Josh Clemente, Founder of Levels

What happens when you build a company founded on questioning norms, radical transparency, and making a healthy lifestyle available to everyone? People start to get interested. When Josh Clemente dealt with a personal health crisis, he followed his curiosity and founded Levels. An innovative continuous glucose monitor, Levels aims to answer the perennial question “should I eat that?” Far from being just another Fitbit device, a Levels CGM gives you real-time feedback on your glucose Levels, pulling away the mystery behind the food choices that are right for you. On Startups for Good, Josh spoke with host Miles Lasater about his hope that CGMs will become much more accessible, aiding in the fight against America’s metabolic epidemic.

Show Links

• Check out Levels
• Follow Levels on LinkedIn or Twitter
• Connect with Josh Clemente on LinkedIn or Twitter
• Check out Startups for Good
• Connect with Miles Lasater on LinkedIn or Twitter

Key Takeaways

04:57 – Taking personal responsibility is key

While working at SpaceX, Josh Clemente learned the culture of questioning the standard approach and taking personal responsibility. That’s the culture he brought to Levels.

“One of the greatest things about SpaceX is it’s a first principles-driven culture where you don’t really accept the standard approach. It’s always questioning the way things are done and finding opportunity for improvement. And that comes from the highest levels like Gwynne Shotwell, and Elon, and the others in leadership really doing an amazing job demonstrating this all the time. There’s just a really strong accountability culture. Space flight has been riddled with unfortunate and in some cases, unnecessary lives lost and disasters. And it’s a culture – like the industry itself has kind of held back by that history. And so throughout SpaceX culture is a real personal accountability. You know, each individual is responsible for ensuring that the end product is successful. And for raising the awareness if something is going wrong and if they’re aware of a concern. And so that can come down to like Elon distributing his own cell phone number prior to launches to the entire company and saying, ‘if there’s something that you’re aware of that I should know about, call me.’ And it allows you to feel very empowered to sign off and hold accountable yourself and your team for the end result. And I think when you’re dealing with people’s health, it’s very similar. You know, it’s important to be building a product that you feel very strongly is the best one. And also to be transparent about your intentions and ultimately to think from first principles and not accept the way things have been done historically.”

06:58 – Building a culture of wellness inside Levels

At Levels, Josh wants to make sure employees also have well-rounded health and wellness so they can be productive and perform at their peak. This not only includes food and diet, but also work-life balance.

“I was working at SpaceX and I was honestly burning the candle at both ends and had, I think for several years, not even taken a weekend off, let alone a vacation, and was just not balancing the immediate-term priorities with the bigger picture. So the work-life balance just really didn’t exist. And oftentimes that was also driven by the culture and it’s a place where everyone’s very competitive and wants to get things done and as fast as possible. And I think understanding how that affected me has really been sort of informative for me and in determining what sort of culture I want to build, or we want to build at Levels. Being more intentional about the individual and ensuring that we, especially as a health care and wellness company, are practicing what we preach and are being more well-rounded, respecting the individual, and making sure that people are controlling not just these sort of nutrition and exercise components, but also stress management and sleep and relationships with their family and friends. All of these are important to produce someone who is healthy and can perform at their peak and just flourish, you know?“

09:32 – “What do I eat and why?”

Levels is answering this question by continuously monitoring your glucose. When users input details on their diet and activities, the technology works to understand how the food you eat affects you.

“What Levels is doing is giving you the ability to measure one of these primary molecules. And this is glucose in the blood in real-time. So, what you’re getting is a series of sensors. These were originally developed for the management of diabetes. But the sensors you wear on your arm stream your blood sugar information to your phone. And so now you can very quickly see the response to an action that you take. And this can be a meal that you’re eating, this could be exercise. This could be the difference between a long eight-hour night of sleep or a four or five-hour night on a red-eye. And you can start to see the effects in real-time through the Levels software and algorithms which provide scores for you. And you can start to orient yourself around the quality or lack thereof of certain decisions you’re making, and then see the opportunity to replace those choices with alternatives. And so right now we’re building that insights layer, essentially building the user experience and the systems that interpret glucose information and score it according to the positive or potentially negative effects and surface that for the individual.“

12:40 – Is CGM the answer to the metabolic health epidemic?

CGM’s should be more readily available to the general public. Especially since the metabolic health epidemic is on a steady rise in developed nations, affecting more than 88% of US adults.

“The devices were developed in that sort of framework where there’s an acute need and a life-threatening one. And so that explains why the FDA controls have been fairly stringent and why the accessibility has always traditionally been through a primary care provider and with a diagnosed condition. So that’s the history. But now we’re at a point where the technology has really evolved. And they’re very convenient devices, and it’s clear that although type one is an important condition and those people certainly need to have access to CGM, one of the bigger concerns is this metabolic health epidemic, which is increasing at an increasing rate across the developing world. This would be like type two diabetes and the other metabolic dysfunctions like cardiovascular disease stroke, Alzheimer’s, PCOS and fertility conditions, all of which are related to insulin resistance, metabolic dysfunction, and entirely preventable due to chronic lifestyle choices. So it’s this area that I believe the technology can really contribute massively to intervening in the case of 88% of US adults who are currently metabolically unhealthy, according to a study by the University of Northern of North Carolina.”

14:48 – The unexpected behavioral change component

Everyone knows they need to eat healthy and exercise. But a startling change in behavior can happen when you see the result of your every action immediately, in real-time.

