Sam Corcos: reverse the trend of metabolic dysfunction at Levels, and more

Sam Corcos was just trying out continuous glucose monitoring (CGM) as a novelty when he discovered metabolic functioning was the key to stabilizing his energy levels. Today, Sam is the co-founder and CEO of Levels Health, a user-friendly platform transforming glucose monitoring into personalized insights for better health. Combining automated reporting with a manual diet review, Levels allows users to assess the direct relationship between their food intake and energy levels. In this episode of Antifragile, Sam and host Esteban Reyes talk about the not-so-secret dangers of sugar, Levels’ unique work culture, and the future of CGM.

• Check out Levels
• Follow Levels on LinkedIn or Twitter
• Connect with Sam Corcos on LinkedIn or Twitter
• Check out Antifragile
• Connect with Esteban Reyes on LinkedIn or Twitter

3:22 – An unexpected intro to CGM

Health-conscious and fit, Sam was just trying out CGM when his glucose monitor showed that his diet was the unexpected reason behind his shaky energy levels.

“I noticed that day that around noon, my hands were shaky and I was tired and I couldn’t focus. And in my head I was thinking, ‘Man, I really OD’ed on caffeine today. I need to switch to tea or something. This is getting out of control’. I checked my levels and my blood sugar has spiked to levels that healthy people are not supposed to be able to see. And I had crashed into 50 milligrams per deciliter, which is hypoglycemia. I just looked up the definition of hypoglycemia and what the symptoms are. And it was like shaky hands, feeling tired. And this light bulb went off realizing that I’ve been misattributing these variables for basically my entire life. And a lot of the behaviors that I assumed were healthy are actually hugely problematic.”

6:20 – The changing face of obesity and diabetes

As medical understanding deepens, science is beginning to consider a number of major diseases – including obesity and diabetes – as symptoms of metabolic dysfunction.

“You’re going to be hearing terminology like ‘diabesity’ a lot more. Which is to say that it’s become increasingly clear that a lot of these things are actually just symptoms of the same underlying condition. Diabetes does not cause obesity or the other way around. Obesity is a symptom of metabolic dysfunction. Diabetes is a symptom of metabolic dysfunction. If you were in medical school now, they would teach you that Alzheimer’s is type-three diabetes. The connection to metabolic dysfunction is so strong that it can’t be ignored. Non-alcoholic fatty liver disease, similarly polycystic ovarian syndrome.There are a lot of these conditions that we’ve historically treated as if they’re independent, but are really part of the same underlying condition. And the root cause for most people is sugar and refined carbohydrate consumption.”

11:30 – A not-so-sweet addiction

Sam points out how sugar’s addictive consumption can lead to a downwards cycle of poor health, energy spikes, and energy crashes.

“When you have too much sugar, it causes these spikes and crashes. And that’s something that leads to lifestyle problems  like feeling tired, having to take a nap. You feel different throughout the day when you have too much sugar.The biggest problem, as I see it, is that these things really compound in a very negative way. Diet is only one pillar of health and these things are also interrelated. I would say that the most important ones are sleep, exercise, diet, and stress, possibly in that order. But it’s hard to say because they’re also interrelated. If you sleep really poorly, you’re going to wake up in the morning and you’re going to have a big cortisol response, which is your stress hormone. And when you have a lot of cortisol, your body craves sugar. If you have enough willpower, you can force yourself not to do it but your body is telling you ‘I want sugar’.”

14:48 – How Levels drives behavior changes

Levels Health leverages a ‘closed loop system’ to change user behaviors by showing a direct, immediate relationship between their diet and how they feel throughout the day.

“We are ultimately a behavior change company. We are here to help people discover how their choices are affecting them. One of the interesting things about closed loop systems, which is a system by which you can directly correlate cause and effect—you make a specific decision and you see a specific outcome—versus an open loop system, which is you maybe get a report at the end of the month. And [the report] says, so we did some analysis. It turns out you should stop eating bananas. It’s like, okay. Maybe. Sure. Probably. But you don’t have the same visceral reaction because you’re not in the moment. Whereas when you have this big spike and crash and you feel really weird, you feel really tired. And then you look at the data, and the data is showing you the choice that you just made is the reason why you feel this way right now.”

17:56 – Discipline is only part of the picture

Without a behavior-changing process, diet and discipline will be ineffective in helping people drive healthier choices.

“I think one of the biggest reasons is that there’s a lot of stigma and judgment around obesity and diabetes, for example, and on measuring glucose in particular. And a lot of that is just because some people have this perception that this is just a discipline thing. And we’ve had some relatively tense conversations with people who, say ‘This product is stupid. People have to just stop eating sugar.’ It’s like, okay, sure. Thanks for that. Shouting at people doesn’t get them to change their behavior. You have to walk them through the process of learning and understanding why this stuff matters.”

22:45 – Levels fuses next-gen tech + real-time experts

Levels syncs CGM data with the user’s phone while Level’s experts contextualize glucose data with the user’s reported food intake for personalized insights.

“We use continuous glucose monitoring, which is a hardware device that measures glucose in real time. It syncs with your phone, and it’ll tell you in milligrams, per deciliter, what your numbers look like. It’s been available for five plus years for diabetics. In the Levels program, we are the consumer software and data science layer on top of that raw data stream that contextualizes the information. So we can start to teach you about how your choices are affecting you and how you can improve those choices. So during a 28 day program, you have a patch that’s on. I have one on right now. You take a picture of what you eat and that’s how we correlate your glycaemic response. And we nudge you in the direction of healthier and better choices.”

25:55 – Health, fitness, and metabolic dysfunction

Although Levels users are often in the top-tier of healthy and active lifestyles, Levels’ surprising data shows a high level of metabolic dysfunction that demands further research**.**

“The population that we’re working with now is ostensibly very healthy. They’re all medically screened. A lot of them are Peloton users. A lot of them are people who are ostensibly very healthy. And we’re finding a very high level of metabolic dysfunction, even among this very ostensibly healthy group. To give you like orders of magnitude, if doctors were to review this, they would be surprised at the level of dysfunction that even this very healthy population has. So that’s one of the reasons why we’re really pushing for doing more clinical research to learn more about this.”

30:12 – The future of CMG accessibility

Affordability and expanded insurance coverage are the first of many steps towards making CGM available  for the demographics that need it most.

