Personal Glucose Monitoring with Josh Clemente from Levels

Josh Clemente, co-founder of metabolic health company Levels, has a background in aerospace engineering, CrossFit, and a curiosity to improve his own energy levels. Josh developed the Levels Continuous Glucose Monitor as a tool for improving metabolic fitness and preventing insulin resistance. As a guest on The Strength and Scotch Podcast co-hosted by Grant and Heavey, Josh dived into all things glucose including how metabolism works, how people can train their own metabolic fitness, and the effects of alcohol and stress on blood sugar.

Show Links

• Check out Levels
• Follow Levels on LinkedIn or Twitter
• Connect with Josh Clemente on LinkedIn or Twitter
• Check out The Strength and Scotch Podcast
• Connect with Grant and Heavey on Facebook or Twitter

11:34 – Put your own oxygen mask on first While making life support systems for astronauts and the new Hyperloop program, Josh’s own health declined due to long working hours, little sleep, high stress, and poor diet choices.

“Everyone wants to compete to the death to be the one that carries over the finish line. And we were all just kind of beating ourselves to death. Like no time off, working 18-20 hour days, sleeping under the desk or not at all, eating whatever we get our hands on. And over time, I attempted to get some work life balance back, but I just generally was trying to maintain health by workout alone. And you know, the other factors – sleep and nutrition – were second thoughts, if anything. And I got to the point where I just realized that I’m burning out physically and mentally. Like I am feeling these waves of fatigue throughout the day that are just incompatible with professional excellence. And it’s really, you know, it’s also affecting my mood in the sense that I was not cognitively at my peak, and I certainly was not there in terms of trying to be a good example and a mentor and also a friend and you know a family member, all the things that we are trying to accomplish in the day. And it was all coming down to the point where I had to come to terms like something is not right. And I actually went to my doctor and said, I think I have a terminal illness, like this whole fatigue thing, I’ll be shaking and like cold sweating and just, you know, my memory is gone.”

14:00 – A continuous glucose monitor can be life-saving – and finger-saving

Traditionally, measuring blood glucose levels typically involves pricking a finger and manually checking the blood on a reader. Diabetics can access continuous monitors, which don’t require finger pricking and give real-time data 24 hours a day.

“I was pricking my finger like 60 times a day and plotting it in Excel. And then I read a book called Wired to Eat by Robb Wolf, and that book talked about continuous glucose monitoring. And I was like, that is what I need. I mean, that technology is perfect. I’ll just wear it. I’ll get the full-time data and I’ll be able to understand what’s going on in my body. So I tried to get one from my doctor. And he basically said, you’re not diabetic. You do not need this. This is for people who are already diabetic. I kind of went through three other doctors who gave me the same story, and eventually I did get one actually from Australia, friend of mine flew out there and he picks them up and put them in his backpack and I used it. And when I got the data, within about a week I had enough information to know I was spending a huge chunk of every day in the pre-diabetic blood sugar zone.”

15:30 – Take charge of your metabolic health to cure the global health crisis

With widespread usage and greater understanding of the data, CGMs can go from being a medical treatment tool to a prevention tool for the global epidemic of rising metabolic disorders.

“The metabolic health crisis is way larger than I had ever assumed. You know, it’s epidemic scale and it’s quietly epidemic. And then this technology is good not just for use after a diagnosis of diabetes, but also for awareness and prevention. And see, the data needs improvement to become more actionable. So there’s this opportunity to take this technology and build, you know, the Whoop like experience or the Oura Ring experience on top of it. And rather than it be just a sort of a medicalized tool for managing therapy, it can also be useful for engaging people and making better choices in real time, right. It can be a proactive tool to make us all kind of take the front seat in our health, and hopefully to reverse the trends of metabolic dysfunction, which are increasing at an increasing rate globally.”

17:04 – There is no “normal” or “optimal” baseline

There are almost no studies on what optimal blood glucose is within a healthy population, as the research is typically based on people with existing conditions. Levels plans to change that by building a modern picture of metabolic health to help people live optimally.

“The second major mission of Levels is to map out the space of metabolic function and define what optimal looks like. Because the answer to your question is no, it is in fact unstudied – nearly unstudied, rather than understudied. So we look a lot at diabetes and we have full-time measurements for folks who have already kind of broken, but we don’t know even what normal looks like because CGM is rarely used for the normal population. And we certainly don’t know what optimal looks like. And so Levels, as we’ve gone through all of the research that’s available on continuous glucose data and and a lot of data on discrete measurements like A1C and fasting glucose to assemble target ranges that – essentially we’ve defined the lowest quartile of chronic illness risk. So the blood sugar levels associated with people with the lowest quartile of risk, that is what we have set as the optimal target range. So that’s where we’re starting. And then we’re also pushing ahead very quickly a research program with the intention of continuing to map this out and to define what it means to be responding positively to a meal. And then what it means longitudinally, what the best outcomes are, how glucose control should look in order to make sure that you don’t increase underlying insulin resistance specifically, and generally you have the energy you need, you know, the fuel you need to get through your day to perform optimally.”

21:56 – Insulin determines if glucose will be turned into energy or fat

The body creates energy to fuel the cells through a chemical process called metabolism. When eating high-sugar meals, any excess sugar that isn’t needed by cells gets stored as glycogen, quick access energy, or fat, which is backup energy.

“Metabolism is the set of cellular mechanisms that we produce that basically produce energy in all the cells in our bodies from our food and environment. So it’s the way that our bodies break down the food. We give it environmental factors like sunlight and create energy, which powers every process in the human body. So everything from brain tissue to muscle, all of that requires energy. And in order to create it, we use the raw materials we provide. So that whole bucket of processes is called metabolism. The way metabolism works is we’re kind of like chemistry sets. So you’re a bag of chemicals and there are chemicals being released in response to other chemicals all the time, and you are introducing chemicals like glucose, which is sugar, via the food that you eat. So if you eat a very sugary meal, that breaks down into blood sugar very quickly, gets into your bloodstream very quickly, and your body has to release chemicals called hormones in response to this chemical you just introduced, right? And so you’re basically producing a reaction in your body and that hormone that the body has to release is called insulin. And the effects of insulin are anabolic, essentially it is the hormone that is responsible for storing things. So when you have a large blood sugar elevation, the concentration of sugar in your body goes up. That can be risky to the body because glucose is very reactive and so you want to bring that back in range as quickly as possible. So your body releases a large wave of insulin, and then insulin tells the cells to allow glucose in to be turned into energy or to store it as glycogen, or if glycogen is full, to store it as fat.”

24:30 – Lifestyle choices are linked to preventable diseases

When the metabolism is not working optimally due to excess sugar or a sedentary lifestyle, insulin resistance and a number of metabolic disorders occur – with life-changing consequences at stake.

“The underlying factor that we are looking to combat in the world right now is that we have a lot of insulin resistance happening. When that happens, you lose the ability to control blood sugar. And when that happens, you start to have dramatic tissue damage across everything from the cells in the brain – examples of this are Alzheimer’s disease, now being called type three diabetes – the vasculature of the cardiovascular system is very, very closely correlated with glucose dysregulation, PCOS, which is polycystic ovarian syndrome, is the number one cause of infertility in women that is associated with insulin resistance and metabolic dysfunction. You know, the list goes on and on. So we have all these names for what is ultimately the breakdown in the processes that produce energy. And so if we can control the lifestyle choices we’re making and the way that we’re influencing these chemical cascades in our bodies, we can ideally avoid or reverse the insulin resistance that is causing all the issues.”

27:59 –  Metabolic fitness can improve with focus, effort, and repetition

Rather than being black and white, healthy or unhealthy, there is a spectrum of metabolic fitness which can be developed through focus on four key areas: diet, exercise, sleep, and stress.

“The reality is that we’re all on a spectrum. It’s a continuum, and every decision we make compounds and so we’re either making choices that are compounding in a positive way and improving our metabolic health or compounding in a negative way and moving us closer and closer to dysfunction. And so this is the concept of metabolic fitness, which is that just like physical fitness and mental fitness, it takes focus, effort, and repetition to improve your metabolic health. So there are factors that are entirely in our control and these are the levers of diet, exercise, sleep, and stress, which ultimately stack up to that chemistry set. What chemistry experiments are you running every single day? And so, if we’re making the right calculations and making the right assumptions and choices every day that are influenced by objective data from our bodies, we can drive more towards optimal and avoid the long-term breakdown. The CDC releases figures every single year on the state of metabolic health, and CDC estimates that there are 120 million preventable cases of chronic illness in this country right now, and that’s just adults. To break that down further, there are 90 million Americans with pre-diabetes today and 90% of them don’t know they have it.”

