Ep #292: Metabolic Breakdown and Your Perfect Diet with Josh Clemente {Founder of Levels}
Episode introduction
Most people don’t think to undertake medical experiments on themselves, but when Josh found himself struggling with mysterious energy loss, he didn’t hesitate to start doing rigorous glucose tests. What he found was surprising – although he was outwardly young, healthy, and fit, he was also pre-diabetic. That’s when he changed the course of his career and founded Levels, a technology that makes gathering lifestyle impact data seamless and simple, for diabetics and non-diabetics alike. Josh joined host Leanne Vogel of The Keto Diet Podcast to talk about how patients should gain control of their own health, relying on feedback from their own bodies instead of confusing or unhelpful diet tips.
Show Notes
Key Takeaways
4:17 – Continuous glucose monitoring changed Josh’s entire life
When Josh found out he was prediabetic, he changed not only his own lifestyle, but his entire career path in an effort to help others understand their own health.
“I did a little experiment on myself. I got a fingerprick blood sugar monitor. I started pricking my finger because glucose is the number one energy molecule for modern humans. And I couldn’t really see anything of use. It was just like a cloud of data points and I was doing this up to 60 times a day at a certain point. Then I read a book by Robb Wolf and he was talking about this new technology CGM. And I thought, wow, continuous measurement. I don’t have to prick my finger anymore. I need that. So I went to my doctor. I asked for one and he basically said, ‘You don’t need that. You’re not diabetic.’ And that was another kind of shocking situation for me where I was like, well yeah, but I still have sugar in my blood and this is what my body’s deriving energy from, and why would I not be able to measure it? This doesn’t make any sense. It seems like I should, if anything, have access to this and should be giving my doctor access to the information. So that kinda got my wheels turning. I eventually got a CGM, and within about two weeks, I had enough data to know that I was either pre-diabetic or borderline pre-diabetic, depending on who you ask.”
11:00 – To optimize health, take it into your own hands
The medical world is focused on healing the sick, rather than preventing disease. If you want to remain healthy, you need to focus on what you can do now before disorders arise.
“I’ve been looking into this research, and it seems like the metabolic epidemic is out of control. And yet the data that underlies your own metabolic function is being – there’s this walled garden. You have to already have a diagnosis in order to get access to the information that can tell you whether you’re heading in the right direction or the wrong direction. It just didn’t make any sense to me. And so I was just floored by that and thought, this is really backwards. It should be the opposite way around where I don’t need a doctor’s intervention in my metabolic condition because I’m taking the first person role there. It’s my responsibility to stay healthy, and if something does go wrong, then a doctor comes in and helps me interpret that data and come up with a therapeutic approach or something like that.”
14:17 – A CGM is a simple device for tracking blood sugar
Continuous glucose monitors, like the kind developed by Josh and his team at Levels, are a simple patch worn on the arm 24 hours a day that track blood sugar as it rises and falls.
“It consists of two parts typically. So it’ll be the sensor itself, which is a really amazing piece of technology where there’s a filament, this little sensing strand that is in the skin. And that is interacting with glucose molecules in your interstitial fluid, which is, it’s a sort of sub-component of blood. It’s interacting with glucose. It’s creating electrical current. That current is being sensed by a little chip on the sensor and then it’s sending a wireless signal out. And you can retrieve that wireless signal either with your phone or with a reader device. And so the beauty of this is that it’s a single location. You wear it continuously for 14 days. You don’t move it. You don’t remove it. You can shower, you can swim, you can exercise. And that wireless connection removes any need to prick your finger or bleed or use test strips or any of that stuff. So it’s a brilliant piece of hardware.”
17:40 – A CGM is a hub for lifestyle information
The data from wearing a CGM can show how diet, exercise, and other factors like stress all affect your blood glucose and metabolic health, informing future decisions.
“When glucose gets dysregulated through hormonal imbalance or through chronic lifestyle decisions, which induce hormonal imbalance, all hell breaks loose, no pun intended. The degree, the cascade of metabolic implications of bad glucose control is amazing. And so the device itself, although impressive and puts out raw data that is interesting, the average person doesn’t yet know that this matters. And you can’t just give them a raw glucose data stream and say, okay. You’re at 87 or you’re at 118, and expect them to know or care about that. So what Levels is doing is layering on the insights framework, so putting a user experience on top of that hardware to connect each individual with their data in a more insightful way, if that makes sense. So, for example, taking their diet, exercise, sleep, and stress habits and combining them in context with glucose data that’s coming out of the sensor in real time and giving scores for meals or scores for meals in combination with exercise, giving you an understanding with your day score of how poor sleep affects, from day to day, your blood sugar regularity. And so it’s the hub for lifestyle information in context with real-time data.”
21:40 – Rely on feedback from your body, rather than fad diet tips
People want to be healthy. However, it’s hard to figure out what diet information is accurate, and what will work for you. How better to simplify the process than with feedback from your own physiology?
“It’s too long to wait multiple months for your scale in the bathroom to change. That process is not tight enough for people to understand ‘Oh, that meal specifically is something I’m sensitive to and I should avoid,’ or ‘I should adjust portions or mix it in a more balanced fashion.’ So that, I think, is the approach we’re taking, which is a bit of a departure, which is that you can’t just build hardware, put it out there in the world and expect people to do the research necessary, get a PhD essentially level of understanding of human physiology. It’s important for us to scale that, take the brilliance of people who have done all of this work. People like Ben Bikman and Dom D’Agostino and Molly Maloof and Sarah Godfrey – take all of their combined skill and knowledge and research and turn it into a platform that helps people understand okay. Again, like I said, ‘what am I going to eat today and why am I going to do that?’ As of now, people make that decision based on how the food tastes or what they read on the Internet or what worked for a friend.”
26:00 – Communicate with the body to understand what it is telling you
Tracking changes in the body explains why particular responses happen, like tiredness, fatigue, and hunger, making it possible to understand when the body is telling you something.
