Dhru Purohit Show - Key Signs Your Blood Sugar Balance Is Totally Out of Whack and How to Fix It with Josh Clemente

Episode Date: September 30, 2024

This episode is brought to you by Lifeforce, Ketone-IQ, and Lumebox.  One in three people have prediabetes, and over 84% of them aren’t aware of it. We know that metabolic dysfunction is at the core of most chronic diseases. So, what’s driving these alarming statistics, and what lifestyle habits can help reduce our risks? Today’s guest is here to share the latest research on metabolic health and more. Today on The Dhru Purohit Show, Dhru sits down with Josh Clemente, Founder of Levels. Josh shares data collected by Levels on the top foods that harm metabolic health and the lifestyle habits that help reduce glucose spikes throughout the day. He also discusses his personal journey to improve his metabolic health and the importance of self-experimentation for individualized results. Additionally, Josh introduces the latest AI technology designed to assist with tracking and weight loss. If you are looking for a deep dive into habits and foods that impact your metabolic health, this episode is for you.  Josh Clemente is the Founder of Levels, a mechanical engineer, and a CrossFit-L2 trainer. At SpaceX, he led a team to develop life support systems that, in May of 2020, began sustaining astronauts on trips to and from the International Space Station aboard Crew Dragon, the first human-rated commercial spacecraft in history. Josh has also spent time designing and building Hyperloop technology and leading engineering for a company providing vehicle-based rescue systems for emergency response teams. Josh enjoys the outdoors, functional fitness training, technology, coffee, and restoring motorcycles.    In this episode, Dhru and Josh dive into:  Why so many people have pre-diabetes? (00:00:40) Top foods that cause havoc to metabolic health (6:46) Why constant spikes can be harmful (16:41) Lifestyle habits to mitigate the impact of spikes (25:11) Coke Challenge (32:51) Foods that promote stable blood sugar (35:15) Josh’s journey to improve metabolic health (40:45) Self-trials that lead to individualized results (46:00) Adding lean muscle and the glucose response (53:50) New AI technology on Levels App (1:01:30) Weight loss, tracking, and BMI (1:08:00) Hope for the future of metabolic health (1:18:30) Also mentioned in this episode: Levels For more on Josh, follow him on Instagram, LinkedIn, or his website. This episode is brought to you by Lifeforce, Ketone-IQ, and Lumebox.  Right now, you can save $250 on your first diagnostic and get personalized suggestions. Optimize your longevity and track your progress; go to mylifeforce.com/dhru!  Right now, my friends at Ketone-IQ are offering 30% off your first subscription order & a free six-pack of Ketone-IQ when you order using the link ketone.com/dhru and promo code DHRU.  Lumebox is offering my community $260 off their FDA-approved FDA-registered portable Red Light device! That's over 40% off! Go to thelumebox.com/dhru and get your Red Light device. Learn more about your ad choices. Visit megaphone.fm/adchoices

Josh, welcome to the podcast. You know, I want to start off with something pretty nuts that you and your team at levels have been sounding the alarm on. In America alone, conservatively, we have one in three people have pre-diabetes. But the crazy thing is the vast majority of them have no clue at all that they have it in the first place. But even crazier than that is that if you look at the nine out of ten leading causes of death, they are directly caused or worsened by having metabolic dysfunction of which prediabetes is a part of. Now, my question for you is, why do so many people out there have prediabetes,

and how come so many of them upwards of like 80%? Why do they have no idea that they actually have pre-diabetes? It's great to be here. And I'm excited to talk about this and all of the sort of sub threads that this opens up. But it's honestly the most important question in the world, in my opinion right now. Why is the entire population seemingly careening towards chronic illness? And at the end of that chronic illness stint, however long it may be for that individual, is one of these causes of death, which the CDC says primarily are preventable.

So metabolic dysfunction, it's really the root of the long-term disorders that we like to label as causes of death, obesity, Alzheimer's, dementia, cardiovascular, disease or heart attacks, diabetes, cancer, stroke. These are the things that we know end lives, but underneath all of them are metabolic disorders and the earliest stage that we label, and unfortunately I think labels are not super useful, but the earliest stage that we label is pre-diabetes. It's where a person starts to show the first signs that their blood sugar control or their insulin sensitivity is no longer what it needs to be in order to maintain a healthy cellular function with minimal toxic byproducts and long-term health.

And so like you said, I mean, we're at a point where it's actually on the order of 52% of American adults have pre-diabetes or diabetes. So more than half the population, you are more likely than not to be pre-diabetic or diabetic today. That's a crazy stat. 30% of adolescents. So teens, 30% of them are pre-diabetic. Okay, this was 10%ish 20 years ago. So we're seeing a tripling in the rate as children.

get sicker earlier on. I mean, this was something that was considered impossible. Children were not thought to be, other than type 1 diabetes, which is a different condition, were not thought to be at risk for a chronic lifestyle-related illness, but it just shows the acceleration that this stuff is driving into our population. And so the question of why, you know, there's a lot of theories. I certainly have some myself. I think we have a pretty disastrous food supply right now and a pretty disastrous lifestyle. So on average, people are not active. They're not getting sunlight. We are not working jobs that challenge us physically. And we are, you know, we are essentially sort of hibernating in thermally controlled spaces throughout our lives. And I think our bodies sort of adapt to that.

And they, they sort of deregulate the important energetic systems that would otherwise keep us alive in situations where we have to be outside or moving heavy, heavy things. And I think what we're seeing is really an adaptation towards, you know, a life where our bodies don't have to function super well. And that's not a good, that is not an adaptation, but it's, in an evolutionary sense, an adaptation. We're seeing a change towards a less active and capable, resilient human body. And then why don't people know about it? Well, I think this goes to the issues with the healthcare system that we have today. The healthcare system, the testing and diagnostics that we have in place are simply not up to the task of identifying the conditions like prediabetes at the stage that we need

to identify them. If you think about the average person, I'll take my parents. Okay. So as of a few years ago, my parents, my father in particular would get his blood work done maybe every three years, maybe every five years, very irregularly. That was the only check. And he's a healthy guy or he considers himself to be very healthy. He's active. But he just doesn't have that consistent interaction. And so he gets one slice of time, one set of data points every, let's say, three years, and those data points are extrapolated to essentially try to define the next three years of his health in the past three years of his health. So one set of data points is supposed to define the complexity of a human being's body, how they're managing their food, their exercise, their sleep, their stress, their body

composition, all on a printed out piece of paper once every three years or really, you know, on a combined six-year time span. It's just not realistic. And what is really happening is we are challenging our bodies on a minute by minute basis. We're sitting down and we're eating meals with more ultra-processed fast-acting carbohydrates with minimal fiber and no protein on a 10-minute basis than was available to another person on an annual basis a few decades ago. And so what's happening is our bodies are being challenged and crushed by these sorts of lifestyle behaviors that we don't have any way of understanding the consequence of

on a minute by minute or an hourly basis, but we're only measuring the effects with an A1C test, say, every few years. So essentially my premise is that the reason people don't know this is because they are simply not aware of their health state at all. They don't know any of the things that are happening in their bodies because we haven't given them the tools and the information to identify these challenges. And it's not just at the individual level.

It's at the system level that, you know, the CDC on their website is showing these stats that 84% of American adults who are pre-diabetic do not know they're pre-diabetic. What we have to do before we can fix the system is we've got to change that ratio. We've got to increase the report. We need to flip that exactly. 80 plus percent need to know the situation they're in so that they can take some action. You know, so many people are asking themselves, these statistics sound nuts.

And the average person is just trying to decide how do they eat and how do they eat healthier that actually supports their body? And sure, we're trying to avoid pre-diabetes, diabetes, Alzheimer's, these other things. But people are also looking for how do they step into having more energy threat? out the day and how do they not have brain fog and we're going to get into all that and part of this is teeing up the fact that you and your team have created an app and an experience that is making it a little bit easier for people to step into and in today's conversation we're going to be talking about the millions and millions of data points that you guys have seen from thousands of users

who are using the levels health system and what we can all learn from that so let's jump into it a little bit. You mentioned that food is one of the biggest issues that we are eating largely a lot of the foods that aren't supporting good metabolic health. Give us an idea of what you're talking about when you're talking about the foods that don't support us. I'll first tee this up by saying that with the level system, we are able to run a kind of a new paradigm of research. So we have started a very large scale distributed research program where people who'd like to participate can contribute their data in an anonymized and aggregated form factor so that we can do some number crunching on it and understand trends and patterns.