32:05 – Manipulating the four levers of health With greater understanding of how the body reacts to diet and exercise choices, or factors like stress and sleep, it is easy to make small changes to replace suboptimal decisions with healthy ones.

“For an example, if I’m at SpaceX and I’m working 20 hour days, and I’m sleeping at best four hours and I’m eating whatever I can get my hands on, I’m compromised on at least two of the levers, those four levers I mentioned of diet, exercise, sleep, and stress. And so it’s in circumstances like that that we see, and the research shows that people who have short sleep, just a single night of short sleep, can introduce up to 40% increase in insulin response. And so you become acutely insulin resistant. So if I’m compromised on sleep I can make up for that by making better decisions on my dietary selection or by attempting some stress management or by attempting to time exercise around meals so that I can help blunt the blood sugar elevation that an indulgent meal will produce. So we’re showing people that just eat that personal pizza and sit on the couch and watch TV versus eating that pizza and going for a 20 minute walk right after, it’s a completely different blood sugar response. Because your largest muscles in your body, your legs, are using that glucose in real time.”

34:13 – Tie your metabolic fitness to your personal goals Whether looking to improve brain function, slow aging, or lose weight, it all comes down to metabolic fitness and blood glucose regulation.

“It’s good to understand that metabolism and metabolic dysfunction is not just diabetes. It’s  fatigue, it’s cognitive function, it’s skin wrinkles, it’s aging. You know, glycation of the skin is what leads to browning and wrinkles. And so even something as simple as that, it’s just understanding all of those sort of quality of life experiences, you know, weight gain. Weight gain is driven by the hormone insulin. You can’t  store fat without having a hormonal input to do so. So connecting the dots between our day-to-day goals and your metabolism generally is the way that we will start to be more intentional about this and understand that the pillars of physical fitness and mental fitness are built on a foundation of metabolic fitness.”

35:53 – The future is personalized health recommendations As the technology develops and different biowearables are integrated, it will be possible to use data to predict outcomes and recommend activities, such as how to eat optimally on low sleep, or in high-stress situations.

“Over time as the algorithms develop on the backend, we’ll be able to be proactive and predictive. So in this case, you know, I take a red eye, I don’t sleep at all, my wearable, which connects directly into Levels so we pull an activity data. We’re starting to pull in sleep data, right. We’ll identify that I slept poorly. It will then be able to surface insights and say: Hey, look, you’re metabolically compromised right now, you slept four hours. The last time you slept four hours, you had a major blood sugar elevation on these foods, recommend avoiding those and opting for these. And so it can intervene at moments when we are compromised to help you identify how to make better choices without a ton of cognitive burden. And that’s the stretch goal. And over time we’ll be able to provide intervention across all of the four levers of diet exercise, sleep, and stress in order to help people optimize.”

38:37 – Alcohol in moderation may support glucose regulation It comes as no surprise that alcohol impacts glucose, as it contains sugar. However, studies show it actually reduces blood glucose by interfering with the liver’s ability to produce glucose.

“[Alcohol] tends to interfere with the production of new glucose in the liver. So your liver is basically taking raw materials in and cranking out glucose all the time, and that’s called gluconeogenesis. Alcohol prevents that process from happening, and instead it causes your liver to start producing fat. So the ethanol is turned into triglycerides, which then gets stored on your body or used for energy. And so If you drink alcohol, you may see your blood sugar actually decreasing, or for many people see that their blood sugar actually decreased due to that cutoff of gluconeogenesis. And this effect, it has not been well studied, certainly not in people without diabetes, and it’s pretty interesting. I mean, it’s well-known that some amount of alcohol consumption is associated with longer lifespan, and some people have presumed that that’s due to the stress reduction, it puts us in an easy mode and helps us kind of forget about our struggles, and so maybe that’s something to do with it. I also wonder if the area under the curve, the lower glucose exposure during the time that your gluconeogenesis is reduced, which can last for several hours, might have something to do with it.”

44:41 – Levels helps build long-term healthy habits Most advice out there is based on other peoples’ experiences – but data from your own body allows you to understand exactly what choices are healthy for you and why.

“The nice thing is that we kind of read about, most of us follow lifestyles that are built on advice, or something that worked for someone else, or something that the bathroom scale kind of indicates to us, or emotion, or just the taste of food. It’s like, we’re literally just using the bare minimum instinctive stuff to get through life. With Levels you can start to get these receipts for micro-optimization. You get data that comes back to you and says, okay, that worked, that little thing is 10% better, or in some cases, 50% better. And so it’s really nice. For me, for example, I don’t want to be an extremist about carbohydrates. I’m very carb sensitive. Basically across the entire Levels team, I’m one of the worst in terms of how my body responds to simple foods, things like sweet potatoes, oatmeal, foods that you would otherwise think are going to be just fine, send me racing to the moon. And so with that in mind, it’s nice to know that if it’s a nice night out, I have dinner, I want to have something that has some carbohydrates or have some dessert. I do that and I just go and I take a walk around and I look at the stars, right. I talked to my girlfriend or whatever, you know, whatever I want to do. But I’ll generally do something active. And having the insight, having that data that shows me that was a positive choice and that it improved my blood sugar response is really the thing that causes that long-term habit formation.”

47:33 – No two people are the same

Studies show that every person has a unique composition and reaction to foods. Therefore, the only way to know what is healthy for yourself is to track how your body reacts, and adjust accordingly.

“One study that was a study from the Weitzman Institute in 2015, which put CGMs on about 800 non-diabetic people and tracked them through as they ate calibrated meals. It basically showed that two people can eat the exact same two foods and have equal and opposite blood sugar responses to them. In this case, it was a banana and a cookie. And it’s not saying that somebody should eat cookies only and avoid bananas. It’s probably more something like fruit sugars versus grain sugars, for example, and how these people metabolize them. And it could be microbiome, it could be genetics, it could be stress, it could be body composition. There’s a ton of factors involved. But there’s also a ton of other implications. If you’re the person who has a huge blood sugar elevation on a banana, you’re likely also having a huge insulin response to that banana. And so over time you might be making the decision to fuel up on a banana before every workout thinking it’s what’s best for you, but you may actually be working directly against your goals.”

53:07 – Don’t underestimate the effects of stress

Stress creates a hormonal response in the body, which signals the liver to generate glucose in case energy is needed for fight or flight. This leads to a rise in blood glucose much like eating a high-sugar meal – including all of the unwanted effects.

“Don’t underestimate the effects of stress. So that is like such a nebulous term out there, like stress, oh yeah, we all have stress of various types. And yes, we all have stress. But I have seen my blood sugar elevate from normal to over 140 milligrams per deciliter, which is effectively the normal, it’s like the prediabetic threshold for a response to a sugary meal, just from the stress of going on a stressful podcast. The fact is, when your body is hit with cortisol or adrenaline, which are the fight or flight, they’re the glucocorticoids is what they’re called, but they’re hormones that tell your body that you’re in a fight or flight scenario. Your liver just says, go all out, like just starts cranking out glucose and putting it into the bloodstream to fuel your escape from whatever the scenario is. And so this is pretty useful if you are, let’s say in the gym or you know, I’m trying to hit a PR or you’re running from a mountain lion. But if you’re sitting on the couch with headphones on, all that glucose that’s being released into your bloodstream is going to be taken back up as fat, for example. Or that blood sugar spike and crash is going to contribute to the inflammation that we know is associated with glucose variability, which is bad for cardiovascular disease. And so seeing that data really drove home to me how important stress is and stress management is.”

Intro: [00:00:00] Welcome to Strength and Scotch, the show where health fitness and alcoholism come together. So pour a couple of fingers, throw a barbell on your back, and listen closely.

Host: [00:00:18] Welcome to Strength and Scotch, the show for people who take their health and fitness seriously, but not themselves. I’m Grant. And with me as always is Coach Brandon Heavey.

Hey Heavey. How are you doing?

Brandon: [00:00:29] Hey Grant? I am super pumped today to be talking about glucose monitoring with a very special guest Josh Clemente from Levels.

Host: [00:00:38] I’m excited too. But before we get into that, I really want to remind everyone that Strength and Scotch is proudly brought to you by you- the listener.

We really are having a lot of fun with our Strength and Scotch plus community, and thank everyone who’s been supporting the show and want to let you guys know if you haven’t checked it out, go to www.strengthandscotch.com/plus, and get more of the episodes that you like, more interaction with us.

