Josh Clemente, Co-Founder of Levels: A Masterclass on Metabolic Health, The Next Frontier in Real-Time Health Optimization

Feedback loops are important in your relationships and career. So why not in your diet, too? In this episode of Outliers, Levels founder Josh Clemente breaks down exactly why our small daily choices have such a big impact on our overall health. He’s also developed a way to measure and view that dietary feedback loop in real time: with Levels biowearables that monitor blood glucose. Josh shares the Levels origin story (it started when he was an engineer at SpaceX) and explains why stress, sleep, and lifestyle impacts can all become clear when using Levels.

Show Links

• Check out Levels
• Follow Levels on LinkedIn or Twitter
• Connect with Josh Clemente on LinkedIn or Twitter
• Check out Outliers
• Connect with Daniel Scrivner on LinkedIn or Twitter

06:06 – The Levels origin story

Despite being a CrossFit trainer, Josh started seeing his energy dip and fatigue hit almost every day. This is when he found out that he was prediabetic and that diet was key to health and that everyone needs CGM to measure their metabolic fitness.

“I got to a point in my life support program where I now had a team and I’d been there for five years, and I was at the point where I needed to perform at my best. That burnout had set in. Mentally and physically, I did not feel like I was performing and certainly at the worst timing. It was when it mattered most to me. Delivery was so important, not just for me, but for everyone who was working with me. I was having these episodes, my mood would fall out from underneath me. I would be irritable, dead tired. I’d want to sit down and go to sleep. And that’s all I wanted to do. It was a true struggle to get through a workday. And I had just had not ever experienced that. Separately but related, I’ve always been a physically fit person. I’ve been active my whole life playing sports. I was a CrossFit trainer at this time and it was a side thing I did just to stay in shape. I was physically in shape. My doctor would laugh at me every time I would come in to get blood work done. It’d be like, if you knew some of the people that came through this door, you wouldn’t worry about these things. You’re one of the fittest people I see. The philosophy I had was that fitness was health. When this happened to me, this burnout, I became brutally aware of the fact that there’s clearly something off here. I should feel healthy. And yet I don’t. So that started a process of self-exploration or experimentation that coincided with my work at space X, but ultimately led to discovering metabolic fitness, glucose monitoring, and now has become Levels.”

08:45 – Is a calorie just a calorie?

The body processes glucose and fat differently. A study has shown that mice metabolizing fat molecules were able to withstand oxygen toxicity for five times longer than mice metabolizing glucose.

“So I found this paper from Dom D’Agostino, who’s a ketogenic researcher at the University of South Florida, and it basically showed that in mice or rodents, when they’re on a ketogenic diet or when they’re in a ketogenic state, and I can explain what that is in just a moment, but essentially they’re metabolizing these fat molecules instead of sugar, and they can live up to five times longer in the same environment when in this ketogenic state. And to say that shattered something in my consciousness is to understate it. I had to reread it five times because, to me, a calorie is a calorie. Something that you metabolize is just a calorie, it’s energy and what you eat does not matter. So that was what I believed. It was what I had been taught my whole life. To see that there’s actually a physiologic change that allows these rodents and I’m extrapolating to humans, but allows this organism to develop essentially superpowers by eating something different was something I couldn’t wrap my head around. So that actually is the moment that I started to think, wait a minute, what if I’m doing the wrong thing? What if I’m just eating the wrong things?”

10:40 – Fueling the brain

Most fat molecules don’t dissolve in water and therefore can’t cross the blood-brain barrier. However, ketones can cross that barrier and be used by the brain for energy.

“Our bodies turn our food and environment, like sunlight, into energy. Every cell in every tissue in your body requires energy to function and to survive. So this is happening in orders of magnitude we can’t even comprehend all the time. The primary fuels that our bodies use for these metabolic processes are glucose, which is sugar, and fat. Inside a fat, if you click into that, there are different types. So most fat molecules don’t dissolve in water. They can’t cross this barrier that’s around the brain called the blood-brain barrier. But ketones are a specific type. They’re basically a repackaged fat molecules that can cross the blood-brain barrier. It’s a specific fat that your body can produce. It can be used by the brain for energy. So it’s a very unique molecule and most people are not producing ketones unless they’re deliberately doing something like either fasting for extended periods or eating a super high-fat diet, like 80% of your calories are coming from fat. In those circumstances, your body kicks into this mode called ketogenesis, where it’s basically breaking down the nutritional fats and the adipose tissue on your body and turning it into ketone molecules.”

13:57 – The insulin resistance process

The body becomes resistant to even things it likes. That’s exactly what happens when there is too much glucose in the body and there is more and more insulin needed to process it.

“Imagine a situation where you’re constantly eating a high carbohydrate diet that is also high in fat. So insulin is circulating in the blood and it is preventing anything from being burned. It’s basically only storing. You’re in a situation now that you can store the energy that you’re consuming, but you can’t access it for energy because insulin levels are high. This is a situation that can, for many people, go on basically daily for decades, and ultimately, when you are in this, what’s called hyperinsulinemic state where insulin is always high, your cells eventually get to a point where they stop responding. The mechanisms are hard to explain, but just imagine as you walk into a kitchen and there are freshly baked cookies. You smell that. It’s a very strong smell. And then 20 minutes later, you’re no longer aware of the smell. So your body has sort of adapted to the environment and is no longer sending that strong aroma, even though it’s still there. This is how I would describe the insulin resistance process, where insulin is so high all the time that your cells tend to essentially desensitize to it.”

17:30 – The compounding and quiet process of metabolic dysfunction

There is no feedback loop between eating and the impact it has on the body. Because the symptoms of metabolic dysfunctions like fatigue are so easy to overlook, most people realize there is a problem when they are well into the deep end.

“Levels answers to the question: what should I eat and why? If people sit down and I ask what you’re about to eat lunch, what are you going to eat, and why, most people scramble. They start, well, I’m going to eat what I ate yesterday, or I’m going to eat this thing that I read on the internet that this person I trust said, or my mom said. It’s typically emotion-driven or flavor-driven. It’s never data-driven. I have no examples of someone who’s using data to drive their choices and typically that’s okay. But the reality is that in modern times where we essentially have an extremely processed food supply, we don’t have a feedback loop between the actions we’re taking, the foods we’re eating, and their effects on our health, it’s very easy to go way off in the deep end, through this compounding and quiet process of developing metabolic dysfunction. The reason this is so critical is if we look at the state of things today, here in the United States, a study was conducted by the University of North Carolina in 2018 that showed that 88% of US adults are metabolically unhealthy on at least one metric and 70% of people are overweight or obese. 90 million Americans are pre-diabetic and 84% of them don’t know they are pre-diabetic. So 70% of that 90 million Americans are likely to get type two diabetes. It’s one of the top causes of morbidity in the United States within five to 10 years if they don’t change something now. How are you going to change something if you don’t know there’s a problem?”

27:07 – The fat gain moments in your day

Every stressful moment in the day causes a spike in blood sugar and stops the body from burning fat. Even time we allow stress to build, we are creating moments of fat gain in the body

“I started to see this happening repeatedly throughout any stressful moment. I started to see these elevations and some of them were small and some of them were huge. I started looking into the mechanism and the mechanism is when cortisol is released, it signals to your liver, you got to escape, we need fuel. And so it essentially stops the action of insulin and you start producing new blood sugar and it just floods your system. Now, the reason that’s important is that for the everyday person, who’s just trying to get through a workday, and for many of us who have weight loss as a primary goal, every time we allow stress to build, we’re potentially introducing a fat gain moment where during that time period we’re producing blood sugar, and then we’re storing that as fat immediately thereafter because we’re not using it for exercise. That mechanism of stress then extrapolates out from just those acute moments to the pervasive chronic stress. This is where sleep comes in. When I started to see the difference in how my body responded, both for my baseline fasting glucose, and to meals specifically after say four hours’ night of sleep or after a red-eye or something like that, versus eight hours of deep rest, it completely changed my approach to sleep.”

