Continuous Glucose Monitoring and Why Everyone Should Be Tracking This Important Metric

Despite the dietary advice touted by researchers, the American Diabetes Association, or the internet — there’s no one-size diet for preventing diabetes. The only surefire way to know how your blood sugar reacts to different foods is to see it in real-time. That’s why mechanical engineer Josh Clemente founded Levels, a metabolic fitness company that has made continuous glucose monitoring accessible to all, not just those who already have diabetes. Josh talks with Dr. Anthony Gustin of The Natural State podcast about his own journey to glycemic control and its incredible impact on his quality of life — and the role he envisions for Levels in reversing the national diabetes epidemic.

• Check out Levels
• Follow Levels on LinkedIn or Twitter
• Connect with Josh Clemente on LinkedIn or Twitter
• Check out The Natural State podcast
• Connect with Dr. Anthony Gustin on Twitter

10:55 — Bye bye buttons

People feel safer pushing buttons and moving levers to control a vehicle, even a spacecraft, says Josh — but spacecrafts and airplanes are designed to fly without human input.

“One of the big efforts that we had on the Dragon program was convincing the sort of entrenched aerospace that it is a good idea to have the vehicle fly itself, essentially, and to have the crew members interact with the vehicle through touchscreens. So that kind of a heavy lift because the technology is there and we’re very confident that it would work. But people are very familiar with buttons and tactile feedback and pilots moving instrumentation to make things work. And it’s just like, you know, computers are really good at this stuff now. And for the most part, airplanes fly themselves and land themselves. And there’s no reason the spacecraft should be different. Of course there have to be emergency systems that astronauts can step in and take the wheel, so to speak, if necessary. But for the most part, the goal for that development project was that from launch until docking with the International Space Station, it’s entirely autonomous — and that was successful.”

13:46 — Stream your own data

Continuous glucose monitoring (CGM) gives an individual an inside look at how their body responds to the things they do all day, every day — eating, drinking, activity, etc.

“The goal is to connect people with their own real time biological information so that they can make data-driven decisions. And that kind of sounds like a bunch of words, but what we’re primarily doing is getting real-time continuous glucose monitoring, into the world of wellness and performance optimization. So you can tap into a data stream from your body and see the reactions to the actions you take every day. You sit down, you eat something for lunch; you see how that affected you in terms of your glucose control, which has these downstream effects on hormones and weight gain, weight loss, performance in exercise — all of these downstream effects that we experienced, but now you can get a data stream for.”

17:15 — The must-have technology to better understand your body

Josh couldn’t ignore what he now understood about glucose metabolism; he needed to get a monitor and start optimizing his own blood sugar.

“That was kind of a screeching moment for me. It was like, I actually have no idea. I’ve never thought about this and now it’s something I have to take seriously. And how am I going to do that? You know, I don’t know how to select for diet. I don’t know how to opt-out. I mean, should I just go full keto? If so, how do I know it’s working? All these questions started bubbling up and so I kinda went down a rabbit hole, started researching physiology and metabolism. I realized that there are two primary energy substrates in the body, right? It’s glucose and fat. And one of those, there’s amazing technology coming available called continuous glucose monitoring. And I need this; I need to start measuring this substrate and see if I can start to improve my own slowly flagging mood and energy issues.”

18:13 — But I’m doing everything right!

While Josh was pushing himself hard in the gym and carefully calibrating his diet, his blood sugar revealed a completely different story: he was prediabetic.

“I ultimately got my hands on a continuous glucose monitor and I found that I was either borderline or full-blown pre-diabetic, depending on who you asked. That was a kind of a life-changing moment for me, because I had been painstakingly formulating whole foods meals, and certainly thought I was doing everything right, buying good ingredients, and all of this traditional fitness culture advice, like carbo-loading after workouts and making sure you get your glycogen replenished. All of these things were floating around in my brain. And I was eating based on these heuristics that had no grounding in data — and it was causing me to be sick!”

19:39 — The ripple effects of every little decision

Using finger pricks, Josh was able to pinpoint the impact of his carb loads on his energy level.

“I was using a fingerprint glucometer because I had been turned down for CGM by several physicians. So I was pricking my finger up to 60 times a day. And I was like, I’m going to start with a plant-based diet and work my way to full carnivore, if that’s what it takes, but I’m just going to use data to try and figure out what’s best for me…I was eating quite a large serving of like brown rice or sweet potatoes after every meal or during every meal. And my glucose levels would be, like you said, elevated in the pre-diabetic or in some, some cases like over 180 for multiple hours, and then they’d come crashing back down. And those crashes were perfectly safe with my 2:00 PM ‘Where’s the coffee?’ moments, feeling like I needed to grab a nap. And it was an immediate feedback loop thing. So you close the loop between action and reaction. You see that this is happening. You understand what’s the normal, what’s optimal and what’s suboptimal. And you just realize that these little decisions you’re making can be improved and the numbers tell you the whole story.”

23:47 — The irony of insulin

Thanks to super-high insulin levels, people with advanced metabolic syndrome have plenty of stored fat and glycogen…but no energy

“Digging into the effects of insulin, for example, which is an anabolic hormone, it’s the bulking hormone, right? It’s what causes us to store things. And when you are in a hyperinsulinemic environment, your body physically cannot tap into its available energy stores. So you are storing glycogen, you are storing fat and you are unable to oxidize the fat that you already have. And so this, in the worst-case scenarios — for people who have very advanced metabolic syndrome —  they can have hundreds of pounds of fat on their bodies, topped-off glycogen stores, and yet have absolutely no energy available because their insulin levels are so high and they can’t tap into that energy store.”

26:42 — Coffee: now an indulgence, not a requirement

By wearing a CGM, Josh took back control of his blood sugar to the point that he no longer needs coffee.

“And in retrospect now, after bringing my glucose into control, I can stay +/- 10 points on my blood sugar day in and day out, if I put the effort in. Now I just have this flat, consistent output of energy day in and day out. Like, I don’t drink coffee after 11:00 AM and that’s only if I want to, I’ll have one, but it’s a total indulgence, whereas it used to be an absolute requirement. I was just sipping it was my lifeblood for every single workday. The consistency there is certainly due, in my opinion, to these hormonal fluctuations that I’ve taken out of the system by stopping that massive kick to a dynamic system that I was doing at every single meal.”

30:18 — Miss a meal? Your body will adapt

Josh feels a sense of empowerment and freedom from food; he’s no longer thinking about it all the time or letting it dictate his energy level.

“Feeling that independence is really amazing. And it’s also a sense of empowerment over your physiology. You know you’re safe. And I think the glucose data that we produce is really one of the main sort of keys to understanding this, realizing that you’re not going to go into some sort of hypoglycemic state and pass out if you miss a meal (anyone who’s practiced fasting knows this), but watching glucose in a low, flat controlled output as your body taps into its glycogen stores and then taps into gluconeogenesis as necessary to keep you running. And then seeing ketones come up and just watching your body do its thing, you realize the crazy hormones that drive hunger are completely out of the equation.”

31:19 — Never better sleep

Since he started paying attention to his blood sugar, Josh is sleeping more and better and waking up rested and happy.

“My sleep is just far better than it ever has been. And I still am trying to take a lot of data here. And this is something that Levels is looking into — bringing sleep data, heart rate variability and recovery, into the picture with glucose. There’s a ton to learn here. ButI really think the overnight glucose dysfunction that I had previously was closely correlated with a lot of heart rate variations and poor, light sleep. And so now I get much more deep sleep and I also get, I think, more restful sleep as a result of not having large, carb-filled meals towards the end of the day. That’s also benefited my mood in the downstream, you know — waking up rested rather than groggy and unhappy.”