“The first moment that your body speaks back to you is really interesting for many people. I remember that vividly. I had been pricking my finger and it felt like a very manual mechanical process. And then when this wireless connection came through and I put the CGM on and I eat my first meal and I scanned. It was like a cyborg moment, but in such a non-weird bio-hacker way. It was like, I can finally communicate back and forth with my own body. I’m picking up the signal now and it’s all becoming very clear to me in real time. And now I have an intuition. I probably could get away without wearing a CGM for a while and estimate my blood sugar within about 5% on average. I like to do this with myself, just kind of guess at where I am based on how I feel, flushing in my face, tingling in my hands – very minor sensations that I otherwise would not have known, but now I understand are correlated with my blood sugar control. But again, like you’re saying, that accountability component is so important because people don’t want to make unhealthy decisions, especially when the understanding of the connections between blood sugar management and long-term chronic illness are so obvious that once you make that connection and then give people that data, you stop following those one-size-fits-all heuristics like glycemic index.”
29:45 – A healthy life can include indulgences
Understanding the metabolic response does not mean constant restrictions, it actually allows for more freedom and indulgence with better understanding of how to create balance.
“When you eat a pizza and your blood sugar goes through the roof, and then you eat a pizza and take a walk and see that your body completely changes its response, because your legs are consuming that glucose in real-time and assisting – they’re giving the assist to the insulin system and making sure that you’re not blowing through the roof and then crashing back down like you would if you were sitting on the couch. That gives you a sense of confidence and empowerment, because next time you want to go indulge with your friends, just walk to the restaurant, if you can, or park far away and walk there and walk back, or take a few rounds around the block and you can assist your body and help make sure that you don’t do as much damage as you otherwise would. And so I think that that’s really the most powerful thing is understanding that this is not just happening without your ability to control it. You have four big levers: diet, exercise, sleep, and stress, and you can choose to indulge on one and make up for it with the others, if you can.”
37:56 – Eating specific to how you live
For people who train frequently, it is tempting to follow the patterns of elite athletes and how they workout. However, you need to fuel for your body and your workout, which is probably much less than that of an elite athlete.
“Although it is true for the elite athletes who are draining their glycogen day after day, doing four or five, six hour workouts, and then trying to go hit a tournament, it is not the case that the average person who is just going into the gym for a one-hour session in between desk work needs to be eating a gigantic plate of pasta or chugging a smoothie in order to get through a workout. And so, I think a lot of that nuance, like bringing the realization that we should be fueling for our lifestyles. Gatorade makes sense if you’re on a Tour de France and you’re doing a hill climb section. It does not make sense to drink Gatorade while you’re doing an ab set next to your desk. So this is starting to bring awareness to a targeted lifestyle. Eat specific to how you live.”
41:30 – The next stage is integrating all health data
The future of health is integrating all data to build a bigger picture of an individuals health and how this measures against the population as a whole.
“The next stage is surfacing that for the individual so that you can, in a very straightforward way, click through your history and see not only how these different lifestyle factors affect you, but then how you stack up against the population, which I think is really important to provide context. It’s always interesting for people to know. Oh, I got a 9 out of 10 when I eat a pizza and go for a walk. How does that stack up to everyone else? So that’s the next thing we’re building out is, not only the insights, but then comparing you to you and you to the population so that you can understand where you fit and where there’s areas for optimization.”
44:30 – If each individual works on themself, the world can change
Health conditions related to lifestyle choices seem to be worsening, especially in the West. But individuals have the power to improve their own health, and this will lead to improving health across the world.
“It became just somewhat depressing to look at the numbers and to see, not only in every developing country the rates of metabolic dysfunction increasing at an increasing rate, but also the rates among children of non-alcoholic fatty liver disease, and Type 2 diabetes and even heart conditions. It’s just staggering, and it seems so counterintuitive when we have a society that is increasingly wealthy and all the metrics of human flourishing are actually increasing. Which sometimes it doesn’t seem that way, but if you look at the data, it’s the case. And yet, our lifespan in the United States has gone down for the last three years, and 7 of the top 10 causes of death are related to chronic lifestyle…If each person just focuses on themselves, they don’t think about how to solve all the world’s problems, they just work on themselves and look for optimization – you do that times many people, you can get social scale change. I think, by empowering the individual, we can genuinely change the metabolic outcomes globally.”
Episode Transcript
Leanne Vogel: [00:00:00] Hello. Hello. Hello. My name is Leanne Vogel. I blog over at healthfulpursuit.com. I am a holistic nutritionist and the best-selling author of The Keto Diet, The Keto Diet Cookbook, and Keto for Women, plus a whole bunch of other online things. And you are watching the Keto Diet Podcast. Today is Episode 292. I’m joined today by a brilliant human being who is also very inspiring. His name is Josh Clemente, the founder of Levels. He’s a mechanical engineer and CrossFit Level 2 trainer at SpaceX. He led a team to develop life support systems that sustained astronauts Bob Behnken (I hope I said that right. He sounds pretty important) and Doug Hurley on their May 2020 trip to the International Space Station, aboard Dragon Endeavor.
Are you kidding me right now? So cool. The first new crew carrying spacecraft since 1980. Josh has also spent time designing and building Hyperloop technology and leading engineering for a company providing vehicle based rescue systems for emergency response teams. Josh enjoys the outdoors, functional fitness training, technology, coffee, and restoring motorcycles.
So, a couple of months ago now on episode 279, we chatted all about continuous glucose monitoring and so many of you were so pumped about this topic that I wanted to have Josh on to go even deeper into continuous glucose monitoring and specifically when we wear a CGM and we’re starting to get our glucose data, what we do with that data, why it’s important, how it heals our body, how it empowers us, and really go through the nitty gritty. So when I reviewed, or when I interviewed Casey, back in episode 279, (I’ll include a link up here if you want to listen to that episode) I had never worn a CGM before and now having had 28 days on it. As of the time of this going live, I will have also worn it for another three weeks. You can follow me at Leanne Vogel on Instagram to catch up on all of that stuff. I have a little highlight in my stories where you can watch all my CGM data and really start to understand how all of this works. It’s been so great to get to learn more and more about my body and also to empower you to learn more about your body and how just these small little adjustments, either adding certain foods in or removing other foods and getting them out of your eating style for a bit can really start to heal your metabolic health.
I am very, very super passionate. If you’ve been following me for more than two weeks, you know that my message has always been about empowering women to make changes and adjustments that fit their bio individuality, and to be able to partner with a brand and an amazing product that gets this and aligns with this, it’s just been so incredibly amazing.
