The Coke Challenge

Josh Clemente: I used to work construction when I was in high school and I would literally fuel myself on giant two or three pound bags of Skittles and Chipotle balls with double rice, double beans, double tortilla on the side. And-

Josh Mohrer: I mean, all of that sounds so good though.

Josh Clemente: And it is. It’s delicious.

Ben Grynol: I’m Ben Grynol, part of the early startup team here at Levels. We’re building tech that helps people to understand their metabolic health and this is your front row seat to everything we do. This is a whole new level.

Ben Grynol: So finally the time had come. We had on two Joshes on the podcast, Josh Clemente, founder of Levels and Josh Mohrer, head of global operations. And it was a really interesting conversation around the Coke Challenge was one of these community initiatives that we decided to undertake and we wanted to see what would happen if we ran an experiment with the community, how engaged would people be, what would happen. And there were a lot of interesting results, but moreover, we really dug into all of these factors that have to do with the way you can think about not just metabolic health, but what’s happened from a macro economic perspective. What’s happened in the world from a capitalism perspective and why certain choices that are available to people have steered us all as a society, why we’ve been led down the path that we have, and really how we got to where we are today, which is this massive epidemic called the metabolic health crisis.

Ben Grynol: And it’s what we’re set out to solve on a global scale, really hard problem to solve, but it’s something that we’ve got our eye on every single day and it’s something that we’re working towards incrementally. So we had a really interesting conversation about the Coke Challenge, but ended up weaving in and out quite a bit into all these different subtopics and great conversation, but really the fruit of it all ended up at the end, the very end of the podcast, where we unpack the mystery of why there are so many Mikes at Levels. Here’s where we kicked it off.

Ben Grynol: Gents, we got to jump into this because we’ve got to be efficient with our hour here. So we got to set this one up with the Coke Challenge. I guess it was probably back in February, I think it was Sam and not to be surprised that it was Sam had this harebrained idea that we should all drink glucose 75 milliliters or 75 grams depending on which country you live in, but 75 units of orange glucose drink to see what would happen if we all consumed it, what kind of blood sugar spike would we get and could we mitigate it with exercise? And our whole team got behind it. We tried it and the outcome was a disaster, if you want to call it that. I remember Sam, I think we actually recorded a podcast that day. There was something we were doing, but he went to like 300. He was sweating and not feeling super well.

Ben Grynol: And so we pivoted and we ended up really changing it into this thing called the Coke Challenge and that’s where, JM, you had started in March and you grab the reins by it and took over. So we’ve got to set it up with what is the Coke Challenge and sort of talk through how we’ve got to this point, which is July 27th, 2021.

Josh Mohrer: Sure. Well, for me, I think it was a bit of hazing as a new employee, but the director was, “Send everyone a glucose drink, a couple of glucose drinks and let’s see what happens if they drink one sedentary on one day and then on another day, drink one and go for a walk and see what the difference is.” And I think we had the idea from other research that the reactions would be different if you’re doing some form of activity, so we wanted to test that since we all are on Levels and on CGM, there’s an opportunity for that. So we sent out the glucose drink and I think it was a little much for some people. Everyone’s different, everyone responded differently. I ended up doing only one trial of the glucose drink because we pulled the plug before I got to number two and we rebooted it with Coca-Cola with the same idea, but Coke, that definitely spiked everyone a lot as well was a little more subtle, but the idea was to really get some data around the difference between activity and not and how our body handles the glucose.

Ben Grynol: For Josh, when we started doing this, this was around the time that you were really focused on research, right? And you’re still diving into it, but you were deep, deep in papers. And I remember when Sam said, “Hey, let’s do this thing.” You were like, “Yeah, we could do this at scale and we could get some pretty meaningful data from the public, really unbiased data as far as the test goes.” Because if N equals, whatever it was, 15 for our team to try it, what does that look like at 10 or a hundred or a thousand X as far as meaningful research in the world?

Josh Clemente: Yeah. I think the interesting value proposition here is to show people how easy it is to intervene in the consequences of a meal decision and originally we wanted to kind of combine that insight with the clinically relevant oral glucose tolerance test, which is what that 75 grams of glucose is used for, for screening for diabetes and or for screening for gestational diabetes, which is often temporary type 2. They will administer the 75 gram drink and then monitor in like four discrete points in the two hours after that. And so we were thinking, “Well, we can use the CGM data. We don’t need to obviously draw blood and we can still use the 75 grams because it has this clinical relevance.” But at the same time, it’s also not meaningfully relevant to the average person. Nobody is drinking 75 grams of straight glucose. And not only that, but we are eating and, or consuming really high glucose or high carbohydrate standardized, in quotes, meals all the time. And the best examples are soft drinks. They’re just loaded up with sucrose and or high-fructose corn syrup, which has a ton of glucose in it as well.