37:46 — No one-size-fits-all glycemic diet

There’s so much individual variation in how the body responds to glucose; two people can eat the exact same foods and experience opposite glycemic responses.

“The landmark paper was in the Cell journal by the Weizmann Institute in 2015. And it took 800 people without a diagnosed metabolic dysfunction and gave them continuous glucose monitors. And that data was shocking because it showed the two people can eat the exact same two foods — in this case, it was a banana and a cookie made with wheat flour — and those two people could have equal and opposite responses to those two foods. So it’s not that they had varying levels of response; it was that one person was straight up flat on the banana and had a huge spike from the cookie, and the other person had a huge spike from the cookie and nothing from the banana. This is demonstrating the personal variations here that are driving our glycemic responses and ultimately will drive the hormones that are, for example, associated with weight gain. So people who are trying a one-size-fits-all diet are going to run into this personal variation.”

39:47 — An issue of accessibility

Want a finger prick monitor? Just buy one at the drugstore. But to get a CGM — which is minimally invasive and has lower risk of infection, yet infinitely higher quality data — you need a prescription.

“The accessibility issue is complicated for sure. And every CGM that’s out there is prescription only. And it’s an interesting risk problem here, because if you want to get access to your glucose measurements, you can go to CVS and pick up a finger prick monitor, and stab yourself and bleed on your fingertips, which are exposed to infection. And you gotta do that a few hundred times really to get enough data points, to really understand how your glucose levels are changing. Or you wear this patch CGM, which has a little filament in the skin. It is minimally invasive, but there’s no blood involved from 90% of installations and you wear it continuously for 14 days at a time and there’s no capillary bloods, there’s minimal infection risk, basically zero pain. And you have a full time data stream, right? While you’re sleeping, while you’re exercising, while you’re eating — you’re recording this information. And so the quality of the data and the output of that is a much more resolute picture of how you are actually responding to your dynamic system.”

43:48 — Halting the diabetes epidemic

With a Levels’ CGM, the average person can use their glucose data to make better lifestyle choices, ultimately reducing their risk of type two diabetes.

“The glucose breakdown that is most associated in our society with long-term issues is caused by chronic lifestyle choices. That would be type two diabetes, pre-diabetes. There are 30 million people in the US with type two diabetes, 90 million with pre-diabetes. And of those 90 million, 90% don’t know they have a problem. The CDC estimates that of those 90 million people, 70% of them are gonna end up being type two diabetic by 2035, if they don’t do something now. So our hope here is that this information, this data, this technology, by becoming more consumer friendly and having an elegant user interface and these machine-learning algorithms on the background that can help you surface and make better choices, we can avert disaster in terms of the metabolic outcomes in the country.”

46:24 — Checking in on health

Josh predicts Levels will keep adding real-time analytes so users can check in on their health account information (like the free fatty acids or insulin running through their bloodstream) the same way they’d log into their bank account.

“I’m optimistic about the future of real-time monitoring equipment. I think we’re going to have several new analytes on the market in the next few years. And so the goal for Levels is to be the metabolic fitness company. And to bring in, as more of this information becomes available, maybe we can measure free fatty acids or lactic acid, or potentially even hormones like insulin in real-time. And we will use that to fill in machine-learning models of you, the individual, and how you are metabolizing and tapping into the energy sources, storing fat, and feeling. I’m really optimistic for the future where you can look much more like the way you treat financial information. You brought your phone, you can check out your bank account balance and your deposits and withdrawals and stuff, and have a prediction for the future. You should be able to do the same thing with your bodies.”

Dr. Anthony Gustin   (00:05) Hello, and welcome to The Natural State Podcast. I’m your host, Dr. Anthony Gustin. It is my belief that the natural state of any living organism’s health in their artificial habitat has forced us into having artificial health problems. This show is my attempt to dive deep and learn about using nutrition, sleep, movement, relationships and more to help you reclaim your natural state of health in a modern world and show you how to thrive in an environment that’s stacked against you. If you enjoy today’s show, you can find out more details and information at dranthonygustin.com.

Dr. Anthony Gustin   (00:36) This week, I welcome on the podcast Josh Clemente, who is one of the founders of Levels a new company that was founded to take on what I have been ranting about for years now, which is making continuous blood glucose monitoring accessible. So Josh has a really interesting background. He actually designed a lot of the life support systems for SpaceX originally and the stuff that carried the astronauts up to space recently. We talked a little bit about that on the show, but more so his experience and why they think that a continuous blood glucose monitor is one of the most important tools that humans can have.

Dr. Anthony Gustin   (01:10) And if you’re new to the show, you may not know, but I have historically been very, very big on this product and I’ve been wearing CGM now for on and off for several years. And it really pissed me off how people can’t access this technology. You can go to a Walgreens and buy a fingerpick, but you can’t get one that continuously monitors your blood  glucose. This is unfortunate because this is where you get the most amount of data around what you should be eating, how food’s affecting you and when you shorten that feedback loop, you get a lot of behavior change in nutrition and health. So super important what they’re doing.

Dr. Anthony Gustin   (01:44) And as a full disclosure, I was one of the very early alpha testers of their product and loved it so much that I decided to become an early investor in the company, which allows me to get you guys some hookups to this product. So they currently have a 25,000 person waitlist to be onboarded before their big launch later this year. But if you want to try out their products, you just head to D-R-anthonygustin.com/cgm. It will auto apply and skip you through the entire line so you can sign up and you can get a CGM right now without a doctor’s prescription. So again, one of the biggest tools that I think are helpful as far as calibrating your own health and I hope the conversation with Josh illuminates some of the ways that people can use this to help foster their own health. So tune in and I hope you guys enjoy.

Dr. Anthony Gustin   (02:32) This episode of The Natural State is sponsored by Ned. Ned is an incredible company that makes a lot of CBD products. And you guys can probably go back to some of my episodes and realize that I have been a CBD skeptic for a very long time. I think that it’s really hard and it’s an industry that’s exploding to have really high quality products that actually do anything. I tried a bunch of different CBD brands before this one and unless they had THC in them as well, not enough to get high but just enough to amplify the effects of CBD.

Dr. Anthony Gustin   (03:06) I didn’t feel anything until I tried Ned and then was completely blown away. I’ve been using their products before they sponsored the show for about four to six months and have noticed a huge increase the nights that I use their product about 25 mg or 50 mg per night of the CBD and I sleep way better. But then also the most interesting part is my HRV as tracked by my Oura ring the next morning is about 20 points higher the day that I use CBD versus not.

Dr. Anthony Gustin   (03:36) I also have not been doing a lot of social drinking as of this year. So anybody who’s been following my stuff knows that I’ve been taking the back seat to any glass of wine here, a drink there to take the edge off. And the last few months I’m sure everybody in the world feels a little stressed out. And I’ve been taking the same amount like 25 mg to 50 mg to replace that glass of wine to wind down in destress and it’s been pretty remarkable to pull down the edge and make sure that I can just calm down at night with all that’s going on in the world.

Dr. Anthony Gustin   (04:10) The founders are amazing people. They really care about their supply chain, their sourcing. They do things the right way and I asked them to hook you guys up with a little bit of a discount code. So if you want to try Ned out just go to helloned.com/ag15 for 15% off and free shipping. That’s H-E-L-L-O-N-E-D.com/ag15. That’s A-G-1-5 for 15% off and free shipping.