34:37 – Getting rid of complexity in health and wellness

Levels is measuring glucose in real-time with CGM. It’s also making the data accessible by processing it into forms that are easy to understand and make decisions based off of.

“Right now our core focus is on improving the actionability of real-time blood sugar information. If you just buy a CGM, which is prescription-only in the United States, and put it on, you’re going to end up getting a raw data stream. It’s going to be like a curve. It doesn’t quite look like a heart rate. It doesn’t change that quickly, but it’s all over the place. Understanding exactly what you’re looking at and what’s influencing it can be somewhat tricky. There’s a ton of variables each of which has been studied separately, that all matter. So Levels is focusing on stripping away the complexity and providing you with the minimal amount of clean, easy-to-use interface that will help you understand the actions you’re taking and how they’re affecting your body. We’ve developed two scores primarily. The first one is called the zone score. So when you’re using Levels, you are logging your activities. Whether it’s a meal you eat or exercise that we can detect through Apple health, or your sleep, all of these things are stacking up into a context like we just touched on. And so when these zones happen close by, or these activities happen close by, we capture that and call it a zone. So let’s say you eat a meal and you go for a walk. We will contextualize both of those. And then track how your body responds over the corresponding, say about two hours. Once your blood sugar returns back to normal, we’ll give you a score just on a one-ten scale for how well that meal or that set of activities affected you. This is a very easy way to get rid of the complexity.”

37:53 – The problems for the chronically stressed

The glucose level in the body drops during the night and there is a spike in the morning to wake the body up. This spike, known as the Dawn phenomenon is much worse for the chronically stressed who get less sleep than the others.

“One of the theories is that while you’re sleeping, you have very minimal energy demands. Your brain is running, but your muscles aren’t and you’re at rest. So your body will typically have a blood sugar drop overnight, and that’s good. But then as your circadian clock senses that you’re about to wake up, there’s a natural flood of cortisol that’s released to get you primed. So to essentially get your blood sugar back up, get your heart pumping and get you on your feet. And this seems to be closely timed with the patterns that people follow for their sleep. Now, the issue is that for someone who is chronically stressed, or it seems to be for some, this may just have gone a little bit errant where you’ll have a huge blood sugar spike and you haven’t eaten anything. This is happening every single morning. And of course, as we know, that’s not something you necessarily want. So the Dawn phenomenon seems to be worse for people who get shorter sleep. And it seems to be worse in some, for people who ate a very indulgent meal the night before. So it could be like you’re releasing more glucose because you had more the next day. It’s very individual, very personal. And the mechanism we know is cortisol, but we don’t know specifically why it’s worse in some than others.”

40:14 – The benefits of the 28 day Levels program

Users are seeing numerous benefits from the program, including restoration of confidence in the food they are eating.

“We’ve had a few examples of people that have really transformed their metabolic health in 28 days. Many of them have turned into subscribers and continued long-term, but we’re talking about across multiple biometrics, not just glucose control. So those are my favorites for sure. Specific examples that I enjoy tremendously are just hearing from people who restore their confidence in the foods they’re eating. A lot of people are really anxious and tend to follow very stringent dietary philosophies because either they’re fearful of gaining weight again, maybe they’ve had a weight gain issue in the past, or they’re just generally afraid of getting a bad outcome health-wise, and they have no confidence because they don’t have the feedback loop. One person I know, she was eating a very strict ketogenic diet for years, and she really missed better diversity in her diet and by using CGM and using Levels, she was able to see that she could stay in a ketogenic state despite eating fruit and having specific vegetables that were more on the starchy side. And all it took was just accurate timing and portion sizing. She’s dramatically broadened her dietary approach while staying in a ketogenic state, which she wants to do for therapy and weight loss. It’s massively improved her quality of life, which it matters just as much as our quantitative risk of illness because again, stress hurts.”

41:39 – Find a lifestyle that works for you

Another example of a satisfied Levels user is a gentleman who gave up oatmeal thinking it was not good for him. CGM showed him that his body is able to process his favorite meal without causing a spike and he went back to happily eating oatmeal.

“Another one is one gentleman, he was using the product and he wasn’t eating oatmeal at all. It was the opposite of the example I gave. He grew up really loving oatmeal. His wife, I think, told him that it was bad for his blood sugar. So he had stopped eating it. And ultimately with Levels, he found out that there was a recipe for oatmeal that by adding some almond butter and some chia seeds, so basically a little fat and fiber, he can make a really hearty meal out of it. His blood sugar was super controlled, and specifically, if he worked out just prior. He basically wrote us a long note that said, ‘I stopped eating this out of fear. It was always my comfort food my mom gave me growing up and this has allowed me to live the lifestyle I had hoped for and do it in a way that is healthier and fits with my goals.’ I just love those examples. There are so many of them, whether it’s just finding out that sourdough bread works better than potato bread or white bread, being able to navigate all of this complexity and have ultimately a lifestyle that is even more enjoyable than you might’ve assumed you could get.”

Daniel Scrivner:

Welcome. I’m Daniel Scrivner and this is Outliers where every week I sit down with an entrepreneur, investor, or iconoclast to dissect what they’ve mastered and how they see the world. Digging deep to find the ideas, patterns, and perspectives that can help us all become better entrepreneurs, investors, and leaders. And today, we’re incredibly lucky to have Josh Clemente on the show for our second Outliers Masterclass. Once a month, we highlight someone who has mastered a meta-skill or insight, something that can help us all perform at an even higher level.

Daniel Scrivner:

Today’s masterclass is all about sugar or more accurately, glucose, and how it shapes our health and metabolism. Before founding Levels, Josh was the lead life support systems engineer at SpaceX. And one day while doing research, he came across a startling study that would change his life forever. Josh is the founder and president of Levels, which is revolutionizing the world of individualized health. Levels combines an off the shelf glucose sensor with an iOS or Android app that you use to log everything that you eat and do. It then provides a simple score that captured how each meal and activity positively or negatively affects your own individual metabolism and glycemic index. All to help you better understand how your own body works and reacts to everything that you do.

Daniel Scrivner:

Josh shares how Levels helped him find out he was nearly pre-diabetic, even though he’s a CrossFit trainer and looked and felt incredibly healthy. We go deep on what glucose is and why it matters. How our choices shape our metabolism moment to moment, how a little activity after a big meal can have a big difference and how it affects our bodies, and how to improve everything from your sleep to overall energy level with personal insights from Levels. It’s an incredible episode.

Daniel Scrivner:

As always, for links to everything discussed, as well as the show notes and the full transcript of our conversation, visit outliers.fm. And finally, here’s the bit where I remind you that nothing we discuss should be considered medical advice. This conversation is for informational and hopefully entertainment purposes only. Please do your own research and come to your own conclusions or speak to your doctor before putting anything we discussed into practice. With that, let’s jump in.

Daniel Scrivner:

Josh, thank you so much for your time. I’m so excited to chat with you today about all things metabolic health and Levels and glucose and chat about it all.

Josh Clemente:

Daniel, thanks for having me on. I’m stoked to dig into it.

Daniel Scrivner:

So, it’s been so much fun preparing for this interview and doing all of my kind of homework and research and listening to some of your previous interviews. And I thought a neat place to start, and I know it’s only tangentially related, would just be talking about some of what you did at SpaceX before founding Levels. Can you share a little bit of your background and what you did there?

Josh Clemente:

So, my background is in mechanical engineering. I had a fascination with vehicles of all kinds or anything that goes fast when I was younger. And so that mechanical engineering was my way of working on those things. And, ultimately, I ended up at SpaceX after school as my first engineering job. You can’t really ask for a better kind of initiation into the world of-

Daniel Scrivner:

Seriously.

Josh Clemente:

… machine. Yeah. So, I spent about six years there. I did a bunch of different stuff. I started out as a manufacturing engineer, essentially trying to get the Dragon spacecraft from kind of a first article prototype to multiple sort of production processes so that we could make this spacecraft at rate. And then from there, I moved into more systems responsible engineering. We call it at SpaceX, which is like, you are kind of a project manager. You own everything from the design through to flight. And so, that system and everything it touches has to work and it’s your responsibility to make it happen.

