Continuous glucose monitoring can be a powerful tool for gaining real-time insights into how diet, lifestyle habits, and the many decisions we make daily affect our health. Retired astronaut Scott Kelly tried a CGM for a month and shares his personal insights. Scott Kelly and Josh Clemente discuss how CGM can be used to effect habit change, what Kelly’s participation in the unique NASA Twins study was like and what was learned, and insights Kelly gleaned about society and the environment while viewing Earth from space.
- Scott Kelly, retired U.S. Navy Captain and Astronaut: http://www.scottkelly.com/
- Endurance: My Year in Space, A Lifetime of Discovery by Scott Kelly: http://www.scottkelly.com/endurance
- Scott Kelly on Instagram: https://www.instagram.com/stationcdrkelly/
- Scott Kelly on Twitter: https://twitter.com/StationCDRKelly
3:55 — CGM provides insight into eating and lifestyle habits
Scott Kelly describes the insights he gleaned from wearing a continuous glucose monitor (CGM) and how he thinks such a tool could be beneficial for others.
This shows you what you’re eating that’s good, what you’re eating that’s bad, how your body is dealing with it. And like I said, incredibly, incredibly powerful tool. I lost over 20 pounds in three months, and some of the stuff I thought I was eating that was good was actually some of the worst stuff I was eating. Like healthy cereal with oat milk. To get that data—almost immediately after you eat something or you exercise—is so, so powerful and something I think we should have available to especially younger people that struggle or are struggling with their weight. obviously the advantage to diabetics is huge, but even for people that don’t need it for diabetes, just the insight it gives you on your health is just absolutely incredible. So that’s why I reached out to you to talk about it because people need to know about this and we need to get this especially to kids that struggle with their weight to show them in real time what they’re eating that’s good, what are their healthy habits and what are their unhealthy habits.
6:06 — Our hundreds of daily actions have an impact on our health
Although we often don’t notice an immediate impact of our daily actions on our health, these actions are compounding and can lead to either chronic health issues or improved metabolic health, depending on what we’re doing.
The thing that it helped me with is realizing that these actions I’m taking—I’m taking like hundreds of daily actions—are not happening in a vacuum; they don’t have a non-impact on my health, right? They are actually having an impact on a pretty core and important fuel source for my body, which is impacting hormones. And those are connected to chronic risk and they’re compounding on each other over really long timeframes. And that’s why you end up with a chronic health outcome, but that’s so completely out of sight and out of mind in our daily lives. I mean we’re just going through life picking something to eat because it tastes good or because we heard it’s good for us and we just have no real feedback. So being able to like sort of smash that window with a piece of hardware and data stream is pretty powerful.
13:28 — The “normal” range for various biomarkers isn’t necessarily the optimal range
Bloodwork results are often used to diagnose a problem, such as Type 2 diabetes, but if a result is in a “normal” range, patients generally aren’t provided info on how to prevent moving outside of that range or how to make changes to achieve an optimal result.
I think that what you’re touching on there is really interesting because most people, when they get bloodwork, they get a pdf or print out. You’re either in range or above range, and there’s really no question about what to do with that information unless you’ve crossed a boundary, like this line that we’ve drawn that says this is the high-risk category. I think one of the huge benefits potentially of this technology is that we can start to think of molecules that are in our bodies that sort of describe how we’re functioning and what our risks are as not some cliff that you can fall off, but actually this gradient that you are moving on at all times.
17:07 — How CGM can help change eating habits
Even though CGM generally isn’t covered by insurance for people who don’t have diabetes, the cost of using for even just a month can be a good investment in long-term health, Scott Kelly says.
What they learn in that month will have a lifetime of health benefits that will be paid for thousands of times over, in my opinion. If people use the information they got to make adjustments. Now when I eat something sweet on the occasion, it’s like too sweet for me. I used to drink orange juice every once in a while. I tried a little orange juice; I could barely even stomach it because it was just so sweet. So it shows you that you established certain habits and then it basically caused me to completely change my diet, which has had significant impact on my quality of life.
18:12 — Menu items labeled “healthy” aren’t always healthy
Josh Clemente describes his large glucose response after drinking a pressed juice.
I was in New York, and I hadn’t slept well. I was going into an investor meeting, and it was just a green apple, carrots, and celery pressed. I’m drinking this thing, and my blood sugar was well above 200 mg/dL. For people who aren’t familiar, over 180 mg/dL is considered a response that you would typically see with diabetes to a meal. So I was over 200 mg/dL. And this was the interesting thing: the drink on the menu was called Health Drink. That was their health drink recipe. And again, it’s just fruit and vegetables, but the immediate response and the way that I quickly wanted to learn more and started to understand: well, when we press that juice out, we’re stripping all the fiber out of that fruit and vegetables and causing it to hit the bloodstream instantly. And if I actually just eat some celery, eat some carrots, eat a green apple, I have a completely different response. And so fairly nuanced concepts like that become possible to understand and honestly interesting when you have that immediate feedback. And it’s really a magic moment because it’s able to take this abstract idea and make it something that becomes behavior change and habit.
23:56 — The epidemic of Type 2 diabetes and obesity
CGM can be a tool to help reduce the risk of some prevalent chronic health conditions.
I think I might put it on again at some point over the next year just to double check on how I’m doing on my habits and stuff—aa trajectory check. And then what would be a good price point to make it available for everyone that needs it? It’d have to be pretty low. Because a lot of people in this country, a broad demographic of people, could probably use this technology. I think you would have to get it pretty low. But if maybe insurance companies pay for it, maybe the government would pay for it or offset some of the costs, because I do think it has incredible value and insight and we do have such an epidemic of diabetes and obesity in this country. I can’t say it enough just how incredibly powerful and insightful this tool is. So I hope people get the message. And if they have the means to consider using it because everyone I’ve turned onto it are like blown away by how incredibly valuable it’s been to them.
30:49 — NASA’s Twins Study
Scott Kelly describes NASA’s Twins Study, which he and his twin brother, Mark, were a part of.
There were some interesting results. My microbiome changed while I was in space, and my brother’s didn’t. And I think that’s interesting because it shows that there’s stuff on the space station or something about what we’re doing that affects our microbiome, which is incredibly important to our health. Imagine if we could monitor that. If we could tell, “Hey, your microbiome’s in good shape or bad shape.” I don’t think we know enough about the microbiome at this point. But someday we will. And yeah, we’re realizing how important that is for our health.