Dr. Anthony Gustin   (04:39) This show is also brought to you by BLUblox blue light blocking glasses. Blue Light is one of these things that a lot of people do not realize is completely trashing their sleep. So this is verified at least for me. I looked at my Oura ring and anytime I get blue light exposure from devices past say 4PM, the latency, the time it takes for me to fall asleep, as well as my deep sleep are completely diminished, then when I wear glasses like BLUblox, it completely reverses that and I can get a full rested sleep with no problem. There are a lot of brands out there right now that are trying to get on this trend of blocking blue light for good reason.

Dr. Anthony Gustin   (05:14) And what happens is most of them are either really cheap and they break super easily. They are terrible looking. They make you look like a freaking goon or they actually just don’t work. So I’ve tried some out that are a spectrum of many of these things, all the way to being so dark that I get headaches from wearing them.

Dr. Anthony Gustin   (05:32) And what I like about blue BLUblox is it addresses all these  things. So they’re made, actually, in Australia, really, really high quality stuff. They have 20 plus different styles of each one, so no matter what  style fits your head and your face – My face is sometimes a little tough to make look good. So I’m glad to have options for me.

Dr. Anthony Gustin   (05:49) But also they test all of their lenses to make sure that they meet specific criteria to block very specific wavelengths of light. And this is the important part here. Not a lot of brands do this. And so I’ve actually tested theirs side by side and you can do this as easily as just looking at a spectrum of blue and you put on their glasses and you can’t see the blue anymore. It goes completely black or has a shade of a gray and this isn’t what you want. And these guys who have done this company have done a phenomenal job at really sourcing the highest quality lenses, highest quality frames and the ones that actually look good. So I’m not embarrassed when I put these on in public.

Dr. Anthony Gustin   (06:22) And I asked them if they could hook you guys up and they obliged. So 15% off is yours if you use code ag15, also you get free shipping. So if you want to, just head to B-L-U-B-L-O-X.com and use code A-G-15. That’s blublox.com. Use code ag15 for 15% off and free shipping.

Dr. Anthony Gustin   (06:45) Josh, thank you for joining me today.

Josh Clemente         (06:47) It’s great to speak. Thanks for having me on.

Dr. Anthony Gustin   (6:49) Yeah. It’s been a while, a couple months. Your background, I’m sure we’ll get into for a while, but let’s just start with your previous role, your company. I don’t know if SpaceX was just right before this. But yeah, starting there because I think there’s some big news in the last couple months since we’ve chatted, but I just want to ask you personal questions about –

Josh Clemente         (07:08) Nice. Yeah. So SpaceX was not just prior to Levels, but it was about a year and a half prior to Levels. So I spent six years at SpaceX working on rocket systems and then eventually I moved into the life support and astronaut development systems and was able to lead a team developing pressurized life support equipment. So think breathing apparatus and things that keep the cabin of the vehicle pressurized, fire suppression equipment and that was for the Crew Dragon vehicle, which just flew its inaugural mission to the ISS on May 27th with Bob Behnken and Doug Hurley.

Dr. Anthony Gustin   (07:46) Congrats, man. I was watching the launch and I know a lot of people were and I assume that you were.

Josh Clemente         (07:51) Absolutely. Yeah. That was –

Dr. Anthony Gustin   (07:52) I saw it on TV. But I’m sure a lot of the work that you did was instrumental in setting the groundwork to get to the point where you’re at. I’m sure even a year and a half, a year ago or whatever it’s like there can’t be too many tweaks they were making to the systems you were working on anyway.

Josh Clemente         (08:07) Yeah. Yeah. So I pushed that program to the critical design review phase, which is where we lock the designs down and then you go into production mode. And at that point, like I said, I’d been there about six years and I started to have these other interests that I wanted to explore, entrepreneurial, and it just felt like that now’s the time and so I do feel it was a bittersweet experience to watch from a distance. But at the same time it was amazing to be a part of the program, to be able to contribute and watch that success happen and look forward to having those guys come back down from the space station in a few weeks.

Dr. Anthony Gustin   (08:38) Yeah. Is that still like another? Let’s wait and see what happens?

Josh Clemente         (08:43) Yeah. There are other systems involved there. And development projects I was working on have different failure modes that occur on ascent versus on re-entry and landing. So far, everything’s been just flawless from what I can tell and all the info I’m getting. So it’s amazing and it’s still a bit of a nail biter until they’re back on solid ground.

Dr. Anthony Gustin   (09:04) Yeah, totally. I’m sure you have tons of company-workers and friends that are still at the company.

Josh Clemente         (09:08) Yeah. Yeah. Super embedded there. My sister still works there. So we’ve got a big SpaceX family.

Dr. Anthony Gustin   (09:16) And I’m sure everybody was just thrilled how it went.

Josh Clemente         (09:18) Yeah. Yeah. It was just wild to see. This is the first new spacecraft that can carry astronauts since essentially 1980 when the Space Shuttle rolled out. So it’s just a once in a lifetime opportunity to be able to be a part of that and then also to see the evolution of spacecraft design. If you look at the interior of Crew Dragon versus the cockpit of the Shuttle or the Soyuz capsules, it’s clearly an evolutionary step and I think it’s just exciting to see the future coming together a little bit and to be optimistic again about the American Space Program and not just the American Space Program, but just space in general. I’m a huge, huge space nerd and I can’t wait to see more. I hope competition heats up and we get more  vehicles available and start to have space tourism and moon bases and things this, stuff you read about and think about but don’t believe will ever happen.

Dr. Anthony Gustin   (10:13) Yeah. It’s wild. I was actually on a plane before quarantine hit, before lockdown happened and I looked in there as I was boarding or exiting, I don’t know which it was. I was looking into the cockpit and it looked like a video game machine from 1974. How – ? It’s the same thing you see, but just in a little larger scale of the old type that you were referring to it. How have we not gotten, like even the same little like, just only green. You know what I mean? It’s like –

Josh Clemente         (10:45) A hundred percent. I totally know what you mean.

Dr. Anthony Gustin   (10:48) Great! Like technology couldn’t get stuff worse than before. Should I feel safe on this thing?

Josh Clemente         (10:51) Yeah. It’s amazing. One of the big efforts that we had on the Dragon Program was convincing the entrenched aerospace that it is a good idea to have the vehicle fly itself essentially and to have the crew members interact with the vehicle through touchscreens. So that was a big kind of a heavy lift, because the technology is there and we’re very confident that it would work. But people are very familiar with buttons and tactile feedback and pilots moving instrumentation to make things work. And it’s just like – Computers are really good at this stuff now and for the most part, airplanes fly themselves and land themselves and there’s no reason the spacecraft should be different. Of course, there has to be emergency systems that astronauts can step in and take the wheel, so to speak, if necessary. But for the most part the goal for that development project was that from launch until docking with the International Space Station, it’s entirely autonomous. And that was successful. The crew did, they played around with the controls and navigated the spacecraft for a little while in orbit. But then they re-entered autonomous mode and the whole docking procedure was entirely done through pre-programmed algorithms essentially. We have the capability. It’s happening. And it’s exciting because you don’t have to be a traditionally trained astronaut really, to go to space now. You can just climb aboard and be a passenger. So that’s just – It’s a paradigm shift.

Dr. Anthony Gustin   (12:15) Yeah. It’s a big step. Were there people who were concerned that if the touchscreens freeze, they would be able to do anything?