And so that general population study, it's the largest of its kind. And it allows us to take all that blood sugar data, other activity data, sleep data, combined with nutrition logs and other sorts of lifestyle logs and combine all that and understand it. So I do want to caveat that this data is, these are early cuts on the research data sets. that we have. So we'll be publishing this in the future. So I just want to say like these are not yet sort of finalized numbers, but just for the listeners to get some contacts there. Foods that we see in the data set today that are not supporting good blood sugar control. And the reason,

you know, the reasons that we want to control blood sugar and have nice, consistent reactions as opposed to huge spikes and crashes, go directly to what you were just talking about, that quality of life. It's not just about avoiding disease. I think living a life where we're just trying to run away from a disease state is not the best way to go about it. We really should be focusing on aspirational stuff. Like, let's feel better every day. Let's be better parents. Let's be better coworkers.

Let's be better performers in the gym or whatever our athletic endeavors are. Let's lose weight and feel great. Those are the things that I like to focus on as opposed to. And if we do that, we will inherently be improving our risk of disease. So, you know, the common spikers, you know, as we refer to them, in nearly all cases, are the heavily refined products. So the flowers, they've been stripped of their fiber. They've been stripped of their protein.

their water content. So a lot of this stuff is brand name foods. So I'll rattle off the top three. These are these are going to be brand names. They're going to be restaurants. I might get some hate for this, but Panera McDonald's, prolon. So one of those is not like the others. Some of our listeners may be familiar with prolon. These are these are a fasting mimicking diet product. They're losing a caloric deficit to help people, I suppose like prolong their fast. But what our data set is showing is that these have some rice flour, some quinoa flour. They're they're actually very stripped down to their dry ingredients. And people aren't really responding super well to them.

They're seeing very large spikes and poor, so greater than 50 milligram per deciliter spikes from foods like these. And they sit in the category alongside Panera sandwiches, McDonald's foods. Others are a lot of foods that have sort of secret sugar. And I call it that because, you know, it's not called out on the ingredients list. But this is frequently salads. So prepared salads at restaurants, we're at places like Panera and soups, actually. So, f, surprisingly, although it does have noodles in it. It also has, like, a lot of rich broth, a little more fat, some protein.

But a lot of the sauces, like Hoysen sauce and some of the others that are added to these soups to give it a really nice flavor are typically very high in sugar. And then just a lot of snacks. So I think the major takeaways, you know, we could we could rattle off a bunch of these, but pretzels, skittles, twizzlers, candy, things like this. Chick-fil-A is another one that is really on the towards the top of the list. So foods that we are reaching for when we're on the road or when we're just, you know, we're feeling like we want to indulge a little bit. And I think the reminder is just that although people in our dataset are using this tool and they're paying attention, I think what's important is like these are everyday people

and they're eating real normal foods. And you can see the responses to these different foods. And you can also see as you go through and sort of iterate the effects of one food versus another. So you can really understand, you know, is this? Is there actually a difference between Chick-fil-A and McDonald's? You know, should I pick one of those if I'm going to be on the road? And the answer is like they're roughly in the same category.

But, you know, when you're trying to think of what should I, what should I reach for? Well, pretzels versus pretzels with peanut butter are two totally different situations. And so like the addition of that of that nut butter, the additional protein, additional fat, takes a pretzel from something that could be, you know, maybe causing a huge spike and causing an energy crash only 30 minutes later to something that can give you a nice, steady, consistent blood sugar output. But so those are those are a couple, you know, there's also drinks. I think liquid calories are one of those that they can be comforting. But when you're reaching for, say, a Thai iced tea instead of something like an Americano,

you're probably going to be experiencing a blood sugar crash shortly thereafter because people in our data set who drink Thai iced teas show scores that indicate a glucose delta far above 50. So these are, again, you know, things that we're reaching for when we're probably on road trips or we're trying to get a little snack or feel, feel good and reward ourselves a little bit, that a little extra taste. But I think that there are, you know, in the data set, there's a strong indication that subtle differences between the foods, you know, that don't really, I don't think take too much from the flavor profile can have serious effects on the blood sugar control. And that's going to have a consequence on how we feel. So to recap that to make sure that I understood it correctly, foods that are devoid of fiber, which tend to be these ultra-process foods, foods that are devoid of healthier fats,

that are along with it, that typically would slow down the absorption of different sugars and glucose that we'd be absorbing in our body. These foods, which have become super pervasive in our environment today, they used to be a lot fewer percentage of our calories. Now, a lot of people are eating the vast majority of their calories from these foods. These foods are in a place where they're not just moderately raising our blood sugar. They're constantly exceeding quite large quote unquote spikes where you reference the number 50, right? And what was the measurement for that? 50 milligrams per deciliter. So if someone's used a CGM, you're typically going to be at your baseline around 70 to 100 milligrams per deciliter. So a 50 point spike means you're seeing an increase

of between 50 and close to 100 percent of your baseline level, which is a substantial increase. And remind our audience, why is that so problematic? Why should we have a sense of feeling like this isn't something that we want to be encouraging. It's not that we should be afraid of natural raises in our blood sugar from eating, healthy food, or even things like exercising or going to the sauna, which can also increase your blood sugar. But why should we be paying attention to these food-based spikes when they're happening throughout the day and they become a regular part of our life? Yeah, it's such a good point.

And there's a lot of nuance here. And honestly, the depth of the lessons just continues to go on and on. You can learn incredible nuance about how your body responds. But I think, you know, something that's interesting is as we're looking through the foods that are really driving crazy high spikes, you know, a lot of these foods, if you took out the brand name, you know, like a chicken sandwich. If you took out the brand name, that chicken sandwich line item or food lock doesn't show up in the worst foods. But when you add the brand name like Chick-fil-A or McDonald's, it does. I think that's a really important point, which is that the foods that these companies have turned into essentially industrialized products that have super long shelf lives and are available on the order of billions, you know, a year. They're selling huge numbers of these.

They are a fundamentally different set of ingredients and preparation strategies than what I would make at home to make a chicken sandwich, even a fried chicken sandwich. So the number of ingredients in a Chick-fil-A sandwich is on the order of like between 50 and 200, depending on what menu selection you pick. So I just want to remind people like there's a lot of brand names on the worst foods. And the reason for that is that these companies are they're doing industrial production techniques. This is not what you're doing when you're at home. And so when it comes to like should we be avoiding, you know, the entire food group or should we be avoiding some of these foods and that that we can purchase off the shelf or from a drive-thru window and instead making them at home. And I think that's just an important reminder is that you don't have to think of this as pure disciplinary. Like we have to remove entire categories.

It's more like let's get the food in. closer to its original form with as little processing as possible and ideally in, you know, in a manner that is still has its fiber attached and with the other proteins and whole grains, ideally, that it came with. So, but then to your question about why does this matter. So fundamentally, metabolism is a description of how our cells make energy from our food and environment and how effective or efficient we are in doing so. So every cell in our bodies from our brain cells to our muscle cells, to our organs are having to continually power themselves on energy that is that is created from the macronutrients that we that we ingest and along with you know vitamins of mineral sunlight

etc we're synthesizing all this in real time so every single system in our bodies has to be able to generate energy and if it's doing so efficiently there will be minimal byproducts minimal toxins floating through the system that our immune systems have to respond to and it'll be kind of like a smooth, well-oiled machine. The opposite happens, and you start to see chaos. So when our cells cannot generate energy effectively, not only do we experience the sort of mental issues, when our brains are not able to generate energy efficiently, or the physical fitness issues, or performance issues, or the sickness, when our immune systems are being taxed by a lot of toxic byproducts. So you start to see systemic breakdown. Sort of which system breaks down first,

kind of depends on the individual, I think. A lot of this is genetic. So some people will experience the consequences of metabolic dysfunction as early onset of Alzheimer's, which is being called type 3 diabetes or dementia. Or you may see heart disease for somebody who maybe has cardiovascular predispositions. You may see stroke. You may see pneumonia or kidney diseases. Again, this is how this metabolic dysfunction starts to slowly impact systems downstream and cause ultimately one of the causes of death.

