Why track your glucose levels? – Josh Clemente, Levels Health, Ex-SpaceX engineer

It’s obvious from looking around us that everybody is different. But what isn’t as apparent is that we’re all different on the inside, too. How our bodies process and metabolize food can vary dramatically from person to person. The same “inputs” can result in different energy levels, weight gain, or other symptoms depending on who you are. This means that fad diets are out the window. It also means that we need new ways of tracking and assessing our individual health. Josh Clemente has the answer in the form of Levels, the company he founded that provides continuous glucose monitoring. On The Kevin Rose Show, Josh shared with Kevin why the line between healthy and unhealthy is blurrier than it seems.

Show Links

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2:51 – The role of primary molecules

The way our bodies store and access energy varies greatly from person to person.

“Our food breaks down into two primary molecules in the body, glucose and fat. And the way our bodies sort of store those and access them as an individual is very, very different, both between the two substrates and between individuals. So ultimately what we’re talking about here is the concept of metabolic fitness, which means optimizing these metabolism mechanisms so that you can produce energy and effectively access it – whether it’s stored in the body or from the foods that we consume – in an efficient way to power everything that we need from cognitive function to physical fitness, while maintaining optimal weight and the metabolic characteristics that reduce risk.”

4:42 – Input doesn’t equal output

How your body metabolizes food is based on your hormonal balance. Your hormonal balance is affected by your eating and lifestyle habits.

“We have a compounding effect of the choices we’re making over years and decades, which ultimately lead to an outcome. And so every day you may not have an acute symptom. Especially in the early years, teenage years, young adulthood, after consuming a specific meal or you know, skipping a night of sleep. But over time as these become habits and habits lead to outcomes, we start to sort of experience the compounding return on those choices. This is essentially hormonal imbalance. So the body is kind of this big wet chemistry set. It’s kind of how we should think about it. It’s not a pristine machine where, you know, input equals output. Everything is chemical releases and responding to the other chemicals in the body. And so when we make specific choices, especially around diet and nutrition, we’re causing the body to respond to that in a specific way. And ultimately you start to bias towards a hormonal environment that is in some cases adaptive and positive, and in other cases maladaptive and negative.”

8:54 – There’s no one-size-fits-all diet

No two people will have the exact same blood sugar response to the same foods.

“Recently, especially since 2015 essentially, new technology like real-time biomarker tracking has allowed us a much higher resolution of information about what happens in the body of a person without diagnosed metabolic dysfunction when they eat different foods. And so a prime example of this is the recent breakthroughs in the personal understanding of blood sugar response, from studies like the Weizmann Institute, a study from 2015, which put continuous glucose monitors on 800 people without diagnosed metabolic dysfunction and demonstrated that two people can eat the exact same two foods and have equal and opposite blood sugar responses to them. This implication is massive, because what it does is it flips over the concept that there is a one size fits all solution for diet. And the implication of having a blood sugar response that is, you know, extremely high to one food and flat to another that somebody else has the opposite of response to, implies that there is a hormonal downstream effect that will be opposite as well.”

15:22 – There is no binary switch between healthy and not healthy

When it comes to metabolic healthy and insulin related diseases, most people land on the middle of a spectrum that straddles perfect health and disastrous health.

“Like we have this concept in society that I’m just metabolically healthy, or I’m not. And not just that’s a binary switch. There’s no in between. And what [Dr. Peter] Attia is doing, especially like his most recent AMA episode was really fascinating here, because he goes into actual case studies of people who are manifesting metabolic dysfunction somewhere on a spectrum. So it’s not great. It’s not a disaster, but they’re in the middle. And they really have to make some real serious life changes in order to continue optimizing and remaining healthy longer term, because it could very quickly transition into something bad.”

16:26 – Exploring energy loss

Metabolic breakdown will indicate how energetic we feel. If you have a sugar crash, you will feel sluggish, while optimal food will keep energy high.

“For me, my physician when I first became interested in continuous glucose monitoring, it was after I had been working at SpaceX on life support systems for about six years. And I had kind of burned out physically and mentally in some ways, but also had realized that this burnout was, it seemed to be counterintuitive. Because I was very physically fit. I’m a CrossFit level two trainer and I really care about fitness, but for some reason my health, or the way that I felt, did not reflect the way that I thought of myself in terms of health. And so I went to a doctor and I did a bunch of research on my own and discovered that, you know, metabolic breakdown and endocrine breakdown is really underlying all energy issues, essentially. And so I was asking for a full blood panel, I was like, I’d love to get more information here and have something quantitative to drive my choices. And I’d like to get access to a CGM and just take some concrete data. My doctor kind of laughed at me. It was just like, this is for sick people.”

18:59 – The frightening side effects of metabolic dysfunction

If the energy our body utilizes to work effectively is not being metabolized properly, it affects our health in all areas.

“Why are we not constantly aiming towards optimal, and trying to be well ahead of any dysfunction? Because ultimately the side effects of metabolic breakdown are devastating. It attacks the nervous system. It attacks the vascular. It attacks the arteries of the heart. You lose your sense of sight and touch. And all of these things start to break down because of exposure to radical optic oxidative species, or oxygen species, which are really these reactive byproducts of having elevated glucose in the presence of oxygen. So we really want to avoid having these elevated situations. And it’s really not a concept that most physicians, certainly not mainstream medicine, is thinking about. Unfortunately I did not get access to a CGM for about 14-16 months. And when I did, I found out similar to you that I was either borderline pre-diabetic or full blown pre-diabetic, depending on who you ask.”

25:07 – CGM is a safe, effective alternative to finger-prick devices

In contrast to traditional finger-pricks that draw blood in order to test glucose, a CGM is a less invasive option that provides continuous data.

“If you look at the much, much lower risk population, you know, the people who are not using insulin exogenously are not dosing medication off this, but instead they’re just choosing whether or not to go to McDonald’s or like, what time of day to exercise and how much sleep to get, this is an extremely low risk scenario and far lower-risk then that fingerprint device that you just talked about. Because you know, with that device, you’re actually penetrating into the bloodstream. You’re bleeding out. You know, you now have an opening in your fingertip, which is exposed to more germs than any other part of any other part of our bodies. Whereas the CGM is a little filament, it does break the skin, but it stays in a single location, sealed off with a piece of adhesive all the way around. And it’s a full time, high-resolution data stream. The quality of the information is so much better. So I really think that the argument in favor of making this readily accessible and available it’s just very well stated already and will continue to get more obvious.”

27:02 – Staggering obesity rates in the US.

The vast majority of the population is metabolically unhealthy and the statistics are scary.

“We have 70% obesity or overweight in this country. And rates of childhood obesity are on the rise. nonalcoholic, fatty liver disease. It’s like all of these terrifying statistics. And then you go and you look at how the sort of normal ranges are developed for blood sugar control, and it’s basically an average of people who don’t yet have diabetes. That’s kind of how these ranges have been developed. And we realize that’s not what I want to target. I don’t want to be in the normal range. I want to be in the optimal range where every day I’m making choices that are improving my long-term health outcomes, not just, you know, fitting somewhere in the middle of this metabolically unhealthy dataset.”

32:14 – The power of strength training and post-meal walks

Incorporating training that builds muscle and taking short 15-minute walks after a big meal will improve your glycemic index.

“Specifically, adding more muscle to your body will improve the amount of tissue that can consume glucose without having to increase the amount of insulin. So it’s definitely something I would encourage is adding some strength training and building some muscle. But then also depleting your glycogen, using the blood sugar stores that are both on your body and in your bloodstream is a, is a really big one. And then exercising in proximity to meals. If there’s any take home, this is the one I would advise is, I’ve personally seen it with my CGM data, taking a walk after a meal, especially an indulgent meal with a lot of carbohydrates can completely change the blood sugar response that you’ll see, or the blood sugar excursion that you’ll see.”

39:00 – A good night’s sleep is more important than you think.

A lack of sleep does more than leave you tired. It affects how your body metabolizes glucose.

“I’m actually, embarrassingly, I’m currently cruising about 15-20% higher on my baseline blood sugar today. I took a red eye yesterday and didn’t get much sleep. And so I’m playing catch up on my sleep, and my glucose responds the same exact way. Basically my baseline blood sugar without any calories is increased. And then also it seems like I have this acute insulin resistance where any food that I eat that has some carbohydrates in it, my response will be much worse for honestly up to like several days until I’m able to restore that sleep debt. And so sleep hygiene, I think is huge. Everyone can see the difference in their data for the most part, between a five-hour night of sleep and a nine-hour night of sleep.”

44:56 – Self-coaching with a closed-feedback loop

With a CGM, you can monitor your own results and act on the real-time data to become your own best coach.

“You can kind of make these context-driven decisions because, you know, okay – I’m going to have brown rice tonight, or I’m going to have sweet potato with my meal, or I’m going to have pasta. And I know how I respond to that. And I’m going to make sure that I order my meal appropriately. And then also just be a little active afterwards. And it’s a really strong habit-forming sort of driver when you see that data. And you both get the negative reinforcement when you choose not to do these little tweaks, and then the positive reinforcement when you do. When you see much better scores and data coming from your own body, right? It’s like it’s your body telling you, great work, you did it!”

59:31 – The simplicity of Levels Health

The goal of Levels Health is to make CGM tech mainstream. The elegantly simple process makes it easy to implement into users’ everyday life.

“So after the physician consultation, which is quick and effortless, the pharmacy delivers your Levels kit and inside there are two CGMs. And then we have these performance covers that go over the sensor and help keep it adhered, especially for an active lifestyle. And you use the Level software, that’s your lifestyle hub. So logging, for example, we’re very focused on making this minimal, easy, elegant experience. So we don’t want people to have to, you know, weigh their food and intro macronutrients and worry about ratios and again, serving sizes. It’s all about effortless and low overhead. And so you just snap a picture and enter a few words about what the food is. And that’s mostly just so that you can do it for your recall. So then a few hours later after the software has analyzed your blood sugar response to that meal, you’ll get a score. And that’s a score out of 10. That’ll surface and you take a look at how that meal affected you, and then also how any secondary lifestyle choices that you’ve made affected you.”