So if you listened to today’s episode, and you haven’t had the chance to get a CGM, you’re really interested in continuous glucose monitoring, you want to take that next step and learn your body, learn to have an open communication with your body, Levels has been so amazing at giving instant access to all of my followers. So if you decide to get a CGM, you don’t have to sit in the 55,000 person lineup waitlist for this thing. You go to the front of the line so that you can try their beta program. So I’m going to include a link in this corner (I think it’s this corner) and down below where you can skip the line with Levels. No pressure. You’re still going to learn so much from today’s episode. So I hope you enjoy it. Let’s cut over to today’s interview.
Hello, Josh. Thank you so much for coming on the show today.
Josh Clemente: [00:04:00] Yeah. I’m so excited to be here and thanks for having me on.
Leanne Vogel: [00:04:02] Yeah, of course. So I’d love to just… I already did your intro and I just would love to know your experience and getting to understand the role of glucose in your body and how you got into all of this, what you’re doing.
Josh Clemente: [00:04:17] Yeah. I’m happy to go down that rabbit hole. It’s been about three years now since I really completely changed my approach to lifestyle and all of it comes down to this technology, continuous glucose monitoring. The beginning of it was, I started out working at SpaceX on life support systems development and I was leading a team that developed pressurized life support systems. So these would be breathing apparatus, the mechanisms that keep the cabin of a space vehicle at the right pressure and concentration of oxygen and nitrogen, fire suppression systems. And during my time on that project, we were really interested in a few edge case scenarios and one of those scenarios is when people are exposed to, by accident, exposed to high pressure oxygen environments. And I stumbled on this study by Dom D’Agostino who I’m sure you’re very familiar with his work in the ketogenic spaces, second to none. And his study was basically describing a situation where rodents who were exposed to the same high pressure oxygen environment could live five times longer if they were in a ketogenic state, so if they had ketones circulating in their blood. And that study literally stopped me in my tracks because I am a CrossFit Level 2 trainer. I have always cared about fitness. I’ve taken an approach to lifestyle that is – if you’re able to run fast, jump high, lift heavy weights, you’re healthy. I had never thought twice, honestly, about diet. And reading a study that said that just a macronutrient change can give these super powers to – of course these are rodents, not humans – but the fact that it could happen was a complete earth shattering moment for me. And so I started thinking, ” I actually don’t feel all that great day to day. I certainly don’t feel like I’m in optimal health, even though … Given what I think of myself physical fitness wise, I should be feeling really good. I wonder if there’s some optimization to be had in a diet outside of what I’m currently doing. And so this really got my wheels turning about what am I doing day to day? And it frustrated me after digging into the different nutrition literature out there that I could not find any cohesive evidence. It just seemed like everything was hearsay. It was based on surveys. It was epidemiological, which works for virology and immunology, but it doesn’t seem to tell me anything about nutrition. I became very frustrated. There was no objective data. So I did a little experiment on myself. I got a fingerprick blood sugar monitor. I started pricking my finger because glucose is the number one energy molecule for modern humans. And I couldn’t really see anything of use. It was just like a cloud of data points and I was doing this up to 60 times a day at a certain point. Then I read a book by Robb Wolf and he was talking about this new technology CGM, and I thought, “Wow, continuous measurement. I don’t have to prick my finger anymore. I need that.” So I went to my doctor. I asked for one and he basically said, ” You don’t need that. You’re not diabetic.” And that was another kind of shocking situation for me where I was like, “Well yeah, but I still have sugar in my blood and this is what my body’s driving energy from and why would I not be able to measure it? This doesn’t make any sense.” It seems like I should, if anything, have access to this and should be giving my doctor access to the information.
So that kinda got my wheels turning. I eventually got a CGM and within about two weeks, I had enough data to know that I was either pre-diabetic or borderline pre-diabetic, depending on who you ask. That was like the third and final straw for me. I left what I was working on and just focused 100% on research and understanding metabolism and how someone could display metabolic dysfunction in such different ways.
I didn’t have a body fat problem. I didn’t externally show any of the classic symptoms or correlations with metabolic dysfunction, but what I was experiencing was fatigue, cognitive dysfunction in the sense that my memory and my day-to-day mood were really like a rollercoaster I was riding. I did not feel like I was running the show, so to speak. And all of this kind of came together in a realization that the metabolic health epidemic manifests itself in many different ways. And we call these different things. We call them PCOS. We call them dementia. We call them Alzheimer’s disease, heart disease, stroke. All of it comes down to the inflammatory conditions of metabolic breakdown. Once that realization happened and the tool CGM showed me that I could take a front seat in this and use data to make my own lifestyle. I realized this is something I want to do, and I just want to work on it and hopefully other people will be interested as well.
Leanne Vogel: [00:08:51] Wow! Okay. There are so many things you just said that I find so fascinating. The first, pricking your finger 60 times a day, and even at that… But I understand. Wearing a CGM and seeing the power that’s on my phone and I can see everything. Not even pricking your finger 60 times a day will give you the input that you get with the CGM.
Would you agree?
Josh Clemente: [00:09:16] A hundred percent agree. Most of that is just due to the fact that I can’t prick my finger when I’m sleeping, I can’t prick my finger when I’m at work and I’m trying to get something done, when I’m in a meeting, and so the continuous high resolution nature of a CGM is where all the magic is happening.
You eat a big meal at work and you run into a meeting and you’re feeling sluggish and you’re upset and irritated and then you come out and prick your finger, ” Oh, it looks normal. Nothing’s going on here.” Then you have a CGM you see, “Oh my blood sugar went through the roof after that meal and then was crashing right in the midst of that meeting.” And all that irritation and unhappiness and cold sweat, “Oh, that’s a reactive hypoglycemic event.” And I was completely missing all of that dynamic information, which you can only get with a real-time data source.
Leanne Vogel: [00:09:59] Yeah. And the other piece that you said is your doctor saying no, but then you getting the CGM and realizing that you were pre-diabetic and had you not had that conviction, you would have left the doctors and been like, “Okay, I guess I’m fine.” And then waited, I don’t know, a year or two years to be diagnosed with diabetes. And that’s what just upsets me so much because there are so many people that could benefit from having this data, and getting empowered to make the choices for themselves.
