JOSH CLEMENTE

Josh Clemente was a lead Life Support Systems Engineer at SpaceX, but his discovery that he was metabolically unhealthy led him down a path of research into the intersection of blood glucose and health. From there, his mission became figuring out how to get that important data into the hands of more people. Josh is now the founder of Levels Health, a metabolic fitness startup that uses continuous glucose monitoring to provide users with real time data and insights into how their daily choices are impacting their health. On this episode of Pod of Jake, Josh talks to Jake about the technology behind Levels, how they’re building a powerful dataset, and how things like exercise and sleep affect our blood glucose levels, too.

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• Connect with Jake on Twitter

18:48 – Increasing healthspan instead of lifespan

There is quite a bit of research being done on how we can live longer lives, but Josh is focusing more on how to live healthier lives in the time we have.

“I’m more interested personally in ensuring that when I die, I die quickly and I am maximizing my fitness and my independence until the very last moments. I don’t want to be a person who’s infirm for any amount of time. And so I want to avoid a situation where I age slowly and painfully and gracefully. And my independence is slowly taken from me and I think there’s far too much of this happening in society. We sort of accept that aging is debilitating and that is what I pushed back on and think it’s totally unnecessary. And we can avoid much of that with better choices at the individual level and obviously with medical advances, but really, I think a huge amount of it comes down to lifestyle choices and, and basically the compounding effects of the decisions we make every day from the earliest age they stack up.”

23:07 – Making decisions with data, not emotions

88% of Americans are metabolically unhealthy, but that number can’t change unless people have the data that tells them how to make better decisions.

“That’s what Levels is changing, we’re delivering data at the moment of decision. So having that available in real time to know which foods, which meals, which choices are affecting you positively and negatively, and to what degree, and then also seeing specifically how something like a simple walk after a meal or adding a salad upfront or reducing portion size of certain foods that you’re very sensitive to, you can improve not only your short term sort of qualitative experience by removing maybe some of the fatigue of an insulin related crash, but also quantitatively in the long term, reducing your on paper risks of these chronic illnesses. I think it really speaks to people and it doesn’t take much convincing when your body speaks back to you and tells you exactly what’s happening, there’s no one really to argue with. It’s just, Oh, okay. That’s informative and now I’ll make different decisions.”

28:02 – Continuous glucose monitoring has evolved

Diabetics used to have to prick their fingers multiple times a day to monitor their blood glucose levels. But software-enhanced CGM data like Levels is using gives far better insights for diabetics and non-diabetics alike.

“This device, you wear it full time and it gives you a continuous signal of your blood sugar in real time. And not only that, but it can show you because you have the continuous signal. You can see both where you are right now and also where you were 20 minutes ago and how fast your sugars are changing. So this is a total breakthrough for diabetes management. And it’s led to a super improved standard of care and much better outcomes for people with diabetes. Now, what we’re doing differently is actually taking that raw data, pulling it into metabolic models, which are based on machine learning algorithms and turning raw blood sugar data into scores that are oriented around lifestyle choices you’re making and grades of your metabolic control overall. And so surfacing high level insights that can be specifically turned into behavior change rather than just saying you’re at 88 milligrams per deciliter. We’re saying here are the foods that are most optimal for you. Here’s how poor sleep affects you. Here’s how a walk after a meal improves your responses. So really filtering things down to specific choices.”

31:12 – Creating a powerful dataset

Levels will soon move out of beta and open to a larger number of users. They’ll also be adding new lessons and insights to the software.

“So rather than being entirely receptive of data and just recording it and feeding it back to the user, we’re going to surface new lessons and new insights that can be constructive to making better choices. And so that insights framework is our next big product push and right now our data set that drives this is already the largest non non-diabetic glucose dataset for wellness ever. There are some research entities that have on the order of 800 people participants for seven days. And we have about five times that already, and we haven’t gone public or opened up the product to a larger market yet. And so our dataset will continue to grow and expand. And along with that, as you mentioned, the rigor or the statistical relevance of subsets within that data is going to continue to improve. And we’ll be able to pull that much more insight out and improve our algorithms and our recommendation system. So, just a lot of great things will come from the sort of network effects or the compounding effects of having a much larger data set with richer and more diverse participants.”

33:09 – The sleep and metabolism cycle

Sleep affects blood glucose levels and blood glucose levels affect sleep.

“If you only sleep five hours versus nine hours, your body has this, we believe it’s an adaptive response, but basically you have acute insulin resistance that sets in which I described earlier, and it makes everything you eat and your blood sugar control generally much worse. And it likely is to preserve glucose for the brain in a stressful situation because your body is not well rested. But it is something that many people are living chronically with. And so being able to show with sleep data and glycaemic data how these things are so interconnected and it’s closed loop. Sleep affects metabolic control and metabolic control or lack thereof affects quality of sleep. So there’s plenty of overlap there and same with people or teams like Whoop, Oura, etc., who are all using wearables to show activity data and recovery data. A lot of this is very closely tied in with nutrition and metabolism.”

35:59 – Bringing together data from different wearables

Josh uses wearables to track his sleep and exercise in addition to a CGM and sees a future where these trackers will be combined.

“I’ve really found some really fascinating sort of insights from both the connection between something like alcohol and sleep quality, exercise quality and glucose control. Basically having a few glasses of wine after 6:00 PM can completely decimate my sleep until four or five in the morning. And my heart rate will be as elevated as it is when I’m awake and moving around. And that causes me to lose that night asleep. The next day, my blood sugar control is about 18 to 20% higher than typical. And my response to my regular meals is much worse. And that leads me to essentially feeling. My exercise is totally depleted and, it’s kind of a little bit subjective and anecdotal, but seeing all this data and imagining the future where all of this can be combined, and you can track the quality of your exercise and personal record setting, for example, in the environment of the decisions you’ve made leading up to that. So both the nutritional choices, the sleep quality, recovery scores and whether or not you were, for example, indulging in alcohol or anything leading up to that, it can all really paint, a nice picture of where is your peak performance, where does optimal lie and, and people can then choose how often do they want to indulge?”

42:01 – Finding a nutritional balance

Josh figured out he was very carb sensitive, even to so-called healthy carbs. He now uses his data to make choices that keep him in the optimal zone of 70-110 in his blood sugar readings.

“I try to actually maintain a hundred percent time in range for optimal, but that’s a little bit trickier. I still have a little bit of underlying dysfunction, so it’s very easy for me, even just after a few hours of missed sleep to have a baseline glucose level that’s higher than that optimal range. So I’m still working my way back. But the specific ways I’m doing it are always eating mixed meals, making sure I have fat protein and complex carbohydrates with a lot of fiber on the plate. I definitely use intermittent fasting, so I typically don’t eat anything before noon at the earliest. Oftentimes I’ll go to 3:00 or 4:00 PM and I try not to eat late. And then other early tricks of the trade are avoiding foods that I know I’m specifically sensitive to. Indulging in foods that I know that work really well for me. So dark chocolate as an example, blueberries as an example, finding ways that I can get the richness and the taste. Rebel ice cream, Rebel makes a very low sugar ice cream that is just phenomenal, tastes amazing and has generally really good ingredients.”

45:03 – The best blood sugar hack is going for a walk

A 15-20 minute walk after a meal can keep you in the optimal zone.

“The biggest hack, in my opinion, if you want to try to improve metabolic control, whether or not you’re wearing a CGM, is just being more active around meals. It doesn’t mean you have to go do squats or pushups just within 10, 15 minutes of eating a meal, I’d advise, just get up and take a walk, you know, 15, 20 minutes. And it shouldn’t feel disciplinary, but it’s a really powerful tool. And I think humans historically have been super active all the time. And as we get more sedentary and live lives that are indoors and at desks, it’s really important to just get steps in and keep moving.”

50:09 – Eat for the way we live

Sometimes there is a mismatch between how we’re fueling our bodies and the type of exercise we’re actually doing.