Kevin Rose: [00:00:00] Hey everyone. Kevin Rose here. Welcome back to another episode of the Kevin Rose Show. Before we get into this episode, a quick reminder that I publish an email newsletter that comes out every four to six weeks or so. It’s really – once I’ve accumulated enough for a newsletter, I publish it. So it’s not weekly where I’m trying to figure out how to cram in stuff just to fill out a newsletter. This is really high quality things, things that I’m paying attention to, apps and products that I’m checking out, sometimes little mini reviews and some great tips on how to live a healthy and balanced life. You can sign up for that over at my website at kevinrose.com.

Now today’s episode is all about glucose and insulin, its impact on fat storage, energy Levels, cancer and dementia risk and why that even if you’re skinny, you should consider tracking glucose levels with a continuous glucose monitor.

So today’s guest is Josh Clemente, founder of Levels, which is a startup that uses data and continuous glucose monitors to give people a window into the real-time health. Josh is a mechanical engineer and CrossFit L2 instructor and previously he developed life support systems at SpaceX and actually the most recent launch that we all watched here just a few weeks ago that took those astronauts to the space station and back. He was the one that developed those life support systems, which is just insane. And then even previous to that, he was working on another Elon Musk project, Hyperloop. And so he did that for Virgin Hyperloop. So just an insanely talented engineer, fellow biohacker and someone that really digs into the science to figure out what’s going on with metabolic syndrome, glucose, and insulin. So I’m really excited to have him on the show.

Josh, thank you so much for coming on the show. I can’t wait to dive into all things metabolic health. It’s great to have you on.

Josh Clemente: [00:01:42] It’s great to be here. I’m super excited to talk and dig into some of this exciting stuff.

Kevin Rose: [00:01:46] Yeah. It is really exciting and I feel like there is a certain set of the population out there that are really into health, whether it be the biohackers or the early adopters and we have been… If you track this stuff, as I do, on Reddit and all over the place, we’ve been aware of some of these issues and why this is so important for a few years now, but really curious to get your take on what’s going on, why do we care about tracking glucose, what is metabolic health and where you think it’s going and why you think it’s going to be a big deal in a few years.

Josh Clemente: [00:02:18] Definitely! At the highest level, metabolism is the set of cellular mechanisms that our bodies use to make energy from our food and environment. So it’s fundamental to life in order to power any process in any cell in the body, whether muscular or brain, we need energy. And so that metabolic layer is how we get that energy and where we get that energy is up to us. So that’s the lifestyle choices we make. And our food breaks down into two primary molecules in the body, glucose and fat and the way our bodies store those, access them, is individual, very different, both between the two substrates and between individuals. Ultimately, what we’re talking about here is the concept of metabolic fitness, which means optimizing these metabolism mechanisms so that you can produce energy effectively, access it, whether it’s stored in the body or from the food that we consume, in an efficient way to power everything that we need from cognitive function to physical fitness while maintaining optimal weight and the metabolic characteristics that reduce risk. So long-term when metabolic dysfunction sets in we start to see things that range from pre-diabetes, Type 2 diabetes, all the way to sexual health dysfunction, PCOS, which is the number one cause of infertility, mood disorders, Alzheimer’s disease as being called Type 3 diabetes, stroke, cardiovascular diseases, a whole host of problems that we talk about on a social scale, but we don’t necessarily focus on the underpinnings, which is chronic lifestyle choices leading to metabolic breakdown.

Kevin Rose: [00:03:47] What is it that changes? I think of how I felt when I was a teenager. I would throw anything into my gut, it didn’t really matter what it was, have limitless energy, run, play all day, crash out and feel amazing the next morning. What happens between that teenager kind of life and then getting into your – I don’t know. I first started noticing certain changes here, I’d say, probably in my early thirties. What’s happening there?

Josh Clemente: [00:04:14] Yeah. It’s a complex and multi-variate problem, but what we know is that you can think of this as interest on the deposits we make. So we have compounding effects of the choices we’re making over years and decades, which ultimately lead to an outcome. And so every day you may not have an acute symptom – especially in the early years, teenage years, young adulthood – after consuming a specific meal or skipping a night of sleep. But over time as these become habits and habits lead to outcomes, we start to experience, again, the compounding return on those choices. And this is essentially hormonal imbalances. So the body is this big wet chemistry set. It’s how we should think about it. It’s not a pristine machine where input equals output. Everything is chemical releases and responding to the other chemicals in the body and so when we make specific choices, especially around diet and nutrition, we are causing the body to respond to that in a specific way, and ultimately you start to bias towards a hormonal environment that is in some cases adaptive and positive and in other cases maladaptive and negative. This is the hormonal theory of weight gain and disease which has recently come to the forefront as opposed to older nutritional concepts like just the calories model of energy exchange. And I really subscribed to this because I’m very similar to you. When I was younger I was a candy addict. I was playing sports all the time, just fueling on pure sugar and I would eat literally anything within grasp at any time, day or night, just no concern for nutritional guidelines of any kind, because I was exercising. I considered myself to be super fit. And now, in the later years I have –  ultimately, the reason I’ve become even interested in metabolism specifically is because I hit this wall of personal fatigue and mental mood swings that related directly to my physical energy and all of this, ultimately I found through accessing my blood sugar information, to be driven by choices I was making, so the meals I was eating, the sleep habits, the stress management techniques, the exercise, timing, all of this was causing a really wild instability in not only my glucose levels, but then the hormones that are downstream of them. And I really think this was a compounding effect over, like I said, two decades of making just frivolous decisions without any real cause for concern.

Kevin Rose: [00:06:33] Gosh! I was in that boat. I was just talking to a friend of mine yesterday. Do you remember Pop Rocks?

Josh Clemente: [00:06:38] Oh, yeah.

Kevin Rose: [00:06:39] I was talking to him about that. I had a drink that I had opened and it was super fizzly and I – it just reminded me all of a sudden, for some reason, back to those Pop Rocks that we used to eat and then just pop in your mouth and I was thinking, “Oh my God!” That was pure sugar, just pure sugar. It was just like, “Oh, pour the sugar into your mouth and swallow it.” It was crazy and we did that with all kinds of crap. Like those dipsticks too. You dip with those sticks and you dip them into the sugar. Fun Dips. Yeah. It was so bad. Nerds is another one.

Josh Clemente: [00:07:08] Nerds and the Nerds Rope, which is like Nerds attached to Twizzlers, which you then just chew on for hours.

Kevin Rose: [00:07:13] Right. Yeah. It’s crazy. I think about the evolution of our knowledge in nutrition and the body and I think back to just a few years ago and it was all about, okay, super low carb, cutting out sugar, then there’s people that are in the camp of vegetarian. There’s people in the camp that are vegan and people are changing their diets and they do feel better when they make these changes. Some people are keto now and they feel much better. What do we know? What’s happening behind the scenes? Why did these changes make people feel better? And where do you stand on all those different types of inputs? What are your thoughts?

Josh Clemente: [00:07:51] I used to be a very calories in calories out person, where it really did not matter where the food source was or what it was rather with the macronutrient balance was. None of that really mattered. What mattered was just whether you were getting enough energy or the appropriate amount of energy for what you were doing.

Recently, especially in the past, since 2015 essentially, new technology like real-time biomarker tracking has allowed us a much higher resolution of information about what happens in the body of a person without diagnosed metabolic dysfunction when they eat different foods. And so a prime example of this is the recent breakthroughs in the personal understanding of blood sugar response from studies like the Weitzman Institute, a study from 2015, which put continuous glucose monitors on 800 people without diagnosed metabolic dysfunction and demonstrated that two people can eat the exact same two foods and have equal and opposite blood sugar responses to them. And this implication is massive because what it does is it flips over the concept that there is a one-size-fits-all solution for diet and the implication of having a blood sugar response that is extremely high to one food and flat to another that somebody else has the opposite response to, implies that there is a hormonal downstream effect that will be opposite as well. So the amount of insulin that your body releases and the rate of release will be different because the blood sugar – basically your body responds with hormones to the amount of glucose in your blood to get it out into the cells for energy production and if that is a slow and controlled process, the insulin release will be slow and controlled. However, if that’s a wave, basically a spike in the blood sugar levels, your body has to spike insulin to get that taken up into the cells. And insulin spikes ultimately lead to, as we know from longstanding research, eventual insulin resistance, where we are in a constant state of elevated insulin and ourselves become numb to them.

And so that original implication of which foods am I personally sensitive to in a glycaemic sense, has very large implications for how my body is responding and storing those foods, essentially, as either fat or energy used by the muscles and the rate of responses that’s really important there. So this type of research, and there’s been additional trials, gluco types trials in Stanford, the Kings College studies in the UK, which actually showed that this effect of individuality extends all the way to identical twins who share a hundred percent of their DNA.

Kevin Rose: [00:10:05] Wow!

Josh Clemente: [00:10:06] Yeah.

Kevin Rose: [00:10:06] So it must be microbiome related then. Yeah?

Josh Clemente: [00:10:10] There’s a ton of different underlying variables that it could be. Genetics plays some role because you can see some genetic overlap, in particular, the foods that both are sensitive to, but you still have that really strong difference between people. So some genetic component, some microbiome component seems to be involved.

Kevin Rose: [00:10:27] Sleep too. Right? Sleep’s a big one.

Josh Clemente: [00:10:28] That’s exactly right. So a lot of it, I think, is context. So it’s what is your body composition? So body mass will matter, adipose tissue, amount of muscle on the skeleton and then the amount of sleep and stress that you’re experiencing in real time. All of that is going to play into how your hormones are responding. And so I really think that it’s contextual and even though you will have those specific permanent, I think, sensitivities which might be allergies, they might be genetic they might be microbiomic, you will also have this context stuff which you can manipulate.

And that is really where I’m the most interested. It’s like taking real-time data, giving it to the individual and then allowing them to guide their choices with a closed loop feedback system. So you can either improve your sensitivities or guide around them to make sure that you’re optimizing.

Kevin Rose: [00:11:12] Yeah. This just makes so much sense. I like to give the analogy of just any modern car that has hundreds of sensors on it. Like my Tesla will tell me my back left tire is down by two percentage points in air and it needs to be – and we had no window into what’s going on in the human body in a real-time nature until these continuous glucose monitors started to come out.

