Podcast

Josh Clemente Founder of Levels Health on CGM and Bloodsugar

Episode introduction

You can’t manage what you can’t measure. That’s one of the sayings that underpins the goal of Levels – a metabolic fitness company that’s revolutionizing blood glucose measurement. Josh Clement, co-founder and the driving force behind Levels, knows this to be true from firsthand experience. When he started feeling ill, he started tracking his glucose. And the insights changed his life. Now, he’s hoping to help others do the same, setting new baselines for metabolic health and aiding Americans in avoiding metabolic catastrophe. On The Fit Farming Food Mom, Josh shared his insights with host Connie Nightingale.

Show Notes

Key Takeaways

16:19 – Experimentation is possible when you have data

Josh saw incredible health benefits when he started experimenting with macronutrient rations and fasting, based on the data from his CGM.

“Since this whole sort of exploration period over the last few years, I have done extended fasting. I’ve tried different macronutrient ratios. I certainly do not stick to a ketogenic diet typically, but I’m in the high protein, moderate fat, low carb range. That’s just where I feel best, where my energy levels are controlled, and seeing that sort of dashboard of information every day and being able to iteratively improve my decisions based on how prior decisions worked out for me is super powerful. Just today I went on a 30-mile bike ride and it was pushing pretty hard and I didn’t bonk, but I was watching my glucose levels plummet. I actually made a few changes to my cadence, like chose when to push hard based on how my glucose levels were trending and I didn’t bonk, but I think I may have because I was fasted on the bike. If I had just kept pushing hard, it would hit that wall and been 20 miles away from home with just walking my bike and looking for an ice cream sundae or something to get me back on my feet. I think another really interesting part of this is like being able to experiment with timing and not be forced out of your comfort zone in terms of how you’re trying to eat.”

21:33 – Three square meals are overrated

Contrary to popular belief, it is not critical to eat three to five meals a day to keep up with the body’s energy requirements.

“It’s so counterintuitive to a lot of people. Just the concept of not eating a meal for the majority of people is really concerning, and then to go more than just a full day and then to consider even working out while fasted, it’s just like this whole crazy concept that I think most people are so used to hearing that you have to eat three to five square meals a day. Otherwise, you’re going to be, I’m not entirely sure what the repercussions are in people’s minds. But we have a couple of people on the team who are really experimenting with this fasted exercise and training in particular that fasted zone to cardio right at the lactic acid threshold with the goal being to increase mitochondria density, to increase mitochondria efficiency, and to be able to just go for days essentially, just that ultra-endurance space. It’s really cool to see because there is a ton of personalization in there. I do some of this stuff. I do fasted cardio quite a bit. It’s not my go-to personally. I’m still getting into the endurance space from the cross-training space. But one of the guys on the team, Mike is really killing it here. He’ll go for like half marathons fasted from the day prior. His glucose is just rock solid.”

25:29 – Don’t pull an all-nighter

When people know which foods increase their blood sugar level, they are able to make much better decisions on what to eat based on when they want to go to sleep, and how much sleep they had had the night before.

“We are still trying to characterize this really effectively, but there’s a really strong correlation between sleep in particular and, it seems to be, acute insulin resistance. So the way that I personally will respond to you the same meal after, for example, four hours of sleep versus eight hours of sleep, is pretty wild. Like two, three days ago I pulled a really late night. I didn’t get to bed until like 3:00 AM and then got up at 7:00 or 7:30 AM. And I knew I was going to be seeing some elevated levels all day, but it was amazing. My baseline increased by 30 points. It was a significantly higher base glucose level. And then even like a handful of cashews, which typically I do a pretty all right with, they do have some carbs, but they’re high in fat, and so usually fine for me, a handful of cashews treated me like a banana. I was up at like 1:35 AM and so that’s the signal to me. I’m going to eat like a higher fat, like being able to adapt to the circumstances and say, all right, well, I didn’t sleep well last night. I know that I’m going to be in a bad place. Let’s try and keep things from getting crazy here.”

28:57 – Empowering metabolic fitness

The Levels CGM works by having users log meal and lifestyle details. By combining these two data sets, the software is able to help users get meaningful data that helps them make much better decisions for their metabolic health.

“We have that data coming from the device, and then we have lifestyle logging. And so you use the app and you record your meals, your sleep quality, and your exercise very straightforwardly, and then you get these scores. These metabolic fitness scores and meal scores help you to understand how all of these different metrics about your glucose levels are summing together into a response. I’ll break that down a little further. So rather than just staring at a single number, you check your glucose with a glucometer. You get one number that is 87 milligrams per deciliter. Well, that’s interesting, but where were you three minutes ago? Where were you an hour ago? How fast are you changing? Are you going up or are you going down? That’s the context that is missing with these point measurements…We build these composite metrics on the Levels side that turn all of that information into a single score. So you record your meal, and then two hours later after we’ve been able to pull in all the data that follows that meal, we provide you a score that you can then use to optimize. If it’s a positive score, this is something that maybe you want to keep in your dietary archive. If it’s a negative score, you can start to split out some of the ingredients or some of the other factors like maybe I didn’t sleep well last night, maybe I haven’t worked out in a few weeks and that will affect insulin sensitivity. So we’re helping people. We’re really empowering people to log their lifestyles and really tap into this metabolic awareness component in order to achieve metabolic fitness.”

 

32:02 – Keeping catastrophe at bay

People don’t want to make bad decisions. They want better information. With CGM, Levels is trying to reverse the epidemic of metabolic dysfunction in the United States.

“About 50% of the adult population in this country is pre-diabetic or diabetic. This is a catastrophe for the future. It’s not just an individual problem. It’s a social problem. It’s a fiscal problem. We’re looking at a healthcare system that’s already overloaded without adding 80 million, 90 million additional diabetes cases into it. The lost word, the lost time with loved ones, the inability to be mobile, it’s a really tragic and prolonged metabolic state that people are in. People don’t want to make bad decisions. They want better information. And this is just an objective metric that is super useful for people because it’s real-time because it responds to the actions you take. In my opinion, one of the most valuable technologies that have come of age, so to speak, in the past 10 years for health outcomes. And so that’s the illness side of the relationship. And I think giving people access to their own data and allowing them to make better choices is just table stakes. We need to allow this across the board, this should be a thing already. And so we’re excited to bring that to a broader audience.”

37:34 – It all comes down to metabolic dysfunction

Most diseases, including COVID either are made worse by metabolic dysfunction or are rooted in it.

“It takes a long time and a lot of glucose dysfunction for your fasting glucose numbers to start to get erratic. There could be underlying dysfunction for years before this starts to become a problem. When I put the CGM on, I had real-time dynamic information, I saw it as it was happening, and I saw that there was a huge amount during the day caused by my lifestyle choices that were out of control. And that’s the key. People need this. 90% of people who are in the dark about their impending metabolic dysfunction or their current metabolic dysfunction. That is going to get worse. They need to have better information so they can make better choices. Currently, with the COVID thing, there’s been more talk about the metabolic disorder and how we can tackle it. It’s just one of the most threatening trends to see globally. We have metabolic dysfunction that is increasing at an increasing rate across the world. As countries get more developed the rate of diabetes and cardiovascular disease increases non-linearly, and this has been holding for decades now.”

 

41:14 – Testing in beta mode

Levels is enrolling a limited number of high intent users and iterating the entire program based on the high-value feedback they are getting from them.