Josh Clemente         (12:21) Totally. Yeah. And there are tons of valid concerns with that. There are always going to be these unknowns that can crop up, but you can quantify them fairly well and you can develop what’s called fitter responses to fault detection and response. You can figure out ways to be able to have an alternative all the way through two degrees of failure where you have backup systems that are analogue. And so that’s the process of developing one of these programs over many years is fully painting in the picture of how faults trickle down to each other and what states the machine can end up in and how you can get out of it. And so once you go through that process, you can convince yourselves and then, in this case, the customer NASA that it’s good idea and that the risk is tolerable and things will work. And so that was basically my job, to some extent, was doing the same thing with life support systems.

Dr. Anthony Gustin   (13:14) Yeah. Congrats, man. Huge, huge success.

Josh Clemente         (13:16) Thank you very much.

Dr. Anthony Gustin   (13:16) Yeah. You’ve obviously taken a very hard, hard turn after that and I think it really shifted your priorities in what you’re working on, obviously. You said, getting into space was a huge deal and it’s a crazy accomplishment, but now sort of like really, really shifting gears. So maybe just a brief overview of Levels and what you guys founded there and then we’ll chat in between and what got you from SpaceX to there.

Josh Clemente         (13:41) Totally. Yeah. Levels is the metabolic fitness company. So the goal is to connect people with their own real-time biological information so that they can make data driven decisions. And that sounds a bunch of words, but what we’re primarily doing is getting real-time continuous glucose monitoring into the world of wellness and performance optimization so you can tap into a data stream from your body and see the reactions to the actions you take every day.

Josh Clemente         (14:08) You sit down. You eat something for lunch. You see how that affected you in terms of your glucose control, which has these downstream effects on the hormones and the weight gain, weight loss, performance in exercise – all of these downstream effects that we experience that now you can get a data stream for.

Josh Clemente         (14:27) And so we’re developing the data analytics system and the program that allows you to get access to the hardware, work with it for a month or multiple months and index on metrics and reports that can help you understand how to improve not just monitor a raw data stream.

Dr. Anthony Gustin   (14:45) Right. And what you guys are dealing mostly with right now is the continuous blood glucose monitor.

Josh Clemente         (14:50) That’s right.

Dr. Anthony Gustin   (14:51) Which is – I started wearing one a couple years ago. I got a prescription. It’s super, super expensive. Interfaces are terrible and, you know, to get into what makes you guys different. But I guess before we do that I would love to hear – I’ve already heard your story before, that’s why I’m super excited to have you on, but just your initial thoughts of this and how you guys pulled it together and how you went from being obsessed with the tech in life support systems to health and made that your priority.

Josh Clemente         (15:18) Yeah. So it was a personal experience that led to what was ultimately Levels. And so while I was at SpaceX, actually, I was exposed to – In the world of life support systems you’re talking a lot about performance. You’re also talking about worst case scenarios and it’s not okay for a crew member to come down with a sudden illness, but it’s also not okay for a crew member to have long term chronic illness set in when they’re on orbit. You don’t have emergency services. You don’t have traditional medical care. And so thinking about how they approach their wellness leading up to their missions multiple years in advance, there’s a lot of biomarkers, there’s a lot of monitoring and there’s also a lot of really cool research. There’s a lot of people thinking about how are we going to do this for multiple years.

Josh Clemente         (16:05) And one of those people is Dom D’Agostino. He works with NASA on some really cool long duration experiments and I read a paper from him. It was a study on rats that showed this amazing central nervous system protection in a ketogenic state against basically convulsions caused by high pressure oxygen environments. So this is something I was actually dealing with and designing around. And I read this study and it was like, “Man, this ketogenic state is actually protective. They can introduce multiple hours of additional longevity life in this emergency situation just by simply modifying the macronutrients that these animals are consuming.” And you can, of course, extrapolate that to divers and astronauts.

Josh Clemente         (16:50) And that was the first moment where I was hit in the face with the potential for diet to have essentially superhuman physiologic impacts. And I had never really thought that way in my life. I was always a calories in calories out person. If you work out hard and you keep your body fat low, you’re going to be in good health.

Josh Clemente         (17:08) And yeah. So that was kind of a screeching moment for me. I actually had no idea. I’d never thought about this and now it’s something I have to take seriously and how am I going to do that? I don’t know how to select for diet. I don’t know how to optimize. Should I just go full keto? if so how do I know it’s working? All these questions started bubbling up. So I kind of went down a rabbit hole, started researching physiology and metabolism and just realized there are two primary energy substrates in the body, glucose and fat.

Josh Clemente         (17:38) And one of those – There’s amazing technology becoming available called continuous glucose monitor and I need this. I need to start measuring this substrate and see if I can start to improve my own slowly flagging mood and energy issues that I’ve just, as I get older, I’ve just started to notice. And so ultimately, after seeing that research and slowly noticing my fatigue levels are getting worse. I’m dependent on coffee in a very detrimental way. I feel terrible in the middle of the afternoon no matter how hard I work out in the morning. I ultimately got my hands on a continuous glucose monitor and I found that I was either borderline or full blown pre-diabetic, depending on who you ask.

Josh Clemente         (18:23) And that was a life changing moment for me because I had been painstakingly formulating whole foods meals and I certainly thought I was doing everything right and buying good ingredients and all of this traditional  fitness culture advice of carb loading after workouts and making sure you get your glycogen replenished and all these things were floating around in my brain and I was eating based on these heuristics that had no grounding in data and it was causing me to be sick and I was pushing myself into this pre-diabetic state.

Josh Clemente         (18:57) And again, another life changing moment. And so from that point on I just dug deeper in the research and saw that there’s a huge opportunity to improve lives, turn around the metabolic outcomes that we are seeing in this country and globally by just giving people better information.

Dr. Anthony Gustin   (19:12) So when was that moment when you were like, that holy shit moment for you?

Josh Clemente         (19:17) That was in 2018 and I was – It was shortly after I had left SpaceX and I had a little extra time to start experimenting. And yeah, I was actually, at that time, trying a plant-based diet. So essentially, I had made the decision to find out how I can optimize my diet and to take quantitative measurements. So I was using a fingerprick glucometer because I had been turned down for a CGM by several physicians. So I was pricking my finger up to 60 times a day and I was like, “I’m going to start with a plant-based diet and work my way to a full carnivore if that’s what it takes, but I’m just going to use data to try and figure out what’s best for me.”

Josh Clemente         (19:56) And trying to maintain my weight and quote unquote “carb load” and keep my glycogen up after workouts, I was eating quite a large serving of brown rice or sweet potatoes after every meal or during every meal and my glucose levels would be, like I said, elevated in the pre-diabetic or in some cases over 180 for multiple hours and then they’d come crashing back down. And those crashes were perfectly synced with my 2PM ‘where’s the coffee moments’ or feeling like I needed to grab a nap.

Josh Clemente         (20:29) And it was just a total, it was an immediate feedback loop thing. So you close the loop between action and reaction. You see that this is happening. You understand what’s normal, what’s optimal and what’s suboptimal. And you just realize that these little decisions you’re making can be improved and the numbers tell you the whole story.

Dr. Anthony Gustin   (20:51) Yeah. This is one of the examples that I use all the time is that for me when I eat wheat or anything that, gluten containing, I will get acne within two to three days. Getting the acne took so long and I’d eat so much and so many things can happen that it’s so tough to tell. I didn’t understand this for about 10/15 years. And then I got a test and saw that I was sensitive to these types of proteins. I go, “Oh, okay. I’ll just take them out.”

Dr. Anthony Gustin   (21:17) And if I was getting acne right when I was eating bread, I’d go, “Oh shit! I’m not going to eat this anymore.” And like you said, the feedback loop mechanism here with a continuous blood glucose monitor is the most important thing because people can then start realizing. And just seeing numbers and see what’s going on inside their body at any given time, it’s like you said, you’re able to look at, “Oh, I feel like I need a coffee right now. I feel like I need to recharge myself. I have this lack of energy,” or, “I’m hungry,” or, “I’m angry,” or whatever. Yet your blood glucose is peaked at 180 for several hours.

