The Pomp Podcast - #474: Josh Clemente on Improving Metabolic Health

Episode Date: January 20, 2021

Josh Clemente is the Co-Founder of Levels. Josh is a rocket scientist and worked at SpaceX for 6 years, managing the team that designed the life support systems in their space shuttles. In this conversation, we discuss biowearables, metabolic health, physical output vs food consumption, real time biological information, and working at SpaceX and Hyperloop One.  ======================= The Stacks 2.0 mainnet launched on January 14, 2021. Stacks, which you may recognize as Blockstack, is a layer-1 blockchain that uses the Bitcoin blockchain as a secure base-layer and enables developers to harness its power in new ways. Stacks makes Bitcoin more than digital gold, enabling apps and smart contracts on Bitcoin--unlocking innovation, new value, and a new way to earn BTC. Visit http://www.stacks.co for more information. ======================= Coinbase Wallets are adding support for .crypto and .zil domains through their partnership with Unstoppable Domains. Unstoppable Domains provides an all-in-one solution for blockchain domains. You can send money using these new domains instead of long Bitcoin wallet addresses, while also storing your domain in Coinbase's collectibles section. Go to unstoppabledomains.com in the dapp browser to register and manage your domains.  ======================= Get fresh, pre-measured ingredients and mouthwatering seasonal recipes delivered right to your door with HelloFresh, America’s #1 meal kit. HelloFresh lets you skip those trips to the grocery store, and makes home cooking easy, fun, AND affordable! Go to http://www.HelloFresh.com/pomp10 and use code pomp10 to get 10 free meals including free shipping! =======================

What's up, everyone? This is Anthony Pompliano. Most of you know me as Pomp. You're listening to the Pomp Podcast, simply the best podcast out there. Let's kick this thing off. Josh Clemente is the co-founder of Levels. Josh is a rocket scientist and worked at SpaceX for six years. We managed the team that designed the life support systems in the space shuttles. In this conversation, we discuss biowareables, metabolic health, physical output versus food consumption, real-time biological information, and working at SpaceX and Hyperloop One. I really enjoyed this conversation with Josh, and I hope you do as well. Before we get into this episode, though, I want to quickly talk about our sponsors.

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Use code Pomp10 and you will get 10 free meals, including free shipping. Go to HelloFresh.com slash Pomp10. I'm out here feeding the people. That's what I'm here for. I hope you enjoy this conversation with Josh and let's get into it now. Anthony Pompliano is a partner at Morgan Creek Digital. All opinions expressed by Pomp or his guests on this podcast are solely their opinions and do not reflect the opinions of Morgan Creek Digital or Morgan Creek Capital Management.

You should not treat any opinion expressed by Pomp as a specific inducement to make a particular investment or follow a particular strategy, but only as an expression of his opinion. This podcast is for informational purposes only. All right, guys. Bang, bang. Got an awesome episode today with Josh. Thank you so much for joining us, sir. Thanks for having me on. Absolutely. You've got an amazing background in terms of you've worked at some of the most innovative companies in the world, and now you've started a company that's really pioneering kind of this bio-wearable space. Before we get into what you're doing today, I want to go back. Tell us a little bit about your background, what you did at SpaceX and at

Hyperloop, and then we'll talk a little bit about those companies. Definitely. I grew up in Northern Virginia, a little bit south of DC, had a big property. I was always into machines, most particularly cars, motorcycles, dirt bikes, always building stuff. And, uh, I decided to go to school for mechanical engineering and, uh, kind of spent some time on thermodynamics and heat transfer, and not really knowing what I wanted to do other than work on machines and vehicles. And so, um, ultimately after school spent a brief stint selling used cars and then, uh, got the call I was waiting for and went and worked

at SpaceX for about six years. And, uh, that, that, uh, was for sure one of the highlights of my life. And, uh, you know, during, during my time there, I think I completely changed as a human being, uh, like end to end, just completely transformed the way I think about the world, uh, where I see myself on the hierarchy of intelligence way closer to the bottom than I had previously thought. Um, but it was, it was an unbelievable experience. And I met some of the best people, um, in my life, you know, who are, who will be close

to me to the forever, I hope. And, uh, and generally learned, um, you know, I, I learned essentially how to solve problems from first principles and, uh, you know, using, using that foundational, like what is the simplest solution that gets us to an iterative step forward, right? That, that sort of mindset is, is just rampant in, uh, in SpaceX. And I think in Elon companies, generally, uh, sort of an Occam's razor type approach where you just like go for the simplest solution typically. And, uh, and also attract really exceptional people with a big, a big mission. So, um, that was an unbelievable experience. I have eventually worked on the, uh, astronaut life support program. So SpaceX was previously, you know, they were a

satellite launch provider initially. And then, uh, the big transition came when it became clear that that part of the business was working. And now it was time to try and take humans into space. And that's like a fundamental rewrite of the organization. You know, now you have human lives at stake and, uh, it's no longer an empty shell. It's like, got to keep, keep them alive in there. So I was one of the earliest employees on the life support program at SpaceX and was able to, uh, work on that in partnership with NASA all the way through to the critical design review phase, uh, got that across the finish line and then, uh, moved over to Hyperloop and spent about a year kind of specking out the earliest full-scale system for Hyperloop demonstration.

And for people who aren't familiar with that, um, that system is essentially a maglev train. So a magnetically levitating high-speed train inside of a tube, and you evacuate all the air out of the tube so that there's no aerodynamic resistance. And so now with very limited power draw, you can maintain really high speeds. So much higher than a maglev train in open air can do. So we built a full-scale concept out in Las Vegas, and I was able to work on that, design some life support stuff, and then ultimately got obsessed with human performance and metabolism and started Levels. So that's where we are now. So let's talk a little bit about this idea of first principles thinking and almost the

simplistic solution. Obviously, Elon's fingerprints are all over both of the companies that you just described. But walk through like, are there specific examples where you saw this in practice? Or was it something that maybe there was an experience or some kind of training that really got you from what I'll call a civilian to now kind of be fully indoctrinated into this type of thinking and really kind of problem solving? Yeah, I think it so it's a pervasive culture of simplicity. And, um, the, the easiest way to describe this is like, as a really green engineer going into one of my first meetings at, at the company, um, my expectation was that I was going to have to take notes and research a lot of what I heard in that