What was that like for you? And is that the passion that drives you forward?
Josh Clemente: [00:10:37] Yeah. My parents raised me to challenge the status quo assumptions and just think independently about problems that you face. It’s not necessarily a distrust for expertise or authority. It’s more so just make sure that you’re using your own common sense. And so to me it felt like, I’ve been looking into this research and it seems like the metabolic epidemic is out of control and yet the data that underlies your own metabolic function is being… There’s this walled garden. You have to already have a diagnosis in order to get access to the information that can tell you whether you’re heading in the right direction or the wrong direction. It just didn’t make any sense to me. And so I was just floored by that and thought, this is really backwards. It should be the opposite way around where I don’t need a doctor’s intervention in my metabolic condition because I’m taking the first person role there. It’s my responsibility to stay healthy and if something does go wrong, then a doctor comes in and helps me interpret that data and come up with a therapeutic approach or something like that.
So it was shocking. It was my first kind of experience in that sick care mentality that pervades the medical world right now. And yeah, it was, of course, insult to injury when I found out that I had this underlying condition. And that was shocking as well because I had gotten blood work numerous times. In fact, at one point, thinking back on the fatigue I was describing… I was going through a very stressful time in my life. I was leading a program that was just very high intensity – a lot of stress, poor sleep, again, I was eating whatever I could whenever I could – and the only thing I was doing for my health was working out as often as possible.
And I was going through the day and feeling these really significant fatigue waves, and it would be mental and physical. I would just want to shut down and just crawl under the desk and sleep. At one point I went to my doctor – and this was about a year prior to getting a CGM – and I said, “I think I have a terminal illness. Something goes wrong every single day and I feel like I have no strength in my legs and I just want to sit down and go to sleep. And that shouldn’t be. That’s not normal.” And they ran the standard blood tests and nothing came out out of range. And that’s another problem that we have in society where our ranges are defined as everything below a diagnosis. Right? It’s like once you cross this imaginary line, okay now you’re sick, but until then, you’re totally fine. And so, yes, my numbers in this case was HbA1c, which is an estimate of average glucose over 90 days and fasting glucose. Those were both in the normal range. But when you look at society, we have 88% of American adults are metabolically unhealthy. We have diabetes and prediabetes increasing at increasing rates. 90 million Americans have prediabetes and 90% of them don’t know it. So to just be in that normal or that average group means that you’re averaging in a huge amount of existing metabolic dysfunction. So not understanding that at the time I would have, of course, just dismissed any thought of a metabolic underlying condition were it not for reading about CGM, getting personally interested, Dom’s research, all that sort of side project passion interests that kept me going. So it’s a funny thing the way it turned out.
Leanne Vogel: [00:13:50] Yeah. All the dots connecting and you following this breadcrumb trail of all these next things that you had to do to bring this to market. And so now, we are able, and I’ve been able to wear a CGM, use the Levels app, understand my body, and I’d love to just go through understanding the CGM.
So you apply it. And then what happens?
Josh Clemente: [00:14:17] Yeah. So the CGM system is… It consists of two parts typically. So it’ll be the sensor itself, which is a really amazing piece of technology where there’s a filament, this little sensing strand that is in the skin and that is interacting with glucose molecules in your interstitial fluid, which is… It’s a sort of sub-component of blood. It’s interacting with glucose. It’s creating electrical current. That current is being sensed by a little chip on the sensor and then it’s sending a wireless signal out. And you can retrieve that wireless signal either with your phone or with a reader device.
And so the beauty of this is that it’s a single location. You wear it continuously for 14 days. You don’t move it. You don’t re remove it. You can shower, you can swim, you can exercise and that wireless connection removes any need to prick your finger or bleed or use test strips or any of that stuff. So it’s a brilliant piece of hardware. It was developed for the management of diabetes. And of course in diabetes, the insulin glucose relationship has broken down and it’s often necessary for people to monitor very closely their glucose and inject exogenous insulin to control their blood sugar levels. Now, that’s a specific use case and it’s amazing that we got such high quality hardware for the the management of that condition. There is no consumer market for this at the moment. Now, what Levels is doing is understanding that okay, for most people who are not managing an acute blood sugar dysregulation, we don’t have diabetes. However, glucose is the primary energy molecule and it’s important for us to recognize that it’s not in and of itself bad. However, when glucose gets dysregulated through hormonal imbalance or through chronic lifestyle decisions, which induce hormonal imbalance, all hell breaks loose, no pun intended. The degree, the cascade of metabolic implications of bad glucose control is amazing. And so, the device itself, although impressive and puts out raw data that is interesting, the average person doesn’t yet know that this matters and you can’t just give them a raw glucose data stream and say, “Okay. You’re at 87 or you’re at 118,” and expect them to know or care about that. So what Levels is doing is layering on the insights framework, so putting a user experience on top of that hardware to connect each individual with their data in a more insightful way, if that makes sense. So, for example, taking their diet, exercise, sleep, and stress habits and combining them in context with glucose data that’s coming out of the sensor in real time and giving scores for meals or scores for meals in combination with exercise, giving you an understanding with your day score of how poor sleep affects, from day to day, your blood sugar regularity. And so it’s the hub for lifestyle information in context with real-time data. If you look at another sensor system, like an optical heart rate monitor. Optical heart rate monitors have been around for decades, but when you have companies like Whoop and Oura that come to market and suddenly there’s this huge sort of rage, this frenzy to get this data, what it comes down to is that they’ve built a user experience that provides context for that data. It’s no longer just raw heart rate output. It’s now tracking your sleep quality. It’s tracking your recovery. It’s telling you how much strain you can take on because of the quality of your sleep last night. And so that’s what Levels is doing, but for nutrition and not just nutrition, also sleep recovery, stress management and exercise.
So I think because we’re going below the skin where we’re sensing a molecule directly that is an energy molecule. It’s really powerful new technology for holistic, whole person lifestyle management. And so, of course, we’re still in development with the software itself, but that is the key component is, connecting people, making them care and understand why this data is relevant or valuable or important to pay attention to?