“The cost of the hardware has been coming down every year for the last 10 years. I think we’re really at the turning point where this hardware becomes inexpensive, to where it can be used by a lot of people. I think the moonshot for this would be getting this covered by insurance in some capacity. That’s the thing that really makes it broadly accessible at the end of the day. The people that are most at risk of metabolic dysfunction are the people who can least afford a product like this.”

31:52  – Levels’ fast-moving work culture

Maintaining close  team communication, trust, and internal focus keeps the Levels development moving quickly and effectively.

“We treat people like adults. And we have a very high trust environment with the people that we work with. Very high levels of communication. Internally, we do a weekly, all hands where we all participate. We have regular one-on-ones. I think  the core focus of the company is maintaining development velocity. Almost our whole team is technical. And so it’s all about how do we learn from customers? How do we ship quickly? How do we iterate from those learnings we’ve had at this point?”

33:44 – Develop a product-focused vision

The Levels team is 100% focused on creating a behavior-changing platform, strictly implementing only the ideas and updates that support their unique value proposition.

“Our thesis is that behavior change comes from closed loop systems. So when we have all these new ideas around like, ‘Oh, we should integrate with X, Y, or Z’. All right, does this close a loop on behavior? Is this on thesis? And there’s so many things that are nice to have. One of them being, we actually implemented this in a version, a macro tracking or where we break down the macronutrient composition of what you’re eating. It’s nice to have. You go ‘oh, that’s cool. I can see how many grams of X I ate last week.’ But it doesn’t lead to behavior change. It’s more like an interesting thing. So just being relentlessly focused on the core value proposition.”

37:19 – Re-adjust, rewrite, and realign your goals

Over time, start-ups can lose sight of their original mission. Levels relies on writing exercises and team communication to maintain their philosophy.

“There have been times where there’s been drift. And the way that we solve for this is we do a lot of long form documentation to align on things. We actually had this maybe last week or the week before, where three of the people in leadership – me being one of them –  were talking about a particular concept. It became pretty clear that over the last six months, our own definitions of what this concept means has actually changed quite a lot. And so we put together like a 10 page document on our current understanding of what this means and what the path forward is. And we were able to really get good alignment on what that means.”

46: 57 – Crossing over the mainstream chasm

Growing from a small, select group of users to mainstream market appeal is the next challenge facing Levels.

“These are people who are finding us largely organically. And there are people who already know that they want this. We don’t have to convince them of it. Getting into demand generation, which is probably 6-12 months from now, that’s going to be the real test. Can we convert people who don’t yet know that this is something that they want? How do we bring this to the broader audience? How do we convince the random whole foods shopper that this is something that she should care about? That’s going to be the real test. How do you get past the early adopter biohacker types and how do you make this something that’s more mainstream?”

48:02 – Perfecting your product on the go

Don’t get weighed down by pursuit of perfectionism, advises Sam. Instead, get your product out into the market and start learning on the job.

“Ship early and ship often. That’s something that I talk about all the time. I think it’s a Reid Hoffman quote, that if you’re not embarrassed by your first product launch, you’ve waited too long. I think I built the first version of our software myself in like two days. And we just shipped it and we just wanted to see what would happen. And a lot of people didn’t like it and that’s okay. You have to be willing to put yourself out there and ship quickly. Take negative feedback in a humble way and just keep iterating and keep learning from your customers.”

Sam Corcos: [00:00:00] And I noticed that day, at around noon, my hands were shaky and I was tired and I couldn’t focus. And in my head I was thinking, Man, I really OD’d on caffeine today. Like I just, I need to switch to tea or something. This is getting out of control. I checked my levels, and my blood sugar had spiked to levels that healthy people are not supposed to be able to see.

And I had crashed into 50, into the fifties milligrams per deciliter, which is hypoglycemia. And I just looked up the definition of hypoglycemia and what the symptoms are. And it was like shaky hands, feeling tired. And it was this, there was a light bulb went off, realizing that I’ve been misattributing these variables for basically my entire life.

Esteban Reyes: [00:00:42] Hey

everybody. It’s Esteban Reyes, co-founding partner at La Solas VC, a high conviction B2B early stage venture firm. And this is Antifragile, a podcast to discuss untold make it or break it moments, entrepreneurs had to overcome when building their companies, and where we explore how to avoid the early stage death traps.

Hey everybody, in this episode, we have Sam Corcos, who’s the co-founder and CEO of Levels, a company on a mission to reverse the trend of metabolic dysfunction. Sam’s been backed by founder collective a16z and a number of prominent operator investors like Tim Costello, who’s the former CEO of Twitter, Michael Arrington, founder of Tech Crunch, Mark Randolph, co-founder of Netflix, and many, many more.

In this episode, we talk about Sam’s journey into startups. We also talk about his vision for Levels and why he’s so passionate about solving this problem and how he thinks about building product as well as a enduring valuable business at Levels. Sam, super excited to have you today on the show.

Sam Corcos: [00:01:57] Good to be here.

Esteban Reyes: [00:01:58] Awesome. So I’m really intrigued about Levels and your vision for it. So why don’t we start there, and maybe give the audience a little bit of context of what was your journey to get here?

Sam Corcos: [00:02:11] Yeah. So Levels, we’re a bio wearables company. It’s the first time that you can use continuous glucose monitoring for a health seeking population, in most of the same way that you would use Apple watch to quantify the effect of exercise or heart rate.

This is the first time you could quantify the effect of diet, of what you’re eating on your lifestyle and your health. So, my personal journey was, a friend recommended I try out a continuous glucose monitor, who’s now my co-founder, Josh. And I really didn’t expect to find anything interesting.

I’m six foot one, I’m 150 pounds. I played rugby, football and track in college, and I eat what I considered to be a pretty healthy diet. So for me, this was really just pure novelty. It was the first time you can measure a molecule in your body in real time. And I just thought that would be cool. My first day, I have my, my normal healthy breakfast, which for me has always been steel cut oats.

My mother just drilled that into me as the healthiest breakfast. And I noticed that day that around noon, my hands were shaky and I was tired and I couldn’t focus. And in my head I was thinking, Man, I really ODeed on caffeine today. Like I just, I need to switch to tea or something. This is getting out of control.