meeting afterwards, uh, to understand what was happening, because I did not anticipate that I would be able to pick up on the language of advanced engineering. Uh, and the result was actually that it was a, a essentially a first one-on-one level conversation about designing a product that could be very complicated if you wanted it to be, but because SpaceX eliminates acronyms and jargon, it's not allowed. No one is allowed to use industry speak. Um, I, as a, you know, fresh out of school engineer understood everything that was being talked about. And it was being spoken about in sort of like an explain, like I'm five approach. And it's very, it's like, it sounds a little weird initially when you hear conversations at SpaceX, because they're sort of

like, well, what if we make it bigger? Uh, what if we make it like, what if we make it out of titanium instead of aluminum, that'll be lighter. And then we can add more, you know, the volume will be, you know, improved. And, and so there there's sort of like all these conversations that are just maintaining very low level terminology so that if anyone catches on, and the goal here is that whoever is in the meeting privy to the conversation, no matter what their background

or what their responsibility set is, they can understand and potentially contribute to problem solving. And if you create artificial barriers of complexity, just your language creates barriers. If I had had to take notes in that meeting and go look things up, that means I couldn't contribute in the meeting.

And I may never get back to that same group of people in that same context at that point in the project to offer my insight. And just because I didn't have insight at that moment, doesn't mean that I didn't in the future. And, um, many, many times midstream in, in conversation, people would just hear an idea and say, well, why don't you try this? Um, and, and the company, you know, SpaceX is a, is very build test iterate company. So it's, it's, you, if you are waiting to build a complex version of a potential solution before you test it where it might fail and you have to start over again you're you're going to inevitably spend more money and more time doing so so if there's a version of a concept and one example is um the

so the the spacecraft the the crew dragon spacecraft when it when it mates to the international space station it uses this uh this really complicated system uh called a docking adapter and it sort of like floats and adapts to the iss both vehicles are moving at different rates and then different angles and they connect and like grab onto each other. And originally we were supposed to have to buy this system off an existing aerospace provider, and it was going to be on the order of, you know, close to $50 million, something like that. And instead a team of engineers said, there's a simpler way to do this. And they built using McMaster car parts, which is like a, it's an e-commerce hardware store online and snowmobile

Springs, they built what we called the McDocker, which was, uh, I think it was on the order of like $20,000 worth of parts that did everything that the $50 million component would have done. And they demonstrated it live. And that was the build test iterate approach that allowed like that, that we were constantly using it at SpaceX. It was like, I think I can do this with parts that are laying in my garage. So I'm going to, and then I'm going to record a video of it and share it with the team. And in, in traditional aerospace, that doesn't really happen. You know, You don't, you don't have that license to kind of hack things together if necessary.

Um, and you know, the, and it goes all the way to the top. So like, I remember when the Falcon nine version 1.1 rocket first flew, it, it tried to relight its engine. So, so rockets traditionally burn up and, you know, uh, on re-entry. So they put their satellite in space and then fall back into the atmosphere and burn up. Well, um, SpaceX was trying to land them and recover them and refly them. And when that first Falcon nine flew, that was able to relight its engine and, uh, it

wasn't able to land cause it didn't have any way to do so, but it relight its engine and slowed down. Elon basically went on stage afterwards and said, so we're now gonna, now that that rocket did what it was supposed to do, like, we're just gonna put legs on it and land it because that way it'll be able to land. And if you, if you want to land, like you need to have legs to land on. And it was like the most, it was like a child explaining something, but that is the, that's That's the example I want to drive home is just that the simplicity of the language pervades

the end solution. It ended up that we just put legs on Falcon 9 and it landed. You know what I mean? And oftentimes you can get caught up in thinking about crazy complexity when at the end of the day, if you just describe it in its simplest form, that might be what you can do. How much of the language ends up determining the simplicity of the design versus the simplicity of the design determines the language? Is there a causation there or they both go hand in hand?

I really think it goes hand in hand. I mean, you, um, by, by creating, I think by creating a space where you can speak in very simple terms and describe very simple concepts without embarrassing yourself, um, you, you actually create sort of a competition where, I mean, some of the conversations, as I mentioned, are, are kind of bizarre where engineers are literally talking in absurdly simple terms. simplistic terms about very ultimately complex, complex, complex concepts. And, um, I, so I think it's bidirectional. I think by having a mental model that is like driven by simple language, you, you are keeping yourself at the root of the problem. You're not getting caught up in, uh, you know, as you learn more about a space and you get deeper into an industry, you pick up on jargon and descriptors that are, uh, much more abstract. And, and by default, like if they are abstract descriptors that you need to be deep in the industry to understand, they aren't the core of the, of the concept. Like if you look at the Wikipedia description

of a system, that's the, that's like the first principles associated with it. You know, it, it moves people from point A to point B, you know, that's kind of like what you're solving. And anything beyond that is, is no longer your first principle solution. Like if you're not solving, moving someone from point A to point B, you're on some sort of extraneous part of the problem. So by, by keeping the language focus there and, uh, and then simultaneously, I think rewarding simple scrappy solutions in terms of like what you're actually building, you can create a culture that is like competing for simplicity. And I think that actually ultimately means elegance because, um, I, I feel allergic to complexity generally, you know, the deeper we

have to go, the more parts that you have to bolt on to put things together. There's just more failure modes. There's more people that have to be in the loop. It, uh, it generally creates bloat and, and so fewer, simpler, more elegant in my mind. Yeah. The whole idea of like simplicity equals beauty. Uh, I think it's very, very true and it's cool to see it kind of, uh, implemented in a business and especially in a highly technical and, and, uh, what many people think is a highly complex, uh, type of, you know, hardware type business. Um, let's talk a little bit about Levels. It's an amazing product, but before we talk about the product, what exactly is the problem that you're going after? You're talking a lot about this metabolic fitness or metabolic