“The difference between being told something and seeing something from your own body is pretty profound. And I didn’t fully appreciate that until experiencing it myself. And so as I mentioned, I had this underlying issue happening, and looking back, I had a lifelong addiction to sugar and because I wasn’t gaining weight I didn’t have a bodyweight problem. My metabolic dysfunctions were manifesting in different ways, and my family has a hereditary or some cardiovascular disease and Alzheimer’s in my family tree. And so I think that my family manifests metabolic dysfunction differently than certain other people might. And so seeing the effects of my decisions on my blood sugar, even as it relates to the foods that I was eating, that I thought were healthy, completely changed my perspective on unnecessary added sugars, which I would often indulge in multiple times per week. And so like that behavior change component was unexpected for me. And it came entirely from the fact that this is my body telling me that this is happening. There is no outside advice component. It doesn’t feel patronizing in any way. It doesn’t feel like you’re following a one size fits all approach. This is happening to you, and it’s your body in conversation with you.”

18:43 – The long term goals of Levels

Josh hopes to show statistically relevant results from the device so he can take it mainstream. Once CGM’s become more readily accessible, more people will be able to live a healthier life.

“We hope in the next few months and years to show in concrete, rigorous statistically relevant terms how much this improves the health outcomes for the individual. So by using this device, you’re not just playing with a flashy new tool. It’s not like the new garment, it’s not a Fitbit. This is something that concretely affects your quality of life, and then the quantitative risk of these chronic illnesses that we’re trying to reverse trends with. And so that’s going to be a longer view. And by doing so, assuming the efficacy trials show what we expect them to show, that’s how we can ultimately unlock coverage for perhaps self-insured employers, insurance programs, etc., to make this something that the average person is using, not just because it’s engaging and it has a really strong behavior change component to it, but because it is the best mechanism for making better decisions and living a healthier life.”

20:43 – We’re a chemistry set

Even small changes can sometimes lead to big, and sometimes long-term effects. That’s why it’s important to make data-based decisions. Levels can help you do that.

“We’re a chemistry set essentially. Very small or seemingly small changes in our day-to-day environment can induce very large-scale changes in our metabolic function. An example of this could be becoming a parent, having a newborn and suddenly your sleep schedule changes and you go from having eight full hours of sleep to overnight, you’re getting two, three, four fractured hours of sleep. And that can have a really significant effect on the stress environment this person’s operating under. So with that in mind, we highly recommend that people use the program if not continuously, regularly, so you can do a month, see how things are going, experiment, understand exactly where you can focus, and then use those lessons learned for several months. And then you check in again and make sure that you’re still on trajectory and nothing’s really shifted dramatically. And if something has, find ways to adapt. And so I think that’s likely to be the way the technology is used in those two sorts of buckets, such that depending on what type of personality you are, whether you tend to get somewhat obsessive about data or whether you’re kind of more of a hands-off person and just want to pull the lessons out, we can meet you where you are – no matter who you are.”

23:09 – Two simultaneous epidemics

We are currently fighting both COVID and the metabolic crisis. The best way to combat any current and future epidemic is to become healthier as a society. To do this, we have to empower the individual.

“The challenge is building a system that is intuitive, elegant, delightful to use, and produces in a very short period of time measurable improvement in health. And it’s a very different challenge than any other I’ve worked on thus far, but it’s one that’s very close to me. And having it kind of immersed in just how big this problem is, I think it’s one of the most important for our time. We kind of have the clash of two epidemics happening right now with COVID and the metabolic crisis. And unfortunately, outcomes here in the United States have been really bad. And much of that I believe has to do with the correlation between the co-morbidities of COVID in the presence of an existing glucose dysregulation, like type two diabetes or pre-diabetes. And so we’re kind of seeing the unfortunate effects of the lack of resilience we have in our society and how subjective people are to unexpected factors like a virus. But ultimately what it means is just that we have to get healthier as a society. And in order to do so, we have to empower the individual. And we can’t try and solve this in one stroke with a piece of legislation. It just won’t work.”

25:03 – We’re suffering from a lack of awareness

Without insight from either a primary care physician or a device like Levels, it’s likely that many individuals will end up with a chronic illness before the end of their life.

“The average person who is trying to learn more about their bodies and does not have an acute medication-dependent need should likely be able to get this over the counter at some point soon, I would expect that that’s the direction things are heading. I certainly believe that if you have an existing condition that requires management, it’s really important to have an expert in the process along with you. And that’s where the primary care physician certainly can provide a huge amount of added value for designing a therapy that works best for you. I think right now what we’re suffering from is a lack of awareness, a total absence of information for the vast majority of people who unfortunately, looking at trends, are likely to end up with a chronic illness before the end of life. And that’s where we need to focus, by quickly and with minimal overhead, getting the average person in touch with the effects of their choices.”

32:31 – Practicing radical transparency

Levels believes in unfiltered honesty and trust. This full transparency quickly and shows people the high-quality standards present inside the company at every level.

“I think that radical transparency works in two directions. It first is unexpected. So people are disarmed by the transparency and that immediately takes down any barriers. And then second, it allows them to see that the quality of what we’re doing, we don’t have anything to hide in that respect. So once people can see like into the minds of the team, they immediately understand how we start, how we go about solving problems, how we collaborate. And also I think the quality of our decision-making execution or the way in which we confront failure when we do so, this is an experiment for sure. I’ve never worked at a company where we’ve been so transparent. And so it may be a bit of a risk that some people might think we’re taking. But the problems that we need to overcome in order to succeed as a company don’t really have to deal with transparency issues. I think it’s fundamentally better to build an environment where people have seen under the hood and believe in it than in one where there’s lingering doubts over what’s actually happening behind the scenes.”

Miles Lasater: [00:00:00] You’re listening to Startups For Good, where we explore high growth and high values ventures. I am your host, Miles Lasater, three times founder turned investor. Join us to hear stories of entrepreneurs. Join us to be inspired to be a founder or to work for a startup. Join us to be part of a community that believes that startups can be a force for good.

Welcome to Startups For Good. On today’s show, I speak with a real life rocket scientist. I don’t get to say that every day. He is now tackling a challenge that he believes is bigger still, metabolic fitness. It’s not just fitness in a sense of how fast can you run? What can you lift? Or what are your body fat percentages?