Josh Clemente: Yeah, that’s the more real world relevant without going over the top. And I think we saw the over the top like you said, Sam was like cruising around in the 300s and we just don’t want to administer such pain unnecessarily to our member group. So I think that the Coke challenge, it comes with like a bit of cache. Everyone knows what it means. It’s super standardized, but it’s also way more relevant to the average person. And so I think it’s in many ways more clinically interesting than the OGTT 75 gram thing.

Ben Grynol: Yeah. Not to throw Rockstar under the bus, but let’s throw Rockstar under the bus. Those just are… it blows my mind that those are legal first of all and-

Josh Mohrer: You don’t have to drink, right?

Ben Grynol: Yeah.

Josh Mohrer: Rockstar energy drink.

Ben Grynol: So one of those king cans, whatever they are, like the tall boys. So you get one of those and you look at the back and it’s some bonkers number like… I don’t know, 59 or 69 grams of sugar and you’re like, “Wait a minute. This thing is the equivalent of that orange glucose drink.” And we just can go grab one of those things readily available out of the gas station at the corner. And we think it’s okay to drink that and not just do it once, but do it multiple times a day every day because that’s… Maybe not for everybody, but that is a very realistic scenario for some people.

Josh Clemente: Yeah. Make sure you infuse like 300 milligrams of caffeine per serving too-

Ben Grynol: Oh yeah.

Josh Clemente: … to maximize the cortisol spike and-

Josh Mohrer: And so Josh, is it right that basically how your body metabolizes, that, how fast your resume, how high up you get is in some ways an indicator of metabolic health, is that right?

Josh Clemente: So I hate to say it depends phrase that everybody hates when they say… But it does.

Ben Grynol: Go for it. Go for it.

Josh Clemente: So I’m going to go into why this is more complex than that. Not paying attention to our specific code challenge, which includes exercise which is sort of an intervention into the normal metabolism of this amount of sugar, but the reason it depends, like if you’re just, let’s say you’re driving, you’re commuting and every morning you pick up a Tallboy Rockstar, drinking that while sedentary and watching the way your body responds is typically a good indicator of how insulin sensitive you are because it’s basically pure sugar. There’s almost nothing else in there. It’s a huge bolus. It is already very processed so there’s no cellulose to break down. There’s no fiber. There’s nothing preventing that sugar from quickly making its way into the bloodstream. So you’re going to basically take that glucose right to the blood and then your body has only got one way to metabolize it and that is to get it out using insulin into the cells for energy, which you’re not using much of because you’re sitting in traffic and that’s going to be stored as fat.

Josh Clemente: So the rate of reduction in that glucose elevation should be closely tied to your insulin sensitivity. Now where it goes wrong is like some people will experience as a result of it seems over and over repeating these sorts of very high insulin dependent lifestyle choices. Basically, I’m just saying eating a lot of processed foods, they will over time develop hyperinsulinemia. It’s not entirely clear. There isn’t enough longitudinal data to see exactly how this happens, but suffice to say that people will have high levels of insulin already in their bloodstream when that glucose hits.

Josh Clemente: And so what will appear to be a very metabolically fit or insulin sensitive individual because their glucose doesn’t rise rapidly and it doesn’t go very high, actually could be someone who’s experiencing hyperinsulinemia and their glucose doesn’t get high because they’re already preloaded with a ton of insulin that is still latent in the bloodstream from their most recent spike, from a few hours ago or yesterday and their insulin levels actually never get down below background. So that’s actually a person who’s very metabolically unfit and is experiencing insulin resistance, but they just haven’t gotten to the point where things have totally broken down.

Josh Mohrer: So the best version of this would be one where we test the insulin levels at those-

Josh Clemente: Exactly.

Josh Mohrer: … 30, 60, 90 minutes as well as the glucose to sort of see-

Josh Clemente: Exactly.

Josh Mohrer: … [crosstalk 00:11:03] in your blood?

Josh Clemente: Yep. And so that’s the future sweet spot is being able to have continuous insight into the glucose curve, but then also correlating it with the insulin curve and it’s called a number of things, but the Kraft index or a Kraft curve is kind of what it’s described as, because of this doctor who first developed it as the ideal measure of someone’s metabolic, their metabolic rate or insulin sensitivity in real terms, because it’s showing you your glucose relative to your insulin, all in the context of a known glucose load.

Ben Grynol: And that’s consistent with some of the numbers that we saw when we ran it, to fast forward for a sec, we ran it with the community and there were a few people who did the Coke challenge and let’s say it was a sedentary trial and we’re like, “What? Plus nine?” Is that what would have been likely occurring?

Josh Clemente: So that’s the tough part is because we don’t have that insulin piece, that could either be an extremely insulin sensitive person maybe an athlete, somebody who is really… has amazing glucose disposal or yeah, maybe it’s somebody who should probably consider getting those insulin levels checked because it’s… maybe that is a confusing result for them and they expect to go much higher and so it really without more information, we would need to do a little more digging, but I would say, yeah, it’s one of those two results.

Josh Mohrer: It can also be sensor problems-

Josh Clemente: Sure.

