The longevity medicine boom has physicians and patients alike chasing the latest interventions, from cold plunges to NAD+ infusions to metformin for non-diabetics.
But at PPA’s 2025 Annual Meeting, Dr. Aaron Wenzel and Dr. Jesse Greer took to the stage to argue that we’ve skipped an entire paradigm. Before jumping to biohacks and elixirs, they said, entrepreneurial physicians need to master foundational interventions.
The Case for Medicine 2.5
Dr. Greer framed the problem simply: We’ve jumped from “Medicine 2.0” (the current sick-care model where treatment begins after disease appears) straight to “Medicine 3.0” (the longevity protocols popularized by thought leaders like Peter Attia). In doing so, we’ve leapfrogged an entire layer of care.
“We kind of skipped over all the core principles,” Dr. Greer explained. “Exercise, nutrition, sleep. Moving from sick patients to the newest therapies, we’re losing the foundation.”
He estimates that 80% of results come from these foundational interventions. The fancy protocols matter far less than most patients believe.
Dr. Wenzel agreed, pointing to what he calls “hack culture.” Patients arrive hoping that cold plunges or supplements will substitute for the harder work. Some physicians are tempted to provide these shortcuts.
“You can’t cold plunge your way out of shitty personal relationships,” Dr. Greer said bluntly. “You can’t metformin your way out of it.”
The Unexpected Number One Priority
Until recently, Dr. Wenzel’s priority list resembled that of most physicians. Metabolic health sat at the top. Then, a question from an audience member in Philadelphia changed his thinking.
She asked him to choose: If he could wave a magic wand and ensure his patients never struggled with metabolic disease or never struggled emotionally and spiritually, which would he pick?
He chose emotional well-being. “A really bad day in metabolic disease means maybe you need to go to the ER, get some fluids, some IV insulin,” he explained. “[But] a really bad day on the emotional, spiritual side of the house means there is no tomorrow.”
Metabolic disease kills slowly. An emotional crisis can kill in moments.
For physicians building longevity-focused practices, this reframes the intake process. Dr. Greer noted that many high-achievers arrive chasing metrics to fill voids they haven’t examined. Screening for emotional readiness before diving into biomarkers saves time and improves health outcomes.
Metabolic Health as the Foundation of Longevity
Once emotional health is addressed, metabolic health becomes the cornerstone. Dr. Wenzel’s framework is straightforward: Seven of the top ten killers of humans are either directly or one degree removed from metabolic disease.
“If I don’t figure out how to reverse engineer the top ten killers of humans, I’m probably not going to be reliably successful in helping people live a long time and feel good,” he said.
Both physicians track markers outside of standard panels, including fasting insulin, ApoB, triglyceride-to-HDL ratios, high-sensitivity CRP, and the relationship between fasting glucose and fasting insulin over time.
Dr. Wenzel emphasized that metabolic health offers a quality the emotional work doesn’t: objectivity. “The data is right there,” he said. Coaching someone through unresolved trauma can be elusive and difficult. Metabolic markers don’t lie.
For cardiovascular risk specifically, both physicians have adopted coronary CT angiography (CCTA) as a game-changer. Dr. Wenzel called it the single test that most profoundly affects how his practice approaches risk stratification.
Outside of lab work, Dr. Wenzel pointed to lean mass as the ultimate currency for longevity. “The data is overwhelmingly supportive of this,” he said. “The stronger we can be for the longer amount of time, the more we will have a natural, innate ability to ward off chronic disease.”
For patients resistant to behavior change, Dr. Wenzel uses continuous glucose monitors as a teaching tool. Rather than lecturing about nutrition, he lets the data do the work.
“Put a glucose monitor on, and I just want you to notice what’s happening,” he said. “All of a sudden, the Cheez-Its go away.”
The 51/49 Relationship Principle
Dr. Wenzel shared a value that governs patient relationships in his practice: 51/49.
In every relationship, give a little more than you take. But once you’re above 51%, stop and evaluate.
“Once you get above 51% that you care, this is an unfair relationship,” he explained. “You want it more than them.”
This metric helps his team recognize when patients aren’t ready to change. The physician should lead the charge and demonstrate commitment. But carrying someone’s bag for them doesn’t yield lasting results.
When Dr. Wenzel notices a disconnect between stated goals and actual behavior, he asks pointed questions about fear and resistance. These conversations, he said, often end with patients in tears. His team jokes about what he’s doing to people behind closed doors.
Dr. Greer added that self-agency matters more than self-advocacy. The patient must pull the transformation from the physician, not wait passively to be fixed.
“In the back of my head, I’m like, ‘No one is coming to save you,’” Dr. Greer said. “But this person is not ready for that message yet.”
Building Trust That Accelerates Change
For Dr. Wenzel, the apex asset in his practice isn’t technology or testing protocols. It’s the relationship itself.
“All the tips and tricks could burn to the ground,” he said. “If we have deep, meaningful relationships with our members, I wouldn’t have it any other way.”
Trust, he emphasized, accelerates change in ways that data alone cannot. But building that trust is more art than science. It requires time, consistency, and a genuine desire to help patients map their best lives.
The longevity medicine movement offers real promise for entrepreneurial physicians. Advanced testing, early detection, and proactive intervention can change patient outcomes. But Dr. Wenzel and Dr. Greer offered a grounding reminder: The foundations still matter most.
The takeaways are straightforward: Start with emotional readiness, build on metabolic health, give a little more than you take, and remember that relationship, not protocol, is the ultimate currency.
Insights like this are part of what makes PPA’s Annual Meeting valuable for entrepreneurial physicians exploring healthspan medicine. Members gain year-round access to peer discussions, monthly webinars, and a network of physicians refining these approaches in their own practices. Learn more about PPA membership today.