[00:00:53] It’s about how you process food. Are you eating the right foods for your body and are you eating them at the right time? Josh Clemente is founder of Levels Health. And as a mechanical engineer and CrossFit level two trainer at SpaceX, he led a team to develop life support systems that sustained astronauts on their May, 2020 trip to the international space station, aboard Dragon Endeavour. I’m told that’s the first new crew carrying spacecrafts since 1980. Josh has also spent time designing and building Hyperloop technology and leading engineering for a company providing vehicle based rescue systems for emergency response teams. We cover more about Levels’ product and mission, how they successfully raise a series a from big name VCs during a time of COVID who they never even met in person. And how they’re intentionally building a culture that has transparency baked in and better work-life balance than he’s seen in other places. Stay tuned. Josh, welcome to Startups For Good. Thanks so much for coming on.

Josh Clemente: [00:02:00] Thanks for having me on Miles. I’m excited.

Miles Lasater: [00:02:03] I’d love to start with, why did you become a founder?

Josh Clemente: [00:02:06] I started this company with my co-founders because I personally kind of am patient zero for the need and the need cases for people to have better information about their health so that they can identify the ways in which they’re making decisions that they may or may not think are bad for them and how poorly or positively they’re being affected by them, those same decisions. And so essentially like starting at the beginning, I discovered that I had underlying metabolic dysfunction, despite being a CrossFit trainer and thinking I was doing everything right, being physically fit. But just stumbled upon this underlying metabolic dysfunction that was building and that unfortunately many people don’t identify. And the way I did this was with a really amazing piece of real-time technology called a continuous glucose monitor. And my own experience and my ability to get a grip on my lifestyle decisions, how they’re affecting me, and then turn that around for myself is the use case that showed me there’s an opportunity here to help a lot of people.

[00:03:07] Miles Lasater: [00:03:07] So the combination of a big need and problem in the world and experiencing yourself helped you connect with this for Levels Health, but it’s not the first company that you’ve helped start.

[00:03:16] Josh Clemente: [00:03:16] It’s not. So I’ve worked at startups my whole career. I started off at SpaceX. I went to Hyperloop when they were pretty young.

[00:03:23] And then I started another company that was in the world of sort of rescue and tactical equipment prior to Levels.

[00:03:32] Miles Lasater: [00:03:32] And I see a real through line there of mission in almost all or all those organizations that you’ve worked at throughout your career.

[00:03:39] Josh Clemente: [00:03:39] I think so. I’m one of those people that just really gets motivated by the underlying scope of what we’re working on.

[00:03:45] I, I maybe I’m a little bit of a, I don’t know, it’s hard to say. I’m not super sort of passion driven necessarily. I like working on something that is going to be needed. I think that’s what it comes down to is I really like to solve problems that are relevant to large numbers of people, and

[00:04:03]Certainly ones that are relevant to myself. And I think that’s what it comes down to is just like the utility of what it is that we’re working on. And of course I love being driven by a big dream too, and that, the SpaceX the SpaceX mission, it doesn’t get much bigger than that.

[00:04:16] And so I just always refer back to that experience and how much it drove myself and my teammates to do really good work and do so at a rapid pace.

[00:04:25] Miles Lasater: [00:04:25] What did you learn there that you’re able to apply, that you want to do the same? And what would you want to do differently than SpaceX?

[00:04:31]Josh Clemente: [00:04:31] The big things I would say are there’s definitely a few. One of the greatest things about SpaceX is it’s a first principles driven culture where you, you don’t really accept the standard approach, right?

[00:04:43] It’s always questioning the way things are done and finding opportunity for improvement. And that kind of comes from the highest levels, like Gwynne Shotwell and Elon and and the others there in leadership, really doing an amazing job, demonstrating this all the time. And there’s just a really strong accountability culture.

[00:04:59]Space flight has been riddled with unfortunate and in some cases, unnecessary lives lost and disasters. And it’s a culture like the industry itself has held back by that history. And throughout SpaceX culture is a real personal accountability. It’s, each individual is responsible for ensuring that the end product is successful,

[00:05:21] and for raising the awareness if something is going wrong and if they’re aware of a concern. And so that can come down to Elon distributing his own cell phone number prior to launches to the entire company and saying, If there’s something that you’re aware of, that I should know about, call me. And it’s just, it allows you to feel very empowered to sign off and hold accountable, yourself and your team for the end result.

[00:05:45] And I think, when you’re dealing with people’s health it’s very similar. It’s important to, to be building a product that you feel very strongly is the best one. And also to be transparent about your intentions and ultimately to think from first principles and not accept the way things have been done historically.

[00:06:00] Miles Lasater: [00:06:00] Is there anything in the culture there or somewhere else where you’ve worked that you thought, I learned from that, I want to do it differently.

[00:06:09] Josh Clemente: [00:06:09] Sure. Yeah. I think, just referring back to my own discovery of this underlying concern, I had metabolically I was working at SpaceX and I was honestly burning the candle at both ends and had, I think for several years not really even taken a weekend off, let alone a vacation and was just not balancing the,

[00:06:33] the immediate term priorities with the bigger picture. So the work-life balance just really didn’t exist. And oftentimes that was also driven by the culture, and it’s a place where everyone’s very competitive and wants to get things done and as fast as possible. And I think understanding how that affected me is really been formative for me and in determining what sort of culture I want to build, or we want to build that Levels.

[00:06:59] And and so just being more intentional about the individual and the ensuring that we, you know, especially as a health care company and a wellness company, that we’re practicing what we preach and being more well-rounded respecting the individual and making sure that people, yeah are controlling, not just these sort of nutrition and exercise components, but also stress management and sleep and and relationships, with their family and friends. All of these are important to, to produce someone who is healthy and can perform at their peak and be, just flourish, so I think that’s somewhere, that’s an area where I definitely am going to be pushing to divert a bit from the SpaceX culture.