34:30 — Being in space can lead to muscle and bone atrophy
Scott Kelly explains more about what being in space was like for his health.
The diet is made by nutritionist. Now granted, you can basically eat whatever you want, which I guess you could just load up on candy in the space station if you wanted to. But generally the food is made by nutritionist, so it’s considered a balanced diet. They monitor our mental health while we’re on board and pre-flight, making sure we’re mentally prepared for the flight by having discussions with a psychologist, psychiatrist. We did that every couple of weeks in space. Physical exercise is basically mandatory while you’re on the space station. Even if it wasn’t mandatory, you’d still want to do it, probably even if you hated exercising, because you feel it when, like the exercise machine breaks after a few days, you just feel like your muscles are atrophying. Your bones are atrophying at the same rate—basically 1% of your bone mass a month you would lose if you didn’t do anything about it.
40:17 — Gravity plays a role in our physiology
Scott Kelly describes the impact a lack of gravity had on his health.
Our physiology evolved for our heart to push against gravity. And that’s a strong force. It has to push that blood up to our heads—keep it from pooling in our feet—to where we need it most, our brain or other vital organs. And when you go to space, you don’t have that gravity—now your head’s swollen. Your body’s trying to adjust and lose all that fluid. But at the same time, your heart does not have to work nearly as hard as it did. So despite your efforts, you lose that heart mass, which came back over time when I got back on earth. I don’t know how long it took, but, yeah, that absence of gravity…we evolved with gravity. Our physiological systems evolved in a way to function in gravity. When you take that away, it causes other problems.
48:20 — Looking at Earth from space can provide an interesting perspective
Scott Kelly describes the observations he made from the space station about society and the environment.
When you’re in space, you see land masses, continents—you know there are people there. They’re very similar to us. In some cases they’re suffering. They have challenges. Living on a multibillion-dollar space station for such a long time gives you a sense that we can do some incredible things, but we can do them really only if we work together as a team. And when you look out the window and you see Earth without those political borders, you realize, I think a little more so than before your flight that Earth is a team too. And we have to take care of the environment. I mean, it looks very fragile from space. The atmosphere looks like a thin film over the surface, like a contact lens over somebody’s eye. Despite the planet’s beauty, some parts of it are almost always covered in pollution, particularly China, parts of India, Central America. The rainforest in South America—over the course of my 16, 17 years that I flew in space, noticeable changes for the worst. So that’s part of our life support system of the planet. I think it would be really great if everyone could experience those kind of perspective changes…I think we’d be better for it.
Scott Kelly (00:00:06):
Why wait until you have an illness and have a symptom and then go to the doctor to get it fixed when you could have some kind of wearable that will give you maybe years in advance that you’re developing a problem. I would imagine as this technology grows, that’s not only the future for NASA, but it’ll be for all of us.
Ben Grynol (00:00:35):
I’m Ben Grynol, part of the early startup team here at Levels. We’re building tech that helps people to understand their metabolic health and along the way we have conversations with thought leaders about research backed information so you can take your health into your own hands. This is a whole new level.
We know that environment very much has an impact on your body and your metabolic health. Well what happens when your environment is drastically different than what you are used to day-to-day? Well, this was very much the case for Scott Kelly. Scott is an American engineer, a retired astronaut and naval aviator. Scott’s a veteran of four space flights and he commanded the International Space Station on Expeditions 26, 45 and 46. His first space flight was a pilot of space shuttle discovery in December of 1999. Now we fast-forward to today Scott had lots of impacts that happened to his body as he went to space and returned back to earth, something that is an experience that very few people have gone through. He talked about it with Josh Clemente, co-founder of Levels and talked about how this pertained to things like his metabolic health, what happened to his muscles, what happened to his overall energy levels, what happened to the way that his body metabolized different things.
Eventually he found Levels very recently and he became a member where he started monitoring his own metabolic health and he saw how things like his glucose can be drastically impacted and changed just by the things that he ate. A story that many of us are familiar with and many of us can relate to. Even though Scott has experienced life in space, which very few people have, he also navigates the world in the way that many of us do, the way that foods affect our health. So Scott and Josh, they sat down and they talked about his metabolic health, his journey with levels and some of the things that he’s learned along the way through his extensive career. Anyway, no need to wait. Here’s Josh.
Josh Clemente (00:02:55):
Really excited today on a whole new level to welcome Scott Kelly. Scott is a former military fighter pilot, test pilot, engineer. He’s a retired astronaut, US Navy captain and a veteran of four space flights, including what I believe is still the record for the longest term mission on the International Space Station, which was set in 2015. This mission, it was the longest for a single American astronaut and it also was the basis for the famous twin study, which I’m very excited to talk about. Kelly has since authored a bestseller endurance, A Year in Space, a Lifetime of Discovery. Scott, I’m really excited to talk and look forward to digging into some of this material.
Scott Kelly (00:03:32):
Yeah, thanks Josh. And I don’t know if your listeners are aware of how we came connected, but my brother’s son-in-law, my niece’s husband, he’s a recently graduated PhD in normal science and my brother was getting sworn into the US Senate this last time in January, was in DC and talking to this guy Mark. He told us about this glucose monitor he was wearing and how much insight it gave into your metabolism and your overall health. And so my wife and I were interested enough in it, we got it and we were just both shocked by how incredibly powerful it is to see your metabolism respond to what you are eating. Normally the feedback loop on that is weeks or months or years. You know, change your diet, you see an effect far in the future. This shows you what you’re eating that’s good, what you’re eating that’s bad, how your body is dealing with it. And like I said, incredibly, incredibly powerful tool. I lost over 20 pounds in three months and some of the stuff I thought I was eating that was good was actually some of the worst stuff I was eating.
Like healthy cereal with oat milk. But to get that data almost immediately after you eat something or you exercise is so, so powerful and something I think we should have available to especially younger people that struggle or struggling with their weight. And obviously the advantage to diabetics is huge, but even for people that don’t need it for diabetes, just the insight it gives you on your health is just absolutely incredible. So that’s why I reached out to you to talk about it because I think people need to know about this and we need to get this especially to kids that struggle with their weight to show them in real time what they’re eating that’s good, what are their healthy habits and what are their unhealthy habits. So I’m so happy to be able to talk to you about this because as you can see, I’m pretty excited about this technology and where and how it can help so many people.
