In this episode of Precision Medicine Made Simple, we continue our discussion with Dr. Mohammad Jarbou from Episode 33, where we first explored the significance of VO₂ Max testing and its role in personal health optimization. Now, we dive deeper into the importance of sleep health, heart rate variability (HRV), and the insights provided by sleep studies.

Dr. Jarbou breaks down how HRV can be a valuable indicator of overall health and recovery, highlighting its connection to sleep quality and longevity. He also provides a closer look at mild sleep apnea, its effects on well-being, and how lifestyle interventions can help prevent the condition from progressing.

With actionable advice on improving sleep hygiene and the science behind REM sleep rebound, this episode offers valuable insights for those looking to optimize their sleep and overall health through a precision medicine approach.

Key Takeaways:

• HRV reflects the balance between “fight or flight” and “rest and digest”—high HRV = good recovery.
• High REM percentage can signal sleep deprivation, not “better sleep.”
• Mild sleep apnea (AHI 5.6) is common and often doesn’t require CPAP in young, healthy patients.
• Consistent sleep and wake times matter more than “making up sleep” with naps.
• Sleep, fitness, and recovery exist in a cycle—fix one, improve the others.

In This Episode:

• [00:00:00] HRV explained: stress, recovery, and sleep’s role
• [00:02:19] Taylor sets the stage: VO₂ max test and sleep study follow-up
• [00:05:33] Home sleep study setup, devices, and first-night discomfort
• [00:07:59] In-lab sleep studies vs home sleep tests
• [00:10:35] 4–3–2–1 sleep hygiene rule and real-life challenges
• [00:13:18] HRV, alcohol, and what readiness metrics can and can’t tell you
• [00:16:44] Total sleep time: why 5–6 hours is Taylor’s “first problem”
• [00:18:30] High REM percentage and REM rebound from sleep deprivation
• [00:20:00] Deep sleep vs REM: what truly restores your body
• [00:24:33] AHI, 3% vs 4% oxygen drop, and Taylor’s mild sleep apnea
• [00:29:32] Snoring, sleeping on your back, and positional therapy
• [00:35:42] Naps, “social jet lag,” and protecting your sleep drive
• [00:40:28] When to repeat sleep studies and add body composition (DEXA)
• [00:43:05] Taylor’s takeaways and next step: VO₂ max deep dive in a future episode

Notable Quotes:

• “REM sleep isn’t the restorative stage—deep non-REM sleep is where your body really recovers.” – Dr. Jarbou
• “If your HRV is low in the morning, it’s often your body telling you it didn’t get the recovery it needed.” – Dr. Jarbou
• “Most people don’t need fancy tests—they need better sleep structure and consistency.” – Dr. Jarbou
• “Mild sleep apnea doesn’t mean treatment right away. Fix the basics first.” – Dr.

The traditional healthcare system is breaking under the weight of burnout, short appointments, and profit-driven incentives, and Dr. Adam Wheeler has lived it from the inside. After losing a patient and realizing that all his creative energy was going into improving metrics instead of improving lives, he decided to build something radically different.

In this episode of Precision Medicine Made Simple, recorded live at Bigtree Medical in Columbia, Missouri, Dr. Wheeler joins host Taylor Cu and co-host Dr. William Stanford to share how he reimagined primary care from the ground up. His direct primary care network now serves more than 13,000 patients with a model built on unlimited time, transparent pricing, and authentic, patient-centered relationships.

You’ll hear how Dr. Wheeler’s model leverages nurse practitioners to expand access, integrates genetic and metabolic testing to personalize care, and embraces patient-requested treatments such as testosterone therapy, compounded GLP-1s, IV infusions, and preventive protocols. He also discusses how AI and shared decision-making empower patients to take control of their health, creating a system that rewards outcomes instead of volume.

This conversation explores what it truly takes to make healthcare personal again and why the future of medicine belongs to those willing to rebuild it from trust, data, and compassion.