Josh Clemente         (21:48) Right.

Dr. Anthony Gustin   (21:49) Oh, okay. And yeah. I think with you, especially, I think a lot of people don’t realize this. It’s not like you’re overweight. You’re a super fit guy. And so it’s tough to have a cognitive association between there’s something wrong with me inside when outside you look so healthy. And I think that, even with a lot of stuff right now with Coronavirus sweeping through and decimating a lot of people who looked otherwise healthy from the outside while metabolically, they’re completely trash. And we’ve seen data come out that people have far worse outcomes when their metabolism isn’t allowed to basically get out of the way and then mount an immune response.

Josh Clemente         (22:27) Right.

Dr. Anthony Gustin   (22:28) And so yeah. I think it’s critical that some people who otherwise all signs of that they’re healthy. And maybe you attributed before, “I’m just tired because I’m working so much,” or “Because I’m doing hard workouts,” or “I’m not getting enough sleep.” And sometimes it’s just as simple as, “Oh, I’m not digesting this food properly.”

Josh Clemente         (22:46) Yeah. It’s really amazing. It’s clearly changed my perspective on the way that the human body thermodynamically processes and produces energy. I used to be, like I said, that calories in calories out person who thinks that we’re just a perfect machine and you put a certain amount of energy in, you will get that amount of energy out whether through heat, mechanical lifting of weights or what have you.

Josh Clemente         (23:09) But now the realization is actually we’re like this wet chemistry set. And the way that our bodies metabolize, turn our food and environment into energy, is actually a very complex process using chemicals like hormones and the amount and duration and internal environment of those chemical balances is what dictates the amount of energy that’s released into our cells, produced in the cells, in the mitochondria or outside the mitochondria. And it’s far from a clean balance like a closed formula equation.

Josh Clemente         (23:41) So just becoming more realistic about that and then digging into the effects of insulin, for example, which is, as an anabolic hormone, it’s the bulking hormone. It’s what causes us to store things and when you are in a hyperinsulinemic environment, your body physically cannot tap into its available energy stores. So you are storing glycogen, you are storing fat and you are unable to oxidize the fat stores that you already have. And so this, in the worst case scenario, is for people who have very advanced metabolic syndrome, they can have hundreds of pounds of fat on their bodies, topped off glycogen stores and yet have absolutely no energy available because their insulin levels are so high and they can’t tap into that energy store. So there’ll be laying on the couch and have a respiratory quotient of one. Meaning they’re literally burning sugar as though they’re in a full on sprint, the way an elite athlete would be tapped out at the high end of their output. This is a person who’s at complete stasis.

Josh Clemente         (24:48) It completely changed my perspective on the, I suppose on this whole balance of responsibility. I certainly feel completely differently about metabolic syndrome and obesity. The equation there is very tricky to solve and it’s so hard with our current food environment to understand because of all this contradictory information or lack of information. It’s so hard to understand what’s actually happening. You have a bunch of dogma and all of it contradicts and you can end up this person who is basically a giant fuel storage depot. You have all the energy available, but you can’t tap into it because the hormonal environment is backwards.

Dr. Anthony Gustin   (25:31) Yeah. And it’s like you said, it is certainly calories in and calories out. There is certainly an input and an output. The body is a machine but it’s not a closed system bomb calorimeter where we’re just measuring that input and output in isolation.

Josh Clemente         (25:46) Exactly. Yeah and there is – It’s totally a solution. Your body can solve the thermodynamic equation by just storing fat. It’s not potential energy, but  the calories in calories out philosophy, assumes that if you just walk a certain distance, you will use a certain number of calories. But that that is not necessarily the case. You have people effectively starving. They are experiencing the effects of starvation and yet the reason is that all the energy is going into fat stores and it’s not available to tap into to power their cells.

Josh Clemente         (26:22) And it’s a very strange realization that this can happen. It is happening. I think, to some extent, it was happening for me. I was having – What was happening with me is just long elevations in glucose. And I wasn’t gaining fat necessarily very quickly, but my fatigue levels were extreme and in retrospect now, after bringing my glucose into control, I can say plus or minus 10 points on my blood sugar day in and day out, if I put the effort in. Now I just have this flat consistent output of energy day in and day out. I don’t drink coffee after 11AM and that’s if I want to, I’ll have one, but it’s a total indulgence where it used to be an absolute requirement. I was just sipping it like it was my lifeblood for every single workday. And the consistency there is certainly due, in my opinion, to these hormonal fluctuations that I’ve taken out of the system by stopping that massive kick to a dynamic system that I was doing at every single meal repeatedly, day in day out.

Dr. Anthony Gustin   (27:29) Yeah. I think that with weight loss, in particular, it’s so frustrating for so many people just because they are calories in calories out. They are big inputs or big outputs and for some people that does work to just shift that. And I would argue that those people are already probably metabolically pretty well off.

Dr. Anthony Gustin   (27:45) I think that probably the most intelligent way to approach it is to assess for metabolic flexibility first and then try to dictate what are the bigger things that are causing the weight in people? Is it a hormone based thing? Are they eating too much? Are they eating at the wrong times? Are they not moving their body? What’s they’re inflammatory status? All these things are at least incorporated or should be.

Dr. Anthony Gustin   (28:07) And so that’s why I really enjoy what you guys are doing bringing this to the forefront. And you didn’t have a lot of weight to lose, so like you said, energy was a big one. But what were the things that you noticed when you started getting this under control? Also what were the foods that you changed? And then what did you notice from that as far as a benefit? Was it was mood, energy, satiation, etc., etc.?

Josh Clemente         (28:30) Yeah. I would say the biggest one besides energy is the newfound independence from food and diet generally. So I think that’s a satiation question. But I was a – In college, I was an athlete. After college, I worked out religiously and I was always the five or six meals a day type of person, just constantly eating and that was my way of keeping my metabolism running, so to speak. And I was, in retrospect, completely addicted to the process of eating and concerned about – very, very reliant on food being available all the time. It was like a, “When’s my next meal coming in?” And I had this fear of missing a meal and I was even – almost like  an existential fear like, I’m  not going to make it if I skip lunch or something. This has to happen. I’d get very unhappy if I was going to miss a meal.

Josh Clemente         (29:28) And now, having the metabolic flexibility, tapping in, I think, rebalancing the equation more towards fat than glucose. I’ve experimented with extended fasts. I’m still fairly new to the world of fasting, but overall, I now practice  some intermittent fasting daily. I won’t eat typically until afternoon and if I need to – and by the way, there are no negative side effects of this – I can now go a full day focusing on whatever it is that I’m focused on, whether that’s traveling or work or what have you, I can completely ignore food until the end of the day, getting the appropriate macronutrient balance or meals that I want to eat rather than having to grab what’s available. And feeling that independence is really amazing. And it’s also a sense of empowerment over your physiology. You know you’re safe.

Josh Clemente         (30:24) And I think the glucose data that we produce is really one of the main keys to understanding this, is realizing you’re not going to go into some hypoglycemic state and pass out if you were to miss a meal and  anyone who’s practiced fasting knows this. But watching glucose hit a low flat controlled output as your body taps into its glycogen stores and taps into gluconeogenesis as necessary to keep you running and then seeing ketones come up and just watch your body do its thing and realize that the crazy hormones that drive hunger are completely out of the equation when you eliminate these roller coasters of constant eating and constant, in my opinion, constant high glycemic kicks, which are very closely related, with me, to hunger. So yeah, bringing that hunger and satiety equation into balance.

