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Do you ever wish that you could know how specific foods impact your energy, sleep, mood, or overall health? And better yet, know in real-time so you can take actionable steps to get the outcome you want?
A continuous glucose monitor (CGM) might just be the solution you are looking for. For most of their existence, these tools have only been available to those diagnosed with poorly managed diabetes. So, in other words, once there was already a problem.
My guest on this episode, Josh Clemente, who when seeking answers to his own health questions, found this barrier to be frustrating and confusing. Why should you need permission or wait until you have a problem in order to get information about your own body? Josh channeled these feelings and created Levels, a CGM available to the general public.
Josh says “the intention of Levels is to generate metabolic awareness” and understand how all your individual choices affect you and use that to piece together tactics to achieve your goals.
I don’t typically dedicate an entire podcast episode to a single product unless it is one I truly love. Levels have given me insight into how the foods I eat and the context in which they are eaten, effects me. Plus, it gives me accountability, and at the same time, liberation. I can eat more carbs than I thought and find ways to fit in occasional ice cream (or tequila!).
Listen in to find out more about CGMs and bio-individuality as Josh and I talk about:
- How Levels started and Josh’s struggle to find out information about his own body
- Why healthcare (or rather, sickcare) needs engineers
- The need for a paradigm shift from one of “symptom care” to one that enables people with feedback to make informed choices
- Why the focus should be on metabolic dysfunction rather than specific diseases
- What leads to metabolic dysfunction and why context matters
- The importance of closed feedback loops in decision making
- Why you should pair salsa dancing with your margaritas
- What the future holds for Levels
Resources:
Wired to Eat by Robb Wolf
Weitzman Institute Study on CGMs
Gretchen Rubin and The Four Tendencies Quiz
Connect with Josh:
Website: Levels
Instagram: @levels
Twitter: @levels
LinkedIn: Josh Clemente
Podcast: LEVELS – A Whole New Level
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Episode Credits:
Thank you to all who’ve made this show possible. Our hosts are Diana Rodgers and James Connelly. Our producer is Emily Soape. And of course, we are grateful for our sponsors, Patreon supporters, and listeners.
Quotes:
“The human body, I think is the most complex system we know of in the universe. They don’t fail immediately from one fell swoop. There’s no lightning strike that causes Type 2 Diabetes. It’s a very slow degradation of the systems that cause our bodies to work or not work.” – Josh Clemente
“In our modern food landscape… I mean, and that’s part of the big problem, right? You have to have some level of tight food selection criteria in order to maintain health.” – Diana Rodgers, RD
“Today, we expect people to not get sick when we have the most processed food system in history, the most sedentary, knowledge-work environment in history. And we don’t give anyone information. It’s very sad.” – Josh Clemente
“I just see so many applications for this – for first responders, for just anyone who needs to be fit for their job.” – Diana Rodgers, RD
Transcript:
Diana Rodgers, RD 0:01
Welcome to the Sustainable Dish Podcast. I’m Diana Rodgers, a real food registered dietitian, author, and sustainability advocate. I co-host this podcast with James Connelly who was a producer on my film Sacred Cow. I also founded the Global Food Justice Alliance an initiative advocating for the inclusion of animal-sourced foods like meat, dairy, and eggs for a more nutritious, sustainable, and equitable worldwide food system. You can check it out and join me at globalfoodjustice.org. Thanks again for listening. And now onto our show.
Diana Rodgers, RD 0:39
Welcome to the podcast, everybody. Today I’m really excited to talk about CGM products and blood sugar regulation and all that great stuff with Josh Clemente, who is the founder of Levels. I first started using Levels last fall. I’m a huge fan of it. I’ve been tracking my blood sugar for many, many, many years. And while it’s great to have a snapshot, I think that wearing a CGM, like first of all automatically just makes you so accountable. Like you absolutely cannot escape the highs and lows anyway. So let’s get into all of this and how you got into this. So welcome, Josh.
Josh Clemente 1:19
Thank you so much, Diana, excited to chat.
Diana Rodgers, RD 1:21
And right before we push record, I was mentioning that I first heard about you well through two people through Lily Nichols, who I just had on the podcast, a good friend of mine, really genius-level dietitian. And then also Robb Wolf, who is my best friend. And I was shocked to hear that you first heard about CGM through reading Wired to Eat that’s was not too long ago. So he created this massive company. So why don’t you tell us all about your background and how you got into all this.
Josh Clemente 1:54
Happy to. Yeah, first of all, big fan of both of those names you just mentioned obviously Lilly. She was one of the first people I read about in terms of her personal experience using CGM, a long time back shoot, she wrote a blog as well. And it was all in the same timeframe that I was catching up on Robb’s work and been familiar with Robb for many years. In terms of the paleo and CrossFit stuff. I am a CrossFit level two trainer now I was a level one prior to this, but really my background is in aerospace engineering. I spent the first six years of my career at SpaceX, developing spacecraft, structural systems, and then moving into the human life support program there at SpaceX. I was one of the first four people to start to think about how we’re going to adapt the vehicles we had built, which were just for putting satellites into space to now carry astronauts. And so that was an amazing opportunity. And during my three years working on that project, I became very interested in the more mechanistic pieces of human performance, I guess, would be the best way to put it. Essentially, how do we maintain health long term? And what does that even mean? Initially, I, you know, growing up, I just thought about physical fitness as the best proxy for health. So if you’re fit, you jump high, run fast, like you’re healthy, do whatever you want. And that’s very much where I was, again, I was a level one CrossFit trainer, lifted heavy in the gym, thought I was in great shape. But getting into this human performance, like long-duration, astronaut mission thinking where it’s how do you keep people from getting chronic illnesses when they’re in orbit? I’d never thought about a question like that. And so I was kind of turning these things over in my mind. And then simultaneously, there’s this weird juxtaposition happening in my life where, again, physically fit not having a problem with weight gain, or you know, any of the other sort of classic symptoms that you associate with a lack of health. However, I felt extremely unhealthy to the point where one day, I actually went to my doctor and said, I think I have a terminal illness. Can you help me figure out which one it is? And it was that degree of extreme sort of overwhelming fatigue episodes, I would get cold sweats. I get shaky. My irritability was just off the charts suddenly out of nowhere as having these mood swings, which was never a part of my personality. And so yeah, I was very frustrated by this. And essentially, my doctor ran a standard blood panel told me my vitamin D was like borderline and keep eating healthy and working out. I