Josh Mohrer: … instead of-

Josh Clemente: That is definitely-

Josh Mohrer: [crosstalk 00:12:26] wrong and they might’ve entered the log. I mean, there’s a bunch of reasons.

Josh Clemente: Yeah. It’s not an RCT. The goal of this trial, which I think we achieved is to basically scale these informal insights. You know what I mean? These magic moments. And it’s not that this is clinically relevant research, but it definitely could feed into clinically relevant research. This sort of like walking it off paradigm, I don’t hear it that often. There’s eat less and exercise more are kind of standard taglines, but if you’re going to eat or indulge exercise immediately after or go for a walk, maybe people hear about that in certain locales around the world, but I certainly didn’t hear that growing up and it seems like it’s a really good opportunity to drive it with data.

Josh Mohrer: I read this somewhere, Josh, and maybe you did too. I think it’s a Japanese phrase from a long time ago, but it’s like, after dinner if you take 99 steps, you’ll live till 99 or something like that.

Josh Clemente: There you go.

Josh Mohrer: It implies that movement after meals is a good thing. I think it was intuitive at some point, but we’re able to sort of show with the data that it is a good thing. I think what was interesting about what we did here, the Levels experiences it has a lot of self experimentation like I’m going to try eating my breakfast oatmeal and see what happens there. I’m going to try this versus that and just sort of see how my body responds. It’s sort of self experiment to sort of see what you’re able to do with different foods. This was kind of the first comparing to others on the platform at the same time and letting everyone do something somewhat synchronously and to generate a result. And I think we proved basically that exercise makes a difference. We saw almost everyone’s spikes were lower during the exercise trial and that’s pretty cool.

Ben Grynol: Let’s go down the path of macro economic factors because why not nerd out on this? So many moons ago, let’s go all the way back to the 1900s or the 1920s, cities, neighborhoods, everything was designed around the central business district, the CBD. And neighborhoods… And that was because factories were put in central parts of a city and then neighborhoods were made around that so that people could walk to work or could bike to work. And people were more physically active. And as cities evolved and we started getting this idea of suburbs it was more efficient to build infrastructure where… There weren’t even sidewalks in many of these suburbs. It was just these roads and cul-de-sacs and driveways. And I think that’s probably like an average suburb across North America looks somewhat similar to that.

Ben Grynol: And once we removed sidewalks, you get further and further out from the CBD, which is now just office towers and many, we’ll call them major metropolitan cities, you get fewer sidewalks and so you get fewer people walking after dinner or going for a bike ride with their kids down a sidewalk, which you see in neighborhoods that are closer to what was once the CBD. And so that alone, I think just removing that infrastructure implication makes it really hard for people to go, “I’m going to go for a walk.” Because walking is now down some road with cars driving on it and it’s not as easy to do or freely available. And then the one other compounding factor is you don’t see other people doing it, so why are you going to do it? It really has changed, the way that we have planned cities has made an impact back to JM’ point of 99 steps for 99 years. That’s one major factor in North America alone and it’s very different from places like European cities or cities in Asia, where there still is walking infrastructure.

Josh Clemente: Yeah. I mean, I think that that couples with a number of other developments like the energy density that we are able to achieve in our food and that relative to the sedentary nature of our lives, like the population is increasingly immobile and increasingly fueling up with jet fuel. And yeah, like you’re saying, there’s also just the at home component where even on weekends when you’re not at the office, you don’t necessarily have the outlet of a strolling around. So you just end up constantly fueled up with nowhere for that energy to go and that’s the recipe for disruption.

Josh Mohrer: I think if you zoom out even further, we evolved to accommodate a certain lifestyle that’s quite different than what we have right now, sleeping in warm beds, having as much food as we need in the refrigerator, not a lot of effort needed to get food. Evolution is quite a bit slower than the progress we’ve had over the last hundred years or so, so I think all those things, no sidewalks is sort of a part of it, but unlimited food is probably a big one too. We sleep in a warm bed, which I think is maybe not how we were designed to sleep. So there’s just all these ways that we’re living differently than how we evolved and I think it’s a larger conversation, but the incidents… There’s a lot of diseases that have come up in the last hundred years also that we didn’t have before and some of that is life expectancy is much longer, but some of it is that we’re just living differently than we really evolved.

Josh Clemente: Threats of abundance rather than the threats of scarcity that we used to have.

Josh Mohrer: That’s right.

Ben Grynol: Hey, you got to watch those words, JM, because some people sleep in a cool bed, thanks to Eight Sleep.

Josh Mohrer: I don’t want to name another brand, but I tried another brand of that and it was too loud for my family. So I was vetoed. I’ve heard the one that Josh uses is more quiet, so that could be worth a shot.

Josh Clemente: Oh, it’s completely silent.

Josh Mohrer: Pretty amazing. And you just have the cover, right?

Josh Clemente: So I have the whole setup, but it actually is designed as a foam mattress with a cover-

Josh Mohrer: Oh, I see.

Josh Clemente: … that goes over it. So they sell that cover separately.

Josh Mohrer: Right. That’s what I was… Got it. Yeah. I want to try that.