Josh Clemente         (31:17) And then to another extent, I think, my sleep is just far better than it ever has been. And I still am trying to take in a lot of data here and this is something that Levels is looking into, is bringing sleep data, heart rate variability and recovery into the picture with glucose. And there’s a ton to learn here. But I really think the overnight glucose dysfunction that I had previously was closely correlated with a lot of heart rate variations and poor, light sleep. And so now I get I get much more deep sleep and I also get, I think, more restful sleep as a result of not having large carb filled meals towards the end of the day.

Josh Clemente         (32:02) And so yeah. I think that’s also benefited my mood in the downstream, just waking up rested rather than groggy and unhappy. So there’s been a lot of secondary and tertiary effects that it’s hard to fill in the whole picture. But I’d say the biggest ones, the most obvious ones are that  food freedom and energy balance.

Dr. Anthony Gustin   (32:20) Right. Yeah. A lot of this stuff can go pretty cyclical as well where one positive change and it keeps going keeps going. The same thing with all the negative changes.

Dr. Anthony Gustin   (32:28) So when you first got your – I guess you weren’t even using a CGM. This time you were just doing finger pricks, but would you just say, “Okay. My goal is to not have any spike in my blood  glucose?” Or was it, “Here is what I’m looking for. I’m looking for a delta of not more than 40 mg/dL.” Or was it a certain time? How did you think about your blood sugar rising and falling? And how do you think about it now? Has it shifted?

Josh Clemente         (32:55) Yeah. So when I first got a CGM – Last year, when I first started pricking my finger, like you said, I was just looking for a pattern and trying to see was I outside of the ADA, American Diabetes Association normal range. And I was seeing a lot of outside the ADA normal range. So it was like a scatterplot of random points. And that’s the problem with these single point measurements like a glucometer. And so I was like, “Ha! This is where there’s a lot of spikes, a lot of drops. I don’t know what’s going on. I can’t really – I’m not going to prick my finger every three minutes.” And so that that led me to really want this continuous glucose monitor even more.

Josh Clemente         (33:33) When I did eventually get the monitor, I started to quickly see that I was not staying within the ADA normal range. So I was waking up over 100–115 mg/dL in the mornings and then after lunches and dinners, my glucose would be over 160 over 180 mg/dL for hours and the top – Basically, the American Diabetes Association says normally you will not exceed 140, except in rare cases. And so seeing that I was not just exceeding but maintaining glucose levels well above that for multiple hours, was  a total shock. And I wasn’t even trying to optimize. I was just trying to compare myself to the nominal average.

Josh Clemente         (34:15) And so that’s when I started to really get serious and dig deep into the studies and figure out, what is – I’m not concerned about normal now, I’m concerned about optimal. I want to be every single day improving myself based on my dietary decisions not damaging my longevity and my goals. And so, I discovered Peter Attia and started digging more into Dom D’Agostino’s work. And  Peter Attia talks a lot – He’s a diehard CGM user. I think he’s been using one now for five years and he talks a lot about maintaining an average of around 90 mg/dL plus or minus a standard deviation of 15 mg/dL.

Josh Clemente         (34:55) And so I started to gravitate towards that, trying to exert maximum control over my glucose curve – lower, flatter, fewer spikes. And by doing so that brought me towards high protein, moderate fat, minimizing grains, minimizing dairy, in many cases. I’ve since added a lot more dairy back in because I tolerate it fairly well. And that’s how I still am to this day. So a lot of leafy green vegetables, fats and protein and with that macronutrient balance – I certainly don’t strive for a ketogenic diet. I will do cycles of  keto, but in general, I’m just shooting for what we at Levels have since determined to be closer to optimal than the American Diabetes Association ranges, which are between 70 and 110 mg/dL 24/7, including meals.

Josh Clemente         (35:56) So there’s a lot that goes into that. We’re going to continue to update these ranges based on new research, both internally and externally. But that seems to be based on what we’ve seen the lowest risk  set of glycemic responses that is least associated with long term cardiovascular dysfunction, diabetes risk and these other things like mood dysfunction and weight gain.

Dr. Anthony Gustin   (36:22) So how many carbs are you eating now still? You said you don’t really strive for a ketogenic diet, but you just found sources that are good for you to stay within that 70-110 range.

Josh Clemente         (36:33) Yeah. So I’ll eat on the order of about 80 to 120 grams of carbs a day, including – Typically, I get these mostly from cashews, nut sources and then I will have, after workouts in particular, I will have  sweet potatoes, a small quantity for sure compared to how I used to eat them. But then in the mornings, I have Greek yogurt with berries and it’ll either be blueberries or strawberries, which I tolerate really well. And I’ll also have chia seeds, flax seeds, which have carbohydrates. So a lot of seeds, nuts and fibrous fruit. And then again, some vegetables that are higher in carbohydrates, but sweet potatoes will be mostly my only starch that I’ll lean on.

Dr. Anthony Gustin   (37:21) Yeah. There’s just so many surprises that way for looking at things individually. And this is why I think people maybe hear this podcast and go, “Oh, I’m going to eat these things now.” I’m sure you guys see that within the team all the time in the users that you have that one person can eat exactly what you just said and be completely destroyed.

Josh Clemente         (37:39) Yeah. Exactly. There’s some pretty profound research and just for the audience’s sake, there are a few studies. You probably talked about them on the show, but the landmark paper was in the Cell journal by the Weitzman Institute in 2015. And it took 800 people without diagnosed metabolic dysfunction and gave them continuous glucose monitors. And that data was shocking because it showed the two people can eat the exact same two foods, in this case it was a banana and a cookie made with wheat flour, and those two people could have equal and opposite responses to those two foods. So it’s not that they had varying levels of  response. It was that one person was straight up flat on the banana and had a huge spike from the cookie and the other person had a huge spike from the cookie and nothing from the banana. And so this is demonstrating the personal variations here that are driving our glycemic responses and ultimately, will drive the hormones that are, for example, associated with weight gain.

Josh Clemente         (38:37) So people who are trying a one-size-fits-all diet are going to run into this personal variation, which could be from stress. It could be from microbiome. It could be genetics. It’s not entirely clear yet, but what we do know is that it exists and that without the real-time data, in this case glucose data, you really can’t know who you are on the spectrum and how you should be eating in order to be optimal. So that study has since been either replicated or supplemented by the PREDICT trials in London, glucotype trial at Stanford and hopefully many more that will be coming soon as CGM becomes more available.

Dr. Anthony Gustin   (39:12) Yeah. Becoming more available is what you guys are all about, which is – It’s so exciting for me why I love what you guys are doing. Like you said before – I had a friend who just wrote me a script for a CGM for a while. You said you went to multiple physicians and could not get access to one and the fact that we can’t get access to this via a continuous measurement, but we can go pick our fingers 800 times a day. No problem.  And also the cost difference it is between like if you don’t have insurance and getting it, is insane. So you guys are tackling that is huge. Kudos to you.

Josh Clemente         (39:45) Thank you. Yeah. The accessibility issue is complicated, for sure. And every CGM that’s out there is prescription-only and like you said, it’s an interesting risk problem here because if you want to get access to your glucose measurements, you can go to CVS and pick up a fingerprick monitor and stab yourself and bleed on your fingertips which are exposed to infection and you got to do that a few 100 times really to get enough data points to really understand how your glucose levels are changing.