was kind of like, okay, great. I’ve been doing that for half my life. So that’s when I took things into my own hands, I started to dig into metabolism and start to read some books. And one of the first ones I picked up was Wired to Eat. And so I picked up a glucometer according to Robb’s sort of seven-day blood sugar plan and started doing finger pricks obsessively and plotting them in Excel. And then what I ended up with was a point cloud of blood sugar points in the morning and in the evening, and then nothing really in between. And so I’d have these shakiness episodes and all these sort of fatigue problems. I couldn’t figure out what it was from. And I read in the back, you know, he has a blurb about continuous glucose monitors which are coming to market. And right around this time, the FreeStyle Libre 10 Day had been approved in the US, the Dexcom G6 had just been approved in the US. And so I read this, I was like, Oh, that is exactly what I need. I need something I can just put on my arm and it will capture all the data. I don’t have to do all this finger stick. So to try to accelerate in the background here, I went to my doctor and I said, great news. Like I’m doing all this obsessive pricking, you can just apparently give me one of these CGM devices. And then I’ll go on my way and figure out if there’s some problem going on with my blood sugar. And my doctor kind of looked at me cross-eyed was like, No way. This is not for you. This is a… this is a device, not only for diabetics but for people with poorly managed diabetes. So you are crazy to even ask for this, it’s actually quite concerning that you would care this much. And so I walked out of that office. And that was one of two major events so that it was the first of two, I left there being confused that I had to even ask permission to get information about my own body. And secondly, confused as a systems engineer, why we were not monitoring these sorts of critical markers before the breakdown, but you had to wait until chaos broke out in order to start measuring. Anyway, I continue to try to get one. I tried a few telehealth doctors, it took me almost a year. And eventually, I did get a CGM when a friend went to Australia and brought one back. And at that point, I had about two weeks of data. And it was pretty clear that I was either borderline pre-diabetic or already pre-diabetic, my average glucose was above 100. And my postprandial meal responses were all well over 180, sometimes multiple hours up there, certainly very high. And so that kind of accessibility issue, and then the actionability of the data. So taking the raw glucose values, and turning them into insight was totally lacking in my experience, and yet, it was the most powerful feedback loop I’ve ever received. So it totally changed my approach to nutrition, exercise, sleep, and stress. And my own kind of patient zero example of understanding the implications of the choices I’m making every day, and then feeling empowered to make better ones, is why Levels exists. And yeah, it all started with that little blurb in Robb’s book.
Diana Rodgers, RD 6:48
That’s amazing. And I took a few notes because I can relate so well. And a lot of listeners know my background. I was undiagnosed celiac, I just was feeding myself constant carbs, just because everything was going straight through me, went gluten-free. But I, you know, my gut issues went away. But I was still, I kept going to the doctor telling them that I was diabetic, but kept testing like normal, had gestational diabetes, which was the first time I ever learned to count carbs. And this was with my first child, so he just turned or he’s about to turn 18. So that’s how long ago that was. And I couldn’t… at the time, 30 grams of carbs per meal, I thought was the most restrictive evil. I mean, because I was doing everything right, I was eating my like lentils, and brown rice, and all of that. And it blew my mind. But I… It wasn’t until I read The Paleo Solution, and effectively went keto, because I don’t really love sweet potatoes that much. So I was like, I’m just not going to do those that my life went from, like Dorothy in black and white to like color, really, and the liberation of not having those sweats if you miss a meal, not having to constantly pack snacks with you all the time. Or to be able to know that you’re gonna feel totally fine past lunch. Or even if you miss lunch, and you can keep on going. It is incredible. And for food to just be like, whatever. I mean, it’s still delicious. But it’s whatever meat and vegetables in the fridge now it’s not like it’s like this thing that I’m thinking about. That’s like swirling over my head all day long. I can’t wait to get home and eat that. I mean, so we both owe a lot to Robb, I guess for that. I’m fascinated that you’re an engineer and figured this out. And I think that that’s the best brains for something like this. I’m not sure if you’re familiar with Marty Kendall,
Josh Clemente 8:53
Not closely.
Diana Rodgers, RD 8:54
I’m gonna make introductions because he’s an engineer in Australia. And he does a lot with blood sugar regulation. And his wife is type one diabetic and wanting to get pregnant. And so he like, engineered a diet for her.
Josh Clemente 9:08
Oh, wow!
Diana Rodgers, RD 9:08
Super healthy. And he’s a super fun guy. And Robb and I are both friends with him. And then I have two more points. One is when I first posted my experience with Levels on Instagram, I had a fellow dietitian basically accused me of being like orthorexically irresponsible, right? And why are you? How dare you recommend this to healthy people who aren’t diabetic? This is not the standard of care. How dare you? And it’s like, how dare I try to help people have information about their own bodies? Like how dare I?
Josh Clemente 9:45
Right. Yeah, unfortunately, and this was a blind spot when I started thinking about this project. This has been kind of a growing sentiment for at least… it’s surfacing more frequently, which I find really, really interesting, for a couple reasons. Mostly, it’s so closed-minded and broken in terms of how systems fail, complex systems in particular. The human body, I think is the most complex system we know of in the universe. They don’t fail immediately from one fell swoop, there’s no lightning strike that causes type two diabetes, right. It’s a very slow degradation of the systems that cause our bodies to work or not work. And so that’s what’s fundamentally missing in that perspective is that people are looking at diagnostic codes as the freedom to then take on a symptom care. It’s like you haven’t yet gotten this stamp of approval to start caring about that system, thus, it is irresponsible for you to care about that system. It shows privilege. It’s quite the opposite. The system right now is so overloaded from people who are unnecessarily burdening it with avoidable chronic illness because they have no better information throughout their lives. That’s the problem with the system. It is not a position of privilege to take early, opportunistic control over the choices you’re making every day. You’re making hundreds of choices, which are going to compound into an outcome. And every single day, you’re making those without feedback. And today, that is leading to a situation where 88% of American adults have some form of metabolic dysfunction, that problem is getting worse. And it is important for people it’s incumbent on people, it’s actually their responsibility to care about the choices they’re making, learn about the reactions that are happening to their actions, and make better ones if they can. And obviously, we’re never going to get to the point where 100% of people can have 100% optimal health. But certainly, we can alleviate the burden on the system. Right?