So what's acutely happening is blood sugar, which is a super, superableness. important molecule. It is the kind of master energy molecule in the body. Like all of our cells can use glucose for energy. Our bodies need to control that in a very tight band. And the reason for that is that it's a very reactive molecule. So it binds to things. It can create compounds. It can create a lot of sort of toxic byproducts when it gets to a certain level. And we have a name for this. Glication is one of the names for what happens when there's too much glucose. Glucose glycation. And glycation is essentially when other cells and proteins get basically gummed up with a bunch of glucose stuck to them. And that process happens at sort of an exponentially increasing rate as more glucose is circulating the body over more longer time periods.

And so essentially what your body is doing is it's constantly trying to respond to the amount of glucose that's being released in the bloodstream by releasing a hormone called insulin to help. That hormone insulin acts like a key in a lock. it basically knocks on all the cell doors and says, open up and let glucose in. And so your body's trying to time this sort of symphony where we are eating foods, glucose gets released, our bodies produce some insulin, the insulin lets the glucose into the cell, the cell uses it for energy, minimal unnecessary byproducts are produced, and everything's great. When the system starts to break down, the essentially one of two things happens. Your body can't keep up with the insulin production demand because the amount of blood sugar

that you're producing or consuming is just far beyond what the pancreas and the body can produce. And secondarily, the cells stop responding. So your blood sugar, when you're spiking over and over and over again, and we're consistently eating these ultra-processed, fast responding, quick to break down, no fiber, no protein-type meals, it's essentially all going directly to glucose and going straight into the bloodstream. And so what we see in that case is that your body is constantly pounding on the cells, trying to get them to take on more of this glucose, pull it out of the bloodstream by introducing more insulin.

And the cells just simply can't respond. There's nowhere for it to go. They are completely sort of stockful of glucose. There is no energy demand for that glucose to be converted into energy and used. And so people essentially start to just put on body fat and the rest of the glucose is circulating through the system causing damage, glycating proteins, glycating structures that are that are necessary. And you start to see the consequences of this.

in systemic issues like nephropathy, where people start to, well, retinopathy, neuropathy, neropathy, essentially issues where the small blood vessels and nerves start to get damaged. And those are some of the first indications. When the small macrobascular of the body starts to break down, you start to get issues like erectile dysfunction or sexual dysfunction for men and women. You start to get eyesight issues. you start to get the effects of glycation where your skin is browning effectively, very similar to cooking, you know, meat in a pan.

And so these are all some of the downstream consequences. But, you know, I just want to focus on like acutely. It has to do with energy demand and energy response. So how quickly can your body convert this food into energy and, you know, and repackage it and or repackage it into, you know, glucose, which can be stored in the muscles as glycogen or as body fat? and, you know, if we are way outpacing our body's ability to keep up, that's where we start to see serious problems. And that manifests as long-term systemic damage. You know, I want to make sure

that our audience is falling along. A lot of my audience knows that I've been a huge fan of levels was an investor. I'm still an investor in levels. And I've been using it for many years now. And so you have both an app of part of the levels system. You guys have built the best app in this space. and there's all sorts of new advances. We'll talk about it later on. And then there's also a CGM that many people wear. Now you have a new version where you don't have to have necessarily a CGM. We'll talk about that.

And the whole idea is that you are using the system throughout the day to get a sense of how do you react to different foods? Do these foods, are they good for you? Do they support you? And then more importantly, because, yes, we want to get people away from super ultra-processed foods is the base of their diet, but there's a lot of foods that many of us will have sometimes, like cake or certain sweets or desserts. There's lifestyle habits that you can incorporate starting today, and you don't even have to have the level system to start incorporating these,

that actually can mitigate these spikes. And I want to touch on one of those that you guys found, which really resoundingly stood out in the data that you collected from all these different individuals like myself who have been using the app. for years. And it's related to the impact of walking, something that we have been designed to do as a species, but increasingly less and less people incorporate into their day. So let's say that somebody is, you know, eating one of these chick-fil-A, highly ultra-processed foods that are out there, or even a piece of cake, you know, maybe it's a birthday party. Give us a compare and contrast of what happens to the person who goes for a walk afterwards and the person who doesn't go for a walk afterwards and anything else that you guys saw in the data when it comes to walking and blood glucose.

Absolutely. This is one of my favorite, really one of my favorite learnings personally, and I love to spread it because it's something that I honestly would not have believed before starting levels and having the opportunity to see this in my own body and then see it scale. I was a person who always thought that to get any benefit from exercise, you needed to kind of leave it all at the gym, 90 minutes, intensity, move a lot of weights, something crazy like that. Otherwise, it's not going to help the body. And the reality couldn't be further from the truth. So to step, take one step back, which was, you know, to round out the issues with high blood sugar and why we want to control it. One of the ones I didn't touch on is inflammation. And so,

you know, I touch on how like as glucose levels get, get higher and higher, damage starts to set. And well, one of the other important consequences is that high glucose is very strongly correlated with and seems to drive inflammatory responses. So higher circulating levels of inflammatory cytokines, high sensitivity C-reactive protein being one of the indicators of inflammation in the body correlates strongly with glucose levels. So as that gets higher, or as glucose gets higher, CRP gets higher. And this is not good.

You don't want to be in a chronic state of inflammation. This causes a ton of other consequences, including to our immune system, our resilience against communicable diseases. And so, you know, just wanted to touch on that because as we are trying to essentially play this, you know, continual game of eating, nourishing ourselves, and also trying to maintain control over our body's reactions to the actions we're taking, it's important to have these tools because we don't want to be in a situation where we eat

at lunch and then we're sitting in an inflammatory environment for the next few hours, right? We want to have tools that can allow us to respond to what's happening in real time and sort of extricate ourselves or minimize the impact. And so like you said, walking is this incredible tool where the posterior change, so some of the largest muscles in our bodies are engaged when we're walking, just like when we're running, but just at a lesser intensity. So the same set of muscles is engaged. And the beautiful thing about muscle is that muscle can consume glucose without insulin. So that's a super important point. It sounds like a subtle nuance, but it's actually really, really important. When muscle is in use, it's contracting, extending, contracting,

it can soak glucose directly into the muscle cell and convert it directly to energy where it is used locally at the site, even without the insulin hormone. This is something that's super well known by people with type 1 diabetes. Again, people with type 1 can't produce insulin. Their pancreas do not produce insulin. And so really the only way that they can dispose of glucose without injecting insulin is their exercise or consuming it in their brains. And so this tool is profoundly powerful. If you can engage the biggest muscles in your body and get them to absorb glucose without having to produce insulin, that's like a freebie. And there are very few things that are free in life. So I just recommend highly, and our research fully backs this up, considering taking a walk after

every major meal in the day. And if you're going to eat something that is a little bit higher in processed food or lower in fiber, a snack or something like that, if we just need to grab one on the run, I recommend literally doing that, grab it on the run, keep moving, take the stairs if you're going back up to work. And what we see in the data is that there's a direct correlation between total steps and not just blood sugar response, like on a sort of an acute basis, but average glucose. So, um, the correlation coefficient is really strong. It's on the order of minus 40%, meaning the, uh,

the correlation is negative between, uh, total number of steps and the average glucose. So meaning as steps go up, you get a negative correlation where average glucose comes down and the strength of the correlation is, is 0.4, about 40%. So, um, so essentially as, um, you know, to make that, that more effective, like you're going to over time, as you get, to on the order of 10,000 steps, see a percent time and range for people who are doing half that many steps drive from 40 percent to closer to 80 to 100 percent time in range, meaning we're spending much more of our time in that 70 to 100 milligram per deciliter range that is considered optimal. So again, this is just from walking. This is not, these aren't people who are

doing any high intensity workout necessarily. This is really just something, you know, the way I implement this in my life is I take my Zoom calls on my phone and I pace around the office. And that's my means of rather than sitting stationary, just getting those extra steps in and trying to drive that average glucose down because it has such a profound effect and is so easy. Any thoughts on how long somebody should be walking after a meal? So the way I do it is just 15 minutes. I've got a little route now that my wife and I take after dinner. And it's about 15 minutes on the nose. And we do that every night after dinner. And I try to do something comparable after lunch, but it's a little harder in the middle of the workday. But yeah, just 15 minutes. We did a really fun experiment at one point,