I checked my levels, and my blood sugar had spiked to levels that healthy people are not supposed to be able to see. And I had crashed into 50, into the fifties milligrams per deciliter, which is hypoglycemia. And I just looked up the definition of hypoglycemia and what the symptoms are. And it was like shaky hands,

feeling tired. And it was this, this light bulb went off, realizing that I’ve been misattributing, these variables for basically my entire life. And a lot of the behaviors that I was that I assumed were healthy are actually hugely problematic. And a lot of people are discovering something similar, like orange juice or some of these green juices that people think are healthy that are actually just 50 grams of liquified sugar,

are actually a huge source of a lot of these problems. So that was, that was really the first phase. At that point, it didn’t even really occur to me that this was a company. It was more like me telling all my friends how cool and important this is. It was when I started digging into the research of understanding the scope of the problem of metabolic dysfunction, that I really realized that not only is this an opportunity, this is something that needs to exist.

As you may have seen in the secret master plan, more than 10% of the US is already diabetic, and it’s increasing at an increasing rate. The second derivative is positive. The number of people who are pre-diabetic, this is also a global problem. So that was really the realization that this is a tool that really for the first time, allows you a better visibility in how your choices are affecting you.

That was really the path to putting this together.

Esteban Reyes: [00:05:11] That’s fascinating. And can you tell us a little bit more about your background, just so people have

context.

Sam Corcos: [00:05:17] I’ve been in early stage and startups for a long time. I’ve historically been on the technical side. My last company, I was co-founder and CTO. I’ve been in

a topographical mapping company for the US military, on a construction software company, a software company for automotive servicing. It’s kind of all over the place in one perspective. But on the other perspective, software, especially consumer software is very similar under the hood. I’ve been on the startup path for a long time.

And so this  is my latest project.

Esteban Reyes: [00:05:51] Fantastic.

So Sam, I want to go back to some of the things you said. And clearly it’s a massive problem. You know, I think I heard Josh say the other day that, I think it was like 78% or 80% of people are metabolically unfit, and they don’t realize it. Help us unpack a little bit more,

what

is the root cause

of being metabolically unfit. And what does that actually mean? And why should people care?

Sam Corcos: [00:06:20] Yeah, it is. It’s something that’s becoming increasingly clear in a lot of the scientific literature coming out is, that we’ve historically treated conditions like diabetes and obesity as if they’re completely independent.

And we treat them with specific medication or specific programs. You’re going to be hearing terminology like diabesity, a lot more, which is to say that it’s become increasingly clear that a lot of these things are actually just symptoms of the same underlying condition. Diabetes does not cause obesity or the other way around. Obesity is a symptom of metabolic dysfunction.

Diabetes is a symptom of metabolic dysfunction. If you were in medical school now, they would teach you that Alzheimer’s as type three diabetes. The connection to metabolic dysfunction is so strong that it can’t be ignored. Non-alcoholic fatty liver disease, similarly, polycystic ovarian syndrome.

There are a lot of these conditions that we’ve historically treated as if they’re independent, but are really part of the same underlying condition. And the main, the root cause for most people is sugar and refined carbohydrate consumption. It’s something, one of the reasons why I was so surprised when I started digging into the literature on this, was that like a lot of people in San Francisco, I don’t eat a lot of sugar, and most people I know have a very low sugar diet by default.

The average American consumed something like 180 pounds of sugar per year. It’s an astronomical number. It’s almost a half a pound of sugar per day. And a lot of them don’t realize it. I’m talking, I’m reminded of one of our early customers who is generally a pretty healthy person. And a couple of days into using Levels,, in the program, you take a picture of what you eat, and we can correlate your glycemic response to those dietary choices.

And he sent me a screenshot and said, Hey, I just ate this meal. There’s no sugar in it. Why did I have this big glucose spike? And I’m looking at the picture. It’s like, Well, it looks like in this picture, you had about a quarter cup of ketchup with your dinner. You know, that ketchup is basically just sugar, right?

He’s like what? No, no, no, it’s just tomato. And he, you know, he looked in the ingredients, it was like, it’s just mostly sugar. And so there’s so much secret sugar in things. I was joking the other day that, did you ever see the movie, The Sixth Sense?

Esteban Reyes: [00:08:44] Yep.

Sam Corcos: [00:08:45] I was joking that I feel like instead of seeing dead people, I just see sugar in everything now.

It’s like, I was, I remember last time I was at an airport going through trying to find something to eat, and my only criteria was, cannot have sugar in it. And there was. In the entire snack area, there was not a single option out of probably 300 skews, that did not have sugar in it. Like the beef jerky has sugar in it.

The nuts had sugar in it. It’s like, there’s nothing I could do. So for most people is really sugar consumption and refined carbohydrates and processed foods that caused these problems. The, this is a tool that allows you to really see, how those things are affecting you. If you buy a keto product, this is the way for you to tell if it’s actually keto or if it’s not. Otherwise you’re largely just trusting somebody’s opinion on whether it’s good or bad.

Esteban Reyes: [00:09:39] Yeah. I

was, thinking about how I would explain Levels to my youngest, Alejandro, which is, he’s six. And I was thinking that one way to do that would be to say that it’s like a language for the human body, right. In the sense that you’re able to understand how your body’s reacting to the food you’re consuming, in a way that helps you, you know, just better adapt to your environment, into the options that you have in order to get access to food, or get access to energy,

right, which is essentially what food does for us. So, with that as context, how would you explain to Alejandro what sugar does to your body? And then also like, what is, why do we need it? Why is it that there’s this reinforcement loop of, you know, wanting more sugar and almost becoming like, you know, this very, addictive

habit.

Sam Corcos: [00:10:39] Well, the irony is that sugar, it’s the only macronutrient you actually don’t need. You could live off of fat and protein. You don’t need to eat carbohydrates. If you don’t have fat or you don’t have protein, you’ll eventually die. The challenge with sugar is that it is really, really addictive,

much more so than I think has been previously recognized. There are several books on this, about sugar. I can recommend a few of them, but the, one of the study, I think it was a mouse study. How mice would, they prefer sugar over cocaine in terms of its addictive tendency, which is pretty hard to believe.

One of the issues with sugar is that, your body uses glucose as the primary energy substrate in your blood. When you have too much sugar, it causes these spikes and crashes. And that’s something that leads to lifestyle problems, like feeling tired, having to take a nap, you feel different throughout the day when you have too much sugar.

The biggest problem, as I see it, is that these things really compound in a very negative way. Diet is only one pillar of health, and these things are also interrelated. I would say that the most important ones are sleep, exercise, diet, and stress, possibly in that order. But it’s hard to say because they’re also interrelated.