[00:07:39] Miles Lasater: [00:07:39] That makes sense. On that line, let’s continue talking about the service of Levels. Can can you tell our listeners about what it is and how it works?

[00:07:49] Josh Clemente: [00:07:49] Yeah. So Levels exist to answer the question, What should I eat and why? And the way we seek to answer that question is with data from the individual’s body surface for them in real time. And so the data we’re using has to do with metabolism. And just to define that real quick, metabolism is the set of cellular mechanisms that produce energy from our food and our environment.

[00:08:13] So this is like the nutrients in our food and then sunlight and other processes that ultimately produce energy in our cells and tissue. Essentially hormones have to respond to other hormones in the body, and they can begin to go haywire where these feedback systems in the body’s chemical feedback loops with hormones being released in response to other hormones can start to bias in one direction or another.

[00:08:36] And these can have a whole host of detrimental effects. And what Levels is doing is giving you the ability to measure one of these primary molecules. And this is glucose in the blood in real time. What you’re getting is a a series of sensors. These are, these were originally developed for the management of diabetes.

[00:08:53] But the sensors you wear one on your arm and it streams your blood sugar information to your phone. And so now you can very quickly see the response to an action that you take. And this can be a meal that you’re eating, this can be exercise. this could be the difference between a long eight hour, night of sleep or a four or five hour night on a red eye.

[00:09:16] And you can start to see the effects in effect in essentially real time through the Levels software and algorithms which provide scores for you. And you can start to orient yourself around the quality or lack thereof, of certain decisions you’re making, and then see the opportunity to replace those choices with alternatives.

[00:09:33] And so right now we’re building that insights layer, essentially building the user experience and the systems that interpret glucose information and score it according to you, the positive or potentially negative effects and surface stat for the individual.

[00:09:53] Miles Lasater: [00:09:53] Yeah. I’ve been using it for a couple of weeks now. Independent of doing this podcast,

[00:09:57] I’ve been interested in this area for a while, and it’s hard to get a continuous glucose monitor if you don’t have diabetes. So part of what you’re doing is opening up access, right?

[00:10:06] Josh Clemente: [00:10:06] Definitely. Yeah. The two areas. When I first used the CGM and realized that something was very wrong with my own glycaemic control,

[00:10:15] I became immediately interested in increasing accessibility of the technology, because it just seemed to me, so niche and unavailable. And I myself had over a year of trouble trying to get one to, just to experiment with. And then after, understanding just how powerful that the data was,

[00:10:34] I was shocked by how it didn’t seem to be it was not getting the attention. I think it deserved. Like once I had used it and was like, this is incredible. This is really it allows you to understand so much about how your body is functioning, that you previously couldn’t, and it’s so valuable for behavior change.

[00:10:51]What am I missing that this is not more readily available. And so threw myself into the research there. And I just think the way that the technology was developed defines its accessibility path. It’s historically been used for people who have type one diabetes and when you have type one, there’s an acute concern, right? If your blood sugar, your body no longer produces insulin, which is necessary to keep blood sugar in the correct boundaries. And so these individuals have to use exogenous insulin, inject insulin into their bodies to control glucose. It’s very complicated condition and they need the immediate access.

[00:11:27] And if the devices malfunction, it can be really detrimental. It could be dangerous. So the devices were developed in that sort of framework where there’s an acute need and a life-threatening one. And so that kind of explains why the, the FDA controls have been fairly stringent and why the accessibility has always traditionally been through a primary care provider and with a diagnosed condition.

[00:11:50]That’s the history, but now we’re at a point where the technology has really evolved, and they’re very convenient devices. And it’s clear that the although type one is an important condition and those people certainly need to have access to CGM, one of the bigger concerns is this metabolic health epidemic, which is increasing at an increasing rate across the developing world.

[00:12:15] And this would be like type two diabetes and the other metabolic dysfunctions like cardiovascular disease, stroke, Alzheimer’s for PCRs and fertility conditions, all of which are related to insulin resistance, metabolic dysfunction, and entirely preventable due to chronic lifestyle choices. So it’s this area that I believe the technology can really contribute massively to intervening in the case of 88% of US adults who are currently metabolically unhealthy, according to a study by the University of Northern, of North Carolina.

[00:12:50] And, or the, 90 million folks here in the U S who are pre-diabetic, 84% of whom don’t know it. So you have this growing wave of metabolic dysfunction, where people are making decisions and they are no longer, or they are not able to understand the effect of those decisions, in some cases for decades until they receive a preventable diagnosis.

[00:13:10]Yeah, increasing the accessibility is certainly one of the main focuses of the Levels business model.

[00:13:17] Miles Lasater: [00:13:17] And are people able to get specific insights that are individual to them? Or is it more a matter of behavioral change because now they see it more vividly. Everyone knows they should eat healthy and get some exercise.

[00:13:28]Josh Clemente: [00:13:28] Yeah, I think, it’s, the difference between being told something and seeing something from your own bodies is pretty profound. And I didn’t fully appreciate that until experiencing it myself. And so I mentioned, I had this underlying issue happening. And looking back, I had a lifelong addiction to sugar. And because I wasn’t gaining weight, I didn’t have a body weight problem,

[00:13:50], it just my metabolic dysfunctions were manifesting in different ways and my family has a hereditary, or, some cardiovascular disease and Alzheimer’s in my family tree. And so I think that my family manifests metabolic dysfunction differently than certain other people might. And so seeing the effects of my decisions on my blood sugar, even as it relates to the foods that I was eating, that I thought were healthy, completely changed my perspective on unnecessary added sugars, which I would often, you know, indulge on, indulge in multiple times per week.

[00:14:23] And so that behavior change component was unexpected for me. And it came entirely from the fact that this is my body telling me that this is happening, it’s there, there is no sort of outside advice component. It doesn’t feel patronizing in any way. It doesn’t feel like you’re following a one size fits all approach.

