Changes in Midlife 19:02 Personal Health Stories and Biases 28:10 Experimental Approaches in Healthcare 36:18 Exploring Red Light Therapy and Vision Health Follow Ali: https://www.linkedin.com/in/ali-zaidi-4a81121/ https://www.alizaidimd.com/ More about Return on Health: https://returnonhealth.de/ Niko: https://www.linkedin.com/in/niko-hems/ https://www.instagram.com/niko_hems https://nikohems.de/ Miguel: https://www.linkedin.com/in/miguel-medina-stanivukovic-857b9720b/ https://www.instagram.com/miguelmedinastanivukovic/?hl=en

  • S1 · E1
    February 12 · 18 min

    What is Return on Health?

    In our first episode, we explain why this podcast exists. We talk about how Miguel and Niko met during their Master’s at NOVA SBE, how endless late-night debates about health, medicine, and broken incentives slowly turned into a shared frustration with the system - and why starting this podcast became the only logical step. We break down what “Return on Health” actually means: why most health decisions optimize for short-term comfort, not long-term outcomes; why good intentions fail when incentives are misaligned; and why prevention, incentives, and system design matter more than hacks and biohacking trends. You’ll get a clear sense of: what we will challenge on this podcast who this is for (founders, operators, builders, and anyone tired of health content that oversimplifies reality) how we’ll approach topics: data-driven, critical, open to uncertainty why we will talk to people we disagree with and why some “promising” health ideas never get good evidence — and what to do with that reality More about Return on Health: https://returnonhealth.de/ Niko: https://www.linkedin.com/in/niko-hems/ https://www.instagram.com/niko_hems https://nikohems.de/ Miguel: https://www.linkedin.com/in/miguel-medina-stanivukovic-857b9720b/ https://www.instagram.com/miguelmedinastanivukovic/?hl=en

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