How to See Inside Your Body Using Continuous Glucose Monitors with Maz Brumand from Levels

Health tech has spiked to a new high in the last decade, and Levels hopes to use CGM patches and glucose readings to help people on their way to a healthier life. At Levels, monitoring your glucose is the first step toward making the best lifestyle choices for your body. Harry Glorikian of the Harry Glorikian show interviewed Levels’ own Head of Business, Maz Brumand. During the episode, Maz shared what Levels is and does, the importance of giving people control over their own health, and what it means to be a platform for metabolic health information.

11:14 – You need a startup to take the risk

Maz said the metabolic health space is still new enough that established companies might not want to risk exploring it. Therefore it’s up to the startups to delve into new territory.

I think the metabolic health space or in some of these things that still it’s just early innings, you need a startup to take the first step and accelerate and take risk to make this into something that consumers will accept. There’s a lot of things that need to be done and put in place for this mission to be accomplished. But I felt that I could do that inside a startup faster. Then obviously, companies like Apple and others can help scale this and make it available to many, many, many more people, not just here in the US, but globally. But I think there’s just a different role to be played by startups and Apple, and I felt like getting to know Levels, I felt like they’ve got the DNA that’s not too different than Apple, high integrity, focus in customer trust, just like Apple focused on privacy and trust, and the way they’re building the company focusing on culture is also something that quite differentiated. So even though they’re at different places in their evolution, I felt like it was similar DNA between Levels and Apple, and it’s just that in metabolic health today, I think a startup like Levels can move a lot faster and create that change.

14:06 – The underlying cause of disease

Metabolic dysfunction is the underlying cause of many diseases, which is why it’s so important to focus on long-term metabolic health.

In the CGM space, I think we should think about what are the underlying things that are leading to these diseases? It is metabolic dysfunction, which is how your cells produce and use energy. This is a long journey. It doesn’t happen overnight. So it may take 10 years for somebody to develop diabetes, and you really want to measure their behavior today that’s going to lead to that metabolic dysfunction and intervene today. So what CGMs do on other technologies like that is they provide real-time feedback at the molecular level, which is what we we call bio-observability, to help you change that. So if I don’t know something is not working for me metabolically, how can I change that behavior?

18:09 – Helping people understand metabolic health

Levels wanted to focus on educating people about metabolic health, so the company created a lot of well-researched, scientifically-based content around metabolic health.

One of the early decisions we made was really focus on creating content and education. So we publish hundreds of articles a year about metabolic health and how different things affect you, and some of them are really deep and well-researched. It’s scientifically based. We put a lot of energy into creating content that will help explain the science and explain the physiology. So there’s a lot of content we’ve created that is available on our blog. It’s available in our app. So that’s a primary focus. So one of our objectives is actually to make metabolic health into the zeitgeist, and if you go on Google and search that, you’ll find Levels as one of the top hits as explaining what all that is. So there’s a huge philosophy within our company that we want to be science-based. We want to help people understand what metabolic health is and how they can affect it. So that’s a core philosophy.

19:53 – How you eat your food matters

The order you eat your food in can affect how your body absorbs and responds to that nutrition.

The order in which you eat your food actually matters, which is actually a really mind-blowing concept, meaning I can enjoy the same thing. I just have to change the order. For example, if you eat naked carbs at the beginning of your meal, versus if you’re having protein, fats, and fiber and then eating the carbs later, your glucose response will be different. So also helping people compare different instances or behaviors is another insight. For example, you could also do easier. You could say, “I ate dinner, sat on the couch, watched TV” or “I ate dinner and took my dog for a walk for 10 minutes,” not even something extreme. It’s just around, and you’ll see the response. So these are moments that it creates these aha moments or insights that will help you change your behavior.

23:58 – Consumers should be able to manage their own health

The best person to care for your health is you. It’s important to give individuals the tools they need to make healthier decisions.

The consumer angle of this space, metabolic health, has for the most part for a long time been ignored. A lot of people are creating products for payers and disease. So we put on the hat and said, “Look, who’s the best person to manage or care about their health and take actions that improve their health? It’s the consumer.” So our whole approach is consumer-centric, putting the consumer in the middle and creating value for them, building trust for them, and helping them in their metabolic health journey. So I think that’s differentiated in the sense that all of our decisions are ultimately driven by that mission.

26:09 – Your health journey is a long-term endeavor

Maz said Levels views the health journey as a long-term thing, which means membership isn’t a one-time transaction, it’s a two-way conversation.

To us, membership means something different. We see as the health journey as a long-term thing. Managing your health and improving your health is not a one-time transaction. It’s also a two-way conversation between us and our members, meaning we want to engage with our members. We want to hear from them. We want them to help us to improve the product, but also create a community. So it’s much more than just transactional, “I’m selling you a single product and/or a subscription.” It’s more about, “How can we create this long-term relationship that’s based on value creation for the member and building trust for the member for the long-term so we can continuously drive value for them?” That continuous value creation, trust, and two-way relationship is the basis of why we call it a membership, because it will help inform our business decisions, product decisions, design decisions in a different way when you think about this as a two-way relationship over the long-term.

38:06 – What it means to be a platform

Being a platform means more than just building a product. For Levels, it’s about creating long-term value for the consumer.

I think this idea of being a platform is just a different model. It’s not about creating a purpose-built product that I will sell for revenue. It’s a platform where other people can build on top and make revenue, but also strengthens your own business, too. It’s not completely for nonprofit. There is a business strategy there, but the business strategy is much more aligned with consumer interest and consumer value creation than in this zero sum game, which unfortunately our healthcare system has developed into, with the disintermediation that we’ve seen, with the buyer being different than the end consumer. So when you’re actually designing a product, natural incentives will make it so that you’re designing it for the buyer, not the consumer. So you end up creating a product and optimizing features for the buyer that has certain interests, but then you expect the end user, which is a different person, to want to use it. That’s how you end up with klugey products that nobody wants to use. So nobody loves using a product that was created for an insurance company as a consumer. So I think this changes that dynamic completely.