Key Takeaways

• Why Dr. Wheeler walked away from the traditional insurance model
• How the direct primary care (DPC) membership system works and why patients love it
• The role of nurse practitioners in solving the physician shortage
• How Bigtree trains new NPs to lead with empathy and precision
• Why shared decision-making is critical to modern medicine
• What peptides, testosterone therapy, and GLP-1 medications mean for personalized care
• How AI tools are empowering, not replacing, doctors
• Why genetic and metabolic testing helps patients “know the fight they’re fighting”
• The real difference between health span and lifespan and how to extend both
• What the future looks like when healthcare becomes proactive instead of reactive

In This Episode

• [00:00] Turning points in medicine
• [01:17] Intro to Precision Medicine Made Simple
• [02:39] Meet Dr. Adam Wheeler
• [05:49] Membership model explained
• [07:23] Bigtree care models
• [08:19] Scaling intimacy in care
• [08:48] Direct vs. concierge care
• [09:51] Innovative patient care
• [31:34] Genetics and cancer risk
• [33:11] Personalized medicine
• [34:06] Motivational interviewing
• [35:11] Prostate cancer and genetics
• [49:50] AI in healthcare
• [53:01] AI’s role in medicine
• [56:39] Bigtree Medical vision
• [57:48] Final thoughts

Notable Quotes

• [05:43] “It’s really sad that all this creative energy is going to juicing the numbers, as opposed to taking care of people.” — Dr. Adam Wheeler
• [05:24] “We allow our patients to leave our practice at any time. If we do a bad job, they’re supposed to leave, and if we do a good job, they stay.” — Dr. Adam Wheeler
• [14:27] “The direct pay model absolutely changes your incentives as a doctor… it forces you to care about the things patients actually care about.” — Dr. Adam Wheeler
• [38:21] “There’s nothing you can do about the Lp(a), but you need to really optimize all of your other numbers.”— Dr. Adam Wheeler
• [55:19] "I think before we have AI replacing me, we're gonna have me enabled with AI." — Dr. Adam Wheeler

Our Guest

Dr. Adam Wheeler is a

In this episode of Precision Medicine Made Simple, we’re joined by Dr. Mohammad Jarbou, co-founder of the Longevity Clinic. Dr. Jarbou, a board-certified physician in pulmonary medicine, critical care, sleep medicine, and clinical informatics, discusses how his clinic uses a holistic approach to aging and health span. The clinic focuses on prevention and early detection, utilizing personalized medicine, genetic testing, fitness plans, and sleep optimization.

Dr. Jarbou explains how cutting-edge practices, such as VO2 max testing, personalized nutrition, and genetic evaluations, help optimize long-term health. He also highlights the importance of muscle mass and good sleep hygiene for aging well, and how these factors are integral to preventing chronic diseases.

Key Takeaways:

• VO2 max testing is an excellent predictor of longevity and health span.
• Muscle mass is critical for long-term health and quality of life.
• Genetic testing helps guide personalized wellness plans and prevent chronic illness.
• Sleep hygiene plays a significant role in overall health, affecting everything from energy to metabolism.
• Personalized health strategies should incorporate fitness, nutrition, and genetics to achieve optimal wellness.
• Prevention of chronic conditions like diabetes, Alzheimer’s, and sleep apnea can be achieved with early detection and lifestyle modifications.

In This Episode:

• [00:00] – Introduction to Dr. Mohammad Jarbou and the Longevity Clinic
• [05:00] – How the clinic’s focus on prevention and early diagnosis led to personalized care
• [10:00] – The significance of VO2 max testing and wearable technology for tracking fitness
• [15:00] – The importance of muscle mass and weightlifting for longevity
• [20:00] – The role of genetic testing in guiding personalized health strategies
• [25:00] – How sleep quality affects overall health and Dr. Jarbou’s tips for better sleep
• [30:00] – The benefits of personalized nutrition and building sustainable habits
• [35:00] – Addressing chronic conditions with early intervention and prevention
• [40:00] – Hormone replacement therapy and its role in health optimization for longevity
• [45:00] – How genetic testing can help identify risks for chronic diseases like Alzheimer’s

Notable Quotes

• "Longevity is not just how long you live, but the quality of life you have along the way." – Dr. Mohammad Jarbou
• "Muscle mass is critical for both physical function and longevity." – Dr. Mohammad Jarbou
• "Prevention should be the foundation, not an afterthought, when it comes to aging and health." – Dr. Mohammad Jarbou
• "You can't just focus on one area of health. Fitness, nutrition, sleep, and genetics all play an essential role in how you age." – Dr. Mohammad Jarbou
• "Small changes in habits can have a huge impact on your longevity." – Dr. Mohammad Jarbou

Our Guest

Dr. Mohammad Jarbou is a physician with over 20 years of...

In this episode of Precision Medicine Made Simple, we’re joined by Dr. Jeff Gulcher, co-founder of Decode Genetics and current leader at Galateo Bio. Dr. Gulcher shares his vast experience in the field of genomics and precision medicine, covering everything from polygenic risk scores (PRS) to the challenges of integrating diverse genetic data into predictive healthcare.