Diana Rodgers, RD 11:32
You know, when I do talks with Robb, he’ll often say, and he probably said this in Wired to Eat but “if you’re not sick, fat and broken, you’re not doing American properly,” right? Like in our modern food landscape… I mean, and that’s part of the big problem, right, you have to have some level of tight food selection criteria in order to maintain health. And I think, for those of us… like, I’ve never been obese, similarly, you know, I have celiac. But other than that, maybe my vitamin D is a little low, that might be the only marker on my charts. And if I eat the normal standard American diet of whatever, three or 400 grams of carbs a day, I would definitely be obese today and type two diabetic. And I’m still super sensitive, and all of us are a little different. And some people seem to do much better on larger amounts of carbs. I’m just not one of those people. And I look at it as a gift that I know this instead of a curse that I can’t.
Josh Clemente 12:39
To me, what this presents is a tool that people can use. It is not an intervention, wearing a continuous glucose monitor does not change your habits. And…
Diana Rodgers, RD 12:48
Well, it did for me a little bit that I’ll talk about…
Josh Clemente 12:51
Right. Yeah, it’s… and different people will respond differently to that information, right. But the way we look at it is, today, and this is non-controversial. All this information can be found on the CDC website. 120 million Americans have pre-diabetes or diabetes. 95% of diabetes is type two, which the CDC says is a preventable chronic lifestyle-related illness. Nine of the 10 causes of death in the US are caused or worsened by metabolic dysfunction. So we’re in a situation where it is completely unambiguous. The problems that people are facing today are noncommunicable diseases that are developed over time through their choices. And the metabolic system. It’s how our cells get energy. Every cell in the body needs energy. And the way it breaks down, I think is unique to the individual. And this is the part that I think is most interesting. Most people are looking for that obesity signal to start caring about metabolic health. And for someone like me, my family does not historically have obesity. We do, however, have heart disease and dementia. And so I think the systems that fail first are the ones that are most affected by the flavor of metabolic dysfunction that your genotype develops or something along those lines. So it is absolutely not right. And Rob Lustig one of our advisors speaks to this very eloquently. It is not the obesity that we need to be worried about, it is the metabolic dysfunction. That’s what you need to focus on. Those are two different things. You know, I’m lucky enough not to have to deal with the weight issues. However, I have seen early-onset dementia in my family and it’s a devastating disease, and it is closely tied to glucose dysregulation. So that’s why I care about this.
Diana Rodgers, RD 14:24
Yeah. And I know or I’ve read that, that is the biggest fear people have as they get older is getting dementia. Right. And nobody knows that this is very closely tied to blood sugar regulation, type three diabetes. I mean, can we talk about that a little bit because nobody knows that.
Josh Clemente 14:43
Yeah, it’s pretty staggering. So my wife went through… So she changed careers a few years ago and became an RN. So while she was going through her nursing program, she sent me a slide deck. This was while I was still kind of in the incubation, kind of conceptual phase for Levels. It was very early on. She sent me a slide that they had been presented that morning that said, Alzheimer’s is type three diabetes. And it was shocking to me that that was already being taught in nursing school. And I’ve heard several medical school programs have picked that up. But it is unambiguous in the literature. I mean, Alzheimer’s shows insulin resistance of the brain. It’s clear. Whether or not it’s causal, I don’t know. But that’s something that has to get out there more is that these underlying systems, you know, essentially, when a system starts to break down – the brain, the muscle, the fat, adipose tissue, when you start to see systems failing, it typically is because there’s an energy problem and energy, you know, our cells need that energy to function effectively. And glucose is one of the primary fuels, right? It’s… unless you’re in a ketogenic state, it is the primary fuel for humans. So I think it’s a very obvious underpinning, if your cells cannot get the energy they need to function effectively, that system will start to break down. So it’s actually quite intuitive when you think about it that way that the brain and all these toxic byproducts and plaques that build up in Alzheimer’s and other dementias would be associated with a breakdown in mitochondrial efficiency or, you know, generally the glucose regulation. So that, I think, is like, we need to piece those puzzles together. And one of the problems is that we use symptom sets to name and label different diseases. But actually, what we should be saying is metabolic dysfunction expresses itself in all of these ways, get rid of the labels, and start to talk about all of the different symptoms, or all the different manifestations of one overarching problem, which is metabolic dysfunction. And the opposite of that coin is metabolic fitness or metabolic health. And we should not be… we shouldn’t be training our eyes on some specific disease. So how do I avoid getting Type Two Diabetes? How do I avoid Alzheimer’s? How do I assemble the choices each day that will lead me towards optimal health such that I don’t need to worry about that in the future? That’s how I’d like to reframe it as aspirational instead of avoidant.
Diana Rodgers, RD 16:58
Let’s talk about kind of the well. I want to talk about the things that can lead towards metabolic dysfunction and what that kind of looks like because it’s not just diet, there’s sleep, there’s stress. I know that very well. Even if everything else is on point, you can still develop insulin resistance just from being super stressed out from a trauma. And there are a lot of people walking around who are not obese, who are metabolically dysregulated. And we also know that there are certain populations like Asians who it is incredibly underdiagnosed in places like Thailand with really growing rates of type two diabetes because they’re not obese. They’re just walking around with it. And the change in diet is largely to blame for that. But let’s talk about what factors in your life other than nutrition… I mean, we’re going to talk a lot about food and how different people respond differently to foods, which is also one of the coolest things about wearing a CGM. Because Robb and I were comparing notes and he and I respond really differently to different foods. I’m cool with potatoes, he’s good with polenta, but like polenta for me is not okay. It’s so cool to know that individual stuff. But anyway, so let’s back up and talk about all the other pillars that you need to really be paying attention to in order to have metabolic fitness.