You know, just last night we filmed a little video that was exclusive for our Patrion supporters. We’ve got a special whiskey tasting coming up where we’ve, the listeners voted on Buffalo Trace for November. We’re sipping that today, so it’s a lot of fun. Check it out at www.strengthandscotch.com/plus.

Brandon: [00:01:26] Alright. Josh, welcome to Strength and Scotch.

Josh Clemente: [00:01:30] Thanks for having me on. Excited.

Brandon: [00:01:32] Yeah. So, Josh, you don’t know this because you don’t know anything about me, but Grant, Josh and I actually have a fair bit in common. Josh is an engineer by school, by training. I’m an engineer. Josh worked at SpaceX. I worked at JPL.

Josh has a couple of CrossFit Certifications, so do I, but that’s where our paths sort of diverge. At that point, Josh has gone on to co-found a very exciting startup, Levels, and, I went on to start this very mediocre podcast.

Heavey: [00:02:07] Josh is who you wish you were.

Brandon: [00:02:09] That’s right. My aspirational being here.

Josh Clemente: [00:02:14] I’m flattered.

Host: [00:02:15] Josh, you know, we’ve heard a lot about Brandon’s background on how, you know, the nerdy engineer ended up super into health and fitness. How did you end up being, you know, bridging that gap?

Josh Clemente: [00:02:31] Well, let’s see. I, growing up, really enjoyed just being outside and as far away from indoor activities, like schoolwork, as possible. So being outside, playing sports and building stuff were the two hobbies of mine all the way through childhood and then played some sports in college, just club stuff, played rugby, played ice hockey. And once I got into the professional world, I needed something to keep me accountable and keep me, you know, from devolving at a desk job, which is what most engineers do, and that thing was CrossFit. So I just got obsessed with the condensed form of the workout. So you can get a lot done and feel pretty confident that you’re making gains every day in just 20 minutes or 30 minutes in some cases. So I got kinda hooked on that form factor and dove into the certification process, enjoyed becoming a level one then a level two trainer, even though I don’t often teach classes, but yeah. That’s kind of how things played out.

Heavey: [00:03:26] Look at that Brandon, you also have ice hockey in common.

Brandon: [00:03:28] Alright.

Josh Clemente: [00:03:30] How about that?

Brandon: [00:03:31] I really did screw up somewhere.

Heavey: [00:03:36] So engineer by trade and you ended up at SpaceX, right? How was that experience?

That must have been amazing.

Josh Clemente: [00:03:43] That was a, it was an amazing experience for sure. I actually, so after school I did not go straight into engineering. I went straight into used car sales because I wanted to go work at SpaceX and they hadn’t hired me yet. So there was this sort of disconnection between my goals and theirs, I guess. So yeah, I was selling cars at CarMax for a while.

And I was actually there, I just sold a, I think like a 2006 Toyota Previa, when I got the phone call from the recruiter that I should fly out and talk to them. So it was an awesome first engineering gig. I was there for about six years and it really kind of transformed my life, both professionally, obviously, but also personally, I met some of my greatest mentors and friends there at SpaceX and was involved in some stuff that, um, as a that, as a bit of a space nerd, I really am proud of and excited to see the future of. So yeah, it was a very strong process, and I also got to see kind of the first principles approach that Elon brings to engineering problem solving, which I am attempting to bring into the other ventures I’m involved with.

Brandon: [00:04:47] From what I understand, while you were at SpaceX, you worked on some life support systems that helped, or that were a part of the recent manned launch from the US, is that true?

Josh Clemente: [00:04:58] That’s right. Yeah. So I led a team that developed pressurized life support systems. So this is like the apparatus that feeds oxygen and air into the capsule. It keeps the capsule pressure appropriate, fire suppression systems, suit-breathing systems, things like that.

Heavey: [00:05:14] Are those important?

Josh Clemente: [00:05:16] You know, it’s questionable. It depends on who you ask.

Heavey: [00:05:20] If I ask someone inside, they’d probably be like, “Yeah, this is important stuff.”

Josh Clemente: [00:05:24] Exactly. It’s all relative. Someone inside the capsule will probably appreciate them more than someone here. But yeah, those flew for the first time in May. And then actually, we have another launch on the 14th, so on Saturday, that will fly four more astronauts up.

Brandon: [00:05:38] You know, that May launch, I think it’s well established on the show that I am a pretty even keeled character and don’t get emotional.

Heavey: [00:05:47] Or have the ability to have emotion.

Brandon: [00:05:48] Sure. Okay. Grant, did you watch that launch anyway?

Heavey: [00:05:51] I did, because you were texting me and saying how I had to turn it on

Brandon: [00:05:54] Yeah. So I was super excited about that.

And honestly, I cannot recall, it’s not like I was crying on the sofa, but I felt like a little bit like, maybe I was welling up a little bit to see that we had sort of restored that capability which had been missing for so long. And I don’t know, I’m guessing Grant just blew it off, but that really, really touched me. So.

Josh Clemente: [00:06:17] I’m right there with you.

Brandon: [00:06:18] I can see, yeah, I can see how it would feel like you’re really, you know, doing important work there.

Josh Clemente: [00:06:26] Yeah. I mean, I left a few years ago now, and so there was some lag time between the design review process and then actually building the vehicle that flew. So I was, you know in large part, involved in the development, but then there’s just an incredible team there that carried it over the finish line and it was bittersweet to watch from the outside, for sure, but amazing to see this kind of new era of space flight kicking off. And I think there’s going to be some pretty amazing stuff. I’m optimistic that, unlike after the Apollo program and the shuttle program, we won’t be losing this capability.

I don’t think, I expect that we’re going to be doing big things on moon bases and such, sometime soon.

Brandon: [00:07:03] Yeah. That’s really exciting. And I can completely relate to the timeline thing because I worked on the Mars Rover Curiosity and, you know, basically it was a total shit show and super difficult work, huge hours for a very extended period of time and then the project ends. And you just sort of forget about all of that, you know, and then like a year and a half later, something magical happens. It’s pretty wild.

Josh Clemente: [00:07:28] Yeah, that’s right. It is. Yeah. A long tail on this project.

Brandon: [00:07:32] Absolutely.

Heavey: [00:07:33] And then I understand you went from SpaceX to Hyperloop, which is another Elon Musk brain project. Right?

Josh Clemente: [00:07:41] That’s right. Yeah.

Heavey: [00:07:42] But when you were working on it, you were actually with Virgin Hyperloop, if I understand correctly.

Josh Clemente: [00:07:47] So when I went there, it actually had not yet become Virgin Hyperloop, it was called Hyperloop one at the time. And that project, Elon although he put the white paper out that described Hyperloop technology, he was not involved specifically with the company.

And so I was, yeah, I worked on infrastructure systems, helping to build the first full-scale route out in North Vegas and then helping to kind of concept out some life support systems for them, since it is essentially a spacecraft in a tube. So, you know, you pull all the air out of a tube and it becomes a vacuum like space.

And so yeah, that was a fun project as well. I was there for about a year. And then left to start iterating on metabolic stuff.

Heavey: [00:08:31] Yeah. And that’s where it gets so interesting because, you know, we wanted to touch base on this background. You’ve got some real, huge experience here and you decided to take it into this metabolic hardware, software experience that makes up Levels. And Brandon, our listeners have heard a little bit about how you were really intrigued in this and for those who either missed those episodes or didn’t hear about it, why don’t you tell them what you sought out, far before we knew we would be talking to Josh.

Brandon: [00:09:05] Well, you know, glucose monitoring, I think it’s something that a lot of people have some, at least some familiarity with, because diabetes is so prevalent in the world, not just this, our country. And so I had diabetes on both sides of my family and was concerned, had some concerns around that. So I had a lot of risk factors for it. I try to be super healthy as most of our listeners are aware, but I felt like it might add value to my life to try to pull out all the stops. And so I had, for years, been trying to hack together ways to understand the way that my body was responding to the foods that I eat and the sleep that I get and all these other factors. And how I had done that historically was just those cheap finger-prick monitors you can buy off Amazon for 20 bucks. They’re probably horribly inaccurate, but that was really the best that we could do. And so, you know, I would sit down to a meal take a pre blood sugar, and then every 30 minutes or so after the meal, I would take fingerpricks and then sort of chart out my blood sugar response to different meals.

But that’s a real pain in the finger and in the ass, you know, and it leads a lot to be desired. You know, I had been doing like the normal lab stuff too with the doctor, but for most people, the only insight they get is a fasting blood glucose level when they do their annual physical checkup. I mean, most times those doctors aren’t going to look at A1C.

