Episode Details

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.