“I remember eating seven or nine meals a day when I was trying to bulk up and get strong and fast and the realization that although that’s grounded in the way that professional athletes approach their training, I was not a professional athlete. And actually I was spending most of my time as an engineer at a desk like doing desk work. And so constantly fueling up with these giant Tupperware full of pasta and rice and such in order to be ready for my one hour workout in the evening was entirely overdoing it. And I was training like an elite athlete, but I was working like an elite engineer. So it was like, these are two different lifestyles and I need to be realistic about I’m a weekend warrior and I’m a one hour a day workout guy. So it makes sure I’ve got the fuel to get through that. But actually my body will produce plenty of energy for that without me having to carb load for it.”

52:32 – How we burn fuel is individual and dependent on our health

There’s a marker called a respiratory quotient that shows what substrate we’re using for energy at any given time. Depending on hormonal factors, one can be set up to only burn glucose and never fat.

“When someone’s at a respiratory quotient of one, it means that they’re burning only sugar. So they’re only consuming glucose for energy. And most of the time elite athletes will be running at a respiratory quotient of one when they’re at like full out performance. So sprinting up a hill in the Tour de France, for example, or just full out performance. That’s when they’ll hit respiratory quotient of one, otherwise they’re always burning some combination of fat and sugar. Now, somebody who is morbidly obese, for example, there’s tests that show or some studies that show that they can be lying on the couch completely stationary, and their bodies can be at a respiratory quotient of one, meaning they’re only burning sugar as though they are you know, basically at max performance. And you can imagine what that’s like from an energetic and fatigue perspective, to not be able to access the energy that’s available in your body and only be reliant on sugar sources. It’s clearly a huge issue and it’s something that we don’t think about that often in society. You just think it’s a calories function, stop eating and burn fat. Well that body fat is not available for consumption in this person who their bodies are not metabolizing it effectively. So this is where again, the individuality really matters like the hormonal environment, the compounding effects of decisions over time can ultimately lead to a situation that needs really wholesale changes.”

56:55 – Caffeine and blood sugar

Too much caffeine can cause a stress response, which elevates blood sugar.

“I absolutely love coffee. It’s like my favorite ritual is just having a cup of coffee in the morning. At one point, it got really bad for me when I was kind of burning out at SpaceX and essentially relying on a full pot of coffee per day in order to make it through. I was just crazy fatigued and I would have cups and cups at 2:00, 3:00, 4:00 in the afternoon. I’ve since reduced that down to a maximum about one, maybe two cups in the morning. I won’t have any after 12 o’clock, if I can avoid it. And a lot of this is, I feel a bit more irritable when I have a lot of coffee, but I also noticed I’m very caffeine sensitive and my blood sugar will increase quite significantly from caffeine. And that’s a stress response. So caffeine is very closely linked to cortisol stress hormone.”

1:00:37 – The future of health

Josh sees more continuous biomarker monitoring and people achieving health through daily practice.

“I want to see a world where 88% of American adults and adults globally are metabolically healthy. And that the people are striving every single day to make choices that are leading them towards optimal and healthier and rewarding lives. And I think it’s totally possible. This is not, I don’t think we need some sort of genetic technology breakthrough like CRISPR or something where we can edit DNA to make us immune to sickness. It’s really just having, like you described. Having almost that second brain where we use technology, we use massive datasets to process the information that is already available. You know this stuff is happening in our bodies. It’s just whether we’re using it or not. So use that information and drive better insights and better decisions at the moment of choice. And by doing that and having the sort of lane lines of accountability of that data stream, we can influence better choices for decades and decades.”

Jake                      (00:10) Hey, Josh.

Josh Clemente      (00:11) Hi.

Jake                      (00:13) Thanks for taking the time today.

Josh Clemente      (00:15) Absolutely. Thanks for having me on.

Jake                      (00:17) Of course. So why don’t we get started talking about the current venture that you’re working on, Levels. You guys are focused on metabolic fitness, explicitly not called metabolic health to speak to the fact that metabolic health is something that can be worked on, it’s not something that you’re born with. And it’s a really interesting journey that you’ve taken to co-found the company. So we’d love to hear about, a bit about your journey and then what you guys are doing with Levels today, just broad strokes overview and then obviously, we’ll dig in.

Josh Clemente      (00:50) Cool. Yeah. So my background is aerospace  engineering. I started off at SpaceX and spent six years there, initially doing a lot of structures development, working on carbon fiber aero components of the vehicle and then some pneumatic systems and then I moved into the Life Support Division. I was one of the first four people to work on life support systems at SpaceX and basically defining how that program was going to go and working on the Crew Dragon project, which flew to the  International Space Station for the first time on May 30th of this year. And so basically, I worked on all the pressurized life support apparatus. So everything that the crew members are breathing off of, that’s keeping the cabin of the vehicle pressurized and would operate in the event of a fire, for example, for fire suppression. And during my time there, I got a really nice glimpse into the world of research that NASA is taking on and thinking about long-term space missions and also a few other researches that are dealing with very acute problems like, for example, central nervous system toxicity in the event of a high pressure oxygen environment, which can be very damaging to life.

Josh Clemente      (01:56) And so seeing all this research, I started to juxtapose this with my own experiences. I was, I am a CrossFit L2 trainer and I was feeling a pretty big difference between how I thought I should feel in terms of health and how I actually felt, like the quality of my life. I was having a lot of fatigue issues, waves of fatigue, both mentally and physically, throughout the day. Generally just was not feeling well-prepared for my work days and  struggling my way through it and using coffee as life support.

Josh Clemente      (02:29) And so realizing this connection between metabolism, physiology, diet and long-term health and control of the metabolic system, I started to take more seriously that there must be a better way for me to go about my life and to make better decisions.

Josh Clemente      (02:44) After I left SpaceX, I spent about a year working for a different entity and exploring the research on metabolic health and endocrine system breakdown and I decided I needed to get some data on my own lifestyle and tried to get my hands on a continuous glucose monitor because they measure one of the key molecules of energy in the body, sugar or glucose and I could not get one. It took me, I tried four different doctors and they all just misunderstood what I was trying to do and didn’t understand why I would care about this if I wasn’t diabetic. And ultimately, when I did get a CGM, I found out within the first week of data that I was either pre-diabetic or borderline pre-diabetic, depending on whose ranges you go with.

Josh Clemente      (03:28) And that was a huge wake-up call for me because I was being really very intentional, all things considered, about how I was eating. I was cooking a lot of my own meals, eating objectively or subjectively, not low glycemic, but picking carbohydrates that were on the glycemic index on the lower end, like brown rice or sweet potatoes and just trying to really be intentional about my diet. And so seeing that the meals I was eating, the way I was eating them and the implications of sleep, stress, on how my body was responding was a total wake-up call for me.

Josh Clemente      (03:59) And so I spent the next about 14 months building a company called Frontier Biometric, which was just intended to get CGM devices into the hands of many people for general information purposes. Through that project, I found that there’s actually two things that need to be solved here, accessibility, people need to access, but then also, there’s an actual actionability issue, where even if you have this raw data stream, it’s not clear how to use it effectively. You have to do quite a bit of research and I think I got at least a master’s degree in physiology on my own just reading all the papers that are out there on blood sugar control. And so that realization caused me to step back and say, actually what I need is to put together a world class team of data science experts and medical experts that can take this and turn it into software and provide low hanging fruit for people to actually just make better choices with real-time data. And so that’s what Levels is today.

Jake                      (04:55) Great. I appreciate the background and it’s a super interesting story. I can sympathize a bit with the piece about facing fatigue. I think, for me any health issues surfaced a little bit differently, but I’ve basically had, despite efforts across the board short of continuous glucose monitoring, I’ve had  chronic back pain for the better part of the last two or three years and I’ve focused on diet focused on – I do fasting and as a nice offshoot, it’s helped me become a lot healthier in a lot of ways, exercising more, sleeping better, things like that. But I still can’t seem to totally resolve the issue. And so I’m somewhat optimistic, cautiously, that I plan on using the Levels monitor once I can get one, frankly.