Josh Clemente:

And then lastly… I maintained that role, but moved into the new life support program that SpaceX was starting. So, initially, it was just a launch company, meaning you basically put a satellite on the top of this giant candlestick and put it into orbit. That’s your job. And so, that’s easy enough. If something goes wrong, there’s insurance for satellites, but once you start carrying humans, it becomes a whole different beast. And you can imagine like… Think about everything that airlines have to do with the FAA to fly around on planes that can glide to a landing basically anywhere. Now, imagine that it’s a giant explosive 10-story, tall building, and those people don’t really have many options if things go wrong. So, it was kind of a redesign of the whole systems approach we took at SpaceX, and I got to be one of the first to work in that program and eventually led a team developing, breathing apparatus and similar life support projects for astronauts.

Daniel Scrivner:

Sounds incredible. And if you like to work on fast stuff, it seems that you can’t really beat working on a rocket.

Josh Clemente:

No, you can’t.

Daniel Scrivner:

So, it’s a good place to start. So, I know part of your story, as I understand it, part of the kind of founding story of Levels is based a little bit in your experience working at SpaceX. And I’ve worked for a couple of startups. And obviously I would probably bet that SpaceX is a little bit more of a challenging environment, but I know the idea of work-life harmony work-life balance just does not exist and you’re working really long hours and… Yeah, you’re just often not taking much care of yourself. So, can you talk a little bit about what a day in your life looked like then and how that eventually led to you founding Levels?

Josh Clemente:

I like starting with the day in the life. So, looking back, days bled together. I literally lived work at that time. And SpaceX set up an environment where you really could live at work if you wanted to. It was not so far as Google where you had rooms available, but there was always space under your desk to crash, and there was food downstairs. And so, many of us who were young and were trying to prove ourselves and honestly had more responsibility than we could ever have imagined, just leaned in. And so, I really didn’t take a break. I don’t think I took a weekend off even for several years continuously and rarely went home for holidays. I would go home for Christmas Eve and Christmas Day, that sort of thing. And the rest of it was just immersed in work.

Josh Clemente:

And for a long time, that’s phenomenal and you love it. And then something changes where I think the toll that it takes to constantly be on starts to set in. And I kind of assumed the type of person that I am is, “That would never catch up with me.” It was something I enjoyed and the payoff of having a project you work on, go into orbit, and seeing that happen was like nothing I’d ever experienced. So, I just kind of leaned into those moments and struggled through the rest. But long story short, I got to a point in my life support program where I now had a team, I had been there for five years, and I was at the point where I needed to perform at my best. And that burnout had set in. So, mentally and physically, I did not feel like I was performing and certainly-

Daniel Scrivner:

It’s like the worst timing.

Josh Clemente:

Exactly. The worst timing. And it was when it mattered most to me. Delivery was so important, not just for myself, but for everyone who was working with me. And I was having these… They were truly episodes. I mean, it was like my mood would fall out from underneath me. I would be irritable, dead-tired. I’d want to sit down and go to sleep. And that’s all I wanted to do. And it was a true struggle to get through a work day. And I had just had not ever experienced that. And separately, but related, I’ve always been a physically fit person. I’ve been active my whole life playing sports. I was a CrossFit trainer at this time and it was kind of a side thing I did just to stay in shape. And I was physically in shape. My doctor would laugh at me every time I would come in to get blood work done. He’d be like, “If you knew some of the people that came through this door, you wouldn’t worry about these things. You’re one of the fittest people I see.”

Josh Clemente:

And that was the philosophy I had was that fitness was health. And so, when this happened to me, this sort of burnout, I became brutally aware of the fact that there’s clearly something off here. I should feel healthy and yet I don’t. So, that started a process of self exploration or experimentation that kind of coincided with my work at SpaceX, but ultimately led to discovering metabolic fitness, glucose monitoring, and now it has become Levels.

Daniel Scrivner:

And I know there was this pivotal research paper… And I’m blanking on it. I think it’s Dominic D’Agostino.

Josh Clemente:

That’s right.

Daniel Scrivner:

But can you talk a little bit about what that felt like to kind of discover that paper and then the path that led you off on?

Josh Clemente:

I was basically in charge of the development of an oxygen breathing apparatus. So, delivering oxygen, breathing gas into the Dragon spacecraft, and then also to the space suits for the crew members to breathe. And there are certain scenarios that you need to be aware of when you’re designing these systems that would be failure modes. And so, one of these situations was like, “What happens when or if there’s high pressure oxygen delivered to the spacecraft?” What can happen in these situations? So, I was researching this and essentially there are central nervous system issues where if you’re in a high pressure oxygen environment, even though we all breathe oxygen, if it’s too high, that’s so reactive a molecule that everything becomes fuel. And so, your brain can literally become this. They call it central nervous system toxicity, but essentially you’re developing these reactive oxygen species, these byproducts of reactions happening with the oxygen that can really destroy your brain tissue very quickly, and you can go into seizure and you can even die.

Josh Clemente:

So, I found this paper from Dom D’Agostino who’s a ketogenic researcher at the University of South Florida, and it basically showed that in mice or rodents when they’re on a ketogenic diet or when they’re in a ketogenic state, and I can explain what that is in just a moment, but essentially they’re metabolizing these fat molecules instead of sugar. And they can live up to five times longer in the same environment when in this ketogenic state. And to say that, that like shattered something in my consciousness is to understate it. I had to reread it like five times because to me a calorie is a calorie. Something that you metabolize, it’s just a calorie, it’s energy, and what you eat does not matter. So that was what I believed. It was what I had kind of been taught my whole life. And to see that there’s actually a physiologic change that allows these rodents, and I’m extrapolating to humans, but allows this organism to develop essentially superpowers by eating something different was something I couldn’t wrap my head around.

Josh Clemente:

So, that actually is the moment that I started to think, “Wait a minute. What if I’m doing the wrong thing? What if I’m just eating the wrong things?” Or rather if I could have superpowers because of what I eat, I’d like to make sure I am. So, that’s where I started to explore human metabolism, explored diet nutrition, general wellness practice as an avenue to potentially improve my own. As I mentioned, flagging energy levels and overall disposition.

Daniel Scrivner:

And you touched on there just the… Whether it’s ketogenic or ketosis. And I know there’s a lot of terms that people potentially have heard or haven’t heard, but can you just set up for people, I guess, what is ketosis? What is your body processing and how is that different and distinct from kind of glucose in your blood?

Josh Clemente:

Yeah. So, actually, I’ll remind even a little bit before that and talk about metabolism. So, metabolism, we kind of talk about this all the time in society, but most people are in the context of “I have a fast or a slow one based on if I gain or lose weight,” but the actuality of it is a metabolism is all of the processes our bodies use to turn our food and environment like sunlight into energy. And every cell and every tissue in your body requires energy to function and to survive. So, this is happening in orders of magnitude we can’t even comprehend all the time. And the primary fuels that our bodies use for these metabolic processes are glucose, which is a sugar, and fat.

Josh Clemente:

And inside a fat, if you click into that, there are different types. So, most fat molecules don’t dissolve in water. And so, they can’t cross this barrier that’s around the brain called the blood-brain barrier, but ketones are a specific type. They’re basically a repackaged fat molecule that can cross the blood-brain barrier. So, it’s kind of a specific fat that your body can produce and it can be used by the brain for energy. So, it’s a very unique molecule.

Josh Clemente:

And most people are not producing ketones unless they’re deliberately doing something like either fasting for extended periods or eating a super high-fat diet. So, 80% of your calories are coming from fat. And in those circumstances, your body kicks into this mode called ketogenesis, where it’s basically breaking down the nutritional fats and the adipose tissue on your body and turning it into ketone molecules.

