Levels is the first biowearable system to provide real-time feedback on how your diet impacts your health. The same way that fitness trackers are worn to quantify physical activity and exercise, Levels measures the impact of your diet and lifestyle on metabolic health by pairing continuous glucose monitoring (CGM) technology with intelligent software.
The mission of Levels is to reverse the trend of metabolic dysfunction, which underlies most chronic diseases. While metabolic fitness can be improved by consistently making choices that keep glucose levels in a stable and healthy range, more than 84% of people with prediabetes don’t know they have it, according to the CDC. Prediabetes puts you at increased risk of developing type 2 diabetes, heart disease, and stroke. Levels seeks to support long-term metabolic health by helping users close the loop between overall health and daily choices around food, exercise, sleep, and stress management.
Josh Clemente, President and Co-Founder of Levels, took time out of his busy schedule to talk to MuscleTech.com about how he discovered he had very erratic blood sugar levels while working as the Lead Life Support Systems Engineer at SpaceX, why personalized metabolic data is so important, and how he and his co-founders are planning on making Levels more affordable in order to help more people with their health and fitness journeys.
Q: How did you and your co-founders come up with this novel idea?
A: “Well, it started for me several years ago. I was working at SpaceX at the time and I was working on the Astronaut Life Support Program that we were developing there. I was about six years out of school at that time. I’ve always been an athletic person. I was kind of a bodybuilding nut for a while. Then after school I got into CrossFit and I was a CrossFit trainer.
So, I had this perception that maintaining peak health means just maintaining peak physical health. Like if you can be really fit, you’re really healthy. And I was doing that. I was working out, had a good body fat percentage – below 10 percent, and was always able to lift heavy weights, run fast, and jump high. You know, all these metrics of physical fitness. But I’m at this point in my personal career where stress is amplifying. I’m leading a team with a really significant objective. I’m sleeping poorly, I’m eating whatever I can, and I’m cramming in aggressive workouts. And I hit this point where I came to the realization that I don’t feel healthy. Something about my health is off. I actually went to my doctor and said, ‘I think I have a terminal illness. Can you help me track this down? Because I have these waves of just like zero energy. I just crash. And my mood is terrible, my disposition has changed, I get shaky and fatigued, and I have all of these strange symptoms. I don’t know what’s going on.’
Ultimately, through my work, I discovered some papers by Dom D’Agostino who is a ketogenic researcher. I read about the physiological effects of the ketogenic diet, which although I’m not a ketogenic dieter now, I was blown away by. They kind of flipped my internal perception of health over, and described all of the ways in which specific macronutrients in our diet have different physiological effects. They affect different hormones. They make systems function differently. An example is that ketones can be used by the brain and can prevent central nervous system toxicity in high oxygen environments. They’ve been used to treat epileptics. All of this fascinating stuff.
So, I started to measure my own blood sugar just by pricking my finger to try and get a data stream and see what’s going on. After trying a few times through my doctor, I was also able to get a continuous glucose monitor, which is a device developed for the management of diabetes. I discovered that I had very erratic blood sugar – like it was a prediabetic degree of dysfunction. So, that was the moment that everything kind of changed for me and I realized I had this silent thing that I just stumbled upon. And when I looked into the statistics it was massive. And there was a potential to take this kind of clunky medical device that gave you a raw data stream and turn it into something really elegant and insightful for kind of a mainstreamification of metabolic awareness and ultimately metabolic fitness.”
Q: How are you and your team planning on spreading your message when more than 84% of people with prediabetes don’t even know they have it?
A: “Well, it’s a good question. That is the underlying reason why we’re taking the approach we’re taking. So, rather than targeting people with prediabetes, which, as you know, would not make much sense because out of the 84 million here in the United States, 90% don’t know they have it, and I was one of those people. So, rather than take that approach, we instead considered the fact that every human being has a metabolism. Every human being lies on the spectrum of metabolic health. And we’re all sort of just flying blind really.
Some percentage of us are making enough bad decisions that we’re heading in a very dangerous direction – closer and closer to prediabetes, or ultimately to diabetes. So, rather than segregate, and split up the spectrum into some group to look at, it’s like, ‘Why don’t we just produce the product that everyone wants to use?’ If it’s something that’s cool and insightful, and educates you on how your body functions, then we can maybe get mainstream adoption. And by doing so, those people with prediabetes who don’t know it will actually use the product just on a whim because it’s interesting, and then they may discover it. Then they may be able to change that outcome.