Josh Clemente      (05:49) Yeah.

Jake                      (05:49) And hoping after this episode, I’ll connect with you and make that happen. But –

Josh Clemente      (05:53) Yeah. Definitely.

Jake                      (05:54) I’d like to be able to track that and see if the metabolic health is really the simple, as you would hope, answer despite all these complex solutions that aren’t working as well.

Josh Clemente      (06:07) For the back pain, it’s interesting. There are strong links to inflammation in terms of metabolic dysfunction and ties to inflammation. Specifically, these would be pro-inflammatory chemicals, like IL-6, TNF-α and C-Reactive Protein. These are the ones which typically are taken to be immune markers and they’re increased in people who have blood sugar dysregulation, so it could be potentially an inflammatory link with muscular pain or nervous system pain. So yeah, it’s unique and individualized. If you haven’t found the underlying cause, certainly, there could be something there with metabolism.

Jake                      (06:42) Right. And just that short snippet that you provided is just about as good of an answer as I’ve gotten from any doctor that I’ve seen for it. So I appreciate the quick, remote diagnosis or at least attempt at it.

Jake                      (06:55) So I’d love to start at the top of your story. Obviously, I want to spend a lot of time talking about metabolic fitness and everything you guys are doing at Levels. But super interesting background, obviously being one of the first four in your department at SpaceX. I don’t know how many people were in the company as a whole at the time, but I imagine you were some degrees of separation away from Elon Musk who’s, in my opinion, the most inspiring entrepreneur in the world and one of the most inspiring companies in the world that just sent Bob and Doug to space, like you mentioned, and I understand you were pivotal and in making sure that happened safely. So I would love to hear the early story of your experience at SpaceX.

Josh Clemente      (07:37) Yeah. My experience in SpaceX was kind of a saga. It feels like 10 years and one year at once. I, first of all, totally agree with you in terms of Elon as an inspirational figure. He’s one of my role models in business in just the way that he doubles down personally and professionally on everything he does. He picks extremely large projects, impossible projects  and he puts everything he has into them, and when the stakes are highest and the risk is highest, that’s when he doubles down and goes in even harder. And I think that is – I’ve seen that both in the entities like Tesla that I haven’t worked for directly and then personally at SpaceX. I had a weekly stand up meeting with Elon and actually had quite a bit of involvement in how he handles projects and how he makes decisions that have multi decade implications. So he is putting pieces in place that are very painful to implement. And it’s  hard to describe specifically, but just like forcing change inside of a large, successful, profitable structure that could –

Josh Clemente      (08:39) Bet  it all, in a sense, because the end goal is reaching Mars. It’s very hard to convince someone on business fundamentals that you should take a perfectly successful launch provider and, again, bet it all on Starship or some other crazy program in order to ensure that Mars is within reach. And so that’s the thing that Elon is exceptional at, is not only convincing people and building the team that can go out and make it work, but then constantly redirecting, keeping that course correction happening so that the really huge mission that sometimes you lose track of still ends up happening.

Josh Clemente      (09:18) And so seeing that firsthand and being able to be a part of it was hopefully not the peak of my career, but certainly was a high point very early on. I was super lucky to get to work at that company and with the teams that I got to work with. Early on we were about – I was employee, I think, 680 or something and ultimately when I left it was over 7000 people. So seeing the company transition from recently having achieved orbit for the first time, so initially getting their rocket into orbit, and then going from there to building the life support systems that would put humans back in space. It was the first new space vehicle that could carry astronauts since the 1980s, when Space Shuttle came on board. It was a really amazing transition to be a part of going from, again, that small scrappy startup, but then maintaining that environment all the way through to human spaceflight.

Josh Clemente      (10:17) So yeah, pretty incredible. And I got my hands dirty on a lot of interesting projects.

Jake                      (10:23) God! Sounds like a tremendously interesting experience and something that you would grow a lot, presumably very fast, and with Elon at the helm and everyone under him probably sprinting to keep up.

Jake                      (10:38) You described yourself previously in a podcast that I listened to as a space nerd and I don’t know too much about space. It’s obviously very exciting, even to someone who is relatively ignorant on the space, no pun intended. But we’d love to hear your perspective, with any caveats you might want to offer, about what you see happening in the next 5, 10, whatever the appropriate time horizon is in term of years, just anything that people should  keep an eye out for or expect to happen.

Josh Clemente      (11:12) Yeah. There’s two super interesting things right now happening and one of them has already been demonstrated, which is reusable spacecrafts. So SpaceX is the first entity to be able to put a space craft or a satellite into orbit and then land the launch vehicle and reuse it. And that was previously assumed to be impossible and now is commonplace for SpaceX.

Josh Clemente      (11:33) And there are other companies like Blue Origin and others still who are developing the same technology, and I think they will achieve it. And that’s fantastic for everyone because what that allows is orders of magnitude reduction in cost, safety, reliability of space hardware.

Josh Clemente      (11:48) So being able to only fly a rocket once and never be able to inspect it and see how that stressed the vehicle and make improvements is really bad. And that’s how we’ve operated in spaceflight for a long time. And so now with reusability, we have a total breakthrough in terms of making launch vehicles more like airplanes, where you can do this repeatedly all day and it’s just fuel up and go. And then that’s pivotal because it will bring down the cost of access to space, which is great for spaceflight and also for bringing payloads up or payloads back from space. And so I think that’s going to open up –

Josh Clemente      (12:22) Really, I don’t want to describe it as a gold rush because that’s such an old trope, but it’s going to open up orbit and extra orbital, I think, marketplaces and industries that we really can’t picture quite yet. And I think it’s going to happen much faster than other people might assume. And partially due to projects like Starship, which is going to be a single stage to orbit capable launch vehicle that is going to put more payload in orbit for cheaper prices than ever before.

Josh Clemente      (12:54) And combine that with the Artemis Program, which is – It’s a NASA initiative, but there are  plenty of entities. They’re commercializing it through private providers. And so the Artemis Program is all about putting humans back on the moon and part of that will be building a lunar gateway, which will be like a space station between Earth and the Moon. And then, yeah, getting landing craft and basically building a moon base. And so this initiative is well underway. There are a lot of bids that have been accepted already. And so just like building the hardware that can get us there and then building the first permanent base on another planetary body is really going to be transformational in the way that we look at space and I think it’s going to open up some fantastic paradigm shifts. And I personally would love to work in the world of the future space trade that I think is going to develop as a result.

Jake                      (13:52) What got you interested in space in the first place?

Josh Clemente      (13:57) I have an obsession with machines and engines and flying vehicles from an early age. Fighter jets have always been one of the things that I’ll stop in my tracks even now and just stare at a fighter jet flying overhead. And I think that’s like a holdover from when I was a toddler and I was just obsessed with watching things fly overhead.

Josh Clemente      (14:18) Space, it’s transformed a little bit for me and it now is the ultimate frame of reference or context reset. Whenever I remember to zoom out and look up and see the vastness and everything that we don’t know, it can help to minimize some of the nonsense that we can stress out, or I don’t know, over index on and daily life. So for me, it’s really, it’s cathartic in a sense. And it is also just fascinating from a machinery and a challenge perspective.  I think I have this addiction to big ideas and thinking about the things that we don’t know and the places that we’ve never been, is really inspirational to me. So space is the ultimate draw.

Jake                      (15:06) Yeah. I share your addiction to big ideas and obsession with big ideas. And also the point you make about looking into the sky and thinking how small everything is and how little it matters, in a sense.

Josh Clemente      (15:19) Yeah.

Jake                      (15:19) I really like and actually, coincidentally, first heard this from Elon Musk in a podcast with Lex Fridman, I think, which was Carl Sagan writing about the Pale Blue Dot to accompany the picture, which I’m sure you’re familiar with. It’s something that I had actually as my computer background for a little while. That was just a pretty cool little piece that I – It was almost like a poem.