Josh Clemente 18:19
Definitely. So you touch on the differences between people. And then all of these other factors. And I think that is actually one unified argument or conversation is that we are each operating in a context, right, which consists of what we eat, how active we are, in which ways our sleep quality and duration and our stress levels. And I think that is what dictates how we respond to any of those factors, right. So if I’m sleeping poorly, because I have a newborn who’s crying all night, and I’m just not able to get to sleep, I am going to be, according to specific clinical research, at a 40% disadvantage in terms of my insulin resistance. So there are studies that have been done that show that just a single night of interrupted sleep, can cause up to 40% higher circulating insulin levels to clear the same glucose load. That’s a very fast response – one night of bad sleep. And you do that for a week and you start to get to the point where people are essentially clinically prediabetic. So that is the sort of context driver that I think explains a huge amount of this interpersonal variation. Although, there will certainly be perhaps… it’s like epigenetic or some sort of genetic underpinnings to why you and I might respond differently to polenta or potatoes, I think that the most aggressive day-to-day interpersonal, so… or intrapersonal… So my changes when I eat polenta today versus polenta in two weeks, I will also see variations there. And I think the explanation to that is this context of your overall lifestyle. It’s kind of put a pin in this there have been a couple of really fascinating studies that have come out studying continuous glucose monitors in people without diabetes. And one of the most interesting is a study from the Weitzman Institute in Israel. This is around 2015. They took 800 people, had them where continuous glucose monitors for seven days. And they had them eat a bunch of standard meals and compare responses. And they were able to show that two people can eat the exact same two foods. In this case, it was a banana and a whole wheat cookie. And they can have equal and opposite blood sugar responses to those two foods. So one person – flat on the banana, big spike from the cookie and the other person have the exact opposite response. So that’s like a staggering example. And what we need to study further and something that Levels is currently focused on with our research program is why and also what are the other downstream consequences. So if those people are having equal and opposite blood sugar responses, are they also having equal and opposite insulin release responses, because we can show that… then we really have shown that the food consequences are equal and opposite for those two people. It’s not just that their blood sugar temporarily rises and falls, if that weight gain, the sort of insulin resistance epidemic is being driven by two different problems for these two people. There are again, insulin, and the continuous cycling of it or oversaturation of the system with insulin eventually causes this numbness of the cells to the signal of insulin. So for people who are eating a food that they think is objectively healthy day-in and day-out, and driving their insulin levels higher and you know, sort of spiking, temporarily the sort of insulin circulating their system, they’re going to be getting further and further into insulin resistance, despite thinking they’re doing something good for themselves. So we need to start to show that it’s not just glucose, it’s actually the downstream mechanisms are also being affected by these choices. But it’s pointing us in the direction that this is a real thing. And these aren’t just like sort of fun differences actually could mean that there’s no optimal diet, there is no one size fits all diet. Certainly, I believe that today, and I look forward to being able to show it more completely.
Diana Rodgers, RD 21:43
Yeah, the idea that there’s only one optimal diet is absolutely ridiculous. And for those who are listening that are not quite as geeky, as you and I are, I remember this really resonating with me when I was first learning about nutrition and what insulin resistance was. One of my nutrition, alternative nutrition instructors through Nutritional Therapy Association, not when I was becoming a dietitian, but she said, you know, imagine, you work in an office and someone’s wearing really heavy perfume. And after a while just smelling that perfume over and over and over again, you don’t even smell it anymore. And that’s what insulin resistance is, and your cells are just like lalala I can’t even… I can’t even hear it anymore. Don’t even tell me anything else about insulin, I don’t want to hear it anymore. It’s too much. You know.
Josh Clemente 22:34
It’s adaptation. Yeah, I think that’s exactly it, is that we… our food supply and you know, take the individual, you have situations where we are constantly pushing ourselves into a high stress, poorly slept, I would say, oftentimes we workout in ways that don’t… I guess this goes back to your original question. But you know, we workout in ways that we’re kind of incentivized by our culture to workout… it’s like you have to go 150% every time you go to the gym, you know, 90 minutes all out, otherwise, it didn’t happen. And when you take the context of, did you sleep well? Are you eating right? Are you eating foods that work specifically for you? What are your stress levels? Are you leaving an extremely stressed-out work environment right now and then going and adding to that with high-intensity training? You know, I think these are the sorts of decisions that right now we’re making in a vacuum as though they are individual decisions. But in fact, they are all related and interdependent. So one of the, you know, just tactically some of the most interesting stuff coming out of our dataset… Right now, we have the largest dataset on non-diabetic blood sugar information combined with nutrition logs of its kind, as far as I know. We also collect data on activity from other wearables and sleep quality and sleep duration. So we have a really nice, refined data set. And some of the fascinating things are, for example, with movement or activity, I have recently learned through this project, just how important it is to just simply move, it doesn’t matter how intense it is really, I mean, of course, you can get performance benefit. But if you’re just trying to achieve better health, we push our members to try an experiment where you eat a food that you know, you’re going to have kind of an elevated blood sugar response to. So let’s just say eat pizza, and go on the couch and just watch a movie. And then a few days later, eat that same pizza and get up right after you finish and go for 25, 30, 40-minute walk. Just walk around the neighborhood, enjoy it, relax, no need to jog, and then come back and then compare those two blood sugar responses. And what people see… and this is, you know, robust across all different types of person, a dramatically different area under the curve and peak blood sugar response to that food. So just simply moving your body at a slow, leisurely pace, helps dramatically in absorbing that blood glucose directly into muscles, using it for your walk instead of your body having to release a ton of insulin and pack it into the fat cell which is the alternative. So that’s a very simple way that like the way that you are moving directly correlates with what you’re eating and vice versa. And then again, imagine if you are poorly slept or well-rested, those two things are also remember back to the 40% insulin resistance problem if you sleep poorly. So if you’re well-rested, you take a walk after big meals, those are both making you much more likely to be able to respond favorably to the same meal, right. So this is the context that we can develop by stringing together good decisions and understanding that all of it works together. And similarly, if you know you’re compromised like I said, if you have a newborn baby that’s keeping you up all night. Rather than kind of seeking comfort in indulging in foods, I think it’s actually even more important that we make these choices like walking after meals or choosing a salad instead of a pizza because we know we are compromised on one of those main verticals. So that’s the really fascinating thing is finding out that this thread is one long thread, you can pull it at different areas, but they are not discrete decisions.