Daniel Scrivner:

That’s pretty incredible. I guess, in terms of how your body processes that or how that… I mean, I’m guessing… We’ll get to this in a little bit, but is that a gentler fuel source for your body as compared to something like glucose?

Josh Clemente:

Well, it’s a different fuel source. And that’s really what all of this research, and ultimately what Levels is working on is that we’ve now got the data we need to recognize that all calories are not the same. So, there are these different molecules. I just laid out three of them. The fourth sort of macro-nutrient is protein. So, we’re basically consuming fat, sugar, and protein every day. And each of those molecules has a completely different implication for our metabolic processes. And those implications are hormones. So, when you consume, you just think of the human body as a giant chemistry set because that’s ultimately what we are. And what you eat is just like pouring chemicals into the chemistry set. So, when those chemicals arrive in the bloodstream after being digested, other chemicals have to respond to them. These are signaling molecules, and these are hormones that are basically marshaling resources.

Josh Clemente:

So, for example, with glucose, the glucose is the primary energy molecule in most modern people. So, most of us are well-fed all the time, we’re sedentary. And so, what we eat typically contains carbohydrates. Those breakdown into the bloodstream and the way the body gets those out of the bloodstream is through this hormone called insulin. And insulin’s purpose is to store things. The way it works is… It’s like a key in the lock of every cell. So, these cells have receptors. They identify insulin. When insulin attaches to them, they open up these transporters and glucose moves into the cell to be used for energy.

Josh Clemente:

Now, insulin, we call it an anabolic hormone because it is primarily focused on storing things. And when you have high levels of insulin, your body is constantly storing the glucose that’s being released into your blood, and turning it into body fat. Now, the difference is, for fat, there is no insulin response. So, fat can be readily stored on the body without hormones. And it can also be readily metabolized as long as there is no insulin in the blood. So, imagine a situation where you’re constantly eating a high carbohydrate diet that is also high in fat. So, insulin is circulating in the blood and it is preventing anything from being burned. It’s basically only storing, and you’re in a situation now that you can store the energy that you’re consuming, but you can’t access it for energy because insulin levels are high. This is a situation that can, for many people, go on basically daily for decades. And ultimately when you are in this, what’s called hyperinsulinemic state, where insulin is always high, your cells eventually get to a point where they stop responding.

Josh Clemente:

The mechanisms are hard to explain, but just imagine like you walk into a kitchen and there are freshly baked cookies. You smell that. It’s like a very strong smell. And then 20 minutes later, you’re no longer aware of the smell. So, your body has sort of adapted to the environment and is no longer sending that strong aroma, even though it’s still there. This is how I would describe the insulin resistance process, where insulin is so high all the time that your cells tend to essentially desensitize to it. And the problem is that you’re now in what’s known as an insulin resistant state, which is where things go haywire. So, insulin is constantly elevated. You can’t oxidize or use the fat that’s on your body for energy. And you’re basically locked in this energy crisis where when you need energy, you can’t get it because you’re blocked and where you can only add energy for brief periods of time as you spike your blood sugar and in the period between that spike and when it’s sort of marshaled into fat stores.

Josh Clemente:

So, anyway, all that to kind of describe the hormonal differences between the macronutrients we’re eating. Carbohydrates signal insulin release, fat does not. And so, that’s a very big deal, especially in modern society where we’re experiencing such high rates of metabolic dysfunction.

Daniel Scrivner:

And I want to come to that in a second. That was a fascinating analogy. I love that cookie smell example. So, I want to just stop for a second and I guess transition and talk a little bit about what Levels is, and I’ll try to tee it up and you can take it from there and help flesh it out a little bit more. But my understanding of it, I’ve been trying it recently, is it’s basically an app that pairs with a sensor. That sensor is, I think, a constant glucose monitor that’s always in your body. And it allows you to basically have a feedback loop where you’re able to see how your choices and your actions influence that glucose level. And what’s fascinating about it, which I definitely want to spend some time talking about is, there are a lot of inputs into what that level looks like. It’s not just what you eat. It’s the level of activity, when you have that activity, how you manage your stress. Do I have that right? And can you, I guess, that flush that out any more about what Levels is?

Josh Clemente:

My summary I like to use is Levels answers the question, “What should I eat and why?” If we think about it, if most people sit down and I ask, “You’re about to eat lunch. What are you going to eat and why?” Most people scramble. And they start thinking, “Well, I’m going to eat what I ate yesterday,” or “I’m going to eat this thing that I read on the internet that this person I trust said.”

Daniel Scrivner:

Or “What sounds good.”

Josh Clemente:

Or “This thing my mom cooked.”

Daniel Scrivner:

Yeah.

Josh Clemente:

Yeah, it’s typically emotion driven or flavor driven. It’s never data-driven. I have no examples of someone who’s using data to drive their choices. And typically that’s okay, but the reality is that in the modern times where we essentially have an extremely processed food supply, we don’t have a feedback loop between the actions we’re taking, the foods we’re eating, and their effects on our health. It’s very easy to go way off in the deep end through this sort of compounding and quiet process of developing metabolic dysfunction.

Josh Clemente:

And the reason this is so critical is if we look at the state of things today… Here in the United States, a study was conducted by the University of North Carolina in 2018 that showed that 88% of US adults are metabolically unhealthy on at least one metric. And 70% are overweight or obese. 90 million Americans are pre-diabetic. And 84% of them don’t know they are pre-diabetic. That 90 million, so 70% of them are likely to get type 2 diabetes. It’s one of the top causes of morbidity in the United States within five to 10 years if they don’t change something. Now, how are you going to change something if you don’t know there’s a problem? Remember, 84% of that 90 million don’t know they have it. So, this is a silent epidemic that is building and it’s reached literally epidemic rates. And it’s slowly moving down our age brackets. It’s reaching younger and younger audiences every year.

Daniel Scrivner:

Which is depressing.

Josh Clemente:

Yeah, it’s a sad state of affairs. And I think it all comes back to this problem of “There is no feedback loop.” We’re making choices based on emotion and on flavor, or potentially, we’re adjusting things by trial and error based on, say, how the bathroom scale is changing. Like, “Oh, I gained 15 pounds this year. That’s not good. I should probably change something about what I’m eating for lunch.” Well, that’s a really long feedback loop. A year is too much time to figure out which lunch is causing the problem. So, the philosophy that is driving levels is that we can use real-time biometric data. In this case, your actual blood sugar levels, your glucose levels to close the loop within minutes between an action you take and the reaction your body’s experiencing. And there are implications to all those reactions. So, if we’re measuring glucose, we can assume the results in terms of insulin. So, if you have a large blood sugar elevation, we know physiologically that you need insulin release in order to move that out of the bloodstream. And so, there’s likely a large insulin response.

Josh Clemente:

So, with the sort of real-time predictions based on your biometric analytics, we can help you understand how a specific nutritional decision is affecting you within minutes. And that is a powerful thing for driving behavior change. So, the level system is, again, focused on using these biometric sensors, which I can give some history on if that’s useful, connected with a behavior change platform, which is what we’re developing. It’s the sort of analytics layer, the detailed data science that is helping to drive decision-making through simplified scores. So, rather than trying to tell you, “Your glucose variability is X% and your postprandial response is moving at X rate per minute.” Instead, we just say, “That meal was a two out of 10. And here are some recommendations on how you could potentially improve it.” Something as simple as taking a walk or a swap on a certain nutritional ingredient. So, that’s the direction we’re moving in. It’s just simplifying and helping to remove the cognitive burden of interpreting complicated glucose information.

Daniel Scrivner:

I never [inaudible 00:20:09] become a doctor of some sort to try to figure out how to change your behaviors. So, the stats are scary. One of the things that I thought was pretty incredible, again, going back to your story is via using Levels, you actually found out that you were borderline type 2. Can you talk a little bit about what that was like figuring that out?