Josh Clemente      (15:45) Yeah. It’s beautiful. Carl Sagan is one of the best of all time.

Jake                      (15:48) Yeah. So speaking of big ideas, space is one. Another one for me and obviously, you’re working more directly in this now, or maybe not directly, but certainly associated, is I focus a lot on longevity. My first guest on the podcast was Aubrey de Grey, who is well known, it sounds like you’re familiar, with coining the term longevity escape velocity, the idea that people can basically reverse their biological age quickly enough, over time. That if we give ourselves 30 years, we can then figure out how to get another 30 years in those 30 years and if you can just go back, rewind one year basically, for every year that you’re aging, then theoretically, humans will be able to live forever. And obviously, that’s a far out notion, which I don’t know if it’s completely impossible. I wouldn’t say that it is, but a lot of people have a hard time believing it. I have a much easier time convincing people that I think there’s a decent chance that people like myself or people that are my age could live well past 120, even 150, which is something that’s totally foreign to your everyday person to understanding.

Jake                      (17:09) Is this something that you’re interested in as well? And did it play any part in you wanting to transition into more of a health tech company?

Josh Clemente      (17:17) Longevity is interesting. I think there are two camps. There’s the immortality camp and then there’s the people who want to live. They want to avoid unnecessary early death and fragility. And I fall, I think, into the latter camp where I’m not necessarily – It’s not that I’m not interested, it’s just something I don’t spend a lot of time thinking about the immortality piece. I don’t know enough to talk in an informed way about it. I’m hopeful that something like that is possible because that would be – Yeah, it opens up a lot of opportunities.

Josh Clemente      (17:50) But I’m more interested, personally, in ensuring that when I die, I die quickly and I am maximizing my fitness and my independence until the very last moments. I don’t want to be a person who’s infirm for any amount of time. And so I want to avoid a situation where  I age slowly and painfully and ungracefully and my independence is slowly taken from me. And I think there’s far too much of this happening in society. We accept that aging is debilitating.

Josh Clemente      (18:25) And that is what I push back on and think it’s totally unnecessary and we can avoid much of that with better choices at the individual level and obviously, with medical advances, but really, I think a huge amount of it comes down to lifestyle choices and basically the compounding effects of the decisions we make every day. From the earliest age, they stack up and they – We earn a return on that investment, so to speak, over time. And it’s really important that we are earning positive interest, not negative interest, if that makes sense.

Josh Clemente      (18:54) And I think that’s really what drew me to this space. I want to make an impact. Selfishly, I also want to benefit from making better choices every day that are guided by objective data, but also in an unselfish way I would want this for my parents and I would want this for really, everyone. It’s pretty important that we improve the way we go about our daily lives. Looking at the numbers in society today, 88% of American adults are metabolically unhealthy and 70% are overweight or obese and 35% are Type 2 diabetic or pre-diabetic, which are both preventative chronic illnesses. And we’re heading in the wrong direction and every developing country is heading in the wrong direction as well. And that’s where I think it’s really important that we correct course and we could totally turn this ship around and have some real serious human flourishing and enjoy long and healthy lives.

Jake                      (19:52) I totally agree with you on the sentiment with wanting to increase health span, I think, is how I refer to it. So even if you’re going to live 90 years no matter what, to live 89 of them relatively healthfully and then have a tough year, tough last few months or whatever it might be. I think that’s a super aspirable goal.

Jake                      (20:14) And obviously, that’s what Levels is working towards with the metabolic epidemic that you’re referring to where 88% of people having something wrong in that category Stateside. I’m not sure what the international figure would be. But I would imagine it’s similar.

Jake                      (20:30) So is this something where – And  my understanding, because when I first saw that number I was pretty startled and wondering, this seems like something that – No one’s been using a Levels device or any continuous glucose monitoring device, historically, or very few people with diabetes have been using them. So my thought was like, alright, this has probably been an issue for a long time. And it’s awesome that we now have a solution to this large problem. But I was questioning the concept that the problem is actually getting worse and that this is a critical time where it’s getting a lot worse. But then I read some of the content that you guys have put out on the blog and it became pretty clear that this is a worsening issue, that it’s mostly due to – I think, we’re eating more, moving less and sleeping less generally as a population and the stuff that we’re eating is has more sugar and it’s more processed than ever.

Josh Clemente      (21:30) Yeah.

Jake                      (21:31) So is this an issue that – Obviously you mentioned 88% of people with metabolic issues and pre-diabetes, but not quite diabetics. Is this an issue that’s going to come to the surface regardless of what you guys do in the next 5 or 10 years or whatever it might be and then Levels will hopefully be there with a solution by that time to help people come out of it?

Josh Clemente      (21:53) We want to be in intrinsically involved in both drawing awareness to the issue and having a resolution available. So I think that disturbingly little time is spent in the mainstream thinking about this problem that you just re-summarized nicely. 88% of people being metabolically unhealthy is a shocking, tire-screeching number and the rates are not just affecting adults. That number, that figure is relating to adults, but the rates of non-alcoholic fatty liver disease, obesity and diabetes in children are skyrocketing. They’re at an all time high. It’s basically 4×2 the numbers they were at in the 1950s. And we’ve seen 1,000% increase in the rate of diabetes in adults since the 1950s.

Josh Clemente      (22:40) And this is something that is 100% avoidable and preventable. It’s just that we’re making completely uneducated decisions and it’s not the fault of the individual. It’s that, again, like you said, the food supply is getting more processed, our lifestyles are getting more sedentary and the way that we make decisions is entirely emotional. It’s driven by internet advice or something that worked for someone else or just emotion – just the taste of food and the texture and the food advertising we see. It’s not driven by data.

Josh Clemente      (23:07) And that’s what Levels is changing, is we’re delivering data at the moment of decision. Right? So having that available in real time to know which foods, which meal choices are affecting you positively and negatively and to what degree. And then also seeing specifically how something like a simple walk after a meal or adding a salad up front or reducing portion size of certain foods that you’re very sensitive to can improve not only your short-term qualitative experience by removing maybe  some of the fatigue of an insulin related crash, but also quantitatively in the long-term, reducing your, on paper, risks of these chronic illnesses. I think it really speaks to people and it doesn’t take much convincing when your body speaks back to you and tells you exactly what’s happening. There’s no one really to argue with. It’s just oh, okay, that’s informative and now I’ll make different decisions. And this is what we’re seeing with our earliest customers.

Jake                      (23:59) Right. And so I think it’s pretty clear why the continuous glucose monitoring is the best tool for optimizing this metric and theoretically, this metric is doing a large part of optimizing health if you get it to where it needs to be.

Jake                      (24:15) And my understanding of that is basically flattening any spikes and having a pretty consistent level, to use the company name. So basically, do you want to talk a little bit about the historical ways that diabetics would manage their health and so how this differentiates from finger pricking and what you guys have been doing with the data from the better tool to take it to that next step?

Josh Clemente      (24:44) Yeah. So first off, just real quick. So metabolism is the concept that we’re talking a lot about on the show and metabolism is basically the set of processes that our cells use to turn our food and environment into energy. So every cell in the body needs energy to operate the brain, the muscles, everything. And so the way that we create that energy is from our food and environment like sunlight, for example.

Josh Clemente      (25:09) So when metabolic systems break down, energy is no longer being produced effectively or it’s being mismanaged. So for example, energy is being spent storing fat as opposed to burning fat. And this is where you get into the concepts of metabolic flexibility and the hormonal theory of weight gain, which centers around insulin resistance, which is a hormone. So insulin is a hormone that is used to get sugar out of the blood and into the cells  where it can be turned into energy, or stored as fat or glycogen, which is a stored2 form of sugar.