Diana Rodgers, RD 25:48
Yeah, and I think we have such a culture of weekend warriors who are so sedentary and then they crush it in the gym, after being so sedentary, actually inducing even more… I mean, CrossFit can induce Cushing’s. So for folks who are highly stressed, it may not be to their benefit to be killing it in the gym. And just, I was shocked at just what walking did after lunch, or after dinner bonus after dinner, you know, and I… when I work with nutrition patients, and I try to help them with habit change, you know, breakfast, it’s a hard one to change. But once that’s flipped, it’s changed, like people tend to eat the same thing for breakfast every day. So once you kind of get them off their coffee with sugar, which they’re going to be kicking and screaming about. But once you do that you’re set, right. But dinner tends to be, I found, the time when people want to relax and indulge. And you know, maybe it’s more not as great choices because they have the extra time and they’re finally home. So just going for a walk after dinner can help manage your glucose spike, but can also get you off the snacking train, if you’re used to sitting in front of the TV and snacking. You know, I think it’d be really cool when you send Levels out to people to give them like a ‘choose your own adventure,’ little booklet for them to log, you know, like what you just said, like try pizza, you know, because I got it… And I can’t remember who I was chatting with, one of your team members who said, Okay, two things happen when someone wears this thing. One is they try to keep it as low as possible. And like never spike, which is actually was my initial urge, right? Like, how can I be as non-spiky as possible? So that’s what I did the first two weeks, and then I was like, Okay, well, I’m not learning anything. Um, although it’s keeping me quite compliant. And I have quite a few clients who will tell me that they’re being fine, but they’re not moving in the right direction. And so you know what, slap this thing on and see if you’re really, you know, right. But then when I did try to see what was going on, I just learned so many things. And, that I could even eat more carbs than I thought I could, which was a really liberating thing as long as it was in the right context. And as long as my sleep and exercise were on point, some butternut squash, some dessert, you know, once in a while a little bit of ice cream, you know, as long as it’s not in the middle of the afternoon on an empty stomach was okay.
Josh Clemente 28:22
Glad brought this line up. Because really the intention of Levels today is to generate that metabolic awareness, that objective, driven by data from your body understanding of how you respond to the choices you make. So there isn’t really a benefit to… for someone who’s never used a continuous glucose monitor and has no idea you know, what’s gonna happen to put that on and then try and you know, flatline it. Well, you’re just gonna eat the same thing until you’re done with the sensor. And then, like you said, you haven’t learned anything. What we want is for you to explore the boundary box, understand how all of these combinations and all these individual choices will affect you individually, and then start to piece together tactics. So you know, if you are going to have ice cream, maybe it’s best to walk to the neighborhood ice cream spot and walk back while you’re eating it rather than going and picking it up at the supermarket and eating out on the couch. Those are two very different contexts for ice cream. But most of us don’t think of it that way. We’re just like ice cream and ice cream is gonna have the same effect no matter what. So starting to realize, you actually have a really broad toolset. And you can decide the context for those sorts of choices is amazing. And so building the product to achieve that is certainly where we’re focusing now. We call them Guided Journeys right now, but we’re starting to build exactly that. You know, what is your current goal? Is it to just develop awareness? Or are you more of a CGM expert, you’ve been doing this for a long time, and what you really want is accountability and consistency. You know, you want to know that that data is going to be there to close the loop on your choices, and it will be the accountability system for you, which is kind of the mode I’m in now.
Diana Rodgers, RD 29:45
Well, and I think for a lot of us who are… I mean, I don’t know if you’ve read any Gretchen Rubin where she classifies people into questioners or upholders. I’m a questioner, and I think a lot of the people that are your beta testers are questioners right? So for me, I’m not accountable to anyone else other than myself, like I don’t, I don’t have any, like, other goals other than proving to myself. And so that’s why for me Levels is best because I can’t cheat myself because I have the data right there, right on my phone.
Josh Clemente 30:20
Ultimately, what underlies the Levels thesis, what we’re building here is that people respond to closed feedback loops, tight closed feedback loops. So what that means is that when you make a decision, you get feedback on the quality of that choice. It’s not feedback that comes to you weeks or months later, when the bathroom scale climbs, because let’s be realistic, if two months from now you find that you’ve gained 10 pounds, how are you going to relate that to what you ate for lunch today, right? Whereas if I can sit down for lunch today, and within less than two hours, I have a score based on how my body reacted to that food, I can then make a choice about modifying the ingredients of that meal, making a different choice like walking or just eliminating it all together and trying something different. So I can then iterate through these decisions with rapid feedback to decide what works best for me. That’s how behavior change ultimately sticks is that people have a feedback, you know. In the workplace, we want this… we want to know immediately is what I’m doing working well or not working well? How can I improve? And this is what you know, a feedback system for our bodies looks like. So we want to put the individual in the driver’s seat so to speak. Today, we expect people to not get sick when we have the most processed food system in history, the most sedentary sort of knowledge work environment in history. And we don’t give anyone information. It’s very sad. I make this financial analogy where it’d be like having your bank account and being told, do not overdraw or you’ll have to declare bankruptcy. However, you don’t get to look at your deposits or withdrawals, you have no bank balance information. Now make sure you don’t overdraw. That’s kind of the situation we’re all in here. We’re trying to make choices that are good for us, we’re hearing from friends, well, this worked for me, I lost five pounds doing that. And so we’re just experimenting, or we’re using emotion or frankly just comes down to flavor, like what flavors do we like. And we really have to change that paradigm and start to drive choices from feedback from our bodies. The next wave of this is that glucose is very interesting and important. But it’s not sufficient to define your health as an individual. So CGM today is a… it’s an amazing sort of benchmark, it’s a great way to start this new space of, you know, people using informational wellness, glucose information to make better choices. The next iteration is to take that same feedback loop mechanism and expand that across the molecules that define health. And there are many of these, you know, you can think about hormones. Think about insulin, which we talked about a little bit and its mechanisms. You can think about lipids, which certainly play a role in health, long term triglycerides as an example of one that we want to keep nice and controlled. And so we’re looking to the future and thinking, what is the biological observability platform look like? Which essentially, how to find that is the continuous molecular monitoring platform that always tells you your health status in real-time and not just a single molecule, but many. And then how can we activate something like that to give you a full, high-resolution awareness of where you stand today – the full bank account balance everything that you’ve got in motion, and help you close the loop on the choices you’re making continuously. You know, one example might be, if you could sit down for an hour of watching mainstream news on TV, and then you get up, and you’re trying to wind down for the day. And you could see that your cortisol levels had shot through the roof while you were sitting there watching TV. That would be a really nice way to close the loop on the stress mechanisms that are in our life that we could probably evolve or adapt. And maybe that looks something more like reading traditional books, or going for a walk after dinner instead of sitting down for the news, you know. So there’s a future where we have these closed feedback loops that go well beyond glucose to define whole person health across the sort of vectors are there in our control today.