If you sleep really poorly, you’re going to wake up in the morning, and you’re going to have a big cortisol response, which is your stress hormone. And when you have a lot of cortisol, your body craves sugar, And you can like, if you have enough willpower, you can force yourself not to do it. But like, your body is telling you, I want sugar. But when you eat a lot of sugar, you have these spikes and crashes.

Yeah. You feel worse. You want more sugar because you’re tired. And these things are just self-reinforcing. You do more of that. You get worse sleep. You don’t feel like you can exercise because you’re so tired. These things are all really interrelated, and sugar is one of the things that. I’ve actually, of the people at Levels,

I probably, I think I’m in the bottom 25% of metabolic health of our employee base, because I run these crazy experiments on myself. Like I’ll intentionally sleep deprive myself to get like less than two hours of sleep for a couple of nights. And then I’ll try it like the same, like high carbohydrate meal, or I’ll do one when I’m well rested and I’ve gotten some exercise and I feel a lot better.

And my response is double what it would be otherwise, sometimes more than double. I’ll have. I will have a glucose response that if I were to go to a doctor with those conditions, it would be diagnosable. But because it’s just, it’s a lifestyle, when you’re compromised in terms of sleep, when you’re not getting enough exercise. There’s a great study on inactivity and sedentary behavior.

This was on the effect of bedrest. And a healthy person who is on bed rest. Imagine being in a hospital, maybe you need knee surgery and you can’t get out of bed. It is profound how quickly your metabolic system can be compromised through inactivity or from lack of sleep. High stress is also a pretty big indicator.

So that’s why it’s important, is all of these things really fit together. And if any one of them is out of whack, it’s going to affect all the others.

Esteban Reyes: [00:13:58] Yeah. And I would

imagine, I mean, just kind of pulling from my own experience that, you know, I’ve read some books about this topic. Matthew Walkers, Why We Sleep is pretty exciting, is that you start to compensate.

And you almost believe that living with these handicaps is the way you are and the way your life should go. And you don’t realize that it’s, you know, you’re essentially sick.

Sam Corcos: [00:14:23] Right, it becomes the new normal.

Esteban Reyes: [00:14:26] Exactly. Exactly. So I guess Levels is a way to gain awareness, be able to measure your response to the different kinds of foods that you’re consuming, and then be able to adapt, hopefully your

behaviors.

Sam Corcos: [00:14:41] Yeah, that’s exactly right. I mean, ultimately our. We wrote a blog post, the Levels theory of behavior change. We are ultimately a behavior change company, where we are here to help people discover how their choices are affecting them. One of the interesting things about closed loop systems, which is a system by which you can directly correlate cause and effect.

You make a specific decision and you see a specific outcome, versus an open loop system, which is you maybe get a report at the end of the month. And it says, So we did some analysis, it turns out you should stop eating bananas. It’s like, Okay. Maybe. Sure. Probably. But you don’t have the same visceral reaction because you’re not in the moment.

Whereas when you have this big spike and crash and like, you feel really weird, you feel really tired. And then you look at the data, and the data showing you, like the choice that you just made is the reason why you feel this way right now. We’ve had customers who describe it as a much more, the feeling is much more like getting food poisoning.

Which is to say.

Esteban Reyes: [00:15:46] Interesting.

Sam Corcos: [00:15:46] Yeah, you don’t have to decide. Like one of our customers, he used to drink four cans of soda a day, and he kind of thought of himself as invincible. It’s like, Ah, I’m, I’m healthy, I don’t need to worry about this. And then he started seeing the numbers, and the numbers were really bad.

And he said at that moment, he didn’t consciously decide, Alright, I need to stop drinking soda. He said it was more like when you’re, when you get food poisoning and your body just says, You’re not eating clams anymore, by the way, I don’t know if you caught the memo, but you’re not making this decision. So like he would go to a soda fountain, and getting a soda is not even.

It’s not even an option anymore. Like why would I do that? I know how this is going to affect me. So that’s why this type of behavior change is so powerful.

Esteban Reyes: [00:16:33] Yeah.

And, I guess another way I was thinking about Levels in the context of the podcast, right, in sort of Antifragile. And it’s a framework that I borrowed from Nassim Taleb, who you probably have heard of.

Sam Corcos: [00:16:46] I’ve read the book.

Esteban Reyes: [00:16:46] And yeah. And, you know, essentially the basic concept is that we make decisions that we don’t really are able to understand what is the impact that those decisions are going to have long-term, until sort of things happen unexpectedly. And we could have anticipated some of those things. Right. So the question is, how do you build

anti-fragility in your decision making process and the things that you’re doing in order to survive any stressors that come your way. And I think about Levels as a way to give people visibility into the decisions that they’re making. And if they are A, you know, making them more anti-fragile, and B, improving quality of life.

Right. So with that said, why do you think we haven’t been paying enough attention to this problem? I mean, obviously you’re saying a lot of more people, a lot more people are talking about it, but it still seems like it’s pretty opaque, in the

grand scheme of things.

Sam Corcos: [00:17:50] Yeah. That’s

a good question. Yeah.

And it’s something that we’ve talked a lot about as a team. I think one of the biggest reasons is that there’s a lot of stigma and judgment around these things, around obesity and diabetes, for example, and on measuring glucose in particular. And a lot of that is just because there, some people have this perception that this is just a discipline thing.

And we’ve had some relatively tense conversations with people who, they say like, This product is stupid, people should just stop eating sugar. It’s like, okay, sure. Thanks for that. Shouting at people doesn’t get them to change their behavior. You have to walk them through the process of learning and understanding why this stuff matters.

So a big part of this is probably a hold over from the nineties era of like low fat being really healthy and sugar being good for you. The challenge is that during that era, we were largely convinced that a calorie is a calorie. That’s all that matters. It’s just thermodynamics. You don’t need to worry about

what the source of the calories are, it’s just calories. That’s all that matters for weight gain and health. I think almost all of the evidence that we have in the last 20, 30 years really shows that it’s completely untrue. And that, there’s obviously some truth to the thermodynamic model as they call it, which is to say, If you eat zero calories,

eventually you’ll die. If you eat 20,000 calories a day, you’re probably going to gain weight. But realistically, most people don’t live in these extremes. Most people live within a margin of error of the same number of calories. And some people gain a lot of weight and others don’t. Like when I played football in college, I was seriously underweight for playing football.