Josh Clemente      (25:43) So when insulin and glucose become erratic and you start to see elevating levels of sugar, the body releases elevating levels of insulin to correspond with that and attempt to modify it or moderate it rather. And then there’s this condition called insulin resistance, which when there’s chronic insulin elevation, the tissues, the cells become numb to its effects and the body starts to lose control of the feedback loop between glucose and insulin and your insulin levels continue to climb and the body essentially is no longer able to access and burn either glucose or fat effectively because it’s stuck in this hyperinsulinemic state.

Josh Clemente      (26:23) When that system breaks, this is often like in the advanced stages, this is what’s called Type 2 diabetes, essentially, when the pancreas even though it isn’t affected by an autoimmune condition, which is called Type 1 diabetes, but it can no longer moderate or control glucose levels by releasing insulin. That’s when someone has Type 2 diabetes and they have to use a device or a measurement method of some kind to measure their blood sugar levels and attempt to control them through diet or external medications like Metformin or insulin.

Josh Clemente      (27:00) So that whole process of measuring glucose traditionally has been done by pricking your finger and dropping some blood on a little test strip and this device will give you a number that basically says your blood sugar is 110. And so historically, that’s how people with diabetes have managed their care by using this single point measurement.

Josh Clemente      (27:23) Now, the problem with that is that a single number, it just tells you where you are right at this moment. It doesn’t tell you where you were 20 minutes ago, where you’re heading, how fast – It lacks a ton of context. And so that led to some really poor standards of care for people with diabetes and they were experiencing a lot of the complications of diabetes like neuropathy, which is destruction of the nervous system, sense of touch, this can lead to infections, retinopathy, which is a loss of vision, heart disease, etc. because their glucose levels are poorly controlled.

Josh Clemente      (27:57) And so more effective means had to be developed. And that is the continuous glucose monitor. And this device, you wear it full time and it gives you a continuous signal of your blood sugar in real time. And not only that, but it can show you – Because you have the continuous signal, you can see both where you are right now and also where you were 20 minutes ago and how fast your sugars are changing. So this is a total breakthrough for diabetes management. And it’s led to a super improved standard of care and much better outcomes for people with diabetes.

Josh Clemente      (28:29) Now, what we’re doing differently, is actually taking that raw data, pulling it into metabolic models which are based on machine learning algorithms and turning raw blood sugar data into scores that are oriented around lifestyle choices you’re making and grades of your metabolic control overall. And so surfacing high level insights that can be specifically turned into a behavior change. Rather than just saying you’re at 88 mg/dL, we’re saying here are the foods that are most optimal for you, here’s how poor sleep affects you, here’s how a walk after a meal improves your responses. So really filtering things down to specific choices.

Jake                      (29:15) Yeah. That all sounds super helpful and I understand how CGM would be an upgrade from the fingerpicking. But then taking the data and using the machine learning seems like basically taking that better tool and giving it steroids.

Josh Clemente      (29:28) Yeah.

Jake                      (29:29) And making it a whole lot more useful to not only diabetics, but the common person who is part of that 88% and probably doesn’t know it.

Josh Clemente      (29:39) It’s building a platform, basically on the hardware that was originally developed for therapeutic diabetes management. It’s taking that and pushing it into the future where no matter where you are on the metabolic health spectrum, it can be used daily to make better choices rather than in a strictly medication or rather medication management environment, if that makes sense. It’s turns it into a lifestyle tool.

Jake                      (30:02) Yeah. And you guys are still in the fairly early stages. Is that right?

Josh Clemente      (30:06) We’re in a beta phase right now. We’re actually scaling our beta up. So this program is invitation only and it was an attempt to basically get real customers using our product and giving us feedback in real time. And so we’ve released about 400 iterations of our beta app, our initial development program and we’ve now reached a point where we’re scaling up volume quite aggressively in there and we’re nearly at the inflection point where we’re going to launch the product and become more widely available. So although right now we are still invite only, we’re very close to releasing –  We’re targeting pre-holidays for the full launch.

Jake                      (30:47) Now, is that going to help you guys also to collect degrees of magnitude more data from more users? Or do you already have a pretty sufficient amount to work with to be able to make some early insights?

Josh Clemente      (31:00) We’re already able to make some early insights and we’re building a – Right now the main thrust of the development process is building our insights framework, which is surfacing proactive insights. So rather than being entirely receptive of data and just recording it and feeding it back to the user, we’re going to surface new lessons and new insights that can be constructive to making better choices. And so that insights framework is our next big product push.

Josh Clemente      (31:26) Right now, our data set that drives this is already the largest non-diabetic glucose dataset for wellness ever. There are some research entities that have on the order of 800 people, participants for seven days and we have about five times that already and we haven’t gone public or opened up the product to a larger market yet. And so our data set will continue to grow and expand and along with that, as you mentioned, the rigor, the statistical relevance of subsets within that data is going to continue to improve and we’ll be able to pull that much more insight out and improve our algorithms in our recommendation system. So yeah, just a lot of great things will come from the network effects or the compounding effects of having a much larger dataset with richer and more diverse participants.

Jake                      (32:13) It’s funny, I spoke with Matteo Franceschetti, I hope I’m saying that right, yesterday, founder of Eight Sleep.

Josh Clemente      (32:22) Yeah.

Jake                      (32:23) And he’s a huge fan, loves your guy’s product. So we talked a bit about it and he was talking about how they’re collecting, basically unprecedented amounts of data around sleep and that’s a relatively new company. You guys are now collecting unprecedent amounts of data in your category. You can’t help but be excited about the optimization of health that’s going to be possible in the next 5/10 years versus what’s been possible previously, I think. Right?

Josh Clemente      (32:53) Absolutely. Yeah. I love what Eight Sleep is doing and the quality and resolution of their sleep data is second to none, I think, because it’s much larger than just a wearable. Right? So love what they’re doing. There’s a lot of collaboration opportunity there to show how sleep both affects metabolic control.

Josh Clemente      (33:08) For example, if you only sleep five hours versus nine hours. Your body has this – We believe it’s an adaptive response, but basically, you have acute insulin resistance that sets in which I described earlier and it makes everything you eat and your blood sugar control generally much worse and likely is to preserve glucose for the brain in a stressful situation because your body is not well rested.

Josh Clemente      (33:31) But it is something that many people are living chronically with. And so being able to show with sleep data and glycemic data how these things are so interconnected, and it’s closed loop, right, sleep affects metabolic control and metabolic control, or lack thereof, affects quality of sleep. So there’s plenty of overlap there. And same with teams like Whoop, Oura, etc., who are all using wearables to show activity data and recovery data. A lot of this is very closely tied in with nutrition and metabolism.

Josh Clemente      (34:01) And so there’s a ton of potential and as we get larger datasets and richer data sets what Levels core focus is, is not just generating data for data’s sake, it’s generating data and using it to enrich lives and improve human metabolic outcomes. And so we won’t add additional data sources into the Levels platform unless they are actionable and there’s concrete behavior change that we can produce from it. So we’ll remain very lightweight and continue to add data streams as they become very clearly beneficial.

Josh Clemente      (34:35) Yeah. To your point, there are tons of improvements where we can embed sensors and how we can pull insights out of them and I’m super stoked for it.

Jake                      (34:43) So it seems pretty clear that you’re big into self-experimentation. That’s what brought you on this mission in the first place. Have you tried a number of these different apps and wearables and other things in similar categories around health on yourself?

Josh Clemente      (35:00) Yeah. So I was never really much of a biohacker per se. I think the experience with CGM was a real wake-up call for me to realizing that real-time data is an unbelievably powerful tool. And I certainly think that it, in many ways, helped me avoid a potentially very arduous future and a lot of suffering if I had not been aware of it. So I definitely use a lot of data for exercise in particular and sleep.