Diana Rodgers, RD 33:58
Well, yeah, and I have a good example of that, too. Because one thing that I learned that was shocking to me when I was wearing the glucose monitor was that tequila makes me crazy hypoglycemic and triggers my hunger cues. And so it’s not just, you know, when I first went paleo, and I was like, you know, first dropped all the carbs. I felt incredible. But then once you have that dialed in, there’s so much more to know. Right? And one is how you individually respond differently than other people. But the other is, it’s not the only solution. And I was dipping so low at nighttime while I was sleeping. And then I started reading about it. And I was like, oh, that’s why I had nightmares that night because I was actually super, super low glucose. And it can actually make you hungry. So now I’ve learned that one I have to watch how much tequila I drink and maybe not drink so much of that. But the other is to actually have a little bit of carbs with my meals so that I don’t go super hypoglycemic because my body tends to go really low really easily.
Josh Clemente 35:09
Yeah, this is another huge area of I think information and education that this product allows is that for most people, they assume that alcohol is going to cause a huge blood sugar elevation. And someday… I’m going to talk specifically about ethanol here, which is, you know, just the pure ethanol. If you start adding mixers, you start adding cocktails, sweet drinks, etc, yeah, certainly you can. But if you just have like, you know, something on the rocks, or you have a kind of a light wine, or, like you said, you know, tequila soda, something like this, most people are actually seeing their blood sugar drop. They’re seeing a decline. And what’s happening there is your liver is reprioritizing triglyceride production. So you can only really turn ethanol into triglycerides. They can’t really be used by the cells in the other way. So the liver seems to be reprioritizing that and in the process, it’s not releasing glucose into the… from the liver into the bloodstream. And so you have this like, dip in gluconeogenesis, or glycogen release from the liver. And I think that seems to be what’s happening, but it’s not very well studied. And this was so surprising to us how robust and consistent this response was that we have education that pops up in the app now, where if you log a beverage that has, you know, alcohol is one of the ingredients, we will surface that insight for you if your blood sugar drops, just so that you can know that this is something that you may not have expected. And there’s an opportunity here to learn about it. And I like to kind of think back to my, you know, college, post-college days where there are many times I would go out, you know, after work and in the US, we like to push alcohol drinking too late at night as late as possible. So it’s 10pm or something, you’re out having a few beers. And by the time you know, you leave the bar, it’s it’s close to one o’clock in the morning. And I’d be just absolutely famished. starving, and so you know, just like I would eat anything in my path. And so I’d go to a food truck or go to a restaurant or something, I’d eat a bunch of takeout. Now that I have sleep tracking information, I now know that the consequences of that alcohol are, I’m going to sleep terribly all night long. I’ve got a full stomach of food that I needed just to feel comfortable, because I was hypoglycemic because my blood sugar was crashing, I would wake up the next day poorly slept. Now I’m insulin resistant, because I slept poorly. And I would be I’d be starving again. It was just like I, as someone who when I’m eating consistently and within my sort of nutritional decisions, I’m rarely hungry. I wake up just famished. And then I’d go and of course, I would indulge even more so because I was poorly slept and I was insulin resistant. And I was hungry because I was hypoglycemic. And so this cycle… I started to understand the full spectrum of that cycle of decisions, which stretched not just from 10pm when I had those beers, but all the way into the next day and the day after, because my sleep was disrupted. And because I was insulin resistant, and because I was hypoglycemic from those choices. So once you start getting that insight, you start to realize, wow, like a simple different choice, for example, I try and just have alcohol, I’m going to have it at home and have it around happy hour, five o’clock. Not gonna have it at 10pm. Because that spares me that late-night indulgence. And that disrupted sleep. Right, right. So
Diana Rodgers, RD 38:08
Right, right. So, if you just have… I always, you know, recommend people just cut it out for the first 30 days, just to clear out everything. But then when they start to pull it back in again, one drink while you’re cooking dinner, or happy hour, and then you’re gonna have a second drink… one drink with dinner. And then that’s it, like not only close the kitchen by seven, but close the tap by seven. Let it cycle through your system, be clear-headed when you go to sleep, and then you don’t feel anything the next day, and you slept well. And so that’s, you know… Glucose Goddess has a lot of really cool tips like that, too. I don’t know if you follow her? Yeah, but like, there was one recently it was really clever, where she said like a margarita and salsa dancing or a margarita and sitting and watching other people dance, and like, you know what your glucose curve was so…
Josh Clemente 38:56
Right, and those are the insights that you know, people find so fascinating. I love that because, you know, she… I think her following is just exploding right now, which is so great, because she’s demonstrating sort of these n of one experiments. You know, she’s trying all these different things that people are out there living their lives doing every day. And people find it so fascinating to realize that their intuition is correct. Their intuition is that I feel differently when I do something versus this other thing. And now there’s she’s starting to put names, to starting to put evidence behind it. And I love that there is so much interest in that because it points to the future, where I feel very optimistic about this space that you know, the individual, independent of any sort of disease diagnosis wants to know their health status. They want to live a long, healthy life. And understanding that it does matter the choices you make. Even the small nuance ones do matter to your health and sometimes in very significant ways. People love that they feel empowered. It’s like, you know, having that information and being able to make educated decisions about me is a lot different than being told that the average person, by the way, the average person doesn’t exist, should do this. Yeah, well, that’s not specific to me. It doesn’t help me choose whether I’m going to have a margarita and go salsa dancing, or you know, have margarita and go sit on the couch. I think this can provide the encouragement to change your lifestyle across everything from social decisions through to how and when I sleep and whether or not I watch the news versus reading a book.
Diana Rodgers, RD 40:17
Yeah, it’s so crazy right now that I can even go and check my vitamin D status without going through my doctor who I actually just right before we got on, booked a physical for August. And right now it is January. And that’s as soon as I could get into see her. Not an emergency but I would just like to have my panel done and just know where I’m at, can’t find out until August. And maybe she’ll order the tests that I’m requesting likely not. She’ll probably only do TSH, and I’ll want the full thyroid panel, blah, blah, blah, we kind of go back and forth with that kind of stuff. So are you going to be or maybe you can’t talk about it, but is that one of the things on your horizon is allowing people to be able to find out much more about their blood work?