Josh Clemente (00:06:06):
Let’s just sign seal and deliver that. That was an awesome testimonial. I really appreciate first of all the interest that you, you’ve sort of shown by stepping into an early stage product and giving something like this a chance. And then obviously it’s amazing to hear about the results in the short timeframe. I mean this technology I think is obviously in its infancy, but the fact that it gives a person a sense of control and kind of puts you in an empowered position to understand what’s happening in real time as opposed to the traditional healthcare strategy, which tends to be a single point in time a year or maybe once or twice a year that you get some data point and you then extrapolate that to try to understand where you’re going with your health.
And I think one thing that is that it has helped me with, and I’d love to share some background on how this whole thing started, but the thing that it helped me with is realizing that these actions, I’m taking hundreds of daily actions and these are not happening in a vacuum and they don’t have a non-impact on my health. They are actually having an impact on a pretty core and important fuel source for my body, which is impacting hormones. And those are connected to chronic risk and they’re compounding on each other over really long timeframes and that’s why, you end up with a chronic health outcome. But that’s so completely out of sight and out of mind in our daily lives. I mean we’re just going through life picking something to eat because it tastes good or because we heard it’s good for us and we just have no real feedback.
So being able to smash that window with a piece of hardware and a data stream is pretty powerful. And anyway, I’d love to learn more about… I’ve got several questions about your experience and I guess the first one would be what was it that was interesting to you about metabolic health or about something that is effectively a metabolic health monitor in the first place? What sort of caught your attention about the product and made you want to give it a chance?
Scott Kelly (00:08:02):
A couple things. One thing is that interested in living a healthier lifestyle. And if you think about it, the stuff we eat has probably more effect on our health than anything else we do, more than the air we breathe, more than probably even exercise. ‘Cause if you consider the amount of stuff we put in our bodies in the form of food, that is probably the… And I’m not a scientist and I don’t study this stuff, but I would think that has the biggest impact on our overall health. So I was interested in it from that perspective, but also I’m not a scientist like I said, but I’m a science-minded person, engineer by education and I’ve done a lot of science. So the science aspect of it was interesting to me too, not only for what your product currently does but potentially what are the other similar types of technology that maybe you’re working on, other people are working on that’ll be very similar to this.
So it was a combination of my personal health but also interested in the technology because I do think this kind of wearable tech that tracks many aspects of our health is just going to become a bigger and bigger industry. And like I said, I’m just interested in this kind of cool stuff. Once I used it, the amazing insight… And I only used it for a month because basically, I learned everything I needed to learn in a month about what I was eating and drinking that was bad. And surprisingly stuff that I thought maybe was bad, at least from a metabolism perspective or your glucose response, isn’t bad at all, you can go out and eat the best steak and drink. But if you drink one IPA, watch out. And then not only did I lose weight, my joints feel better, my digestive system feels better. So there’s a whole other advantages and then there’s all the stuff that are not symptomatic that you don’t see that I’m sure is going on inside of us as we adjust our diet to be something healthier.
Ben Grynol (00:10:45):
One of the many things that we do with Levels is create content about metabolic health. The main thing that we do is we have an app, the Levels app pairs with the continuous glucose monitor so you can track your glucose in real time. More than 40,000 people have used Levels to lose weight, gain energy and increase longevity. You can see how things like food, sleep, exercise, stress and environmental factors affect your metabolic health. And Levels is backed by some of the best thought leaders in the world, including Dr. Sara Gottfried, Dr. Robert Lustig and Dr. Mark Hyman amongst others. To learn more about Levels and track your blood sugar in real time, join Levels at Levels dot link, /podcast.
Josh Clemente (00:11:33):
So you and I share some personality traits. I think we’re both engineers, we’ve both been interested I think I’m sure in cool technologies. I worked at SpaceX on the life support program leading up to starting Levels. And it was really the interest of the technology that kind of garnered my interest originally, but it was the insights like you’re saying that hooked me. I think that what it’s opened up for me and I’d love to dive into as sort of an initial conversation topic is using the tool really kind of shows an entirely different way to approach health, which is N of one as the goal. So seeing how your body responds to an IPA versus a steak versus cereal with oat milk, it may be quite different from how I am responding. And the interesting thing is that it may just be that the glucose effects, how those different foods break down in our microbiome get out into the bloodstream is different.
But if the impact is shared physiologically in the sense that as a blood sugar spikes insulin spikes and we experience the downstream consequences of that and low energy as we crash, blood sugar crashes potentially higher risk of insulin resistance and on and on. If that is true, then there truly is no personalized diet that can be scaled. You can’t just say that this one size fits all diet is the right one for you personally. And in that case we need these personal tools. The other interesting thing though is today there is only one tool like this, it’s the continuous glucose monitor. It was developed for diabetes management, which it’s a tremendous tool. But for me it opens up this kind of whole frontier of opportunity, which is what other important data streams are there that we should be monitoring in a more continuous fashion order to make better decisions.
I’d love to hear from you on what you’re thinking about this now that you’ve tried a CGM and seems made some substantial kind of changes in your daily life, what questions come to mind? What would you want to be able to measure more continuously that the healthcare system is not producing today?
Scott Kelly (00:13:41):
I think that if the technology supports it, anything you can get during your annual physical, granted the technology has to be there to be able to do this, but if you can measure levels of inflammation as an example, that would be I think very, very powerful and would give you insight. But many of the other things that we have on our annual blood tests, I do know it’s hard to do that. I mean we’ve seen in the past people try to figure out how to monitor or look at their test blood and get results with small amounts of blood and they’re very challenging. We know that we’ve seen how hard that is to do.
But those type of things, maybe even you could have something that measures whether you have COVID or not at some point, a continuous monitor for diseases potentially. Maybe at some point we’ll have a little sensor embedded under our skin that’ll light up and you go, huh, I got to look into that because maybe it’s on my wrist and it’s an indication that you got some kind of disease you didn’t know about. So I think with AI and technologies, this is just the beginning of some incredible future for monitoring our health.
Josh Clemente (00:15:09):
I’d love to take that one a little bit further. I think that what you’re touching on there is really interesting because most people when they get blood work they get a PDF and that PDF printout, there’s like you’re either in range or above range. And there’s really no question about what to do with that information unless you’ve crossed a boundary like this line that we’ve drawn that says this is the high risk category. I think one of the huge benefits potentially of this technology is that we can start to think of these molecules that are in our bodies that sort of describe how we’re functioning and what our risks are as not some cliff that you can fall off but actually this is a gradient that you are moving on at all times and there’s a spectrum of health and everything we’re doing is causing these molecules to react.