But even A1C leaves a lot to be desired. So as soon as I heard about what Levels was doing with continuous glucose monitoring, it was something that I knew that I was excited to experiment with. And that’s ultimately what drew me in. And there’s a huge wait list and somehow I was able to get a sensor.

I think now you guys have over like a 37,000 person wait list to use your product, which is incredible. But I was lucky enough.

Josh Clemente: [00:11:02] It’s about 45,000.

Brandon: [00:11:03] Okay. 45,000. Wow, it keeps going up. But I was lucky enough to get in early and get to play around with it and see precisely, I mean, I can, it’s named continuous glucose monitor, because you can see, you know, minute by minute, what’s happening to your blood sugar after you don’t sleep well, or after you eat something or after you drink booze or you do whatever.

So you can really get some powerful insights into how your body is responding, at least in one dimension, to a bunch of stimulus, and that was my interest.

Josh Clemente: [00:11:34] Yeah, we really do have more in common than I, yeah, your whole experience with finger pricking and hanging out values, you know, 15, 30, 60 minutes after a meal and then trying to make heads or tails of it.

It’s exactly what I went through and is the reason that ultimately I discovered CGM because I was so frustrated by the experience that I was going through. So to back up a little bit, I was, you know, working on the life support program. It was, as with everything at SpaceX, the schedule’s impossible.

Everyone wants to compete to the death to be the one that carries over the finish line. And we were all just kind of beating ourselves to death, like no time off, working 18, 20 hour days, sleeping under the desk or not at all, eating whatever we get our hands on and over time, I mean, I attempted to get some work life balance back, but I just generally was trying to maintain health by workout alone. And, you know, the other factors, sleep and nutrition, were second thoughts, if anything, and I got to the point where I just realized that I’m burning out physically and mentally. Like I am feeling these waves of fatigue throughout the day that are just incompatible with professional excellence. And it’s really, you know, it’s also affecting my mood in the sense that I just was not cognitively at my peak and I certainly was not there in terms of, you know, trying to be a good example and a mentor and also a friend and, you know, a family member, all the things that we are trying to accomplish in the day.

And it was all coming down to the point where I had to come to terms like something is not right. And I actually went to my doctor and said, I think I have a terminal illness, like this whole fatigue thing, like I’m, I’ll be shaking and like cold sweating and just, you know, my memory is gone.

I don’t know what meeting I’m supposed to be at. I don’t care. Like I need coffee to get through the day.

Brandon: [00:13:25] Now you’re sounding a lot like Grant, who’s a hypochondriac and always worried that he’s dying.

Heavey: [00:13:31] Yeah, thanks a lot, Brandon. Throwing me under the bus.

Brandon: [00:13:33] It’s all good.

Josh Clemente: [00:13:35] Yeah. So we’ve got a lot in common with all three of us. Yeah so, I mean, I was just like, something’s wrong. And he ran those tests, you know, the fasting glucose check and I actually even gotten A1C and both of those were in the normal range. So glucose never came up in our conversations.

And in fact, I was told you’re fit. You don’t have any extra body fat. You’re fine. You know, basically just move on.

Heavey: [00:13:55] Did they say maybe don’t work 20 hours a day? Cause that would have been where I

started in the conversation.

Josh Clemente: [00:14:01] Lifestyle factors never came up. It was looking for a diagnosis. No, and unfortunately that’s kind of the standard approach.

But anyway, I did get one of those glucometers. I was pricking my finger like 60 times a day and plotting it in Excel. And then I read a book called Wired to Eat by Robb Wolf. And that book talked about continuous glucose monitoring and I was like, that is what I need. I mean, that technology is perfect.

I’ll just wear it. I’ll get the full-time data and I’ll be able to understand what’s going on in my body. And so I tried to get one from my doctor. And he basically said, you’re not diabetic. You do not need this. This is for people who are already diabetic. And I kind of went through three other doctors who gave me the same story.

And eventually I did get one actually from Australia, friend of mine, like flew out there and he picks them up and put them in his backpack and I used it. And when I got the data, within about a week, I had enough information to know I was spending a huge chunk of every day in the pre-diabetic blood sugar zone.

And depending on who you ask, but Dr. Peter Attia, you might follow him, he’s a CGM easiest and functional doctor. And, you know, he would say that I was, you know, certainly from what I’ve heard, he would describe me as borderline or at least somewhat metabolically dysfunctional.

And so that was like the first moment that I found an edge where this tech can be not only useful to understand where I am, it could also be useful to iterate in a better direction. And so I completely changed my approach to sleep management, stress management, and diet by using the data from CGM. And it just became obvious that A- the metabolic health crisis is way larger than I had ever assumed. You know, it’s epidemic scale and it’s quietly epidemic. And then B- this technology is good, not just for use after a diagnosis of diabetes, but also for awareness and prevention and see the data is, needs improve to become more actionable. And so like, there’s this opportunity to take this technology and build, you know, the WHOOP like experience or the Oura Ring experience on top of it.

And rather than it be just a, you know, sort of a medicalized tool for managing therapy, it can also be useful for engaging people and making better choices in real time. Right. It can be a proactive tool to make us all kind of take the front seat in our health and hopefully, to reverse the trends of metabolic dysfunction, which are increasing at an increasing rate globally.

Brandon: [00:16:17] Right. And so you said that, you know, your levels were basically at a pre-diabetic type of a response to, throughout the day, and you only were able to discover that with this continuous monitoring. The thing that I’m curious about is, you know, we do have a pretty reasonable understanding of dysfunctional response to foods.

But I’m not aware of a whole ton of research on what healthy responses are supposed to look like. I’m sure you’ve done a lot of research and probably read everything that is available, though I imagine it’s limited. So how do we, I mean, do we even have that characterized? What a healthy glucose response should be or what an idealized response?

Josh Clemente: [00:17:04] Well, that is the second major mission of Levels, is to map out the space of metabolic function and define what optimal looks like. Because the answer to your question is no, it is not, it is in fact unstudied, nearly unstudied rather than understudied. So we look a lot at, yeah, we look a lot at diabetes and we have full-time measurements for folks who have already kind of broken, but we don’t know even what normal looks like because CGM is rarely used for the normal population and we certainly don’t know what optimal looks like. And so Levels has, we’ve gone through all of the research that’s available on continuous glucose data and a lot of data on, you know, discrete measurements like A1C and fasting glucose to assemble target ranges that are essentially, we’ve defined the lowest core tile of chronic illness risk.

So the blood sugar levels associated with people with the lowest core tile of risk, that is what we have set as the optimal target range. So that’s where we’re starting. And then we’re also pushing ahead very quickly, a research program with the intention of continuing to map this out and to define what it means to be responding positively to a meal. And then what it means long longitudinally, like what the best outcomes are, how glucose control should look in order to make sure that you don’t, you know, increase underlying insulin resistance specifically. And generally you have the energy you need, you know, the fuel you need to get through your day to perform optimally without, you know, excessive byproducts, like reactive oxygen species and other sort of inflammatory molecules that you get when you have blood sugar elevations and variability. So, still tons of work to do here. Every person that participates in the Levels program is helping us better understand what the population looks like.

Because as of now, there’s like I said, very, very little information out there. So the data set’s growing and over time, you know, Levels I think, will have the best understanding of this and will be able to help define what, you know, the standard of care should be.

Brandon: [00:19:03] Right. When I heard the great interest that you guys had in your product the first thing that occurred to me well, after I got excited and added myself to the wait list, was that you have huge potential to advance our understanding of blood glucose response. And I was curious if you were going to be like registering clinical trials and showing, you know, trying to really shepherd us on in our understanding of all of this forward and not just, you know, sort of create a product, but sort of get back at the same time.

Josh Clemente: [00:19:40] Absolutely. Yeah. So we’re building our research team right now. So far, we have some of my all-time heroes in the space- Ben Bikman, Dominic D’Agostino from University of South Florida, Molly Maloof have all joined in the past few months and are starting the initiatives at their research organizations to start the process, it’s going to be a long road ahead, but the process of better understanding normal and optimal, real-time glucose  information. And so the goal is going to be to reduce insulin resistance long-term, using composite metrics, which basically analyze all of the sort of sub responses in your blood sugar curve and turn them into a single unified metric. So this is what Levels is doing. We take into account things like variability, postprandial elevation, the rate of change, the duration of the spike, all of these different things that’s really hard for a person to look at and visually analyze. And we’re building them into a composite model on the backend, which we will then validate in our clinical trials to help associate with outcomes.