[00:14:41] It’s very much, this is happening to you and it’s your body in conversation with you. And so I think that component of it is really fascinating for behavior change. But then there is the personalization element. These devices, continuous glucose monitors were used in several trials, including one in 2015, which I would call the landmark study.

[00:15:00] But this trial showed that 800 people who did not have diabetes, could have profoundly different responses to the exact same foods. So in one case they had two folks who ate the exact same two foods, a banana and a wheat cookie, and had equal and opposite blood sugar responses to them. And the implication there is that if you’re having equal and opposite blood sugar responses, you’re likely having equal and opposite hormonal responses like insulin to those foods.

[00:15:26] And so the effects, the health effects could literally be opposite for these two people if they choose these foods, continuously. And that’s a really important finding because it really shows just how much the personalization element could factor in the longterm this whole development of a personalized lifestyle and a personalized diet could really be the key to us, unlocking at a large scale, social health improvements, because, if people are currently following kind of the average of the whole population, that may shift the whole population, more towards the center, but it may not bring the tails together.

[00:16:00] It may not bring that person who responds super negatively to a banana, but is eating it because they think it’s healthy. It may not bring them closer to the center. Does that make sense? And so if we can, instead target the individual, empower them with their own information to make personalized choices,

[00:16:14] we could very likely shift the entire curve closer to health.

[00:16:18] Miles Lasater: [00:16:18] And have a healthier population, which is really inspiring. But how do you reach more than just the techie, the geek, someone who’s into quantified self. I live in San Francisco Bay area. People are using continuous glucose monitors for, I don’t know, five-plus years ago

[00:16:32] because they’re kooky, but how does the, how does this reach the average person.

[00:16:37] Josh Clemente: [00:16:37] Yeah, that’s our primary focus, in, in the longer term, is certainly making this a very accessible technology, not just in terms of having the access pathway, but making it attainable financially. And the way that we’re going about this is first, targeting the early adopters.

[00:16:52] We’re kind of in the Tesla Roadster phase where, the devices are fairly new. It’s cool. It’s got a little bit of a, of an element of experimental early adopter- ness to it, and so people are willing to give it a shot. But then we’re demonstrating, with our, with both the early adopters and with our clinical research program, the efficacy of this.

[00:17:10] And so we hope in the next few months and years to show the, in concrete, rigorous statistically relevant terms, how much this improves the health outcomes for the individual. So by using this device, you’re not just playing with a flashy new tool. It’s not like the new garment, it’s not a Fitbit. This is something that concretely affects your quality of life,

[00:17:32] and then the quantitative risk of these chronic illnesses that we’re trying to, reverse trends with. And so that’s going to be the longer view. And by doing so, assuming the efficacy trials show what we expect them to show that’s how we can, I think ultimately unlock, coverage for perhaps self-insured employers, insurance programs, et cetera to make this something that the average person is using, not just because it’s engaging and it has a really strong behavior change component to it, but because it is the best mechanism for making better decisions and living a healthier life.

[00:18:04] Miles Lasater: [00:18:04] Do you see people wearing this all the time, healthy people wearing it for years? Or how does it work in that regard?

[00:18:10]Josh Clemente: [00:18:10] I certainly see it’s interesting. We see a lot of people who want to wear those continuously. And the reason is that it’s a, some people describe it as once you have the data, it feels like leaving your cell phone at home to eat a meal without it.

[00:18:23] And you just feel disconnected and there’s a little bit of uncertainty. And so the confidence of seeing that positive result, every time you eat a good meal, it just boosts confidence in your decisions. It helps you feel like you’re sticking to your goals. So there’s a really strong accountability component to this, which I think likely goes hand in hand with

[00:18:43] what we’ve seen with closing your rings on the Apple watch and getting your 10,000 steps and you can feel good about it every day, the end of the day. And you know this with the Levels program, you can feel that same way about the nutrition side of your lifestyle choices. And, beyond that, even if people don’t, I choose to wear it full time it’s one of those things that the human body is a dynamic system. We’re a chemistry set essentially. And very small kind of, or seemingly small changes in our day-to-day environment can induce very large-scale changes in our metabolic function. An example of this could be, becoming a parent, having a newborn, and suddenly your sleep schedule changes. And you go from having eight full hours of sleep to overnight, you’re getting two, three, four fractured hours of sleep.

[00:19:29] And that can have a really significant effect on the stress environment this person’s operating under. So with that in mind, we highly recommend that people use the program if not continuously, regularly. So you can do a month, see how things are going, experiment understand exactly where you can focus and then use those lessons learned for several months.

[00:19:51] And then you check in again and make sure that, you’re still on trajectory and nothing’s really shifted dramatically. And or if something has, find ways to adapt. And so I think that’s likely to be the way the technology is used in, those two sorts of buckets, such that, depending on what type of personality you are, whether you tend to get somewhat obsessive about data or or whether you’re more of a hands-off person and just want to pull the lessons out we can meet you where you are no matter who you are.

[00:20:17] Miles Lasater: [00:20:17] How true. Are you creating any fundamentally new tech here? You’ve had a background as an engineer working on really hard engineering problems. Where’s the challenge here for you?

[00:20:30]Josh Clemente: [00:20:30] I think that the challenge is an exciting one because normal human metabolism and then optimal metabolism remain to be studied.

[00:20:38] And much of it has to do with the fact that , we haven’t had this real-time technology and the ability to scale it and perform really, large scale longitudinal studies with large numbers of people. But I think the potential here for us to produce really groundbreaking research is massive.

[00:20:56] And that’s one thing that really excites me is that we can, by using not just the hardware, but then advanced software machine learning algorithms and insights, frameworks that can help people orient themselves and then make better choices in a very short period of time, you can start to demonstrate just how quickly you can take control of your metabolism and improve metabolic fitness.