Ben Grynol: That being Eight Sleep?

Josh Mohrer: I love sleeping in cold.

Ben Grynol: Is it Eight Sleep?

Josh Clemente: Yeah. It’s Eight Sleep.

Ben Grynol: Rogan was talking Eight Sleep the other day with Andrew Huberman on the episode they ran. It was really cool.

Josh Clemente: I had some believer.

Ben Grynol: There you go. Well, we got to pull it back to real world scenario of glucose/Coke/Rockstar/insert high glucose. I don’t even want to call it food input. You can’t call Rockstar food, but high glucose input. Real world scenario is… And I think this is pretty common. People go to Starbucks in the morning. They like what tastes good, they like what gives them the dopamine hit, they like what gives them a little kick of glucose. It’s not even the caffeine is the Venti Caramel Macchiato or something like vanilla latte. And I think naively people don’t understand that three or four or however many pumps of that syrup in those drinks is basically, it’s pretty close to a Rockstar. And so you start your day off, you crush your coffee on your… Well, let’s assume people were commuting because things have changed now with remote work, working from home, but in general, people still consume these drinks.

Ben Grynol: So let’s assume that you were going from A to B, you grab your Venti drink, you crush it and then you’re kind of like shaky after. And people are like, “Oh goodness, I need to eat.” Or, “I haven’t slept enough.” Like there’s always some excuse because they actually don’t understand what’s happening metabolically in their body. And it all stems back to this thing that is not just legal to sell that we promote, it is, to use JM’s words from the the episode we did, I guess it would be a couple ago from this one, capitalism gone wrong is his framing of the cereal industry, which is a different conversation altogether, but-

Josh Mohrer: Misaligned incentive structures.

Ben Grynol: Yeah.

Josh Clemente: There you go.

Ben Grynol: I mean, that alone is something that really makes a difference in the way that we work, the way that people feel, the way that they live their life and these choices over and over it’s like you are hitting the button almost like a lab test on yourself and you’re going, “Sign me up for this.” And it’s actually doing detrimental damage.

Josh Clemente: It’s pretty amazing once you start to actively try to pull added sugars out of your diet, whether because you just want to see if it’s possible or because you’re using something like a CGM and it’s lighting up left and right. You realize just how prevalent this stuff is. And when we started to turn against fat back in the seventies and eighties, there’s only one other real flavor substitute, salt being consistent. The other flavor substitute is sugar and that’s what ended up in the food supply as the main source of calories, as an alternative to the terrifying fat products that everyone was trying to eradicate.

Josh Clemente: And so, yeah, you have a situation, like you said, where you’re hitting the nitromethane button repeatedly, and this was… it was not available. If you look back… Of course, we’ve been able to produce through our agricultural systems a lot of, significant food for hundreds or thousands of years, but in general, people were still calorie constrained so to produce that food required a ton of effort and you were out there on foot moving consistently. And I think that these parables like 99 steps will help you live to 99 years or something like that, generally speaking, I think that held across society. People were not indulging to a significant degree without having corresponding output. And we now have a complete imbalance where some people work out, but they typically go above and beyond to over fuel, even though they are already living in a society that is constantly over fueled, you know what I mean? And so we have all… It’s like layers of this where everyone feels like they are constantly at risk of being under fueled or undernourished and it is just could not be further from the truth.

Ben Grynol: That’s also the marketing behind it, right? People think… It’s just what you hear. You hear your friends say, or somebody says on Instagram, whether or not they know what they’re talking about. Somebody does an IG story, crush your protein shake and do X, Y, and Z before working out. And so you get all this misinformation and it’s just steering people in the wrong direction altogether because you see people who are highly active like Mike Di Donato and he’s like… [Gay Mendoza 00:22:52], same thing. He’s like, “Man, the only way I work out is fasting.” Because it’s so much better, metabolically is so much better for the way that they process the energy that they have.

Josh Mohrer: Yeah. I mean, I think it’s sort of why we exist, right? Everyone wants to understand how their body works. They want to be healthy and feel good, but there’s just so much we don’t know. And a lot of conventional wisdom out there that’s just wrong. And so I think that’s what got Josh into CGM originally, he wasn’t feeling good. He wanted to understand it. And that’s kind of why Levels exists because we ought to stop taking a guess, looking at the back of the cereal box shouldn’t be how we decide what’s good for us.

Josh Mohrer: And I think I said this in our interview last time, Ben, but 10 years ago, I probably would have assumed if you fasted for a few days, something bad would happen to you and it’s Tuesday morning now. I haven’t eaten since Sunday and I feel really sharp and really good and think it’s like a reasonable thing for humans to do every once in a while. So I think we’re just starting to figure it out as a human race.

Josh Clemente: Yeah. And by the way, congrats on being close to, what are you going for? 72?

Josh Mohrer: Yeah. I mean, I would like to… I’m looking more for biometric results to indicate a stop time than a certain duration, though I do have a dinner plan tomorrow night, so that’s as far as it could go. So it could be nearly 72, but I’ll probably end it today.