Josh Clemente:

Yeah, we skipped right past that. After that paper that kind of shocked me into a realization that I needed to take the other parts of my lifestyle seriously, I started to prick my finger obsessively to measure blood sugar. And this was basically having an understanding of where our energy is coming from. I knew that glucose was one of the primary molecules and you can go to CVS and you can buy these finger prick devices where you can basically take a blood drop and get a single measurement. So, I started to do that and plot these numbers in Excel. And it was kind of a point cloud. It didn’t really make any sense to me. I was very unsophisticated what it should look like anyway.

Josh Clemente:

Anyway, I read a book called Wired to Eat by Robb Wolf. And in this book, he talks about this new device called a continuous glucose monitor. And I was like, “Wow. You can just wear this thing continuously and it’ll give you your blood sugar information.” So, I asked my doctor for one and he said, “That’s for people with advanced uncontrolled diabetes. It’s not even for people with just diabetes. It’s the worst cases. And you definitely [inaudible 00:21:25].”

Daniel Scrivner:

And it’s not for experimenting.

Josh Clemente:

Right. “This is not for you to play with.” And when I came away from that… Well, I can circle back on that. But ultimately I did get a device. And when I had about two weeks of data, I had enough information to know that my glucose was in the pre-diabetic range at least, and was borderline. It was touching the diabetic zones regularly. And the scary thing was that I was doing things at this point that I thought were all healthy. I was working out regularly. I was eating whole foods. I was sticking with brown rice instead of white rice. I was having sweet potatoes. I was having-

Daniel Scrivner:

All the things.

Josh Clemente:

… green vegetables in every meal. Yeah. And so to see how bad things were… Essentially within a month, I had changed everything about my lifestyle and it has sustained since then. So, I mentioned I was a calorie type person. Once I saw how brown rice affected me, I haven’t touched candy, which I used to be addicted to in years. And literally three years since putting this device on because the realization that the effects of my daily decisions were compounding together, and I was heading in a very bad direction very quickly, was all I needed. I wasn’t trying to get unhealthy. And I wasn’t willing to compromise a short-term reward of taste for a snack with the ultimate potential consequences of getting a truly diagnosable disorder. So, that experience of understanding or identifying that I had this kind of latent unknowable borderline or full-blown pre-diabetes, and then looking into it and realizing, “I’m not a needle in the haystack. I’m a needle in a stack of needles.” Like everyone is pre-diabetic effectively.

Daniel Scrivner:

Sure.

Josh Clemente:

And this is a huge problem. And then, yeah, the device helping me get out of it.

Daniel Scrivner:

That story is incredible. In part, just because it just goes to the core of, I think, what’s so broken with how we think about health. You alluded to a few times, but just to reiterate it, you look incredibly healthy, and you’ve always been active and you took all those popular diet to kind of ideas and were implementing those. And so, clearly, there’s… I think what’s powerful about Levels is it tells you your internal health as opposed to just your external health of how are you looking, how are you feeling, how much do you weigh? It’s just really incredible.

Daniel Scrivner:

So, one of the things that I wanted to talk about a little bit is just surprising discoveries or insights. Clearly, you talked about brown rice there. And I remember reading something maybe a month ago about just how much sugar and rice, which for me, was also like, “Oh my God, there’s sugar in rice.” [inaudible 00:23:43]. But I would love just to riff on that for a little bit. Can you share, I guess, some of either what you’ve learned or what you’ve observed from, I think, at this point, potentially thousands of people that are using Levels you’re collecting data on?

Josh Clemente:

The interesting thing starts day one. So, for me, it was putting this device on and immediately having a feedback loop. It felt like I was in conversation with my body. So, sort of throughout my life, I’ve either had coaches or doctors telling me to eat healthier and work out more. That’s the continuous refrain. And different ones had different opinions about what healthy meant, which fed confusion, of course, as we all are. You Google the healthiest diet, you’re going to get 10 different conflicting answers.

Josh Clemente:

And so, being able to just immediately get a feedback loop from my body was like… It was the first magic moment for me. So, then there was the process of experimentation. And a couple examples that I really like to highlight are… Well, one in particular is the recognition of stress and the role that it plays in overall health, but specifically metabolic function. So, again, we’re these giant chemistry sets. And as I mentioned, hormones have massive roles to play in how we function.

Josh Clemente:

So, there is another hormone called cortisol, which we’re all pretty familiar with. It’s the fight or flight hormone. It’s associated with adrenaline as the fight or flight mechanism. And this is the stress response where essentially when cortisol is flooding the system, your body is in a state of elevated stress. It’s in a position where historically or evolutionarily, we were probably in danger and we needed to escape. And oftentimes that meant needing fuel. So, to run or climb a tree or whatever it was.

Daniel Scrivner:

Probably lots of fuel.

Josh Clemente:

Right. So, I’ll just give an example. I was a few weeks into using the CGM. And I had a really stressful phone call and it was a meeting essentially, but it was a presentation as well. And I did this call and my heart rate I knew was elevated the entire time. And I was just kind of gasping for air throughout. And then I looked at my CGM data afterwards and my blood sugar had gone to 145 milligrams per deciliter, which for people who don’t know, after a carb heavy meal, your body should stay below 140 milligrams per deciliter.

Daniel Scrivner:

Wow.

Josh Clemente:

That’s considered the pre-diabetic threshold. If you respond beyond that, you want to very quickly get out of that range because it’s not good. So, I hadn’t eaten a single calorie.

Daniel Scrivner:

Just to clarify too, what did it start at? What was that climb like in the meeting?

Josh Clemente:

It started at about 85 or 90 milligrams per deciliter.

Daniel Scrivner:

Wow. It’s a huge climb.

Josh Clemente:

Yeah. It was a 50 point change and I hadn’t eaten anything. And at first I thought that wasn’t a problem. And then I started to see this happening repeatedly. Throughout any stressful moment, I started to see these elevations and some of them were small and some of them were huge. I started looking into the mechanism and the mechanism is, when cortisol is released, it signals to your liver, “You got to escape. We need fuel.” And so, it essentially stops the action of insulin and you start producing new blood sugar and it just floods your system.

Josh Clemente:

Now, the reason that’s important is that for the everyday person who’s just trying to get through a workday, and for many of us who have weight loss as a primary goal, every time we allow stress to build, we’re potentially introducing a fat gain moment where during that time period we’re producing blood sugar, and then we’re storing that as fat immediately thereafter because we’re not using it for exercise.

Daniel Scrivner:

Wow.

Josh Clemente:

And so that mechanism of stress then extrapolates out from just those acute moments to the sort of pervasive chronic stress. So, this is where sleep comes in. So, when I started to see the difference in how my body responded, both from my baseline fasting glucose, and two meals specifically. After, say, four-hour night of sleep or a red eye or something like that versus eight hours of deep rest, it completely changed my approach to sleep.

Josh Clemente:

So, for anyone who’s used a CGM… Well, I’ll just give my example. I will get off a plane. After [inaudible 00:27:29], I used to take these all the time. I don’t take them anymore. My blood sugar will be 15 points higher than it was yesterday. And then throughout the day, every meal I eat is aggravated. It’s an exaggerated blood sugar elevation, and I remain higher longer. And so, again, this is a phenomenon that’s been studied in the research environment, and they’ve been able to show that just a single short night of sleep can cause essentially an acute 40% increase in insulin in the body. So, in order to clear the same meal out of your bloodstream, you’ll need 40% more insulin. And going back to the conversation about insulin resistance, that’s not something you want.

Josh Clemente:

So, I started to get this appreciation, which I think is counterintuitive or non-intuitive that this device, that is measuring blood sugar that you think is only associated with food is actually telling you a huge amount about everything you’re doing and the way that your lifestyle is wrapped up into a context. So, combine that with… I’ll give a few food examples here. One of the earliest ones. I was in New York and I was going to another stressful meeting and I stopped right outside the office building, and there was this organic juice cart. It was a pressed juice cart. And they had a drink on the menu called health drink, and that health drink was carrot juice, celery juice, green apple juice. Nothing else.