just to kind of drive this point home with our members, which we called the Coke Challenge. And so we essentially asked everybody to drink a full sugar Coca-Cola on day one. And again, this was for science, and not everyone had to do it, but drink a full sugar soda, and then don't do anything. Just day one, stay stationary, sit on the couch, keep doing your work, whatever it was. then the next day at the same time, drink the same soda and go for a roughly 20-minute walk. And we showed that for people who walked for longer than 15 minutes, they had a nearly 30% reduction in area under the curve. So not just the height of the spike, but the absolute area under the curve was suppressed by about 30%

in people who walked just for greater than 15 minutes. And as a reminder, I mean, this is pure liquid sugar. Like, that's one of the fastest acting substances that we can get. and even so just a walk again not a run nothing intense was able to suppress that the impact of that by by 30% you're just supporting really you're supporting your body you're reducing the risk of inflammation and long-term consequence and you're doing it without having to produce the extra insulin for the equivalent suppression because the muscles are absorbing it directly and so that should have a lot of consequences for weight gain and and on and on so really probably the number one tool maybe number two

would be, you know, consistency with a generic exercise program, but I would say that number two is probably sleep. So from our data set, it just shows that there's a super strong correlation between getting an extra hour of sleep and up to a 10% reduction in average daily glucose as well. So that's the other really big one that is almost like, how can this be true? That's great. And we'll come back to sleep in a minute. But I want to continue on that thread of food, because that's how we started the podcast. And not only do, you guys have so many data points on the foods that create spikes, but you also have data points and the things that people were eating that led to a lot of stability in their blood glucose.

And a lot of these foods may not be surprising to people, but it's still good to hear. So for the folks who are having generally stable blood sugar throughout the day or moderate spikes that are there, not these 50-point spikes that are leading to potentially glycation, inflammation, many of the things that you talked about earlier. For the folks that are eating these balanced blood sugar diets, what are a lot of the foods that they're consuming? As a reminder, as you mentioned, the tools that we build help people to be able to keep track of foods, macronutrients, and the breakdown of or proportion of macronutrients in the

foods that you're eating, whether or not you have a CGM on. So just a reminder. that, you know, this is not just information that you have to keep track of in your head. This is stuff that we can, we can easily surface through our tools. And, you know, those foods that are are least likely to cause spikes above 30 milligrams per deciliter and that tend to have our highest average zone scores. So a zone is really, we describe it as the two hours after consuming food. And the reason we call, the reason we have that two hour zone is because that's where the,

the vast majority of blood sugar response occurs. So, you know, generally people are able to fully metabolize a meal. It'll break down, digest, and you'll have either a blood sugar response or you'll be able to sort of suppress that. That'll mostly happen within two hours. And so we look at the level product really looks at how a person's body responds to a meal over the course of the following two hours. And we score that. And so these are the foods that have a zone score that's greater than nine. Typically an average glucose stays below 100 and a glucose delta that's on the order of.

of about 10 milligrams per decilers, so just about a 10% swing. And rarely, these foods rarely are associated with a spike over 30. So eggs. This is like the top answer. Whether alone or combined in sort of a recipe with other ingredients, eggs are really in up to 40% of the logs that score over a nine. So they are a very, very frequent sort of featured ingredient and or standalone meal. And, you know, with the amount of protein in them, healthy fats,

they really seem to be something that can be a staple, unless you have a sensitivity, a real staple in people's diets and people with great blood sugar control go back to eggs consistently. Coffee with and without cream is up there. So people who have good, steady control blood sugar typically have a really nice response to coffee, and they do so on a daily basis. There's a lot of keto foods now that are coming out that, you know,

there was a time early on in levels where there were a lot of foods that were labeled as keto-friendly, or low sugar, and they really were not. You know, you'd put a CGM on, you'd see a massive blood sugar response. Well, we're starting to see that trend reverse, and now foods that I think these have likely been developed in combination with a CGM,

so people can, you know, companies can really confirm that their product does what they think it does. And so we're starting to see a lot of foods like, you know, from perfect keto, rabble ice cream, keto cupcakes and Quest Hero bars. You know, these foods are actually doing what they, they intend to do. And so these really do maintain a steady suppressed blood sugar. Now, I should say they do tend to lean on fat more heavily. So if you're somebody who's trying to pay attention to

saturated fat, you know, you don't have to reach for a keto bar in order to have a snack that keeps your blood sugar controlled. And then a lot of the basics are, again, these are whole foods. So this won't surprise anyone, but meats, avocados, cheese, a lot of smoothies, and then nuts and seeds. So these are the categories that round out the sort of top 10 of foods that are again, have these really nice favorable blood sugar profiles. So I eat a lot of non-fat Greek yogurt on a daily basis. That's another one that sort of comes up next on the list. It's one of the ingredients inside of the smoothie, typically.

And so people are making a lot of meals that are based on just some vegetables, some healthy fats like avocados and cheese, and some meats, chicken, sausage, typically lean meats, and or high omega-3 fatty foods like salmon or tuna. You know, comparing this to the list of foods that were causing these big sort of jumps in blood sugar points when you're scoring using a CGM. We obviously can see that you're talking about whole foods, foods that inherently don't really have that much sugar or in some cases have, you know, no sugar inside of them. they also in other instances would have maybe higher levels of fiber depending on which of these foods we're talking about but I think that one thing that I've seen you your co-founders like Casey Means who's been on this podcast before really talk about is that this isn't

to discourage people from eating the sort of quote unquote fun foods or the ultra-processed foods that are out there, but rather to have awareness. The challenge is most people actually have no awareness. I think generally speaking, we are all for adults, right, being in a place where they can choose whatever they want to eat. But the problem is most people are eating things, just trying to make it through the day, which often leans towards convenience, which often leans towards hyper-addicted foods that are going to hijack their taste buds, and they actually have no idea of the impact that these foods are having on their body. It's interesting because even somebody like yourself who thought of himself as relatively healthy, you worked out a lot,

you were trying to pay attention to the different foods that you ate, even you didn't know that a lot of the way that you had structured your diet led you to a place where you found yourself on the border of basically being pre-diabetic. Can you share a little bit more about that? I consider myself patient zero, really. You know, the first person to, in my life, at least, to use a CGM and see some crazy mind-blowing experience come to the forefront was myself. And so basically what was going on is I was working a really stressful job.

I actually have an aerospace engineering background and was working a lot of intense hours 18 hour days. But I had a real commitment to staying healthy, quote unquote. And the way that I thought that I should do that is physical fitness. So in my brain, physical fitness and health were the same thing. They were interchangeable. The most elite athlete was the healthiest person. I now better understand through the work of, you know, really through podcasts like yours, Dr.

Hyman, Dr. Atia, Casey, I now better understand that elite human performance, physical fitness can often come at a at the expense of true sustainable and sort of a longevity, you know, long-term health span sense. Yeah, it can come at the expense of health. And so for me, it was work long hours, drink a lot of coffee to stay motivated and then go to the gym and decompress with an intense workout. And with, you know, that sort of lifestyle, I was able to maintain, you know, good body fat percentage. I was lean. I had a lot of strength, physical strength. And I looked, you know, from the outside, I looked healthy. But I felt terrible every single day.

And at one point I had a moment where I literally went to my primary care doctor and I said, I'm convinced I have a terminal illness of some kind. Like, please help me figure out what's going wrong because I cannot, I just can't function in the day. My mood was just terrible. I had lost a lot of the personality elements I pride myself on, my sense of humor. I felt very, very low energy. I would have these physical energy episodes where I would be, I would feel shaky and like a cold pit in my stomach.