“So we’re in what we’re calling beta mode, which is essentially we’re improving the software continually. And basically we’re in an invitation-only mode right now. We have a fixed number of slots each month, and we bring in people who are very high intent and are willing to help us out with the development process and give me super high-value feedback as we go. That being said, we’ve made huge strides on the product and experience and we’re getting really high-quality signals that people are improving their lives, improving their decisions, every single day. They’re getting this recursive feedback loop, which is helping them to make better choices. And we’re seeing trends. We provide reports throughout the program. We’re seeing trends that the glucose control that they are exerting over themselves is improving as well, which is a really good signal. That’s our current mode, and we are going to be rolling out pre-orders this summer in order to allow people to reserve a spot for the full launch.”

43:09 – It’s the team that sets Levels apart

While Levels is highly technology focused, Josh believes that the people on the team are the real catalyst for innovation.

“Firstly we have, to my knowledge, the only program that includes a physician consultation for a prescription. In the United States, the FDA controls all CGMs as prescription-only devices. So we ensure that there’s a fully independent telehealth consultation for the devices. We fulfill them directly from a pharmacy. There are no foreign imported sensors or anything of that nature. So I believe we’re the only program that has that system in place. We have a world-class team of software and medical experts. The machine learning models that we’re building that take that data and turn it into insights and action, I think is second to none. There certainly is going to be a ton of focus on CGM and bringing this technology to market. What we are oriented around again, is the actionability to behavior change and the future, which is these other analytes that are coming to market in the next few, I’m hoping, quarters, which we will be continually adding to those machine learning models of metabolic fitness. So over time, we’ll be adding more and more metrics, and we’ll be improving our ability to predict how you’ll respond to certain food decisions, lifestyle choices, and then giving you scoring and metrics that allow you to continually improve. We’re really just cracking the surface right now with glucose. And I think our team is what’s going to set us apart.”

46:32 – You can’t manage what you can’t measure

Biological information has not become accessible in a way that financial and other data in people’s lives has been. So while people are trying to lead healthier lives, it’s also extremely challenging with the absence of data.

“The right to access one’s own biological information, I think is really important. We need to have a broader conversation about this in society because, for the most part, it’s not just your medical records which are hard to get access to. It’s the data about these molecules and these trends that are coursing through your body every single day. It’s happening whether you measure it or not. There’s an old saying you can’t manage what you can’t measure. That’s what it is. You can’t manage what you can’t measure. It’s kind of similar, I would relate it to financial information. Imagine giving someone a bank account and saying don’t overdraw, and then not telling them what the balance is. How do you know what choices to make when you have no idea what’s going on in the account? We’re doing this daily with people and they’re flying blind. If we could just provide them with an easy path to gaining access to the information that they need to optimize around, this would stop happening.”

 

49:56 – We are measuring metabolic health all wrong

A glucose test done once a year is not a good measure of metabolic health. That’s because most people have unique blood sugar cycles and thresholds.

“What’s interesting to me though, is this concept where we don’t worry about measuring it until it’s broken. Once it’s broken, then we’ll measure. This is currently how we approach metabolic health. You’re in the normal range, you’re in the normal range. Then you cross this invisible line and now you’re not in the normal range. Oh, something’s wrong. Let’s work on that. You need to start focusing when there is a problem, but it’s the whole process of developing the problem that we need to pay attention to. In 2009, there was an international group of experts that met about these crazy trends in metabolic health. They reviewed the literature and basically said there is no lower bound for glycaemic risks for diabetes, there’s no lower threshold. It’s basically a spectrum, and different people’s systems will fail at different thresholds if that makes sense. It’s not the case that there’s just like a single line in the sand. If you cross this, you now have pre-diabetes or diabetes. It seems to be that each person has a personal threshold where they will start to see faster and faster degeneration in their glucose control. We need to recognize that people are not averages. People are individuals.”

52:05 – Try setting a goal

Everyone should try setting personal and physical goals for themselves and work towards it. Josh found that working towards a physical goal and exercising led to a lot of positive experiences in his life that he might have missed out on.

“If you haven’t set a goal for yourself, that is an exercise-oriented goal, I think you should try it. It’s amazing. Whether or not you have career goals or have personal goals, an exercise goal is always available and you can always have something to work towards. You can always push the line ahead and achieve something that you’ve been working hard for. It’s built into the human condition. People want to have goals to strive for. And exercise, although I don’t always love it, it certainly is consistently the thing that can get me through hard times. It helps with my mental state. I don’t like the person I am when I don’t exercise. It doesn’t have to be something crazy like you go do an Iron Man or something. You just set a simple goal, make it outside, go for a long walk, three times a week, something like that. I genuinely believe that it leads to all these other experiences just getting more in touch with your neighborhood, meeting new people, and then ultimately transforms into a different lifestyle together.”

Episode Transcript

Connie Nightingale [00:00]   Hi! Welcome to my podcast. I’m Connie, I’m a certified nutritionist and personal trainer, and I live on a small hobby farm. I have a huge passion for bodybuilding, but I don’t fall into the typical bodybuilding mold. The naysayers, they can have their bro science. Yep. I said it! I’m a natural health and nutrition nerd. Some would call me a granola, but that couldn’t be further from the wrong word. I stay away from the typical processed, standard American diet, and I don’t eat granola. I created this podcast to share my health journey and the many things I’ve learned in my quest to find what it takes to live a mindful, happy, balanced life for all humans, not just athletes. I hope to help you discover your inner nerd and help you make some hefty deposits into your knowledge bank account that can help you crack your health code.

Josh Clemente [01:05]  There’s a really strong correlation between sleep in particular and like acute, what seems to be acute insulin resistance, really. So the way that I personally will respond to the same meal after, for example, four hours of sleep versus eight hours of sleep, it’s pretty wild. Like you know, two, three days ago I pulled a really late night. Didn’t get to bed until like 3:00 AM and then got up at seven or 7:30. And I knew I was going to be seeing some elevated levels all day, but it was amazing. Like my baseline increased 30 points. I was just like significantly higher based glucose level. And then, even like a handful of cashews, which typically I do pretty all right with, they do have some carbs, but they’re high in fat, and so usually fine for me. A handful of cashews treated me like a banana. I mean, it was like a huge, I was up at like 135 and, you know, so that’s the signal to me. “All right. I’m going to eat a higher fat.” Like being able to adapt to the circumstances and say, “All right, well, I didn’t sleep well last night. I know that I’m going to be kind of in a bad place. Let’s try and keep things from getting crazy here,” is really clutching. Yes, it’s something that I want to do much better on in terms of our product. It’s like pulling in these other metrics, in particular sleep, and comparing and pulling insights out about how you personally respond to these stressors. It’s really stress is what it comes down to. I think it’s like stress and recovery.