I think my playing weight was 165 pounds, and it probably should have been 20 or 30 pounds heavier. And I had to eat with the offensive line. And these guys are much bigger than me, eating the same thing. They’re able to put on weight, and I’m not. You can see different people just respond differently to these things.

And there were a couple of studies that really solidified what was called the endocrine theory of obesity. Endocrine, meaning your hormones. At the end of the day, your hormones determine how your body processes and manages your metabolism. Insulin in particular, is an extremely important hormone in this whole process. To simplify it

somewhat, insulin is the molecule that decides whether your calories go towards your metabolism. So when you think of people as like having a fast or slow metabolism, whether it goes towards your metabolism or get stored as fat, that’s the job of insulin. If you don’t have insulin production, you are a diabetic.

And you could die if you don’t have insulin. If you have too much insulin, you’re going to gain a lot of fat. And the two studies that really blew my mind on this, one was a, it was a human study, taking healthy people with the same initial basal metabolic rate. So the same starting metabolism, something you can measure. And they gave them different doses of insulin.

They just injected them with insulin over the course of some period of time. And they ate exactly the same diet. So same starting conditions. Same number of calories in, same diet. The people who were given. If you look at the chart, there’s like a, one-to-one, almost a one-to-one correlation, the amount of insulin they were given and the amount of fat that they gained.

And this is actually also related to what you were saying before, like your, how you feel. The people who were given a lot of insulin and gained a lot of fat, those calories would have ordinarily gone towards their metabolism, and they did not feel good. They felt tired all the time, because all those calories are zero sum. They’re being pulled out of your metabolism, and being put into fat.

The other study that really nailed home, why just how powerful insulin is as a molecule, it was a mouse study where they injected these mice, healthy mice with exogenous insulin. So giving them extra insulin. These mice ended up dying of starvation while morbidly obese. Because insulin is so powerful,

your body would rather cannibalize its own internal organs for calories, than it would override insulin’s pull of calories out of your metabolism into fat. It would prioritize putting stuff into fat, over cannibalizing internal organs for calories.  That just give you a sense of how power, if your endocrine system is not functioning properly,

it almost doesn’t matter what you’re eating, because your body is going to prioritize insulin and prioritize fat.

Esteban Reyes: [00:22:29] Wow.

That’s a fascinating and scary at the same time. Yeah. We’d love to talk a little bit about the product itself, just to give the audience, you know, some understanding of what Levels is, how it works.

Why don’t we start there?

Sam Corcos: [00:22:44] Yeah, sure.

So we use continuous glucose monitoring, which is a, it’s a hardware device that measures glucose in real time. Okay. It syncs with your phone, and it’ll tell you in milligrams, per deciliter, what your numbers look like. It’s been available for five plus years, for diabetics.

And in the Levels program, we are the consumer, software and data science layer on top of that raw data stream, that contextualizes the information. So we can start to teach you about how your choices are affecting you and how you can improve those choices. So, during, it’s a 28 day program.

You take, you have a patch that’s on. I have one on right now. You take a picture of what you eat and that’s how we correlate your glycaemic response. And we nudge you in the direction of healthier and better choices.

Esteban Reyes: [00:23:32] Do people need to specify what they ate or are you able to recognize the food just by way of the picture?

Sam Corcos: [00:23:41] Yeah. They will often add some annotations to it. It kinda depends on what sort of reporting you want afterwards, but the more annotation the better for sure.

Esteban Reyes: [00:23:50] Right. It makes

sense. You said that CGMs have been around for a little bit, and what makes Levels unique? And as you think about, you know, building a large sort of sustainable business, what makes it defensible over time?

Sam Corcos: [00:24:07] Yeah, I think the biggest one is that the hardware that exists now, it’s built for mostly the use cases for type one diabetics. And that’s why it’s been around for a long time. They’ve been there, as type one diabetics will tell you who have used this, it’s like a life-changing technology. The problem is that, for different populations is that the software that comes with it, is built for

the use case of helping type one diabetics avoid risk of acute death from hypo or hyperglycemia. And that’s not a use case for a health seeking population, so different segment. So if a diabetic goes, say below 70 milligrams per deciliter, that’s cause for concern. If you’re not a diabetic, you just might feel kind of weird, but it’s not a life-threatening situation.

And similarly, if you go above a certain threshold, your body will adapt if you’re a non-diabetic. And so, the software that we’re building contextualizes that information for a health seeking population, to teach you how your choices are affecting you. There’s also a lot of gamification, longitudinal information.

The core product offering is building that consumer software layer for a really, a very different audience.

Esteban Reyes: [00:25:24] Got it.

Okay. And without like talking about any specifics, are you seeing any non-obvious or exciting insights about human behavior?

Sam Corcos: [00:25:34] Yeah. For sure. I can talk as specific as you want. I think probably the most interesting and concerning one, which is also why we’re putting a lot more effort into our clinical strategy.

We have a couple million dollars allocated towards clinical research over the next couple of years. The population that we’re working with now is ostensibly very healthy. They’re all medically screened. And the population is, a lot of them are Peloton users. A lot of them are people who are ostensibly very healthy. And we’re finding a very high level of metabolic dysfunction, even among this very ostensibly healthy group.

I think, to give you like orders of magnitude, if doctors were to review this, they would be surprised at the level of dysfunction that even this very healthy population has. So, that’s one of the reasons why we’re really pushing for doing more clinical research to learn more about this. I think one of the others is that different demographics and different types of people get different value out of the program.

So for some people, it’s really just exploratory, and they want to discover how different foods are affecting them. Like maybe they do really well with fruits, but they don’t do very well with pasta, or they do really well with pasta, but not with rice. And they can make these small nudges that really improve

their responses and how they feel throughout the day, quite a lot. And other people really like the accountability that comes with it. Because you’re, somebody was saying that this is a diet you can’t cheat on. Right? If you have a nutritionist and you’re supposed to take a picture of what you eat, and

you know, if you have a doughnut, you’re just gonna, you’re just going to not take that picture. But in this case, we’re literally measuring molecules in your body in real time. So if you eat a donut, it’s going to show up, and there’s a level of accountability that’s really never been possible before. So there were so many different subsets of populations that really resonate with this type of product.

So we’re learning as much as we can from those people. We do a lot of user research. We do. Mike need an auto on our team, does. So he just probably five plus phone calls per day with our customers, just like trying to deeply understand what it is that they’re using.