[00:21:18] And that is the challenge. The challenge is building a system that is intuitive, elegant, delightful to use, and produces in a very short period of time, measurable improvement in health. And I think it’s a very different challenge than any other I’ve worked on thus far, but it’s one that’s very close to me.

[00:21:35] And having it immersed in just how big this problem is, I think it’s one of the most important for our time. We have the clash of two epidemics happening right now with COVID and the metabolic crisis. And unfortunately, outcomes here in the United States have been really bad.

[00:21:53] And much of that I believe has to do with the correlation between, the co-morbidities of COVID in the presence of an existing glucose dysregulation, like type two diabetes or pre-diabetes. And so we’re seeing the unfortunate effects of the, the lack of resilience we have in our society, and how subject people are to like unexpected factors, like a virus.

[00:22:16] But, ultimately what it means is just that we have to get healthier as a society, and in order to do we have to empower the individual. And we can’t try and solve this in one stroke with a piece of legislation. It just won’t work.

[00:22:30] Miles Lasater: [00:22:30] Thank you for being a loyal listener. One thing I’d ask is please consider joining our giving circle. We support startup tech nonprofits with our donor dollars to act as the angels to seed new organizations seeking to scale and do good. So please go to StartupsForGood.com and click on giving circle.

[00:22:57] Do you think that people should have access to this technology without a doctor?

[00:23:04] Josh Clemente: [00:23:04] I certainly think that it’s  case dependent. The average person who is trying to learn more about their bodies and does not have an acute medication dependent need should likely be able to get this over the counter at some point soon. I would expect that’s the direction things are heading.

[00:23:18] I certainly believe that if you have, an existing condition that requires management, it’s really important to have an expert in the process, along with you. And, that’s where the primary care physician, certainly can provide a huge amount of added value for, designing a therapy that works best for you.

[00:23:33]Yeah, I think right now what we’re suffering from is a lack of awareness, a total absence of information for the vast majority of people who, unfortunately looking at trends, are likely to end up with a chronic illness before before the end of life. And that’s where we need to focus is by quickly and with minimal overhead, getting the average person in touch with the effects of their choices.

[00:23:59] Miles Lasater: [00:23:59] Do you foresee a world where continuous glucose monitoring is part of longer-term wearables like built into your watch or maybe not even require breaking your skin?

[00:24:14] Josh Clemente: [00:24:14] I definitely think so. As we start to demonstrate that there’s such a large, not just market but appetite for this technology,

[00:24:24] I think we’re going to see a ton of great innovation. And, I would expect that the form factor will improve quite a bit. I would, if I’m going to project forward, say five to 10 years, I would bet that we’ll be wearing a multianalyte continuous monitor of some kind that is checking, not just glucose, but also other really interesting molecules like insulin, cortisol, potentially, maybe blood lipids.

[00:24:45] And that will be really an amazing kind of gold standard for understanding an individual’s chronic choices and how they’re affecting outcomes. And it’ll be a really powerful tool that will go well beyond what we have in our current wearables. And I think it can do all of those additional wearable functions tracking activity and heart rate and body temperature, et cetera.

[00:25:08] And it’ll likely be I don’t think that we’re going to see a fully non-invasive sensor technology that can measure molecule concentrations in the skin for a very long time. No, I, I don’t know that’s something we’re going to crack with like optical techniques anytime soon, but I could totally be wrong.

[00:25:24]I think it will be in a minimally invasive zone with maybe like micro needles or what we currently have, these interstitial filaments, which are very flexible and ultimately not a, an inconvenient solution and provide really good data. So I think we’ll be there for the foreseeable future.

[00:25:40] But I am, I’m really looking forward to seeing what comes.

[00:25:44] Miles Lasater: [00:25:44] Yeah. If only it could track your food for you.

[00:25:47] Josh Clemente: [00:25:47] Yeah. That’s next. Although I don’t exactly know how to crack that one.

[00:25:50] Miles Lasater: [00:25:50] Yeah. Maybe part of the behavioral change comes from becoming aware of your food and the tracking makes you more aware of it.

[00:25:56] I’d love to turn the conversation a little bit more back to the company. You recently announced that you raised a nice round VC round with big name venture capitalists, and we’d love to hear you talk about that process of how that came about.

[00:26:11] Josh Clemente: [00:26:11] Yeah. So we, we did announce the round, a16z took lead and, we’re really excited about the potential that the additional financing brings for this next phase.

[00:26:20] And, it was definitely an interesting process given that, know, we actually started the process the week that COVID made landfall here in the US. And so that, that put a real many issues came out of that obviously. But one of them was that we just put a hold on our process, and

[00:26:37] tightened up the belt and just decided, you know what, we’re going to buckle down and keep focused on product and see what happens with the world. If the investment market is receptive sometime soon, hopefully we’ll be able to kick those conversations off. And so we went back into product mode for a few months and really made some exceptional progress, I think, in that time.

[00:26:56] And once it became clear that the VC landscape was opening back up again, we had some really excellent, excellent progress I think to show. And since we had kicked off conversations with some of these VCs at the beginning of the year, we were then able to show like a large degree of Delta in the conversation when we picked them back up towards the, like the late summer. And so that was really interesting. I think that benefited us significantly, because it showed that we had not only not slowed down in, in the post COVID situation, we had actually accelerated, and that there was arguably an increased desire and attraction for the product because the correlations, as I mentioned, between COVID and metabolic health could potentially be driving some of it.

[00:27:38] So we had really strong conversations towards the end of the summer, ultimately we, I think, we closed around that was it was all virtual. I still have not yet met the partners in person who invested in our company in this round. And I think that’s really interesting and it’s it’s cool to be a part of.

[00:27:55]And I think the process was just really efficient and to the point. We were able to share a lot of data asynchronously. We were able to just keep people in the loop with continuous little kind of micro updates. And we kept a very transparent process going, which I credit my co-founder Sam with. He’s all about radical transparency.