Josh Clemente:

I watched the lady press it right there. And I drank this during the meeting. And what was funny is everyone in the meeting was commenting on how healthy I was. They’re all having Coca-Colas or they’re having snacks and I’m drinking a pressed juice. Well, halfway through the meeting, I checked my blood sugar and I was well over 200 milligrams per deciliter.

Daniel Scrivner:

Wow.

Josh Clemente:

So, this is well beyond the diabetic threshold, which is 180. You should never exceed that if you don’t have diabetes or at least that’s the standard of care as of today. So, my blood sugar remained up there for some time and came crashing back down. I was starving. I was irritable. I was shaky. All those sensations really from my SpaceX days. And again, this was something that I had actively chosen as a healthy alternative to a Coke or two-

Daniel Scrivner:

It’s called a health drink.

Josh Clemente:

And a lot of people every day are using pressed juice as a healthy option. And so, for many of us, if we are not metabolizing that effectively, that’s as bad or worse than that Coca-Cola. It really depends on how we’re metabolizing. It’s super important to have the real-time context. Another interesting one, I think, for many people is, Google the healthiest breakfast out there, top three, guarantee it, it’s going to be oatmeal. Steel cut or rolled out, it doesn’t matter. It’ll be on the list.

Josh Clemente:

About 60% of the people, 70% of the people, last time we checked in the data set have a pre-diabetic or diabetic response to oatmeal every morning. And that’s just plain oats, no sugar or maple syrup. And you’ll note that on oatmeal, there’s typically a heart-healthy label saying, “This is good for you.” Well, glycemic elevations and variations are both closely connected with risk of cardiovascular disease. So, if people are actively trying to pick this oatmeal breakfast to make themselves healthier or to improve cardiovascular health, it may not be working and it could be working directly against them.

Josh Clemente:

And so, again, I’m not saying that this is the case for everyone, and I can touch on the personalization piece, but it’s certainly important that we, as individuals, are not guiding our choices based on marketing because marketing is not always data-driven. It’s important that we’re connecting them with our own bodies and what’s truly happening.

Daniel Scrivner:

Yeah. And I’d love to talk about that personalization piece because to me that’s the power of technology. That’s the power of what Levels can deliver is rather than, as you alluded to before, putting people into very simplistic, fuzzy buckets of like, “This is the diet for you,” or “What are you after?” “Okay. This is what you should do.” It really takes it all the way down to the individual level. And one example I heard you give that I thought was fascinating is giving two people the same thing, whether it’s a banana and a cookie, and seeing inverse effects there. Can you talk a little bit about that personalization piece?

Josh Clemente:

One of the fascinating things about the tech that’s coming out is that the miniaturization… The micro-electronics revolution is allowing us to make these devices smaller and smaller and more convenient, last longer, more affordable. So, the proliferation of what’s allowing Levels to exist is also allowing better research. And one of the most interesting trials happened in 2015. It was called the Weizmann Institute Trial on Personalized Nutrition. It was published in the Cell journal.

Josh Clemente:

And basically they took 800 people without diabetes, put these continuous glucose monitors on them and had them eat standardized meals for about two weeks. And in this data set, they could show that two people who ate the exact same two foods, in this case, it was a banana and a wheat cookie, had equal and opposite blood sugar responses. So, the inverse effect. And this effect has since been restudied or replicated or bolstered in some way by multiple studies since. One of which was the twins trial in the UK, which showed that the same effect is evident in identical twins who share 100% of their DNA. It’s not just genetics that dictate it. It’s actually more likely the context of our sort of lifestyles.

Josh Clemente:

So, you can imagine if two people are… One of which slept for four hours last night, and one slept eight hours, and one of which has 25% body fat, and the other is primarily lean muscle mass. They have different genetics, [inaudible 00:32:30] microbiome. All of this stacks up into a context for how their metabolic system is functioning. And that context is what Levels cause metabolic fitness. So, this is the degree to which you have developed a context for optimal metabolic function. It’s something that is trainable. You can improve everything from body composition through to your muscle mass, through to stress and sleep quality, but what you can’t do is change your genetics.

Josh Clemente:

So, I think the good thing that we learned from that trial is that this is not binary. It’s not something that you’re stuck with because your parents had it. It’s something that with focus, effort and repetition, you have control over and you can improve just like you can work your way towards benching 300 pounds or you can work your way towards a fast quarter mile. We can do the same with metabolism.

Daniel Scrivner:

One of the pieces that I wanted to talk about for a little bit is… I don’t know. To draw a little bit of a parallel between glucose monitoring and heart rate monitoring and in heart rate monitoring, you’re looking at multiple different variables. You’re looking at everything from heart rate variability, your resting heart rate. I’m guessing that there’s probably a lot of signals that you’re looking at on the glucose side that then derive some sort of simplistic, easy to understand score. Can you, I guess, help us understand those or kind of illustrate some of those.

Josh Clemente:

We do pull in additional data in addition to glucose, which includes heart rate and sleep. But right now our core focus is on improving the actionability of real-time blood sugar information. If you just buy a CGM, which are prescription only in the United States, and put it on, you’re going to end up getting this sort of raw data stream. It’s going to be like a curve. It doesn’t quite look like a heart rate, it doesn’t change that quickly, but it’s kind of all over the place. And understanding exactly what you’re looking at and what’s influencing it can be somewhat tricky. There’s a ton of variables, each of which has been studied separately, that all matter.

Josh Clemente:

So, Levels is focusing on stripping away the complexity and providing you with the minimal amount of clean, easy to use interface that will help you understand the actions you’re taking and how they’re affecting your body. So, the two scores that we’ve developed primarily are… The first one’s called the zone score. So, when you’re using Levels, you are logging your activities. So, whether it’s a meal you eat or exercise that we can detect through Apple Health or your sleep, all of these things are stacking up into a context like we just touched on.

Josh Clemente:

And so, when these zones happen close by or these activities happen close by, we capture that and call it a zone. So, let’s say you eat a meal, and then you go for a walk. We will contextualize both of those and then track how your body responds over the corresponding, say, about two hours. Once your blood sugar returns back to normal, we’ll give you a score just on a one to 10 scale for how well that meal or that set of activities affected you.

Josh Clemente:

And this is a very easy way to, again, get rid of the complexity and understand, “Okay. Between this meal where I ate it and I sat on the couch or I did work all day, and this other meal which was exactly the same except I took a walk, the difference was a six out of a 10 versus a two out of a 10.” And the difference was the walk. You start to make these connections using a simple square mechanism between the way these activity combinations affect you.

Josh Clemente:

And then the second metric that we’re developing is the Day score. And so, we currently call this the metabolic score, but we are developing a third which is going to take that name. We’re going to split it into two. But anyway, the day score is giving you just a grade point average or a grade overall out of 100%. So, each day, the goal should be to get 100%. And this is the combination of all of your zones. It’s the combination of the time in between zones. So, how well you sort of adapt and return to a low controlled baseline. The effects of stress would be captured in here. The effects of what’s called the dawn effect, which essentially is a stress mechanism by people who, say, wake up in a stressful environment will have this big blood sugar spike first thing in the morning. And that’s called the dawn phenomenon. Used to be assumed that that was only something that happened in diabetes, but we see it with a huge portion of our non-diabetic users. So, this is a natural phenomenon, but one that we want to control.

Josh Clemente:

So, all of this stacks up for your day score. And then as you string together streaks of high-quality day scores, that ultimately should eventually lead to better metabolic fitness overall, which is what we will track with our third metric.

Daniel Scrivner:

And what was it? Dawn score, dawn [inaudible 00:36:35].

Josh Clemente:

Dawn phenomenon or dawn effect.

Daniel Scrivner:

Dawn phenomenon. I’ve never heard of that before. And it sounds fascinating and maybe as soon as you said that, I immediately I’ve got a five week old at home. And so, constantly at night, I’m waking up to basically a crying baby. I’m pretty certain that’s what’s happening with me, but I guess more generally, is that people waking up to alarm clocks, is that people waking up traveling? What causes that?