Josh Clemente      (35:27) I do not have my Eight Sleep pod yet, but I will be getting one. And instead I use Whoop and a few other wearables to track my sleep and recovery. I rotate through them because I find that some are better than others at, for example, tracking exercise and others are better for strictly the recovery element. But yeah, the ones that are on my wrist right now are a Garmin 245 watch, which I use for exercise and a Whoop band, which I use for sleep primarily.

Josh Clemente      (35:58) And I’ve really found some really fascinating insights from both the connection between something like alcohol and sleep quality, exercise quality and glucose control. Basically having a few glasses of wine after 6pm can completely decimate my sleep until four or five in the  morning and my heart rate will be as elevated as it is when I’m awake and moving around. And that causes me to lose that night of asleep. The next day, my blood sugar control is about 18% to 20% higher than typical and my response to my regular meals is much worse. And that leads me to essentially feeling – My exercise is totally depleted.

Josh Clemente      (36:41) And it’s a little bit subjective and anecdotal, but seeing all this data and imagining the future where all of this can be combined and you can track the quality of your exercise and personal record setting, for example, in the environment of the decisions you made leading up to that. So both the nutritional choices, the sleep quality, recovery scores and whether or not you were, for example, indulging in alcohol or anything leading up to that, it can all really paint a nice picture of where is your peak performance? Where does optimal lie? And people can then choose how often do they want to indulge in when and really, I think, make data driven choices across their entire lifestyle.

Jake                      (37:23) Yeah. I think, for me, personally, it seems refreshing to hear about your guy’s product in the sense that I feel like almost I’ve been flying blind in terms of nutrition, among other things that affect your metabolism.

Josh Clemente      (37:39) Yes. Good way to put it.

Jake                      (37:40) I grew up in a house, my dad’s a doctor and my mother’s always been obsessed with finding what’s the most healthy way to live, whether it’s eating a paleo diet or taking various natural supplements, so health all around me. And obviously, through childhood, I rebelled against some of that, but over time, it has rubbed off, so I’m pretty curious. I told my mom actually that she’s probably going to be getting one of these things.

Josh Clemente      (38:12) Awesome.

Jake                      (38:14) So it should be pretty cool to see. And I know I, actually this year, made some pretty drastic differences to the way I eat. I’ve committed pretty hard to and I’d experimented with fasting previously for a couple years, but this year, it’s been very consistent. Weekdays, I do 16 hours fasting and about eight hours eating and it’s not exact, but generally I stop eating around 8pm and don’t start until afternoon and then I also did, I’ve incorporated pretty strict vegan, gluten free eating and nutrition during the week. But on the weekend, I’ll eat five slices of pizza for dinner and throw everything out the window.

Jake                      (38:59) So I would be curious to hear some of the things that you’ve learned from your own experience using Levels or any of these other devices and how you’ve gone and trended in terms of nutrition, exercise, fasting, anything along those lines.

Josh Clemente      (39:15) Yeah. So historically, I have not been a nutrition oriented person either. I was a calories in calories out extremist and I’ve been – I played sports and been active my whole life. I’m a CrossFit trainer and I always assumed that if I wasn’t gaining weight and I was working out hard in the gym, I could eat whatever I wanted and it had no implications on my health. That obviously, I now believe very differently and understanding how the human body works. It’s much more like a chemistry set than it is like some rigid machine where inputs equal outputs. Your body is acting and it is turning food into energy through the release of hormones and when your hormonal system is spiked in one direction or the other or imbalanced in one direction or the other, it completely changes the way your body is responding to the foods you’re eating. And actually, the foods you’re eating can influence the direction of your hormones and that is the example of hyperinsulinemia that we talked about earlier.

Josh Clemente      (40:20) So I was addicted to candy and sugar, generally. When I was a kid, I would, or even all the way up through after college – There was a time in my life when I would polish off a one to two pound bag of M&Ms throughout an afternoon and evening and just not eat dinner. And that’s the type of, again – If a calorie is a calorie that’s no different than eating whatever, 2500 calories of broccoli. Right?

Josh Clemente      (40:44) Well, the implication to the endocrine system is completely different than that. So you don’t need insulin to get broccoli into the cells for energy. So what I was doing is just kicking my system over and over again. And now once I have the data from CGM, I’ve now seen that I’m incredibly carb intolerant, so even a small  portion of brown rice will put me into a pre-diabetic blood sugar zone for, in some cases, an hour plus. And I’m not entirely sure how my body was responding years ago, when I was younger and if this is something that I’ve developed over time, I’m fairly confident that it is.

Josh Clemente      (41:19) But now I’m all about restoring function for my metabolic system. And so I like to maintain pretty rigorous eating habits and the accountability component of seeing the data full time is really helpful here. But basically, seven days a week, I try to stay 100% in range and avoid spiking myself out into the above normal glucose ranges.

Josh Clemente      (41:42) And actually at Levels, we’ve developed some ranges that we call optimal, which are influenced by a lot of research that’s out there that show the lowest risk quartile of people, essentially highlights where their blood sugar typically lies. And so that’s what we use as the optimal range, the lowest risk quartile.

Josh Clemente      (42:00) So I try to actually maintain 100% time and range for optimal, but that’s a little bit trickier. I still have a little bit of underlying dysfunctioning, so it’s very easy for me, even just after a few hours of missed sleep to have a baseline glucose level that’s higher than that optimal range. So I’m still working my way back, but the specific ways I’m doing it are, always eating mixed meals, making sure I have fat, protein and complex carbohydrates with a lot of fiber on the plate. I definitely use intermittent fasting. So I typically don’t eat anything before noon at the earliest. Oftentimes, I’ll go to 3pm or 4pm and I try not to eat late.

Josh Clemente      (42:39) And then a few other tricks of the trade are, avoiding foods that I know I’m specifically sensitive to, indulging in foods that I know that work really well for me – so dark chocolate is an example, blueberries is an example – finding ways that I can get the richness and the taste, Rebel ice cream. Rebel makes a very low-sugar ice cream that is just phenomenal. It tastes amazing and has generally really good ingredients. And so finding those types of foods, protein bars, like Perfect Keto. A lot of protein bars will advertise they’re net zero carbohydrates and actually they’re packed with something like tapioca fiber, which mostly turns directly into sugar in the bloodstream. And so by testing all the different foods I’ve been able to develop a repertoire of, the archive of foods that I can rely on. And so I always lean on those.

Josh Clemente      (43:31) And then exercise is a really big one and sleep quality. So I try to avoid alcohol after a certain time. I make sure that I have a dark room and practice good sleep hygiene and try to get seven to nine hours of sleep every night. And then just exercising around any indulgences in particular, just taking a simple walk after a rich meal or a meal that has foods in it that I know I’m going to have a blood sugar spike from is really powerful. So just 15/20 minutes of brisk walking can totally change the way that most people’s blood sugar responds to a meal. It’s pretty profound when you see it and it really reinforces that habit going into the future.

Josh Clemente      (44:14) So I am pretty aggressive about taking an after dinner walk every night and just whether or not it’s a rich meal it’s just building that habit and it’s really a nice way to end the evening anyway, so it’s not a disciplinary action of any kind.

Jake                      (44:27) Yeah. I like walking and recently I’ve been more into running, but walking is definitely something I’d like to incorporate more and knowing that it’s super beneficial after meals.

Josh Clemente      (44:36) Yeah.

Jake                      (44:36) You’ve given me a good time to work that in. I definitely hope that dark chocolates are on the list of things I can indulge in as well. That would be a very nice and a welcome surprise. I’m off to check the Rebel ice cream too.

Josh Clemente      (44:51) I highly recommend all the above. I think for me dark chocolate above, 86% I can just, I can eat an entire bar and there’s really no impact to my blood sugar. But yeah, for anyone listening, the biggest hack, in my opinion, if you want to try to improve metabolic control whether or not you’re wearing a CGM is just being more active around meals. It doesn’t mean you have to go do squats or push ups, just within 10/15 minutes of eating a meal, I’d advise just get up and take a walk 15/20 minutes. And yeah, it shouldn’t feel disciplinary, but it’s a really powerful tool and I think humans historically have been super active all the time and as we get more sedentary and live lives that are indoors and at desks, it’s really important to just get steps in and keep moving.