44:37 – Research isn’t always representative of the real world

Research isn’t always indicative of the real world because research is performed in controlled environments and under perfect circumstances.

We all know a lot of the research is also done in perfect situations, and it’s done on a cohort that’s probably not representative of the entire world. So yeah, I think it’s both things. I think one is if it’s not out of the normal, which is probably a large standard deviation, it gets passed through, and then also if we just don’t know because we didn’t have the tools to research the way that we’re doing research today, and this is my point about Apple changing also thinking about research, not being 30 people in the Northeast that we studied and then came up with a guideline for the entire world. This doesn’t work that way.

47:02 – Small changes can help you live healthier

Taking control of your health doesn’t always mean drastic changes to your lifestyle or diet. Sometimes it just means tweaking a few things for optimal health.

A lot of people think if they want to take control of their health, whether to lose weight or whether to feel better, they have to make these massive changes. They’ve got to stop eating all the foods that they like. They’ve got to go to the gym two hours a day. My personal CGM experience has shown me the opposite, where there was just a few tweaks I needed to make to change the outcomes completely. The reason I was doing the things I was doing, it wasn’t because I was like, “Hey, that’s my cheat, and I really won’t care and I enjoy that.” Some of the stuff, I didn’t even care about it. I really didn’t think that oats is so much better than eating eggs in the morning. That was not. But science, the best available science at the time said eggs are bad for your cholesterol and oats are heart-healthy. So a lot of it is also just figuring out based on real data that’s personalized to you, “What are those small changes that I can make that will completely change my life?” That’s what’s magical about this technology. It’s not somebody writing a hypothesis piece about a general population that makes no sense with your lifestyle, but instead figuring out, “Okay, based on you, your physiology, and your lifestyle, how can I help you?”

Harry Glorikian (00:03):

Hello. I’m Harry Glorikian. Welcome to the Harry Glorikian Show, the interview podcast that explores how technology is changing everything we know about healthcare, artificial intelligence, big data, predictive analytics. In fields like these, breakthroughs are happening much faster journey that most people realize. If you want to be proactive about your own healthcare and the healthcare of your loved ones, you’ll need to learn some of these new tips and techniques of how medicine is changing and how you can take advantage of all the new options. Explaining this approaching world is the mission of the new book The Future You. It’s also our theme here on the show, where we bring you the conversations with innovators, caregivers, and patient advocates who are transforming the healthcare system and working to push it in positive directions.

Harry Glorikian (00:57):

People used to go through their lives not knowing very much about what they were eating or what was going on inside their bodies. If you traveled back in time to the year 1900 and you stopped a person on the street to ask how much they weigh, they probably wouldn’t be able to tell you, because the bathroom scale didn’t become a common consumer item until the 1920s. If you visited the 1960s and walked into a grocery store, you wouldn’t have been able to figure out calorie, protein, and carbohydrate content of anything, because nutrition labels weren’t a thing until the 1970s. Until very recently, the only way to figure out your blood pressure was to visit a doctor’s office or find someone who’d been trained to use a blood pressure cuff. Now you can buy an automated home blood pressure monitor for under $50, and of course if you have a wearable device like an Apple Watch, a quick glance at your risk can show you your heart rate and even an EEG readout.

Harry Glorikian (01:59):

So what’s the next health-related measurement that’s about to go from obscure to commonplace? It might just be your glucose level. Until recently, getting a blood glucose measurement required a finger stick. The whole process was painful and annoying, so only diabetics taking insulin bothered to do it regularly to avoid episodes of hypo- or hyperglycemia. But there’s a new class of device called continuous glucose monitors, or CGMs. They’re pain-free, and they’re rapidly coming down in price. A CGM sticks to your arm, and it has tiny electrodes that go into your skin to measure glucose levels in the interstitial fluid. I wear a CGM myself. Over time, it’s teaching me which foods cause my glucose to spike the fastest and which ones can help me keep it more even over time.

Harry Glorikian (02:57):

My guest today, Maz Brumand, works for a company called Levels that wants to use CGMs to help everyone understand how their choices about food and lifestyle affect their health. Maz left a pretty high-level position at Apple last fall to join Levels, and my first couple of questions for him were about what attracted him to the company and why he would leave a company like Apple with more than a billion users worldwide for a health tech startup that isn’t even out of beta. So here’s my conversation with Maz.

Harry Glorikian (03:31):

Maz, welcome to the show.

Maz Brumand (03:44):

Thanks, Harry. Thanks for having me.

Harry Glorikian (03:47):

So I want to start by maybe the story behind Levels. You’ve got five great founders with stellar Silicon Valley credentials from companies like Google, SpaceX, and you know pretty much why they started the company. I’d love to understand the special sauce and unique insight that you guys felt that you could bring to the market for mobile health monitoring.

Maz Brumand (04:16):

Yeah, so that’s a good question. We have five founders, as you mentioned, and they’re just a fantastic group of people. They’re very passionate about this area in health, and I think all of it started from Josh, one of the founders, where he quickly understood that there is power in CGMs and that he has been in his account living a healthy life. But when he actually started measuring his glucose, he realized that a lot of things, common knowledge or advice around food, was wrong. There is a great story on that on our podcast, for example, drinking juice, and all of us think that drinking juice is the healthiest thing you could do. So I think at one of the investor meetings, he took a juice that was presumably very healthy, a green juice, and drank it and saw his glucose spike sky-high. So I think that was indication that there is something here.