Connie Nightingale [02:29]                         Hi guys. That right there was a little clip from Josh Clemente. He is the founder of Levels Health, which is a continuous glucose monitoring company. So I talked with Josh a little bit today about what got him interested in continuous glucose monitoring. He is a CrossFit trainer and he started noticing some interesting things and feelings and trends with his blood sugar and how he was feeling. So. Super interesting episode today, he talks about their platform and how it’s going to revolutionize health, fitness, anywhere from the regular general population to elite athletes. And we dive into a lot of things, blood sugar related. So this is a wonderful episode. I’m so excited to be bringing him on. And before we get to our conversation, I am going to let you guys know that I need some reviews. And so I will be for the next few episodes, I’m having a little contest. So if you guys go on and leave a written review on iTunes, that would help me out immensely. Also I want you to throw it in your Instagram stories, tag me in it, and I will enter you a second time. And then I will just draw a name out of a hat for a, it’s your choice: We can do a recipe pack that has a bunch of wonderful recipes and ideas for some reasonable macronutrient ratios. Or I can throw in a nutritional guidance consultation. So, there are some goods there. All I need for you to do is pop on there and leave me a review. And then that will get you a name in the hat. And if you tag me in your Instagram stories, that will get you another name in the hat. So anyway, so excited to be bringing Josh on here. I look forward to seeing all of your wonderful reviews for this episode. And here is Josh Clemente.

Well, guys, I have a treat for you today. Welcome back to the podcast. Today, I’m talking with Josh Clemente. He is the founder of Levels Health, which is a whole system for continuous glucose monitoring. How are you doing Josh?

Josh Clemente [04:49]  Fantastic. Thanks for having me on the show.

Connie Nightingale [04:51]                         Yeah. So I’m excited to have you on here. First of all, I’m not having you on here because you guys are giving me some kind of funding for this. This is not a monetized podcast. I get no benefit, except for talking to you about awesome things, which is amazing. And that’s great for my listeners as well because continuous glucose monitoring or glucose monitoring in general is something that I have really been into and have dove into a lot further in the last year or so. I’ve been monitoring my own blood glucose for almost three years now, which is crazy to think of, just by poking my finger multiple times a day, and definitely in bodybuilding preps because I noticed all sorts of crazy things started happening with my blood sugar. So anyway, I’ve talked to you on the phone in the past and we’ve had some good conversations. And so I thought that it would be super beneficial to my listeners to have you on as a guest today.

Josh Clemente [05:54]  Awesome. Yeah, I enjoyed our conversation the first time around and I’m super stoked to dive into the subject matter. I really love this space and you know it’s, although I did found a company in continuous glucose monitoring, it has actually changed my life across the board personally. So it’s something that I feel very personally, sort of, an evangelize. I’ve been evangelized. I want to bring this technology out to the mainstream because I do think that it can help a lot of people across the board. Everything, from performance optimization, cuts for bodybuilding, all the way through to long-term reduction of chronic illness, and things of that nature. So I’m very optimistic and long on the personal right to biological information. And I think continuous glucose monitoring is one of the first core technologies that really has promise there.

Connie Nightingale [06:41]                         I love it. Well, before we dive too much into the continuous glucose monitoring and all that stuff, can you give my listeners a little bit of background about yourself and then maybe kind of how you found yourself in this space?

Josh Clemente [06:54]  Totally. So my background is aerospace mechanical engineering. So I did systems engineering,  composite structures engineering, and life support systems development at SpaceX. That was my first job out of school. And actually the launch that just went off from Cape Canaveral, with Bob and Doug the astronauts, to the international space station, that was my life support program that was involved in that spacecraft. So it’s really cool to see that happen. I’m very passionate about space personally, and it was actually during my time on that life support program that I was first exposed to a paper by Dom D’Agostino about the neuroprotective benefits of ketosis. And essentially the long and short of it is that when in ketosis, these mice could be exposed to high percentages of oxygen and high pressures for long durations without having seizures, which is super surprising. And it caught my eye because I was like, “Hmm, how can a diet give this like superhuman protective benefit?” This is really surprising. I’ve never thought twice about diet, you know. My whole thing was fitness. As long as you’re fit, you’re healthy. And so that was like kind of broiling around in the back of my mind for a long time. And then I started to like more and more focus on how I was feeling. And I realized that actually, my day-to-day is kind of low energy, feeling a lot of fatigue, certainly not feeling an optimal mood. And this is all while being a CrossFit trainer and you know, hitting the gym regularly and really valuing my workouts and, you know, thinking that I was doing everything right. So these two things didn’t make much sense to me. It’s like, A, I believe that fitness is health. I’m doing the fitness thing. I’m not feeling healthy, something’s missing. And then there’s this whole other thing that I’m being exposed to in the research that says that diet has this really powerful, physiological transformation ability. You know, the neuroprotective thing, just being one element of it. And so I just started to dig in, I was like, “Alright, how can I understand whether I’m making the right choices every day?” And started really getting obsessed with metabolism, you know, because metabolism is the cellular mechanisms that produce energy from our food and environment. So they power every process in the human body. So if I’m feeling low energy, something’s going on with my metabolism clearly. And so I came across, I was actually reading Robb Wolf’s book Wired To Eat when that came out and I read the blurb about continuous glucose monitors. And I was like, “That’s what I need.” You know, glucose is this energy molecule. It’s the fuel in my blood. If I’m feeling low energy, something might be happening with glucose. Let’s check it out. And, you know, first I got a finger prick monitor, I was pricking my finger like 60 times a day and trying to make sense of it. It wasn’t making much sense. Eventually I had to, after being denied about four times by doctors for a CGM prescription, I was able to get one from Australia. And within two weeks I had discovered that my glucose was completely erratic and dysfunctional. I was spending a large portion of every day in the pre-diabetic and occasionally diabetic blood sugar states, in particular when I was doing these huge carb loads, which I thought were optimal for glycogen replenishment after workouts, and to make sure I was, you know, recovered for my next workout. In reality, they were spiking my blood sugar way out of the normal range and sustaining it there for long periods of time. And then I would kind of crash at about two o’clock, three o’clock in the afternoon after my big lunch. I would plummet back down into this hypoglycemic, this reactive hypoglycemic space. And that’s when I would be on the couch looking for a nap or digging up another pot of coffee. And this was the cycle, the vicious cycle I was experiencing. And I saw for the first time with the CGM, the data happening, and it was like this tire screeching like, “Wait a minute. I wasn’t expecting to find anything of value here. And in reality, I’m like creating this rollercoaster of dysfunction myself.” And so that launched about a 14 month personal journey of digging deeply into the science of glucose metabolism, metabolic flexibility, ultimately discovering this untapped space of metabolic fitness, which is to say optimizing that metabolic machinery so that you can switch between fuels effectively, keeping low and controlled glucose levels in order to avoid this hormonal cascade. And yeah, ultimately started the company Levels with our killer team, which is bringing us to the masses.

Connie Nightingale [11:16]                         I love this. And you’re a smart guy. I can tell already. You get, the wheels are turning all the time for you. I can tell because the same kind of thing happens to me and it’s, I get stuck on something and then I just keep diving further and further into it, and it gets crazy. And, myself, just like you, kind of discovered things the same way. I was riding this glucose wave that was just like up and then down. And then the tide comes in and it goes out and it’s just was this crazy thing. And the other thing that would happen to me is during contest preps, I would go hypoglycemic constantly. My blood sugar would go down into the 50s and I would feel like I was going to die and I would have, I was like, “I need to eat carbs or do something.” And I would carry an emergency, like little honey sticks in my bag or a jolly rancher or something to try to get myself back up. And it was just this crazy thing. And that’s when I really started, that was my first contest prep, so I started monitoring my glucose at that time was when I really started getting into it because my coach was like, “Listen, we got to stop, start watching this because you can’t go jump on the StairMaster when your blood glucose is 55.” And at first I think she thought I was just being a pansy and I was like, “I can’t get on the stairs. I’m so exhausted. I can’t keep my eyes open. My legs weigh a hundred million pounds.” And she’s like, finally one day, I went down to her training studio and she was like, “Holy cow, what is wrong with you?” And I was like, “I don’t know what’s wrong with me, but I can’t move.” And she’s like, “Let me check your blood sugar.” It was down in the 50s. So I think at that point, which if I only knew then what I know now, I had been riding that glucose wave for so long that my body didn’t know how to go to fat storage and you’re getting low or going into your fat storage burning code. And at the time I wasn’t, I was super lean anyway, and there was just not a lot there, but I don’t think that I had that metabolic flexibility. So then I had no idea about that. I would just load myself up with some carbs, shoot my blood sugar back up. And then here we are again on this awesome wave that we’re riding.