So the goal is to demonstrate that, you know, this is not just an interesting lifestyle tool, which it is, it’s not just interesting for athletes who want to avoid bonking or for people who want to optimize diet. It’s also clinically valid in the sense that improvement on the metrics Levels cares about, equates to improvement in long-term health and risk of negative outcomes.

Brandon: [00:20:59] Grant, I think you try to steer toward bonking, if I understand.

Heavey: [00:21:05] Well, you know, you bring up an interesting point there is like, who exactly is your target demographic, your target customer with Levels, where you’re at right now?

Josh Clemente: [00:21:17] So right now we’re in an early adopter phase for sure. And, you know, folks like, I mean, the two of you, obviously you’ve both got some awareness of the space we’re working in, but most people don’t know what metabolism even means, which, you know, ultimately it’s hard to sell someone, a product that influences a metabolic fitness when, most people don’t understand the space and don’t understand why it would be relevant.

Brandon: [00:21:42] I think that’s a good point too. By the way, after you finished talking about well, who Levels is for, it might be good for us to take a quick step back because we’ve just sort of skirted over the idea of everybody understands glucose response and metabolism, and maybe give us a quick high level on that also.

Josh Clemente: [00:21:58] Let’s do that right now. So, we keep using the term metabolism. Yeah. So metabolism is the set of cellular mechanisms that we produce, that basically produce energy in all the cells in our bodies, from our food and environment. So it’s the way that our bodies break down the food we give it and environmental factors like sunlight, and create energy, which power every process in the human body. So everything from brain tissue to muscle, all of that requires energy. And in order to create it, we use the raw materials we provide. So that whole like, kind of bucket of processes is called metabolism.

And so yeah. The way metabolism works is we’re kind of like chemistry sets. So you’re a bag of chemicals and there are chemicals being released in response to other chemicals all the time. And you are introducing chemicals like glucose, which is sugar, via the food that you eat. So if you eat a very sugary meal that breaks down into blood sugar very quickly, gets into your bloodstream very quickly, and your body has to release chemicals called hormones in response to this chemical you just introduced, right? And so you’re basically producing a reaction in your body and that hormone that the body has to release is called insulin. And the effects of insulin are anabolic, essentially it is the hormone that is responsible for storing things.

So when you have a large blood sugar elevation, the concentration of sugar in your body goes up, that can be risky to the body because glucose is very reactive. And so you want to bring that back in range as quickly as possible. So your body releases a large wave of insulin, and then insulin tells the cells to you, allow glucose in, to be turned into energy or to store it as glycogen, or if glycogen is full, to store it as fat. And so that’s kind of how your body metabolizes glucose. Now over time, if you’re kicking the system constantly with these waves of glucose and basically trying to maintain elevated blood sugar, and the way you can do this is by being sedentary and eating a processed diet with a lot of carbohydrates, your body’s constantly spiking insulin to try to take care of all those elevations. And over time, this seems to introduce a numbing effect in your cells. So your cells are basically saying like, we can’t use this for energy because you’re not using energy right now. We can’t store any more of it because your glycogen stores are full and your body fat is also getting full.

So this is like, the individual who is overweight and experiencing, you know, those negative effects they can run into this numbing effect where the cells stop responding to insulin and that’s called insulin resistance. And that is the underlying factor that we are looking to combat in the world right now, is that we have a lot of insulin resistance happening.

When that happens, you lose the ability to control blood sugar. And when that happens, you start to have dramatic tissue damage across everything from the cells in the brain. Examples of this are Alzheimer’s diseases, now being called Type 3 diabetes, the vasculature of the cardiovascular system is very, very closely correlated with glucose dysregulation, PCOS, which is Polycystic Ovarian Syndrome is the number one cause of infertility in women, that is associated with insulin resistance and metabolic dysfunction. You know, the list goes on and on. And so we have all these names for what is ultimately the breakdown in the processes that produce energy. And so if we can control the lifestyle choices we’re making and the way that we’re influencing these chemical cascades in our bodies, we can ideally avoid or reverse the insulin resistance that is causing all the issues.

Brandon: [00:25:27] And to me, that seems like a really compelling use case for the device. And Levels is, you have so many people that go to the annual checkup. And I think that this is improving now that we’re moving to electronic health records and so forth, and we can kind of track, even though the discrete measurements we’re still tracking year over year before it was just like, well, you’re fine.

You know, your levels below the threshold. So. Keep doing what you’re doing. Now, we can see trends year over year, but even that isn’t a super great look at it. And that’s my interest in doing the, using the sensor in the first place was just to zoom in and see what’s happening at a continuous level. And now you’re going to provide those insights for a much larger swath of the population.

And that seems really, really great. And I think that a lot of people can relate to it, not just within the disease state, but as you mentioned, you were suffering from energy crashes and so forth. And that’s a typical glucose response, like rollercoaster type of thing where maybe the blood sugar spikes up because of some large carb less, or, you eat gummy bears, which has been known to happen from time to time.

Heavey: [00:26:31] Or chocolate-covered caramels.

Brandon: [00:26:33] Yeah. And then your buddy, your body, your buddy, your buddy-body releases insulin and maybe too dramatic effect, which crashes your blood sugar level, and it goes below and you go hypo and that’s when you start to feel shaky and get sweats and all of those types of symptoms. And so I think that’s a relatable set of circumstances for people, to make it a little more real, just in case, you know, they’re not worried about the disease stage yet.

Maybe we’ve got 20 year olds listening to this that aren’t, you know, haven’t gone through the trenches of life yet and they’re still popping those gummies.

Heavey: [00:27:04] If you start monitoring your glucose though, and almost like what you were saying, Josh, where you noticed some of the time I’m in this almost pre-diabetic level, can you reverse that in a way that you cannot later reverse, you know, if you’re diabetic and you have to take insulin and things like that,? If you act soon, can you see an improvement? Or is it just a matter of getting it under control and not getting worse?

Josh Clemente: [00:27:31] Great question. So we kind of have this concept in society that.

for those people that know about metabolism, there’s this sphere that I’m either metabolically healthy or unhealthy, and that it’s kind of binary. You’re like one or the other, or it’s going to inevitably happen to you. But the reality is.

Heavey: [00:27:48] It’s like you hit that A1C score, right, of 6.5 and it’s like no, at 6.4 you’re not, at 6.5 you are.

Josh Clemente: [00:27:54] Exactly. It’s like, boom, you’re diabetic now. And the reality is that you’re, we’re all on a spectrum. It’s a continuum. And every decision we make.

Heavey: [00:28:02] Heaveyss definitely on the spectrum,.

Josh Clemente: [00:28:06] We all are. But every decision we make compounds. And so we’re either making choices that are compounding in a positive way and improving our metabolic health or compounding in a negative way and moving us closer and closer to dysfunction. And so this is the concept of metabolic fitness, which is that just like physical fitness and mental fitness, it takes focus, effort and repetition to improve your metabolic health.

And so there are factors that are entirely in our control and these are the levers of diet, exercise, sleep, and stress, which ultimately stack up. It’s that chemistry set. What chemistry  experiments are you Are you running every single day? And so if we’re making the right calculations and making the right assumptions and choices every day that are influenced by objective data from our bodies, we can drive more towards optimal and avoid the long-term breakdown and the CDC releases figures every single year.

on the state of metabolic health. And CDC estimates that there are 120 million preventable cases of chronic illness in this country right now. And that’s just adults. And to break that down further, there are 90 million Americans with pre-diabetes today and 90% of them don’t know they have it. And so that was the track I was on.

I had no idea, no indication that I had pre-diabetes or it was close to it. And yet every day I’m flying blind. I’m making choices that , I’m feeling some quality of life stuff like I’m not feeling like I’m performing well, but it’s not showing up in a diagnosable state. And so it’s kind of brushed under the rug or it’s assumed that everything’s fine.

And, uh, to go even further, there are something like 35 million Type 2 diabetics today in the United States. And that number is increasing and it’s increasing in children and, you know, across the board, This is preventable. So Type 1 diabetes is a very separate, it’s a, different condition where it’s an auto-immune state, where you stop producing insulin.

That is a very small percentage of diabetes. The vast majority, 95% of it is the preventable kind, where with better lifestyle decisions, it can be avoided. And certainly, companies like Virta Health, which you may have heard of, have already demonstrated that even if you do get Type 2 diabetes, strong dietary intervention and exercise, no medication, can reverse the symptoms of diabetes of Type 2, and so, it’s very clear that this is within our control.