Leanne Vogel: [00:18:14] Yeah. So once I wore a Levels and used your app, I encouraged a couple of my clients to get CGMs so we could just play around with it. They ended up getting the prescription from their doctor and we used the freestyle app and I quickly learned that as a health professional, I can dig pretty deep and figure out a bunch of stuff and educate them, but it’s nearly impossible for somebody to go through all the data points and sit there. I have post-it notes everywhere trying to figure out how all of this comes together. Your app does all of that and the average person who doesn’t have three hours a day to lay on their stomach with post-it notes and figure out what happened in the day. That’s really the difference, and that was one of the questions we got from our last episode on CGM. It was like, “But what’s the difference and why does it matter?” So I’m happy that you went into more detail about how the app is different from, you just get the CGM from your pharmacy, plug it in, and you’re just going to be told a number, but nothing to do with what that means, what to do.
Josh Clemente: [00:19:19] Yeah.
Leanne Vogel: [00:19:19] You end up in the dark still.
Josh Clemente: [00:19:22] Exactly. The key there, I think is… Levels is not a medical device company. We’re a behavior change company, and we’re a behavior change company enabled by technology that has been developed for the medical industry. But, it’s fundamentally a different approach.
When you start looking at behavior change as something that everyone wants, they want to be healthy, but without evidence, without closed feedback loops, it’s too hard to decipher. As you were saying, the difference between an A1c measurement I get this year and an A1c measurement I get next year telling me what I should eat for lunch, I’m going to sit down today and I’m going to eat something for lunch. What am I eating and why? And Levels strives to answer that question as close to the moment that you need to make that decision as possible. And so that’s the theory of behavior change that we have, which is that people respond to closed feedback loops. It’s too long to wait multiple months for your scale in the bathroom to change. That process is not tight enough for people to understand. “Oh, that meal specifically is something I’m sensitive to and I should avoid,” or “I should adjust portions or mix it in a more balanced fashion.” So that, I think, is the approach we’re taking, which is a bit of a departure, which is that you can’t just build hardware, put it out there in the world and expect people to do the research necessary, get a PhD essentially level of understanding of human physiology. It’s important for us to scale that, take the brilliance of people who have done all of this work. People like Ben Bikman and Dom D’Agostino and Molly Maloof and Sarah Godfrey – take all of their combined skill and knowledge and research and turn it into a platform that helps people understand. “Okay. Again, like I said, what am I going to eat today and why am I going to do that?” As of now people make that decision based on how the food tastes or what they read on the Internet or what worked for a friend. And we have to bring objective data into the conversation, especially when you think about how personalized all of this really is. It comes down to not just philosophy on diet or one-size-fits-all statements like ‘avoid carbs’. It’s much more nuanced than that and individuals have different requirements and they also have different genetic makeup, and so all of that will determine whether or not a specific lifestyle choice will or will not work for them.
Leanne Vogel: [00:21:37] What’s that process like? I really want to paint a picture. You get the CGM, you apply it. It doesn’t hurt, I swear. I was so worried. I laid on my stomach. I had my husband do it because I didn’t want to pass out and then I was like, “That’s it?” Okay. Okay. And then I was like, “What am I going to eat? What am I going to eat? I guess I’ll just eat normal and see what happens.” And quickly I learned that I needed to make some changes. And so what does that process with that first meal? And what are they told? How are we making these behavior changes?
Josh Clemente: [00:22:12] Yeah. So right now Levels is in development still and so right now, we have the largest dataset of non-diabetic blood sugar information combined with nutrition information ever. And that’s amazing, but we are still… This is a very nascent field. The concept that people without diabetes would use a CGM is foreign to many people in this industry. People who have been studying metabolism for a long time, they assume that it would be a massive burden on an individual to do this. And the reality is that people are fascinated by their own bodies and they want to know how to make better choices. And frankly, and as you have, I think, experienced, this is such a convenient thing to have. I’ve been wearing one continuously for almost three years now and it’s not just the fact that it doesn’t interfere in my life, not having it on interferes with my life because I lose that confidence in my choices and the accountability.
We’re still in learning mode, very much so. But what we know is that the best way for people to make changes is first to understand where they are. So we recommend that when you first put that sensor on, you take a week and don’t make any changes, although it’s tricky for some people. They see a big blood sugar spike from something they eat every day and they’re like, “Oh, I don’t want to do that tomorrow.” We recommend just do a full week without making any changes. Go through your day exercising and eating and sleeping the way you normally do. And then in the middle of the month, weeks two and three, we recommend people start to make edge cases. These are like experimenting with foods maybe you don’t often eat or eating foods that you consume in a mixed meal on their own and calibrating your body’s response to each of them individually, trying different exercise routines, comparing the difference between a smoothie and a whole fruit – just starting to explore the experimental boundaries so that you can get as much information as possible in that middle of the month about how you specifically respond in these different environments and then also compared to the population. And then in that final week, the goal is to bring it all together and optimize. And so this would be like take all of the little lessons you’ve learned, the little micro optimizations and try to put together the best week of metabolic control you can.
And this is all liaising towards a better zone scores, better metabolic base scores, which are the two primary metrics we have in the app and and trying to just nail that. And then at the end of the month, you get this full report. The breakdown shows you your best scoring meals, your worst scoring meals. It shows you your development in terms of improvement in average glucose and improvement of these sub metrics like variability time and range. And you can use that to go forth and continue following these same daily protocols. Now, a lot of people… That by the way, is the definition for the 28-day program, which is our primary product right now. Now a good number of people, once they get through that first month, they just don’t want to lose the data source. It’s like getting rid of your phone after you’ve had it for awhile, like, why would I do that? This is too valuable. So many people just continue using this ongoing and that’s me. I wear two things full time. One is my CGM and the other is my Whoop Band, and the Whoop Band I use because it gives me such great data on my sleep quality and although I can divine that out from CGM data, like my blood sugar will be very high when I have a poor night of sleep, it’s still just the combination of those two metrics that keeps me accountable. And so we’re always learning from these longer datasets. People who have been in the program for a long period of time, they’ll have this really amazing first month where they rapidly iterate and they improve their behaviors, and then in the following months they just maintain. And it’s a really beautiful representation of what we were talking about in terms of behavior change, where once you have the closed loop feedback, it becomes easy. You know what to do.