And I just have sweat trickling down my face. And it's like 11 o'clock in the afternoon and 70 degrees in the office. And I would have to, I would literally sit down on the floor or on a table or whatever was nearest to me. And this is as, you know, a 20-something-year-old adult who had 8% body fat and could bench press more than his body weight. And so, you know, it was a very strange. experience. And what I ultimately found, the first time I put a CGM on, was that I was experiencing reactive hypoglycemia. So my blood sugar, I was eating anything I wanted because, again, I didn't have a weight problem. And I always thought calories were calories. I didn't really consider macronutrients

to matter much. And so I would eat whatever I wanted. I'd have, let's say, a bowl of oatmeal with a bunch of brown sugar on it. So bananas in the morning, my blood sugar would go through the roof. So I would experience pre-diabetic or even bordering on diabetic blood sugar responses to these. So my blood sugar would go well over 200 milligrams per deciliter. I would frequently be up there for a long time period. And then ultimately my body would produce enough insulin that would pull that glucose back down. And I would absolutely crash. And so my blood sugar would crater from above 180 down to 65 in a matter of about 30 minutes.

And I couldn't tell that. I had no way of knowing that that's what was going on. But once I put a CGM on, I saw this happen in real time. and I would just get the wind knocked out of me. I mean, I would just have no energy. I'd be really irritable, hungry, shaky. And so long story short, that, you know, the path that I was on was just trying to, you know, I thought I was trying to be healthy.

But in reality, what I was doing is I was stressing myself to the absolute max with long work hours, poor sleep and intense exercise late in the day, which I thought would help me sleep, but it actually did the exact opposite. I would then hit my body, which was now insulin resistant from all of the above, the stress, cortisol pumping through my blood, and the poor sleep, which leads to insulin resistance. And I would then hit my body with a bunch of ultra-processed fast-acting carbohydrates, which I could not, my body just could not keep up with. That would cause a huge blood sugar spike. And then ultimately when that crash happened, I would repeat the whole cycle. I'd get some new food

because I was hungry and shaky and start the process over again. And it wasn't until I put a CGM on and saw the direct correlation between my actions and the reactions I was experiencing that I finally had a hook and I understood what was going on. And long story short, I changed my whole lifestyle. So the things that I eat, the way that I consider, you know, work and stress and sleep quality and how I structure my exercise routines are all completely different. And it came from a real confidence in being able to see, you know, a closed loop between what I'm doing and how it's affecting me.

Well, that's great. I want to add in just a couple points based off my experience. You talked about the walking example, that you had no idea that walking after a meal would make that much of an impact. You would have thought that you'd have to have like an intense 45 minute or an hour-long workout. Even as a doctor, move the needle forward when it came to like stabilizing your blood sugar. I had that same effect with all these different theories that I would hear around by diet. I'll give you one perfect example. And this is actually one of your challenges inside of the app that anybody can do.

if you get the CGM, you get the app, you sign up for levels. We have the link in the show notes below. You can do this challenge. I did it. So I would always hear people, because I came from the world of sort of growing up being vegetarian, and I was vegan for a while, and a lot of that sort of like holistic space, I would hear from people, even medical doctors, I would say things like, hey, brown rice is better than white rice.

White rice is just pure sugar. Brown rice is better because it has fiber, and you're going to be in a much better position. So for many years, when I started eating rice again, I would always go for brown rice. And I would actually tell people that, hey, brown rice is better because of this, because of that, because of other stuff. And when I got levels, I don't think this was an actual challenge you guys had programmed in, but I just did the challenge of my own. Later on, you added in the challenge, which was really cool for people. I actually tried brown rice. And then I did a little experiment of like, wow, how does that impact my blood sugar? Then I tried white rice.

And for me personally, as it is with many people, there was no difference between brown rice and white rice. Now, I'm in a place right now where I'm not eating a lot of rice in general, pretty occasionally. But just to know that, there's so many things that are out there that people tell you are good or this or that. But until you actually try it, you don't actually know what makes a difference for you. Did you have that experience with any particular ideas or theories that you had seen floating out there in the sort of world of the internet or social media or even books? I mean, that is that is like my whole experience. It seems like it's just directly in opposition to the sort of best practices that I'd picked up. So I was in a very similar boat.

You know, I thought, again, I was more of a calorie as a calorie person. I had really absorbed that from my early days in college where I would hang out at gyms and I would talk to a lot of bodybuilders. I was on bodybuilding forums. I really cared about getting strong. And I picked up a lot of what I felt I knew about nutrition from those sorts of formats and exactly, you know, correlates with what you were just describing. You know, one of the rules of thumb was brown rice, not white rice because it's a, quote unquote, low glycemic index food, which, you know, basically correlates with, or the

interpretation is that it has higher fiber. Also, you know, sweet potatoes, eat sweet potatoes. there are low glycemic food. Another one that was that I really lived by was you need to replenish glycogen if you're going to exercise. If you're going to exercise hard, you want enough energy, you need to have a lot of glycogen available. And so glycogen is stored glucose for those who aren't familiar. It's essentially your body can package up strands of glucose and basically stick it in the muscles and in the liver and then use it later on for energy. And so the way that I strung all these things together is that at every meal, I would, in order to replenish glycogen

for my next workout, I would eat a lot of brown rice or sweet potatoes. And then I would add on, you know, say two or 300 grams of, in total of carbohydrates from these two sources. And ultimately, when I put a CGM on, I realized one of two, or three things. Like, firstly, brown rice for me is arguably worse than white rice. I don't exactly. know why, but it seems to have if either no effect on the blood sugar response or potentially a slightly worse one. Maybe I'm sensitive to, you know, in some sort of, in some sort of way, the whole grain of the white or of the brown rice. I'm not entirely sure, but has no effect, maybe even worse. Sweet potatoes, above a certain portion size, blood sugar disaster for me. I just,

I, I, I'm quite sensitive to carbohydrates. It doesn't really matter how quote unquote complex they are. And so it's really about portion control for me, although I do still love sweet potatoes. And I, and I eat them frequently. But then most importantly is just this concept of glycogen replenishment or carb loading was just completely bunk for me. It was not the case that I needed to be consuming a ton of carbohydrates in order to get my workouts in. And in fact, it directly worked against me. So here's one that was a real finding for me.

Before I would go to the gym, I would always have a smoothie. So I would assume like, oh, I'm depleted. My energy stores are depleted because it's the morning or at the end of the day. So I would take a smoothie, typically would have a banana and some brand flakes and stuff in it. It would have a lot of carbs in it. I would drink that either right out on the way out the door before I left for the gym. And what would happen is because it was a blended up high carbohydrate food, it would break down super fast. I'd have a huge blood sugar spike.

And that spike would happen while I was in the car on the way to the gym. And by the time I got to the gym and was at the bar, you know, about to do my first set, my blood sugar was crashing. And I was experiencing total fatigue, tiredness. I would literally be yawning like over and over again at the gym. And hilariously, like when I put that CGM, again, I thought that was something that I was correcting. That tiredness was what I was correcting by having that smoothie. But in fact, it was driving it.

As my insulin was being released and that crash was getting suppressed, I'd be at the gym with my blood sugar in the, you know, again, in the low 70s or 60s after coming off a spike. And I'd have no energy. And so really what's most important for me to feel good exercising is not to eat at all if I'm doing it in the morning so that I have. a good consistent steady blood sugar state turns out you know when metabolically flexible my body can't has all the glycogen stores it needs typically unless I'm been fasting for multiple days and even if I have been it can produce the energy I need from my body fat stores and through gluconeogenesis which is another thing I just knew nothing about before starting this this whole experience so you know