It’s fascinating. I feel very fortunate that my doctor, Peter Attia, he put me on a CGM, a continuous glucose monitor. I guess it’s been almost five years now.

Josh Clemente: [00:11:45] Wow!

Kevin Rose: [00:11:46] I started wearing one. And so we have a ton of data around that. But he did so because – and most physicians at a physical, they will never do this. But this is a great first step, I think, for a lot of people. I’m curious to see if you agree, but Attia had me do this glucose tolerance test. So I would go into the actual office – it’s harder these days with COVID – but you go in, you get your blood drawn, you figure out what your baseline glucose levels are, fasting. You drink this drink, which is just pure sugar and then you do blood draws, what is it? About every half hour?

Josh Clemente: [00:12:18] Yeah, approximately.

Kevin Rose: [00:12:20] For essentially, a couple hours, and you can see not only how high did you spike, but also the insulin levels during that time period and then how good you are at disposing of the glucose, how quickly does it return to baseline. And we found out that – and this is why he put me on a CGM –  we found out I’m not pre-diabetic. I don’t have diabetes, but I’m a horrible disposer of glucose. I stay elevated longer than I should.

Josh Clemente: [00:12:45] Yes.

Kevin Rose: [00:12:46] And so that was like a little bit of a red flag. We need to pay attention to this. This is something we need to track. And I would have to imagine there are a lot of people in a similar situation. The other thing to your earlier point about not all foods being equal and being so different between individuals – it’s funny, seven, eight years ago, I was paying close attention to the glycemic index and glycemic load of foods. And this is a number that is associated with a food like a blanket one-size-fits-all. A piece of white bread has this much glycaemic index, this much as glycemic load, brown rice has this – right? But the crazy thing is the second I started putting on a CGM, I did all those tests. I’m like, “Oh! I can have brown rice because it has a lower glycemic load.” But guess what? For me, brown rice shoots me up through the roof. I’m like, “How is that possible?” And it totally makes sense based on what you’re saying. It’s so based on the individual that we almost have to throw away everything we knew back then or we thought we knew about glycemic load and glycemic index. Would you agree with that?

Josh Clemente: [00:13:44] Absolutely agree across all the points. So the first – I want to take them one at a time because they’re all so relevant to where we are today and how we got here. So the physician question. Peter Attia, first of all, is like a total luminary in the space, really shining a light on the underlying manifestations of metabolic syndrome that go beyond just your standard threshold effect, prediabetes, diabetes. We have this concept in society that, “I’m just metabolically healthy or I’m not.” That’s a binary switch. There’s no in between. And what Attia is doing, especially his most recent AMA episode was really fascinating here because he goes into actual case studies of people who are manifesting metabolic dysfunction, somewhere on the spectrum. So it’s not great, it’s not a disaster, but they’re in the middle and they really have to make some real serious life changes in order to continue optimizing and remaining healthy longer term because it could very quickly transition into something bad.

I’m very similar to you in the sense that I’m just objectively carb intolerant. It’s across the board, very small quantities. Unless I’m extremely careful about fiber content and mixed macronutrients, including protein and good fats, I’m going to stay elevated at a very high level for hours. And so my experience initially with CGM was very different than yours, unfortunately. I’m glad to hear that Dr. Attia is so forward thinking with this. I knew he was, but for me, my physician… When I first became interested in continuous glucose monitoring, it was after I had been working on SpaceX on life support systems for about six years and I had burned out physically and mentally in some ways, but also had realized that this burnout was – it seemed to be counterintuitive because I was very physically fit. I’m a Crossfit Level 2 trainer and I really care about fitness, but for some reason, my health or the way that I felt did not reflect the way that I thought of myself in terms of health. And so I went to a doctor and I did a bunch of research on my own and discovered that metabolic breakdown and endocrine breakdown is really underlying all energy issues, essentially. And so I was asking for full blood panels like, “I’d love to get more information here and have something quantitative to drive my choices and I’d like to get access to a CGM and just take some concrete data.” My doctor laughed at me. He was just like, “This is for sick people. You’re underweight if anything. You need to stop worrying about this. This isn’t a concern at all. I would know because your A1c would be over 5.9 or something and that’s where we start needing to worry.” And the shocking thing there…

Kevin Rose: [00:16:03] Can you explain to people real quick, what A1C is just so they…

Josh Clemente: [00:16:05] Yeah. Sorry. Sorry. So A1c is, it’s basically measuring the amount of glucose that binds to your red blood cells. A red blood cell lives for about 90 days on average and so if you can measure the amount of glucose stuck to a red blood cell, you can approximate the average blood sugar of that individual. Now the issue here is some people’s red blood cells last 90 days, some last 120 days, some lasts only 75 days, and so it’s a very, very rough and inaccurate calculation of average glucose. Whereas, a continuous glucose monitor is measuring your blood sugar full-time and is giving you average glucose. You just divide the amount of your glucose levels over the day and it’ll just spit out average glucose. So A1c is a very rough measurement and the way that this physician and standard care approaches this, is they wait until your average blood sugar has exceeded a threshold of objective disorder before you start monitoring in a more meaningful way or intervening. And the problem there is it takes very, very long time periods of dysfunction for your A1c to break. You imagine –

Kevin Rose: [00:17:09] it’s almost too late at that point, right?

Josh Clemente: [00:17:11] It’s certainly more complicated. At a minimum, I think it is. Virta health and some others have shown that you can reverse the symptoms of Type 2 diabetes even when it’s dramatic with diet and focused lifestyle. But why should we wait until that time period? Why are we not constantly aiming towards optimal and trying to be well ahead of any dysfunction? Because ultimately, the side effects of metabolic breakdown are devastating. It attacks the nervous system. It attacks the vasculature. It attacks the arteries of the heart. You lose your sense of sight and touch. And all of these things start to break down because of exposure to radical oxidative species or oxygen species, which are these reactive byproducts of having elevated glucose in the presence of oxygen. So, we really want to avoid having these elevated situations and it’s really not a concept that most physicians, certainly not mainstream medicine, is thinking about. And so unfortunately I did not get access to a CGM for about 14 to 16 months and when I did, I found out similar to you, that I was either borderline pre-diabetic or full blown pre-diabetic depending on who you ask. I didn’t have an oral glucose tolerance test. This was just my glycemic response after meals was remaining elevated for hours in the pre-diabetic zone. And this is something that did not show up on, again, my A1c test or on a fasting glucose test. So using that CGM, I was able to start to implement closed loop decisions. So testing foods, testing sleep and stress and how I was responding to different choices I was making every day, seeing how my blood sugar responded and then implementing permanent habit change.

Kevin Rose: [00:18:41] So it’s really – sadly, it’s still extremely difficult to get access to CGMs from a standard physician. I have had several friends that have reached out to their primary care provider and they just say, “No.” Are they worried? Are doctors worried of writing a prescription that may come back to bite them in some way? Why won’t they just more freely write these?

Josh Clemente: [00:19:01] It’s a really good question and something that I think unfortunately is to some extent due to a culture of litigation and we really put the onus on physicians to be perfect. And so, there’s a long history of malpractice, actions being taken against physicians who I think are trying their best to make the choices best for the patient. But I think what it ultimately leads to is a bit of fear of moving into an experimental space or a space that hasn’t been rigorously demonstrated to be the ideal standard of care. And so in this exact example where using monitoring technology that was developed for the management of diabetes, but using it for a completely different population, which is interested in avoiding long-term dysfunction or making optimal choices, it seems like, to certain physicians, an unnecessary risk to have anyone use any medical product that is not designed specifically for their use case. And it’s an unfortunate thing. It’s something that we’re going to change in the coming months and years as people realize that real-time information is the thing that’s been missing from their daily life. Everybody’s sitting down and making a choice for lunch. What am I going to eat and why? And all of us, with very few exceptions, are doing that based on Internet advice, something that worked for a friend or just taste – the way it makes you feel. And unfortunately that’s skipping all of the under the hood effects, like the hormonal implications and then the long-term compounding interest on those choices, which we don’t have any feedback loop for. We don’t know, “Is that a positive choice or a negative choice?” – until now. And once people realize that – and there will be, I think, an access to the personal health information component of this – so we’re starting to see a transition in society to the point where people want their own data to be theirs, to own it, whether that’s data from social media and privacy implications or your own body’s health information, biological information. We should own that at the individual level and we should be able to reach out and combine forces with an expert or a medical provider that we trust and give them access to that data. But we certainly shouldn’t have the opposite situation where there’s a gatekeeper scenario where we can’t access our own data from our own bodies because of this nebulous concept of, I don’t know, litigious or malpractice concerns type of environment. It requires both parties to change their perspectives and have a little responsibility.

Kevin Rose: [00:21:12] Do you think this eventually gets to an over-the-counter? It’s crazy today that you can actually go into any drug store and buy a standard glucose reader, meaning you prick your finger, you put a drop of blood in. Don’t have to have any type of a prescription for that.

Josh Clemente: [00:21:28] Right.

Kevin Rose: [00:21:28] But yet a device that does the same thing… I get that it’s a little bit deeper needle, you have to swab with an alcohol thing. I guess you do on both cases. It just seems silly to me that it’s the same thing, but one is over-the-counter. How long until we see over-the-counter continuous glucose monitors?

Josh Clemente: [00:21:45] I’m very optimistic. I think that just given the scale of the problem and also the optimistic potential outcome, if the mainstream market, uptakes this as the bio wearable of the future, I think it’s going to be really an amazing outcome. And so there is a lot of incentive pushing in this direction for amazing new breakthroughs in the technology, both in accuracy, availability, affordability. And so I think we’re seeing some great progress in this direction and I do believe it will become over-the-counter soon. This will eventually be integrated into a wearable that you would think of as your Whoop or your Oura, something very minimal and easy to use.