awareness in pursuit of metabolic fitness. Talk about where is the impetus for this idea? What was the problem? How did you come across it? Why did it catch your eye and you're so passionate about it? Yeah. Um, so essentially levels solves the question of what should I eat and why? And, uh, you know, we have wearables that tell us a lot about what's happening, you know, with our step count and with our heart rate and such, um, a lot of exercise and sleep tracking, but we don't have anything to answer a fundamental question, which is, uh, where is my energy coming from and, uh, how well is my body functioning at producing that energy? And so this is the concept of metabolism, essentially every tissue every cell in the body requires energy to function and where it gets

that energy is from our food and environment so the the calories we consume the sunlight that we absorb and uh this is this concept of metabolism is very abstract for society but in fact it is you know metabolic fitness which is the efficiency with which we're producing energy for our brains and our muscles and the rest of the tissues in our bodies fundamentally underlies physical fitness and mental fitness. So we spend a lot of time trying to perform better in the gym and perform better at work. Um, but at the end of the day, we never, we never think about the foundation for both of those, which is how well are we producing the energy for our brains and bodies. And so, um, that's, that's what levels is seeking to do is to optimize metabolic fitness by using real-time

data in as essentially a, as closed loop, a feedback style as possible. Meaning when you take an action, you receive feedback on how well that performed for you or how well you did, uh, your, you know, the reaction you experienced, how, uh, how positive or negative that was within as near zero time as possible. Right. So closing that gap to the maximum degree that we can. So, uh, the concepts that you throw out there, metabolic awareness, metabolic fitness, you know, metabolic fitness is the goal. We all want to incrementally improve day after day. And, um, as with anything, you know, focus, effort, and repetition are necessary to improve, physical fitness, mental fitness, and metabolic fitness. So the decisions we're making,

they compound over time into a positive or negative result. And if we don't have feedback on whether we're heading in a positive or negative direction, we have no way of achieving metabolic fitness because we don't know which direction we're heading. And so metabolic awareness is that feedback. It's the moment where your body has a closed loop of a data stream, essentially to your brain telling you positively or negatively how well you're doing and so the level system essentially we take in feedback well we take in data from what we call bio wearables so these are devices which are measuring a molecule in the body this is fundamentally different from a traditional wearable which is measuring sort of a superficial marker so pulse which you can measure

with your finger or step count which you can kind of just count in this case it's a molecule that would otherwise not be measurable without this device. And we take that data in context with your lifestyle choices. So the nutrition decisions you're making, your stress level, your sleep quality, and your exercise. And we pull out insights to help you understand specifically how well your body is functioning and where your areas for opportunity for improvement Got it. And so as you're doing this, maybe let's talk about kind of the traditional wearable market. So you talked about pulse, you talked about step count. There's a whole bunch of them, you know, everything from a Whoopin to an Apple Watch, all the way on down. And really what those seem to be focused on is what I'll call output, right, in terms of it's the physical body doing an activity. And what is the impact of doing that activity. So you can get everything from very simple, just how many steps did you walk today, to, hey, you walked a lot of steps, which meant you burnt a lot of calories, and then you slept well tonight. And that is all connected. And we'll tell you that. And so that's very, very valuable for people. But what you're really focused on is the input of what's going in the body. So how do you actually measure what's going in the body? Like, what does the product look like today? And what is it doing when somebody puts it on? so um it's a complicated problem ultimately uh metabolism is it's describing the chemical

reactions going on in your body you know the human body is essentially a large chemistry set with a lot of chemicals being released in response to other chemicals and so it's it's not like a you know a very clean machine where gears are connected and you turn the crank and energy comes out it's It's actually, you're, you're pouring chemicals into your body all the time. And, and then hormones have to be released to essentially to, uh, allocate where those chemicals, those resources end up. And that might be weight gain that might be to the brain for, for cognitive functioning. That might be to the muscles for exercise.

Um, all of that is dictated by hormones and complex processes and signaling by, uh, by other markers, um, chemical markers. So in this country, we have an extremely concerning yet largely unspoken about epidemic of metabolic dysfunction, where the University of North Carolina released a study in 2018 showing that 88% of adults in the United States are metabolically unhealthy. And the CDC is constantly releasing scarier and scarier updates where younger and younger people are getting type 2 diabetes, non-alcoholic fatty liver disease, all of these concerning side effects of very poor diet and chronic lifestyle decisions. And so at a point where 90 million Americans have prediabetes, 70% of whom will become type 2 diabetic if they don't do something about it, and yet we have no feedback system to tell us whether what we're doing is working in our favor, we ultimately are heading in the wrong direction and flying blind when doing so. So the question of how to measure input versus output is a tricky one. Ultimately, we need behavior change. We need to make better choices.

But it's much easier to focus on the outputs than it is on the inputs. It's very tricky to get really good data on what's going into the body. So the way that Levels attacks this is by highlighting for the user, for that member who's using the Levels product, we highlight for them the way their body reacted to a specific input, right? So you, you eat a meal. Uh, let's say you have a pizza. Well, you tap that into the levels, uh, interface, take a picture, and then let's say you sit on the couch levels monitors using the continuous glucose information coming from the bio wearable. We monitor the way your body responded to that pizza. And we then surface that to you as a score. So just a simple score

out of 10, and that's the output, but you are, you see the input. It was a pizza and I sat on the couch and the output was a negative response. My body experienced a prolonged blood sugar elevation followed by a hypoglycemic reactive crash. When I was flooded with insulin, insulin stores glucose as fat. So I gained body fat as a function of this. Um, and, and then we encourage you to try something different to compare that input to, to a different set of inputs. And so this time we maybe recommend have that same pizza, but this time take a walk around the block. So So take 20, 25 minutes and immediately after finishing that pizza, instead of sitting down, go walk around.

And now you see a completely different output, which is that for many of us are the muscles in our posterior chain that are powering that walk, um, can absorb glucose without insulin, that fat gain hormone, uh, as long as they're being contracted, as long as you're exercising them. And so now you, you know, you eat that same pizza, you go for a walk and your body experiences a totally different blood sugar response and correspondingly a totally different hormone response. And then we surface those two sets of inputs and outputs for you to compare.