Maz Brumand (05:15):

But the thesis behind the company is that we don’t know what’s going on in our bodies, and if we could create a dynamic where we have bio-observability, and by that, I mean we can actually see what’s going on inside our body based on our behavior and actions. For example, in the case of CGMs, if you eat a hamburger, the CGM will tell you how your body’s going to react to that in real time, or if you eat a donut, it will tell you. So there is no two questions about it. It’s very specific to you, and it will show you in real time how your behavior is going to impact your health. That’s very powerful. So the thesis of Levels is starting with CGMs, can we create that feedback? Can we close it in real time? Can we show you how food and your lifestyle affects your health and create this path towards healthier lifestyle and healthier decisions?

Harry Glorikian (06:15):

Yeah. We’re going to jump all of that, but I want to step back for just a second. You spent nine years at Apple. You were Head of Business and Strategic Development for Health, Strategic Initiatives Division. So what products did you guys did you work on? Because that sounds super exciting.

Maz Brumand (06:37):

Yeah. The stuff that’s public, we’ve worked on a lot of research efforts to really understand, for example, how human cognition works. One of the projects I led was quantifying cognition to understand how cognition changes based on lifestyle and then also based on decline due to disease. That’s just an example of one research. We had research around how screening AFib early on will change the trajectory. So I spend a lot of time thinking about how does our behavior and how does technology allow us to improve human health?

Harry Glorikian (07:15):

So I was reading about your background. You seem like an outdoorsy guy, former triathlete, if I read it correctly. Were you always interested in health and wellness technology, or was that evolved over time?

Maz Brumand (07:31):

Yeah, that’s a tricky question. From the wellness perspective, I’ve always been interested. I’ve always been an athlete. I’ve always been active. I’ve always tried to manage my food. But if you asked me 10 years ago that I would end up in health, I would’ve told, “You are crazy.” The way I thought about health was always big hospitals and IT systems, and it did not interest me at all. I thought it was slow and not very interesting. But as Apple entered its health journey, obviously with releasing the Watch and then putting a heart sensor on the watch, which was actually for [inaudible 00:08:12] … Yep, I’ve got one, too. We quickly realized that there is so much power putting the consumer at the center of their data, and that led to the whole platform Apple created around healthcare and researched it and then built the products on top.

Maz Brumand (08:30):

That, being involved in that, and I was part of the new technologies group within Apple on the commercial, so I got introduced to that, and when I saw that, I fell in love with it, because I saw that we can really change the discussion about health and put the consumer at the center. Nobody’s better than the consumer to make decisions about their health. They’re the one that probably cares most about their health. So creating the dynamic where you allow consumers to take control of their health by providing insights, by providing clarity, by providing services to help them manage that seemed like a better way than having a disintermediation that we’ve obviously experienced in US healthcare and is very well documented.

Harry Glorikian (09:19):

Yeah. I’m in the venture world, so I love the way the technology is changing the entire center of power or center of gravity that’s evolving over time. But Apple is, I don’t know, over a billion users in the world. So you left for a startup. Why?

Maz Brumand (09:45):

Yeah, that’s a good question, too. Working at Apple, I learned that to really make a difference, it has to be an ecosystem, and each of the players in the ecosystem have a different role. For example, Apple has really played a fantastic role in creating the platform and allowing people to take control of their health data on their phones, and it’s built a platform where other people can now build on top of to help. But Apple plays a unique role in the sense that it is this platform and it is going into verticals and trying to help wherever it can. But there are many more opportunities for startups like Levels to come and build on top.

Maz Brumand (10:26):

When I was doing a little bit of soul-searching about what would I want to do with my life for the next 10, 20, 30 years, I was thinking about what are the big problems that we need to solve in health? Two areas became pretty apparent to me. One was metabolic health, because it’s the underlying of many of our chronic diseases, which has not only economic implications, but health implications around morbidity and mortality, and it’s a big problem not just in the US, but around the world. Then the second was mental health, and looking at the space and what I thought made sense and looking at the companies, metabolic health is what I really wanted to go tackle.

Maz Brumand (11:02):

I got introduced to Levels about a year ago, and I’ve been watching them. The fact that they’re building in public and being so transparent really helped me get to know them over the year, and I think the metabolic health space or in some of these things that still it’s just early innings, you need a startup to take the first step and accelerate and take risk to make this into something that consumers will accept. There’s a lot of things that needs to be done and put in place for this mission to be accomplished. But I felt that I could do that inside a startup faster. Then obviously, companies like Apple and others can help scale this and make it available to many, many, many more people, not just here in the US, but globally.

Maz Brumand (11:49):

But I think there’s just a different role to be played by startups and Apple, and I felt like getting to know Levels, I felt like they’ve got the DNA that’s not too different than Apple, high integrity, focus in customer trust, just like Apple focused on privacy and trust, and the way they’re building the company focusing on culture is also something that quite differentiated. So even though they’re at different places in their evolution, I felt like it was similar DNA between Levels and Apple, and it’s just that in metabolic health today, I think a startup like Levels can move a lot faster and create that change.

Harry Glorikian (12:31):

Yeah. I’ve looked at a lot of these different technologies. People say, “Well, you’re wearing an Apple Watch. What does that do? What does this do?” I always tell them, I’m like, “I think of the Apple Watch as an aggregator or data repository, and things that sit on top of it are the monitoring or applications that would then do something with the data that then is useful to me.” But I’ve worn a CGM. I can tell you that Korean bibimbap spikes the hell out of my … and it stays up there for much longer. But I was talking to somebody the other day, and they were like, “Okay, why would you wear a CGM? How do I use it?” So I was trying to walk them through the other thing, but you get to now tell our listeners. So why do healthy people need this data? Why is a CGM data useful for people who are not diabetic or pre-diabetic, right?