Esteban Reyes: [00:27:50] So would you say

that overall you’re seeing the people that are using the product trend, significantly down in terms of their consumption of sugars,

relatively flat, or inconclusive so

far.

Sam Corcos: [00:28:05] Uh it’s uh it’s. I would say most people significantly improved their diet over the course of it, just because they learn about their health. It’s a little bit difficult to parse it out because people do a lot of exploration and experimentation. People who use it for longer periods of time,

we can see the trends more clearly. But in the 28 day program, peoples are still running a lot of experiments. So I’m here with somebody who is using Levels now for the first time. And he just had as an experiment, a, he had, he went to In-N-Out and got French fries and a milkshake and two cheeseburgers.

And, he really just wanted to see what would happen. And, his response honestly was way better than mine would have been. So, he did those experiment. You could say, Well, is he, is his diet getting better? It’s like, well, he’s discovering certain things and he’s being, he’s able to make better choices going forward, but there’s still a lot of exploration that happens in that month.

But certainly over time, we’ve seena pretty substantial improvement in health.

Esteban Reyes: [00:29:08] Yeah.

I ordered the product as you know, and I can’t wait to put the patch on. I was having lunch with a friend today, at Houston’s and I ordered a burger. And he’s like, Have you had your patch on, would you be getting that burger?

Maybe the first time, just to see what it does to me, and I don’t know about after that.

Sam Corcos: [00:29:28] Exactly.

Esteban Reyes: [00:29:28] It’s cool. Okay. And, so as you think about the future, I know one of the things that you’re really passionate about is making Levels accessible to a broader population. How will you do that?

What’s the plan.

Sam Corcos: [00:29:44] Yeah. I mean the biggest one is through process automation. So right now we’re doing a lot of things manually just because we’re accumulating data. And we’re doing a lot on the data science side. We recently brought on Jen Lou, who’s running data science for us, and pulling information from what our customers are learning,

what questions they’re asking, how do we get fewer humans in the loop? The other piece is on the hardware side. The cost of the hardware has been coming down every year for the last 10 years. So we’re, I think we’re really at the turning point where this hardware becomes efficiently inexpensive to where it can be used by a lot of people.

I think the, sort of the moonshot for this would be getting this covered by insurance in some capacity. That’s the thing that really makes it broadly accessible. At the end of the day, the people that are most at risk of metabolic dysfunction are the people who can least afford a product like this.

So we need to figure out how to increase accessibility. If you look at people who are in lower socioeconomic groups, they have by a significant margin, the highest rates of metabolic dysfunction. Rates of diabetes in certain communities, it’s just, it is the default. You just know, you know, lots and lots of people who have it.

So we need to, in order to penetrate those communities, we need to break the stigma around glucose monitoring. We have to make it an object of desire or something that people actually want, and we need to make it sufficiently inexpensive that people can afford it, and that this can be broadly accessible.

Esteban Reyes: [00:31:18] That sounds great, Sam. So we’ve talked a lot about Levels from the outside and sort of your vision and mission and how you’re going about that, but we’d love to give people a glimpse into the inside of Levels, how you’re building the company. How do you run the business? Like, you know, what is your operating system of sorts?

Sam Corcos: [00:31:39] Sure.

Yeah. I mean, we’ve been all remote from day one, which has turned out to be quite a blessing, which we were not necessarily expecting. The biggest one is we treat people like adults. And, we have a very high trust environment with the people that we work with. Very high levels of communication

internally. We do a weekly all hands, where we all participate. We have regular one-on-ones. I think the core focus of the company is maintaining development velocity. Almost our whole team is technical. And so it’s all about how do we learn from customers? How do we ship quickly? How do we iterate from those learnings. We’ve had at this point,

probably five or 600 version releases since January, when we first launched the early beta. So it’s all about how do you maintain that velocity? Because the only way you get to product market fit is by iterating and learning from customers and continuing to iterate. So we’re really focused, very firmly on development philosophy within engineering.

Esteban Reyes: [00:32:47] And

for, I guess, founders that are looking to implement that approach,

what are the things that you find critical to get right, in order to build that culture, right, of high velocity, customer driven

and so on.

Sam Corcos: [00:33:02] Yeah. I think the biggest one is focus, which is, understand your customers and what is driving value for them. One of the companies that I think does this best is Superhuman,

and who I know, believes very strongly in this sort of customer feedback loop. They are relentless at only building the things that are the most important. Like, I don’t even think they have an Android app yet. And it’s because most of their customers are not Android users. It’s iPhone, it’s Mac.

And so they’re just relentlessly focused on building the killer app features that are really adding value. In our case, our thesis is that behavior change comes from closed loop systems. So when we have all these new ideas around like, Oh, we should integrate with X, Y, or Z and say, all right, does this close a loop on behavior?

Is this on thesis? And there’s so many things that are like nice to have. One of them being, we actually implemented this in a version of macro tracking, where we break down the macronutrient composition of what you’re eating. And it’s a nice to have. You go, Oh, that’s cool. I can see how many grams of X I ate last week, but it doesn’t lead to behavior change.

It’s more like an interesting thing. So just being relentlessly focused on the core value proposition. People are often also surprised to discover how small our engineering team is. This was, I think in July, I was talking to a partner, a major venture capital firm, who’d been using Levels for several months.

And he was really surprised by our rate of product releases. It was like multiple times a day, and he could see things improving in real time. And he said, Man, your velocity is so fast. Like how many full-time engineers do you have? And I said, full-time, it’s just John really. It’s just the one.

He’s our developer at Columbia. And he was like, Well, I thought you guys had like 10 engineers. It’s like, No, it’s pretty much just, it’s just John mostly. And it’s by being just relentlessly focused on the things that we’re adding value, like to the detriment of things like operational scalability.

We were throwing human hours at solving these problems that a lot of companies would say, Well, we need to solve this before we sell more, because otherwise it won’t scale. And like, I tell the team all the time, they’re probably sick of me saying this, but you will always have problems. But you can choose the kinds of problems that you have.

And we chose to have the kinds of problems where if we got a lot of customers, everything is going to break because our systems are not made for that. Our systems are made for like 20 customers. But would you rather have a system that breaks because you have too many customers or have a really great scalable system and no customers.

I would much rather have that first type of problem. So our engineering focus has always been on how do we learn from customers? How do we iterate? How do we get closer to product market fit?