Leanne Vogel: [00:25:48] Yeah. I think the accountability was really big for me. I only wore it for 28 days and I agree with you. That last day I was really sad that it was over. I wanted to wear it forever because it was true. Even when I was at a restaurant with friends, we went mini golfing and then we went to a pizza place and normally I’d be like, “Yeah, I’ll just have a small gluten-free pizza.”
And then I was thinking, ” Do I want to see that on the app?” I sure don’t. I’m going to go with chicken wings and a salad instead. So just to have that accountability and those data points, I made better choices than I would have made. Far better, not even looking at behavioral changes or anything, but just the accountability of wearing it. I just made better choices overall, because I knew I would see what I ate on my phone moments later.
Josh Clemente: [00:26:36] Yeah. Yeah. It’s funny. The first moment that your body speaks back to you is really interesting for many people. I remember that vividly. I had been pricking my finger and it felt like a very manual mechanical process. And then when this wireless connection came through and I put the CGM on and I eat my first meal and I scanned. It was like a cyborg moment, but in such a non-weird bio-hacker way. It was like, “I can finally communicate back and forth with my own body. I’m picking up the signal now and it’s all becoming very clear to me in real time. And now I have an intuition. I probably could get away without wearing a CGM for a while and estimate my blood sugar within about 5% on average. I like to do this with myself, just kind of guess at where I am based on how I feel, flushing in my face, tingling in my hands – very minor sensations that I otherwise would not have known, but now I understand are correlated with my blood sugar control. But again, like you’re saying, that accountability component is so important because people don’t want to make unhealthy decisions, especially when the understanding of the connections between blood sugar management and long-term chronic illness are so obvious that once you make that connection and then give people that data, you stop following those one-size-fits-all heuristics like glycemic index. I’ve tested it against the glycemic index and I can tell you that it may be useful on a society level. It may be interesting to average everyone together, but at an individual level, it’s essentially useless.
My diet before using CGM, when I was training for CrossFit and just trying to stay fit, I followed the glycemic index. I was eating sweet potatoes and brown rice and avoiding the high-glycemic foods. I would start every day with a bran flake and banana smoothie with protein powder and the foods that I ate that I thought were optimized, whole food, ideal meals were the worst ones for me. It was consistently the worst blood sugar response. And at the time, like I mentioned, I was in that pre-diabetic zone. My blood sugar would exceed 160, 180, and it would stay up there for some time after every single meal. And then it would come crashing back down, and that rollercoaster that crash is what I would feel as that shaky fatigue, irritation, cold sweat, all of these uncomfortable symptoms. And because I was following this dietary program that I had developed, listening to CrossFit conversations and was eating just plates of brown rice rather than white rice. I’m thinking, it can’t be mine. It’s not my meal because I’m doing everything right. And I think this is happening at such a large scale and people just… They don’t know to even suspect that they’re doing something wrong. And that first moment when you have that bowl of heart-healthy oatmeal in the morning and your blood sugar skyrockets, I think it all comes together for people.
Leanne Vogel: [00:29:17] Yeah. That moment for me was… So on my ketogenic diet, I cycled carbs and I’ve always cycled with sweet potatoes. That’s kind of my go-to. And so I’m on day three of wearing my CGM and I eat the sweet potato and then my glucose spikes so high, stays elevated, I crash, I’m hungry again, and I’m like, “Whoa! I need to rethink everything.” And it was a big moment.
Josh Clemente: [00:29:45] Right. Yeah. We call those ‘magic moments’ because they happen both in the… It’s interesting, they happen in the positive and negative direction for people. So when you’re using this, a lot of people… Or even when considering using Levels, a lot of people ask, ” Do I really want to just be told I can’t do everything that I want to do. At the end of the day, I just want to live my life and be healthy.” And that’s something that we really are striving to explain, that this program does not strictly discipline us. I learned through this that my expectations around carbohydrate sensitivities were way off. I can eat blueberries all morning, and I can have… I can eat cheesecake and I can have ice cream and I can… All of these indulgent foods that I would have completely avoided are actually, in some cases, either I just have very little sensitivity to them or they’re quite balanced in terms of macronutrient content. Ice cream, for example, which has protein and fat and sugar, tends to be a very smooth and controlled response and I can stay… If I am in a ketogenic state, which I oftentimes like to cycle into, I can stay in ketosis and eat ice cream. And it’s pretty amazing to realize that and become familiar with the ways that I can indulge without breaking my own goals. And I think that’s the most interesting thing is that these ‘magic moments’ they happen in both directions. When you eat a pizza and your blood sugar goes through the roof, and then you eat a pizza and take a walk and see that your body completely changes its response, because your legs are consuming that glucose in real-time and assisting… They’re giving the assist to the insulin system and making sure that you’re not blowing through the roof and then crashing back down like you would if you were sitting on the couch. That gives you a sense of confidence and empowerment because next time you want to go indulge with your friends, just walk to the restaurant, if you can, or park far away and walk there and walk back, or take a few rounds around the block and you can assist your body and help make sure that you don’t do as much damage as you otherwise would. And so I think that that’s really the most powerful thing is understanding that this is not just happening without your ability to control it. You have four big levers, diet, exercise, sleep, and stress, and you can choose to indulge on one and make up for it with the others, if you can.
Leanne Vogel: [00:31:48] Yeah. So I’m very happy that you mentioned that because I did find a lot of foods that I can personally handle that I’ve avoided. We’re talking like six years. Medjool dates with almond butter? Total win for me. I have not had a Medjool date in years, and to be able to have that as a snack and I stay completely level at a 10, it is like I didn’t eat anything. Another one was beans. I used to love bean salad and being able to have beans again every once in awhile and see that level off. That was amazing. Oranges. I don’t react to oranges. How great is that?
Josh Clemente: [00:32:25] That’s amazing.
Leanne Vogel: [00:32:26] Oranges, but apples. No.
Josh Clemente: [00:32:28] Right.
Leanne Vogel: [00:32:28] And so, just being able to understand that even from a hormonal perspective, oranges and progesterone, they’re like best friends. And so when I get up to my 23rd, 24th, 25th day of my cycle, and I’m craving an orange, now I can have that orange and help with my cycle. It’s all good things. So I’m glad that you touched on also the foods that we are now open to by having a CGM. Yes. Thank you so much for that.