Maz Brumand (13:33):

Yeah, that’s a really good question. You can look at everything from a disease perspective and look at, “So now I’ve got a disease. How do I treat it or treat the symptoms?”, or you could think of it foundationally and say, “What is actually leading to these things that are now disease and/or symptoms of disease?” It’s like saying, “I’m overweight, so I should go get a scale,” versus having a scale to measure yourself, make sure we don’t become overweight, but then saying, “I will only sell you a scale if you’re already overweight.” So if I show up and I’m skinny, I cannot buy a scale. It’s a crazy thought, right, experiment.

Harry Glorikian (14:06):

Right.

Maz Brumand (14:06):

In the CGM space, I think we should think about what are the underlying things that are leading to these diseases? It is metabolic dysfunction, which is how your cell produce and uses energy. This is a long journey. It doesn’t happen overnight. So it may take 10 years for somebody to develop diabetes, and you really want to measure their behavior today that’s going to lead to that metabolic dysfunction and intervene today. So what CGMs do on other technologies like that is they provide real-time feedback at the molecular level, which is what we we call bio-observability, to help you change that.

Maz Brumand (14:40):

So if I don’t know something is not working for me metabolically, how can I change that behavior? For example, I used to eat oats in the morning, right? I think many people do, and I always thought that’s the healthiest thing I could do. I sometimes would even skip the milk, and I would just be literally raw oats, which is crazy, right? I thought I was the healthiest person in the world until I put on a CGM or saw other people put on a CGM that oats are really bad for you, especially right smack in the middle of your morning, where you’re actually trying to have sustained energy over the day.

Maz Brumand (15:20):

So CGMs enable you to see that, because first of all, I don’t think science and knowledge around some of these things is well understood, because it’s so hard to do a clinical research to study food. There are just so many barriers. So I think CGMs for the first time at a personal level tell me, “What do I need to do today that would help me have a better outcome years from now?” Also, that’s the disease perspective. So you asked about disease, and then from a wellness perspective, there’s a lot of benefits, like the fact that I have higher energy, the fact that I am probably healthier, metabolically healthier, so I’m more resistant to disease, obviously COVID being a big issue. So I think there’s a lot of benefits in thinking both from, “How can I address the underlying factors that lead to disease?” and then also, “On a day-to-day basis, how does that make me feel better?”

Harry Glorikian (16:10):

Yeah. So for those people listening, what’s the benefit of keeping your glucose level flat and steady? I do my best to do that, but I’m not sure that everybody fully appreciates what that does.

Maz Brumand (16:24):

Yeah. Yeah, I’ll talk about it from the wellness perspective. When you have a glucose spike, your body produces insulin and crashes that back down. When you get back down, that’s the afternoon lull, where you feel low energy, lethargic, brain fog. So just from a wellness perspective, just from a “How do I want to live my life?” perspective, managing these spikes allows you to feel better during the day, and that’s a pretty easily … You’ll feel that. That’s from energy level, also from brain fog. You know how in the afternoons you might feel like just your brain’s not working?

Harry Glorikian (17:05):

Yes. I remember how it used to be.

Maz Brumand (17:09):

Yeah, me, too. I used to think that afternoon dozing or if you’re feeling tired was normal until now. It’s like now, “Why do people take naps in the, afternoon?” I don’t even get it anymore. But joking aside, I think there’s a huge impact on energy levels and your mental fog, and then obviously long-term, leads to insulin insensitivity, which leads to all sorts of problems, chronic problems.

Harry Glorikian (17:34):

Yeah. So on the website, you guys talk about hardware, software, and then this very interesting word called insights. So I want to focus on the insights part of it, like what kinds of analysis or advice do you offer members about eating or exercise? If you can describe the scoring system in the app, I think it’s called the zone score and the day score, right? So just if you could help me understand that, that would be good.

Maz Brumand (18:07):

Yeah. One of the early decisions we made was really focus on creating content and education. So we publish hundreds of articles a year about metabolic health and how different things affect you, and some of them are really deep and well-researched. It’s scientifically based. We put a lot of energy into creating content that will help explain the science and explain the physiology. So there’s a lot of content we’ve created that is available on our blog. It’s available in our app. So that’s a primary focus. So one of our objective is actually to make metabolic health into the zeitgeist, and if you go on Google and search that, you’ll find Levels as one of the top hits as explaining what all that is. So there’s a huge philosophy within our company that we want to be science-based. We want to help people understand what metabolic health is and how they can affect it. So that’s a core philosophy.

Maz Brumand (19:09):

The second question you asked is around what is insight? So you want to know, for example, if your glucose spiked, right, and you haven’t logged anything. We asked the user, “Hey, did something happen?,” and that’s a teaching moment where they go on and put in, “I ate oats for breakfast,” or something. That’s the teaching moment. Then having content that explains that is when you have that aha moment, or let’s say you ate something one day that affected you nothing, fine, and then the next day, it’s a crazy response. We give the ability for people to compare. So imagine one of the things is the order in which you eat your food actually matters, which is actually a really mind-blowing concept, meaning I can enjoy the same thing. I just have to change the order.

Maz Brumand (20:02):

For example, if you eat naked carbs at the beginning of your meal, versus if you’re having protein, fats, and fiber and then eating the carbs later, your glucose response will be different. So also helping people compare different instances or behaviors is another insight. For example, you could also do easier. You could say, “I ate dinner, sat on the couch, watched TV” or “I ate dinner and took my dog for a walk for 10 minutes,” not even something extreme. It’s just around, and you’ll see the response. So these are moments that it creates these aha moments or insights that will help you change your behavior.

Harry Glorikian (20:43):

Does the app actually … Other than showing the spike, does it make it digestible for someone to … I’ve not played with it, so that’s why I’m asking. Does it put it into human speak or some way to communicate with someone to let them know that these are things they should be paying attention to?