We think about, I certainly have done this when I get my blood work, my triglycerides are some number and for the next year I’m saying my triglycerides are 90 or 70. Well those triglycerides move minutes after I ate a meal and they change as dramatically as dramatically as glucose. And this is happening with a huge milieu of molecules that are driving our experience like our quality of life, our weight gain, our weight loss, our muscle mass, our risk of disease and on and on. And so really transitioning, I think that the major benefit, and I want to get some unique experiences you’ve had that I think this technology would specifically impact, but the benefit is starting to understand that this is a live system, this is moving in real time.
Just because we take one blood work lab per year and call that sort of the standard, that does not mean that those are static markers. And so how has it impacted… Has it changed anything in your perception of how your body is actually functioning and when you’re taking your daily walk or rolling through your daily routine, has this impacted how you think about what might be behind the scenes happening and what kind of questions does that open for you?
Scott Kelly (00:17:17):
One thing that you learn, you can associate your symptoms with your glucose response. So you eat something that is high in carbohydrates and you have a rise and then a crash of your glucose and then you feel like crap. Now you understand why, it’s right in the data it shows you here’s what you ate, if you’re writing it in down, which we did. Here is how your glucose responded and now you know why you’re tired in the afternoon or you don’t have as much energy. I just really can’t congratulate you enough for just coming up with an amazing, amazing product.
And I really wish we have such an epidemic of people that are unhealthy because of probably mostly due to the carbs that we eat in our diet and sugar obviously is a carb too, but the bad carbohydrates and when you see that your glucose is going up because you just ate that, it’s a very, very powerful tool and I think we need to look at more ways to get more people to be able to use this not just for diabetics. ‘Cause if you think about it, you give a kid this product, some person that struggles with their weight at a young age and it’s going to cost, I don’t know, $400 for the month that they use it let’s say.
But that what they learn in that month will have a lifetime of health benefits that will be paid for thousands of times over in my opinion, if people use the information they got to make adjustments. And now when I eat something sweet, on the occasion I do, it’s like too sweet for me. It’s like I used to drink orange juice every once in a while, try a little orange juice I could barely even stomach it because it was just so sweet. So it shows you that you established certain habits and then basically caused me to completely change my diet and which has had significant impact on my quality of life. I would say.
Josh Clemente (00:19:40):
It’s amazing. I think it’s kind of that experience of what we call the first magic moment, which is when you put that CGM on and you try a thing, whether that’s drinking orange juice or in my case it was actually a pressed juice from an organic juice cart. I was in New York and I hadn’t slept well. I was going into an investor meeting and it was just a green apple, carrots and celery pressed. And I’m drinking this thing and my blood sugar was well above 200 milligrams per deciliter, which for people who aren’t familiar over 180 is considered a response that you would typically see with diabetes to a meal. So I was over 200 milligrams per deciliter and the interesting thing is the drink on the menu was called health drink. That was their health drink recipe. And again it’s just fruit and vegetables, but the immediate response and the way that I quickly wanted to learn more and started to understand, well, when we press that juice out we’re stripping all the fiber out of that fruit and vegetables and causing it to hit the bloodstream instantly.
And if I actually just eat some celery or eat some carrots, eat a green apple, I have a completely different response. And so you start to fairly nuanced concepts like that become possible to understand and honestly interesting when you have that immediate feedback and it’s really a magic moment because it’s able to take this abstract idea and make it something that becomes behavior change and habit. And I’m fascinated by how sticky it sounds like the experience has been for you going through this for one month and completely evolving your dietary approach. That is something that is generally considered not to be possible. If you talk to people who are in public health, people who think a lot about chronic illness and about our risk for things like diabetes, the expectation is that behavior change is not going to happen. So we have to produce kind of a dietary philosophy that people can adhere to that will be backed by nutrition companies.
You put it on the ingredients, you put it on the marketing and I think there’s something… Of course to that we need to monitor what products we’re putting out there to some capacity to make sure that we’re not deliberately harming people, but at the end of the day people are individuals and they have to make decisions. And I think no one wants to be unhealthy, it’s just that we don’t give feedback that helps you navigate your choices. So yeah, I’d love to hear a little bit more about that. Has it changed your perception of how we can approach the problem bottom up versus top down so to speak?
When you’re thinking about, the statistics today are that we have 10% and growing of the population that has diabetes now and another 90 million plus people who are pre-diabetic. And so the disease burden is rapidly approaching $400 billion just for diabetes, just here in the United States a year and increasing and that’s increasing globally. And so this isn’t all about diabetes, what levels is, it’s about giving somebody control over their health to an extent. But I’d love to hear from you, how do you think about tools like this and their ability to impact the healthcare system and disease trends?
Scott Kelly (00:22:46):
I think if you gave every kid at a certain age, I don’t know middle school, what the right age is, you have them wear this monitor for a month and they would see in near real time what their habits are that are good and what are bad. And I think it would pay for itself long term. And whether it’s saving money just generally in the healthcare system or Medicare or Medicaid, whatever programs people’s healthcare is funded, I think this $400 small device that you wear for a month is just so, so powerful and could be maybe the thing that allows us to get out of this epidemic. I wasn’t a label looker when I would buy or eat something and now because of Levels, I actually look at the carbs on the label and I know how much I should have in a day and I pay attention to it because I see how much of an impact it has on my metabolism.
Josh Clemente (00:23:59):
It’s fascinating and I love hearing it. I think my hope is that today the technology… I love the way you’re framing it, the kind of compounding or exponential return on the investment is pretty high. The earlier in life you can make a change that is kind of driven by data, obviously the better and the return on that is going to be really powerful as you reduce the overall risk over time and live a healthier life. That said, I think that one of the major opportunities is to really lower the cost of access for this sort of technology. And I think my personal position on it is that the best way to do that is to ensure that the product delivers a lot of value to people, solves problems that they need and make it available to a very large group of people, the old mechanisms of supply and demand.
If we can really drive up demand across a huge portion of the population and increase the supply, we should see prices come down. And that’s key because right now the technology was developed for a pretty small use case, which is diabetes management with insulin. So for people who are metering insulin based on blood sugar levels and ultimately that drives a pretty high cost for the device. So I think I’d love to hear what you’re thinking on… Is there a price point at which this becomes something that you feel the general user, the average person might incorporate into their lifestyle on an ongoing basis? And also whether this is something that you feel is this a technology that you see as an everyday ice item or is this something that you see kind of use it once and the lessons last a lifetime sort of thing?