Now, in terms of timing, I’m going to guess that this is going to happen on a two to five year timeframe where we’ll see a direct over-the-counter solution. One thing that is a little bit tricky is it’s hard to determine specifically why the regulation exists. It’s arguable that for someone who is managing diabetes currently with exogenous insulin (this is insulin that you have to inject because your pancreas isn’t producing it). If you’re wearing a CGM and you’re making those choices based on the data, it’s definitely possible that a malfunction in the device could cause a very life-threatening situation for that person, if they inject the wrong amount of insulin. Insulin is a deadly hormone in too high of quantities. So that’s a scenario that I understand there should be some protections and some regulation around. But if you look at the much, much lower risk population, the people who are not using insulin exogenously, are not dosing medication off this, but instead they’re just choosing whether or not to go to McDonald’s or what time of day to exercise and how much sleep to get. This is an extremely low risk scenario and far lower risk than that fingerprick device that you just talked about because with that device, you’re actually penetrating into the bloodstream, you’re bleeding out, you now have an opening in your fingertip which is exposed to more germs than any other part of our bodies. Whereas, the CGM is a little filament. It’s a single – it does break the skin, but it stays in a single location. It’s sealed off with a piece all the way around and it’s a full-time high resolution data stream. So the quality of the information is so much better. So I really think that the the argument in favor of making this readily accessible and available is just very well stated already and will continue to get more obvious.

Kevin Rose: [00:23:50] So if someone does, and we’ll talk about the ways to get access to your data both in terms of devices and the fingerpricking. Let’s just say someone does notice – Okay, first of all, what do you consider abnormal? If someone is looking at their glucose levels and I guess we can say you could do this without having to have a CGM. Right? You can go and get a device at your drug store, prick your finger measure pre-meal, measure 30 minutes after a meal, an hour after a meal, and get the same data. It’s not going to be in five minute increments like you would with the CGM, but if you just wanted to say, “Listen. I don’t have the budget to go and do this, but I do have $50, $75 to go and play with it, to test this out and see where I stand on a few meals.

Josh Clemente: [00:24:32] Yeah.

Kevin Rose: [00:24:33] What ranges are you looking at? Where do you like to fall? What would you consider to be healthy?

Josh Clemente: [00:24:38] We owe a pretty significant debt to people like Dr. Attia and Rhonda Patrick, Jason Fung, others who are really looking hard at this space and pushing to redefine what is normal and what is optimal, and especially in a world, specifically in the United States, where 88% of American adults are metabolically unhealthy. 35%…

Kevin Rose: [00:24:57] It’s insanity.

Josh Clemente: [00:24:58] It’s hard to imagine, but 35% are either diabetic or pre-diabetic. We have 70% obesity or overweight in this country and rates of childhood obesity are on the rise, nonalcoholic fatty liver disease. It’s like all of these terrifying statistics and then you go and you look at how the normal ranges are developed for blood sugar control and it’s basically an average of people who don’t yet have diabetes. That’s how these ranges have been developed and you realize that’s not what I want to target. I don’t want to be in the normal range. I want to be in the optimal range where every day I’m making choices that are improving my long-term health outcomes, not just fitting somewhere in the middle of this metabolically unhealthy dataset.

So, at our company Levels, we are currently taking a really hard look at the research that does exist and unfortunately, the non-diabetic blood sugar space is unstudied, essentially not just understudied. There are very, very few trials that were done with continuous glucose monitoring in people without diabetes. However, what does exist there shows that for the lowest risk, so basically the bottom quartile of risk for long-term chronic illness, people maintain glucose levels between 70 and 110 or 120 mg/dL for 95% or 99% of the day. And so that’s where I really liked to aim. I actually personally try to keep my blood sugar below 100 or 110, including meals 24/7 and my average, I shoot to keep at between 85 and 95 mg/dL. These are much tighter than the American Diabetes Association normal ranges and certainly it remains to be seen as we continue to improve both the populations who is using this, so expanding accessibility and increasing the dataset that all of these information is derived from. We’re going to get much better, higher resolution information on outcomes as a result of where people are staying, in what ranges they’re staying in. And so I think this is a space of study.

Kevin Rose: [00:26:53] Do you like to stay under 110 after a meal, like an hour after a meal?

Josh Clemente: [00:26:58] Yeah, full-time. I like to keep my CGM data always under 110. Yeah.

Kevin Rose: [00:27:03] Are you just eating steak? How do you keep that – ? No carbs? What are we talking about here?

Josh Clemente: [00:27:08] I actually do eat a fair number of cards. A lot of it comes in the form of nuts and seeds, cashews, and almonds, and a lot of almond butter. And then I also eat very high fiber carbs. I have this daily – it’s almost like a cold cereal type thing, but it’s Greek yogurt, wheat bran, flax seeds, chia seeds and protein powder. I mix this all up. It’s really a delicious treat. There are  blueberries in there, which I have a very positive response to. I don’t spike off the charts and I think that it’s a low-glycemic fruit with high fiber that just works for me. And so I’ve found the foods that I can indulge in and get 80 to 120 grams of carbs a day out of without this large blood sugar excursion result.

For me, it took me some time to find this combination of foods that really works well. But I certainly do not eat like a carnivore and I actually don’t even eat ketogenic. I have a pretty mixed diet, all things considered, and Casey Means actually – Casey Means is my Co-founder at Levels and she is a Stanford trained surgeon and then she turned to functional medicine and she’s 100% plant-based and fascinatingly, despite having a diet that is largely vegetables and largely carbohydrate based, she has some of the best glycaemic control of the entire data set that I’ve seen. Her blood sugar typically stays below 100, including post-meal. And this is with beans and with a lot of vegetables that some of which are starchy and tons of carbohydrates. And so it’s really fascinating and certainly there is an individual element. But the beauty of it is with that data, you can find what works for you and just cling to it and you’ll actually see – so I’ve seen improvement in my insulin sensitivity, the way that I respond to it, even a carby meal that I don’t typically indulge in is much better now as a result of retraining my body and probably lowering my insulin background levels.

Kevin Rose: [00:28:44] So when you say retraining your body, obviously, diet is a piece of this. So I think we’ve got one big takeaway for people at home in that you should figure out, whether it be through spot checking or a CGM, what foods are offenders for you and what keeps you in a healthy range. So that’s the food component of it.

Now, when you’re talking about – What are the things that you can do for your body in terms of exercise? Attia talks about Zone 2 cardio fitness, what are your thoughts on ways to sensitize the muscles and get them so they’re doing some of the lifting as well?

Josh Clemente: [00:29:17] That’s a huge one. I think that – Given the way that muscle can… So muscle is a specific type of tissue in the body that can actually use glucose even without insulin. However, it can only do that in a low insulin environment. And so, specifically, adding more muscle to your body will improve the amount of tissue that can consume glucose without having to increase the amount of insulin. So definitely something I would encourage is adding some strength training and building some muscle. But then also, depleting your glycogen, using the blood sugar stores that are both on your body and in your bloodstream is a really big one. And then exercising in proximity to meals. If there’s any take home, this is the one I would advise. I’ve personally seen with my CGM data, taking a walk after a meal, especially an indulgent meal with a lot of carbohydrates, can completely change the blood sugar response that you’ll see or the blood sugar excursion that you’ll see.

Kevin Rose: [00:30:07] I want to dive into that a little bit. I’m curious because I’ve heard mixed things on this in that some people say it has to be a pretty intense walk. Other people say just a stroll around the block. You have the Tim Ferrisses of the world that were doing this a long time ago that were doing air squats in the bathroom in between the courses of a meal. Where do you have to be? What does your heart rate have to get up to? What’s your take on that?

Josh Clemente: [00:30:31] Yeah. That’s a really good question. I personally actually see the best results from a brisk walk. Now, we’re not race walking or anything, but my heart rate, when I’m moving at a comfortable pace walking, will be around 100 or 105 beats per minute. If I eat a meal that I know is pretty rich – Actually, this is now just a habit. I like to walk after every meal. I’ll do a 15 to 20 minute walk at a brisk pace, and again, nothing strenuous. I’m not breaking a sweat, but the fact that we’re using the largest muscles in our body during that time when the carbohydrates we’ve eaten are breaking down into glucose and flooding into the bloodstream, your muscles can pull those directly in, as opposed to waiting for the insulin signal to store that glucose as either glycogen or fat, depending on how much energy or how much storage capacity you have in glycogen. So for people, especially people who want to avoid weight gain, this is a really easy and honestly, a really nice habit to implement because we can all benefit from walking a bit more, and just getting up and doing it right after a meal and seeing in the data how positive that change is versus eating the exact same meal without a walk, is really powerful for people. And so I actually see, yeah, I see great results without having to go too strenuous and I think nobody should really worry too much about having to do air squats or pushups or anything in between meals. That doesn’t seem super practical. So I would just encourage, generally, try and get up and walk as quickly as possible after a big meal and you’ll feel really good. Walk to and from restaurants.

Kevin Rose: [00:31:49] Yeah. You’re doing 15, 20 minutes, 30 minutes. What’s your recommendation?

Josh Clemente: [00:31:53] 15 to 20 is the sweet spot for me. Obviously, the longer the better. I think in general, if you can do 30 or 40 minutes and feel happy about it, by all means I would encourage it. Definitely, I’ve seen dramatic improvement in post-meal response, especially on those nights that you want to indulge a little bit more.

Kevin Rose: [00:32:08] And what about sauna usage? Because I do that post dinner sometimes. Your heart rate does go up, so I can get my heart rate up to about 115 or so if I do a 20-minute 185 degree sauna.

Josh Clemente: [00:32:23] Wow!

Kevin Rose: [00:32:24] Do you think there’s benefits there as well?

Josh Clemente: [00:32:26] I believe there are. I’m not a super expert on the sauna stuff, but I’ve personally – My family actually installed a sauna recently at our family home and so when I go back, I definitely use that often and I’ve seen some interesting results in blood sugar data. Oftentimes my glucose will actually increase.

Kevin Rose: [00:32:40] A lot of that has to do with the actual sensor heating up.

Josh Clemente: [00:32:43] Exactly. Yeah. The resistive sensor elements are likely being affected there. I don’t have really good data in terms of glucose control on whether or not sauna is actively disposing of glucose from the bloodstream or not, but, I can certainly see if your body is being stressed by the heat. You could release cortisol and other stress hormones, which could be causing lower glucose disposal, which you’ll also see this effect if you’re doing high intensity exercise, like above 90% of heart rate. A lot of people see actually a flooding of the bloodstream with glucose as your body tries to respond to this sort of fight or flight scenario and just give you as much energy as possible.