Josh Clemente [13:39]  Ride the wave. Yeah.

Connie Nightingale [13:40]                         Yeah. So about a year ago I started getting really experimental with what I was doing and I started to notice some trends, and that’s when I was like, “Hmm. Okay, well, metabolic flexibility. This seems like a good idea.” But I still had that kind of bodybuilder mentality. And here I did all this nutrition schooling that says that you will lose your gains if you don’t have carbs.

Josh Clemente [14:06]  Right.

Connie Nightingale [13:07]                         If you go ketogenic, you’re going to lose all your muscle.

Josh Clemente [14:09]  Absolutely.

Connie Nightingale [14:10]                         And so I was scared, but at that point I had come out of a contest prep and I was super unhealthy. And I was like, “You know what? I’m doing it. I’m going to do it. I’m going to.” So I went straight carnivores to start and I didn’t go into ketosis, could not get into ketosis, straight carnivore. And I think that was because of gluconeogenesis. I didn’t have my fats high enough. I was just, “Yeah, it just didn’t work out.” So after that, I kind of pulled carbs back in because I was bonking out in the gym and I, my blood sugar was just not that great. So, it was better than it had been in the past. I’m sure there was a small amount of ketones and things that were going on, but it wasn’t optimal. So I pulled carbs back in and then I was like, “No, I got to try this again.” Only this time, I talked to Robert Sykes. Do you know who he is?

Josh Clemente [14:59]  I’ve heard the name repeatedly.

Connie Nightingale [15:01]                         He, yeah. Anyway, he’s a bodybuilder. He’s a ketogenic bodybuilder. And I was like, “Okay, Robert, I’m going to try this again, but I’m scared.” And he was like, “Oh, you don’t have to be scared.” He’s like, “When I’m in contest prep,” and he’s a guy, he’s a bigger guy. Got lots of muscle. He’s like, “I only have like 60 grams of protein,” and I’m like, “No, you can’t do that.” You know.

Josh Clemente [15:23]  Yeah.

Connie Nightingale [15:23]                         And anyway, I talked to him and I was like, “Okay, time to pull the trigger on getting ketogenic.” And I pulled my fats up and dropped my protein down and it took me about three weeks to get into pretty good ketosis. And at that point I started noticing a lot of changes in my energy. I wasn’t tired. There was a lot of things that had changed. So that’s when all of a sudden I was like “Ha! Metabolic flexibility. Here we go! This is perfect.”

Josh Clemente [15:53]  Exactly. Yeah. It’s amazing, that protein sparing effect seems to be really strong where you- The body will preferentially burn fat because it does not want to pull skeletal muscle off when you are metabolically flexible. And you see this with people who are fasting for prolonged periods of time and have sort of entered the fast from a ketogenic state, they see much better muscle preservation. I certainly have done since this whole sort of exploration period over the last few years, I have done extended fasting. I’ve tried different macronutrient ratios. I certainly do not stick to a ketogenic diet typically, but I’m in the high protein, moderate fat, low carb range. And that’s just where I feel best, is where my energy levels are controlled and seeing that sort of dashboard of information every day and being able to iteratively improve my decisions based on how prior decisions worked out for me is super powerful. Like just today I went on a 30 mile bike ride and I was pushing pretty hard and I didn’t bonk, but I was watching my glucose levels plummet. And so I actually made a few changes to my cadence, like chose when to push hard based on how my glucose levels were trending and I didn’t bonk, but I think I may have because I was fast on the bike. So if I had just kept pushing hard, I would hit that wall, you know. I’ve been 20 miles away from home with just kind of like walking my bike and looking for an ice cream sundae or something to get me back on my feet. So that’s I think another really interesting part of this, is being able to experiment with timing and not be forced out of your comfort zone in terms of how you’re trying to eat because you make a choice that you don’t have information about, you know? Like you want to go and get that ride in and you bonk, you’re going to need some calories. You’re going to need something to get you back on your feet. And that’s kind of where people typically will grab the candy or eat a banana or something. So, yeah, it’s fascinating stuff. It’s really cool to hear that story of yours on your past. So you’re ketogenic now?

Connie Nightingale [17:52]                         Well, so I’m constantly experimenting. If you only saw the spreadsheet I have going on on my computer right now, it will blow your mind. But I’m trying to find what’s optimum for myself.

Josh Clemente [18:00]  I love spreadsheets.

Connie Nightingale [18:02]                         Oh, I look at it, I’m like, “Oh, I might be slightly crazy.” But anyway, I’m trying to figure my body out because I think long-term dieting and contest prep and doing things wrong way definitely didn’t set me up for future success as far as building muscle and staying lean and things like that. So I’ve had to start kind of hacking my system a little bit. So, I was ketogenic for quite some time. And then I kind of hit this plateau and I wasn’t going anywhere. And my energy levels weren’t optimal either, I didn’t feel. So, I was like, “Well, I’m going to start maybe doing, adding a little carbs back in here and there.” And I started doing that and I noticed I started dropping weight faster again, which most people are afraid to come off of a ketogenic or low carb diet and go to carbohydrates. But I was also experimenting with how that affected my blood sugar and what things affected my blood sugar. So one day I pulled in, I’m usually looking for a quicker carb, I try to incorporate them pre strength training. I don’t- Cardio I do fasted. I know there’s different stuff out there, but cardio I do fasted because I’ve noticed I do, I perform a lot better on cardio fasted. And I actually was talking to somebody that researches this and I could totally slaughter this, but I was going on a long ride, like yesterday is a prime example. I had been fasted about 16 hours and I put in 20 miles on my bicycle, and no problems at all. I had plenty of energy. When I got done, I checked my blood sugar. I was like 73. And so that tells me that even though I’m pulling carbs back in, I’m kind of carb cycling right now, every couple of days, I’m still able to be flexible with my going to fat as a fuel source rather than looking for sugar. So I think that I have kind of trained my body to be able to switch gears. But anyway, I was talking to this researcher and I asked her about that because one thing I noticed is the longer I’m fasted, the less lactic acid I build up. And she was telling me, and I could totally slaughter this, that it’s, I think it’s a methyl carboxylate transmitter actually suppressed when you’re in ketosis, deep ketosis and you’re fasted, it actually suppresses lactic acids. So you will be going along at an easier pace because your lactic acid has been suppressed. So I could have gotten-

Josh Clemente [20:42]  Interesting. So it’s like a subjective effort like improvement because you’re not building that acid base. Interesting.