Josh Clemente: [00:32:56] Love it. Yeah. For me, one of the big surprises was… I think this is pervasive in sports science is, people hear what elite athletes do and they think that they should just project that onto them and I am case number one. Like I said, I was working crazy stressful hours, 20 hours at the office sometimes continuously just sneaking naps in here and there. And I would make time to go to the gym and get an hour workout in. Now, in order to do that, I would think that, “Okay, I have to replenish my glycogen and I have to carb load prior to my workout and I have to be ready to really go all out.” And this is CrossFit, which is pretty high intensity. And so I would have this big smoothie and it would be all good things. I’d put spinach in there and feel good about it and add the bran flakes, some banana and all that and then I’d go hit my workout. Once I got a CGM on, I found that not only is that smoothie arguably the worst thing I’ve ever eaten while having a CGM on, but secondly, when I don’t have the smoothie and I just go straight to my workout and I do this high-intensity lifting session, my heart rate goes 95%, 99% of my max heart rate, my body produces stress or cortisol and adrenaline, and those two hormones indicate to my liver that I’m in a fight or flight situation and my liver starts to crank out glucose for all its worth. And so my blood sugar, even without any calories before a workout actually increases. And that is my body’s way, from an evolutionary perspective, of ensuring that I have what it takes, I have the fuel, I need to get out of that situation. And so now I’ve realized that I don’t need that massive blood sugar and then the crash that accompanies that right as I’m stepping into the gym to do the first rep.
And secondly, my body does what it needs without any calories. And so actually I can teach my body to tap into the energy sources that are available. In this case, this is a demonstration of metabolic flexibility, where that glucose is being produced from protein and fat stores that are in me already. I won’t experience any of that hypoglycemic crash and I’m teaching myself to tap into the energy stores available. And so that was a huge realization for me as well, is that this whole carb replenishment or carb load glycogen replenishment concept is… Although it is true for the elite athletes who are draining their glycogen day after day, doing four or five, six hour workouts, and then trying to go hit a tournament, it is not the case that the average person who is just going into the gym for a one-hour session in between desk work needs to be eating a gigantic plate of pasta or chugging a smoothie in order to get through a workout. And so, I think a lot of that nuance, like bringing the realization that we should be fueling for our lifestyles. Gatorade makes sense if you’re on a Tour de France and you’re doing a hill climb section. It does not make sense to drink Gatorade while you’re doing an ab set next to your desk. So this is starting to bring awareness to a targeted lifestyle. Eat specific to how you live, I think is really one of the things I’m most excited about because I’ve learned just so much about it personally.
Leanne Vogel: [00:35:54] Yes. We’ve talked a lot about all the things we’ve learned about our bodies. How do you keep track of all these things? Can we talk a little bit about, does the app do that for us? Do we have to memorize all these lessons? How do we keep track of all this data and information that we’re getting about our bodies?
Josh Clemente: [00:36:12] Yeah. I’m glad you touched on that one. Levels is currently focused on what’s called the Insights Framework. This is an algorithmic structure for the way the app interprets the data for an individual and then surfaces insights for them and stores insights to be available for them later. It’s kind of behind the scenes, but it’s been a very big effort on our part to build a system that is very modular and scalable so that we can incorporate not just glucose data, but other data sources so that we can start to put together the pieces for the individual.
And so specifically I’ve mentioned diet, exercise, sleep, stress. Those are the four big levers of metabolic control. And right now we have continuous glucose information, which is great, and then we have a manual logging. So people can log exercise manually and note-taking manually about their sleep and their stress control.
We are working on integrations and we’ve rolled out the first one where we can import exercise automatically from Apple Health and Google Fit. So this is the first step towards us having additional integrations, additional data streams coming in and being interpreted by the same algorithms with glucose. The way this is working is, we’ll be able to sense whether or not a blood sugar elevation is from a meal that you ate or based on activity data, maybe it’s a CrossFit workout. And so the difference there is very important because a blood sugar spike from an adrenaline load for a high intensity workout is extremely different physiologically from one sitting down and having a smoothie at my desk. And so being able to sense that and then provide the appropriate scoring for that experience, that moment, is our current focus.
The next thing that we’re interested in is bringing in sleep information. And so importing sleep data from Apple Health, Google Fit, specific wearables, like Oura, these are very interesting to us. There’s some amazing technology on thermoregulation from Eight Sleep, which is a whole mattress which tracks your heart rate variability and blood sugar and controls your body temperature.
And so being able to import data from these sorts of additional devices is really important for us to bring all of that into context and show you how well you sleep when your body temperature is elevated overnight, and then how that affects your blood sugar control versus how your body responds after two consistent days of long duration, aerobic exercise versus a single anaerobic session.
So for all of this, right now we’re doing the backend work to interpret those integrations, interpret that additional data, and then the next stage is surfacing that for the individual so that you can, in a very straightforward way, click through your history and see not only how these different lifestyle factors affect you, but then how you stack up against the population, which I think is really important to provide context.
It’s always interesting for people to know. Oh, I got a 9 out of 10 when I eat a pizza and go for a walk. How does that stack up to everyone else? So that’s the next thing we’re building out is, not only the insights, but then comparing you to you and you to the population so that you can understand where you fit and where there’s areas for optimization.
Leanne Vogel: [00:39:09] How exciting is this? Can we just take a moment to totally crush on all of this science and just the fact that regular people are able to be so incredibly empowered with their health? As a holistic nutritionist who learnt about nutrition, what are we telling him 13 years ago to see what we’re able to do now and what we’re able to wear. As you’re speaking, I’m just like, “This is unreal.” it’s so cool. I’m so happy for you guys.
Josh Clemente: [00:39:34] I feel excited. Thank you. I’m so excited to be working on it because for a long time when getting into the research, it became just somewhat depressing to look at the numbers and to see, not only in every developing country, the rates of metabolic dysfunction increasing at an increasing rate, but also the rates among children of non-alcoholic fatty liver disease, and Type 2 diabetes and even heart conditions. It’s just staggering and it seems so counterintuitive when we have a society that is increasingly wealthy and increasingly… All the metrics of human flourishing are actually increasing, which sometimes it doesn’t seem that way, but what if you look at the data, it’s the case. And yet, our lifespan in the United States has gone down for the last three years, and 7 of the top 10 causes of death are related to chronic lifestyle. It can get depressing, but then when a technology like this becomes available and the microelectronics revolution allows us to miniaturize this amazing lab technology, and then manufacture it at scale, combine it with amazing software and you can make each person a mini end of one optimization study, a case study.
