The Curbsiders Internal Medicine Podcast

Episode #520: Healthspan Medicine, A Practical Approach

Air Date: April 6, 2026
Guests: Dr. Sandeep Palakodetti (MD, MPH)
Hosts: Dr. Matthew Watto, Dr. Paul Williams, Dr. Paul Wertz

Episode Overview

This episode explores the concept of healthspan medicine—personalized, preventive care strategies that focus not just on lifespan, but on maximizing years of healthy, functional living. Dr. Sandeep Palakodetti, a leader in this field, shares practical approaches to optimizing diet, exercise, sleep, and the management of metabolic health, using emerging metrics and tools accessible to both patients and clinicians.

The Curbsiders team discusses the rise of CGMs (continuous glucose monitors) in the non-diabetic population, how to interpret biometric and wearable data safely, exercise prescriptions, new labs like ApoB and Lp(a), and frameworks for assessing novel interventions such as peptides. The conversation emphasizes applying evidence with nuance while avoiding data-induced anxiety.

Key Discussion Points & Insights

Introducing Dr. Sandeep Palakodetti

• Background: Board-certified internist, former Chief Population Health Officer, Mayo Clinic and university hospital experience. Founder/CEO of Velocity Health, focused on personalized preventive care. Author of “The Ultimate Asset.”
  (04:02)

Personal Interests

• Amateur musician; enjoys time on his farm’s recording studio with his children.

  “I think I tinker with the electronics. I played piano and guitar and I just got an electric drum set…”
  — Dr. Palakodetti (05:08)

Continuous Glucose Monitors (CGMs) in Non-Diabetics

Case: Tony, 45, with Hypertension, Family History of DM2, BMI 30

• Using a CGM, notes post-meal glucose spikes of 180 mg/dL, which drives him to a carnivore diet. Labs: A1c 5.7%, ApoB 115.
  (06:33)

Are Glucose Spikes Dangerous for Tony?

• Post-meal spikes up to 160-180 mg/dL are common, especially with simple carbs. Concern rises if elevations are sustained (>2–3 hours).

  “A spike to 180 is not something to worry about as long as you’re coming back down… it invites a deeper conversation…”
  — Dr. Palakodetti (09:54)

Non-Food Factors Affecting CGM Data

• Exercise, stress, and sleep can also produce glucose variability.

  “People start to connect the dots of things like poor sleep or stress leading to chronic cortisolemia, leading to chronic hyperglycemia…”
  — Dr. Palakodetti (09:24)

When Should Primary Care Recommend a CGM?

• Not pushed universally; useful as a learning tool in select populations: strong DM family history, features of metabolic syndrome, or discordant A1c and glucose readings.

  “We suggest [CGMs] for people who have strong family history of diabetes and who are displaying other metabolic syndrome features…”
  — Dr. Palakodetti (11:36)

Avoiding Data Neurosis & “Over-Gamifying” Health Metrics

• Remind patients that glucose spikes after exercise or eating fruit are often normal.

• Avoid “orthosomnia”—fixating on perfect numbers from wearables.

  “We definitely see this orthosomnia, this kind of over-reliance on the wearables telling you how you should feel.”
  — Dr. Palakodetti (18:23)

• Balanced diets are preferable; extreme avoidance of carbs to flatten CGM data can raise ApoB/LDL and overall CV risk. Adjust recommendations as risk profiles change.

Notable Moment

“Any diet that is either canonizing or demonizing one macro is probably not taking the full picture into account…”
— Dr. Palakodetti (20:56)

Beyond CGM: Major Metabolic & Cardiovascular Risk Markers

The “Big Rocks” of Healthspan Medicine

(27:05)

• Labs: ApoB, Lipoprotein(a); A1c; body composition (e.g., via DEXA); VO2 max.
• Many are overlooked in standard primary care but provide a comprehensive risk profile.

  “Instead of saying, hey, your LDL is high… it’s like, your ApoB, your Lp(a), your insulin resistance, your genetics—all these things are pointing to real risk.”
  — Dr. Palakodetti (30:03)

Body Composition: DEXA, Home Scales, and Trends

• DEXA is gold standard for muscle/fat ratio but trends over time (even with body fat scales) matter most.

  “Whether you’re 16% or 17% body fat doesn’t matter. Whether you’re 35 or 18 matters…”
  — Dr. Palakodetti (31:47)

VO2 Max—Why Cardiopulmonary Fitness Matters

• Quantifies cardiorespiratory fitness; low VO2 max is a profound predictor of mortality.

  “Having a low VO2 max confers a 400% increased mortality risk… way beyond smoking or diabetes.”
  — Dr. Palakodetti (35:19)

• Focused improvement (through zone 2 and HIIT training) can strongly impact long-term independence and function.

Practical Exercise Prescriptions

• At least 150 minutes/week of moderate-zone aerobic exercise; resistance training for muscle mass and strength; focus first on balance and posture to avoid injury.
• Use functional goals (e.g., ability to stand, place bags overhead) to motivate patients for strength gains.