So we can show you like just a simple stroll after every meal can completely transform the way your body is processing those meals and the load you're putting on your hormonal system and how your body is forced to respond and allocate those resources. So that's where we focus is at the end of the day, we want to make sure that the person who needs to make better choices is being presented with all the information. And we only want to pull in as much input as necessary to highlight an insight, essentially. So we don't make you tap in calories or macronutrient count or kind of anything that most nutrition apps make you focus on. We instead just focus on closing that loop between the input and the ultimate output.

Right. So let's go back to the way that you're measuring this is it's a patch that essentially goes on the back of an arm and what exactly is happening with that patch? Yeah. So this technology is called a continuous glucose monitor and it was developed over the past few decades in the lab and then ultimately was moved into the therapeutic space for people with diabetes. And essentially what it's doing is when you have diabetes, the, the insulin glucose feedback loop is broken down. So basically when, when you eat carbohydrates, glucose gets into the blood, that's a, it's a form of sugar. It's in your bloodstream. Uh, the hormone insulin has to be released by your pancreas to get that glucose out of your blood. And if it doesn't,

it can start to cause serious tissue damage. So for people with diabetes, they, they really have to have a full time high resolution awareness of their blood sugar levels. Historically, they've had to prick their finger every single time they need a blood sugar measurement. And that just gives you one point in time, it says you're, you know, you're at 106. And you have no idea if you're going up or you're going down or you know where you were two hours ago. So this amazing technology, which is a CGM, which is essentially a tiny little patch, it's about the size of two quarters. And there's this little flexible filament on the underside of it. And that filament, it's very hair-like essentially it sits in the skin and it actually interacts directly with glucose

molecules and so this this breakthrough over the past roughly 10 years has allowed people to go from pricking their finger you know dozens of times a day to having a continuous full-time data stream right to their phone and that is telling you glucose in say five minute increments without having to prick your finger without any mess or inconvenience and um and so that that's the development process for the tech. It's typically a wireless data transfer from this little patch that you wear full-time for about two weeks directly to the phone. And, you know, we're now getting to a point where, again, the convenience factor, the price point, and the usability, the usefulness of this information has made it such that we can start to expand it to

areas outside of therapy, right? So it's no longer just necessary that you have diabetes that you're managing, but in fact, we can start to focus on optimization. So whether or not you have diabetes, no matter where you are in the metabolic health spectrum, we can be making better choices. You know, if we have better insight, I'm sitting down to eat lunch. What am I going to eat and why? Well, we can now ground that in objective data. And so that that's the currently the application we're using CGM for. And that platform, uh, I expect will, will include many more analytes in the, in the coming years. Yeah. And what's so interesting to me about this is the obvious thing would be, Hey, you had this, you know, kind of persistent

flat glucose level, you ate a bunch of candy, and now all of a sudden it's spiked. You shouldn't do that anymore, right? So kind of a very binary eat this, don't eat that. But you highlighted an example of it's not just a single perspective of eat this, don't eat that. It's also kind of holistically looking at you ate the pizza, and then you sat on the couch versus if you eat the pizza and go for a walk. And so would it be fair to say that the only way to get truly holistic kind of measurement of this stuff is to actually understand what's going on inside the body combined with what's going on outside. Like it almost feels like if you're just measuring the external output, or you were just measuring the internal kind of consumption, both of those

things don't tell the whole story. So you kind of need to understand both in order to really give people, uh, kind of a true recommendation of here's the best thing you can do to be as healthy as possible. Yeah. Yeah. I, I, I definitely think that, um, it's both. So the, the situation is that people have for a very long time been scarcity constrained, right? For, for most of human evolution, we've had, um, essentially to be on the constant lookout for food. We never knew where our next meal was coming from. We were in a constantly fasted state between meals. And we now have a situation where we have an abundance and not only an abundance, but we almost have this ability with our processed food supply to short circuit the human metabolism. In a single

meal, we can get more fast acting carbohydrates than a prehistoric human would have come across an entire lifetime. And that's not a, not a joke, you know? So, um, we, we now have this situation where, because we didn't, I don't think we evolved, uh, sensory feedback for the quality of what we're eating because every calorie was positive. It was going to keep you from dying. Uh, we, we don't have the system to give us the feedback that we need. So when we eat those potato chips or we, we eat that candy, you know, we are relying on very, very abstract feedback mechanisms. And Sometimes, and for most of us, I think it's we wait for potentially months or years until the bathroom scale starts to change or until we get a scary diagnosis at the doctor before we start to think about what am I putting into my body? And so it's necessary in this day and age specifically when we're increasingly moving to internet-based productivity, we're becoming, as a result, more sedentary, and our processed food supply is continuing to get more energy dense.

It is truly possible to poison ourselves with abundance. And so we have to build new feedback mechanisms to, to give us that, that, you know, give us that sensory response that we otherwise wouldn't have. So, you know, so there's that problem, which is that we, you know, we, we genuinely do need this as a function of where we are in, in our evolution. And then, uh, secondarily, there's no sort of one size fits all. And this is where it really gets complex. You know, there are some high level things I'm comfortable saying, like candy is not a good idea. You know, you're just, it's just sugar. And we, that is such an energy dense system or a situation that our systems can't handle it.

And this is coming from someone who is a confessed recovering candy holic. And I'll go into those stories in a minute, but, um, but beyond that, it gets more nuanced. So to the question of like a cookie versus a banana, you know, which, which is healthier. Most people I think would answer pretty easily that the banana is healthier. Well, in 2015, there was a, the largest study on non-diabetics with continuous glucose monitors was done. And this was at the Weissman Institute in Israel. They put 800 subjects through a week of continuous glucose monitoring and made them eat these

standardized foods. At the end of the trial, they were able to show that two people could eat the exact same two foods. In this case, it was that banana and a cookie made with wheat, and they could have equal and opposite blood sugar responses to those two foods. And so one person flat on the banana, big spike for the cookie, another person, the exact opposite. What that indicates is that they're also experiencing opposite hormonal responses.