And if each person just focuses on themselves, they don’t think about how to solve all the world’s problems, they just work on themselves and look for optimization. You do that times many people, you can get social scale change. I think, by empowering the individual, we can genuinely change the metabolic outcomes globally. It’s going to be a long road ahead, and there’s a lot of work to do for sure. We’re not there yet, but I’m looking forward to that day when people treat their health information more like financial data where you always have it available. You’re looking at your “deposits and withdrawals”. You’re making a plan for the future and using expert help, as needed, to make sure you hit it. I really think that that’s the future we’re heading towards.
I like to use the example… In that world, you not only have a retirement plan, but you’re going to be healthy enough to take advantage of it. In order to get there, we just have to get people empowered with their own data. We can’t get there by having this walled garden mentality about individual health.
Leanne Vogel: [00:41:34] Beautifully said a hundred percent, and I’m really excited for that day also. Where can people find more details from you and where can they connect with you?
Josh Clemente: [00:41:43] We always love to hear people’s input on our blog, so we publish consistently and we’re really trying to produce the information that we wish we had when we started this company. Everything from all ends of the spectrum, from athleticism through to weight loss and everything in between, we publish it on the blog. So that’s levelshealth.com/blog, and then you can sign up for our wait list at levelshealth.com. And we have a Twitter and an Instagram presence, and we like to publish customer testimonials and just stories about how we’re using it. And those are both at Levels. Leanne, I think you have a link, which… Right now I mentioned we have, I think about 55,000 people on the wait list. It’s increasing constantly and we’re running this invitation ‘only beta’ program. So it’s still in development. The product is very much in development, but for those people that want early access and want to help us develop the product, we have this beta program. We pull people in from the wait list, but we also are working with people like yourself who are extremely intellectually aligned and your audiences are enthusiastic and great, we like to offer a link. So I think you have levels.link/KDP and…
Leanne Vogel: [00:42:49] Yes.
Josh Clemente: [00:42:49] Awesome! Yeah. So that’s an opportunity to you, if you’d like to be a part of the early beta program and join us in developing this, you can use that link to sign up and jump ahead of the wait list. Yeah. So those are the different ways, and of course, I guess I’m on Instagram @Josh.f.clemente and I always love hearing from people. If you want to just reach out there, definitely ping me and love to trade crazy stories about what we’re all learning with this stuff.
Leanne Vogel: [00:43:12] Yeah. And that’s really what it is. It’s been so cool to see the women that have purchased the Levels from last episode and getting to hear their experiences and how excited they are and how empowered they are. It makes my heart so happy to see people really making these actions and behavior switches and doing it themselves and getting excited. Like you said, looking at your finances as much as you look at your body, of course, a hundred percent, that makes sense. And to see them start to develop these practices, it just makes me so happy.
Josh Clemente: [00:43:45] I completely agree. I’ve been… It’s amazing how quickly… This has gone from pie in the sky idea to a real thing and I’m very grateful to the amazing team that I’m surrounded by. I’ve personally profited from this experience. I know more about my body now than I would ever have known, honestly. Even had I gone into medicine, I think I would still not know as much as I do now due to just the amazing software that has been developed by our team and the expertise of people like Casey joining and just helping us build something that is grounded in objective data and useful to the individual. I’m very lucky to be a part of this. There have been people who have reached out and have used this product and some people have discovered underlying diabetes that they had no idea it was happening and could have gone unmitigated for years. Some people have lost dozens of pounds in just a few short weeks although they’ve always struggled with diet programs and never been able to break through. It’s really giving people, I think, an edge and helping them understand that they can take control. They don’t need to wait for the next emergency room scare. That type of stuff just always wakes me up out of my stupor because I’m so lucky. I was able to get to this so early that I did not have the major consequences and I hope to avoid it in the longterm. Many people are already dealing with the acute symptoms of metabolic breakdown and I look forward to a future where we don’t have 88% metabolic unhealth in this country where we have people who are optimizing every single day. They’re pushing for that last 1% or 2% of optimal and we’ve eliminated chronic illness because this is so unnecessary. If we can help everyone stop flying blind, I think we’ll get there.
Leanne Vogel: [00:45:19] Yes. Wonderful. Thank you for coming on the show. Thank you for putting together an amazing team to create this product and I’m so happy and thrilled and I’m feeling very blessed to be a part of it all. So thanks again for coming on.
Josh Clemente: [00:45:33] Thank you for helping us spread the message and for being so supportive and enthusiastic about this. It’s so important to have experts like yourself who already know how to tell the stories to their audience, just be a part of this with us. Yeah, just very grateful. Thank you for having me on, Leanne, and I look forward to many more of these in the future.
Leanne Vogel: [00:45:52] I hope that you took so much away from today’s episode. I really wanted today’s episode to empower you to really get to know your body and to just get excited about all the data points that we can learn and then act on. It’s one thing to wear a CGM and then not know what all those numbers are. It’s completely different to wear a CGM and have it connected to an app that tells you what is happening and gives you these action points and stores all this data so that you can really start to understand what works, what doesn’t, and go back to the drawing board as you need to adjust things as you go.
So thanks again for watching today’s episode and thank you to our two partners, which made today’s episode possible. The first being Billings Seafood Guys. They make the Wild Alaskan Seafood box. You can find out more details with a saving code down below. I get their salmon and whitefish every month and I’m obsessed with their salmon. That skin is the best skin I’ve ever had outside of living in Victoria and eating it when I can. Also a big thanks to LMNT. They make electrolyte powder that’s delicious, simple, balanced, fantastic. You can get more information down below about them.
And thank you for watching the podcast today. I will see you next Sunday for another episode and as always, if you have questions, suggestions, comments, anything, you know where to find me. Just click that link down below to send me a message and we will try to incorporate it onto the show. Okay. Have a good one. Bye.