Jake                      (45:38) So outside of walking, you mentioned you’re big into CrossFit. What are the core things that you do there that you enjoy the most or that you think are most beneficial?

Josh Clemente      (45:48) Yeah. So I got to Level 2 in my training experience and I actually have been doing less CrossFit over the past  year and a half, two years and more endurance training because – for two reasons. One, I’m really interested in trying to train metabolic flexibility, which is being able to switch between sugar and fat that’s stored on your body very easily.

Josh Clemente      (46:16) So the reason here is that we can store about 2,000 calories of sugar in the form of glycogen for the average person and we can store about 80,000 calories of fat on that same body type. And that’s like 10% body fat at 150 pounds. So it’s really important if you want to be energized at all times, especially if you want to be able to maintain an energy output for long duration events like triathlon or marathon or running generally, it’s important that you be able to access that those fat stores easily.

Josh Clemente      (46:47) There is this term called bonking, which is when, a runner will be really familiar with this, but when you deplete your glycogen, so all of your sugar is depleted during a run and you suddenly hit a wall and there’s basically no energy. You’re  cold sweating, you feel shaky and many people just drop out of their races at that point. And the reason that happens is that they train fueling on high sugar foods and Gels, Gatorades just basically strictly powering themselves off sugar and their body doesn’t know how, it’s not hormonally set up to tap into the fat stores that they have.

Josh Clemente      (47:23) And so there’s this concept of metabolic flexibility and mitochondrial density improvement which can happen when you train specifically fasted, but also just eating a high fat diet and you do long duration endurance exercising. And so I’ve been dabbling in this space now. I’ve been doing a lot more running, cycling, I’m trying to get into swimming and ultimately, I’d like to complete a triathlon sometime soon.

Josh Clemente      (47:48) And this has been taking my full focus as I experiment and learn more about the space and improve. Certainly it’s a work in progress. I’m no endurance athlete, but this has taken my attention from the more weights and high intensity CrossFit stuff lately. I’ll still do a lot of high intensity interval training at home like just pull ups, push ups, bodyweight squats, kettlebells. I think there’s a ton of importance there in keeping your body, strength train, keeping muscle mass and just maintain flexibility and mobility. So that’s where I’ve been spending more time is in between the endurance stuff, just keeping backyard workouts going.

Jake                      (48:27) That’s awesome. I hear a lot about the HIIT training these days, high intensity interval, and people seem pretty convinced that it’s a good thing and I have no reason to doubt them. But it’s refreshing to hear someone who’s turning the other way and getting into endurance training as well because that’s what I’ve spent the year doing as well in terms of running.

Josh Clemente      (48:49) Nice.

Jake                      (48:50) And particularly doing so in a fasted state has been a huge difference maker for me. I just feel a whole lot better running in the morning before I eat than later at night. So hopefully – I wish you the best of luck with the triathlon and hopefully you have some pretty cool insights coming out of that, if not just for yourself for the company as well.

Josh Clemente      (49:12) Yeah. Exactly. When I got serious about – So I was training up for a triathlon in March and then COVID hit and that ended up not happening. The triathlon was actually going to be in July, but in March, I was in the thick of the training. And so I got derailed for a bit there and now I’m getting back on the wagon, so to speak. And this time around I want to do some, potentially even muscle biopsies, so I can take a look at how the training affects my actual tissues and where the changes actually set in. So I have some concrete objective data on the assumptions here. And then obviously using, ideally, CGM and low glycemic training, so a lot of fasted training, a lot of higher fat and protein in my nutrition mix.

Josh Clemente      (49:56) And just a little bit against the status quo or the standard sports fueling philosophy, which is that you should be always replenishing glycogen and carb loading before workouts and always be replenished. I remember eating seven or nine meals a day when I was trying to bulk up and get strong and fast.

Josh Clemente      (50:16) And the realization that, although that’s grounded in the way that professional athletes approach their training, I was not a professional athlete and actually I was spending most of my time as an engineer at a desk,  doing desk work and so constantly fueling up with these giant Tupperware-full of pasta and rice and such in order to be ready for my one-hour workout in the evening was entirely overdoing it. And I was training like an elite athlete, but I was working like an elite engineer. So these are two different lifestyles and I need to be realistic about – I’m a weekend warrior and I’m a one-hour a day workout guy so make sure I’ve got the fuel to get through that, but actually, my body will produce plenty of energy for that without me having to carb load for it.

Josh Clemente      (50:59) So that’s the big realization is that we allow advertising to really get into our heads and convince us that we all – like if the elite are doing it this way, we should all be doing it that way because that’s what healthy is like or that’s where performance is unlocked. But actually we should train the way we live and optimize our nutrition choices for what we’re actually doing in the real world and stop being so, I think, all or nothing about our approaches.

Josh Clemente      (51:26) Sorry for the spiel there, but that’s just a thought about how traditional sports philosophy has trickled down to anyone that walks into a gym these days.

Jake                      (51:36) Yeah. No. That’s all great and if there’s anyone to agree with you on something that goes against the status quo, I’m your guy. And particularly when it comes to nutrition and fitness, even if there was a status quo that’s correct, that’s just the amount of personalization and the genetic factors and lifestyle habits and everything. It’s a different answer for everyone so there couldn’t really possibly be a status quo. There might be some general guidelines.

Josh Clemente      (52:04) Exactly.

Jake                      (52:04) But it’s a pretty easy status quo to get over pretty quickly.

Josh Clemente      (52:09) Yeah. Yeah. Body composition and historical metabolic function are all super involved here. There’s some crazy stuff with insulin resistance and people who, for example, are really overweight. There is an actual  hormonal element here to how available that energy is to someone who’s struggling to lose weight.

Josh Clemente      (52:31) There’s this respiratory quotient, which is a measurement that basically can tell you what energy substrate you’re running on, whether you’re burning fat or burning glucose and it basically measures, I think, the ratio of CO2 to oxygen that you breathe in to the CO2 that you read out. And when someone’s had a respiratory quotient of one, it means that they’re burning only sugar, so they’re only consuming glucose for energy. And most of the time, elite athletes will be running at a respiratory quotient of one when they’re at full out performance, so sprinting up a hill at the Tour de France, for example or just full out performance, that’s when they’ll hit a respiratory quotient at one, otherwise, they’re always burning some combination of fat and sugar.

Josh Clemente      (53:16) Now, somebody who is morbidly obese, for example, there are tests that show or studies that show that they can be lying on the couch completely stationary and their bodies can be at a respiratory quotient of one, meaning they’re only burning sugar as though they are basically at max performance. And you can imagine what that’s like, from an energetic and fatigue perspective, to not be able to access the energy that’s available in your body, to only be reliant on sugar sources.

Josh Clemente      (53:44) It’s clearly a huge issue and it’s something that we don’t think about that often in society. We just think it’s a calories function – stop eating and burn fat. Well, that fat, that body fat is not available for consumption and this person is not, their bodies are not metabolizing it effectively. So this is where, again, the individuality really matters, the hormonal environment, the compounding effects of decisions over time, can ultimately lead to a situation that needs really wholesale changes. It’s not a simple switch to flip. You have to really make dramatic changes across a whole host of factors in order to  reset the hormonal system.

Jake                      (54:26) You mentioned earlier that Metformin was something that diabetics use, obviously, and I’ve read a lot about that being pretty effective in longevity. So just while we’re wrapping up here, I’d like to ask you about some more nominal supplements, ingestibles you could call them for lack of a better category, like alcohol and coffee and how you think about those types of things.

Josh Clemente      (54:49) Yeah.

Jake                      (54:49) But then on the supplement side, I’m curious if you’ve experimented with anything in those categories?