Dr. Gulcher takes us back to the early days of genetic research with Decode Genetics, where his team pioneered genome-wide association studies (GWAS) in Iceland. He dives into the development of PRS and the challenges of improving disease prediction models, especially by ensuring they are accurate across diverse populations.

In addition, Dr. Gulcher discusses his personal journey with prostate cancer and how polygenic risk scores helped predict his elevated risk at an early age. The episode also covers how genomics, when combined with other clinical data, can revolutionize preventative healthcare.

Key Takeaways:

• Polygenic risk scores (PRS) are essential in predicting the risk for diseases like cancer and cardiovascular conditions.
• The development of PRS is revolutionizing preventative healthcare, especially when there's no family history.
• Ancestry-aware PRS models are crucial, as current models are mainly based on European populations.
• Dr. Gulcher’s personal experience with prostate cancer demonstrates the power of early genetic screening.
• Combining genetic data with clinical risk factors can provide a more accurate disease risk prediction.
• The future of PRS lies in the integration of AI and better data representation across diverse populations.

In This Episode:

• [00:00] – Introduction to Dr. Jeff Gulcher and the significance of polygenic risk scores
• [05:00] – Dr. Gulcher’s background and the founding of Decode Genetics
• [10:00] – How polygenic risk scores work and their application in predicting diseases
• [15:00] – The challenge of making PRS models work for non-European populations
• [20:00] – Dr. Gulcher's personal story: how early genetic testing saved his life
• [25:00] – The role of genetic data in determining the risk for common diseases like prostate cancer
• [30:00] – The importance of combining genetic risk with lifestyle factors in disease prevention
• [35:00] – The potential of AI in refining polygenic risk score models
• [40:00] – The challenges of integrating genetic data into real-world clinical practice
• [45:00] – How diverse genetic data will help improve precision medicine globally

Notable Quotes:

• “Polygenic risk scores help us understand how much our genes contribute to disease, but they are just one piece of the puzzle.” – Dr. Jeff Gulcher
• “Genetics isn’t destiny, but it’s an important part of the story, especially when combined with other risk factors.” – Dr. Jeff Gulcher
• “We need to build more inclusive data sets so that precision medicine works for everyone, not just for those of European ancestry.” – Dr. Jeff Gulcher
• “Personalized healthcare is about understanding each individual’s...

In this episode of Precision Medicine Made Simple, we’re joined by Lucy Janoyan, the Chief Operations Officer and Chief Strategy Officer at Biography Health. Together with Taylor Cu, Lucy dives into a wide-ranging discussion on the state of healthcare, DIY testing, and the future of personalized care.

Lucy and Taylor reflect on their experience at Rosetta Fest, where they explored the complexities of the healthcare system, the growing trend of employer-sponsored healthcare, and the role of digital health platforms in improving care delivery. They also discuss the challenges of managing family health data, the importance of building trusted care teams, and the increasing role of DIY health tools and AI in the personal health journey.

Through personal anecdotes, Lucy shares her perspective on how healthcare consumers are navigating the fragmented system, the need for better data transparency, and why it’s crucial to combine innovative technologies with trusted healthcare professionals.

Key Takeaways:

• The complexities of the current healthcare system make it hard to deliver personalized care efficiently.
• The rise of DIY health testing and the role of AI in managing health data raises concerns around data security, accuracy, and the need for expert validation.
• Employers are becoming more involved in providing innovative health benefits, but challenges remain for smaller businesses in offering comprehensive plans.
• How fragmented health data across different systems impacts patients and caregivers, and why consolidation and integration are essential.
• The importance of trusted care teams and providers, even in an age of digital health platforms and self-directed care.

In This Episode:

• [00:00] Introduction to the challenges of navigating healthcare and the role of employers in healthcare
• [05:00] Reflections on Rosetta Fest and the conversations around transparency, costs, and improving outcomes
• [10:00] The rise of DIY health testing and its impact on trust in providers and healthcare plans
• [15:00] How employers are evolving their healthcare offerings and the rise of self-insured companies
• [20:00] The importance of consolidating fragmented health data for easier patient navigation
• [25:00] The limits of AI in healthcare and why expert validation is still necessary
• [30:00] Managing family healthcare data and the importance of self-advocacy
• [35:00] Exploring the power of genetics in managing health risks and creating personalized care plans
• [40:00] The importance of having a trusted care team in the DIY health era and the future of personalized care