Josh Clemente:

It’s a good question. So, there’s a lot of theories. One of the theories is that this is something that when moderate is good. It’s basically your body going from… So, while you’re sleeping, you have very minimal energy demands. Your brain is running, but your muscles aren’t and you’re at rest. And so, your body will typically have a blood sugar drop overnight, and that’s good. But then as your circadian clock senses that you’re about to wake up, there’s a natural flood of cortisol that’s released to get you primed. So, to essentially, get your blood sugar back up, get your heart pumping and get you on your feet. And this seems to be closely timed with the wake up of… Or the patterns that people follow for their sleep.

Josh Clemente:

Now, the issue is that for someone who’s chronically stressed or seems to be for some, this may just have gone a little bit errant where you’ll have a huge blood sugar spike, and you haven’t eaten anything, and this is happening every single morning. And, of course, as we know, that’s not something you necessarily want. So, the dawn phenomenon seems to be worse for people who get shorter sleep. And it seems to be worse in some, for people who ate a very indulgent meal the night before. So, it could be like you’re releasing more glucose because you had more the next day, which is-

Daniel Scrivner:

A bad ice cream.

Josh Clemente:

Exactly. It’s very individual, very personal. And the mechanism we know is cortisol, but we don’t know specifically why it’s worse in some than others.

Daniel Scrivner:

That’s fascinating. So, I want to ask one more question and then I would love to just explore a little bit about what things look like behind the scenes at Level, and how you guys are processing this data and some questions around hardware. I know quite a few people that have been early users and adopters of Levels, and it’s been fascinating because they’ve all noticed really striking differences. They’ve all similarly to you. I think just had a lot of aha moments using it. I know two people, but clearly, there’s thousands that are using Levels now. What are some of the stories that you’re hearing coming out of people that are using it that are remarkable or, I don’t know, insightful or just crazy?

Josh Clemente:

Really remarkable ones are the people who discover something that would have been a problem long-term. So, they find out that things are really not good and they then very quickly just make simple micro-optimizations. And the way I like to put it is, they’re making micro-optimizations and Levels gives them the digital receipt.

Daniel Scrivner:

Interesting.

Josh Clemente:

So, if you simply add that walk onto your meal, you see how much better your blood sugar responses to it. And you repeat that over and over again or sometimes you remove a nutrient and/or adjust the portion size, or you start to embrace sleep. So, we’ve had a few examples of people that have really transformed their metabolic health in 28 days. And many of them have turned into subscribers and continued long-term, but we’re talking about across multiple biometrics, not just glucose control. So, those are my favorites, for sure, and there are several.

Josh Clemente:

And then specific examples that are really just… I enjoy tremendously are just hearing from people who restore their confidence in the foods they’re eating. So, a lot of people are really anxious and tend to follow very stringent dietary philosophies because either they’re fearful of gaining weight again. Maybe they’ve had a weight gain issue in the past or they’re just generally afraid of getting a bad outcome health wise, and they have no confidence because they don’t have the feedback loop.

Josh Clemente:

So, one person I know she was eating a very strict ketogenic diet for years, and she really missed just the better diversity in her diet. And by using CGM and using Levels, she was able to see that she could stay in a ketogenic state despite eating fruit and having specific vegetables that were more on the starchy side. And all it took was just accurate timing and accurate portion sizing. And so, she’s dramatically broadened her dietary approach while staying in a ketogenic state, which she wants to do for therapy and weight loss. And it’s massively improved her quality of life, which it matters just as much as our quantitative risk of illness because again, stress hurts. So, that’s one example.

Josh Clemente:

Another one is one gentlemen, he was using the product and he wasn’t eating oatmeal at all. It was kind of the opposite of the example I gave. And so, growing up, really loved oatmeal. His wife, I think, told him that it was bad for his blood sugar. So, he had stopped eating it. And ultimately with Levels, he found out that there was a recipe for oatmeal that by adding some almond butter and some chia seeds and… So, basically, a little fat and fiber, he could make a really hearty meal out of it. And his blood sugar was super controlled, and specifically if he worked out just prior.

Josh Clemente:

So, these are examples where… He basically wrote us a long note that said, “I stopped eating this out of fear. It was always my comfort food my mom gave me growing up and this has allowed me to sort of live the lifestyle I had hoped for and do it in a way that is healthier and fits with my goals.” And I just love those examples. And there are so many of them that people… Whether it’s just finding out that sourdough bread works better than potato bread or white bread, like being able to navigate all of this complexity and have ultimately a lifestyle that is even more enjoyable than you might’ve assumed you could get. That is tailored specifically to you, the individual, is we’re getting these anecdotes all the time, and it’s really fun to see the differences, but also to just embrace the positive reinforcement. A lot of people feel that this thing is just going to tell me I can’t do anything I enjoy anymore. It’s really not the case. You can find that there’s a lifestyle that works for you that you’ll likely enjoy a lot.

Daniel Scrivner:

Those are great, great examples. And yeah, I think it just, again, goes to the fact of you’re tailoring it for specific individuals. You’re giving them confidence and you’re allowing them to choose what it is or find out what works for them, and it’s incredible. So, just to switch and transition and talk and explore Levels a little bit, just to set things up, can you talk about where you’re at now? I believe you guys are still in a bigger and bigger beta and where you’re heading in terms of kind of, I don’t know, an official launch. [inaudible 00:42:36], but just in the scheme of things.

Josh Clemente:

We’ve been in development since we emerged from stealth and that’s been a little over a year now. We’re essentially using the feedback from our earliest adopters to rapidly improve the product. We’ve gone from essentially a zero app to where we are today, hand-in-hand with our earliest members. And so, this process is invitation only. We have a limited essentially resource allocation in order to make sure we’re capturing good feedback. And we’ve been slowly increasing volumes and definitely building our scalability in our systems, but our launch is contingent on a few more product milestones we want to get across, and that will likely happen later this year, but we’ve had about 6,000 people total go through or start the program thus far.

Daniel Scrivner:

And that’s the 28 days.

Josh Clemente:

And that’s a 28 day program. We also have several hundred subscribers who are long-term users. And our primary focus, again, as I mentioned, was just customer feedback. So, we’re really focused on that single one month experience right now, and then for the full launch and for the future, we’re going to transition to subscriptions as kind of the primary approach since we do see so much benefit for the reinforcement and accountability. So, when people learn these lessons, when you have that real-time data stream, and it’s always right there, you kind of can continue to reinforce the habits that you’ve developed. So, I think the subscription will be the long-term approach.

Daniel Scrivner:

Do you think you’ll have… Because it’s been interesting using it. And initially I did think, “Oh, we’ll get sensors forever,” and continue to… But I think there is something really interesting in… The model, as I understand it now is you effectively get two constant glucose monitors. Each one of those is good for 14 days, add those together, you get 28 days. And it seems like that may be can serve as a diagnostic period. Is that kind of how you’re thinking about it once you launch or was it just be people say yes or no, decide to kind of sign up?

Josh Clemente:

It’s always going to stay the case that we’ll meet people where they are, and it’s not necessary that you sign up to some commitment or do this longterm. Within 28 days, most people tell us-

Daniel Scrivner:

Learned a lot.

Josh Clemente:

… that they’ve learned more about their bodies than any other… Whether it’s in a bio-nutrition class or chemistry class, or what have you. They learn more about how their bodies function because it’s real and it’s a closed loop. So, it is valuable for people in just a single month, but I think that in the longer term, the lessons keep rolling in. I’ve been wearing one now continuously for close to three years. And it’s the most important piece of data I have in my life. It truly teaches me just as much as something like [inaudible 00:44:59] helps people understand sleep, this helps me understand the entire context of sleep integrated with my overall metabolic status. So, I’ll continue wearing one. I don’t really have a plan to not. It’s really fascinating for me. And I think a lot of people see that, but it’s certainly not necessary to where it continuously.