So there’s this threshold effect and for me, in sauna, I haven’t yet seen a glucose disposal effect, but for others, they have described this. So it’s really interesting that the difference is there too.

Kevin Rose: [00:33:26] Yeah. I have to – I haven’t looked at that. I’ll have to do a pizza night and then give the sauna another roll.

Josh Clemente: [00:33:36] Yeah, I know. These types of things are so fascinating because finding the hacks and learning about  the – First of all, understanding exactly – We touched on the glycemic index a while back, but just seeing whether or not there’s any real content there for the individual, I think is really educational. A lot of people lean so heavily on the glycemic index and then you test brown rice versus white rice and you realize, “This is exactly the same.” And the result of that for many people – The glycemic index is an average and it’s normalized to 100 against pure glucose. And so,  everyone’s peak response to a food is forced into this normalized rating scale against pure glucose, which removes all the individuality. And so, it’s perfectly possible for one person to have a blood sugar response of, let’s say, 110 mg/dL to brown rice and then another person to have a blood sugar response of 250 mg/dL to brown rice and as long as they also responded proportionally to glucose, that they consider it. They force it (it’s kind of hard to describe) they force it down into normalization on a scale of 100 and all of that nuance is lost. When we look at just the glycemic index, we’re looking at incomplete information and it strips out the personalization. So having the data so that you can understand,  “Is eating Brown rice after every workout in order to quote unquote “replenish glycogen” the best for me, or am I completely overdoing it spending two hours on the pre-diabetic blood sugar range, then having an insulin crash and then feeling sluggish and wanting more food and going to the ice cream cabinet or whatever?” And this is the type of thing that’s happening to many people in the background and they have no context for it. They don’t understand because they don’t have the closed loop feedback. So it’s just so powerful to be able to see this stuff happening in real time.

Kevin Rose: [00:35:08] Yeah. Absolutely.

What are your thoughts on sleep? I noticed that for me, if I get less than say, seven hours or just a bad night’s sleep, you have a couple glasses of wine and you’re tossing and turning a little bit and hot at night. I wake up and I would say, 10 to 15 points higher sometimes on my glucose, depending on my sleep.

Josh Clemente: [00:35:31] Exactly.

Kevin Rose: [00:35:31] Do you see sleeping a big factor here as well?

Josh Clemente: [00:35:34] I see the exact same thing and I’m actually – Embarrassingly, I’m currently cruising about 15% to 20% higher on my baseline blood sugar today. I took a red eye yesterday and didn’t get much sleep and so I’m playing catch up on my sleep and my glucose response is the same exact way. I will see this. Basically my baseline blood sugar without any calories is increased. And then also it seems like I have this acute insulin resistance where any food that I eat that has some carbohydrates in it, my response will be much worse, honestly, for up to several days until I’m able to restore that sleep debt.

And so sleep hygiene, I think, is huge. Everyone can see the difference in their data for the most part, between a five-hour night of sleep and a nine-hour night asleep. We’re working with people like the folks over at Eight Sleep who pull really good sleep data, combining that with blood sugar data and there’s a really interesting pilot potential here for us to demonstrate exactly how metabolic control is affected by sleep control and vice versa. These are essentially inextricably linked.

Kevin Rose: [00:36:28] I’ve seen those Eight Sleep mattresses. I have yet to try one. Have you checked out – Do you think it’s pretty high fidelity data?

Josh Clemente: [00:36:35] I think it’s really good data and most interesting is the movement date because it’s underneath the body, the full body and also because it has temperature data too, which is really fascinating and something that’s missed by most of the sleep wearables, although Oura does a really good job pulling temperature as well. But it’s really cool, I think, to have that high resolution data to show specifically how your body temperature is responding and for the most part, the most interesting thing to me is how much alcohol is involved here. I think a lot of people, they think that a nightcap, having a glass of wine or a beer before bed is going to help them sleep and then when you see the data, especially from people at Eight Sleep who can show it in such high resolution that, no. In fact, that’s like raising your body temperature by one to three degrees all through the night and you’re tossing and turning and you spend much less time in deep sleep. It is really fascinating. And then there’s also the metabolic effect of alcohol consumption, which counterintuitively for most people actually, reduces blood sugar and I think there’s a lot of hormonal response there where as your blood sugar reduces, hormones are released that increase hunger and reduce satiety, and so people will often when having drinks, not only is there sleep effect, but also they’re feeling an increased appetite for carbohydrates and indulgence. How many times have people had drinks one night, slept terribly, woken up with acute insulin resistance, gone to a big brunch because they’re really hungry, indulge –

Kevin Rose: [00:37:48] oh Yeah.

Josh Clemente: [00:37:49] Now the effects are like twice or three times worse than they had to be.

Kevin Rose: [00:37:53] Yeah. Absolutely. You’re describing a lot of brunches for me. It’s that reason exactly.

I’m curious on your – It sounds like we’ve already got a couple of really great hacks for people looking to get back on track. One thing I heard about, I think I saw a study on it but I don’t know where it’s at. I’ve never read the study. It was around the order in which you eat your proteins versus starches. Is that just make believe? Is there a real data there? I have never looked at the study.

Josh Clemente: [00:38:18] There certainly appears to be. So the way the study was conducted is people… They studied participants and they gave them the exact same meal in different order. So you imagine there were vegetables, protein and fats all in this mixed macronutrient meal. And so they gave the study participants… I think they started off with eating the carbohydrates first and then eating the protein and then the vegetables. And then they switched the order and had the vegetables with fiber first and the protein and fat and then the carbohydrates last. And fascinatingly, there was a huge effect in both blood sugar response and also insulin response, which to me was the most interesting thing was that insulin was affected by this, given that you’re eating the same number of carbohydrates. I’m actually looking at the study results right now and the insulin effect was – Let’s see, the peak postprandial was 1100 pmol/L with the carbs first, and with vegetables first, it was 500. So it basically reduced the insulin response by over one half by just putting the same meal in a different order. And glucose response was improved by about, it looks like about 25%. The amazing thing there is likely an effect from digestion. So when you have the fiber upfront, it might have a mechanical effect where it limits the rate that… Because there’s a bunch of fiber in there, it might limit the rate that the sugar breaks down and gets into the bloodstream. Fat seems to have a similar effect on constricting the digestive pathways and slowing things down. So taking a blood sugar spike and turning it into a slow, steady increase. And I think that’s what’s going on there. I’m not an expert, but I certainly have internalized that study and I always push to put the fiber and vegetables upfront in indulgent meals.

Yeah. And it’s really cool that there’s data to back it up. It’s one of the things that I’m really eager to do some more research on.

Kevin Rose: [00:39:56] Do you have to do that? Let’s just say, let’s take a plate, a dinner, veggies, chicken, no sugar, no dessert, nothing like that. Does it really – Because those are low offenders generally. Right? You’re just having a vinegarette or something, olive oil dressing. Does it really matter at that point? Are you going to see that big a difference if you, if I do solid first or – ?

Josh Clemente: [00:40:19] This is, I think, where having the individual data is super powerful because you can make that choice on the fly. And for many meals, like the one you just described, it’s unlikely to have a big individual variation, because there’s not much rapid acting carbohydrate in that meal. But for some people they might have a personal response, and certainly for meals that you know you have a strong personal blood sugar response to. But that’s where you can make these decisions like, yeah, macronutrient order, making sure that you have a nice big salad in advance with the vinegarette. Vinegar is actually, apple cider vinegar in particular, has also shown to control blood sugar response. And then maybe choosing to walk after that meal, specifically. And so you can make these context-driven decisions because you know, “Okay. I’m going to have brown rice tonight or I’m going to have sweet potato with my meal or I’m going to have pasta and I know how I respond to that and I’m going to make sure that I order my meal appropriately and then also just be a little active afterwards.” And it’s a really strong, habit-forming driver when you see that data and you both get the negative reinforcement when you choose not to do these little tweaks and then the positive reinforcement when you do, when you see much better scores and data coming from your own body. Right? It’s your body telling you, “Great work! You did it!” It’s not like a coach or somebody else looking at it. It’s just you and yourself. It’s like a closed loop between you and your body. I think it’s very context specific and you need to understand and explore before you can start to make those data-driven choices.

Kevin Rose: [00:41:32] And then what about rate of consumption? Chewing? Have you seen anything there?

Josh Clemente: [00:41:37] I don’t have any personal insight on it yet. It’s something I should probably consider. Now, one thing that I do know is – And this is similar, but let’s say juice versus whole fruit. So you can  assume that a juice or a smoothie is similar to taking a whole fruit and chewing it up in advance. Let’s just think of it that way. So you’ve already processed, you’ve broken the the fruit down or the vegetables down and then you’re just drinking them directly rather than having to do all that chewing. And so the effect of a whole fruit versus a smoothie or in particular a pressed juice where you’ve squeezed all of the liquid out and stripped the fiber away. That is pretty profound. Actually, one of the largest blood sugar spikes I ever had was – I went to an organic juice cart in New York and strolling up there looking for something tasty and nutritious because I had just taken a flight and I picked a drink called Health Drink, which was Apple, celery and carrot. And I watched the lady prepare it and she just pulled the fruit and vegetables and pressed them. There was no additives at all and I drank this. It was a 16 ounce drink, feeling pretty good about myself. And my blood sugar was over 200 mg/dL within an hour.

Kevin Rose: [00:42:41] Yeah. I’ve been there. That is insane.

Josh Clemente: [00:42:43] It’s wild. I can eat an apple and I can eat carrots and I can eat celery – Carrots and celery don’t even move my glucose for the most part. An apple will, but I won’t exceed 110 most likely for a green apple. And so seeing that by stripping out that fiber and just condensing this into a glass and chugging it, effectively, I had just given myself a straight up pre-diabetic episode for no reason actually assuming that it was healthier, it was a good choice for me. And I think people are doing this all the time unnecessarily and it’s fascinating.