Notable Quotes

• “We need to combine AI and digital health tools with trusted providers to ensure the data we’re using is accurate and impactful.” – Lucy Janoyan
• “More data doesn’t always equal better decisions if we don’t know how to use it. It’s about action, not just information.” – Taylor Cu
• “Your genes are not your destiny. We have the power to influence our health with the right information and the right team.” – Lucy Janoyan
• “We’re moving toward a more holistic care model,

In this episode of Precision Medicine Made Simple, we welcome back Dr. Yelena Bykhovskaya, the Chief Scientific Officer at Biography Health, for a deep dive into polygenic risk scores (PRS) and their emerging role in precision medicine. Dr. Bykhovskaya breaks down the complexities of genetics and its application in clinical practice, focusing on how polygenic risk scores can be used to assess an individual's risk for common complex diseases.

We discuss the evolution of genetics in healthcare, how PRS differs from monogenic testing, and why the accuracy and predictive power of these scores are becoming increasingly important. We also address some of the challenges in applying PRS across different populations and the future potential of genetic risk scores in personalized healthcare.

Key Takeaways:

• Polygenic risk scores are a powerful tool for assessing genetic predisposition to complex diseases like heart disease, Alzheimer’s, and more.
• PRS are calculated using multiple genetic variants, not just one, making them useful in understanding complex traits.
• While still evolving, PRS are becoming more accurate, especially with the incorporation of data from diverse populations.
• Understanding PRS can help prevent diseases before they manifest, offering proactive healthcare solutions.
• The challenges and benefits of integrating PRS into clinical practice, and how the field is rapidly advancing.

In This Episode:

• [00:00] Introduction to polygenic risk scores and their relevance in precision medicine
• [05:00] How the Human Genome Project and next-generation sequencing revolutionized genetics
• [10:00] Explaining the difference between monogenic and polygenic diseases
• [15:00] The limitations of current PRS models and how they’re improving over time
• [20:00] Why PRS is especially useful for assessing cardiovascular risk and other common conditions
• [25:00] The impact of ancestral diversity on PRS and how researchers are making improvements
• [30:00] What it takes for PRS to move from research to clinical use
• [35:00] The potential for PRS to inform more personalized treatment plans
• [40:00] Dr. Bykhovskaya’s personal experience with blood pressure medication and how PRS could have helped
• [45:00] How precision medicine is changing the way we think about healthcare

Notable Quotes:

• “Polygenic risk scores are not just about predicting the future, they’re about empowering people to take control of their health today.” – Dr. Yelena Bykhovskaya
• “You can't just focus on a single gene; it's about the whole picture, understanding how multiple genetic factors contribute to disease risk.” – Dr. Yelena Bykhovskaya
• “Genetics is a moving field, and as we gather more data, the accuracy and usefulness of PRS will continue to improve.” – Dr. Yelena Bykhovskaya
• “Personalized medicine is about understanding you as an individual and tailoring healthcare to your specific needs, not just your symptoms.” – Dr. Yelena Bykhovskaya

Our Guest

Dr. Yelena Bykhovskaya is the Chief Scientific Officer at Biography Health, where she...

In this episode of Precision Medicine Made Simple, we’re joined by Dr. Rich Joseph, a physician with a rare blend of expertise as both a strength and conditioning specialist and a competitive athlete. Dr. Joseph is the founder of VIM Medicine and the Board Chair of Vital Connections. He’s also a faculty member at Harvard Medical School and Brigham and Women’s Hospital, where he focuses on preventive medicine.

Dr. Joseph’s unique approach integrates performance medicine, which he defines as the capacity to bring energy and attention to what matters most in life. His philosophy blends athletic mindset and proactive health practices to help people achieve peak performance in all aspects of life—physical, mental, and emotional.

In this episode, we dive into his journey from athlete to physician, how he started VIM Medicine, and how performance medicine can optimize health and longevity. We also discuss the importance of mindset, recovery, and behavior in achieving long-term wellness.