Maz Brumand (21:05):

Yeah, I think that short answer is yes and no. Yes in the sense that we do it today and we’re planning to make it better. No, have we reached the end goal to make the perfect app? Not yet. We’re in that journey, and we’re constantly innovating and creating new experiences and new ways to help people understand their behavior. But I’ll give you an example. If you, for example, see a spike after a workout, which happens when you do extraneous workout. Your body produces glucose to power you, and so you’ll see a spike. But that spike is not the same as if you ate a donut. So we will show content to people that say, “Hey, did you know that this is a spike? We’re not going to hold this against you. For example, we’ll take it out of your score, because it was generated based on a good behavior, which is exercise, versus not so good behavior, which is eating a donut.”

Harry Glorikian (21:55):

Right, right, right. There’s a difference between a spike that comes up and down, which is normal, versus one that stays up for a long period of time.

Maz Brumand (22:04):

Yeah. The area on the curve is important. Now, I think another angle we haven’t talked about yet is research. I think we know a lot, but real-time CGM in health and wellness, at least in the wellness side, is relatively young.

Harry Glorikian (22:19):

Yes, yes.

Maz Brumand (22:20):

So there is a lot of work to be done to actually understand at a deep level all these questions that we have and you have and the customer will have. So there’s a lot to do there, which we can talk about separately.

Harry Glorikian (22:35):

Yeah. Actually, I think about all the different companies in this space, and I think you guys are running probably one of the largest … I don’t want to call it a clinical trial, but for a better word, right? On actually a healthy population looking at this space. So the data’s going to be hugely valuable to drive next level of how to communicate and what to communicate to each person.

Maz Brumand (22:59):

Yeah, and also that we take, actually, research pretty seriously and science pretty seriously. If you look at the list of our advisors, we have some of the most thoughtful people in the world being on this journey with us, people like Dr. Lustig that wrote the book Metabolical or Dr. Ben Bikman that wrote Why We Get Sick or Dr. David Sinclair that wrote Lifespan. So we have a lot of serious people that are involved with us trying to further science, and we also have a lot of research projects going on with some of these folks plus other folks to answer some of these questions.

Harry Glorikian (23:42):

So how do you guys … There’s a few different companies out there that are doing this. How do you guys differentiate yourselves from these different players that are out there?

Maz Brumand (23:56):

Yeah, that’s a good question. There was a couple things. I think the consumer angle of this space, metabolic health, has for the most part for a long time been ignored. A lot of people are creating products for payers and disease. So we put on the hat and said, “Look, who’s the best person to manage or care about their health and take actions that improve their health? It’s the consumer.” So our whole approach is consumer-centric, putting the consumer in the middle and creating value for them, building trust for them, and helping them in their metabolic health journey. So I think that’s differentiated in the sense that all of our decisions are ultimately driven by that mission.

Maz Brumand (24:31):

I think the second thing is that we are very much science-based and research-based. So if you look at how we think about these things and read our content, it’s very much ground level up thinking about at the cell level what’s happening. We also haven’t narrowed it to a specific disease, right? We don’t call it a diabetes management program, which we can’t, anyways, because we’re in the wellness space. But even if we could, we wouldn’t. So because we’re looking at a much more broad metabolic health, how can we make sure that your cells are healthy and using energy and producing energy in a way that will prevent both the disease states, hopefully one day, but also the wellness space? So really marrying this short-term, “I want to feel better. I want to look better. I want to have more energy. I want to spend more time with my kids. I have high fertility,” whatever it is, that is just as important than trying to tackle disease through payers. So I think going from this broader angle is also something that’s unique.

Harry Glorikian (25:41):

Yeah. I’m a firm believer that everything is moving towards keeping people healthier, as opposed to just treating them when they’re sick. It’s going to be much more profitable, which brings me … The website talks about customers as members, right? So I’m assuming the business model is around subscription. So can you explain how that works, that subscription program, and what features are included?

Maz Brumand (26:06):

Yeah, so we think of it as a membership. To us, membership means something different. We see as the health journey as a long-term thing. Managing your health and improving your health is not a one-time transaction. It’s also a two-way conversation between us and our members, meaning we want to engage with our members. We want to hear from them. We want them to help us to improve the product, but also create a community. So it’s much more than just transactional, “I’m selling you a single product and/or a subscription.” It’s more about, “How can we create this long-term relationship that’s based on value creation for the member and building trust for the member for the long-term so we can continuously drive value for them?” That continuous value creation, trust, and two-way relationship is the basis of why we call it a membership, because it will help inform our business decisions, product decisions, design decisions in a different way when you think about this as a two-way relationship over the long-term.

Harry Glorikian (27:14):

So just talking about business models, people always ask me, “Harry, all these technologies are great, but they’re usually pretty expensive, right? Depending on where they start.” Then obviously, these things come down over time. How do you see this? I know the group it’s starting with, which is usually the higher price, and how do you see this coming down for a much broader audience over time?

Maz Brumand (27:42):

Yeah, that’s a good question. I think the technology obviously in the wellness space is relatively new, right? So any new technology is going to be higher-priced. So I think as CGMs or other technologies become more mainstream, the concept of not just CGMs, but bio-observability becomes more mainstream, and it becomes a consumer thing, it will help drive down cost. Ultimately, I think there’s two questions to be asked. One is, is the product and service providing more value than it’s taking in terms of cost or price? That’s question number one that we have to answer regardless of what the price is, right? When Tesla came out for a subset of their customers, it was a $120,000 car. It created more value in their eyes than the price tax. So I think that has to be important and true, and so that’s question number one.

Maz Brumand (28:34):

The second question is affordability, right? No matter how much value you’re creating, if it costs $10,000 to get this membership per month, nobody’s going to be able to afford it except a few. So I think you have to solve both problems, the value problem and the cost problem, and the cost problem is getting more efficient in terms of creating product and services using technologies that become more mature and consumer-friendly so that prices go down.