Brandon: [00:30:16] I get the pre-diabetic use case and approaching that and wanting to avoid disease. It makes a lot of sense. I’m curious though, to go back to what you said, you’re thinking in terms of, you know, binary mindset, that’s a way that people approach numerous dietary and fitness topics, there’s a good and a bad and evil, you know, and true, there are healthy foods and unhealthy foods.

Is there a concern on your part that in being so focused on blood glucose that we might miss the larger picture?

Josh Clemente: [00:30:52] Yeah, I think that, you know, so Levels doesn’t take a dietary philosophy, right? We don’t say that you should eat carnivore or that you should eat ketogenic or that you should eat vegan or any of that stuff.

We basically say that whatever your dietary philosophy, whatever your goals are, you should ground them in objective data. So you should use information from your body to close the loop between the actions you’re taking and the reactions they produce. Otherwise you have what’s called open loop decision-making, which is essentially flying blind.

So the goal is, connect people with their body’s information and get them to understand the context, within which they make choices, matters. And so, you know, for an example, if I’m at SpaceX and I’m working 20 hour days and I’m sleeping, at best, four hours and I’m eating whatever I can get my hands on, I’m compromised on at least two of the levers, those four levers I mentioned of diet, exercise, sleep, and stress. And so it’s in circumstances like that, that we see, and the research shows, that people who have short sleep, just a single night of short sleep can introduce up to 40% increase in insulin response.

And so you become acutely insulin resistant. So if I’m compromised on sleep, I can make up for that by making better decisions on my dietary selection or by attempting some stress management or by attempting to time exercise around meals so that I can help blunt the blood sugar  elevation that, uh, uh,, an indulgent meal will produce.

So, you know, we’re showing people that just like, you know, you eat that personal pizza and sit on the couch and watch TV. versus eating that pizza and going for a 20 minute walk right after, it’s a completely different blood sugar response because you’re, the largest muscles in your body, your legs are using that glucose in real time.

And so just demonstrating that right there, which sounds kind of like folklore it’s like there’s no way taking a walk is that useful right? I mean, it doesn’t matter. I ate the pizza. It’s over. No, the reality is that even if you choose to eat the pizza, you can use the context in the education on how your body functions to mitigate the effects and to be able to kind of live a life with confident decisions that doesn’t require all or nothing choices.

It’s like, everything you do is in context with your other choices.

Heavey: [00:32:56] So really the target audience for this is people who are health focused, nutrition focused, fitness, but not diabetic yet it requires a piece of hardware that you have to have prescribed and they’re not going to prescribe for you unless you’re diabetic usually. Right?

Josh Clemente: [00:33:16] That’s right.

Heavey: [00:33:17] Obviously it’s a catch 22. How are we getting around that?

Josh Clemente: [00:33:22] So every person that uses the Levels program has a prescription consultation process. So you fill out a medical history form, and we have a tele-health network of providers that they’re partners to the Levels organization, and they review the information and they ensure that there are no concerns that should be seen by a primary care doctor.

And so every person who uses Levels has a prescription that is usable at any pharmacy. We have a partner pharmacy that we fulfill the devices through right. to your door. And so we are, you know, we’re basically using equipment that was developed for the management of diabetes and is prescription grade but using it for a new market, which is people who are looking to learn more about their, how their bodies are functioning day to day. And so it’s, you know.

Heavey : [00:34:04] Sorry

Heavey: [00:34:04] go ahead

I was just saying that’s so important because it isn’t for the people using it to manage diabetes. Right? It might use that hardware, but it’s not.

Josh Clemente: [00:34:13] That’s right. So it’s, you know, eventually we would love to be able to get this technology to anyone, and the technology I’m referring to is the Levels software, which is certainly the most advanced out there in terms of taking raw blood sugar data in and providing lifestyle guidance, scores, and insights to help you make better choices, not just look at, you know, kind of a number on a line.

And so, you know, over time as we continue to refine the product, we will eventually try to bring this to as many people as possible who need it most. And for right now, you know, like I said, we’re in the early adopter phase where getting this to people who, you know, generally the entire mainstream needs to, I think better understand the scale of the metabolic health epidemic, but then also tie it to their personal interests. And so it’s good to understand that metabolism and metabolic dysfunction is not just diabetes. It’s fatigue. It’s cognitive function. It’s skin wrinkles. It’s aging. You know, glycation of the skin is what leads to browning and wrinkles. And so even something as simple as that, it’s just understanding.

Heavey: [00:35:17] I feel personally attacked.

Josh Clemente: [00:35:19] I’m sorry. I meant to identify that this is not a personal. But yeah, I mean, all of those sort of quality of life experiences, you know, weight gain, weight gain is driven by the hormone insulin. You can’t store, you know, fat without having a hormonal input to do so.

And so, connecting the dots between our to day-to-day goals and your metabolism generally is the way that we will start to be more intentional about this and understand that. You know, the pillars of physical fitness and mental fitness are built on a foundation of metabolic fitness.

Brandon: [00:35:52] And it seems like the app, you really have a big future planned for that component of what you’re offering. And I know that you guys are continually evolving it, but maybe briefly paint us a picture of the end game that you see with the app.

Josh Clemente: [00:36:08] Yeah. So, the goal of the app is that everything you do in your day-to-day lifestyle, which you’re already going to do, right?

You’re going to sit down and you’re going to eat lunch. What do you eat and why? This app, this product is intended to answer that question with objective data from your body, personalized to you. And so we, the way we will get there is by calibrating your specific metabolism by having you go through your daily life- eat foods, exercise, sleep, exactly as you normally do, we gather information and pulling your blood sugar responses to all those decisions and then start to, you know, provide scores. So feedback to you. So you can help, you can start to understand how you are responding to the choices you’re already making.

Once we have that baseline down, you’ll start to see like the areas of opportunity, right? You may see that every single day I have, you know, oatmeal for breakfast, which is, you know, I Google it, it’s the top three healthiest foods I can eat, right. Well, every time I have oatmeal, my blood sugar goes into a diabetic range and this is specific to me.

And then it comes crashing right back down. And so as soon as I’m walking into the office at 11:00 AM, I’m experiencing a reactive hypoglycemic crash and I get a terrible score from Levels, which tells me this food is not great for me. It’s causing massive blood sugar elevations and variability.

Maybe try something different. So I go for the avocado toast, which has more protein, more fat, still has a lot of healthy whole grains, if that’s what I’m looking for. And now I get a score of eight, right? And so helping you to start to understand exactly what factors are key. And then over time, as the algorithms develop on the backend, we’ll be able to be proactive and predictive.

And so in this case, you know, I take a red eye. I don’t sleep at all. My wearable, which connects directly into Levels, so we pull an activity data. We’re starting to pull in sleep data. Will identify that I slept poorly. It will then be able to surface insights and say, Hey, look, you’re metabolically compromised right now you slept four hours.

The last time you slept four hours, you had a major blood sugar elevation on these foods, recommend avoiding those and opting for these. And so it can intervene at moments when we are compromised to help you make better choices without a ton of cognitive burden. And that’s the stretch goal and over time, you know, we’ll be able to provide intervention across all of the four levers of diet, exercise, sleep, stress in order to help people optimize.

Brandon: [00:38:21] Every Thursday evening, Grant and I get together and we pour a whiskey and we record this episode. Two years from now, if we’re using the Level’s app, what would it tell us on Thursday evenings?

Josh Clemente: [00:38:36] So alcohol is an interesting one. Alcohol does something really cool where, or really interesting at least where it tends to interfere with the production of new glucose in the liver. So your liver is basically taking raw materials in and cranking out glucose all the time, and that’s called gluconeogenesis. And alcohol prevents that process from happening and instead, it causes your liver to start producing fat. So the ethanol is turned into triglycerides, which then gets stored on your body or used for energy. And so, if you drink alcohol, you may see your blood sugar actually decreasing, or for many people, see that their blood sugar actually decreased due to that cutoff of gluconeogenesis and this effect, it has not been well-studied, certainly not in people without diabetes.

And it’s pretty interesting. I mean, it’s well-known that some amount of alcohol consumption is associated with longer lifespan and some people have, you know, presumed that’s due to the stress reduction, you know, it’s like kind of like puts us in an easy mode and helps us kind of forget about our struggles.