Scott Kelly (00:25:40):
Well I think it’s probably as far as single use or someone who wears it for a year or always wears it or I think I might put it on again at some point over the next year just to see just a double check on how I’m doing on my habits and stuff. But..
Josh Clemente (00:26:03):
Scott Kelly (00:26:04):
And then what would be a good price point to make it available for everyone that needs it, it’d have to be pretty low. ‘Cause a lot of people in this country… A broad demographic of people could probably use this technology. So I think you would have to get it pretty low, but if maybe insurance companies pay for it, maybe the government would pay for it or offset some of the costs because I do think it has incredible value and insight. And we do have such an epidemic of diabetes and obesity in this country that this can give you just… I mean I can’t say it enough, just how incredibly powerful and insightful this tool is. So I hope people get the message and if they have the means and if it’s necessary to consider using it because you’ll find… I mean everyone I’ve turned onto it are blown away by how incredibly valuable it’s been to them.
Josh Clemente (00:27:14):
Well it’s amazing. I think it’s the most exciting thing is that it is really day one for the use case that we’re opening up here and hearing stories like yours, really the inspiration is to make this more available. Everyone in my life who has tried this tool has learned something and has used it and we don’t get to take credit. I think there’s a lot more that we have to do to take that data and make it more useful, more impactful, more understandable for the average person. But just out of the box as you said, the tool is in and of itself very powerful. Scott, I’d love to back up and take this in slightly different direction and dig into what I think our listeners will find a very fascinating experience that you went through and ultimately a piece of scientific evidence collection that is going to impact the way I think health is approached for space flight as well as eventually for humans.
And that’s the twin study that you participated in with your brother. So you and your brother Mark are both astronauts. In the 2015 to 2016 timeframe you took on a one-year-long space flight where you went, underwent some pretty rigorous monitoring, I think blood collection, a number of other test modalities while you were on the International Space Station. And the objective was while your brother Mark was on the ground, you both share DNA as identical twins and therefore you were able to compare in a really fascinating way the effects of space flight on health.
And for me, reading through the results of this, which I was following very closely at the time as I was working on the life support program at SpaceX at that timeframe, the most interesting thing was the metabolic impacts. And it’s not clear I think to many people how tough space is, right? I’d love to just kick off, this was an end of one to study, but it really answered some interesting questions and teed up many, many more. So first of all, at a high level, what was the twin study experience like for you? What was the process of the research itself while you were up there, up on the ISS?
Scott Kelly (00:29:25):
Yeah. The study consisted of a lot of different experiments. Most of them were in the genetic area of studying parts of our genetics, DNA, RNA, protein, epigenetics, telomeres. Part of it was cognitive, part of it was looking at our microbiomes and how they change. Generally everyone’s microbiome is affected by illnesses they’ve had, places they’ve traveled. So our microbiome was different over to start with because we’ve lived and have had different experiences over our lives. So those were the goals. And then how the environment of space between the radiation, the stress and the microgravity, how that affects all this parts of our physiology. Like you mentioned, it was an N of one experiment, meaning that from a scientific perspective the results were not statistically significant to draw absolute conclusions, but there was interesting anecdotal information and also it’s a longitudinal study, so you’re comparing my brother and I to ourselves over a longer period of time.
So you do get more data points in that regard. So I was in space, did a lot for years, did a lot of pre-flight, two and a half years of pre-flight data collection. I’ve probably had more MRIs of my brain than I think anybody else ever it felt like. And CAT scans and all kinds of sample selections, collections of various parts of our… What comes out of our bodies did that both on the ground and in space. Often do blood draws, urine collection, things like that. Even taking our skin and doing ultrasounds on our muscles and arteries.
So pretty extensive. My brother on the other hand, he did most of the stuff I was doing, but he was on the ground living his normal life because he had previously left NASA and he was not on this flight. And I really have to hand it to him because it was part of my job doing this. It wasn’t his job. He no longer worked for NASA. Actually, it’s kind of funny. They asked if they could pay him for his time and he said, “Nah, no, don’t worry about it, I’ll just volunteer.” And then NASA came back later and says, “Well, it turns out you can’t just volunteer, we have to pay you something.” So they paid him minimum wage for his time. So at one point he was like the lowest paid government employee in the whole [inaudible 00:32:28].
Josh Clemente (00:32:29):
Wow. That’s a great anecdote for science.
Scott Kelly (00:32:33):
But it was some interesting results. I mean my microbiome changed while I was in space and my brothers didn’t. And I think that’s interesting because it shows that there’s stuff on the space station or something about what we’re doing that affects our microbiome, which is incredibly important to our health. Imagine if we could monitor that, if we could tell, hey, your microbiomes in good shape or bad shape. I don’t think we know enough about the microbiome at this point, but someday we will. And we’re realizing how important that is for health. My telomeres got better while I was on the space station.
Originally we thought that was due to the very controlled diet and exercise. But about six months after I got back from the mission, NASA learned that at the same time I was on the space station, the Japanese were doing an experiment on telomeres on these little worms and their telomeres got better too. And I never once saw those guys on the treadmill or working out on the weightlifting machine. So there was more to this than we understood. It seems like radiation can have a positive impact on your telomeres, certain amount.
Josh Clemente (00:33:49):
Scott Kelly (00:33:49):
May have negative impacts on other things, but it certainly helps our telomeres, I don’t know, somehow exercises on so they don’t get as short and freight. Mine actually went back to normal a few months after, what pre-flight normal, was after the mission.
Josh Clemente (00:34:08):
Telomeres, can you explain what the telomere is for the person listening and how that might impact health?
Scott Kelly (00:34:15):
Yeah, the telomeres are ends our chromosomes and they’re like little caps and as we age, they get damaged, they get shorter, they get frayed and it really is an indication of our physical age, not our age based on when we were born. And you could actually go online and get a measure of your telomere age. I think this company’s called TeloYears maybe that does that kind of thing. And it’ll tell you what your telomeres are doing and how old you physically are based on your telomeres. Whether that’s accurate or not, I have no idea. But interesting that the space environment made mine better.
Josh Clemente (00:34:58):
Yeah, that’s fascinating. The radiation combined with weightlessness, you’re body isn’t loaded in the normal way. So it’s really for those of us that haven’t gone to space, it’s hard to even imagine. But to not have your bones and muscles being loaded the way they normally are is actually a bad thing. It’s similar to bedrest. So that confinement, I’m sure the isolation and just the small space you’re working in. And then the lack of sunlight, another thing that we really lean on and sort of the health and wellness space when trying to improve metabolic health, you don’t have much sunlight there.