• The concept of performance medicine and its relevance to overall well-being.
• How performance-based healthcare goes beyond disease treatment to emphasize proactive, personalized care.
• The importance of behavioral grounding and experimentation in health optimization.
• How to use performance metrics like VO2 max and strength to monitor and improve health.
• The evolution of health insurance and its role in a more proactive, patient-centered care model.
• The growing field of longevity and the need for more balance in the conversation around aging

• [00:00] Introduction to Dr. Rich Joseph’s approach to performance medicine
• [05:15] Transitioning from athletic training to a medical career
• [10:00] The importance of a mindset focused on progress over perfection
• [14:30] Starting VIM Medicine and the integration of exercise into healthcare
• [20:00] The role of recovery and mindset in optimizing longevity
• [25:00] Exploring peptides, supplements, and managing the noise in health trends
• [30:00] Biomarkers: What should you focus on for long-term health?
• [35:00] The difference between functional medicine, longevity medicine, and personalized care
• [40:00] Vital Connections and the effort to address healthcare inequities in Boston
• [45:30] Dr. Joseph’s vision for the future of healthcare and his practice’s growth

• “Health is an asset, something you have to strategically manage and invest over the long term.” – Dr. Rich Joseph
• “You can’t just treat the symptoms; you have to optimize performance to live well.” – Dr. Rich Joseph
• “Prevention is not sexy, but performance is something everyone can get behind.” – Dr. Rich Joseph
• “You have to pair stimulus with recovery to create adaptation.” – Dr. Rich Joseph

Dr. Rich Joseph is a Harvard-trained internist, founder of VIM Medicine, and Chief Medical Officer at Restore Hyper Wellness. With a background in strength and conditioning, he has created a unique model of Performance Medicine that combines athletic principles with healthcare. His approach emphasizes proactive health strategies, personalized wellness, and performance optimization. Dr. Joseph also leads Vital Connections, a nonprofit focused on improving health equity and community well-being.

Dr. Rich Joseph

• https://www.linkedin.com/in/rich-joseph-md-mba-61448b33a/

Most of today’s healthcare still treats problems after they happen. Dr. Leroy Hood thinks that needs to change. In this episode of Precision Medicine Made Simple, he explains how genomics, regular health tracking, and AI can shift the focus to preventing disease before it starts.

Dr. Hood is one of the scientists who helped build the automated DNA sequencer that powered the Human Genome Project. He also founded the Institute for Systems Biology. He has worked across research, government, and healthcare to push ideas that were unpopular at the time but are now standard practice.

You’ll hear how he went from a professor at Caltech to building new departments, starting research institutes, and working with governments around the world to change how healthcare works.

He also explains the idea of P4 medicine: predictive, preventive, personalized, and participatory care and why most of the healthcare system isn’t built to support it yet.

• Seven shifts that shaped Dr. Hood’s career and could change medicine
• Why most healthcare money goes to chronic disease and how to cut that
• How genome and phenome data can find diseases years before symptoms
• What polygenic risk scores mean for different ethnic groups
• How AI helps doctors create personalized care plans
• How useful data can slow aging, prevent Alzheimer’s, and support your health
• Why chasing profits slows down U.S. healthcare
• How kids in Seattle learn to manage their own health
• Why commercial insurance may fail if it doesn’t adapt
• How Tom Brady trained his brain to last longer and how you can apply that

• [00:00] Introduction to Dr. Leroy Hood's journey
• [01:49] The evolution of precision medicine
• [03:11] Introducing Dr. Leroy Hood
• [04:41] Dr. Hood's early career and challenges
• [06:43] The birth of systems biology
• [08:20] Pioneering cross-disciplinary research
• [10:56] The Human Genome Project
• [13:49] Establishing systems biomedicine
• [22:51] The Luxembourg initiative
• [23:45] Data-driven health insights
• [30:42] Challenges with polygenic risk scores
• [31:42] Ancestry and genetic variants
• [32:52] Pharmacogenomics and drug response
• [33:16] Rare diseases and carrier status
• [34:57] Lifestyle genetics and athletic injuries
• [36:18] Actionable possibilities in genomics
• [38:27] Economic impact of chronic disease prevention
• [39:04] Obstacles to deep health analysis
• [40:48] Advancements in personalized medicine
• [45:50] The future of health care and AI
• [56:15] Brain health and cognitive function
• [59:39] Conclusion and future topics

• [00:00:39] "I decided “Big Data” was necessary to deconvolute the complexity of human biology. But the instrumentation for “Big Data” didn't exist at that point in time." — Dr. Leroy Hood
• [00:11:41] "The big science of the genome project revolutionized so many fields of biology in profound ways that it's really quite remarkable." — Dr. Leroy Hood
• [00:12:15] "The Human Genome absolutely transformed our understanding of how we can think about human biology." — Dr. Leroy Hood
• [00:13:39] "If you really want to have fun with science, you can't do it at a place where people are criticizing two of the major thrusts in your laboratory." — Dr. Leroy Hood
• [00:44:14] "Over the last 40 years, Americans extended their lifespan by 10 years. They didn't expand their health span by a single year." — Dr. Leroy...