Josh Clemente      (54:55) I haven’t personally experimented with Metformin at all and a lot of people use that. Basically it prevents gluconeogenesis, which is where your liver produces glucose from protein and fat and so by preventing gluconeogenesis, you basically limit the amount of sugar that your liver is releasing into the bloodstream and you can bring down overall glucose  levels. And this is really important for people who have unmanageable diabetes to help reduce glucose exposure.

Josh Clemente      (55:22) Some people, it’s actually very common now because it’s a low side effect drug, for people to take this preemptively as a longevity aid and I think there’s maybe some research that it has anti-cancer benefits, but it certainly has risk reduction benefits for diabetes.

Josh Clemente      (55:38) I don’t take it because there also seems to be an effect where it limits mitochondrial function. So it reduces the beneficial effects of exercise. And so I think it’s probably not ideal for everyone. It’s not my – By no means is this medical advice, I’m not an expert on this, but it just seems like something that I don’t want to necessarily use unless I would absolutely have to.

Josh Clemente      (56:03) Other things like berberine, cinnamon, vinegar – these are more holistic quote unquote “supplements”. They’ve been studied for blood sugar control. I haven’t seen a ton of benefit from any of them except vinegar and I think it’s probably something to do with digestion. It changes how fast the glucose gets into the bloodstream or in some way there’s a mechanism there that is reducing the blood sugar increase when I, personally, have vinegar along with my meals if there’s carbohydrates in there. So actually, I make a lot of dressings and sauces with vinegar and use that pretty consistently. The others like berberine and cinnamon I’ve experimented with but don’t see any real benefit. Again, this is all anecdotal and personal.

Josh Clemente      (56:45) And then you touched on alcohol and caffeine. Caffeine is interesting. I absolutely love coffee. My favorite ritual is just having a cup of coffee in the morning. At one point it got really bad for me when I was  burning out at SpaceX and essentially relying on a full pot of coffee per day in order to make it through. It was just crazy fatigue and I would have cups and cups at 2, 3, 4 in the afternoon. I’ve since reduced that down to a maximum of about one, maybe two cups in the morning. I won’t have any after 12 o’clock if I can avoid it. And a lot of this is – I feel a bit more irritable when I have a lot of coffee, but I also noticed I’m very caffeine sensitive and my blood sugar will increase quite significantly from caffeine and that’s a stress response.

Josh Clemente      (57:37) So caffeine is very closely linked to cortisol stress hormone. So when I drink a lot, I’m definitely increasing my cortisol and that’s causing my body to – That hormone release actually causes an addition of insulin and you see, blood sugar increases. So for that reason, I’ve also lean more heavily into avoiding a lot of caffeine.

Josh Clemente      (57:59) Alcohol, I talked about the disruption to my sleep. It’s pretty rare for me to have alcohol in the afternoon or early day. So it would be – Typically it’s only an evening thing for me and I always know that that’s going to come with some disrupted sleep. I think it’s to each their own and I personally just have been consuming less and less of it over time and really just not enjoying the effects as much as I maybe once did and it’ll be like a glass of wine, maybe two in the evening when cooking dinner at most.

Jake                      (58:33)  Right. I appreciate all the anecdotal stuff. I appreciate that it’s only that, but coming from someone like you who’s obviously working in the space and has clearly done his homework to learn more about a lot of these things, I think it’s a lot more valuable than just asking someone who is less informed about the types of habits that they do and the types of things that they think about.

Jake                      (58:58) So in closing, I would like to ask – You talked about what you see for the future of space earlier. I’d like to ask what you see for the future of health and obviously, coming from a Levels point of view, I think it’s really exciting that, obviously, we’ve come a long way in terms of software engineering, but I think we’re just getting started in biological engineering and engineering our human health and increasing our health span, like we mentioned earlier.

Jake                      (59:34) So I envisioned something one day where, and hopefully sooner than later, where I have some sort of, whether it’s an app or app combined with a device, whatever it might be, that’s basically telling me what to do and  I can choose to ignore it if I want, but it uses my personal data combined with all the data that’s collecting in the background from a population of other people and it just knows what’s best for me or it can give me a few options of what’s best for me, like after a meal time to walk, something as simple as that or telling me even what to eat at a certain time.

Jake                      (01:00:10) I’m curious to hear your vision and how you think about the next 5 or 10 years of health and people hopefully being able to take more control of it.

Josh Clemente      (01:00:22) Yeah. I like to think about this one. I would love to see a world, and I’m intent on being a part of it, where we are no longer so focused on symptom care and waiting until there’s a diagnosis to take action. I want to see a world where 88% of American adults and adults globally are metabolically healthy and that people are striving every single day to make choices that are leading them towards optimal, healthier, more rich and rewarding lives. And I think it’s totally possible.

Josh Clemente      (01:00:53) This is not – I don’t think we need some genetic technology breakthrough like CRISPR or something where we can edit DNA to make us immune to sickness. It’s really just having, like you described, having almost that second brain, where we use technology and we use massive datasets to process the information that is already available. This stuff is happening in our bodies, it’s just whether we’re using it or not. So use that information and drive better insights and better decisions at the moment of choice and by doing that and having the lane lines of accountability of that data stream, we can influence better choices for decades and decades.

Josh Clemente      (01:01:34) And it’s really fascinating to think about how little we use data in our in our daily lives, in terms of how we make lifestyle choices. We use data everywhere else, with the exception, again, of health and wellness and that’s a big miss. It’s something that’s going to change really dramatically. We’re starting, obviously, with sleep and exercise, as we’ve seen the wearables wave that’s come up. Now, the Apple Watch is incorporating the ECG, so it can take a wave form of the heart.

Josh Clemente      (01:02:01) And so we’re seeing more and more medical technology make its way in and Levels is a paradigm step in the sense that taking deeper biological information, so the molecules in your body that your system is running on in energetic terms, is a real step function in change. So it’s going below the surface of the skin and giving us, I think, that paradigm shift and clinical relevance of the data.

Josh Clemente      (01:02:26) And it’s the first step towards a world where we have many analytes, so triglycerides, cholesterol, insulin, hormones in addition to sugar that we’re measuring. And so we can have – I can see a wearable that provides a very high resolution multiple analyte data stream that is all turning into insight for us right in front of our faces as we need to make better choices and that I think it’s the world where we have a much, much better health span and lifespan at a social scale.

Jake                      (01:03:02) Yeah. That’s awesome and I’m optimistic that you and the Levels team are helping to drive it.

Jake                      (01:03:09) I do want to give you the last word, in particular would love if you could share, for anyone listening, how to get Levels or get on the waitlist for Levels today and what the product could offer them. At what point in the future – I think you said before the holidays?

Jake                      (01:03:26) But before you do that, just thanks for coming on, Josh. It’s been awesome picking your brain about this stuff and I think what you guys are working on is really interesting and bodes well for human health, which is obviously a great mission to be a part of.

Josh Clemente      (01:03:40) Thanks a lot, Jake, for having me on and digging into this stuff. And for people listening who want to get involved, I recommend going to our website levelshealth.com. Check out the blog firstly. I think that’s the place everyone should start. We have a ton of interesting information there that breaks down how glucose dysregulation and metabolic fitness is related to basically every qualitative experience we have in a day. It explains that plainly and straightforwardly and I think it’s really insightful and we’d love feedback on it. From there, follow us on social @unlocklevels and then you can sign up on the website for our waitlist.

Josh Clemente      (01:04:14) We are again, we’re working quickly through our beta and we are looking forward to launching in a meaningful way towards the end of the year. And we’ll be releasing more details through that waitlist in the form of newsletters, exciting information that’s happening and keeping everyone up to speed on product release dates, etc. So, yeah, please sign up. Reach out to us and we’re happy to engage in and share as much information about what we’re doing as possible.

Jake                      (01:04:42) Awesome. Thanks, Josh.

Josh Clemente      (01:04:44) Thank you, Jake.