Scott Kelly (00:35:29):
Yeah, we take a lot of vitamin D in space for that reason.
Josh Clemente (00:35:30):
Yeah. Exactly. I’d love to hear more about how the space flight program approaches kind of those four pillars which we are building into our education and content, which are just nutrition, exercise, sleep, stress management. What are those things like? Just for those listening, some of the effects of microgravity and being on orbit have been known to be bone loss and muscle atrophy and cardiovascular and metabolic changes. And then impaired wound healing likely from inflammation and low-grade insulin resistance. So to keep all that in check, there is a pretty comprehensive health routine that you’ve touched on there. So what is that like?
Scott Kelly (00:36:13):
Well, the diet is made by nutritionist. Now granted, you can basically eat whatever you want, which I guess you could just load up on candy in the space station if you wanted to. But generally the food is made by nutritionist. So it’s considered a balanced diet. They monitor our mental health while we’re on board and pre-flight, making sure we’re mentally prepared for the flight by having discussions with psychologists, psychiatrists, did that every couple of weeks in space. Physical exercise is basically mandatory while you’re on the space station. Even if it wasn’t mandatory, you’d still want to do it probably even if you hated exercising because you feel when the exercise machine breaks after a few days, you just feel like your muscles are just atrophying. Your bones are atrophying at the same rate. Basically 1% of your bone mass a month you would lose if you didn’t do anything about it, like exercise. Yes, of diet, mental health, exercise. What was the other one?
Josh Clemente (00:37:32):
Stress management and sleep.
Scott Kelly (00:37:35):
Oh, sleep, yeah. So yeah, stress management. Now NASA takes that… I don’t know, maybe not as important as the other one because there can be a lot of stress onboard the space station, but they do do a good job at our mental health part of this. And of course sleep. I mean sleep is so incredibly important to having our bodies recover. I discovered this other company, this company called Eight Sleep, actually the same guy, my brother’s son-in-law, told us about this. And if you don’t have one of these mattresses, you need one.
Josh Clemente (00:38:10):
I do and I love it.
Scott Kelly (00:38:12):
Yeah. If you are like my wife and she sleeps a lot warmer than I do, so now she’s always perfect temperature. My side of the bed is perfect and better yet our house is not freezing when I wake up in the morning. Yeah, sleep is important too. And NASA actually takes it very, very seriously and it’s hard to sleep in space when you’re floating. You’re used to sleeping on a bed with a pillow. Most things are harder to do in space. Just about everything.
Josh Clemente (00:38:44):
Scott Kelly (00:38:45):
Josh Clemente (00:38:46):
The sleep one is really interesting because I can imagine that without the normal circadian rhythm of sun, sunrise and sunset and your day being structured that way and your body getting that signal, what is it like, what are the strategies that you have to use that combined with the weightlessness not being able to just lay down in a comfortable position? How difficult is that and… Yeah.
Scott Kelly (00:39:09):
Yeah, it’s difficult. Like now you’re moving around all day against gravity. You’re expending energy just sitting on the couch, you’re holding your head up. That takes effort that you’re not really aware you’re using. And then when you lie down at night, you’re now more comfortable. You’re in a more comfortable position, you’re more relaxed. In space, just having a conversation like this, it’s the same exact level of relaxation and comfort that I would have when I’m trying to go to sleep. So it’s almost like, okay, I’m going to close my eyes and go to sleep, now that’s hard. Not having that change in your level of relaxation. Often on the space station it could be hot sometimes, it could be cold, it could be loud. Sometimes you see the cosmic rays hitting your… At least flashes of light in your eyes. With your eyes closed. The carbon dioxide might be high.
So you have maybe a headache and you’re falling and you can sometimes feel like you’re falling. It was kind of fun would sometimes when I was getting ready to go to sleep, I close my eyes and I could just move my body a little bit in my crew quarters and I could meet myself that sensation that I was just falling around the earth, which what I was doing. And I could let it run on for as long as I wanted. Even if it was an hour it’d feel that way. It took me a while to get to that point to…
Josh Clemente (00:40:45):
Scott Kelly (00:40:47):
I had my mindset adjust to the environment like that and what we’re actually doing. But, so there are a lot of challenges to good sleep in space. I prefer sleeping on a bed with a pillow and a blanket. Some people say they’re more comfortable sleeping in space. I never was. Certain things, like if you have shoulder pain, you won’t have that in space. If you’re a shoulder sleeper, sleep on your arms, your arm’s not going to fall asleep while you’re sleeping. But there are, like I said, a lot of other challenges you have to deal with.
Josh Clemente (00:41:23):
Yeah, I think it sounds like such a wild experience. And obviously all this stuff is in the context of your body transforming as it’s adjusting to this new environment, which is kind of amazing. The amazing adaptation, like you’re saying, 1% bone loss, so your body’s just like, well no longer need to expend energy keeping this bone around if it’s not fighting the gravitational forces. So it’s pretty amazing how fast that happens. And I think that kind of speaks to the resilience and adaptability, if you change your circumstances, your body will adapt.
Scott Kelly (00:41:54):
Yeah, my heart lost 25% of its mass in that nearly a year I was on the space station. And that’s despite all the exercise you’re doing. But if you think about it, our physiology evolved for our heart to push against gravity. And that’s a strong force. It has to push that blood up to our heads, keep it from pooling in our feet where we need it most, our brain or other vital organs. And when you go to space and you don’t have that gravity, now your head’s swollen, your body’s trying to adjust and lose all that fluid, but at the same time, your heart does not have to work nearly as hard as it did. So despite your efforts, you lose that heart mass, which came back over time. I got back on earth, I don’t know how long it took, but yeah, that the absence of gravity… We’ve evolved with gravity. Our physiological systems evolved in a way to function in gravity. When you take that away, it causes other problems.
Josh Clemente (00:43:02):
Yeah, it’s really fascinating to think about it. It’s almost like an additional sense where gravity is a sense. We know which orientation our body is in. You’re constantly picking up cues from our position because of the force of gravity. And so I can imagine that can be disorienting. Like you were describing, you’re able to almost trick your central nervous system into thinking you’re falling for a long time, which you are. But just build that sensation. Really amazing. I love thinking about it. I’d love to then hear… Obviously all those changes are happening. You’re sort of fighting the changes of the adaptation to space by introducing weight training and the treadmill and all that, which I think you have tethers over your shoulders, kind of where your waist pulling you down onto the treadmill so you can do the work.