Maz Brumand (29:01):

One of the things in our membership, actually, I should have probably clarified is we will not mark up the hardware and services that we provide from third parties. So we will try to do it at closest cost as we can. There may be a small difference, just because prices go up and down, and there may be volatility cost. But our promise is that we will provide these products and services at cost to our members so that we have no incentive, financial incentive to sell you more stuff, upsell you more stuff. When I say you should buy another CGM, we don’t make any money on that, and so therefore when we say you should get another CGM, we want that to be truly aligned incentive with our members, or when we say you should go get X, Y, Z down the line, that’s all pass-through cost for us. Really, what we’re focusing on is the membership fee, which is an annual number that’s detached from your level of consumption.

Harry Glorikian (30:12):

Yeah, and I think just so that people understand this, you guys don’t develop the CGM hardware, the part that sticks into your arm, right? My understanding is that you ship … and correct me if I’m wrong. It’s a FreeStyle Libre CGM from Abbott, if I’m correct.

Maz Brumand (30:31):

Yes.

Harry Glorikian (30:31):

Okay.

Maz Brumand (30:32):

Yeah. So exactly. So we use third product and services, like the CGM, because that’s a sensor that’s been developed many, many years, and a lot of work has gone into it. So we’ll take that technology, and then our experience in software and insights and scoring will leverage the hardware to help people make decisions about their behavior by closing up.

Harry Glorikian (30:55):

Now, at the same time, I think … Again, correct me if I’m wrong, but I think you guys are still in beta, getting ready to launch.

Maz Brumand (31:01):

Correct.

Harry Glorikian (31:04):

When do you guys think … I know … Well, the last thing I got to see on your website was you’ve got 85,000 people signed up, right?

Maz Brumand (31:15):

Yeah.

Harry Glorikian (31:17):

I don’t know if that number has changed, so I don’t know if you have a newer number for me.

Maz Brumand (31:22):

Yes.

Harry Glorikian (31:22):

But I’m assuming you’re going to try and ship that, get this out sometime this year.

Maz Brumand (31:29):

Yeah. I think the number’s, I think, upwards of 150,000.

Harry Glorikian (31:32):

Okay.

Maz Brumand (31:35):

The answer is yes, we want to ship it. But one of the decisions we made consciously is we wanted to ship it in a way that makes sense, and that means a number of things. As you know, one of the strengths of startups is to be able to iterate and learn fast, to be able to talk to their customers and learn from them. Under a beta, I think that enables you without having huge volumes of people or problems deal with to innovate faster. You can actually in the end get to the product that will really help people or create value to people fast. So that’s the thesis of why beta, and when we plan to release beta, it’s going to be sometime this year, hopefully sooner than later, hopefully in Q2. But it all will be predicated with, “Do we feel like we’re ready to provide that experience out of beta?”

Harry Glorikian (32:26):

Yeah. If you’ve got 150,000 people, and I think I read on … You probably have changed this, but again, I want to say it was 2,000 kits a month. Obviously, the company’s got to ramp itself to be able to get the 150,000 out to people as quickly as it can.

Maz Brumand (32:44):

Yeah, exactly.

Harry Glorikian (32:47):

So is there a, I don’t know, longer-term play that you’re thinking about at Levels beyond CGM, right? Is that just the tip of the spear, or do you want to integrate more types of health data and apps in so that you can give more holistic advice?

Maz Brumand (33:12):

Well, I think the North Star is bio-observability, right? CGM is just one, but what’s happening in my body based on my behavior, and can I show that to the user in a way that will help them change behavior that ultimately will lead to better outcomes for them and short-term make them feel better on a day-to-day basis? So I think that’s the North Star. Obviously, glucose CGMs are available, so we’re using them, but that’s the start. If you think about if you take that to its conclusion, every action that we have affects a lot of things in our body, whether it’s generating stress, like a cortisol response, or generating other reactions in the body. So I think the long-term vision is can we help close this loop based on our behaviors and what’s happening at the molecular level in our body? So that’s the closing the feedback, so getting the assessment to the user, and then also helping them now that they’ve got the insight and they see what needs to be done, help them with the products and services that will help them achieve that goal of improved health.

Harry Glorikian (34:24):

So I’m going to pick on your … You’ve been at Apple and now you’re doing Levels, and you’ve been doing this for a while, your personal vision of possibilities here. Can you imagine a time where everybody with a smartphone or a smart watch is getting daily feedback from their devices on how they can optimize nutrition, exercise, sleep for maximum health?

Maz Brumand (34:50):

Yeah, I think that’s the vision, right? The consumerization of health, I think the stuff that Apple took to put the data and make the data available to the user and allow people to build on top is, I think, the revolution in personal health. I think the market dynamics will drive innovation through many different ways. Levels is just an example, right? Levels would have not existed if this consumerization foundation wasn’t set up by companies like Apple. At least that’s what I believe.

Maz Brumand (35:23):

So I think the short answer is yes. I think by putting the tools in place and creating a business environment for people to innovate and provide services to consumers, I think the market will eventually figure out how to help people live healthier lives, whether it’s in this form or not, meaning whether it’s a watch on your wrist or a CGM in your skin or whatever. It’s hard to say 20 years from now. But I think the end conclusion is going to be that people are going to know based on their individual physiology how to optimize their health. I hope, my hope personally is to not focus on just disease, but the wellness leading up to that, because there is a lot to do in that space to make sure people are living their fullest lives and happiest lives.

Harry Glorikian (36:19):

Yeah. I find it fascinating, right? That Apple has basically created this ecosystem where they’re not necessarily profiting off of the health and wellness space in the way that you would think that being charged for it, but that they’ve created an ecosystem that everybody says, “I have to have these devices and interfaces,” that makes them almost core to how this is all rolling out.