Ben Grynol: Nice.

Josh Clemente: Yeah, exactly. I think that these tools that we’re working on and the way that we weave them into society’s consciousness, they’re the outlet. We’ve been kind of devolving and our food supply has been increasingly misaligned with the incentives of not only the individual, but society, because there’s not enough information. It’s one of these situations, it’s almost classic neighborhood effects. If you don’t have enough information to judge the risk benefit ratio of a certain market or product it’s unfair. And I think that we’ve had that situation now for a long time and individuals are being, for better or for worse, fed information about how to consume foods. And of course we are all individuals and certain people have different needs than certain others, but across the board, you can see the trend and the trend is detrimental and damaging.

Josh Clemente: And so now we’re finally developing the technology that I think can be that source of objectivity and the future looks a lot I think like what we really just trialed here with the Coke Challenge is just helping people to A, connecting them with the levers that they have in their own power, showing them the effects of what is really a mainstream, quote unquote, food product, showing them those effects across everyone so that everyone can see, “Oh, wow, this is not just me. This is broadly relevant.” And then also showing them how they can push back. I believe that the distributed sort of data-driven large scale challenge structure or evidence structure, or research structure, whatever you want to call it is here to stay. So being able to scale those sorts of experiments and have everyone in on it. This isn’t just for academia, it’s not just to collect data and then publish it in some journal that most people don’t ever read. The goal is entirely education for the individuals whose health is involved. I mean, that’s what I think is most interesting.

Ben Grynol: Yeah. I think what we want, we get back to our mission and our goal of educating the world about metabolic health and creating awareness around how people can make meaningful behavior change. The way things spread is a friend does this trial and then the friend goes and tells another friend or family member, “Hey, I did this thing and I saw this crazy data.” And then the friend tells some other friend and it becomes some anecdotal story, but that is how these messages spread. And so you really do get these exponential effects as far as information spreading around when people see eye-opening results. When we did the glucose challenge, the biggest eye-opener for me was, and it happened with the Coke Challenge as well, but not to the same extent.

Ben Grynol: It took more than 24 hours for my… I think it actually took like almost 48 for my levels to come back down because they oscillated and then they remained high, even though I tried to burn off the circulating glucose and get my levels back down, it was just wild to think that a single event, a single, not even an event, a single source of input could have that much of an effect on my metabolic health, my well-being, my productivity, the way that I think for more than a day. And you start to think about how does this tie into the way people work and navigate the world? It’s almost like if you go around with elevated levels of glucose because of the lifestyle choices you make, you’re basically a nauseated zombie trying to figure out like how to be a person and contribute to society. And that is a very common case.

Josh Mohrer: Yeah. And I think for those of us who care about this stuff and are thinking about it a lot, which is implied since we all work here, it was a unique experience. It felt different than how we typically do. I think what’s kind of shocking is that many Americans, maybe most Americans are living with that feeling all the time, so that it’s kind of normal for them. Fruit juice in particular is sort of all over the place for kids, for adults. It’s like the number one thing I try to avoid here with our kids and many or most Americans are having that feeling as their norm. I think that’s really the shocking part. Maybe it isn’t as it as acute of feeling because it’s so normal.

Josh Clemente: Yeah. So it’s like the desensitization. I mean, that was me. I’ve had like a borderline addiction to sugar my whole life. I would chase it down when I had any opportunity, when it was in the vicinity, I mean, I was hunting it down and that was like childhood teenage years. I used to work construction when I was in high school and I would literally fuel myself on giant two or three pound bags of Skittles and Chipotle balls with double rice, double beans, double tortilla on the side.

Josh Mohrer: I mean, all of that sounds so good though.

Josh Clemente: And it is. It’s delicious. Had so many rewards. They’re all short term.

Ben Grynol: I will argue against that. I’m like, I do not like sugar.

Josh Mohrer: I’m involved really.

Josh Clemente: In its clutches.

Ben Grynol: You can have my share of Skittles.

Josh Mohrer: I mean, a big bag of Skittles is… I think Josh, I think we’ve found that we have similarities there in those sorts of things, but that sounds just delightful.

Josh Clemente: I mean, that’s what I went for. And the problem was that for me, it took a very long time to start, so for the compounding of those negative effects to show up for me. And it became dramatic. Now after kind of removing all of those impulses… Or just at least removing it from my house so I’m not tempted by it and I rarely indulged. Now I’m so sensitive to that sensation of elevated glucose and in particular highly processed sugar that hits the bloodstream fast. I am just attuned to it and I know what that effect is. I can’t remember really whether I’ve ever felt that before as a teenager in college or even after when I was really… I mean, it’s hard to imagine how much sugar I could take down in a single sitting. It was hundreds of grams and it’s just like… It’s amazing to me that it’s possible to be desensitized to it, but I have been through it and I know on the other side, I’m so sensitized to it that…

Josh Clemente: I think it’s actually quite easy. You just need to sort of detox and have an awareness of the acute effects and then the next time you go back in and you have, whether it’s data or whether you have intraception, you’re more attuned to your body. It becomes quite obvious and I think that is the cycle that we want to repeat for people, not so that we eradicate sugar, but just so that people are educated and informed about it and they have the opportunity to sort of remove themselves from the experience and then go back in and sample it from like a new perspective.