Kevin Rose: [00:43:12] It is really depressing. It’s funny, Joshua, my wife writes about food and she did an article one time talking about… I don’t think it was the main piece of the article, but there was definitely a big section there talking about the dangers of just straight juicing and ripping out all the fiber and what it can do to the body. And dozens, if not more, pro juicers got on there and just – They are hardcore. I had no idea the pro juicers will tear you up.  They really bought into this idea that juicing is the ultimate healthy food and in reality… I’m the same as you. You take anyone, throw on a CGM and I would say nine times out of ten, you’re going to see spikes that are not healthy in any way. I’m not saying the underlying ingredients and nutrients are bad because of course that’s not the case, but the sugar and the delivery and the mechanism, the fact that it has been all pre digested in a way, it just, it’s not good for you. It’s crazy.

And I actually have a pretty good hack for this. I will occasionally make a smoothie and what you mentioned with the Greek yogurt with your blueberries and I will take some fruits that I wouldn’t normally, that I know have been bigger offenders for me. A great example is, when oranges are in season, we’ll get some locally fresh squeezed orange juice and I’ll put a quarter cup in a smoothie and I won’t see any movement at all. If I were to check that quarter cup straight up without the extra fat I would be back in the bad zone. So I still get all of the flavor and some of the vitamin C and some of the great nutrients from the orange, but I make sure to pair it properly. One of two things. One, you could probably just eat the orange, which would be much better. It is a slower delivery mechanism as well because you’re not just chugging it, but when I do throw it in with that fat, I don’t see – So it’s not to say you can’t have these juices, it’s just that you got to figure out the delivery mechanism and sometimes throw in a bunch of fat as a binder with it. I don’t know if that’s the right word, but you know what I’m saying, right?

Josh Clemente: [00:45:04] Like a buffer. Yeah.

Kevin Rose: [00:45:04] A buffer. Right. Exactly.

Josh Clemente: [00:45:06] Yeah.

Kevin Rose: [00:45:06] That could help.

Josh Clemente: [00:45:08] I totally agree. It’s all context and portion control is something that really does matter. We’re not making the argument of calories here. We’re not saying don’t overeat. We’re saying, the context and the way that your body has to respond to a rate of increase of your blood sugar is very specific and very real. This is not a weight gain balance due to calories, it’s a question of whether – if some is good is more better – always. And I don’t think that’s actually true. If an orange is good, should we strip out all the pulp so that we can pack 10 oranges into a glass and chug it? Probably not. There’s always limitations and we should find the optimal. And I think this is where the people who are really hardcore about any dietary philosophy are missing the boat, is that it’s perfectly possible that the dietary philosophy that you subscribe to can be consumed in a data-driven way using objective data to optimize it. It’s not necessarily that no one should ever drink pressed juice, but I would think that someone who really believes in the nutritional qualities of fruits and vegetables should just strive to have meaningful advice for how people can consume them in a way that is going to work for them and reduce the risk while also getting those nutrients. And that might be portion control. It might be different ingredients. It might be timing, only having them right before or right after exercise or what have you. But there are certainly limitations to the idea that just drinking pressed vegetables is always better for you than alternatives like whole fruits and vegetables.

Kevin Rose: [00:46:27] Yes. I’m curious. Real quick on the supplemental side. There’s cinnamon, there’s a whole slew of different things that have been reported to help. I don’t even know. You always see these on the side of labels, “maintain healthy glucose levels”. What does that even mean? Right? You see that as a claim on some of these things.

What’s crap? What works? Is there anything out there that people can take along with a meal? I know there’s crazy drugs like Acarbose and those are prescription drugs that will bind the glucose and I worry about that stuff. I tried that once and I got to tell you, it’s amazing. Oh my God! I took an Acarbose. Talk to your doctor any type of medical advice. This is biohacking a prescribed substance. I took one and I had a pizza afterwards and my glucose didn’t spike at all. It was crazy.

Josh Clemente: [00:47:12] Oh man! That’s wild.

Kevin Rose: [00:47:13] But it just binds it up. I’ve heard it can cause GI upset. I was lucky it didn’t have that for me. But I’m curious. What out there on the supplemental side have you seen any solid data around?

Josh Clemente: [00:47:22] Yeah. This is a really, really interesting one and there are a couple, like you mentioned cinnamon. We talked about vinegar. There’s berberine, which I think is a naturally dry plant product that has also been studied in research environment  and these make….

Kevin Rose: [00:47:34] Do you take berberine?

Josh Clemente: [00:47:36] I have a glucose control supplement that includes berberine that I have ultimately, not seen any benefit from. I’ve taken it a few times. Actually, I took it quite consistently for a few weeks and didn’t see any change in both my postprandial, post-meal response or my averages.

So having that data, I just feel – I’m generally skeptical about supplements overall. I don’t think – It goes to the pressed juice example where you have all these multivitamins, supplements where it’s like a thousand times your daily value of this or that. And I think it just probably isn’t delivering you a thousand times the improvement and it might not even be delivering single digit improvement and it might have all these side effects. So I tend not to take them.

Now, the exceptions are vinegar for me. I have seen a really amazing difference when I either have a shot of apple cider vinegar in the morning or add a vinegarette to foods. And so I make a lot of sauces and a lot of dressings with vinegar and use them pretty prolifically throughout my nutrition.

Kevin Rose: [00:48:27] What’s the mechanism there? Do we have any sense of what’s going on?

Josh Clemente: [00:48:30] Honestly, I really do not know what’s going on there. I have got to dig into this one. I’ve been meaning to do so for some time. There are studies that show this effect, specifically with apple cider vinegar and the mechanisms themselves are unclear to me right now. So unfortunately, I don’t have a good answer, but I do know that anecdotally and for several other people on the team, we’ve seen the same effect. So some people actually will preload similar to how you used Acarbose for the pizza. They’ll preload for an indulgent meal by shooting apple cider vinegar. It seems to have an effect. it’s pretty fascinating.

Kevin Rose: [00:49:00] I would love to be a fly on the wall at your office and see what all these hacks that are happening.

One thing I will say in this episode that I really appreciated you telling me off before we started hitting record is you said I don’t want this to be a commercial for my company and that’s always appreciated because you never know. When you have guests on, it’s like, “Oh, is Kevin having them on the show because they paid them.” None of this was paid. We just want to have a conversation about glucose control. But I do want to get into your company because I think you are providing a really valuable service at the perfect time.

Josh Clemente: [00:49:29] Awesome!

Kevin Rose: [00:49:29] Tell me about Levels.

Josh Clemente: [00:49:31] Yeah. So Levels is a metabolic fitness company and we’re using continuous glucose monitoring. Ultimately, real-time access to one’s own biological information to help people make better choices to set themselves up for long lives, with metabolic control.

And specifically that means that right now we’re building a metabolic fitness program where you can get access to continuous glucose monitors, prescription consultation with a licensed physician, and then the Levels software, which takes this raw data stream, allows you to log your lifestyle – so your diet, exercise, sleep and stress – and then receive scores that help you make better choices instead of just having this mg/dL unit coming at you and having to do all the research on your own. So we surface insights and help you make better choices.

Kevin Rose: [00:50:11] And so it’s interesting because you’re dealing a bunch of what… We should tell people it’s levelshealth.com to check out. The thing that – And I have used it. I went through your program.

There’s a few things I really like about it. One, you don’t have to talk to your primary care physician to get a CGM. So you guys take care of that. You get a CGM. The second piece I like is that it’s something you do what, like once a year? So you wear it for a month and then you’re done for the year? How do you think of this? How does this fit into people’s lifestyle?

Josh Clemente: [00:50:39] We meet people where they are. So the goal is twofold. One, we don’t push any specific dietary philosophy. We touched on this earlier. It’s just whatever your choices are, however you choose to eat, do so grounded in your own data.

And then also we don’t drive a specific monitoring cadence. We recommend that you do a month, learn a ton about how you’re responding, where you are and set a trajectory for how to make better choices for the future, and then check in regularly. In some cases it makes sense to do this quarterly. In some cases, people like to do it once a year and in other cases, something like 10% or 15% of people that use our program, they just do it continuously because it’s almost like giving up your cell phone. When you have the data, it’s like, I can’t ever not have this. It holds me accountable and it helps me understand context and just keeps me on track. It’s really individualized. It depends on your goals and where you are and where you’re heading. And we make it flexible and easy for people to do whatever makes the most sense for them both financially and due to their metabolic concerns.

Kevin Rose: [00:51:30] Yeah. I’m excited for you guys because people should know that this is not an inexpensive program and that’s partially because the devices themselves at this point when they’re not covered by insurance, which they wouldn’t be for this use case, are expensive.

I don’t use you guys. I used you for the one month to try it all out because I have, obviously Attia and his team and they’re looking at my data. I get a CGM through Dexcom and it’s not inexpensive. We’re talking hundreds of dollars a month for this type of stuff. I would not continue to do it had I not had, and continue to have, issues where I want to pay attention to this stuff. If I was just a healthy person that had no issues – Like my wife, she doesn’t do it because she’s perfect in that. I’m very jealous of her glucose response to certain things.

Josh Clemente: [00:52:14] It’s all individual.

Kevin Rose: [00:52:16] Yeah, it totally is.

But I’m curious. When someone signs up – Okay. So walk me through what they actually get because you get the CGM. You put it into your arm. It’s on. You have an iOS app. I don’t know if you have Android too, but you have iOS.

Josh Clemente: [00:52:29] Yep, we do.

Kevin Rose: [00:52:29] You have Android.

Josh Clemente: [00:52:31] We have both platforms.

Kevin Rose: [00:52:32] And then you launch it. You see your numbers. But then what do you do with your food? How do you coach them? Do they interact with someone? How does that work?

Josh Clemente: [00:52:41] Yeah. So first on the price piece. Right now, like you said, these are devices that were developed for the therapy and moderation or management of diabetes and so right now they’re quite costly. But what we’re seeing is strong indications that this is going to, that the device cost is going to come down, especially as companies like ourselves expand the market and allow supply and demand to do their thing. And so we expect that in the near term, we’re gonna be able to get this down to below $100 a month and people will be able to really cross the metabolic health spectrum. This is our goal is to get this into the mainstream and people that need it the most can have access to it and it’s not a financial issue. So cheaper than a gym membership is where our goal is.