So that insulin release that drives fat gain or ultimately is associated with insulin resistance and type two diabetes could be opposite for these two people. So it is truly the case, I think, that not only do we have the concern about what we're presented with every day in terms of options, but we have to go another layer deeper if we really want to be optimal in the sense that we should also understand specifically how we, our own individual genotype or phenotype, responds to that specific food, our own chemical makeup. And I think much of this is context. So I actually believe that only a small fraction is genetics driving those individual responses. And the rest is something like stress, body composition. So basically how much fat you have on your body, how much muscle you have on your body, how well slept you are, how much cortisol and insulin are circulating in your bloodstream at any time. that's all what dictates how your body's going to respond to a specific meal. And so that's why the levels, the levels system is focusing on bringing in much more than just nutrition. It's nutrition in combination with your activity level, with your sleep quality, ultimately with your, with your stress through additional analyte tracking. And, um, this way

we can help you identify which of the levers you should pull on hardest. You know, if it's, if it's a situation where you're experiencing severe metabolic dysfunction as a, as a result of non-caloric decisions. So you're, you're in very stressful meetings all day and you're sleeping very poorly and your blood sugar is chronically elevated because you're in a state of essentially an enhanced fight or flight mode. Uh, we can highlight that as opposed to someone who's eating candy all day. You know, that's a, that's a little bit of an easier connection to make. Yeah, it's fascinating to me that you're able to get such a great understanding of the holistic picture. You mentioned earlier metabolic health, and I want to make sure that people really understand this. I think this is kind of the crux of everything you're talking about here. What exactly is metabolic health? And then what are the things that people who have great metabolic health or really bad metabolic health kind of experience? Yeah, so this goes back to the metabolic fitness conversation. And so metabolic health, the best way to describe it is when the body is able to produce energy effectively, without harmful byproducts, such that you can perform to the maximum extent that you need to, and can age gracefully. I think that's a good way to describe metabolic health. It's a complex subject, there's a lot that you could dig into there.

But, you know, what's important is that many people assume that metabolic health is something binary. So I'm either very metabolically healthy, or, you know, oftentimes people say I have a fast metabolism, or I have a slow metabolism, and I'm metabolically unhealthy. The reality is that, and this has been studied and international, essentially conventions of diabetes experts have come out and said that there is no such thing as thresholds, right? Everyone exists on this spectrum of metabolic health. and we've drawn these lines in the sand and said, this is diabetes. This is very metabolically unhealthy. And this is slightly less metabolically unhealthy, but still bad. And that's pre-diabetes. And the rest of us are all in this other end of the bucket of the spectrum. So what we're reframing it as is metabolic fitness. It's your fitness level. How well is your body producing energy? How well is it responding to the specific lifestyle choices you're making every day? The nutrition, exercise, sleep, and stress levers you're pulling every single day combine into a metabolic profile. And so, you know, we really want to

reframe the conversation and get people to stop thinking about this as something that's out of their hands or like a switch is flipped and, and start getting us to think in terms of focus, effort, and repetition. If I know what is causing a positive and or negative response in my body, I can modify those behaviors, not just by removing it. You know, if I, if I love cheesecake, Um, I don't necessarily have to remove that if I just add a stroll afterwards or, uh, or if I just make sure that I sleep well that night, you know, get, get a full eight hours and, uh, that can help me maintain insulin sensitivity, which helps me process those indulgences.

Um, and so connecting all of these dots for people into a holistic picture of like, okay, all of that abstract advice of eat healthy, work out more. I can now understand contextually what that means. You know, working out more allows me to use the glucose I'm putting into my body immediately. And eating better means avoiding these massive hormonal kicks to my system, which ultimately can break it down. Got it. The other part of this that to me is really fascinating is there's some, I don't know, taboo things you can put in your body that everyone seems to be really, really religious about. So I'm going to throw a couple of them out there, and you kind of just throw me back whatever comes to mind when I say them.

The first one is alcohol. what's kind of the thought process there and what have you guys seen from a trend perspective yeah this is i think there's a ton more studying that should be done in terms of alcohol and its effect on metabolism but what we know is that it's counterintuitive so for most people the assumption is alcohol is all carbohydrates so if i eat this while i'm wearing a glucose sensor my blood sugar is going to skyrocket the reality is that alcohol actually hijacks your liver it basically tells your liver, well, your liver treats it as an emergency situation and wants to convert the ethanol in, in the drink into fat. Um, and that that's essentially how you can

metabolize ethanol. So, uh, it turns it into triglycerides, which are then stored on in body fat in order to do that. It, it seems to shut down the production of new blood sugar. So what you end up with is a situation where, um, on a glucose monitor, you have a drink or two, and this varies person to person, but there will typically be either no response or an actual decrease in blood sugar. And what's happening behind the scenes is both the alcohol and anything you're eating at that time are being biased towards fat production and fat storage, which is probably not a great alternative to glucose production, but it is a really interesting effect. And, um, you know, I think generally for me, the biggest concern with alcohol

is just, it destroys my sleep. It almost seems like it doesn't matter when I have it during the day. My heart rate's elevated, my body temperature is elevated and my sleep is worse. So I tend to think of it as a stressor that I use sparingly and typically earlier in the day. What about what I'll label as like the keto diet? So basically I'm going to eat no carbs. I'm only going to eat meat and I'm basically going to be as strict as possible with a fanatical focus on just meat consumption? Yeah. Well, I think that there are many ways to put together a diet that avoids the sort of energy toxicity that we touched on, you know, where you have a ton of sugar and really a ton of fat, either of those can cause essentially toxicity in the metabolic system.

So what I think is important is that you, you don't do what I just mentioned. Don't eat a very, the standard American diet, which is high carbohydrate and very high fat, including uh, poor sources of fat. I think the ketogenic diet, it's very hard to maintain in my experience. Um, I, I personally am not keto and I instead strive for kind of a high protein, moderate fat, low carb diet. And, uh, ultimately that's just, that's just my decision. You know, my co-founder Casey is, uh, she's a plant-based vegan. So she only eats plants. She doesn't eat any meat. And she has, you know, between the two of us, we have totally different macronutrient profile. she eats a lot more carbohydrates than I do, but she actually has better blood sugar control than

me. And so that's another counterintuitive piece where she's using a lot of this really nuanced knowledge about how her body metabolizes specific foods and in what order. So like fiber, fat content, along with those carbohydrates can modify the way her blood sugar responds. So she's been able to build a really high quality plant-based diet. I think I've been able to build a really high quality, more animal based diet. And, um, at the end of the day, there are also people who are maintaining exceptional glucose and probably improving their risks of, of certain chronic lifestyle concerns with a ketogenic diet. And so what I think it all comes, comes together as is wherever you are, whatever you're able to pull off, whatever your dietary philosophies are,