Connie Nightingale [20:47]                         Right. And I knew, sorry, but I knew that I didn’t just improve. It wasn’t because I had done the ride a bunch of times before, and I did it the day before that. And it was really weird because the day before that, I was struggling, and it was at that point, you know. There’s always a certain point in your ride where you’re like, “Dang, this is where I’m starting to gas out,” you know?

Josh Clemente [21:08]  Yep, yep.

Connie Nightingale [21:09]                         And I was like zooming through it. And my heart rate was still at the same spot that it always is, but my legs were like, dududut. They were just going.

Josh Clemente [21:19]  Spinning.

Connie Nightingale [21:19]                         And I was like, “Okay.” It’s not like I magically got better from yesterday. I should actually in theory be a little bit tired, but no. And that’s when I asked her. I was like, “What’s going on here?” And that’s what she told me.

Josh Clemente [21:32]  Yeah. It’s so counterintuitive to a lot of people that, A, you know, just the concept of not eating a meal for I think the majority of people is really concerning and then to go more than just a full day and then to consider even working out well fasted, it’s just like this whole crazy concept that I think most people, you know, they’re so used to hearing that you have to eat three to five square meals a day. Otherwise you’re going to be, you know, I’m not entirely sure what the repercussions are in people’s minds. But you know, we have a couple of people on the team that are really experimenting with this fasted exercise and training that, in particular that fast at zone two cardio right at the threshold, lactic acid threshold, with the goal being like to increase mitochondria density, to increase mitochondria efficiency and to be able to just yeah, go for days essentially. You know, just that ultra endurance space. And it’s really cool to see because there is a ton of personalization in there. I do some of this stuff. I do fasted cardio quite a bit. It’s not my go-to personally. I’m still kind of getting into the endurance space from the, you know, sort of cross training space. But, one of the guys on the team, Mike, is really killing it here. And he’ll go for like half marathons, fasted from the day prior. And his glucose is just rock solid. I mean, it’s just like a flat line and he’s moving pretty quick. It’s not like he’s walking and it’s, his efficiency is improving. And his, the fact that his glucose levels are rock solid and his ketone levels seem to be coming up indicates I think really strong metabolic flexibility. And this is someone, you know, prior to him getting access to his glucose information, he was one of the people who would kind of fuel up right before any workout. It was always like, “Got to get that pre-workout meal and got to get those carbs in. Got to make sure that my glycogen is fully replenished.” And now he’s biasing much more towards, “Let’s make fat the primary source of fuel.” And it’s really cool to see it happening and see no negative repercussions. He’s not bonking. He’s not running into a wall. And I think it’s just super counter-intuitive for the mainstream. You know, people do not, couldn’t imagine going 18 hours and then running a half marathon without calories.

Connie Nightingale [23:47]                         Right. Yeah. It’s such exciting stuff. I know for myself, my number stays solid on the bottom side all the time, whether I’m fasted, whatever. I know that my insulin sensitivity is not real good. So that’s where I’ve started, to experiment with foods and what foods do. And it was actually kind of funny. Yesterday, post bike ride, it was a higher carb day. When I say high carb day, it’s like not very many, but, it was a higher carb day. I think I had like a tablespoon of maple syrup in the morning and my coffee to get  my carbs after my bike ride, and my blood glucose didn’t go past 88 over a tablespoon of maple syrup. However, the prior high carb day, I experimented with honey for the same amount of carbohydrate load and the honey shot my blood sugar up to 147. So. Uoh, I lost your voice here.

Josh Clemente [24:58]  Oh, did you?

Connie Nightingale [24:59]                         There.

Josh Clemente [24:59]  Sorry about that.

Connie Nightingale [25:00]                         Okay. Go right ahead.

Josh Clemente [25:01]  Yeah, so I was asking, did you have like a similar sleep and meal schedule prior to that, to each of those experiments? Do you think?

Connie Nightingale [25:09]                         I don’t know why I can’t hear you here.

Josh Clemente [25:12]  Oh.

Connie Nightingale [25:12]                         There we go. Gotcha. So that was weird. Anyway, well actually, I didn’t even look at that. I should go back and look at that. That’s a good point because I know your insulin sensitivity can change based on sleep, but.

Josh Clemente [25:26]  Yeah. It’s pretty profound.  I mean  we are still trying to characterize this like really effectively, but there’s a strong correlation between sleep in particular and like acute, it seems to be acute insulin resistance, really. So the way that I personally will respond to the same meal after, for example, four hours of sleep versus eight hours of sleep, it’s pretty wild. Like, you know, two, three days ago I pulled in a really late night, didn’t get to bed until like 3:00 AM, and then got up at seven or 7:30. And I knew I was going to be seeing some elevated levels all day, but it was amazing. Like my baseline increased 30 points. I was just like significantly higher based glucose level. And then even like a handful of cashews, which typically I do a pretty all right with. They do have some carbs, but they’re high in fat. And so, usually fine for me. A handful of cashews treated me like a banana. I mean, it was like a huge, I was up at like 135. And, you know, so that’s the signal to me. “All right. I’m going to eat like a higher fat.” Like being able to adapt to the circumstances and say, “All right, well, I didn’t sleep well last night. I know that I’m going to be kind of in a bad place. Let’s try and keep things from getting crazy here,” is really clutch. And yes it’s something that I want to do much better on in terms of our product, is like pulling in these other metrics, in particular sleep, and comparing and pulling insights out about how you personally respond to these stressors. It’s really stress, is what it comes down to, I think, is like stress and recovery.

Connie Nightingale [26:55]                         Right. Well, hey, you know, thanks for mentioning that because I’m just going to add that to my crazy graph that I got going on on my computer. And, you know, maybe that means as soon as I wake up, take my blood sugar, that might be a good indicator of when and how much I slept or how well my rest was or stress or. There could be a lot of factors involved in that, but that could be a cool thing to look at as well, instead of just postprandial blood glucose.

Josh Clemente [27:24]  Right.

Connie Nightingale [27:24]                         So, anyway, so back to what you just said there, let’s talk a little bit now, switch gears and talk a little bit about your company and what every, all the data that it is measuring in order to help athletes or even regular people optimize their health.

Josh Clemente [27:42]  Yeah. So the underlying concept is that right now people are making decisions every day. You know, sitting down for lunch, you’re going to pick something to eat. What are you going to pick and why? And most of the time, people kind of sit there and the wheels spin and they’re like, “Well, I’ll probably choose something that tastes good. And that I heard what’s healthy from somewhere,” either like a friend or the internet. And that’s fine. It’s like, you know, you should enjoy your meals. But you know, the premise of Levels is to give you the data that underlies your metabolism, your metabolic fitness, and allow you to use that in your daily life in order to make better decisions. So basically closing the loop between an action and the reaction that your body experiences. And so right now, the entire premise is built on continuous glucose monitoring. So we use these patches that have a little filament that measures electrochemically the glucose levels in your skin. And this information updates every minute. And so you can continually tap in and check your real time glucose information and see in near real time how your body responds to a specific decision that you make. And these decisions are not just dietary. It’s nutrition, it’s sleep, it’s stress, like I mentioned, it’s exercise. And so those are the core metrics that we are building into the app in addition to glucose information. So we have that data coming from the device, and then we have lifestyle logging. And so you use the app and you record your meals, your sleep quality and your exercise very straightforwardly, and then you get these scores. So these metabolic fitness scores and meal scores that help you to understand how all of these different metrics about your glucose levels are sort of summing together into a response. And I’ll break that down a little further. So rather than just staring at a single number, right? You check your glucose with a glucometer, and so you get one number that is 87 milligrams per deciliter. Well, that’s interesting, but where were you three minutes ago? Where were you an hour ago? How fast are you changing? Are you going up or are you going down? That’s the context that is missing with these point measurements. And we’ve been using point measurements for metabolic health checks for a very long time. So having a continuous data stream means that we can take in, like I said, your baseline, the rate of change, the peak response after a meal, the time above your target range, all of this information can be summarized. And then we build these composite metrics on the Levels side that turn all of that information into a single score. So you record your meal and then two hours later after we’ve been able to pull in all the data that follows that meal, we provide you a score that you can then use to optimize, right? So you can, you know, if it’s a positive score, this is something that maybe you want to keep in your dietary archive. If it’s a negative score, you can start to split out some of the ingredients or some of the other factors like, “Maybe I didn’t sleep well last night. Maybe I haven’t worked out in a few weeks,” and that will affect insulin sensitivity. And so we’re helping people, we’re really empowering people to log their lifestyles and really tap into this metabolic awareness component in order to achieve metabolic fitness.