So this whole routine to try to stay ultimately in metabolically healthy condition because that is the consequences of bedrest for example, are metabolic health deterioration, insulin resistance, get worse of processing glucose and other fuels and that sort of thing. And that’s similar to what we see on orbit. When you got back to earth, what was that experience like getting back from space and on a flight that long? What was the immediate experience like?
Scott Kelly (00:44:16):
It was great because all these things… If you think about it, space is cool and going to space is cool, but most of the stuff we care about is on earth. I mean, just going, I remember when the hatch opened and fresh air rushed inside the Soyuz after landing after a year. It kind of smelled like the first time I had ever breathed fresh air in my life. It was just spectacular. And then they pull you out of the Soyuz capsule and there was probably, I don’t know, 50 to 75 people around the capsule. There might as well have been 10,000. It just seemed like an incredibly huge number of people. I didn’t just get to experience warmth of the sun on your face, a cool breeze, rain, the weather, the color green. You don’t have a lot of color green. We got a lot of green here in my yard. Like the green.
Josh Clemente (00:45:19):
Scott Kelly (00:45:20):
Yeah, it was like everything was new again. I remember the first time I saw a dog after I was out taking a walk, couple days after getting back from Houston. It was like the first dog I had seen in a year. It was like seeing a alien being, it was really cool. So yeah, a lot of things are new. It’s a little bit sensory overload when you have all these options again, you can eat and drink whatever you want. You can do whatever you want. Your life isn’t completely controlled by a timeline on a computer running across a screen. Incredible privilege to flying space four times and get the thing do and see the things I’ve gotten to do. But if you told me I could go to Mars and live there for the rest of my life, wouldn’t do it. Earth is too great a place.
Josh Clemente (00:46:22):
Earth is special. So it’s interesting, obviously a ton of psychological adaptation happening there too, which you need to readapt to all that happens here on earth about. In terms of health, did you have any immediately noticeable effects on your body and on your health getting back on earth? I mean, obviously adjusting to gravity again, but did you notice something like endurance and cardio respiratory effects and fatigue? I’m just really interested in what the experience physiologically was like.
Scott Kelly (00:46:57):
Bunch of things. So you mentioned fatigue. Yeah, we lose a lot of blood volume when we’re in space. We get rid of this extra blood we now don’t need because it’s no longer pooling in our legs. But we get that volume back quickly when we come back to earth. But what we don’t get back are the red blood cells. So that takes a while, kind of when you give blood, might get the volume back, but the red blood cells takes months. So you’re fatigued from that. I think you’re fatigued from the experience in general doing something that is just physically and emotionally challenging.
You’re definitely sore and your joints are sore and stiff even despite all the exercise. I mean you don’t realize it, but we have muscles in our neck that hold our head up and they’re kind of hard to exercise and in space they atrophy. So just your neck is sore and it’s in ways that you maybe you would never have thought. And it just has to do with the fact that you didn’t hold your head up for a whole year. You get nauseous at first, dizzy. Your vestibular system is messed up.
On my first long duration flight, I was so nauseous I threw up when I got back. I didn’t on the yearlong flight, I don’t know if my body remembered or for whatever… I would’ve preferred to throw up because that usually makes you feel better. But nauseous or dizzy, when I would stand up, I could feel all the blood rushing out of my head and down to my ankles and my ankles would just swell up this big water balloons, physically see that. Not only is your heart not able to keep up with the rest of your cardiovascular system, which does contract to improve what’s called your orthostatic intolerance. Which is kind of like fainting when the blood rushes out of your head. So it affects our orthostatic intolerance. I had rashes and hives anywhere in my skin had any kind of pressure on it because almost like an allergic reaction to the pressure.
What else? My vision’s affected, I mean that’s a long term thing that I wear distance correction, my brother doesn’t. And it seems to have to be due to the microgravity environment for such a long time affects our vision. So there’s that too. And I think it affects our perspective on humanity and earth. Certainly when you’re able to see the earth with no political borders, you can see them at night in some cases. But during the daytime, as we normally think of our planet, when we think about it, we think about it as we see it on a map or a globe. But when you’re in space, you see land masses, continents, you know there are people there, they’re very similar to us in some cases. They’re suffering, they have challenges. And living on a multi-billion dollar space station for such a long time gives you a sense that we can do some incredible things, but we can do them really only if we work together as a team.
And when you look out the window and you see earth without those political borders, you realize I think a little more so than before your flight that earth is a team too. And we have to take care of the environment. I mean, it looks very fragile from space. The atmosphere looks like a thin film over the surface, like a contact lens over somebody’s eye. Despite the planet’s beauty, some parts of it are almost always covered in pollution and particularly like China, parts of India, Central America, rainforest in South America. And over the course of nearly my… Yes, 16, 17 years that I flew in space, noticeable changes for the worst. And I was part of our life support system of the planet. I think it would be really great if everyone could experience those kind of perspective changes that this privilege gives us. I think we’d be better for it.
Josh Clemente (00:51:35):
It’s really amazing to hear about, and I’ve read about the sort of over-watch or overview effect a number of times. Perspective is such an interesting thing. Cause it sounds like it can kind of change in an instant and last for a very long time. So obviously there were a huge number of health changes and I’d love to hear more about what the strategy is for the space flight program to observe these changes. You were doing a specific study to understand the adaptations or shifts from microgravity between you and your brother. But in general, what is the approach to understanding how astronaut health is trending when somebody’s on something like the International Space Station for a prolonged period of more than let’s say a few weeks? Is there anything specific that the mission crew doctors are doing to monitor?
Scott Kelly (00:52:31):
Well, the science program that NASA has for astronauts to study the environment is, it’s always changing. Different IPs look at different things at different times. As an astronaut, you are a volunteer scientific subject, subject to all the government rules and regulations, we’re human test subjects. We’re all volunteers. So before the mission NASA will give you a briefing and say, Hey, these are all the experiments that all these scientists want to do on you or have you participate in as a human research subject. Which ones do you want to do? So it’s kind of up to you. I think most astronauts recognize that this is, although it’s not mandatory, it’s almost a moral obligation. I mean, you’re flying in space and there’s research to be done and it can only be done on you or your colleagues. So you should probably volunteer. I basically would volunteer for just about everything.