Esteban Reyes: [00:36:06] You should have told the partner at the recognized VC firm that it was John, it’s just that he was using Levels.

Sam Corcos: [00:36:13] Exactly.

Esteban Reyes: [00:36:17] Well, that, that, that’s amazing. Yeah. I mean, I’m a big fan of Superhuman and Rahul’s approach to product building. And I remember my experience in signing up for Superhuman and getting an email from him all of a sudden, which I didn’t really know if it was him. And, you know, it was a series of questions. And pretty quickly he was like, You’re not a customer for us.

And I’m like, Well, just because you have multiple inboxes and that’s not something we’re focused on right now, you know, check in in three months. And I’m like, okay, great. You know, but, that level of focus requires a lot of courage, I would say, and sort of conviction. So what do you find to be the hardest thing in maintaining that focus?

And maybe you can give us some examples of times where you’ve had to make like really hard calls in order to not compromise it.

Sam Corcos: [00:37:11] Yeah. I don’t think we’re lucky in that much of our team is bought into this. There have been times where there’s been drift. And the way that we solve for this is we do a lot of long form documentation to align on things.

We actually have this, maybe last week or the week before, where three of the people in leadership, me being one of them, we were talking about a particular concept. And it became pretty clear that over the last six months, our own definitions of what this concept means has actually changed quite a lot.

And so we put together like a 10 page document on our current understanding of what this means and what the path forward is. And we were able to really get good alignment on what that means. So in the event of focus, it would be writing, let’s say, an example would be, what is our philosophy on integrations?

Should we integrate with Strava? Should we integrate with My Fitness Pal? What integrations should we do? We might, if we find that there’s meaningful misalignment, we’ll write up a long form Google doc, where everyone puts their ideas down, and then we come up with a path forward. All right, these are the conditions that we will use in order to decide whether we integrate a particular thing.

And that just really, really helps too, to get alignment on the team and keep things focused.

Esteban Reyes: [00:38:31] What I’m picking up as well is that you push for clarity.

Sam Corcos: [00:38:35] Yeah, absolutely.

Esteban Reyes: [00:38:37] Yup. And that can be hard at times, right? Especially if people are not sort of bought into the process that you’re describing, which personally I find super helpful to use writing as a way to clarify my own thoughts.

But you gotta have people that believe that is, you know, a good tool to use because it takes a lot of energy. I’ve heard, I forget who said it recently, somebody say like, Writing is the process where you realize you don’t know what you’re talking about. So I can totally see how having a very simple rubric, you know, that is your North star, and then using writing as a way to make sure that you’re aligning always with that rubric, can be super powerful.

Sam Corcos: [00:39:17] Yeah, we,

one of the, part of this is because we’re an all remote team. Writing is a very important skill for people that we bring onto the company, is being able to effectively communicate. We’ve done remote pretty effectively, and it’s largely through writing in long form documentation. I think that, it’s, being remote is helpful in that it forces a lot of these good habits.

We have, our level of documentation is what one would expect from a company 10 times our size, because you have to do that when you’re remote. So it forces a lot of these really good habits where you get good alignment and you, it’s really relatively easy to onboard new people, because they can see

the entire history of the company in documentation form. It’s not like. They don’t feel like they missed the important meetings because they were all documented and they can read through it. And they can see, we have documents for the entire history of thought of product. They can see what were they thinking about product in Q1 of 2020, and what decisions were made? And then what were the thoughts in Q2 2020, and what changes were made and based on what information? And you can just see the whole trajectory, and it makes it way easier for people to get up to speed and gain context.

Esteban Reyes: [00:40:32] Well, and I would

argue, like, in my own case, you know, as an investor now, I write pretty much everything, any decision that I’m making, especially investment decisions. Less about saying I have a memo to show, and it’s more about using it as a way for me to reach a conclusion, but then going back and looking at those decisions and learning from the process.

Right. And looking at the outcome and. Yeah, it just gives you a way to make your decision-making traceable and tractable.

Sam Corcos: [00:41:06] Yeah, absolutely.

Esteban Reyes: [00:41:07] So one of the other things that I guess you have, I think the last time I read about 35,000 people on the waiting list, and maybe

many more by now.

Sam Corcos: [00:41:18] I think it’s closer to 45,000 now.

Esteban Reyes: [00:41:20] Okay. There you go.

So one of the things that I’ve been thinking a lot about is that community led products have the ability to build a highly defensible moat. And the reason is because it’s not just brand, right. Because brand could be just that people, have a preference for a particular product or service.

But when you have a community, there’s engagement, there’s promotion, there’s even co-creation. I mean, you’re talking about all the customer feedback that you use to elicit and how you incorporate that into product development. So it’s much more than brand, right. And Superhuman is a great example, obviously Levels, SpaceX, I would argue, more recently maybe Roam Research.

What is your view on that in terms of how important of a role community plays for Levels now and moving forward? And do you think that it’s the same as the product as just looked from a different perspective, or is it really something independent from the product itself?

Sam Corcos: [00:42:27] I think it’s something largely, it’s an extreme focus on the customer is what it is, and understanding who they are and who your biggest advocates are.

There’s the, I’m sure you’ve read, not to keep talking about Superhuman, but I’m sure you’ve read Rahul’s post in First Round Review on finding product market fit. If you haven’t, I highly highly recommend it. He talks about how most companies, they focus on their detractors and how to convert detractors into advocates,

people who don’t like the product. And he makes the case that you should figure out who your biggest champions are, and lean into them a lot more. And just like fire all of your customers that are not advocates. And just don’t even worry about them. Like the people who say like, I hate this product because of X. It’s like, okay, I’m sorry you feel that way.

We’re not going to get more customers like you, we want more customers like our extreme champions. We want to learn who they are. It’s like, Oh, okay. It turns out these people are in these industries. They follow these certain habits. These are the kinds of people that we really need. So Tesla does something very similar with like, the people who own Teslas are brand advocates.

They have effectively no marketing budget. I think their only real marketing is Elon’s Twitter. So getting those people, who are your advocates, learning from them and really leaning into those people, as like finding more of those types of customers, is what a lot of these companies have done.

Esteban Reyes: [00:43:57] Great.

So let’s talk a little bit about what I call dead zones, and the process of building a startup. I recently heard John Chambers, the ex CEO of Cisco, who took the company from 70 million in revenue to over 40 billion, talk about when Jack Welsh said to him that he would only know if Cisco was a great business after surviving a near death experience.