I think the bottom line is that following the best practices of other people blindly led me really far astray I thought I was doing things properly, but there's enough nuance here that without some feedback, you could really get off track. I felt terrible every day as a function of these decisions that I was copying pasting from other people. And most importantly, I think the people I was copying them from were frequently, you know, athletes, legitimate athletes, people who are training multiple hours per day for the Olympics or for the Tour de France or something like that or a bodybuilding competition. And I thought that doing what they are doing at a smaller scale is the healthy thing. In reality,

we need to be, you know, eating foods that are appropriate for the lifestyles we actually live. I'm not an elite athlete. I spend a lot of my time relatively sedentary being somebody who's working in technology. And so I actually don't need to be carb loading all day. I don't need 400 grams of carbs. And I certainly shouldn't be getting them from something like brown rice. That's great. You know, I want to add in one more anecdote on my end, which is that I actually went through a period of time after using levels and also ordering the blood work that you guys make available through the metabolic labs that you have on the app, which includes like fasting insulin and other important labs. I am not like you. I had not been regularly training. I would play

tennis, soccer and other things, but I wasn't regularly lifting weights. And when I started on levels right around that same time, maybe like six, seven months later on, I also, became friends with Dr. Gabriel Lyon, and she really helped me understand that I was under-muscled as an individual who had been eating pretty much like a lower protein, vegetarian, vegan diet growing up, and then not sort of emphasizing that and not challenging my body enough through strain training. So once I got serious about that, right around the time that I turned 40, I noticed something really interesting is that by focusing on adding lean mass and being focused on building muscle,

which obviously everybody's talking about right now and the importance of not just protein, but resistance training and having a workout and a coach or a trainer that you work with that continues to challenge you and progressive training. In that process of adding about nine pounds of lean muscle mass that first year, I actually saw that I could get away eating

a little bit more carbs that I was having previously because I was very sort of anti-carb at the time and I realized like we don't need to be anti-anything, we don't need to be anti-carves, we don't need to be anti-fat, anti-this, anti-that, as long as we're getting it from the right sources and the appropriate amounts. And so I saw that by increasing my lean muscle mass, I actually could have better glucose regulation and I saw my fasting insulin numbers improve even if I was having a little bit more carbs throughout my diet. Have you ever heard that experience from people who have been using your app? Absolutely.

It's a slightly bigger ask than saying to get some more sleep or take walks after meals. But I think very likely the best thing somebody can do for blood sugar control is to add lean muscle mass. It does not matter who you are. Men, women, any age, adding lean muscle mass exactly like you're saying, it is that beautiful glucose disposal mechanism that does not need in. insulin to function. And it also helps us with, you know, musculoskeletal support late in life, which is one of the leading indicators of whether or not someone's at risk for falling and, you know, fragility. And so it's just going to pay dividends long term. So so muscle, like having

that lean muscle disposal for glucose is is a tremendously powerful tool. And also it, like you're saying, it gives us the opportunity to be, to have a little bit more flexibility with the same sort of blood sugar responses. There's kind of a two effects I've experienced. So I've actually gone in both directions. So when I started using a CGM for the first time, I actually had more muscle mass. I'm about back where I was when I started, but more muscle mass than I did a few, two years ago,ish. And so essentially, I started to fast a lot and I started to really restrict sources of carbohydrate. I was very interested in ketogenic diets.

And I wanted to, I wanted to really see all these different dietary approaches and how they impact blood sugar control. through that process, I ended up restricting calories more than I needed to. And I actually lost, you know, some, a lot of body fat, but also some lean muscle. And my blood sugar control actually did not get much better from when I started. Now I would spike far, far less frequently because I was eating sources that were relatively low carbohydrate. But my sort of average, and if I did eat something, you know, once in a while that was going to be processed or, high in carbohydrates, my blood sugar response would not be great. And, you know, that, that was a little bit,

that was odd to me. And until I started to connect the dots to muscle mass. So I had, I had lost on the order of five, six pounds of muscle. And I think what I was seeing there was a reduction in the glucose disposal mechanism that sort of corresponded with or tracked with my improvement in insulin sensitivity, which I think I was improving insulin sensitivity through fasting and metabolic flexibility training. So I was eating higher fat sources. I was I was exercising fasted. And so I think my cellular insulin sensitivity was improving. Now what that brings us to is now, a few years now in the future, I started, you know, strength training more eating a more varied diet, brought carbohydrates, you know, certainly sources from like, you know, I add berries to my to my smoothie every

morning or my yogurt bowl every morning. I eat a lot of carbs in the form of fiber, a lot of vegetables, have sweet potatoes frequently. So I started adding carbohydrates back in, a lot of protein, started strength training again, got my muscle back up. And right now, my blood sugar control is the best it's been in the five years since I started using a CGM. And it's really, really fun to see the response,

sort of the shape of my blood sugar response, improve as well as the absolute values. So meaning like you really don't want your blood sugar to go super high, but if it does spike at all, you really want it to be able to come back to its baseline quite quickly without overshooting and kind of like doing that reactive hypoglycemia thing I was describing where it crashes through the floor. You wanted to sort of like spike up and come straight down and kind of be consistent after that. I was seemingly incapable of that five years ago, even two and a half years ago.

But since adding my muscle back on and having done all of the sort of longer term work of improving the sources of my foods, the portion control, sleep quality, stress management, all of that has come together to the point where now when I do indulge in, say, a slice of pizza or ice cream or whatever, my body's able to manage it super effectively. And it's really empowering. That said, it can change pretty quickly. So after a few days, say you have a long weekend, traveling for a wedding or something and up late, you know, maybe indulging a bit, but more than you expected, you know, I'll definitely have a couple days where it's not great. But anyway, all that to say, like I've seen it in both directions, the loss of muscle having a negative effect and the gain of muscle having a positive effect.

And I just can't encourage people enough to to start to pay attention to sources, you know, use tools like levels that can help you stay on top of macronutrients and see the direct correlation between the types and sources and amounts of these maconutrients and your sort of muscle mass and weight trend. And just observe how these things are affecting your, you know, how your blood sugar. control is impacted by these various levers that you have at your disposal. One of the thing, you mentioned the blood panel. Yeah, I think it's really important that people not just pay attention to glucose, but also think about the bigger picture of lipids and triglycerides and inflammation. And, you know, a lot of the foods that people are eating, you know, this is not all about restricting carbohydrates, but a lot of the foods people are eating that correlate in our

research data set with higher inflammatory markers in particular. So, see our C-reactive protein above three milligrams per liter. I think are important to pay attention to. They really are the same ones that we were just talking about. You know, potatoes, rice, chips, you know, soup that frequently is blended up potatoes or blended up carbohydrates, pasta, burger, which I think is somewhat confounded by the presence of a pretty large bun in a lot of cases. And then additives, you know, I think tomato is likely corresponding with pizza, frequently,

butter, which is found in a lot of foods. But those are foods that are sort of the top list that correspond. to inflammatory responses. And a lot of them are these foods that, you know, brown or not doesn't really seem to make a difference when it comes to rice. It's just, you know, it's in the category of foods that is probably leading to long-term elevated blood sugar and inflammatory responses that are not ideal. Something that I want to highlight that you guys have featured in your data set,

which is about weight loss, especially for those that have a significant amount of weight to lose. and how tracking using a CGM can play an impact on that. But before I get into that, I've known since I've been talking about levels and I'm always transparent with my audience. I got so excited about the company after I used it. I personally invested, you know, I'm having you on here as just like, I want to talk about the latest stuff.

I want to talk about your research. You guys didn't pay to be on this podcast. I don't do those types of episodes that are here. One really cool thing, though, is knowing that so many of my audience has in the past tried levels and have probably told their friends who are now they themselves listening to the podcast, I thought it would be a good opportunity to chat a little bit about some of the additional improvements and new experiences that are on the app. And one of the coolest ones is this AI component because many of my audience has used levels as the CGM, which is great. That's like

the highest experience. You get the CGM, you get the app, you use them together to get a lot of the insights that we're talking about here. And you can also. to contribute to the research that you guys are doing. But in addition to it, you now can use the app on its own to still get insights about the foods that you're eating. Can you chat about that for a moment? Absolutely. This has been something we've been working on since the beginning of the company for two reasons. One is that, you know, people shouldn't have to use a sensor continuously, a CGM continuously to have an understanding of what's happening in their bodies. It's obviously, you know, it's something that I do, but not everyone should have to do that. And, and,

also the devices are, we know they're not super cheap. And although I'm very excited about the trend and continuous glucose monitors becoming more affordable, more accessible, it's still not something that everyone can do. And so what we've been building is the foundation layer for understanding the real time sort of patterns of our lifestyles and how those are likely to be affecting our health. And so we've been working on what we call our standalone software product, which allows you to whether or not you're using a CGM, leverage some really exciting tools for easy logging of lifestyle and then connecting those dots.

So what we call our Actionability Suite of features. So yeah, with or without a CGM, the AI logging tools that we've rolled out are fundamental rewrites to the features. So if you've used levels, say, a year ago or six months ago, you likely have not seen these tools. So they allow you to just snap a photo and literally close the app. And the AI interprets what's in it, breaks out all the ingredients and all of the macronutrients.