Ben Grynol: You are your old man, Mr. Clemente. Sugar runs deep. So we did this test and when we tested with our team, we thought, “Hey, let’s scale this to the community.” And so what was the thought process? Why did we decide to do it and how do we go about doing it? That’s where you really grabbed the reins, JM, and you started to really just make it happen.

Josh Mohrer: Yeah. I think a lot of the things we experiment with internally are designed to eventually be spread out to everyone, like we try stuff ourselves first. So I think the original idea was intended to be opened up to the community and we were just sort of figuring out how it was going to work internally. I can’t remember a time where I was doing this where it wasn’t sort of intended to be opened up. After the glucose issue, we switched over to Coke. We did that. Everyone did it. No one had that bad of a day and that felt safe to send out, so we offered our subscriber base the opportunity to be in this and got a lot of folks interested and shipped them a bunch of Coke and the rest is history.

Ben Grynol: Yeah. Actually, we have to dig into that and unpack it because it’s really easy to say, cool, you did this if we look at it and we start to poke holes, we go, cool. You did this thing. Well, how did you control for formula in the sense of, granted, this is only open to people in the US, but that was one thing. The second was ensuring that people weren’t using Coke Zero. When we say Coke, everyone’s like, “Oh, it’s a Coke product.” So that was one thing. And then units. And I think that was where Josh was like, “Yeah, we have to…” Because you were looking at it from the clinical lens where you wanted the trials to be as close to each other as possible.

Josh Mohrer: Yeah. We sent out the Coke, right? So we didn’t want people buying it locally because there are regional variations on how they bottle and how they make the Coke. I think it’s uniquely bad in the US and some other places it’s slightly less bad, but we just wanted everyone to be drinking the same thing. And I think there was an internal feeling that we just want to make this as easy as possible for the folks who are going to be in the study. So we mailed out the Coke so that everyone was drinking the same. The origin of the Coke internally was from New York City. The origin of the Coke for the community was Southern California. So we sent it out. We sent a bunch of reminders.

Josh Mohrer: We actually put out a blog after the internal test with our results, which got a lot of traction. People were excited about that post. And so it was sort of on the excitement of that we launched the community version. We know we sent out Coke to about 80 people, about half of them perform the experiment and the results were similar, walking helps. It was exciting and something that I think we could scale to a much larger group in the future.

Ben Grynol: Yeah. And then there was this one cool aspect of it that… I’m pretty sure it came from Josh, but Sam was the one who initiated it and said, let’s dig into mission patches. So we got to unpack that because there’s a whole story behind what a mission patch even is and why we might want to consider doing it.

Josh Clemente: Sam and I talked a number of times about what incentivizes people, like what motivates people, what is a good commemoration mechanism to help people strive for execution and completion of tasks or of projects? The only real personal example that I lean on is the mission patches of SpaceX. This started before my time at SpaceX. In aerospace, you have mission patches. So for the flight crew, they have… You’ll see the cool jackets that people in, whether they’re astronauts or fighter jet pilots, they’ll be covered in patches and even in the military broadly. So that kind of identifies what group you’re in, what your responsibility set is, what you’ve accomplished. There’s all different things in the world of patches, but SpaceX kind of brought that in as well. And they use them to commemorate every flight that we launched. And a couple of them went above and beyond.

Josh Clemente: So in the early days we had mission patches that had our employee number embroidered into them, so every employee got one with their employee number when they started. A few were signed by Elon, a few were assigned by Elon and went into space. So we loaded up the cargo bay on the Dragon capsule and send them into space and then redistributed them to people when it reentered and we were able to land them and get those patches back. So they started out as like a project commemoration, then they became personalized and then eventually they expanded into everything. So if you executed on a really fast test objective that you could call it a project, we would make a mission patch. Or if you were at the company for five years, there was a dedicated five-year mission patch or a ten-year patch. And it became this really, really powerful mechanism to motivate people to be a part of new projects, to execute on them quickly and then to be proud of it to the display their patches.

Josh Clemente: And I have a bunch in there really prized possessions. And I have friends that are still at SpaceX who are basically there to some extent, some fraction of the reason that they’re there is so that they can get the next patch in the lineup. And it’s really cool. I feel personally very interested in this sort of thing, the tangible, mission badge. So, yeah, we were talking about ways that maybe we can map that on two levels, not only internally, but also potentially our community.