NASA, not only do we look at to specific science for specific researchers, there’s also this thing called the longitudinal study of astronaut health. Basically from the time you get selected or maybe in your interview physical to the time you die, NASA tracks the health of their space flyers over the course of the remaining rest of their lives to understand not only what is the impact of space flight on this population, but also what is the impact of having decent healthcare on a population over a long period of time.
But we do need to better understand certain physiological changes that astronauts deal with, particularly the effects on our vision that seem to be due to increased intercranial pressure in our brains from the fluid shift. And then of course, the effects of radiation over a long period of time. Because going to Mars will get you about 10 times the amount of radiation I got on my yearlong flight, which would then put you pretty strongly into the statistical significance. But we’re going to have to understand how this environment affects our health. So the astronauts they get to Mars someday aren’t going to die when they get there or quickly die when they get back.
Josh Clemente (00:55:14):
One of the moments that sort of kicked off this whole thing for me was, as I mentioned, I was working on the life support program. I was focused on the oxygen and breathing apparatus, suit delivery of oxygen and nitrox or air and keeping the cabin filled with fresh air. And we were stepping through some failure scenarios. So essentially you got to kind of role play what happens if this device fails or this sensor fails to fire and you get into these circumstances that are a called, for the listener, like two fault scenarios where two things have gone wrong. And you want to make sure that you can recover even if two things go wrong. And I remember us going through this scenario, one of the worst case scenarios where two valves had failed and the vehicles at risk. And we were able to step through a sequence of fault detection, isolation, recovery.
And I remember looking at all the readouts of all the sensor channels and thinking, okay, the vehicle’s safe, we fixed it. But then realizing, but the astronauts, is the crew safe? Are they healthy? Are they functioning the way that we want them to? And we had no means of knowing that, obviously this was just a simulation, but it was just in my mind as to what would we need to see, what sort of feedback would we need in order to know that a person is healthy and their body is operating the way you want, like the health state of the vehicle, what’s the health state of the human? And that really led me to interest… Opened my interest in biosensors as a category.
What would you want to measure to know that the human body, that my human body, your human body is operating the way you want it to, and that you are sort of heading in the right direction with your health over time. And whether that’s in an acute scenario on a spacecraft or just in your day-to-day life. And so I’d love to hear, do you feel like there’s an opportunity for technology like CGM devices, but generally bio-sensing in what is the cutting edge of the astronaut space flight program? And then maybe the second question I would ask is, what do you think is a moonshot in an Apollo program of health technology that you haven’t seen come to life and that you hope to see?
Scott Kelly (00:57:32):
Well, I think someday NASA and just people in general have a lot of sensors that’ll measure your health. I mean, why wait until you have an illness and have a symptom and then go to the doctor to get it fixed when you could have some kind of wearable that will give you maybe years in advance that you’re developing a problem. I would imagine as this technology grows, NASA will then adopt these kind of things. Maybe they have already, I don’t know. I haven’t worked there in… Wow, gosh, seven years now. My, time flies.
Josh Clemente (00:58:10):
Scott Kelly (00:58:12):
Yeah. So I think that’s not only the future for NASA, but it’ll be for all of us.
Josh Clemente (00:58:19):
If there’s one category of health technology, something that you would describe as an Apollo program like worthy goal, what would that be for you? Where should the industry focus?
Scott Kelly (00:58:34):
Well, I think cancer is such a devastating disease. Unfortunately, it’s not just one disease, it’s a hundreds of different types. So curing it is going to be a challenge, but I do believe humans have an incredible capacity to solve difficult, challenging problems. And one of them being that. So I do think if we put the resources behind it one day we will be able to do just that. And then there will be no cancer ever again. I don’t know when that’s going to be. Might not be in my lifetime. But yeah, just such a devastating illness for people and just so random too. I think that should be… Well, the government does have that Cancer Moonshot program that I’m not sure where it stands how well it’s funded, but I think it should be funded as best we can because if you’ve ever had any family members or if you had ever had cancer yourself, it just could be so devastating.
Josh Clemente (00:59:39):
Yeah. One thing that, although you’re absolutely right, the treatments are sort of unique and specific in the cancer is so varied. One thing that I’m excited about is earlier testing, earlier detection tests like Grail, which is sort of cancer DNA detection in the bloodstream. I think there are tools that can be introduced that would give people an earlier insight into whether or not they have cancer potentially developing, because the strongest correlation between cancer and survival is how early is it detected. It sort of lends itself to this category of making testing more available and testing for more things and making sure people have the insights that they need to understand their health status.
Scott Kelly (01:00:25):
Yeah, currently our whole health system is very reactive, you have a problem, you go to a doctor, be great someday… I mean, I think your product gives you this kind of insight where, hey, I’m getting close to being, not me personally, but if someone’s close to being a type two diabetic or pre-diabetic, good to know that. And you can learn that so very quickly from your Levels technology. So I think we’re going to see many, many products coming out in the future like that. And then how you integrate it all, right? Probably be AI and looking at all this stuff, putting it together, figuring out what’s the best option for you.
Josh Clemente (01:01:16):
Absolutely. I think that fusion and being able to just have a bird’s eye view of your health and what direction you’re going, it’s going to be a pretty amazing future. And I think we’re heading there quite fast. I’m most excited about shifting the perspective from the healthcare system or maybe a doctor in particular is expected to keep me healthy to, that’s my responsibility and also my capability. I am the person who’s making the decisions day-to-day that impact chronic illness lifestyle related risk and therefore it’s super important that I am the one who feels responsible for that health trajectory. And I think because of the way the system has been built, we kind of just wait until a disease sets in before we assign responsibility, so to speak.
Scott, I really appreciate your time today and really fascinating conversation about not just your metabolic health journey, but here on earth and in space, which is something I personally am very, very interested in and excited to see the kind of co-development. I think obviously space is a frontier for a lot of technologies, but I think in particular, seeing how quickly it accelerates a lot of these metabolic adaptations or the other way around has been fascinating. So thank you for sharing your story with us. Thank you for sharing about the twin study and I’d love to… Any closing thoughts and also how can our listeners follow you? I do a lot of speaking engagements. You’ve written books. What’s the best way to keep in the loop about you and your work?
Scott Kelly (01:02:55):
I tweet sometimes StationCDRKelly. Yeah, I do some public speaking. Some of it’s actually for the public. A lot of times it’s for industry groups or corporations. Yeah, I would say my final thought is just congratulations on coming up with a business model, a company, a technology that not only is probably so, so important to people that are diabetics, but also something that could be such an incredibly powerful tool for people in this environment where we have an epidemic of obesity and diabetes. This can solve that problem.