they should be grounded in some objective data so that you can confirm that this is actually doing what you think it does. Um, and there have been plenty of people who have come in having kind of predetermined assumptions about a specific, either a specific food or a philosophy or dietary approach that have, you know, been blown up in the face of better data. Absolutely. Uh, intermittent fasting seems like, uh, another one of these themes or trends that people are grabbing onto. How have you guys seen that, uh, impact some of this? So, um, intermittent fasting with a glucose monitor is pretty cool because you can see the effects of your body doing its thing. Essentially when you cut out carbohydrates

or really when you cut out all calories, um, most people think that they're going to kind of plummet their blood sugar is going to drop and they're going to have this fatigue issue and they're going to probably pass out or something. And the first time that you do an extended fast and you see that actually all of this, like these spikes and drops and all of the hormonal fluctuations associated with that completely disappear and your body goes into this very elegant mode where it is taking what you have on on yourself your your sort of existing body fat and it's converting it into the appropriate amount of blood sugar to keep your brain functioning and so you'll typically see like a nice slow decrease and then a very flat blood sugar line

and most people feel really good and when you see that data when you see that feedback loop and realize that, um, you can actually maintain this for days without any calories and you're not going to pass out most people, you know, of course there are some, some of us who have a condition that prevents that. But, um, the reality is most of us have, um, you know, the average person has about 80,000 calories of body fat stored on them. And they only have about 2000 calories of stored sugar, which is called glycogen. So you can, you can easily burn through the, that 2000 calories of glycogen in a single 90 minute workout, but you can go multiple days on the body fat stores. So training your body to using, you know, I think mechanisms like

intermittent fasting to tap into that body fat and become more acclimated to using it, I think is a really great approach. And, um, I do a lot of it myself. It helps to kind of release you from, from the grasp of food scheduling as well. You know, it's nice to be able to do one meal instead of three sometimes. Absolutely. Uh, the other thing that I find fascinating about all of this is, uh, multivitamins and just what I'll kind of label as, uh, not food yet trying to get some sort of nutrient, um, impact. How do you guys see that playing out? Are there any trends or takeaways? I think there are some supplements that probably make sense. Um, if you, if you certainly, if you know, you're going to be, um, I think it compromised

on them. I think vitamin D is a really good one. Vitamin D is super important. And especially as we like in winter months or are indoors, I think vitamin D supplementation makes a ton of sense. Magnesium is another, uh, I think really important supplement that I take commonly, um, especially when fasting. And, um, I tend to, I eat a lot of avocados and I, I do add bananas in here and there

for potassium. Those are the ones that I've noticed the symptoms or side effects associated with too little of that, you know, specific, uh, vitamin or supplement beyond that. I, I tend to be skeptical. Um, if there, there isn't good research connecting a, um, you know, a specific effect of, of too little, then I would argue that you're probably just urinating most of it out because many of these supplements tend to have like 10,000 times your, your necessary daily value And, um, you know, this goes to the, the, if some is good is more better type concept.

And I think generally, no, um, there's a sweet spot for almost everything. And, and just taking a multivitamin probably isn't doing much that you couldn't get from a better diet. Um, so let's talk a little bit about the bio wearables. So we talked a lot about kind of what you're measuring and how that can be impacted, but the actual device itself and kind of this growing class of things I put on my body that measure something going on inside of my body. How do you see that evolving over time? And is that something that levels will say, look, you know, we've got one product we want to eventually expand into an

entire product suite, or is it just staying, you know, really, really focused on that glucose monitor? Yeah, I think we're just cracking the shell on bio wearables right now. I consider levels to be kind of like a bow wave into an entirely new market that has previously been undiscovered of um you know the the metabolically aware or the nutrition aware or the honestly the health seeker who wants to continually know that they're making positive compounding returns on their lifestyle investments right we're each we're making decisions all day every day whether it's going to the gym taking time away from family to do that or eating food that may not taste as good as that delicious donut, but we're doing it because we want to improve our health.

And, um, and so we're, we're opening up an opportunity to get those micro-optimization receipts. Like you're, you're, what you're doing is working or not working and here's how to do it better. Um, and to continually feel like you are moving in a positive direction. Glucose is one piece of this. It's a really important, you know, I mentioned some, some stats in the beginning. it's a really important problem in society today, glucose dysfunction and, and, um, all of the side effects associated with it are ravaging over 120 million people each year are dealing with some sort of metabolic dysfunction that is preventable. So we're going to stay focused there and continue to expand access to that technology and, uh, improve the actionability, but, but it's one

of many, you know, and so we're going to continue to, um, push innovation and look to work with innovative companies who are developing the next generation of sensors that are going to go a little bit deeper in the, in the direction of bio wearables. And I think this will probably be real-time sensing of hormones like cortisol and insulin, um, which are associated with your stress and how your body is allocating, you know, fat storage, um, and probably deeper into kind of lipids and triglycerides. So ultimately I think you'll be able to get a really good immediate view on your, your full metabolic health, not just your glucose regulation. And it'll probably be, I would imagine in a consolidated form. So you'll wear one thing

on your body and it will do everything that your current wearable does. Plus it's measuring molecules below the skin, which I think is the ultimate, it's the Holy grail of, of longevity using these, um, you know, these, you know, closed loop feedbacks, uh, sort of fashion. For sure. You've mentioned a couple of times, real time, especially focused on like the real time data collection or, or presentation. Is that something that previously just wasn't available? And now there's the technology and kind of the platforms to do it in real time? Is there some other reason why that's kind of the future? Or is it just literally, if you have more data, and you're able to track it in real time, then you can be more effective in the recommendations and ultimately the behavior change? yeah i mean we have a theory of behavior change that it is closed loops that make the difference so most people do not want to be unhealthy and ultimately it's by prolonging the the length of time between an action and the negative reaction to that action by prolonging that you allow the sort of behavior change piece to to dissipate right we our memory just sort of dissolves and