Maz Brumand (36:53):

Yeah, because I think it’s not a zero sum game. If you change your mentality from “How can I make the most amount of money?” to consumer-centric, actually helping consumers, and by that, what does that look like, it no longer becomes a zero sum game.

Harry Glorikian (37:07):

Yeah, but if you think about it, though, I’ve been in the health world for … Right? Everything we make is very purpose-built, right? There’s a reimbursement or something that’s attached to it. Apple is saying, “Listen, I’m going to create an ecosystem. I’m going to create a platform you can use an API to get information in and out,” right? “I’m going to make it easy for you to do monitoring and apps and everything else. You just need to buy my devices.” I’m fairly happy. I don’t need to make money on the purpose-built product, like we have in healthcare historically. So it’s a different way to make money, but in the same ecosystem, which is fascinating.

Maz Brumand (37:57):

Yeah. Yeah, completely. People that build on top obviously can monetize that, in a way. But yeah, I think this idea of being a platform is just a different model, right? It’s not about creating a purpose-built product that I will sell for revenue. It’s a platform where other people can build on top and make revenue, but also strengthens your own business, too, right? It’s not completely for nonprofit. There is a business strategy there, but the business strategy is much more aligned with consumer interest and consumer value creation than in this zero sum game, which unfortunately our healthcare system has developed into, with the disintermediation that we’ve seen, with the buyer being different than the end consumer.

Maz Brumand (38:49):

So when you’re actually designing a product, natural incentives will make it so that you’re designing it for the buyer, not the consumer. So you end up creating a product and optimizing features for the buyer that has certain interests, but then you expect the end user, which is a different person, to want to use it. That’s how you end up with klugey products that nobody wants to use, right? So nobody loves using a product that was created for an insurance company as a consumer. So I think this changes that dynamic completely.

Harry Glorikian (39:20):

Oh, yeah. I think had you looked pre-iPhone and apps and so forth, this platform to lay all these other things on top of, just, again, they were either purpose-built or they didn’t exist. So this completely creates a brand new ecosystem for opportunities like Levels and other technologies like that.

Maz Brumand (39:42):

Yeah, definitely. I think Apple’s done a lot of great things, which I’m really proud to be part of and really have deep respect for the company and leadership. The work on research is quite groundbreaking, starting the virtual research, for example, at the scale that it did for the Apple Heart Study and just changed the thinking about research and obviously continue with the research app and collaborating with researchers and then creating platform research kit for other people to do research. It just completely changed the conversation, and I have tremendous respect for the impact that Apple has had in this space and will continue to have.

Harry Glorikian (40:27):

Yeah. The conversation I always have with people is when we were working on a product, we already knew we were going to go for regulatory approval. Everything we were doing, there was no time to play. You had to have it baked where you were going to go from day one, whereas a lot of these companies that are in the wellness space, let’s say Apple, you get a chance to get feedback, adjust, get feedback, adjust. Then if you want to step over the regulatory hurdle, you have a lot of information now to make that play. Historically, the playing was not necessarily easy to do. Getting this data, if you think about billions of users, that’s a lot of data that you get to look at and screen and decide what you’re going to do next before you do it.

Maz Brumand (41:23):

Yeah. I think it’s not that linear within Apple, because very strong privacy stance. So it’s not like you can just grab the data and do whatever you want with it. But I think your general concept is true, right? If you take the idea of these startups and think about, “Okay. I’m going to iterate. I’m going to try a bunch of stuff. I’m going to iterate, and then I’m going to come up with a product and I’m going to go build that,” right? Hypothesis, test, results, building. You couldn’t historically do that enough, right? Then once you do it, it’s locked, right? It’s now locked. You cannot make a change. So even if you found out, let’s say you did that, you created a product, and then things changed, you’re like, “Okay, I can’t [crosstalk 00:42:04]. Sorry, guys. I know you really want that feature, but it’s not going to happen.”

Maz Brumand (42:08):

So I do agree that it’s just changing the conversation, and the thinking has been fantastic. It’s also really important to say there is a reason why the regulatory space exists and the fact that we do need protections that the FDA others put into place. So it doesn’t take anything away from that. The question is, “How do we create other ways to allow innovation to happen while keeping people safe and in the right lanes?”

Harry Glorikian (42:40):

Oh, yeah. Believe me, I love the FDA. Don’t misunderstand me. I think they definitely have to play their role, right? But on the other hand, I love the fact that you can actually interact with someone, get data, identify signals, be able to iterate on that, and then when you find something really worth moving on that may be beyond wellness, that opportunity has now opened itself up, assuming privacy and everything else is kept under control. But I think the advances that have been made, say, in the last five years have been unbelievable. Some of these things that we’re talking about five years ago were really not available, and now I can manage myself fairly remotely and get a longitudinal view that I can share with my physician that helps him understand my body better.

Maz Brumand (43:42):

Yeah, yeah. I couldn’t agree more. I think this idea that you would have these episodic visits with your doctor and they will not be informed from any of the past interactions or data, it’s just we’ll look back on this in 10 or 20 years and think, “Wow, that was the Dr. [inaudible 00:44:01] of health,” where every interaction is a surprise to the doctor, because there’s nothing informing them other than a paper thing that you filled out, which nobody reads, to make decisions about your health.

Harry Glorikian (44:16):

Yeah. I think about these things. I walk in. I give them a longitudinal view of my whatever I’ve been tracking, and the human brain is amazing at looking at a pattern and seeing something that’s out of line. If it looks normal, they just go, “Hey, that looks great,” and move on.

Maz Brumand (44:32):

Yeah. Also, we know … Obviously, you being in this space for a long time, we all know a lot of the research is also done in perfect situations, and it’s done on a cohort that’s probably not representative of the entire world. So yeah, I think it’s both things. I think one is if it’s not out of the normal, which is probably a large standard deviation, it gets passed through, and then also if we just don’t know because we didn’t have the tools to research the way that we’re doing research today, and this is my point about Apple changing also thinking about research, not being 30 people in the Northeast that we studied and then came up with a guideline for the entire world, right? This doesn’t work that way.