Daniel Scrivner:

And I wanted to ask one kind of… I don’t know. Maybe a shot in the dark, but in my mind, maybe it’s a clarifying question is typically in life, in business, it’s a bad idea to focus on one stat to the exclusion of others. And that’s just a recognition that everything is a lot more complex and we give it credit for and if you’re looking at one stat, you maybe missing some things. And so, one thing I was curious about is… Initially when I was thinking about it, I was like, “Oh, glucose is just this kind of very simplistic measure of, say, sugar energy that’s in your blood,” but it seems like maybe it’s more closer to something like pH where it’s describing the environment in your body. Can you just talk about why glucose alone gives you so much insight into those different parts of your life and your health?

Josh Clemente:

It’s a really good question. And certainly I want to front run by saying, glucose is not a panacea. It’s not the only molecule that matters by any measure. It is however, one of the most important to today’s society. And the reason for that is that we have such rampant rates of glucose intolerance specifically. So, again, all of the prediabetes and type 2 diabetes cases are avoidable, chronic lifestyle decisions. And the CDC says… And they have a diabetes prevention program, which is oriented around better lifestyle choices. It is these micro-optimizations about better exercise, better sleep, better eating. It’s just that we don’t understand at a societal level how bad this is and what it means.

Josh Clemente:

So, it is all glucose intolerance and that tends to lead to insulin resistance and insulin resistance affects us, not just in the diabetes spectrum, but also it is associated with PCOS, which is the number one cause of infertility in the world. It’s associated with the stroke and Alzheimer’s dementia and… Well, actually, Alzheimer’s dementia is being called type 3 diabetes today because of the way brain insulin resistance develops, but stroke and cardiovascular disease and all of these other conditions that we call by different names, but ultimately have metabolic implications. They have chronic lifestyle implications, and most of them happen due to this glucose-insulin feedback loop getting out of hand. It’s really due to the fact that glucose is the primary energy molecule our bodies run on. And because of the situation we’re in where energy resources are very high, we’ve got a ton of food supply, we’re not really in a scarcity mode for most of us, and we are increasingly more sedentary as we move to an information age. This is just breaking down.

Josh Clemente:

So, I would say that understanding your glucose status and projecting your insulin status as a result is the most powerful thing we can do for metabolic health today, but it’s really important to Levels that we introduce additional analytes that help paint the broader picture. So, we are actively working in the background on our research program and then also our innovation program to find the next realtime molecule that we can introduce to the platform.

Daniel Scrivner:

That’s exciting. I was going to ask that directional question. So, I’m glad you touched on that. I know you’re not the CTO, so I don’t expect you to answer this maybe as fully as someone on the technical side could, but I’m curious just to talk a little bit about… So, you’ve got a bunch of users that are effectively have this constant monitoring with the app. They’re constantly sharing this data on the backend. I’m sure you’re seeing a lot more data than is being presented in a positive way and are probably doing very interesting things there. Can you talk a little bit about how it works from a technology standpoint tech stack?

Josh Clemente:

Right now, the app is the primary input mechanism. We have sort of a prescription process that people have to go through. The devices are prescription only. So, we’ve essentially built kind of one of a kind, one-off platform where people can gain access to consultations with physicians who are licensed in their state, prescriptions can be generated, pharmacy fulfilled devices sent to their door. So, that whole system was built up internally. And then the app, which we have versions for both Android and iOS and data system is currently live. And the way that we’re analyzing and introducing those sort of insights we’re developing is through what’s called the insights framework. So, we have some data scientists currently on the team who are digging deep into both the broader population set and then also specific subsets in order to identify opportunities for very simple insight surfacing.

Josh Clemente:

So, we’re constantly… Our intention is, essentially, we will never sell data for any reason. We will, however, use the data we’re developing to improve the product and, of course, for research purposes. And the research is kind of twofold. It’s one, what are our current members using or seeing? What are they facing? How can we help them connect dots more easily? And this could be as simple as when you eat the same meal twice, reminding them about the effects of something simple that modified that decision. That’s like kind of a simple-

Daniel Scrivner:

Make sure to take a walk.

Josh Clemente:

Exactly. It’s kind of a simple thing, but timeliness is key. Again, we have to shorten feedback loops. So, that’s what our data science team is looking at is digging into sleep, what happens during overnight sessions? What happens to people who have severe dawn effect? Who are those people? What are the kind of variables surrounding those episodes? And then this is raising, honestly, more questions than answers. So, we now have the largest data set of its kind in sub-diabetic people with lifestyle information attached.

Josh Clemente:

And so, we’re the ones seeing a huge amount of both variation and also, again, these sort of phenomenon that aren’t discussed in the literature and have not been studied at scale. So, we’re also developing a research program that will work hand in hand with our tech development to take advantage of this data set. It’s really important that we don’t just use this ourselves. We want to push the state of metabolic science forward. And so, our tech development is also taking that into account and essentially considering ways that we can build externalizable data sets that can be shared with research teams, obviously, with consent from the member whose data it is, but ultimately with the intention of making this a transformational data set, not just something that we internalize.

Daniel Scrivner:

That’s incredible. Thank you so much for your time. We’ve talked about a tremendous amount. I would love to talk for 30 more minutes, but I want to be respectful of your time. So, I’ll ask you one more closing question, and then we’ll just talk about where people can go to find more, but if someone’s listening to this, we’ve covered a lot of different topics, I guess, what do you hope somebody takes away from this conversation? If there’s just one insight, one idea.

Josh Clemente:

The most important thing is that people understand that beneath physical fitness and mental fitness or mental health, is metabolic fitness. Remember, our brains and our bodies are composed of individual cells, all of which need energy and they need to be able to access it efficiently. If they can’t, things go wrong. And so, you cannot achieve physical fitness or mental fitness without that metabolic function beneath it.

Josh Clemente:

And more importantly, this is not something that’s out of your control. It’s hard to measure for sure, but very simple things can improve it. The most important thing that I implement every day is I take walks after my meals and I make sure that I sleep a full eight hours. Those two things in combination helped me maintain control after a meal and the way my body metabolizes. They fit in some physical movement because some is significantly better than none. And the sleep helps me manage my stress. And if I don’t sleep well, that means that there’s something else that’s disrupting it. And I can focus on where that’s coming from, whether that’s a personal issue or a professional issue, or what have you. So, those two simple things, they require a lot of adjusting for your lifestyle, but they will have outsized impact over the years and decades that they compound.

Daniel Scrivner:

Yeah. [inaudible 00:52:27] fantastic. For anyone listening that wants to follow you, learn more about you, where can they go and where can they go to sign up to be a part of Level [inaudible 00:52:35]?

Josh Clemente:

Well, I’m on Instagram at josh.f.clemente and Twitter @joshuasforrest with two R’s. Levels is at Levels on both those platforms. You can also find us on our website at levelshealth.com. And I would highly recommend. Go to the homepage, sign up for our wait list. As I mentioned, we’re in this invitation mode right now, but we do have a large wait list at about 88,000 people right now, and we’re eager to get this product launched. So, you’ll get all the details through our newsletter once you sign up.

Josh Clemente:

And finally, check out the blog. So, the link is right there on the homepage. This is where we synthesize all the information that is relevant to the individual and how you can better understand what metabolism means for you and what metabolic fitness means for you. So, always open to feedback on what we’re producing there.

Daniel Scrivner:

Thank you so much for your time. Thank you so much for coming on the show.

Josh Clemente:

Thanks a lot, Daniel. This is great.

Daniel Scrivner:

Until next time, thank you so much for tuning in. For show notes, including links to everything mentioned in this episode, visit danielscrivener.com. There you can also sign up for my weekly newsletter where each week I send out a single email with all of the best quotes, themes, and ideas from the latest episode. To sign up for that, visit danielscrivner.com/email. Just one more thing before you take off. If you enjoyed this episode, please leave a quick review in iTunes or Apple Podcasts. Great reviews help us land great guests. So, if you’ve enjoyed this episode, take 30 seconds to leave a short review. We would so appreciate it. Thank you so much.