we lose the immediate reinforcement that happens. Whereas if you do something, you touch a hot stove and immediately feel pain, you don't touch hot stoves anymore. If you were to eat something and immediately feel pain, you wouldn't eat that thing anymore. And as we mentioned, there is no sensory system for that. So by replacing in as close to the same amount of time as possible, that sensory feedback with a visual or a data-driven piece of feedback, we can help to supplement people's senses of positive and negative when it comes to these things like nutrition um and so i do think that the timeliness of a piece of feedback is crucial to its value to the to behavior change so we're all about minimizing feedback loops we we don't really um focus on you know blood tests

where you do it once and you get you know results two weeks later or something like that they're non-specific it's much more temporal so it's you eat lunch and you see how you respond to that minutes later, and then you eat dinner later, another lesson on dinner. And then you can do that over and over again. And you have hundreds of permutations of exploration in a 28 day period. And each of those was an opportunity for immediate lesson learning. That's where I think all of the behavior change value is. And that's what our team, you know, believes. And as we've written about in our theory of behavior change is that by taking micro electronic technology, using it, you know, we've unlocked a huge amount of opportunity with this, you know, essentially

the minimization of, you know, size, scale and cost of electronics, we can now build these closed feedback loops for a huge number of data vectors. And I think completely changed the trajectory of health, not to mention many other things, you know, as we're seeing in finance and elsewhere. Is it going to be a world where literally we all have a bunch of sensors on and we're walking around, there's like a live dashboard. And we almost get to like a predictive state where it says, hey, you're about to eat X, don't eat X, or, hey, you're about to lay down on the couch, don't do that, go for a walk, like, you know, how kind of real time slash predictive does this get? And then also, how pervasive do these technologies come into our life? And this

is something that we necessarily want, or I don't know, you guys have built this. So you tell me kind of how you guys are thinking about some of the, you know, making it available is one thing, uh, wanting the whole world to use something, um, it has kind of a whole bunch of other connotations. Yeah. I mean, I think that in the long run, you know, I would like to see us reverse the trends of metabolic dysfunction, you know, that 88% were unhealthy. I'd like to see that be the healthy set. And, you know, only 12% of us are dealing with preventable chronic lifestyle, uh, related illnesses. If we could see that, I mean, I think the productivity we'd see and the benefits to society would be hard to hard to even imagine,

Uh, the direct costs of diabetes are expected to be over 600 billion in 2030 in the U S alone. And so, um, you know, the secondary effects, uh, I are, as I mentioned, you know, it's really hard to trace them. So I think it's important that we ramp up our focus on, um, metabolic health in, in the nearer term, but I don't think it's going to be an invasive thing. You know, I think this technology is going to continue to, to, to develop and refine, and it's going to be much more, uh, much more similar to a financial data sort of feedback model where you, um, you get feedback, you see your withdrawals and deposits, you see the compounding rate and direction of return on your, you know, quote unquote investments. So what you're doing each

day, you see the connection to your long-term plan, you know, that retirement trajectory that you're on, you get expert advice. If you need it, you know, if you want to do something specific, Or if you just generally want someone to coach you along the way, you can have that directly and it's driven by data. It's not abstract and guesswork. And so ultimately, I think with metabolic health and really health generally, by having that same data-driven, very large data set per individual type of relationship to ourselves, we can build a similar model where you're slowly but surely working towards that future where you are not only financially retired, but also know you're going to be healthy enough to enjoy it type of thing. And, and so it will be kind of a background layer available confidence. You'll be able to build confidence in what you're doing. And, um, I do think it will be predictive in the sense that, uh, you know, the devices will be able to tell you, Hey, look, you didn't sleep at all on that, on that red eye flight,

and you should avoid these foods. Those don't work for you when you're under this kind of stress from poor sleep, recommend this menu instead. Um, very simple, low cognitive overhead. it's not invasive, but it just takes away that guesswork. And you know, okay, yeah, I'm compromised on sleep. This is going to help me be healthier. And you can connect that right with your goals. Yeah. I love that. And I think that you're probably more right than, than wrong there. Before I wrap up, I always ask everyone the same three questions. The first one is what's

the most important book that you've ever read? Yeah, this one I've had to ponder a little bit. I'm going to say, uh, the, this book was extremely important to me. It's only, I've only recently read it. So, um, uh, you know, I'm putting it in on a high pedestal, but it is amazing. And it's extreme ownership by Jocko Willink. Uh, I think that the way he reframes so many of life's problems into a very simple binary where, uh, it is your responsibility. Like that's, that's just all it comes down to is like, if you just take away all the, the mental argumentation about whose responsibility it is and and accept that it is your responsibility to improve um every single day everything that you do everything you're involved in um it's a position of power actually

it's an empowerment book and that's what i loved about it was it was taking something that sounds on the outside like a burden and turns it into a real mechanism for empowerment which i love yeah i i think that uh that book is even though everyone knows about it for those that haven't Reddit. They feel like there's no way it could live up to the hype, but definitely does, at least in my opinion. It sounds like you as well. When it comes to sleep, our friends at Eight Sleep, they've sponsored this question. And as I've talked about on the podcast before, they basically have this bed that cools and helps you get deeper sleep and just a much more kind of refreshing sleep. I sleep on one every night and absolutely love it. What's your sleep schedule? Do you do anything

before sleep? Do you do anything specific, uh, during sleep, um, or, or any kind of things that have changed over the years? Yeah, I, uh, I love the eight sleep folks. I have my eight sleep pod pro that I have not yet unboxed, but I am absolutely ecstatic that I finally have it. Um, I feel like you're, you're measuring what goes in people's body. They're measuring what happens when you go to sleep, but you guys should be friends. We are friends. Yeah. They're great, great friends of ours and supporters. So, um, I'm glad to hear that they've, they sponsored this question. I I'm a, a warm sleeper. Like I always wake up in the middle of the night, just uncomfortably warm. And so the, that thermoregulation that they incorporate,