Ben Grynol: Yeah. And so we now have Coke Challenge mission patches. We decided we wanted to be fast and scrappy so we thought, “Okay, cool. We can get quick turnaround with a sticker.” But a sticker is nice, but it’s just not as good as an embroidered patch. And so we’ve got those on the way, which was a bit of a surprise. Actually, on the way this morning, I reviewed the next mock because there were some minor changes to make sure that it is right in what we want to ship, but that’s something that people don’t know. By the time they hear this episode, those will be shipped to them, but that’s something that at this point, nobody knows, nobody was doing this challenge because we had these mission patches. But if we keep doing these experiments externally, and even it’s something that we’re incorporating into our team internally.

Ben Grynol: Mission patches become a thing, to your point, Josh, it’s something that people strive for and they say, “I want to be a part of this community. I feel connected and how cool would it be if you’re walking down the street and you saw somebody else with a mission patch?” That’s where the head nod comes in, that you go, “Cool. We’re in the same tribe.”

Josh Clemente: Yeah. I mean, it may not get to the point where people have them on jackets and are walking around in public, or maybe they’re just like on a corkboard at home like mine are. But I think that the tangible proof of work is really powerful. It’s like people are putting in effort to be a part of Levels and to learn about themselves and become a more optimized version of themselves in a health sense. And there are lots of motivators for doing so, but having some like mile marker along the way, and some evidence of the community that you are involved in, I think is really powerful. And having that all be digital I just… maybe it’s just me, but I personally get so much more out of the analog, like the real tactile pieces of it, so the swag stuff and the badges and just like, yeah, signaling that you’re a part of something, but also being able to just enjoy it for yourself, even for no one else.

Josh Clemente: And to me, that’s what it kind of represents. It’s just maybe a personal point of pride and satisfaction that you did something that you wanted to achieve.

Josh Mohrer: And I would add to that. These are our hardcore subscribers, they’re folks who are getting CGM delivery every month or every other month from us. They’ve typically been with us for a while. These are kind of the hardcore folks and so I think rewarding them is a nice idea and makes them love Levels even more. It makes it something they want to talk about even more. It’s a way to say, thank you. I think it’s a very early stage thing that we’re doing and it’s great. I personally would like a digital version of it because I have too much stuff, but maybe I’ll get that too.

Josh Clemente: You can do that too.

Ben Grynol: NFT, Coke Challenge NFT coming your way.

Josh Mohrer: It doesn’t even have to NFT. It could just be like an image in my app, but I mean, I would take an NFT. That’s fine.

Ben Grynol: Go into notion, and right click save on that JPEG and make it your phone screensaver.

Josh Mohrer: Exactly. Well, I think badges, I mean, what it taps into a little bit is reward mechanisms are not always rational.

Ben Grynol: Not at all.

Josh Mohrer: There could be, you a clean or you kept yourself in check for a week. Here’s a badge. It’s a small little thing. It doesn’t have any inherent value, but it’s a karat. It’s something to get people excited. So I think there’ value there just as like a hurdle and… If you do this thing you get that reward. There is something there, for sure.

Ben Grynol: So I think we’ll know if we have made an impact if JM goes to his next Pearl Jam concert and Eddie Vedder is wearing a Coke Challenge patch on his jean jacket. That will be the tribal mechanism where Levels will be officially on the [inaudible 00:40:18].

Josh Mohrer: I think there’s metrics of success that fall-

Josh Clemente: Fall short.

Josh Mohrer: … far short of that, but we’ll see what happens.

Josh Clemente: It’s like… Yeah, sorry.

Ben Grynol: So we did this challenge, we wrapped it into community. It’s now officially closed. Mission patches will be on their way. What do we learn from doing the challenge and what are we going to do next?

Josh Mohrer: Look, I think there’s an opportunity for stuff like this that’s larger scale, a little more serious. I think we sort of showed here Levels as a research mechanism is doable. And I think there’s some exciting stuff in there.

Josh Clemente: Yeah. I mean, scale distributed real-world evidence. That’s what I think it points to. There’s a lot of abstract research being done that, that doesn’t end up making its way into the minds of the masses who need to make choices to become healthier. And that’s the objective focus of lots of clinical research out there. To me, it’s to like figure out how to make people healthier. The problem is there’s a disconnect and people don’t often get that download. And so what we can do, I think is just like that tactical, tangible real-world stuff and do it in such a way that it’s convenient, efficient, and has like relevance to the people who are participating. It’s potentially super powerful.

Josh Clemente: And you can see the evidence of this, examples could be like the Apple research program. They have high quality hardware out there collecting data on… They have this hearing study, they have the heart study that use the ECG or EKG in and the Apple watch. It’s cool. It’s distributed clinical research. I think we can do something quite similar, but I think quite a bit more social and more real-world in nature by focusing on the day-to-day metabolic implications of the choices everyone’s making anyway as opposed to like trying to seek out screening and diagnostics and such and look for specific concerns. It’s more so like here’s how a population responds, here’s where you fall on that distribution and here are the tools as evidenced by this data that we’ve collected that you have in your control to improve.

Josh Mohrer: Hey Josh, how big are existing CGM studies that have been done before? Like what kind of scale would we have to be, to be the largest?

Josh Clemente: Much smaller than you probably think.