Connie Nightingale [30:47]                         I love this. This is just the bomb.  And especially for people like me, where, I mean, I have a lot of clients that are, they have type two diabetes. They have a bunch of big things going on and, you know, I’ve slowly had them realizing that- I don’t know why, like they know that type two diabetes and insulin resistance and all these things are involved with blood sugar, but for some reason they don’t notice that certain things make it way worse. So I think a real time feedback on a lot of that, especially for a lot of coaches out there, it could be a huge tool for their toolkit as far as successfully helping their clients understand the impact of the foods that they are eating.

Josh Clemente [31:35]  Yeah, absolutely. I mean, it’s hard not to get dejected when you look at it,  data on metabolic health in the country. There’s a recent study that shows that only 12% of American adults are metabolically healthy. And you have 90 million Americans who are, American adults, who are pre-diabetic. 70% of those are estimated to become type two diabetic in the next 10 years. You have 35 million plus type two diabetes cases. And so basically about 50% of the adult population in this country is pre-diabetic or diabetic. And this is a catastrophe for the future. It’s not just an individual problem. It’s a social problem. It’s a fiscal problem. We’re looking at a healthcare system that’s already overloaded without adding 80 million, 90 million additional diabetes cases into it. You know, the lost work, the lost time with loved ones, the inability to be mobile. It’s a really tragic and prolonged state, metabolic state, that people are in. And I think a lot of it has to do- People don’t want to make bad decisions, they want better information. And this is just an objective metric that is super useful for people to, you know, because it’s real time, because it responds to the actions you take, it’s, in my opinion, one of the most valuable technologies that has come of age, so to speak, in the past 10 years for health outcomes. And so you know, that’s sort of the illness side of the relationship. And I think giving people the access to their own data and allowing them to make better choices is just, it’s table stakes. We need to allow this across the board, this should be a thing already. And so we’re excited to bring that to a broader audience. And then there’s also the world of performance optimization, right? So tapping into energetic molecules and being able to measure them in real time is something that it’s kind of been like a pipe dream for a long time, but now it’s becoming realistic. Right? And I’m looking at the landscape, I think we’re going to have a lot more or analytes coming to market in the next few years, that will be, you know, I’m thinking we’re going to get some fatty acids, maybe some lactic acid measurements, and these in combination with CGM data, it’s going to be like a whole new world for athletes and elite performers. So I kind of see it as the same spectrum. You know, we’re all on a metabolic spectrum. You have people from the very metabolically fit all the way down to those who are, you know, currently metabolically dysfunctional, whether they know it or not, like I was. This information is relevant for all of those people, right? It’s just your personal goals and how you’re going to use that data, it’s personalized. It’s up to you specifically what you’re focused on, whether that’s weight loss or shaving a few tenths off a mile run. You know what I mean?

Connie Nightingale [34:12]                         And, you know, one thing that I really liked that you said there, Josh, was that like yourself, you had some metabolic problems going on. A lot of people don’t even realize that they have big issues happening. And so just, it’s not, this is not about people needing to lose weight. It’s not about obesity. There are a lot of people out there that are athletes that are working super hard and their metabolism, everything, is working against them. They don’t realize that they have a health, an underlying health condition. I know, like myself, I didn’t know I was insulin resistant. I mean, I didn’t know that. And I mean, I was recently diagnosed with PCOS so that makes a little more sense. Right? Because it’s like, “Oh, okay. People with PCOS really struggle with this,” but I didn’t realize that and that can turn into type two diabetes. So here I am, I’m an athlete. I work out all the time. I watch every little thing that I eat, every little thing that goes in my mouth and I actually have an underlying health condition. And so a lot of people don’t realize that they are, that their insulin sensitivity is not good. And they don’t realize all these things. And you know, blood glucose isn’t just about their sugars and diabetes. We’re looking at atherosclerosis, we’re looking at all sorts of heart stuff. There’s a lot of big picture factors here. I know definitely with this COVID stuff going on, I hate to bring it up because I get kind of tired of hearing about it, but it’s here. So we’ll talk about it. There is a huge assimilation between COVID stuff and people’s blood sugar. Huge.

Josh Clemente [35:55]  Absolutely. Yeah.

Connie Nightingale [35:56]                         It’s pretty impressive.

Josh Clemente [35:59]  Yeah. Yeah. One of my co-founders, Dr. Casey Means, she wrote a really amazing article in the Journal Metabolism about the asymmetric outcomes for people who have an existing metabolic disorder and COVID, and it’s pretty shocking.  I don’t fully understand the mechanisms, but it’s, the data is very clear. There is a worst outcome relationship for people who have in particular a disorder of glucose, like type two diabetes or pre-diabetes. And, you know, I was throwing out those numbers about pre-diabetes earlier, but one of the most interesting is that of those 88 million people who have pre-diabetes in this country, 90% of them do not know they have it. That’s the most important thing. And the reason they don’t know is because they have no access to real-time information. When I went to my doctor and requested a continuous glucose monitor, you know, the context for his decision not to provide one was that my A1C and fasting glucose were okay. They were in the normal range. And those are for people who don’t know, A1C is an, it’s an estimated average of glucose, right? It’s not an exact measurement. You’re not measuring glucose and then averaging it. In fact, they’re measuring the amount of glucose that has bound to a red blood cell in your blood. And so that’s a, it’s kind of estimated, depends on how long your red blood cells last. So that number is not very reliable in the first place. And secondly, the fasting blood glucose situation is typically you’ll measure it in the morning, you haven’t eaten anything. That’s going to be when your glucose levels are typically the best. And it takes a long time and a lot of glucose dysfunction for your fasting glucose numbers to start to get erratic. So there could be underlying dysfunction for years before this starts to become a problem. When I put the CGM on, I had real-time dynamic information. I saw it as it was happening, and I saw that there was a huge amount during the day, caused by my lifestyle choices, that was out of control. And that’s the key, you know, people need, this 90% of people who are in the dark about their impending metabolic dysfunction or their current metabolic dysfunction that is going to get worse if they don’t do something, you know, this is the key. They need to have better information so they can make better choices. And, you know, It’s. Yeah, I mean, currently with the COVID thing, it is, there’s been more talk about metabolic disorder and how we can tackle it. And I think, you know, it’s one of the, in my opinion, just one of the most threatening trends to see globally. We have metabolic dysfunction that is increasing at an increasing rate across the world. As countries get more developed, the rate of diabetes and cardiovascular disease increases non-linearly and this is, you know, this has been holding for decades now. And you know, again, like you were saying, it’s not just diabetes, it’s also cardiovascular disease. Where we’re seeing now in schools, in medical schools, that Alzheimer’s is being called type three diabetes because it’s insulin resistance of the brain. You have PCOS, like you were saying metabolic condition, that is the number one cause of infertility. There’s just an amazing number of disorders that are all kind of coming back, it seems, to this chronic lifestyle related glucose dysfunction potentially. So, it’s really interesting to follow.