And so maybe that’s something to do with it. I also wonder if the area under the curve, the lower glucose exposure during the time that your gluconeogenesis is reduced which can last for several hours, might have something to do with it. So it’s something I’d love to study further. I mean, it may be the case that, and actually there is a study that shows, for people with Type 2 diabetes, the people that, the group that had the highest risk of complications was the group that drank zero alcohol. The second highest risk group was the group that drank the most alcohol and the best outcomes were associated with the group that drank in moderation. And so again, this may have something to do with the glycemic control effects.

I’m not entirely sure not making medical advice here, but could be the case.

Brandon: [00:40:21] Yeah, you heard it here folks, alcohol is the latest tool for controlling glucose levels.

Heavey: [00:40:25] Brandon, so one of the things when you sign up for Levels, you get a month of devices basically, right, month of use. So you’ve already got two weeks of data. You were drinking some and eating lots.

What did you learn from those two weeks and how you were drinking and the effects of it?

Brandon: [00:40:45] Well, so the first two weeks, I’m pretty regular in the way that I eat. And you know, my routine is.

Heavey: [00:40:51] That’s an understatement. He’s living with me, every year he comes out, he and his wife live with me and my wife for a couple of months a year.

He brings a scale with him and weighs out six ounces of chicken breasts for every salad every day and mixes the same thing, because he wants to know exactly the calories he’s getting in the macro nutrient breakdown. It’s very disturbing.

Brandon: [00:41:17] I don’t know that it’s nice to keep poking at my place on the spectrum.

Host: [00:41:22] It is.

Brandon: [00:41:23] Okay. Alright. So basically, the first two weeks I treated mostly as collecting baseline data to see all the variations in my life, which are few, but to capture them. And then I was going to use that to inform the second two weeks. Unfortunately, I had a lot of weird, crazy life stuff happened.

Like I sold my house and now I did, you know, the first.

Heavey: [00:41:47] He’s homeless.

Brandon: [00:41:48] Yeah. I’m homeless now. And I’m with you. So lots of change. But the thing that I found through my initial two weeks is that, you know, I respond in what I would imagine is a relatively healthy range for almost everything that I’m eating, which isn’t surprising because I take quite a bit of care in selecting my foods.

However, as I was selling my house, there were a few times where I had to get outside my routine. So one day, thankfully Jimmy Johns will never sponsor the show. One day I had to go to Jimmy John’s. I had no other option and I got a sandwich there. And that thing sent my blood sugar, it’s like spiking more than anything else, like I ate candy during the time I, whatever that sandwich, which by the way, it was like a Turkey and avocado sandwich.

Heavey: [00:42:37] It reminds me, didn’t we talk about Subway? I believe Subway’s bread can’t be called bread in Ireland. It’s gotta be called like dessert or whatever.

Brandon: [00:42:45] Right, because the sugar content’s too high.

Heavey: [00:42:47] The sugar content. Right..

Brandon: [00:42:48] Well, I don’t know the Jimmy John’s sugar content, but it sure sent my blood sugar racing. And beyond that I had a couple sandwiches cause I had visitors come up and we just need a quick lunches and we’d make like a simple lunch meat type of, you know, regular white bread type of sandwich and those, that, the collective group of Jimmy John’s and those sandwiches were the worst case scenario that I got throughout my two weeks. Now, I hope moving forward in the next two weeks since I just added my second sensor to my arm, that I’m going to start doing a lot more experimentation and seeing how alcohol specifically affects my blood sugar, how going for a walk after a meal that maybe otherwise would have compromised me will improve things or not.

And just sort of come up with some new ideas of how I might want to respond if I’m in a compromised scenario in the future. And that’s really the insights I was hoping to gain from the next two weeks.

Heavey: [00:43:44] How have you thought about maybe spending a couple nights not going to bed at nine o’clock and staying up later so that you don’t have so much sleep? Because that could affect it.

Brandon: [00:43:53] No, I don’t mess with sleep, man.

Josh Clemente: [00:43:57] Yeah, no, I mean, that’s exactly the goal is just to basically educate people on micro optimizations they can make. And the nice thing is that we kind of read about, most of us follow lifestyles that are built on advice or something that worked for someone else or something that the bathroom scale kind of indicates to us or emotion, or just the taste of food.

It’s like, we’re literally just using the bare minimum instinctive stuff to get through life. And with Levels, you can start to get these receipts for micro optimization. You get data that comes back to you and says, okay, that worked, that little thing, you know, is 10% better or in some cases, 50% better.

And so it’s really nice for me, for example I don’t want to be an extremist about carbohydrates. I’m very carb sensitive. Basically, across the entire Level’s team, I’m one of the worst in terms of how my body responds to simple foods, things like sweet potatoes, oatmeal, foods that you would otherwise think are going to be just fine send me racing to the moon. And so with that in mind, it’s nice to know that if I, it’s a nice night out, I have dinner. I want to have something that has some carbohydrates on, have some dessert. I do that. And I just go and I take a walk around and I look at the stars, right. I talked to my girlfriend or whatever, you know, whatever I want to do, but I’ll generally do something active and having the insight, having that data that shows me that that was a positive choice and that it improved my blood sugar response is really the thing that causes that long-term habit formation.

And so now, even if I’m not wearing the device, I know, if I have to indulge in something I know what to do. And also I’ve been able to calibrate. So I now know, if I’m on the run, specifically which products work great for me, you know, perfect keto bars for example, are awesome. Whereas these other brands that, you know, may advertise net zero carbs, I just respond negatively to.

And so I’ve now kind of got my arsenal of go tos. And for someone like me who, kind of similar to you in the sense that I like some routine, I like to know where to go and feel confidence. Right. And I think that’s really one of the net benefits is that it can build confidence in the choices we’re making and kind of give you that feedback in continuum.

Brandon: [00:45:59] And that individualization is a key point because just because I responded poorly to sandwich bread doesn’t mean that you do, Grant, or just because you respond poorly, Josh, to oatmeal doesn’t mean that I do. There was, I think one of the few good studies that we have in healthy individuals demonstrated that there is a diverse set of glucose response to identical foods across the population that’s driven by a whole host of factors that we don’t understand. And what continuous glucose monitoring gives you, the tool set to understand is how you personally respond to it, which then allows you to make different choices based upon.

Heavey: [00:46:37] You know, it occurs to me that one of the big advantages to the CGM module that he’s got on him is that it’s collecting real data.

And that’s giving your software, you know, hard numbers to use. And it’s unlike a lot of the things we talked about in the past, whether it’s Apple watch or Fitbit, that’s kind of guessing based on you tell it your height and your weight and how much the thing’s moving around, when you’re washing your hands or, you know, whatever. The thing is it seems like a great opportunity to measure other things, because you’ve got a tiny needle in your arm. How, I guess it’s kind of a two-part question, one is, how much are you guys involved in the development of the hardware? And the second part is, is there any possibility of a future in which we’re measuring, you know, other hormones or other items that would be useful for the Levels app that goes beyond glucose, without inferring?

Great questions. Great questions. Yeah. I love that. So what we’re talking about here is kind of a new wave of biowearables. So right now the wearable devices, we’ve got, they measure things like pulse or step count, you know, which you can actually measure yourself if you think about it. Heart rate variability is kind of the one example there where it’s a deeper metric that we, you can’t measure yourself.

So being able to actually sample molecules through electrochemistry in the skin is a breakthrough. And it’s the beginning of a massive development, I think in innovation towards being able to measure many analytes that are associated with longer life. And, Brandon, you mentioned the one study that was a study from the Weitzman Institute in 2015, which puts CGMs on about 800 non-diabetic people and track them through as they ate calibrated meals. And it basically showed that two people can eat the exact same two foods and have equal and opposite blood sugar responses to them. In this case, it was a banana and a week cookie. And it’s not saying that somebody should eat cookies only and avoid bananas.

It’s like, it’s probably more something like fruit sugars versus grain sugars, for example, in how the, these people metabolize them. And it could be microbiome, it could be genetics, it could be stress, it could be body composition. There’s a ton of factors involved but, there’s also a ton of other implications.

Like if you’re the person who has a huge blood sugar elevation on a banana, you’re likely also having a huge insulin response to that banana. And so over time you might be making the decision to fuel up on a banana before every workout thinking it’s what’s best for you, but you may actually be working directly against your goals.

And so having additional analytes like insulin in real time will completely be able to fill in that void. You know, right now we’re doing a lot of research that will be basically building on an analyte product set that we can bring to market that will allow us to not just have real-time glucose, but also have calibrations of metrics like insulin cortisol, potentially cholesterol and triglycerides, other molecules that do matter.