Josh Mohrer: Yeah. Guess, I’m getting at.

Josh Clemente: The bigger ones are like the Weizmann Institute trial from 2015 was 800 people for seven days. The UK trials for PREDICT 1 and PREDICT 2, which I believe are the largest in King’s College. Those are on the order of 1100 people for a month, maybe two months for a subset of the participants. So let’s say around 1500 people months of data, and that’s like the full dataset. It has a lot of sub trials within it. And so it kind of depends on how you parse it out, but yeah, those are the largest ones. And they’re all remote and distributed in the sense that when you get to that scale, you really don’t run things through a single clinical trial site. You try and distribute them out. And with us stepping even further back and saying like, we’re going to use the real world environment of our members as opposed to clinically controlled environmental factors. It makes it possible to scale that. [crosstalk 00:43:28].

Josh Mohrer: Well, I think, I mean, we’ve basically already have exceeded that because folks are wearing CGM, logging food and exercise, and that data is collected. It isn’t specific, but if there was a certain food or cereal or whatever you wanted to know how people react to that, that data’s there.

Josh Clemente: Yeah. Yeah, there’s like the active possibilities, which are these sorts of opt-in challenges to do something in a very… And I think what we will do is we’ll improve the process controls for sure. This time around, we had a small sample size and people kind of just follow the rules, but in the future, I think we would have more rigorous process controls for these specific active challenges or studies. And then we would also have the passive ones where we have aggregated data across the dataset to look at a specific factor input. And that might be a food, or it could be like a lifestyle choice or it could be quality of sleep, something like that, where we can look at the entire population and start to draw out these correlations, which is something obviously that we’ve been interested in for the lifetime of the company.

Josh Clemente: But what’s cool with the Coke Challenge is that we were able to test that actively involved sort of cohort style, which was maybe not to be assumed as feasible.

Ben Grynol: What’s going to be really cool is when we get to a certain scale with being able to run challenges or actually gather data, meaningful data, is that no one, not that I know of and Josh, you can jump in if I am speaking out of terms here, but I don’t think anybody has yet to figure out any geographic considerations when it comes to data like this. So we’re able to say certain populations… Let’s just make it up right now. For whatever reason, controlling all factors as closely as possible, all input factors, people in New York City react on average in an entirely different way metabolically than people in Los Angeles. And that is where you start to go, wow. And you talk about it globally. There are geographical considerations for the way that people metabolize, whatever input in these cities or in these countries or regions in an entirely different way, because it’s really hard to do it.

Ben Grynol: And if the two largest studies are 800 and 1100 people, we’re still a long way away from that, but that would be very, very interesting to start to try to unpack what those environmental and geographic factors might be.

Josh Mohrer: I personally would love to add a geo tag on all my food logs to know where they happened, either at a venue or in my home. I think if we had data on geographic location, we would probably see a correlation between socioeconomics and health, at least that’s how outcomes are often aligned.

Ben Grynol: Yeah.

Josh Mohrer: It will be interesting though.

Josh Clemente: It is interesting. I mean, I think there are definitely… I think you’re right JM, where socioeconomic factors would dominate in that geographic analysis, but I think the same goes for other demographics. That would be really interesting as we get more data, we can start to understand where the large sort of forcing functions are just to focus on the geographic one though. I can also imagine some other environmental inputs, like altitude, for example… Yeah. If you’re living in an oxygen depleted environment and you run more on anaerobic systems, I’m not entirely sure. I could totally see high elevation regions having different metabolic characteristics across the population, but yeah, more work necessary where we get to that degree of analysis, but it will be cool.

Ben Grynol: Yeah. Because we know temperature definitely makes a difference, right?

Josh Clemente: Totally.

Ben Grynol: And that’s from… [Hiney 00:47:03] put out that post. Gosh! It feels like it was months ago and it was probably last week, but where it talked about brown fat and how people who have different exposure to cold temperatures process things in an entirely different way from a metabolic standpoint.

Josh Clemente: Take those cold showers.

Ben Grynol: We should wrap it. There’s probably a good wrapping point that we’ve got.

Josh Mohrer: Take those cold showers everybody.

Ben Grynol: I think we could probably wrap on… There is like one… There’s always a good wrapping point. We can find one, but I’m always afraid to hit stop because this is where the gold is, but we got some good stuff around name taxonomy earlier.

Ben Grynol: We’re all here. Josh squared. What’s going to be the first to the power four is my question?

Josh Mohrer: I mean probably Mike, right?

Ben Grynol: Well, probability says yes, but you never know.

Josh Mohrer: There’s been a little data around this and Joshua was a top five name until 2008 and it was a top five going all the way back to 1983.

Josh Clemente: Wow. It’s no longer a top five?

Josh Mohrer: It is no longer a top five.

Josh Clemente: Nice.

Josh Mohrer: However, Michael stopped being a top five in 2010 and was a top five all the way back to 1949.

Josh Clemente: Wow.

Josh Mohrer: And from ’54 through ’98, it was the number one name.