And then, as the program rolls out – So initially there’s this e-commerce order experience where you fill out a medical history form. We send that over to our partner physician network. They review and ensure that the product is right for you and specifically what that means is we just want to make sure that you shouldn’t see your primary care provider first. In the event of having diabetes, for example, we would want to make sure that you’re getting more intensive care. In other cases –

Kevin Rose: [00:53:38] That’s interesting. I never thought about this. So you have people that will sign up with you. They have no clue that they have diabetes.

Josh Clemente: [00:53:43] Yeah. Or they do know they have diabetes and they really want the Levels program because it’s so much more insightful than the standard CGM software.

Kevin Rose: [00:53:51] Got you!

Josh Clemente: [00:53:51] And so we aren’t yet ready. As we’re developing very rapidly, we want to make sure that the software is really nailed and the platform is buttoned up before we start bringing on therapeutic use cases. So we’re not currently – We’re just general wellness. We don’t do diabetes management today.

So after the physician consultation, which is quite quick and effortless, the pharmacy delivers your Levels kit and inside there are two CGMs and then we have these performance covers that go over the sensor and help keep it adhered especially for active lifestyles. And you use the Levels software.  That’s your lifestyle hub, logging… For example, we’re very focused on making this a minimal, easy, elegant experience. So we don’t want people to have to weigh their food and enter macronutrients and worry about ratios and again, serving sizes. It’s all about effortless and low overhead. And so you just snap a picture and enter a few words about what the food is and that’s mostly just so that you can… It’s for your recall. So then a few hours later after the software has analyzed your blood sugar response to that meal, you’ll get a score. And it’s a score out of 10 and that’ll surface and you take a look at how that meal affected you and then also how any secondary lifestyle choices you’ve made affected you.

An example here would be that walk. So if you chose to have a meal and then get up and take a walk, we use integrations with Apple Health kit to sense your activity and then we’ll surface that as well and show you that. For example, you can see comparisons between having a personal pizza and doing nothing and then having a personal pizza and having a walk shortly thereafter. And you can see how the differences in scoring affected you, your metabolic control. And then with all those implications of weight gain and just mood and fatigue and all the downstream issues if you have a big blood sugar response, a crash, so you can put in context the scoring and how your body responded with how you felt and the qualitative experience.

So really making a lightweight, easy to log interface, joining it with real-time data and just surfacing real-time actionable insights.

Kevin Rose: [00:55:42] It’s beautiful too. Your website’s beautiful. The app looks great.

Josh Clemente: [00:55:45] Thank you very much.

Kevin Rose: [00:55:46] It’s awesome that you’re doing this.

Josh Clemente: [00:55:48] Yeah. And then we also, we’re pushing more into sleep and exercise and stress, helping people surface when you’re having a non-exercise related blood sugar increase – Sorry, non-meal related blood sugar increase. We can identify if that was exercise or we can surface insights and ask, “Was this a stress related thing where you were maybe in a call or a meeting or something that was very stressful?” And so helping people connect actions to reactions is what we’re all about. Closed, very tight feedback loops.

A lot of this stuff is – We’re in various stages of internal testing versus product release and we’re still in beta mode. We’ve released about 400 iterations of the app since January, but there are some really exciting things coming down the pipeline with specifically, that insights framework and eventually we’ll be able to provide proactive insights and recommend. This morning I got or yesterday morning I got off the red-eye flight. Eventually, Levels will surface and say, “You didn’t sleep at all last night. Typically, your blood sugar is about 20% higher and you respond negatively to these foods. Maybe if you eat more of these, which you tend to do better with after a short night of sleep.” So this type of very proactive, low cognitive load insight is going to really, I think, be a game changer.

Kevin Rose: [00:56:47] Yeah. This is without a doubt the future. Right? It’s early days and obviously it’s going to take a while to accumulate enough data to where you’ll be able to automatically have these insights, but five years from now, when the CGMs are going to be… They’re going to be way less than $99. Right?

Josh Clemente: [00:57:02] Yeah.

Kevin Rose: [00:57:02] And you’ll have millions of data points coupled with all the latest AI advances that we’ve seen in the last couple of months alone –

Josh Clemente: [00:57:09] Right.

Kevin Rose: [00:57:09] It’s just, it’s going to be a beautiful thing of push notification to my Apple watch. “Hey! We noticed you just had this particular meal. Time to get up and go for your walk because you’ll have this predicted outcome.” It’s going to be fantastic.

Josh Clemente: [00:57:23] Yeah. It’s a future where we can use data in our wellness choices daily for the first time. It’s very interesting. Most people, if you think about how you live your life, you have a lot of data and information you’re using to make choices except for when it comes to your health and wellness. And so for the first time, I think we’ll be able to use health data more like we use financial data and in real time. Pull out your phone, see where you are, see the quote unquote “deposits and withdrawals”, projections into the future. The implication here is you can use an expert to help you guide your plans such that you not only are financially secure for retirement someday in the future, but also are going to be healthy and well to enjoy it. That type of large-scale vision that we have to point people in the right direction very early so that they can plan for it and make those daily choices that support it.

Kevin Rose: [00:58:04] Yeah. One thing we didn’t cover that I feel like is just – I can’t believe I missed this. I would love to come back real quick and just talk about weight gain and how glucose and insulin impacts that. So why do people put on weight when they have these big spikes?

Josh Clemente: [00:58:20] The mechanism there is insulin. So insulin is an anabolic hormone, meaning it is a storage hormone. It tells your body to take what’s available and store it. Insulin is also the hormone that lets blood sugar, or it tells cells to bring blood sugar into the cell and use it for energy and if the cell is basically at its energetic capacity, so let’s say in a situation where you’re sedentary and you have a lot of blood sugar or a lot of sugar in your blood, insulin will release, it’ll tell the cell, “Hey! This glucose needs to come out of the bloodstream into the cell. Use it for energy.” The cell does not have high energy needs because you’re stationary, you’re not using your energy. And so the insulin then tells the body to start producing fat and storing it. So it will turn the glucose into triglycerides and store that in the adipose tissue on the body. And so, again, this is a dose dependent situation. So if you have a little insulin, this is happening at a small scale. If you have a lot of insulin and a lot of sugar, this is happening at a large scale. And so, the insulin environment is influenced by the glucose environment. So a little glucose increase will produce a little bit of insulin for most people, a large glucose increase a large response. So it’s really important, if you’re trying to maintain a low insulin environment, to allow your body to not store but actually burn your fat stores and your energy that’s available. It’s really important that you have insight into your blood sugar response so that you can approximate your insulin response.

People like Dr. Jason Fung, who wrote The Obesity Code, really dig deep on this and it’s a really elegant picture of how the human body is not this clean machine where an input equals an output but actually the context of your decisions and the way that your body has to respond to them hormonally, is what’s driving your weight balance, your energy balance.

So it’s really important and I think we’re going to see some amazing impacts. Actually, we’ve run a few trials internally called Our Wearable Challenge, which is a partnership with Justin Mares from Perfect Keto and Kettle & Fire and we gave a bunch of people who are looking to lose a little weight. We gave them access to the Levels program and then the goal was just stay inside this blood sugar range 24/7 for 28 days.

Kevin Rose: [01:00:18] What was the range?

Josh Clemente: [01:00:19] It was – Actually the first one was just below 140 and in the second cohort, we dropped that down to below 120 and the average weight lost with no dietary restrictions – we didn’t say you have to avoid these foods or eat these specific number of calories. It was just, keep your glucose in range – was about 9.8 pounds.

Kevin Rose: [01:00:35] Crazy.

Josh Clemente: [01:00:36] Yeah, for 28 days.

Kevin Rose: [01:00:37] For 30 days?

Josh Clemente: [01:00:38] Yeah, 28.

Kevin Rose: [01:00:38] Wow! So basically what that means, you would think, “Okay. Someone’s watching their numbers in real time, so they’re probably just, they’ve made some mistakes in the past so when they’re having that lasagna, they’re like, “Okay, five less bites will still keep me within the range.” Is that what they’re doing?

Josh Clemente: [01:00:55] To some extent, yeah. Yeah. There was a variety of approaches. So some people went in full keto. Some people did fasting. Some people ate the same diet that they were eating, but just restricted portions and the net effect is just, by lowering the blood sugar response we’re doing that secondary effect of lowering the insulin response. And in many cases, especially if there’s fasting or ketosis stepping in, your body will go into a really low insulin environment and you’ll start rapidly oxidizing body fat that you have on and I think it’s much easier to do that, to access ketosis, if you are in a low insulin environment to begin with, in a low-glycemic environment. And this is what we call metabolic flexibility. It’s where by encouraging a hormonal environment where the body can easily switch between glucose oxidation or sugar burning or fat oxidation, which can come from your food or it can come from your body fat. That’s the concept of metabolic flexibility.

So I think we, we see a lot of that in these challenges where people are removing the super high kicks to the system, the glucose spikes that are influencing a hormonal change and a big insulin response and when they remove those, the entire environment smooths out and they can more easily switch to burning their body fat.

Kevin Rose: [01:01:59] Got you. That makes sense. That’s really cool. What a great little challenge. I hope you have more of those in the app.

Josh Clemente: [01:02:04] Yeah. We’re going to do quite a bit in this space and I think, I certainly believe the implications for weight loss are tremendous.

Kevin Rose: [01:02:10] That’s great. Excellent. How long is the wait if people do want to sign up and become a member, because I know you did have a little bit of a wait to get in. Is that right?

Josh Clemente: [01:02:18] Yeah. Right now we have, we are currently doing an invitation-only beta still and we’re increasing the volumes there and that is very much a development process. We’re reaching the point where we’re really seeing the behavior change and the resonance with the product that we’re looking for in order to go to our full launch.

And right now, join the the wait list on the website. I’d also like to get you a code, if you’d like to share with your listeners so that they can sign up and pre-order today, if they’d like to.

Kevin Rose: [01:02:43] Oh, that sounds great.

Josh Clemente: [01:02:44] Yeah. So let’s do that. I’ll get you a code and we can share that and people can get into the early access beta program.