Josh Clemente 41:06
Absolutely, yeah, it’s becoming more and more clear through this whole project, how important it is that we have a nuanced perspective available to people about what matters. Again, we you know… you can locally optimize blood sugar, let’s just say, and as we talked about, alcohol will cause hypoglycemia. So you could drink a lot of vodka during the day and some canola oil and heavy cream and do that all day every day and you have a great blood sugar curve on a CGM, but you’re probably not getting healthier. In fact, there could be some hidden consequences there that won’t show up for many years. And I think eating a healthy ketogenic diet versus eating a dirty ketogenic diet, both of those are available today is very different in terms of consequences to your health down the line. And so being able to not just provide information about glucose, but more consequential high-resolution information about your whole health through… we’ll call it 360 degree metabolic health status. That is the mission and vision of Levels. So today, we’re taking that on two ways. No, let’s call it three. We have the CGM program, which is demonstrating these close feedback loops continuously. We have the education platform. So we put a lot of effort into being thought leaders in metabolic health spaces. And so our blog, our podcast efforts… Casey, my amazing co-founder, she’s a former Stanford surgeon turned functional medicine doctor and she’s making this message loud and clear that people have the ability to continuously take control of their choices and their actions and learn from them. Then our editorial system and blogs, just publicly publishing the information that is now like, sort of, in these primary literature papers like hidden in academia, turning it into approachable content. People don’t understand the, you know, the context here, what we mean, when we talk about insulin resistance, you know, that is a foreign concept to most people, and it’s because they’ve never been taught. So really building that education platform so that people understand why we should measure these things and care about them. And then lastly, building that future biological observability platform where these molecules that are critical to your health are available continuously. So that last piece, right now we’re experimenting with what we call the Metabolic Health Panel, which is a new way to get blood work. You can order it through the app, and someone will come right to your home, a licensed phlebotomist, and draw blood. And you’ll then have those results in the Levels app a few hours later.
Diana Rodgers, RD 43:29
Wow.
Josh Clemente 43:30
And that is, I’m very excited about this. Because as you mentioned, there’s a lot of friction right now trying to get try to even find a physician who intellectually buys into these sorts of things like measuring your blood work and making choices based on it. So we’ve been in…
Diana Rodgers, RD 43:47
And part of the time, it’s not even just them, but it’s like, what is insurance going to justify paying for? If I’m a healthy person, then she can’t order my thyroid panel. Right?
Josh Clemente 43:57
Yeah totally. Yeah. And that is an issue that we are still going to be navigating because right now all everything that Levels produces is general wellness, right? And so it is not for diagnostics, it’s not for screening, it’s not for treating any condition. So right now, insurance does not cover any of Levels products. And that’s actually by design, we’ve chosen to take a direct consumer path, because we really believe that we need market forces to create… you know, massively open up this market and push pricing down through competition, frankly, eventually…
Diana Rodgers, RD 44:25
I’m a huge believer in all that stuff. And so is Robb too. Yeah, exactly.
Josh Clemente 44:29
Yeah, I think, you know, it’s been demonstrated many times, we really need to break apart the paradigm of traditional healthcare and make this very obvious, you know, who is the customer? Who is the provider? What’s the cost? Today, it’s just completely shrouded, it’s impossible to understand what you’re going to have to pay. So we’re taking a stand there and saying, This is how it should be. You should know the price up front. If it’s worth it to you, you will pay that price and eventually, as more of you come to this marketplace, we’ll be able to push the price down together through increased supply demand. That’s our hope and then eventually, you know, to get to people who need this across all socioeconomic categories. We will eventually have opportunities, I think as the regulatory environment changes, and as insurers start to pick up on the fact this really is meaningful. But for today, that metabolic health panel is, you know, we’re still in development, we’re rolling it out slowly and carefully. But we’re incorporating the tests that have been demonstrated to be super meaningful, and the important markers, like as I touched on triglycerides, ApoB, the NMR lipid profile, so understanding not just your cholesterol level, but specifically what the particles are and what their sizes are, and their densities. This is the stuff that’s really… it’s very esoteric, it honestly… we will have a, you know, a long road ahead to get to the point where we even understand it. But all the nuance there can be, I think, cut through with some very intelligent product design. And so we’re really hoping that we can build a product that gets people interested and engaged with their health metrics continuously. So something that you want to optimize, as opposed to just being a number that’s printed out in a PDF that you throw in a drawer somewhere. And then lastly, we’re thinking about the future of continuous monitoring. So what are the technologies that are being developed that will eventually allow you to not just have to get your blood drawn for that vitamin D level, but know it continuously and know how it responds to your choices. And that’s the true future.
Diana Rodgers, RD 46:16
Yeah, because just sunlight in the summertime is not enough. People think, Oh, I am outside the summer. And so my D should be fine. Not really. Or it might be fine for a few days in the summer.
Josh Clemente 46:28
Yeah, in certain latitudes, like, you just can’t get enough vitamin D, especially during winter months, there’s not enough incident light. So you know, those are the sorts of things that understanding the underlying mechanisms, which we have a research program going right now we have just a list a few names. We’ve got Dr. Dom D’agostino. We’ve got Benjamin Bickman, Molly Maloof, Sarah Godfrey, Joel Shulman. We have this amazing roster of physicians and scientists who are helping us dig into the mechanisms behind the specific like, how do these pathways develop? Or break? And then understanding, okay, what are the core markers that indicate that you are heading this direction? Or you’re already there? Or you’re moving in a good direction? And then that feeds into these choices about what are we monitoring. What’s available in our metabolic health panels? And then what should we be measuring continuously? And so this is all sort of like several pieces that we’re trying to build in parallel such that in the future, you’ll be able to know directly, what needs your attention today, you know, what are the choices that are most important for you, and that might be vitamin D in the winter, it might be something like zone 2 metabolic health training on the bike to improve your mitochondrial efficiency to bring your fasting glucose down. And in the summer, you know, it may change. And it’s not entirely clear to us today, because so little has been invested in these continuous biomarker monitoring platforms. But that is what Levels will be doing for many years.
Diana Rodgers, RD 47:45
And I’m so excited about this too, because, as a dietitian, I do have access to a lot of biome testing, and other types of testing for folks, these, you know, IgE, a lot of stuff that’s really questionable, right, not super supported by the evidence. And frankly, a lot of people have been suckered into paying a lot of money for these things that at the end of the day, we don’t even understand very well, but it’s like a way practitioners like markup stuff. So to be able to just go directly to, you know, no conflict of interest there and actually get legitimate information, I think, is really fantastic.