I think is going to be a total game changer for me. I'm really excited to put it to the test. And, you know, generally I I've over the time that I've been using, uh, metabolic tracking, glucose tracking specifically to understand how well my body's performing. I've totally changed my perspective on sleep. You know, I used to be a sleep when you're dead type person, like that's, that's weakness and just recognize very quickly how bad my, my situation was to give some context. I was actually a borderline pre-diabetic or fully pre-diabetic when I started this company levels, despite being a CrossFit trainer and always caring about physical fitness. And so everything that was going wrong was not my degree of body fat or my exercise. It was that I

was eating foods that were putting me into a bad place and sleeping poorly and being highly stressed. So my current approach now I track, uh, sleep with whoop. I also have my Garmin two 45 that, that do sleep tracking. And, uh, between the two of them, they forced me to recognize that I can't drink alcohol close to bed. Uh, really even in the afternoon, um, I can't eat meals, you know, within about two hours of going to sleep. And I have to get at least seven hours. I do pretty well after seven hours, but, um, ideally eight hours every night. And, um, light another real big one i just i just cannot get the same recovery scores when i have um you know light streaming in so if you uh you don't drink in the afternoon or at night does that mean that you're

waking up and pounding a couple of shots well i gotta tell you man some of these some of these other european cultures i think have it figured out um no but seriously it's it is interesting to look at places like italy um where oftentimes you'll have a glass of wine like sort of in the the afternoon and a big meal in the afternoon, and then, you know, get up and walk and relax and then go to sleep relatively early. And I think that gives the alcohol some time to metabolize out of the system might be, there might be something to it. Yeah, I love it makes a lot of sense. Last question that you'll get to ask me when to finish up is aliens. Are you a believer or a non believer? I'm a believer. And one of my favorite sort of mental problems to wrestle with

is the Fermi paradox about, you know, with the vastness of the universe, why are there not aliens absolutely everywhere? One of my favorite books on this, this was going to be like the other book that I was going to say in your first question is The Three-Body Problem. This is written by, I always screw his name up,

but Sishin Liu, I think, and totally amazing. Kind of, it has a really beautiful explanation for why aliens may not be revealing themselves. And so I just think like, probability wise very unlikely that we're alone and i want to figure out why we haven't seen anyone yet before you ask me the last question uh i gotta ask and i don't know why i didn't think about this earlier uh any idea if eon leaves there's aliens or like what's spacex's like internal like general view on this yeah um so generally i think people look at the statistical

probability and and think yeah we're very likely not alone in the universe but given the fact that we have as far as we can tell a very hard limit on the fast like how fast we can travel which is the speed of light and the size of the universe doesn't actually matter because there's only so far that we could ever make it in you know a million lifetimes and so at a certain point it's like well the universe is actually not as big as it really is because we just could never interact with anything that far away um so i think that kind of cuts into it it's like well maybe maybe aliens are just on the opposite side of the universe and we'll never come across them and so elon's perspective is we don't know that there are aliens all we know is that we are the only

conscious life forms and consciousness has to be preserved and so that's kind of the underlying philosophy of wanting to get to mars is to preserve like as far as we know until we come across intelligent beings besides ourselves we kind of have a responsibility not to extinguish our own existence. So it's a pretty compelling mission there for sure. What question you got for me to, uh, to finish up is when I've been grappling a lot with, um, I'm looking forward to hearing your thoughts. Um, I gotta ask, has social media been good or bad for society on balance? Oh, I think huge, huge net positive, uh, overall. Um, I, you know, look, I'm biased. I worked at Facebook for, uh, for two years. Um, and I think that until I worked there,

I didn't really understand kind of the net positive aspect of it. I just thought I was like agnostic. I didn't really have an opinion. Um, but when you start to understand the benefits of everything from like a high level, just, Hey, you connect billions of people together and now they can, uh, communicate, you know, uh, do commerce, uh, coordinate, you know, all that kind of stuff. Uh, there's a lot of benefit to that. Uh, two is you start to understand, um, the human element of it like you know hey you and i we were in first grade together i moved to a different country and then i find you 30 years later and like we reconnect um there's some of that type of just objectively positive impact on the world that happens um and then the last thing

is uh there's this argument that like the platforms and i'll actually even throw in like the messaging applications and social media applications like they're one of the last stands against uh kind of overreaching governments like if the people can't communicate uh via encrypted you know manner or can't create a facebook group or go to an event or whatever like that's probably not a good thing um but with all of that said like there's definitely downsides to it right and i kind of just think uh the folks who make the argument like social media isn't good or bad the impact can be good or bad but really the impact is merely like a mirror of who we are as a society so like you know if we're all getting worked up about something like it's worse on

social media right if we're all really happy about something it's worse on social media um and so i think that it's more of like an amplification type thing and so if you think of it through that perspective then the question becomes like are we good people or bad people right like and like you know frankly yeah like frankly you know there's an argument depending on what group uh what geographic location at what time like for good or bad you know people right and kind of like good or bad actions so i think it's obviously super complex um and there's frankly no right answer but the positive impact i saw i think drastically outweighs the negative impact but anyone who's making like a perfectly blind argument and just like oh everything is great

on the internet and like the internet's amazing and so is social media and all the stuff and there's no negative impact like i think like you can pretty much now assume that like that argument doesn't you know really kind of stand the stand the test of time yeah i mean we're figuring it out still it's the early stages it's it's interesting to be to have seen like the whole chronology you know it's gonna be amazing to see what happens 20 years from now i uh i continue to joke that uh you know the saying the revolution will be uh televised right it's like the revolution will be tweeted right to some degree like like no doubt absolutely history you know historians will go back and they'll just look at facebook posts and then tweets and stuff like that too

so listen man i really really appreciate you taking the time to do this josh uh where can we send people to find you on the internet uh or find more about levels yeah so i'm on twitter at joshuasforest with two r's and i'm on instagram at josh.f.clementi um and then levels i highly recommend everyone check out the website levelshealth.com and the blog in particular which breaks down a lot of this sort of abstract you know metabolic stuff into understandable approachable terminology that you can kind of bring home every day and uh we're on instagram and Twitter at levels. I found the blog to be amazingly helpful.

So I definitely suggest other people go check it out as well. And hopefully we'll send some people over to you guys and also find you on Twitter. So thanks so much for doing this, man. I want to do it again in the future. Absolutely. Thanks for having me on, Pom.