[00:28:12] And so we made our documentation readily available to anyone interested and that just allowed us to work in public, and let people see a glimpse into the team. And I think that further strengthened the investors’ sort of personal belief, I think in the success of, or the possibilities of success for the team

[00:28:30] and the mission. It’s just seeing it happening in a remote environment, in a post COVID environment and being able to develop a sense of confidence in us, despite having never met us in person, in a partner meeting.

[00:28:42] Miles Lasater: [00:28:42] Can you say more about what it means to work in public. What are some examples of how you’re doing it and how that would be different if you weren’t working in public?

[00:28:52] Josh Clemente: [00:28:52] Yeah. One example is that essentially every person that we talk to as a potential hire or as a potential investor, we’ll have an intro call, but we will share a huge number of internal memos with them as a follow-up to that call. And we share the links directly and they can see comments in addition to the actual text of the memo, and those are living documents.

[00:29:14] So we’re,  we work out of those. We we continue to collaborate inside of them as a team. And I think that is certainly non-standard, and of course we don’t share anything that has, any sort of customer information or patient information in it. We just stick to the business memos. But the point is that we were very open about our strategy our current blockers, like any major problems that we’re working on, as a company are focused on.

[00:29:40] And so just really airing the good with the bad. And I think that radical transparency it works in two directions. It first is unexpected. So people are disarmed by the transparency and that immediately takes down any barriers. And then second, it allows them to see that the quality of what we’re doing. We don’t have anything to hide in that respect.

[00:30:03] So once people can see like into the, the kind of minds of the team, they immediately understand how we start, how we go about solving problems, how we collaborate. And and also I think the quality of our decision making execution or the I think the way in which we confront failure when we do. So I, you know, this is an experiment for sure.

[00:30:24]I’ve never worked at a company where we’ve been so transparent. And so it’s it’s it may be a bit of a risk that some people might think we’re taking. But the problems that we need to overcome in order to succeed as a company don’t really have to do with transparency issues. I think it’s fundamentally better to build in an environment where people, have seen under the hood and believe in it,

[00:30:48] than in one where there’s lingering doubts over what’s actually happening behind the scenes.

[00:30:54] Miles Lasater: [00:30:54] I think that’s really interesting advice. Many, an aspiring founder has that first impulse to keep my ideas secret and not to share it. And it sounds like you’re saying, No do share it and people will see the quality of your thinking in there, and they’ll be attracted to it.

[00:31:13] Josh Clemente: [00:31:13] Yeah. I think the way Sam puts it is that if the concern is that just simply sharing the idea is enough to lose the idea to someone who can execute better, then that’s a concern that you should think deeply about, because if you don’t feel that you’re capable of executing with all of the information that you have and the team that you’re building on your idea better than any other, then you probably need to focus on building a better team or on some other version of the plan.

[00:31:42]Of course there are some limitations to this, but it’s just generally speaking, have confidence in yourself. You’re taking on this project, it’s unlikely that someone’s going to just see an idea and be able to out execute on it. And it’s tough, I certainly understand, like I, it’s,

[00:31:55] it’s very tough to internalize that and then go and put it into action and just share, what you’ve been working on for a long time and that you feel is vulnerable still. But I think in practice it’s worked so well that I’m certainly a believer in this approach.

[00:32:08]Miles Lasater: [00:32:08] Thanks for sharing that with us.

[00:32:10] That’s very concrete, actionable help that people can use. Talking about your fundraise a little bit more. You said you were able to demonstrate progress. How did you do that? What were the metrics you chose and how did that work?

[00:32:24] Josh Clemente: [00:32:24] So we’ve been we came out of stealth mode in January, and we were just in stealth.

[00:32:29] We just didn’t have any public presence to speak of. We launched our website in January of this year. And then we started releasing the first version of the app and, and yeah, just trying to bring on the first few beta customers. So our product is still in beta. We’re very much in development on the software. And we’ve been running a beta program where we essentially handpick or invite people into the the 28 day program, and they get to try the software and provide us with feedback. And we like to get video or video and, or phone calls with as many people as possible to really maximize the feedback. And we first started the process. We were very early in that beta. And by late summer, things had accelerated fairly dramatically, and we had thousands of orders, our revenues, even though we weren’t tracking those as the top line metric, we were still tracking feedback and development milestones.

[00:33:18]Our revenue had climbed significantly, and we had a massive influx in signups for our waitlist. So the waitlist was originally supposed to be like the signup list to get into the beta. But it. We are now, as of this moment, we’re at like 63,000 people on the wait list. But by midsummer, we were around 25 or I believe like 15 to 25,000 when these conversations were happening and, from nothing and with no marketing.

[00:33:44] And so just showing like that acceleration and interest through essentially organic mechanisms, just people sharing from the beta on Twitter and through our content. We’re writing a lot of blogs and our SEO had moved dramatically upwards. And so there was like all of these indicators that were across the entire business that were all moving very quickly upward,

[00:34:04] and and with an entirely technical team, like a non marketing driven result. I think it caught the attention of of, the investment groups. And mostly because, we’re opening a new market. This is something that is not well demonstrated, and there’s definitely some some hesitancy from certain people about

[00:34:22] whether this is interesting to the consumer. And so all of those metrics moving so quickly and all of the sort of variety that we brought to all of the variety we were seeing in terms of customer profiles, who were coming to us and the number of channels it all painted a pretty compelling picture that this has legs.

[00:34:41] Miles Lasater: [00:34:41] How did you communicate during that fundraise about mission?

[00:34:48] Josh Clemente: [00:34:48] Oh we wrote about it. We wrote the Level Secret Master Plan, which is shamelessly ripped off from Tesla, but essentially describing why we’re doing what we’re doing what we intend to build and for whom. And to answer those, it’s we want to reverse the trends of metabolic dysfunction, we’re building the device, the system that will allow immediate behavior change,

[00:35:09] driven by individual biometrics. And we’re building it for everyone. We want to make this attainable by the individuals who need it most, which if you look at the metabolic health or lack the metabolic dysfunction trends in this country, they’re they’re very closely tied to economic status.