Josh Clemente 48:23
Yeah, that’s, I’m glad you brought that up. Because one of the things that we’re doing is, well, there’s two kind of company philosophy choices that we’ve made here. One is that we strongly believe that transparency has to be introduced to the health care system. And any companies that are operating in wellness and health have to be more transparent about what their offerings truly do, and why. And so what we’ve chosen to do is we have a built-in public philosophy. So all of our investor updates, all of our Friday forum all-hands meetings, are posted on our website, after 12 months so that the sensitivity of the information is a little bit less acute. And so we post all of that. And then we widely circulate a lot of memos about exactly what we’re doing, including our business model, or our basic market analysis, our product decisions, all of these are available, that we share them widely. The decision there is that we want to be able to foster trust with the people who are using our product. We want to make sure that if we are doing something that is not supported by science, we are maximizing the opportunities for other people to let us know if we’re making a bad decision. And we’ve been corrected before Hey, you should be looking here instead of there, or I disagree with this choice, you should really reconsider. And it’s been really, really helpful to essentially crowdsource in a sense, the choices we’re making, and of course, this has attracted people like our advisors, Rob Lustig and David Perlmutter, and all these others, Mark Hyman, who have come into our into our circle because they’re recognizing, okay, they’re open, you know, Levels is really seeking to be the thought leader here and in order to do so we have to understand exactly what true north is, so to speak. And then the second decision is we’ve adapted a business model which we’re putting into place right now. It’s a membership model where, rather than having just a transactional relationship where we have to sort of markup products in order to make margin to operate our business. Instead, we have a membership, where that arrangement allows us to completely disengage from how many products of a certain kind someone is buying. We can no longer… our incentives will be aligned with the individual where if you’re a member of Levels, we can make recommendations based on what you tell us you’re interested in. We actually don’t care if you buy 10 CGMs a year or once a year, because we’re going to sell those at cost. So we’re going to drive all of our products towards at cost. And the membership fee will be how Level supports itself. This is a bit of an experiment. But the intention is, again, it’s to align incentives so that we’re not just trying to push more stuff out the door. It’s that we want to make sure that the person who is trying to achieve some goal can make the decisions and purchase the products that they will that will support that goal. And that might be very different for someone who is, let’s say monitoring gestational diabetes, versus someone who is just simply trying to lose a few pounds for summer, right. And we want to be able to accommodate all of those different circumstances.
Diana Rodgers, RD 51:09
Yeah. And I think it’s the difference between a stockbroker making commission per trade versus on your overall growth.
Josh Clemente 51:18
It’s a nice way to put it. Yeah, there’s a… interestingly, Costco has a business model just like this. So yes. We based a lot of these decisions on some internal memos from Costco. So it’s, you know, it’s one of those things that I think as with most of the decisions, you make an early-stage startup, it’s experimental. And what we want is to be able to have a very strong community of people who understand why they’re doing what they’re doing. They’re not just doing it because they’re told to, and that our incentives can stay aligned, we don’t end up with sort of these dark patterns where you intend to do what’s best for that individual, that customer that member, but because of the underlying incentives of your business model, you actually end up pushing them too far, or it’s too expensive, or you’re recommending things that don’t actually help them. So we want to try and avoid that at all costs, especially when you’re dealing with, you know, circumstances where metabolic health is affecting our dysfunction, is affecting so many people across so many different categories. It’s not, you know, we don’t intend to build a fun toy for wealthy people. We intend to reverse the metabolic health crisis. And to do that, we are going to have to reach millions and millions and ultimately billions of people potentially. So, you know, we can’t have a situation where it’s priced out of range. And, you know, frankly, too esoteric to understand it has to be approachable, affordable, and available.
Diana Rodgers, RD 52:34
Gosh, I mean, I just see so many applications for this for first responders, for just anyone who needs to be fit for their job. I mean, anyway, I’m a huge fan, obviously, of your product. And it’s been, it’s been a couple months. So I think it’s maybe time for me to pop another one on and start experimenting. Again, folks who follow me, we’ve done a little bit of promotions with you outside of this podcast, but I am able to offer people who are listening to jump ahead of the line and be one of the beta testers at sustainable dish.com backslash levels. And that will take you directly to the page where you can sign up yourself and try it out. And I recommend a full month at least. And then taking it from there, you may find like me that you’re just automatically a lot more compliant if you are wearing one of these things, because you can’t cheat yourself. But it’s also really cool information to learn about, you know, your overall lifestyle. And that plus, you know, I don’t know if there’s any thought you’ve given to linking up with like a food tracker with calories and all that. But chronometer is what I recommend to my followers just because it gives you the micronutrients breakdown as well. And so you can see what your iron intake is. It’s not always adjusted for bioavailability. But it’s the best tool out there. So, kind of like merging the chronometer with the CGM, I think can give you a perfect snapshot of you know, what you’re eating and how it impacts you.
Josh Clemente 54:08
We’re definitely evaluating that right now. We’ve been optimizing for ease of logging to maintain adherence. So we want to be as easy and quick as possible, but it’s something we’ve heard a lot of requests for. And chronometer, in particular, has come up many times. So stay tuned for some integrations, I think we’ll have a bit more awesome bandwidth in the next few months.
Diana Rodgers, RD 54:26
Yeah, it definitely is a lot of widgets to have to go through at the moment. But yeah, if you guys had one of those like built-in, that’s dietitian wish for your product. Um, anything else that you want to mention before we go?
Josh Clemente 54:42
I would highly recommend checking out our blog. I think it’s the best way to become more familiar with what we’re doing and in particular, what’s available through the Levels ecosystem. And so that’s levelshealth.com/blog, and then you can follow us @levels on Twitter and Instagram. And you can sign up for our newsletter as well. We like to circulate quite a bit of information through that newsletter. So thank you to anyone who is interested in learning more, and that’s the place to start.
Diana Rodgers, RD 55:07
Alright, well, I don’t often have fully commercial-type podcasts on my show, but when I really love a product, I do. So happy to have you, really cool background and story and product. So I wish you guys the best of luck with your company.
Josh Clemente 55:25
Thank you very much, Diana, I appreciate you diving into this stuff with me and I look forward to hearing how your updated product trial goes. Awesome.
Diana Rodgers, RD 55:32
Awesome. All right. Have a great day.
Josh Clemente 55:34
Alright, you too, Diana. Thank you.
Diana Rodgers, RD 55:36
Thanks so much for joining us on the Sustainable Dish Podcast. If you liked the show, please leave us a review on iTunes, and don’t forget to sign up for our newsletter at Sacred Cow dot info. See you next time. Thanks for listening.
