Dr. Swet Chaudhari, MD — Double Board-Certified Medical Director of Wellness Elite Fitness — sat for this conversation in the facility’s consult room on a Tuesday morning in April. He has run WEF’s physician practice since the facility opened. The following is edited for length and read-through, not for content. His voice has not been smoothed.
The word “optimization” is everywhere. What does it mean when you use it?
It means moving one variable, measuring what happens, and keeping the version that was better. It is not a philosophy, it is a method. The reason the word has gotten diluted is that people use it to describe a sense of wanting to be better, which is a feeling, not a process. Feeling is where you start. Optimization is what you do next.
What is the first biomarker you look at when a new member walks in?
Fasting insulin. Not fasting glucose. Glucose is where the body has compromised in order to hold something else stable; insulin is what it had to pay to get there. A member can have a perfectly normal fasting glucose and a fasting insulin that is telling me the pancreas has been shouting for five years. The second number is free sex hormone-binding globulin, because it moves with insulin and with liver health and with a handful of other things that matter. Between those two numbers, I can tell you more about the next five years of a person’s life than almost any other pair.
The popular writing on longevity tends to promise outcomes — more years, reversed damage, and so on. How do you talk to a member about what to expect?
I don’t promise anything. The job is to move the variables we can move, and to be honest about the ones we can’t. The language in our publication is careful on purpose. We say supports, we say associated with, we say research-backed. We do not say will or guaranteed or treats. Those words are a promise the biology has never agreed to keep, and a member who hears that promise and does not get it feels betrayed for a reason.
Tell us about the recovery suite as you actually design a week around it.
The recovery suite is five modalities — cryotherapy, hyperbaric oxygen, infrared sauna, red light, pneumatic compression — and the instinct of most new members is to do a little of each every day. That is a misunderstanding. These are stressors, most of them. They are hormetic. The body adapts to them because they are rare enough to be a signal. Do them every day, and the body stops listening. Do them in a pattern that respects training load, sleep, and travel, and they compound. The week is what matters, not the session.
A member can have a perfectly normal fasting glucose and a fasting insulin that is telling me the pancreas has been shouting for five years.
Dr. Chaudhari · on the labs he checks first
What is the most common mistake you see in members who come in already knowledgeable?
Too many inputs at once. They read something on a Sunday, start three new things on a Monday, and by Friday they cannot tell you which one is working. The job of a physician is sometimes to take things away, not to add them. A month of doing less, measured well, is more valuable than a quarter of doing more, measured badly.
Peter Attia’s work has made longevity something educated professionals read about. Where do you agree with the popular framing, and where do you quietly disagree?
He is almost always right on the importance of cardiovascular fitness as a longevity lever. VO₂ max in the upper quintile for one’s age is one of the most defensible predictors of all-cause mortality we have. Where I am more cautious is around supplement stacks. The popular writing tends to be additive — rapamycin, metformin, NAD precursors, and so on — without a clear picture of which members benefit, which do not, and which might be harmed. I have a smaller list than most of my peers, and I have reasons for each thing on it.
There is a lot of conversation about hormone optimization. Where is the line for you between thoughtful care and overreach?
The line is the data. We are not a TRT clinic. We run a full panel, we consider the full clinical picture, and we move only when the numbers, the symptoms, and the conversation all agree. Hormones are powerful and their signaling is networked, meaning a change in one axis moves others. Any practice that treats them as a blood pressure prescription — one number, one pill — is not practicing the same medicine I am. We also do not optimize a number out of physiologic range because the member wants to. That is not medicine.
What does the ideal member look like from your seat?
Curious, patient, skeptical of their own enthusiasm. Someone who reads what we publish and comes in with one good question, not twelve. Someone who can hear “the data does not support that yet” without feeling dismissed. Someone who sleeps before they supplement.
The facility is physician-led, which is unusual for the wellness category. What does that change operationally?
It changes what can be said in the room. A trainer cannot tell you that your A1c is sliding; a physician can. A recovery technologist cannot tell you that your morning heart rate is drifting up for a reason that is not training load; a physician can. We do not fragment that picture. The member who uses the recovery suite, the strength floor, the nutrition consult, and the labs, is one member, and the same person reads all of it. That is the whole design.
Last one. If a reader of The Bioneer were to change one thing this week, what would you ask them to change?
Sleep. Earlier. Darker. Cooler. Two hundred lux at the eye after 9 p.m. is already too much for melatonin. I have members who have optimized everything else and left sleep on the table because it is not glamorous. It is the single highest-leverage thing almost anyone can do, and it costs nothing. Start there. Everything else is downstream.
— Dr. Swet Chaudhari, MD, is Double Board-Certified Medical Director of Wellness Elite Fitness. The next long interview in this series runs in Issue 02, with Dana Kantara, Cellular Health Expert. This conversation is informational; it is not medical advice.