Every once in a while, you'll have to tune, say, the portion size of one ingredient or the other. But it's really astonishing the quality of that interpretation. You can even take a picture of like, you know, say a label on a menu or on a sweet green box of a salad. And it'll pick up the text and break out the ingredients from that. So really straightforward, photo-based logging, which we call quick logging. You can also just dictate into the phone. So you can use our AI described feature. just, you know, basically I would say something like just had a burger, beef, patty, whole grain

bun, lettuce, tomato, onion, and I'll close my phone. And it'll break out all those ingredients, come up with ideal or likely portion sizes, et cetera. So love that feature. And the goal is just to minimize the overhead so that people, because, you know, frankly, logging our food, I think is one of the most important health practices that we can do. It draws our attention to what we're actually eating, as opposed to what we think we eat. It's really hard to recall what we've been doing. And if you do have a health issue come up, being able to point to, you know, months and months or years of food history is one of the most powerful things we can do with our doctor. So our goal is to just reduce the effort there and make it really straightforward, easy, even delightful. And then the other features

are basically closing the loop between those actions we've taken. We also pull an exercise information and the reactions they're likely having. And so, you know, with the CGM, obviously you can see your blood sugar response to a meal you just logged. But the feature that I'm really excited about is we're rolling out what we're calling community glucose. This is based on the massive data set, you know, now approaching a billion glucose data points that we've collected in our data set of people using CGM in the general population. And what we're able to do with that is show you the response from people in the data set to a food like the one you logged. And so now without having a CGM on, we can use the model that we've trained on the data set of our CGM population to show you how that food is likely affecting your blood sugar. Now, it's not a predictive thing.

It's not going to say this is how you are responding. It's not going to say this is your blood sugar right now. But it will show you sometimes some counterintuitive or some very intuitive things to help reinforce those behaviors. And it really opens up that data set in a way that I'm super excited about to enable us to share those learnings that. that many of our, you know, tens of thousands of members have learned, but we really want the, the broader community to see. And then the other things are connecting not just CGM, but also our blood work. So let's say somebody gets our blood work. And, you know, maybe their A1C, their average glucose is actually quite controlled. But let's say they're ApoB, you know, the, the, the,

atherosclerosis driving lipids or sort of cholesterol particles is really high. You know, the beauty of logging is that it doesn't change. just address glucose related or carbohydrate related patterns. It can also be used to track, you know, where are our sources of fat coming from? What could be driving maybe this APOB, something that I've done because my APOB actually was climbing is I started to introduce a lot more fiber. So in the morning, I add 12 grams of cillium husk, whole cillium husk, not the cillium powder directly to my yogurt bowl. I mix it up with some weight protein. It's delicious. There's some blueberries in there. And the increase in fiber, I'm getting like 20 grams of fiber,

20 to 30 grams of fiber before noon every morning, has brought my APOB down by almost 25%. You know, with no statin. It's been a huge improvement. So these are the subtle things. And this came about actually from me literally using these tools without a CGM, getting my blood work done with levels, paying attention to the AI logging, logging my meals and seeing the correlation between my intake and it will be. And we do this through a feature we call habit loops, which every day the goal is to close three rings. That can be, it can be an amount of sleep. It can be an amount of steps. It can be a spike-free day on the CGM. It could be an amount of protein. So I'm trying to get 165 grams of protein a day. So I close that protein ring. So we have these really cool accountability features,

which come from a broad set of our lifestyle behaviors. All of that surfaced in the app front and center. Again, with or without a CGM, you can use these tools. So, you know, I, I, I, I, I, love it. I use it constantly, obviously, but really the most important thing is just getting feedback from people who are really using this. And I'm super excited to be able to tap into an entirely new set of users who may not have a CGM that is the cause of them, you know, them using levels, but, but ultimately they can learn from the CGM users who have already built up our data set with us. So I mentioned that we were going to touch in on this idea of weight loss, specifically people who have a significant amount of weight to lose. And some interesting data set and information

that came out of your almost now, as you mentioned, a billion data points that you have. Let's talk about weight loss tracking CGM and BMI. This was one that we really were not expecting. So I can just say we started the research with the intention of understanding the patterns of behavior and how our members are, you know, how their health is changing over time. But this is an observational study. So we aren't, there's no intervention. We're not putting people on a diet.

we're not enforcing some sort of pattern of behavior. It's really what happens when someone starts using levels and starts using a CGM. And so to put it to put it sort of straightforwardly, the more CGM hours and meals that levels users log, the more pronounced their weight loss. So there's a direct correlation between the duration of use of CGM and weight loss. And as well, there is a direct correlation between the amount of food logging that our users do and the amount of weight lost.

which is really exciting. I think it goes to kind of an age-old line, which is that what gets measured, gets managed. And I think that's what's happening here is people are paying attention to what they're eating. With CGM, they're seeing the reaction to those foods,

which is like an added benefit. And by doing so, they're sort of subtly tweaking little microchanges in their patterns of behavior, whether it's walking more, getting a little extra sleep, or picking different foods. And that's leading to,

in particular for people that started the study with an elevated BMI, so an elevated body mass index, which is essentially it's a body volume calculation effectively, volume versus height. So it's an indication of overweight. So people that start with an elevated BMI on average are losing 10 or more pounds in the research. And as the BMI, the starting BMI goes higher and higher, the amount of weight goes higher and higher. And so there are people in our data set who have lost like radical amounts of weight, you know, up to 10 points off their BMI, which would be something on the order between like 60 and 100 pounds-ish. And again, we don't have full insight into whether or not some people are doing other interventions.

But what we do know is because this correlation is very strong, it's almost dose-dependent between using the levels, using CGM and logging food and this weight loss, we have a strong sense that this is directly, this is actually causal, that it's the behaviors that come from paying attention to our blood sugar and logging our meals that are driving this weight loss. So again, nearly 70, I think I said, you know, on average people lose 10 plus pounds. And about 70% of people who are starting with an elevated BMI do lose weight. So that's the sort of high level, happy to dive into some of the more details there.

But really what's astounding is, again, this is not a diet program. This is not an enforced behavior change of some kind. This is people who are free living. They're able to do exactly what behaviors they want to do on a daily basis. and their self-initiating changes through this sort of feedback loop system that are leading to the weight loss. One of my neighbors, I just literally set him up with levels last week, two weeks ago. And he is a very busy surgeon. And the thing that he had shared with me, and he grew up very similarly in the same type of kind of community that I grew up in, South Asian.

and he was telling me it was the first time that he started to actually know through logging his food that certain dips in energy, certain feelings that he had, some even aches and pains or bloating or whatever it might be, he finally developed the interoception, even as a doctor, that this way of eating or this way of not eating was leading to not feeling good. Before, it was all just sort of blended, and especially because he's busy and has two kids and is running around and doing other things, it's just not easy to separate out

what is actually contributing to what until you start logging, and then you can see, and you can see how your blood sugar spikes, and you can see how the response is, and now all of a sudden you have a sense of, oh, well, that was causing that. oh, that's why I felt that way because it happened now two times in a row, three times in a row.

