Karolinska MD PhD: You Feel Healthy. Your Data Disagrees

Most people think they’re healthy.

But biology doesn’t care how you feel.

Long before symptoms show up, your physiology is already shifting.. and most check-ups won’t catch it.

In this episode, we sit down with Natalia Trpchevska (MD, PhD Karolinska, Medical & Scientific Director at AYUN) to break down what longevity medicine actually looks like when applied properly.

We go beyond surface-level optimization and talk about what actually drives risk: mitochondria, metabolic flexibility, genetics, and why most people are already off track without knowing it.

This episode covers:

• Why longevity medicine still struggles in practice
• Mitochondria, NAD+ and optimization myths
• Biohacking and the future of healthcare

Key takeaways:

• Health declines silently — symptoms come late
• Longevity medicine asks: where are you heading biologically?
• The basics still dominate outcomes — most people underestimate them
• The next level is personalization, not more hacks
• Two “healthy” people can have completely different risks
• Mitochondria adapt first — then they start driving dysfunction
• Most mitochondrial interventions are misunderstood
• Genetics gives probabilities, not certainty
• Real optimization = prioritization + sequencing

About Natalia:

Natalia Trpchevska is a medical doctor and holds a PhD in genetics from the Karolinska Institutet.

She is the Medical & Scientific Director at AYUN in Zurich, where she focuses on applying systems biology and layered diagnostics to detect early shifts in physiology — before disease develops.

Her work bridges clinical medicine and research, with a strong emphasis on translating complex biology into actionable interventions.

Timestamps:

00:00 – Introduction & Natalia’s background (Karolinska, genetics → clinic)
03:30 – Why genetics naturally leads into longevity medicine
05:00 – What longevity medicine actually does differently
07:30 – “Physiology before pathology” explained
09:30 – The basics vs. the real next level
11:30 – Same lifestyle, completely different risk profiles
13:30 – APOE4, Lp(a) and personalized strategy
15:00 – Mitochondria: what actually happens as you age
18:30 – When mitochondrial dysfunction becomes clinically relevant
21:00 – Cause vs. consequence: where mitochondria fit in aging
23:30 – How mitochondrial function is actually measured
26:30 – Why isolated tests don’t work (layered diagnostics)
29:00 – What happens after testing: prioritization & sequencing
32:00 – Why “doing everything” doesn’t work
35:00 – IHHT explained: mechanism, benefits, limitations
38:30 – Risks, contraindications & when it backfires
41:00 – Environment vs. lifestyle: what really drives dysfunction
44:00 – The hierarchy: metabolism → inflammation → toxins
47:00 – Why most people focus on the wrong layer
49:30 – What genetics got wrong over the last decade
53:00 – Polygenic risk, probabilities & real-world use
56:00 – Gene–environment interaction: what actually matters
58:30 – Final thoughts: what people still misunderstand about health

Links:

Natalia:
https://www.linkedin.com/in/natalia-trpchevska/
https://www.ayun.ch/

More about Return on Health:
https://returnonhealth.de/

Niko:
https://www.linkedin.com/in/niko-hems/
https://www.instagram.com/niko_hems
https://nikohems.de/

Miguel:
https://www.linkedin.com/in/miguel-medina-stanivukovic-857b9720b/
https://www.instagram.com/miguelmedinastanivukovic/