Josh Clemente         (40:12) Or if you wear this patch, CGM, which has a little filament in the skin, it is minimally invasive, but there’s no blood involved for 90% of installations and you wear it continuously for 14 days at a time. And there’s no break, there’s no capillary blood, there’s minimal infection risk, basically zero pain and you have a full time data stream while you’re sleeping, while you’re exercising, while you’re eating, you are recording this information. And so the quality of the data and the output of that is a much more resolute picture of how you are actually responding – your dynamic system.

Josh Clemente         (40:52) In modern America, we use a single fingerprick, fasting glucose measurement or an A1c test, which is an approximation of average glucose to determine whether or not your metabolism is functioning well. And most people do that once a year at best. And to me these screening measures are core, first of all, to see whether there’s dysfunction. But even worse, that has zero utility for optimization. You cannot check a single point measurement once per year and make improvements based on that. All you’re doing is waiting for yourself to violate a threshold and then call yourself sick.

Josh Clemente         (41:27) And so what we want to do is not just an enhanced availability of this information for screening and avoiding risk, but also for the optimization of our performance. We want elite athletes like Anthony Kunkel who is using our system right now. He’s a fat optimization, endurance athlete, ultra runner and  he’s already having breakthrough realizations by using continuous glucose information. And so everyone across the spectrum of metabolic fitness can use the same information for their goals, again, whether that’s weight loss or shaving a few seconds off your 50k time, it’s all the energy substrate of the body that we’re measuring in real time. It’s so much more utilitarian than these fingerprick measures.

Dr. Anthony Gustin   (42:13) Right. Another thing that is awful about the current offering is that if I just use the Libra FreeStyle app, the interface and what you can do with it and what you can actually learn and use as a way to generate that better feedback loop is brutal. I don’t know if they just have no incentive to make it better and the people that use the product just don’t care. But you scan, you essentially can’t see any data unless you pull it out in a spreadsheet and look at it.

Dr. Anthony Gustin   (42:45) And you guys – I’ve been using your product for, I don’t know what, like five, six months now and just to see the amount of progress you’ve made and the addition to things that – You can log meals, look at these changes. You can actually read your data in real time. It’s phenomenal.

Josh Clemente         ****(43:00) Awesome. I love to hear that you’re loving it and yeah, we’ve released hundreds of iterations in the time that you’ve been on. But we see an extremely bright roadmap. We have some amazing product concepts for the future, bringing in additional analytes and metrics like tapping into your exercise also pulling in and surfacing insights based on how you respond to the same food with no exercise afterwards versus with a walk afterwards. These are really profound levers that you can pull on. And so the software will eventually be able to identify these personal responses and variations among them and give you these low hanging fruits, micro optimizations to improve.

Josh Clemente         (43:38) And so definitely the technology was developed for an extremely important reason. It was developed to help those with diabetes monitor and manage their condition. But the glucose breakdown that is most associated in our society with long term issues is caused by chronic lifestyle choices. So that would be the Type 2 diabetes, pre-diabetes. So there are 30 million people in the US with Type 2 diabetes, 90 million with pre-diabetes and of those 90 million, 90% don’t know they have a problem. And so the CDC estimates that of those 90 million people 70% of them are going to end up being Type 2 diabetic by 2035 if they don’t do something now.

Josh Clemente         (44:20) So our hope here is that this information, this data, this technology, by becoming more consumer friendly and having an elegant user interface and these machine learning algorithms on the background that can help you just surface and make better choices, we can avert disaster in terms of metabolic outcomes in the country because people will be – You might be optimizing towards just better energy levels like I was, but that qualitative focus can also come with the quantitative benefit of lowering your long term risk of this really bad metabolic breakdown.

Josh Clemente         (44:57) And so that’s what we’re going for is to tap into this desire to feel better, look better, experience life everyday better, and come along with this longevity improvement. So yeah, it’s important that the product is exceptional and elegant to use and we’re doing everything we can to take this amazing medical technology and make it the next consumer frenzy.

Dr. Anthony Gustin   (45:19) It’s clearly the number one problem to be solving right now for health of Americans, especially in the Western world in general and COVID brought that to light. We were talking about earlier, just the fact that even if you do not have any weight issues and you think you’re otherwise healthy, disease can rip through and really test your metabolic health. And to be able to put this out there and wake people up. I don’t know what the latest stat is, but I know it’s always hovering around between 80% and 90% of people are metabolically dysfunctional in this country.

Josh Clemente         (45:48) Yeah.

Dr. Anthony Gustin   (45:49) It’s just shocking and I think that no solution’s perfect right now and I have had some friends who have gotten CGMs and then they eat a  bunch of garbage food and then go, “Look, it didn’t raise my blood sugar.” So therefore, I think that there’s also a qualitative section here where we could always dive into. But I think that even if people were eating garbage food, their metabolism was working better. It’s would say probably it’s a step in the right direction from where we’re at right now.

Josh Clemente         (46:15)Yeah and that’s a really an important point. The local optimization, taking a single data stream and optimizing that is never going to be the full picture. And so that’s why I was talking about bringing in more analytes as they become available. I’m optimistic about the future of real-time monitoring equipment. I think we’re going to have several new analytes on the market in the next few years. And so the goal for Levels is to be, again, the metabolic fitness company and to bring in as more of this information becomes available. Maybe we can measure free fatty acids or lactic acid or potentially even hormones like insulin in real time. And we will use that to fill in machine learning models of you, the individual and how you are metabolizing and tapping into the energy sources, storing fat and feeling.

Josh Clemente         (46:58) And so ultimately, I’m really optimistic for a future where you can look much more like the way you treat financial information. You pull out your phone and you can check out your bank account balance and your deposits and withdrawals and stuff and have a prediction for the future. You should be able to do the same thing with your body’s real-time bio data and use this as a daily decision-making machine rather than kind of guess and check, doing what the internet tells you or asking a friend what worked for them. You should be making data driven decisions based on your information.

Josh Clemente         (47:26) And yeah, we don’t want to imply that improving glucose levels is the only thing that matters. It certainly is very – It’s a high gain lever, especially in modern society where we have such a processed food supply, but it’s not perfect. Like you said, there are certain people who maybe already have a hyperinsulinemia situation or maybe some other underlying metabolic conditions that we really don’t quite understand yet that might not see a big response to a food that would spike someone else. And so we’re still learning as well and really looking forward to contributing to the state of our understanding as a society.

Dr. Anthony Gustin   (48:01) Yeah. If you guys can whip together an inflammatory proxy or some  sort of marker that you can measure in real time, I think that would be huge too. Like something to out vegetable oil.

Josh Clemente         (48:11) Yeah. Oh, man! That’s a big one.

Dr. Anthony Gustin   (48:12) My dream. Because yeah, nobody even knows it’s in their food. No one knows how destructive it is and how long it can be in your body for [inaudible 48:19].

Dr. Anthony Gustin   (48:20) But yeah, I think that the individuality as well, in making sure that people even retest over time. My talk about a certain carbohydrate right now is far different than it was two years ago. And for whatever reason, if that’s my metabolism is different, or my microbiome is different or my activity level is different or my muscle mass is different or my exercise is different. It doesn’t matter. There are so many things that could change that even what works for you today may not work for you in three, four, five, six years.

Josh Clemente         (48:47) Totally.

Dr. Anthony Gustin   (48:49) That’s why I’m wearing one right now. I don’t think that – Peter Attia, he said he’s been wearing one for five, six years. You never stop learning with this stuff and your body, it never stops changing. So why would you not want data like continuous? It’s just, you know –

Josh Clemente         (49:06) What direction did your did your sensitivities move to carbs? Are you better or worse at tolerating them now?