Which I thought was very insightful. I know it’s early days for Levels and you’re in a extremely, you know, promising trajectory. But have you dealt with one of those experiences so far? And if so, what

did you learn?

Sam Corcos: [00:44:40] Yeah, I, I don’t think. We haven’t had near death yet. We had one. We had one that felt like it might be a near death experience, which was mid March of this year.

And we’re definitely not alone in that, where we were mid-process on a lot of things. And then like people just stopped responding to emails. And we started looking at our runway and going, like, how long is this going to go for? COVID just shut down the world for like two weeks. And we wrote up, we had, everyone had thoughts.

We, as I mentioned before, wrote a lot of memos. We wrote out a memo on like, what are the contingency plans here? Like what’s happening? How do we think about this? And that was helpful. Fortunately, things opened up again pretty quickly. And I remember somebody asking me like a month after, it was in April.

And again, we were also very lucky because we were, we’ve been all remote from day one. So there wasn’t this scramble to figure out how to do remote. And, we, I think the only real productivity loss we had as a team was our head of product had to take a half a day off work once to move some stuff.

But other than that, nobody was really affected by it in terms of logistics, because we were already fully remote. But there were some moments where we had to think about, do we cut our salaries? We still had some cash, but we didn’t know how long it would last. And I remember somebody asking me about a month later when investment started picking up again, we’re in healthcare technology, we’re in telemedicine, we’re in one of these fields that people seem a lot more interested in now.

He said, so, you know, it was a, is this a tailwind or is this a headwind? And my answer was that, it feels very windy at the very least. I don’t know. I don’t know which direction the wind is going, but certainly a lot in both directions. And I think we came out of it generally in a pretty good spot.

So that was the closest we had to like, you know, emotional, near death experience. But the company was, in retrospect, perfectly fine.

Esteban Reyes: [00:46:38] Yeah, like you said, you know, for good or bad, you’re not alone on that one.

Sam Corcos: [00:46:42] Yeah.

Esteban Reyes: [00:46:42] So what do you think would be the hardest thing that you need to get right in order for Levels to be successful?

Sam Corcos: [00:46:51] Yeah, I think the most obvious answer to that is we need to figure out how to cross the chasm. Right now, we have a small set of really enthusiastic, early adopters who are already pretty well-educated on the content that we’re covering. I would say we’re in a, to use some growth terminology, we’re in the demand capture phase.

We don’t spend any money on marketing, like a trivial amount. These are people who are finding us largely organically. And there are people who already know that they want this. We don’t have to convince them of it. Getting into demand generation, which is probably six to 12 months from now, that’s going to be the real test, is can we convert people who don’t yet know that this is something that they want?

How do we bring this to the broader audience? The, how do we convince the random Wholefoods shopper that this is something that she should care about? That’s going to be the real test, is how do you, how do you get past the early adopter biohacker types, and how do you make this something that’s more mainstream?

Esteban Reyes: [00:47:53] Make sense?

Yeah. So Sam what are some parting thoughts that you have for the audience here, that you would like to share

that we haven’t talked about?

Sam Corcos: [00:48:03] I think the biggest one is to ship early and ship often. That’s something that I talk about all the time is, I think it’s a Reed Hoffman quote that if you’re not embarrassed by your first product launch, you’ve waited too long.

I think I built the first version of our software myself in like two days. And we just shipped it, and we just wanted to see what would happen. And a lot of people didn’t like it and that’s okay. You have to be willing to put yourself out there, and ship quickly, take a negative feedback in a really like humble way, and just keep iterating and keep learning from your customers.

Don’t under-invest in. We have a full-time person on our team who just gets, gathers user feedback all the time, every day. And he gives a weekly Roundup to the whole team. So we can just keep a pulse on the health of our customers. So that’s something that I would definitely.

Esteban Reyes: [00:48:59] Awesome.

Sam,

if you could teach the world one skill, just like when Pank uploaded skills into Neil’s brain in this movie, The Matrix, what

would it be?

Sam Corcos: [00:49:12] That’s a good question. It could be, if it was a skill, I would say if I could upload one thing, I would say it would probably be something ego related, maybe stoicism. Just understanding that

being able to detach from situations, and being able to see things clearly, and not take things personally. And I think that would probably be it.

Esteban Reyes: [00:49:36] Yeah.

And, what drives that desire in

you?

Sam Corcos: [00:49:41] I just felt that my life is a lot better since I have had time to really introspect, and I took a year off work recently, and spent a lot of time thinking about this stuff.

And, it’s one of these deep ironies that a lot of people have experienced, where the less I care about the outcome, the better the outcome tends to go. And I’m not quite sure why that is, but the less financially motivated I am, the better the financial outcomes are. The less I care how a particular project goes,

the better it tends to go. I don’t really know why that is entirely, but it’s a, it’s been an interesting process.

I have a

Esteban Reyes: [00:50:22] hypothesis

on that. And I believe it has to do with how we perceive the future. When you worry about the outcomes, you’re thinking about what’s going to happen. And when you think about what’s going to happen, you tend to worry. And worrying

doesn’t help whatever you’re doing in the present moment. Right. Whereas if you’re not thinking about the outcome, but you’re actually thinking about the things that you need to do, and how you need to do at that present time, then you’re probably channeling, if not all, the majority of your energy in driving an outcome without realizing

it.

Sam Corcos: [00:50:58] Yeah. Certainly could be. And I think one of the biggest things for me was,  the more detached I was. I think a big part of it was that the less I cared about it, the less I worried about other people’s perceptions of the outcome as well. It’s something I think just comes with being older and wiser.

That when I look back at myself in like my college years and the few years after that, most of my decisions were driven by how I would perceive other people would perceive me making those decisions. And the older I get, the less I care about that. And so I’m able to make decisions that are things that I am more interested in.

And so I think there’s a lot of overlap there. I can’t quite articulate it though.

Esteban Reyes: [00:51:41] Well, that’s a wonderful place to end. Sam, thanks again for spending time with us. This was a great. I had a lot of fun and, I can’t wait to get it out.

Sam Corcos: [00:51:50] Good to be here.

Esteban Reyes: [00:51:53] Thanks for listening. Hope you enjoyed this episode as much as I did.

If you’re an early stage B2B founder, building a next generation technology company, drop us a note on Twitter at L A S O L A S VC. Or visit us at L A S O L A S V C.com. Would love to hear from you. Until next time.