Connie Nightingale [39:15]                         Yeah. And thanks for bringing up the Alzheimer’s thing, because that’s another big thing where the, you know, a low carb or ketogenic diet comes into play big time. And it’s actually kind of interesting. I see this shift kind of happening. You’ve got half of the, it seems like half the medical field. It’s like, “Yeah, no way.” And then half of it, that’s like actually starting to go, “Oh wait, hold on a minute.” So one of the nursing homes that my friend is a nurse at locally here, is taking their Alzheimer’s patients and putting them on a low carbohydrate diet.

Josh Clemente [39:47]  Wow.

Connie Nightingale [39:48]                         And there’s a big study going on in their nursing home over this. And they’re like, there’s like-

Josh Clemente [39:53]  That’s amazing.

Connie Nightingale [39:53]                         It’s like, and I was like, she told me that and I was like, “That’s freaking amazing. I love it. I love to hear this because-“

Josh Clemente [39:59]  That’s great to hear.

Connie Nightingale [40:00]                         You see these things and you’re like, “Wow, what if you could just change this with diet?”

Josh Clemente [40:05]  Right.

Connie Nightingale [40:06]                         And you won’t lose your loved one to something that can be treated.

Josh Clemente [40:12]  Yes.

Connie Nightingale [40:12]                         And not by a bunch of medications, but just by changing their food.

Josh Clemente [40:17]  If, you know, if the link gets stronger and I think that this recent type three diabetes label is a really strong step in the right direction to start looking at alternative causes for Alzheimer’s. It runs in my family. It’s something I’m very concerned about, you know, my cognitive, preservation of my cognitive function is one of the most important things to me. You know, I want to increase my health span. I want to be fit for a long time, but I also want my brain to be functional obviously. You know, it’s no value to me if my body is in good shape, my heart is in good shape if my brain is not. So you know, understanding the underlying mechanisms there would be amazing. I don’t think we are at that point quite yet, but we’re getting much closer.

Connie Nightingale [40:59]                         Yeah, that’s super exciting. So your guys’ program hasn’t launched yet, or is it starting to actually launch to where consumers can start testing their blood sugar with your products and getting into your program?

Josh Clemente [41:14]  So we’re in what we’re calling beta mode, which is essentially we’re still in developing, we’re improving the software continually. And we’ve, basically we’re in an invitation only mode right now. We have a fixed number of slots each month and we bring in people who are very high intent, who are  willing to help us out with the development process and give in a super high value feedback as we go. That being said, we’ve made huge strides on the product and experience and we’re getting really high quality signals that people are improving their lives, improving their decisions every single day, right? So they’re getting this recursive feedback loop, which is helping them to make better choices. And we’re seeing trends. You know, we provide reports throughout the program. We’re seeing trends that the glucose control that they are exerting over themselves is improving as well, which is a really good signal. So yeah, that’s our current mode and we are going to be rolling out pre-orders this summer in order to allow people to reserve a spot for the full launch. And then our full launch is going to be coming sometime later this year, ideally before the holidays. So yeah, I mean, I wish I had a hard date where,  you know, the biggest thing for us is that we’re achieving the goal, which is that the product adds value and that people feel that they have control over the decisions they’re making, that they have confidence and that the data stream is actionable. You know, it’s very important not to just dump out numbers and say, “Good luck.” We want people to know, “Okay, this is what I have to do with this information.”

Connie Nightingale [42:41]                         All right. So I’m going to put you on the spot a little bit here. Are you ready?

Josh Clemente [42:45]  Yep, I’m ready.

Connie Nightingale [42:46]                         You can choose not to answer, but I mean, obviously continuous glucose monitoring is becoming more popular. There are several programs out there, but you guys are making your program a little different. And so what’s going to set you above these other programs?

Josh Clemente [43:07]  Well, firstly we have, to my knowledge, the only program that includes a physician consultation for a prescription. So we, you know, in the United States, the FDA controls all CGMs as a prescription only devices. And so we ensure that there’s a fully independent tele-health consultation for the devices. We fulfill them directly from a pharmacy. There are no foreign imported sensors or anything of that nature. So I believe we’re the only program that has that system in place. And we have a world-class team of software and medical experts. And so the machine learning models that we’re building that take that data and turn it into insights and action, I think are second to none. And there certainly is going to be a ton of focus on CGM and bringing this technology to market, but you know, what we are oriented around again is the actionability, the behavior change and the future, which is these other analytes that are coming to market in the next few, I’m hoping next few quarters, which we will be continually adding to our again, those machine learning models of metabolic fitness. So over time we’ll be adding more and more metrics, and we’ll be improving our ability to predict how you’ll respond to certain foods, decisions, lifestyle choices, and then giving you scoring and metrics that allow you to continually improve. So we’re really just cracking the surface right now with glucose. And I think our team is, again, our team is what’s going to set us apart.

Connie Nightingale [44:33]                         And, you know, I love that. I know you guys are going through some rigorous beta testing and stuff to make sure that your product is second to none. So, and you’re putting the time in, and that’s part of the reason that this product has got a little bit of a wait in order to jump in on it. So, I’m certainly appreciative of you guys taking the time to completely make sure that you’re putting the best product on the market.

Josh Clemente [45:00]  Absolutely. You know, we, Sam for example, my co-founder and CEO is, he’s done several hundred lead calls. We’ve had a call with every person who’s using the program thus far. And we, you know, we do these interviews just to understand where this person’s coming from, what their goals are, what they’re looking to learn. And it’s very instructive for us to  understand what our audience is,  who is looking for this product and just hasn’t yet found it. And so we’ve been building, the product is built on the feedback we get from our beta customers. We could not be luckier to have the enthusiastic group we do. And each person that goes through is improving the program for the next thousand people. And yeah, that’s our philosophy is that, you know, we have to build the thing that people want and that people will use. And so we are all, everyone on the team uses this daily, is personally striving for metabolic fitness, metabolic health. And so I think that the core enthusiasm, that passion, and then the connection to our audiences is really key for us to improve daily and succeed in our goals.

Connie Nightingale [46:02]                         I love that. I appreciate it because here’s the other thing, all of this data that is becoming relevant to health is going to change the future as far as all sorts of things go. So the medical industry may not be putting in the time to research it, but now we, as the people, are personally doing it ourselves, and I think that’s definitely going to make a huge paradigm shift.