Dr. Anthony Gustin   (49:11) Better, I think, just testing more as well. And it seems like it’s – I was really overweight when I was younger, so before it was just like when I first started doing any keto stuff, five, six years ago plus, I would react pretty negatively to almost all carbohydrates. And now I’ve noticed it’s like a 50/50 shot whether I track carbohydrate and it reacts negatively or not. So I would say I’ve gained some capacity.

Dr. Anthony Gustin   (49:42) We talked a little bit about that in the Q&A episode I did with Chris on this podcast a couple episodes ago and I think that there’s been certainly – Now it’s been even four months since we started doing that. I’m starting to see things creep up a little bit. So I’m going to go back to doing keto for a little while and see how that resets things.

Dr. Anthony Gustin   (50:00) Again, like I said that things change all the time and things you can learn are just always different as well. I’ve noticed when the heat has gone up here in Austin, my sensitivity has also improved when that goes up. So I don’t know if it’s just I’m sweating more and my blood flow is moving more.

Josh Clemente         (50:16) Interesting.

Dr. Anthony Gustin   (50:17) Weird things. Yeah. I’m super excited to see what you guys are going to be able to pull from the data and that is for three, four, five years. It’s going to be fascinating.

Josh Clemente         (50:26) Oh yeah. Yeah. So I have a similar situation. My carb tolerance has definitely improved and it’s not so much – I will still have a large, I’ll have a big response or spike typically to a large portion of carbs, but I will return to baseline much faster than I used to. And so I think my insulin response and sensitivity is improving. That point that you just mentioned about as the heat, as it’s warming up, you’ve seen a better response. I was just listening to Ben Pakulski and he has some really interesting seasonal theories about diet and so there’s definitely a relationship it seems like between vitamin D and carb metabolism and I’m wondering if it’s maybe are you getting more sun? Are you outside more? And maybe that has something to do with it? And yeah, the temperatures rising, but perhaps it’s that vitamin D mechanism which I certainly do not – I’m not an expert on.

Dr. Anthony Gustin   (51:19) It’s 30 degrees at this time in Austin where I’m actually inside more because it’s so hot.

Josh Clemente         (51:23) Okay. So it’s not that.

Dr. Anthony Gustin   (51:24) I’m trying to get in the shade more. But yeah, I think just looking at what foods are available, what times of the year as well. More carbohydrates are going to be available now. Every week I go to a farmer’s market. There’s more fruits, more things like this that are coming ripe. So yeah, I’ve always thought to have seasonality being part of people’s diets and eating local and seasonal as much as you possibly can is probably going to be the best thing to match your environment.

Josh Clemente         (51:51) Yeah. That makes total sense. I think what’s most important here is just – and I loved your Q&A with Chris – getting rid of dogma. It’s really hard. Food and religion are very closely tied, I think, and people get very embedded in their philosophy towards eating. So with Levels, we want to just maintain an independence from any dogmatic approach to diet philosophy and instead just have – The thesis here is that whatever your dietary philosophy is it should be grounded in data and ideally, that’s your data not an average of somebody else’s from a different background. And so I think this will be key to being able to establish a circadian or seasonal approach to eating instead of this all or nothing binary approach where you’re either eating fat or carbs or you’re either eating keto or low fat, whatever it is. So I’m optimistic for the future as well. And it’s really cool to see all of these different movements converging, I think, on the realization that better information is key. We really can’t make these decisions without better data.

Dr. Anthony Gustin   (52:53) Good point, man. Before we wrap it up, I have a question for you. When are you guys going to be able to let people sign up and get this thing. I’ve referred so many people to you. It’s always like, “Man, I’m on a waiting list. I can’t get it.”

Josh Clemente         (53:07) I’m sorry, to those people. We are moving. We’re trying as hard as we can to get to rolling out pre-orders and then a full launch. So pre-orders this summer and our full launch, we’re shooting for in the early fall. And the pre-order system, you’ll be able to grab a reservation for the program. We’re conducting this beta right now basically. The goal here is to get to a degree of product experience where people can easily understand and make behavior changes that are improving their metabolic control.

Josh Clemente         (53:41) And we’re seeing really great signals that we’re essentially there. And a key a key metric here is the rankings or scores that you get in the app and then also our reporting, which brings all this together into a weekly and a monthly report so people can understand how they’re trending. And so we’re starting to see signals. The beta program is pretty intensive. We have quite a few interviews with most of the people that participate, so it’s definitely a development product and all of the enthusiasm is amazing and I think we’ll be able to open up the program hoping in four to six weeks. That’s optimistic. Don’t hold me to that time. We’re doing the best we can to scale.

Dr. Anthony Gustin   (54:24) Whenever you guys do let me know I’ll put it in my email newsletter and people can sign up.

Josh Clemente         (54:28) Amazing.

Dr. Anthony Gustin   (54:28) Just super grateful for all the work you guys are doing. You’re tackling a huge problem that I think I’d mentioned on this podcast about 55 times that I hoped somebody will do so I don’t have to. You and your team are smarter than me so I think you’re going to do an even better job than I would have.

Josh Clemente         (54:43) You guys have been just amazing supporters. The whole Perfect Keto crew and – First of all the products you guys make are amazing. Equip, same deal. I’ve been experimenting with your stuff and it’s just amazing to see high quality foods coming to the forefront that make a claim and back it up.  We can back that up with data as well. I know that Perfect Keto Bars are the best thing out there in terms of my own glucose response. So if I’m looking for a low glycemic snack to power me through the day that’s what I go for and I think that we can, by collaborating with people like yourselves who are super driven for the same mission but in an adjacent space,  we can really make a movement out of this thing. I’m stoked for it. Thank you for being strong supporters.

Dr. Anthony Gustin   (55:25) Yeah. And like you said, if your data shows otherwise and our products aren’t the best for you, I don’t care. I want to be non-dogmatic as well. I just developed them to be as good for most other people and if it doesn’t happen for you, then great. Go find whatever works for you. And yes, the great thing about being in this space and be able to push things forward with companies like yours as well.

Josh Clemente         (55:46) I’ve got real respect for that.

Dr. Anthony Gustin   (55:48) So where can we go and get or chat about where people can find more information. And you guys are investing a lot of time and energy into the blog and putting a lot of great content there too.

Josh Clemente         (55:56) Yeah. Totally. We definitely recommend checking out levelshealth.com/blog, producing new content and collaborating with people like yourself and so anyone who’s listening, please check that out. Send us some feedback on what you’d like to see, what you’re interested in learning about the metabolic space and how it relates to the qualitative  experiences we have and then follow us on Instagram and Twitter @unlocklevels and give us a shout. The team loves to hear from people and just know how we’re resonating and where we can go to make our product better. So I really appreciate all the support.

Dr. Anthony Gustin   (56:31) You got it, Josh. Thank you.

Josh Clemente         (56:33) Thank you.

Dr. Anthony Gustin   (56:34) Thanks for listening to this episode of The Natural State Podcast. I hope you enjoyed it and if you did, I’d really appreciate you heading over to whatever service you’re listening to this podcast on, dropping me a five star review and your thoughts on the show. This helps us get discovered by more people in spreading the good gospel of health. And if you want to stay plugged into all of my self-health experiments, recent research and books that I’m reading and my interpretations of those things, products that I’m testing and thoughts on all things related to health, check out my free weekly newsletter called The Feed. You can sign up for that at D-R-anthonygustin.com/thefeed. That’s dranthonygustin.com/thefeed. Thanks again for tuning in and your support of The Natural State Podcast.