Maz Brumand (45:17):

So yeah, I think there is a lot. I think we’re in the early innings of really changing health and healthcare, not just Levels, but everybody, I think the big players, us, the healthcare systems, the payers, and it’s a pretty exciting time. You asked me the question of why did I leave Apple to come do this, is because there’s just so much interesting stuff going on. It is the time to actually make those leaps in collaboration with people like Apple and then hopefully one day also with the payers and the providers.

Harry Glorikian (45:50):

Yeah, no, and I think their world is changing, too, just because now we’re moving more towards paying for outcomes as opposed to I pay you for everything that you do.

Maz Brumand (46:01):

Yeah, yeah. Medicare Advantage being a good example, right?

Harry Glorikian (46:05):

So anything else that I didn’t ask you that you’re burning to tell us about Levels, or do you think we covered it?

Maz Brumand (46:17):

I think you covered most of it. I think there’s just so many things to talk about in this space that we could probably go on forever if you wanted to.

Harry Glorikian (46:28):

Yeah, no, I’ve been trying to convince people that are interested in health, wellness, energy, optimum performance that having a CGM and getting a good feel for what’s the right food, when to have it, what happens, measuring it, et cetera and being able to give them the right feedback, being able to give them maybe an alternative food so they don’t have to give up something necessarily that they really like, those are all important feedback loads to give them.

Maz Brumand (47:00):

Yeah, and you bring up a really good point, because a lot of people think if they want take control of their health, whether lose weight or whether to feel better, they have to make these massive changes. They’ve got to stop eating all the foods that they like. They’ve got to go to the gym two hours a day. My personal CGM experience has shown me the opposite, where there was just a few tweaks I needed to make to change the outcomes completely. The reason I was doing the things I was doing, it wasn’t because I was like, “Hey, that’s my cheat, and I really won’t care and I enjoy that.” Some of the stuff, I didn’t even care about it. I really didn’t think that oats is so much better than eating eggs in the morning. That was not. But science, the best available science at the time said eggs are bad for your cholesterol and oats are heart-healthy.

Maz Brumand (47:49):

So a lot of it is also just figuring out based on real data that’s personalized to you, “What are those small changes that I can make that will completely change my life?” That’s what’s magical about this technology. It’s not somebody writing a hypothesis piece about a general population that makes no sense with your lifestyle, but instead figuring out, “Okay, based on you, your physiology, and your lifestyle, how can I help you?”

Harry Glorikian (48:19):

No, yeah. My new book just came out on how to incorporate technology into your life, and I always tell people, I’m like, “Pick one, your scale. If you see the line going in the wrong direction, maybe it’s time to course-correct,” right? Or a wireless blood pressure cuff, right? Blood pressure is one of those things that sneaks up on most people. They don’t see it until it’s too much of a problem. Well, if you notice that it’s moving in the wrong direction, right, maybe you’ll lose some weight. Maybe you won’t add as much salt. These aren’t huge changes, because you’re trying to do it early enough that you affect where the line is going. So a CGM is the same thing, in a sense. If you have enough of these in your arsenal over time, I think you can do a pretty good job of managing at least extending how healthy you’ll be for how long.

Maz Brumand (49:13):

Yeah. I’ll explain how we think about this. So we look at certain metrics or biometrics or information from your body. You can think about [inaudible 00:49:25] law that are high frequency and give you feedback. Let’s just call them feedback metrics for a second, right? These are things that … For example, my glucose, when I see that move in real time, high frequency, I can change my behavior. These are all high frequency, completely correlated to your behavior and short-term outcomes. Then there are other metrics that are much lower frequency, meaning you don’t take them all the time, but are really representative of your health, right? Which is, for example, “Is my A1C below or above a certain amount? Is my blood pressure below a certain amount? Is my waist circumference below a certain amount?” That really shows you the outcome.

Maz Brumand (50:08):

Then the question is, “How can I influence behavior by measuring these feedback metrics today and based on the science and correlations that we know leads to better target metrics or health metrics in the future?” So that’s the framework, where health, effect, behavior today with high frequency metrics to drive better outcomes with lower frequency, more outcome-driven metrics in the future.

Harry Glorikian (50:37):

Yeah, no, and I totally agree. It really is going to come down to the data that you’re putting in, the way the software does its analytics and then communicates back with the individual, because some of this has to be put into normal speak, as opposed to sometimes when you talk to a physician, they’re using acronyms and a language that most people can’t necessarily easily understand.

Maz Brumand (51:03):

Yeah. Yeah, definitely. I think there are three problems probably to solve to really get to mass market. I think one is the hardware, software, making the software more intuitive, more insightful, the hardware cheaper, less intrusive, so on and so forth. I think the second problem is the research problem, right? How can we actually understand these realtime metrics better and its correlation to long-term metrics, and what are the best ways to influence behavior? So there’s a big research component there, given that a lot of these things are new. Then the third one is the social aspect of it to make sure that people understand it, providers understand it, payers understand it. So how can the ecosystem adopt this new way of thinking and new way of affecting health among us? So I think you have to have all those three to really make a big impact at the much larger scale than the early adopters.

Harry Glorikian (51:58):

Yep. Nope, couldn’t agree more. Maz, it was great having you on the show.

Maz Brumand (52:03):

Thanks, Harry.

Harry Glorikian (52:04):

I wish you and the rest of the Levels team good luck in this upcoming launch, and I should probably go get another CGM and tack it on and see what’s changing over time.

Maz Brumand (52:18):

Sounds good. Thanks, Harry. It was a pleasure.

Harry Glorikian (52:20):

Thanks.