Josh Clemente [46:28]  Yeah. Yeah. You know, again, the right to access one’s own biological information, I think, is really important. We need to have a broader conversation about this in society because for the most part, it’s not just your medical records which are hard to get access to, it’s the data that has, these molecules and these trends are coursing through your body every single day it’s happening, whether you measure it or not. The only way though, there’s an old saying, “You can’t manage what you can’t measure.” That’s what it is. You can’t manage what you can’t measure. And so, we’re expecting people, it’s kind of similar, I would relate it to financial information. Like imagine giving someone a bank account and saying don’t overdraw, and then not telling them what the balance is. Right? How do you know what choices to make? You have no idea what’s going on in the account. And so we’re kind of doing this daily with people and they’re flying blind. And if we could just provide them with an easy path to gaining access to the information that they need to optimize around, this would stop happening. I truly believe it. And we see it everyday with our customers, you know, they come in and they have a fixed set of assumptions about what’s healthy. And a lot of times they ratify those things, right? They see positive reinforcement of the choices they’re making. And then a lot of times they’re seeing counterintuitive, you know the opposite is happening where, for example, oatmeal, you know. You Google the healthiest breakfast and top three, oatmeal’s going to be there. And I don’t think there’s been a more consistent trend in our program than oatmeal puts people in a high blood sugar state, and I’m one of those people. You know, no toppings, no maple syrup, no brown sugar. I eat plain rolled oats and I might as well eat a donut. So these types of things where people may be forcing themselves to have that oatmeal because they think it’s going to help them with, maybe it’s a concern about long-term heart disease or whatever it may be. But if you look at the relationship between glucose variability, spikes and crashes in your glucose and cardiovascular disease, it’s a very strong correlation. So it could be that this is actually not working in favor, in these people’s favor and in fact could be working against their goals. So again, like I was saying, you know, the right to one’s own bodily information, I think, should not be infringed upon and we should bring this into the conversation more.

Connie Nightingale [48:40]                         I 100% agree. You know, it’s funny, I posted a thing in my Instagram stories, which I don’t have a huge Instagram following because I used to shut my Instagram off for every contest prep. So.

Josh Clemente [48:56]  Makes sense. Got to focus.

Connie Nightingale [48:59]                         Thank God for my podcast, but anyways, I posted in my Instagram stories. And I had so many people are like, “Why would I?” I put, “Who checks your blood sugar? Like, have you ever checked your blood sugar?” Because I was curious and I had only one person that said I only do it when I’m experimenting, which was good. She’s a medical student. Everyone else was like, “Why would I do that? That’s crazy.” I mean, I have friends that are nurses that are like, “I’m not poking my own finger.” And I’m like, “Why? Why? You can learn so much about yourself.”

Josh Clemente [49:33]  Yeah. I mean, look, I get it. The poking the finger is, it’s a pain and not to mention the whole apparatus. You know, you got to put the lancet in, you got to stab. Blood’s going over. And so I get it. And that’s again, the beauty of CGM, you know, you wear it continuously and it’s a little filament. Literally painless and it doesn’t, you forget it, you have it on, you know, you can swim with it, you can shower with it and you’re getting that data full time. So, you know, what’s interesting to me though, is this concept where, “Don’t worry about measuring it until it’s broken,” right? “Once it’s broken, then we’ll measure.” And this is currently how we approach metabolic health. You know, you’re in the normal range, you’re in the normal range, you’re in the normal range. Then you cross this invisible line and now you’re not in the normal range. “Uhoh, something’s wrong. Let’s work on that.” And of course, you need to start focusing when there is a problem, but it’s the whole process of developing the problem that we need to pay attention to. You know, in 2009, there was an international group of experts that met about  these crazy trends in metabolic health. And they reviewed the literature and basically said there is no lower bound for risk, glycemic risk for diabetes. There’s no lower threshold. It’s basically a spectrum and different people actually will, their systems will fail at different thresholds, if that makes sense. So it’s not the case that there’s just like a single line in the sand. And if you cross this, you are, you know, you now have pre-diabetes or diabetes. It seems to be that each person has a personal threshold where they will start to see faster and faster degeneration in their glucose control. And so, you know, again, we need to recognize that people are not averages. People are individuals. They have personal responses which are going to be affected by their genetics, their microbiome health, their current body fat percentage, for example. All of these things have an effect on how your hormones interact. And so. Yeah, we need to start using the tools we have at our disposal, like machine learning, where these models can learn the individual and make predictions and provide insights in real time. That’s what we need. That’s what we’re going to do.

Connie Nightingale [51:42]                         Awesome. Well, I’m so excited to see how this manifests Josh. One thing to ask you before we wrap it up here, I ask all of my guests this, if there was one thing you could put out there in the world that you would want to share with everybody else that you think could benefit their life, what would it be?

Josh Clemente [52:02]  Oh man, for me it’s definitely exercise. You know, if it’s, if you haven’t, take, you know, set a goal for yourself, that is an exercise oriented goal. I think you should try it. It’s amazing to, whether or not you have career goals or you have personal goals, I think an exercise goal is always available and you can always have something to work towards. You can always push the line ahead. And achieving something that you’ve been working hard for, I think, it’s part, it’s built into the human condition. People want to have goals to strive for and exercise, although I don’t always love it, it certainly is consistently the thing that can get me through hard times, you know. It helps with my mental state. I just, I don’t like the person I am when I don’t exercise. And I think a lot of people would benefit from, you know? It doesn’t have to be something crazy, you know you don’t have to do an iron man or something, you just set a simple goal, you know. Make it outside, go for a long walk three times a week, something like that. I genuinely believe that it leads to all these other experiences, like, you know, just getting more in touch with your neighborhood, meeting new people and then ultimately I think it transforms into a different lifestyle altogether, you won’t even see it happening. And I just think it’s generally positive and the correlation for our interests here at Levels, the correlation between is very simple. Just walking after a meal and better glucose responses is incredible. So I’m a total believer in any type of movement. It’s something that we should all do.

Connie Nightingale [52:28]                         Awesome. Well, thanks Josh so much for joining me today. I’m excited to see where your program goes and maybe we’ll follow up in the future.

Josh Clemente [53:37]  Yeah, a hundred percent. And, you know, if anyone wants to read more about this stuff, definitely encourage you checking out our blog at levelshealth.com/blog. And then we’re on Instagram and Twitter @unlocklevels. And, you know, reach out to us. We love to hear from people who are interested in what we’re doing, and I can’t wait to bring this to launch time.

Connie Nightingale [53:55]                         Yeah. I’m excited and I’ll make sure and put all your information in the show notes and that kind of stuff too. So people can find you.

Josh Clemente [54:03]  Perfect. Connie, this is awesome. I really appreciate you having me on.

Connie Nightingale [54:06]                         I appreciate you. Thanks so much, Josh.

Josh Clemente [54:09]  All right.

Connie Nightingale [54:12]                         Well, everybody, thank you so, so much for listening and spending your time with me again. I am so thankful for this podcast and all of my listeners and all of my guests that come on here and talk with me about all of these subjects that can help people achieve their health and wellness goals. It’s so amazing networking with all of these people that have so many different facets of knowledge that they are willing to share with all of us. So it has been really rewarding, being able to share all sorts of information with you guys. And I seriously look forward to every single podcast. So, thank you so much again for joining me. If you need anything at all, DM me. I’m on Instagram @conniebegonnie. I love questions, comments, feedback, anything you’re never a burden. And I promise I will get back to you. It is always wonderful getting great feedback from my podcast or even not great feedback. I’m totally for hearing what you have to say. So, thank you again for listening to my podcast and I will see you next time, everybody.

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