So those things make a huge difference when we log. And then we can all start to have that self-correcting behavior because we now actually know that these actions leads to these feelings inside of the body. We don't want this feeling anymore. Change up the actions. I love it. I think interoception, which is not a commonly understood term, you know, being able to perceive the internal state is is probably one of the again one of the most powerful things that we can do for our health is to is to start training that that concept of interception for ourselves you know i i i often

like talk about how our senses all of the five senses that we have are trained on the external world right our vision our sense of touch smell taste all of these things are perceiving what's around us but we can't tell when we have a tumor growing on our liver like we don't have a sensor system that tells us what's going on in our bodies. We are very under-equipped to understand what's happening in our bodies. And so anything we can do, a lot of this is going to be psychological. It's going to be training the feedback system, like subtle changes in heart rate, perspiration, like the kinds of things that are actually changing after a meal can be easily missed if we,

if we're not sort of putting in deliberate effort. And so I completely agree my sense of interoception. I can actually now basically predict my blood sugar to within about five points. just because I've been continuously using a CGM for six years now and seeing, you know, how I just directly correlating these things. And through that repetition, I now have basically have a built-in mental CGM. Now it's nice to have the device really tell me. But the point is, is that that reinforcement is really a strong lever on health. And, you know, the food logging, just to go to the weight change correlation with food logging, I'm really excited for us to do

the sort of next wave of research with the standalone software, without the, CGM involved to see if this continues to hold. But, you know, there is a strong linear correlation between, as I mentioned, the number of days with food logs and the amount of weight lost. So as people continue this behavior set, you know, from on average, or the median weight lost at 50 days with food logs is about five pounds. And the median weight lost at 100 days of food logs is about seven pounds. So it just continues, you know, the correlation is is linear and proceeds into the future. And so what I'm excited about is does that hold with or without a CGM? And, you know, again, we will be, we will be enabling people who are using the standalone

software to participate in this sort of research to really help us understand. Like, you know, first of all, is this happening? And then secondly, why is it happening? Is it introception? Is there something else that's changing? Is the, you know, are the patterns of behavior, you know, introducing more exercise or is it introducing more, you know, selectivity between different food groups? I, you know, still remains to be studied.

and we'll be publishing as we go. But it really points to a promising future where this is very sustainable, right? If people are getting in the habit and we build tools that make it really effortless to pay close attention to what we're doing on a daily basis, it should be something that can be sustained for life. Amazing.

Josh, before I give you the final word, I always tell my audience, I am the first person, especially as an entrepreneur, to highlight any product, service, tool, whatever, that can make their life easier. make it easier to be healthy because being healthy in our actually healthy in our modern world is kind of a little bit weird. And I mean that in a good way. You know, if, you know, everybody out there who's normal is unhealthy. So you want to be healthy, which is actually being

abnormal, which is being a little bit weird. And sometimes we need a little bit of support to do that. So that's why I'm excited for levels. That's why I'm excited about everything that you, Sam, Casey have built together the entire team over there. That's why I invested in levels. I've been such a big advocate of it to my audience, to my friends. If you listened to this episode, my audience, and you got excited about levels before I give the final word to Josh to take us out here, something really cool that's there.

They always give me different offers and things that I can bring to my audience. We can offer right now, and the offers change, just go to levels. That's D.H.R.U. Again, that's levels. Dot link slash DHRU. And I believe the current offer is you can have two months free when you sign up for a membership.

So you can really get a chance to try the CGM, start logging. Whether you have some weight to lose, whether you are just doing it to optimize, I guarantee when you make that connection between what you eat and how you feel, you're going to be better off for it. So check that out. That's at levels.

That's at levels. I link slash DHRU. And you can sign up with or without the CGM for any of the features that we've mentioned. And that's in the show notes as well and the YouTube show notes as well. Josh, you know, we started off this podcast talking about this pretty alarming number, which is how many people are pre-diabetic and don't even know it. And so many of my audience members, they have great health care. They go to the doctor.

And many of them have had similar experiences that they get told that their blood sugar is out of range. And their doctor might not even tell them that they have pre-diabetes. They have to actually go look it up themselves and are like, whoa, I'm in the pre-diabetic range. If this continues to keep up. And that sets them off in this journey of actually figuring out how do they get, healthy. You know, a huge part of this is awareness and a huge part of this is people having access to the right tools. Do you feel like the tide is finally turning and people are waking up to this? Or, you know, do we still have a few decades more of a bleak future before we can actually say

we're shifting things for the better here in especially America? On a day-to-day basis, it can feel a little bit disheartening. that the trends are going to continue forever and that we're going to get sicker and sicker. But I actually think that the tide is turning. And there have been some very recent initiatives, you know, like presidential candidate-type conversations about metabolic health, you know, something that I would never have believed would be a discussion. The fact that we're having this conversation more frequently, it's starting to enter the zeitgeist.

We have CGMs that from Dexcom and Abbott that are over-the-counter now. so no prescription necessary intended for for monitoring glucose that the transitions in the technology and in the conversation are happening. And I have to say that it's it's rare now that people look at me sort of cross-eyed when I talk about what we do at levels. Very frequently now, people get it. They're like, oh, yeah, CGM or blood sugar control, metabolism, metabolic health. In the past five years, when we first started levels, it was really, really something that had to be explained deeply for people to get it. They, most people just, just did not know that there was, that there even was sugar in their blood. You know, it's the fact that

we're now getting this to this level of mainstreamification, podcasts like yours, and so many other sources of information have really done the work over the past few years to make this something people think about. And I think there's a, there's a sort of groundswell of people who are really, really intent on taking, and this is, this is the key thing, taking their life into their own hands. Somebody else is not in charge of our individual health, right? Our physician can't to keep us from getting sick. It's impossible. We're the ones making the decisions each day that compound into a health outcome. And I think people are starting to understand that that, you know, it's not something that can be outsourced. It's not something that's someone else's

responsibility. It's our own. And first, there's that realization. And then there's, okay, well, what do we do about it? What are the tools that are necessary in order to make those better, those better decisions? And it's a whole bunch of things. But I really do look forward to a world where healthcare is not something that is, you know, nebulous and hard to describe, but it's actually just, you know, the set of tools and actions that we take on a daily basis that we can confidently say with evidence on an individual level are making us healthier every day, not avoiding disease. It's making us healthier every day. And I think people are excited about that future. So I hope that along with the development of these new technologies,

we can move the science forward because if there's anything I'm even more frustrated about then the lack of conversation about this. It's that if you look at nutritional science and you sort of compare it to like physics or computation, computers, information systems, our fundamental knowledge of the human body and why we gain weight or the onset of these sorts of diseases

that are affecting so many people, in my opinion, really has not improved. It's the fact that Levels has the largest study of its kind on continuous glucose information in a general population, I think is part of the problem here. It's that there really isn't enough interest in why so much human flourishing

and human health is being derailed by unnecessary and preventable conditions. And I wish that there was more curiosity and I wish there was more evidence-based science that would have led to, you know, sort of a Cambrian explosion and understanding and what's going on and why the rates of disease are so,

are so off the charts. I mean, you started the show talking about why are all these people so sick? And I just, you know, I am frankly quite frustrated by the lack of answers there and look forward to levels being able to contribute to painting the picture. Josh, where can our audience go to keep in touch with you and any other links that you want to mention to them? So I occasionally tweet at Twitter.com slash, I think it's Joshua's Forrest with two R's. That's the main hub for me. It's going to be Twitter. but otherwise check out levels.com, check out the blog, and reach out to us on any of our channels. We're at levels on YouTube, on Instagram, on Twitter, and we respond to all the messages we get. It may take us a little while, but we're always, always interested in what do you want to learn about?

Our blog is an informational, I think Powerhouse, as is our YouTube channel in our podcast, whole new level. So share with us, like, what are you interested in hearing and we'll do our best? Amazing. Josh, it was such a pleasure to finally get a chance for us to. connect here and chat about this important topic. I appreciate you coming on the show and breaking down all the incredible research that you guys are doing out there. And I appreciate the team's advocacy and commitment to the mission. There's a lot of different things that people could be working on these days. And I don't want to yuck somebody's yum, but I couldn't think of a better thing that is more important to us than dedicating your career to being focused on like, how do we truly get

people healthy? So thank you for that. Thank you for the work that you guys do. Well, thank you, Drew and right back at you. You've been an awesome partner and amazing, you know, mouthpiece for this, this health revolution that we, that we really desperately need. So thank you for what you've done. You've been a huge influence on a lot of us. And we really appreciate it. Hi, everyone, Drew here. Two quick things. Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean the world to me.

And it's the number one thing that you can do to support this podcast is share it with a friend. share with a friend who would benefit from listening. Number two, before I go, I just had to tell you about something that I've been working on that I'm super excited about. It's my weekly newsletter, and it's called Try This. Every Friday, yes, every Friday, 52 weeks a year, I send out an easy-to-digest protocol of simple steps that you or anyone you love can follow to optimize your own health. We cover everything from nutrition to mindset to metabolic health, sleep, community, longevity, and so much more. If you want to get on this email list, which is, by the way, free and get my weekly step-by-step protocols for whole body health and optimization, click the link in the show notes that's called

Try This or just go to Drew Perot.com. That's D-H-R-U-P-U-R-H-I-T dot com and click on the tab that says, try this.