[00:35:27] And unfortunately they affect the people who frankly can’t afford a $400 one month program. And so we’re very clear eyed about that. We know that the technology ultimately has to be scalable. And it has to be, there has to be potential to bring the price down significantly and, or get it covered in the long-term in order to really move the needle on metabolic health.

[00:35:49] And so just being, I think, again, being transparent about the fact that we are prioritizing, we’re starting off with the Tesla Roadster phase, and we intend to get to the Model 3 or, even more affordable commuter car version of the Levels product as quickly as possible.

[00:36:07] Miles Lasater: [00:36:07] That’s inspiring.

[00:36:08]You’ve had some good success so far. I’m wondering where have been the challenges along the way.

[00:36:12]Josh Clemente: [00:36:12] Certainly the regulatory environment is tricky. We’re working in a space where we ultimately want to do best by the the user of our product. And we are striving to help people make better choices and become healthier.

[00:36:27]That the healthcare industry and certainly anything dealing with a prescription product is somewhat slow to change. And certainly not. It’s certainly not an area that you see a ton of disruption happening in. And, we really see that as both an opportunity and a challenge because we want to make sure that we’re abiding by

[00:36:44] the spirit of all of the regulations and with the best interests in mind. However, certain things just haven’t contemplated the pace of technological progress. There’s a lot of work to be done. I think, in the healthcare industry, broadly speaking, to improve the use case for health data, if you just zoom out and think, when was the last time you used your own health data to make a choice?

[00:37:07] Like when was the last time you used anything from a blood panel or that you received from a clinic to decide what to eat for lunch or how to exercise or how to sleep. It just doesn’t really happen. And I think that’s critical, and getting there is going to have to be, we really do need to

[00:37:23] collaborate with the regulatory bodies and the industry professionals, the medical practitioners who are out there doing this every day in order to find the best solution. And I, I think just getting to the point where we have a business that is stable and is working within the intentions of the regulations across HIPAA and across patient health data requirements and logistically fulfilling prescription devices across all 50 States,

[00:37:48] it’s been a real challenge. And certainly I’m proud of the progress we’ve made, but I feel like there’s a lot of ground to cover to get to that end state where, we can really get these in the hands of many more people than we currently can.

[00:38:01] Miles Lasater: [00:38:01] Do you have any advice for inspiring founders?

[00:38:03]Josh Clemente: [00:38:03] From my own perspective, I think a lot of people can be somewhat hesitant to bring on a co-founding team  or co-founder or co-founding team. And certainly it’s been absolutely amazing from my perspective to see just how critical that has been for the progress we’ve made. I think this kind of goes back to the same sort of security question about how, who to share information and ideas with.

[00:38:33] And, there can be a lot of hesitation to it, to share the business and the vision with someone else when you’re just getting started. And I just have to say that my co-founders are absolute force multipliers. They have a diverse set of skills and expertise in areas that I do not.

[00:38:50] And together we’ve put together I think a really exceptionally execution oriented group. And I don’t think we would be where we are without any one of us,  and by the way, we have five on the founding team. It’s just been really awesome to feel vindicated by the the strength and numbers approach there.

[00:39:08] And certainly, that definitely takes some, just careful and intentional approaches to business operations, you know, making sure that how decisions are made and by whom and how things are documented is all very important. But I would just encourage people who are maybe feeling stuck or trying to do everything themselves to consider, bringing on someone who has a complimentary skillset and sharing the burden and, multiplying your effectiveness.

[00:39:36] Miles Lasater: [00:39:36] If you want to go fast, go alone. If you want to go far, go together. Huh?

[00:39:40] Josh Clemente: [00:39:40] There you go.

[00:39:41]Miles Lasater: [00:39:41] Do you have a piece of content you would particularly recommend, a book, a blog, article, podcasts?

[00:39:48] Josh Clemente: [00:39:48] Yeah, let’s see. I’m gonna, I’m gonna recommend a few things. I recommend the podcast, The Drive by Peter Attia for anyone who wants to understand the mechanisms of

[00:39:59] metabolic dysfunction or just health generally. I think I’ve learned just so much from his episodes and show notes. I can’t recommend that enough. I highly recommend the Levels Blog. We take a lot of the information out there about metabolism and break it down and make it approachable and help people understand that this is not something that’s just has to do with diabetes.

[00:40:18] This has to do with quality of life the way our energy is produced and where it goes. And so helping folks understand that. And and then lastly, there’s a really great book that recently came out by Ben Bikman, who is one of our research advisors, but it’s called Why We Get Sick. And this is I think an amazing read for anyone who, audio format or a hard copy, but it describes just how rampant insulin resistance is in modern society.

[00:40:44] And I think it’s, as a single point, it’s a, couldn’t start with a better resource than that.

[00:40:49] Miles Lasater: [00:40:49] And where can people follow you and your work online?

[00:40:53]Josh Clemente: I personally am at JoshuasForrest on Twitter and I’m also on Instagram at Josh.F.Clemente, but you can also just follow Levels on both Twitter and Instagram @Levels, and highly recommend going to our homepage.

Sign up for the waitlist and check out our blog there at LevelsHealth.com.

[00:41:12] Miles Lasater: Thanks so much for coming on the show.

[00:41:14] **Josh Clemente:**Thanks so much for having me Miles.

[00:41:21] Miles Lasater: If you liked what you heard today on the podcast, be sure to subscribe using your favorite podcast player. And please give us a rating and review. The reviews help others find us. You can follow us on Twitter and Instagram and you can follow me on LinkedIn. Be sure to visit our website, StartupsForGood.com. That’s StartupsForGood, all run together. No spaces, dot com. If you were inspired today and want to join our online community or our giving circle, please do so on our website.