  “These things have to be non-negotiables for patients… we have to paint them the picture for why and how to build that in.”
  — Dr. Palakodetti (53:12)

Sleep as a Foundational Pillar

Case: Anita, 40, High-Stress Job, Five and a Half Hours of Sleep

• Labs: A1c 5.6%, triglycerides 190, creeping BP, low HRV, "strain" on wearables.
  (43:44)

Framework: The “Core Four”

• Sleep, Nutrition, Fitness, Emotional Resilience

  “No amount of medications or supplements or life hacks… is going to help you if you can’t sleep and you are living a life full of cortisol…”
  — Dr. Palakodetti (47:30)

Sleep Metrics & Wearables

• Look for sleep architecture (deep/REM >30–40% of total), beware orthosomnia.

• HRV is a directional marker; day-to-day variation less meaningful than monthly trends.

  “There’s a lot more variability [in heart rate] with healthy autonomic balance… HRV is sort of the only metric we have to understand that.”
  — Dr. Palakodetti (57:44)

Navigating Peptide Therapy and Novel Supplements

• Patients increasingly request compounds like BPC-157 and NAD+. Use a structured, non-dismissive approach:
  • EASI framework: Evidence, Alignment, Safety, Impact
  • BHB matrix: Benefit, Harm, Burden
  • Score each intervention before proceeding and ensure full discussion of risks and unknowns.

“Most people want a clinician who will not make them feel stupid for asking... and so it’s incumbent on us to meet people where they are and educate.”
— Dr. Palakodetti (65:02)

• Example: BPC-157 has mostly animal data; no human RCTs, but appears safe—discuss the uncertainties, the patient’s goals, and harm-reduction principles around sourcing.

Summary Table of Core Metrics & Recommended Interventions

| Domain | Key Metric(s) | Target / Comment | Basic Intervention | |----------------------|-----------------------|------------------------------------------------------------|----------------------------------------------| | Glycemia | CGM, A1c | Spikes <180 mg/dL usually OK; focus on overall trend | Balanced diet; address sleep/stress/exercise | | Lipid Risk | ApoB, Lp(a), LDL-c | ApoB <80–90; Lp(a) low preferred | Statins/other Rx as appropriate | | Body Composition | DEXA, % body fat, ALMI| Trends matter more than absolute %; focus on lean mass | Strength training; dietary protein | | Cardio Fitness | VO2 max | Trend up; >30–35 mL/kg/min for long-term independence | Zone 2/HIIT exercise | | Sleep | Deep/REM %, HRV | >7 hrs, 30–40% restorative sleep; HRV variable | Establish sleep hygiene, reduce "strain" | | Psycho-Social | Emotional support | Not measured, but stress management/connection crucial | Mindfulness, therapy, social interaction |

Notable Quotes & Memorable Moments

“Reps really matter. There’s no one protocol, no one thing. Every patient presents differently… humility and context are key.”
— Dr. Palakodetti (75:13)

“We use evidence, alignment, safety, and impact—that easy framework—to guide if and how we proceed when evidence is lacking.”
— Dr. Palakodetti (69:14)

Orthosomnia:
“The unnecessary and pathologic obsession with achieving perfect sleep scores… People let the score tell them how they should feel.”
— Dr. Palakodetti (63:02)

“There are no more efficacious interventions in all of medicine than the Core Four: sleep, diet, exercise, emotional resilience.”
— Dr. Palakodetti (75:02)

Suggested Timestamps for Key Segments

• 06:33 — Real-world case: Using CGMs in clinic
• 09:24 — How to interpret CGM spikes, data neurosis
• 18:23 — Pitfalls of "orthosomnia" and wearable obsession
• 27:05 — Expanding risk assessment: new labs and fitness metrics
• 35:19 — Why VO2 max is an underused vital sign
• 40:04 — Structuring nutritional and exercise guidance
• 47:30 — The “Core Four” foundational lifestyle domains
• 57:44 — Practical use and pitfalls of sleep wearables and HRV
• 65:02 — Frameworks for evaluating peptide therapies
• 75:02 — Take-home points and closing reflections

Take Home Points

• Balance data with context: CGM and wearable outputs can be helpful when used thoughtfully, but over-fixation is counterproductive.
• New metrics: ApoB, Lp(a), VO2 max, and body composition measurements can better inform cardiovascular and metabolic risk than A1c or LDL alone.
• Lifestyle is foundational: Sustainable improvements in sleep, nutrition, fitness, and emotional resilience trump quick fixes and unproven supplements.
• Frameworks for innovation: Use structured conversations—EASI and BHB matrices—to evaluate novel therapies.
• Personalize and meet patients where they are: Shared decision-making, humility, and context are essential.

Guest Plugs

• Book: The Ultimate Asset — Out now on Amazon and (soon) Audible.
• Podcast: “The Ultimate Asset” with Dr. Sandeep Palakodetti.

“There is no greater return on investment than investing in ourselves—the ultimate asset.”

For CME credit and more detailed show notes, visit curbsiders.vcuhealth.org.
For questions, feedback, or future episode requests, email askcurbsiders@gmail.com.

This summary omits advertisements and non-content banter.