Kevin Rose: [01:02:49] Yeah. I’ll put that in the Show Notes for people that are listening over at podcast.kevinrose.com so people can find it there.

Josh Clemente: [01:02:56] Okay. Great.

Kevin Rose: [01:02:57] Yeah. And we should also mention that – I always like to do this. There is no affiliation. You guys aren’t paying me for this. I think it’s an important topic to talk about and I’m excited to get more people on a healthy path. So that’s good.

Josh Clemente: [01:03:09] Yeah. So anyone that would like to contribute to the development process, we’ll get you that link. It’s going to likely be, it’ll be in the Show Notes and you can participate in what we’re building here and help us guide product features as we move towards full launch, which will likely be towards the holiday time.

Kevin Rose: [01:03:21] That’s awesome. Josh, thanks for being on the show. Is there anything else that you want to mention or that we’re leaving out? I feel like this has been a great overview of all things glucose.

Josh Clemente: [01:03:29] Yeah. This has been awesome. I really appreciate keeping it tactical and helping surface the insights.

That’s ultimately what the company is all about is making metabolic, well, reversing the trends of metabolic dysfunction in this country and abroad. And we just want people to understand that this is in your control, and metabolic fitness is focused effort and repetition, to improve your metabolic health.

And it’s not a binary situation. You may put on a device for the first time and it’d be a little bit uncomfortable with what you see, but you have full autonomy to make the changes that improve that well into the future. We’d love to share this information. I highly recommend anyone checking out our blog at levelshealth.com/blog. We publish a ton of research just bringing that research down to the approachable level where you can see how it affects you in your daily life. And please send us feedback on that.

Kevin Rose: [01:04:09] I’ve read some of those articles. They’re are fantastic and I think that the other thing to just reiterate at the very end of this is that a lot of people when they’ve seen my CGM over the years, they’ve said, “Why do you care so much about glucose?” And I think that it’s easy just to think, “Oh, it’s just people that care about diabetes.” But in reality, obesity, so many different types of cancers linked to that outside of diabetes, cognitive health and Alzheimer’s. There’s just so many different processes that hang, that are connected here that are much more serious than just someone that has basic diabetes. Do you want to do – Have we listed them all off? What would we be your main ones there that people should know about?

Josh Clemente: [01:04:49] To start off, the implications of metabolic control vary all the way from just the daily quality of life, like you had mentioned, the cognitive overload, the fatigue levels that I was experiencing due to just this rollercoaster ride of blood sugar and insulin crash that I was on. And then yeah, there are these chronic lifestyle illnesses, like pre-diabetes, Type 2 diabetes, Alzheimer’s as being called Type 3 diabetes today, stroke, cardiovascular disease, sexual health is one of the first co-morbidities of metabolic dysfunction, mood disorders, PCOS, which is the number one cause of infertility in women today in the United States and then all the way down to skin glycation, which causes wrinkles and acne. This has also been proven in research to be connected to glucose dysregulation. Add into the mix, weight gain and the entire picture comes clear that this is something that is not for sick people. It’s actually for anyone who wants to pursue health each day and make better choices influenced by their own knowledge of their bodies.

That’s what Levels is really doing is changing this stigma where you should only concern yourself with blood sugar if you’re already sick.

Kevin Rose: [01:05:48] Right.

Josh Clemente: [01:05:49] It’s actually quite the opposite. You should concern yourself with blood sugar so you don’t become sick and also so that you can optimize your performance. It’s being used by athletes right now to improve fueling choices before they go out and try to break records. So yeah, we’re all using metabolism every day and it’s certainly a tool that will be used well into the future as people look to improve and optimize it rather than just wait until it’s broken.

Kevin Rose: [01:06:10] Yeah. Last question, I promise. I just keep coming up with them as I’m supposed to have you on.

Josh Clemente: [01:06:15] I’m pleased to  keep you company.

Kevin Rose: [01:06:17] So we can talk about this because I don’t have anyone to bounce these ideas off of during COVID. I have noticed that for me – You mentioned that range going into the 70s, if you can get there, and that oftentimes for me, I don’t know if I’m going to get there on any given day. I might be in the 80s somewhere, obviously, but not… 70s is a little bit harder. One of the things I have noticed without a doubt that gets me back to really healthy levels is when I fast. If I can do an 18-hour fast, I am almost certainly in the 70s by the end of the 18-hour fast.

Have you noticed fasting to be a great way to rebalance and get back down to decent levels?

Josh Clemente: [01:06:56] Absolutely. Yeah. Fasting, I think, is an amazing mechanism because without the external pressure of external food and macronutrients that you’re throwing at your body and removing that digestion and also what those breakdown into glucose, etc., your body can start to clear out the insulin levels, so the high insulin background that you might be experiencing and then start to access your stored glycogen. So that’s your stored sugar, it’ll consume that and then it’ll switch over into ketosis and start using your adipose tissue. That’s the fat tissue on your body. That process of reducing the insulin environment and then reducing the fuel storage levels in your body, even without – It’s not like you have to go be super active while you’re fasting. It’s just this is going to happen even if you’re stationary. About 18 hours of fasting will put most people into fasting ketosis. So I think this is, certainly it’s something that people should ramp into. Don’t try and go and do a 72 hour fast if you’ve never done it before.

Kevin Rose: [01:07:47] Oh, no!

Josh Clemente: [01:07:48] It’s really brutal.

Kevin Rose: [01:07:49] Yes.

Josh Clemente: [01:07:50] Yeah.

Kevin Rose: [01:07:50] And potentially dangerous too.

Josh Clemente: [01:07:52] Yeah. Totally.

Kevin Rose: [01:07:53] People should always because – I always tell people, because I get a lot of fasting and questions obviously starting zero. And a lot of people will say, “How do I get started? Should I do this crazy fast?” I’m like, “No. No. No. No. If you’re going to do anything outside of a 13 to 16 hour fast, baby steps, number one and number two, talk to your physician to make sure you don’t have any underlying health conditions that would prevent you from doing something like this because it can be dangerous.”

Josh Clemente: [01:08:15] Totally. Yeah. And you know what? It also points to another point. Talking about getting as low as possible with glucose down into the 70s, I think that overall, we want to reduce our area under the curve, so our exposure to high glucose levels. But there is actually a low bound where it’s not favorable to get lower. And this goes all the way back to the pressed juice conversation where, if lower is better then the lowest must be the best. That’s not true here. Right?

Kevin Rose: [01:08:35] I’ve had low glucose levels. That is not fun.

Josh Clemente: [01:08:38] Right. I’m doing more endurance training and – So bonking is the point where you run completely out of sugar if you’re in a glucose oxidating state and you just hit a wall and your energy drops out from under you and that’s not actually the dangerous situation. The dangerous scenario is when, for someone who has diabetes, for example, having a blood sugar get critically low can lead to seizure and ultimately death. And so your body needs glucose. We have to have it. Now, the interesting thing is that your liver can produce the amount of glucose you need, even when you’re fasting. You’ll see this, especially with CGM data. As you fast it’s not like your blood sugar continuously ramps down, down, down, lower and lower towards zero. It’s actually going to ramp down and it’s going to asymptote towards this level where your liver is producing it from your fat stores and protein and just keeping you rock solid and flat all day long. And it’s really beautiful to actually see that that system is well controlled and you don’t need to rely on dietary sources for blood sugar. But again, it won’t be near zero and no one should ever strive to get towards zero.

Kevin Rose: [01:09:34] Have you ever seen an issue where – I’ve run into this a few times where you… It’s mostly those brunch days where you go over the top, you do something carby because you had some drinks or whatever. You spike up again and then your body releases so much insulin that you actually drop into a low level.

Josh Clemente: [01:09:51] Yeah.

Kevin Rose: [01:09:51] That’s like the worst feeling ever.

Josh Clemente: [01:09:52] Yeah. It’s the worst. Yeah. It’s like your stomach is dropping. I get a little cold sweat. I get shaky. This is actually –

Kevin Rose: [01:09:57] Oh, shaky. Yeah.

Josh Clemente: [01:09:58] Yeah. This is exactly what I was experiencing when I was describing my fatigue levels. So I was having these rollercoasters of super high elevations after these big carby meals and then my body would just flood my system with insulin and I would experience that reactive hypoglycemic event where my blood sugar would just plummet suddenly and I would feel just this intense, like just shakiness fatigue. I’d have to sit down and I would be desperate to grab either another coffee or more food.

Kevin Rose: [01:10:20] More food, anything you could do to get it back up. Yeah.

Josh Clemente: [01:10:23] Exactly. And once you see the data, it’s like, “Oh, I can just completely cut this out by just avoiding that thing that caused the whole rollercoaster in the first place.”

Kevin Rose: [01:10:29] Right.

Josh Clemente: [01:10:30] Yeah. And so once you maintain those low control glucose levels to making data-driven diet decisions, you’ll notice just the total absence of that reactive hypoglycemia, for me in particular, without the big spikes.

Kevin Rose: [01:10:41] Yeah, same. Now that I’ve really started to keep it within a tighter window, I don’t really ever get those, unless I go crazy and then I know why.

Josh Clemente: [01:10:47] Exactly. Yeah. At least you know. You have the data.

Kevin Rose: [01:10:49] Exactly. Josh, thank you so much for being on the show. This is so much great information. We’ll get a lot of detailed show notes on the website and that code that people – What does that allow them to do? To just jump the line and be next on the beta?

Josh Clemente: [01:11:01] Yep. You sign up for the beta. Yep. We’re moving as quick as we can on delivering beta. I think the delivery dates right now will be towards late September, early October, but we’ll get you into that early access program. You can help us develop the product.

Kevin Rose: [01:11:12] Awesome! Thanks, Josh. Thanks for being on.

Josh Clemente: [01:11:15] Kevin, thank you so much. This was really exciting and I’m glad to be able to be on the show.

Kevin Rose: [01:11:19] All right. That is it for this episode. If you enjoyed it, head on over to podcast.kevinrose.com. You can get all the show notes there and the links to things that we talked about, and then also you can sign up for my newsletter. It comes out every four to six weeks. I think you’ll enjoy it. Thanks so much. Be well.