And then we can sort of better resolve and calibrate our assumptions about how healthy you are, how specifically positive your choices are with more molecules, which is only going to enrich the dataset. So, you know right now, we’re not doing a lot of hardware development. We’re definitely contributing, I think, to the hardware development process, because we’re showing that there is a massive market opportunity here.

I mean, we with, we don’t have any marketing people on our team and we’ve done almost no marketing whatsoever, other than, you know, podcast conversations. And yet we have a waitlist of almost 50,000 people and that’s all organic and it’s people sharing their real, you know, genuine interest in what this is doing, and then also others’ raw appetite for knowing more about themselves.

So I think this just demonstrating that there is so much opportunity here showing the hardware manufacturers who have been doing this for generations, that there’s way more to come if they continue innovating and we’ll be able to produce the, like the bow wave into this new market and bring their new hardware to a customer base that wants it.

I think we are generating a lot of potential value there. And hopefully, you know, over the long term, we don’t have to get into hardware development. It’s certainly not the core competency that we want at Levels, necessarily. We want to focus on the user experience, the data science and the consumer side, and leave kind of the hardware side to the people who’ve been doing it for a long time.

I sorta was making fun of Brandon when he first told me about it, because to me it was just another way of him being as nerdy as possible. But as he explained more of it, and then certainly throughout our conversations, I found myself being like, well, I want in. If I were, and that’s not a joke or just because we’re doing this interview, I want to sign up on the wait list, but you have 50,000 people. When would I get my device? When would I be able to participate? Or if they went online now?

So we can, I think, figure out a way to get you in there for sure, Grant. But as far as the waitlist process, you know, we’re expanding volume in our, right now, we’re in our beta development program. So everything you’re using in the software is changing rapidly. We’ve probably released a few versions just since you’ve joined, Brandon, and we’ll continue to do so. And so all the feedback that we’re getting is immediately being taken into account and new features and it’s helping us guide development. And so that’s an invitation only process.

We do put some links out through known audiences like through podcasts. We’d love to get you a link if you’re interested, but over time, we are expanding the volume going through our beta, you know, sampling feedback and making sure we’re still like hitting the right notes and people are still learning the things that we want them to learn for behavior change.

We will likely go fully live sometime in 2021, assuming that we hit all our product milestone goals and that things are still on track. And so yeah, I don’t have a hard date there when we’re going to just, you’ll be able to go to the website and order it, but as soon as possible, for sure.

How often do you put one on and track for a couple of weeks?

Josh Clemente: [00:52:24] I’ve been wearing one essentially nonstop for about three years now. Once I put it on, it was not only just like the most interesting data I’ve ever had about myself. And the first time I was using my own body’s health information to make choices, which if we all kind of think about it, it’s probably rare for anyone to actually use their medical data to make a decision in their day-to-day. So it was instantly addictive and then it also just kind of seamlessly transitioned into my number one accountability mechanism. So it is the thing that keeps me on track with my goals, period. And so I just don’t want to fly without it.

Heavey: [00:52:57] I feel like you gave us a really great sort of tip which is, go for a walk after you have your quote unquote cheat meal, whatever. If you were to give people one more tip from what you’ve learned about yourself and knowing, you know, that’s just N equals one, whatever, what would it be?

Josh Clemente: [00:53:14] Don’t underestimate the effects of stress. So, that is like such a nebulous term out there, like stress. Oh yeah. We all have stress of various types and yes, we all have stress, but I have seen my blood sugar elevate from normal to over 140 milligrams per deciliter, which is effectively the normal, it’s like the prediabetic threshold for a response to a sugary meal, just from the stress of going on a stressful podcast.

So, hopefully it’s not having to me right now, but the fact is, when your body is hit with cortisol or adrenaline, which are the fight or flight, they’re the glucocorticoids is what they’re called, but they’re hormones that tell your body that you’re in a fight or flight scenario, your liver just says, go all out.

Like just starts cranking out glucose and putting into the bloodstream to fuel your escape from whatever the scenario is. And so this is pretty useful if you are, let’s say, in the gym or, you know, I’m trying to hit a PR or you’re running from a mountain lion, but if you’re sitting on the couch with headphones on all that glucose that’s being released into your bloodstream is going to be taken back up as fat, for example, or that blood sugar spike and crash is going to contribute to the inflammation that we know as glucose variability, is associated with glucose variability, which is bad for cardiovascular disease.

And so seeing that data really drove home to me, how important. Stress is and stress management is. And so I’ve actually started a mindfulness practiceand breathing practices just because of the evidence I got from my body from glucose information. And I really now take seriously that like background stress.

It is building, it’s doing something physiologically to you, and it’s really important to take some time to, yeah, take another walk or close your eyes and breathe, or listen to a good song for a few minutes that will have a physiologically, restoring effect.

Brandon: [00:54:59] I think that’s excellent advice that all of our listeners should take home.

And if our listeners do want to check out Levels, what’s the best way for them to do that?

Josh Clemente: [00:55:10] Definitely go to our website levelshealth.com and check out the blog. So the blog is where we kind of publish everything that we know about this space and how it affects all of us right, in our daily lives. And so there’s a ton to read there.

Sign up for our wait list. We’re going to be distributing more information through our newsletter and through, the email is there, and letting you know how you can get access to the program. And then also, we’re on Twitter and Instagram. We share a lot of testimonials and just follow along with the team at Levels.

Brandon: [00:55:38] Alright. Great. Well, Josh, we very much appreciate your time. Thanks for joining us. Thanks for everything that you’re doing at Levels. And it was great to meet my kinder, but more successful spirit.

Heavey: [00:55:52] I can’t believe there’s two of you.

Brandon: [00:55:55] Alright. Cheers.

Heavey: [00:55:56] Cheers. That was fun.

Brandon: [00:55:59] It was. Did you ever think you’d be so excited about talking about sticking a needle into your arm?

Heavey: [00:56:06] Well, hang on now. We’re not going there. You know, I really, I know that we never want to. seem like we’re shilling for somebody or a service or whatever. And I hope everyone on that episode didn’t think it was just about Levels. It was about the constant glucose measurement and the kind of data we’re getting.

But at the same time, their product is so cool. And what they’re offering is so cool and the way they’re trying to get people to think about their health and their body and their metabolism is, it’s kind of the future, I think, of health management right, before you’re sick, getting, making sure that you don’t get to those disease states.

It’s all really cool stuff and I’m pumped to try it. And I was really stoked that he gave us the link for you and I.

Brandon: [00:56:48] Right. So, you know, Grant’s going to give it a shot. I’ve been doing it. And then he also created a link for our listeners who can, as I understand it, use the link to jump the line so they don’t have to wait in a 40,000 person plus line.

Host: [00:57:04] He says over 50.

Brandon: [00:57:06] Yeah. You get to move up a little bit. That’s the Strength and Scotch hookup.

Heavey: [00:57:10] Yeah. And actually, you know, we’re recording this now a day later. As soon as we’re done with the recording, I used the link he gave us, I already got notification that I’m cleared and it was really cool.

Yeah. You got to get the doctor’s approval, but you don’t have to talk to anybody. It’s like a two second thing.

Brandon: [00:57:25] That’s my favorite thing.

Heavey: [00:57:26] That’s my favorite thing. It’s like two seconds of a multiple choice fill out. So anybody that’s a listener, that’s interested in what, Josh talked to us about. We’ve got a link for you and it is.

Brandon: [00:57:40] It’s levels.link/strengthnscotch.

Host: [00:57:45] That n is just N. So it’s levels, with an s, dot link slash strength, the letter N, scotch. strengthnscotch. We’ll also be putting that link in the show notes. So if you guys are listening to this and it’s hard to remember, you didn’t understand, just check out the show notes for the episode and you can do that.

Brandon: [00:58:05] And if anybody out there actually moves forward with the device, gets it, plays around with it, you know, reach out to us and let us know how it goes. I’m curious to see what sort of things people learn about themselves. Grant, I’m curious to hear, and I’m guessing once you go through this and play with the device a bit, you’ll have some insights and we might talk about that in a future episode.

Heavey: [00:58:23] Yeah, I’m excited.

Brandon: [00:58:24] Cool. Last thing here before we go, the health and fitness recommendations and research that we discuss on these episodes come from my reading and experimentation with clients over at Evidence Based Athlete, where we offer evidence-based data-driven personalized, pretty effective coaching.

So if that’s something that interests you, I invite you to check us out- evidencebasedathlete.com and Grant, this will be maybe the first episode in Strength and Scotch history with a double cheers.

Heavey: [00:58:53] Cheers.