I don’t want to say that this is something that can prevent diabetes, or prevent prediabetes, but the point is that better information about what’s happening in your body is key to making any change at all. And so it has got to be a mainstream product. We have to sort of destigmatize it, make it enjoyable, insightful, and exciting to use. So, that’s kind of the approach we’re taking with Levels.”
Q: Wanting to help users close the loop between overall health and daily choices around food, exercise, sleep, and stress management to support long-term metabolic health, you and your team were able to develop software capable of interpreting glucose data captured from a sensor. Can you take us through how Levels works and its key design features?
A: “First of all, Levels seeks to answer the question, ‘What should I eat and why?’ That’s a very simple question, but if you ask someone, ‘OK, It’s lunchtime. What are you going to eat and why are you going to eat that?’ Often times you draw a blank, or it’s something like, ‘Well, I like the taste of it,’ ‘My mom always made it for me,’ or ‘I read about it on the Internet.’ Unfortunately, those are not sufficient answers to put something into your body. It’s an emotional thing. I love food personally, and I totally understand it, but we need better information to guide those decisions. And with the degree of technology that we have today we can answer them with specificity, meaning for the individual, rather than for the average person.
So, the way the Levels system works is you have a little patch that you wear on the back of your upper arm. It has a small filament in it, sort of a flexible strand, which is interacting with glucose molecules in the skin. Those glucose molecules are creating an electric signal, which is measured as a concentration of sugar in your blood. That data is then transferred wirelessly to our smartphone app. Using the Levels app, we turn that raw data stream into behavioral insights so you can understand through the Levels system how a specific meal affects your body in almost real time, and then you’ll get a score for it.
We have these composite metrics we’re developing and they will give you an out of 10 score of how good or how bad that meal was for you. Then we have a score called our Day Score, which does what it sounds like. It sums up your entire day and it gives you a grade out of 100 percent for how good that day was. So, you can now start to – in combination with those features and others that allow you to explore different challenges – try different activities, try different sleep, try different foods, and in summary you end up, at the end of a 28 day experience, learning a tremendous amount in real time directly in conversation with your body. And you get reports throughout it. So, it’s that hardware-software feedback loop, which is closing the gap that exists between what we’re doing everyday and how it’s affecting us.”
Q: You’ve said that people shouldn’t need a PhD in nutrition or human physiology to know what to eat for lunch. Why do you think there’s so much confusion out there as to what people should or shouldn’t eat? And how has Levels been able to reach out to and connect with people in order to help them improve their diet and exercise regimen?
A: “I think the first thing is just that studying nutrition is really hard. The gold standard for studying anything is something like a randomly controlled trial where you really control every variable, and you know what’s going to change. But you can’t put people in boxes and force them to eat specific foods for long durations in order to figure out whether they get cancer, right? That’s just not a trial we’re going to do.
So, you’re stuck with very poor quality methods that are mostly based on food surveys. You can imagine someone sits you down and says, ‘What did you eat for the last four years?’ or ‘How many times have you eaten berries in the last four years?’ Well, I’m not going to be able to answer that question well. And then there’s going to be all these confounding factors that ultimately just give you a poor result.
Unfortunately, I think the lack of high quality nutritional research is one of the core causes of this confusion. Researchers are doing what they can, but unfortunately it’s just not rigorous, or at it’s not causal in the sense that we can directly connect the dots between certain actions and outcomes. That’s why in a span of two weeks you might see two headlines: Eggs are causing cancer. Eggs are great they’re going to make you live ten times longer. I don’t know how you can explain that other than the fact that the data isn’t good.
I think we’re in a tough spot with options for research. But what we can do is we can take what has been demonstrated, which are the markers of metabolic health and the markers of metabolic unhealth. We can start to measure those in the individual. So, we can sort of trial and error our way to a better solution, which is that if I know what bad blood sugar patterns look like, and I’m measuring my own blood sugar, I can see those things that I’m doing that are causing unhealthy patterns. Then I can try different ones. Ultimately, I can iterate towards a personal approach to nutrition, exercise, sleep, and stress that lend themselves to metabolic health. You do that times enough people and you’ve kind of solved the problem without needing to solve it, right? Each person solved it for themselves, and society did it together by all focusing on themselves. So, that’s kind of the approach.”
Q: Why is personalized metabolic data so important?
A: “Well, there are a few reasons. First and foremost, right now we’re in a very bad place. 88 percent of American adults have at least one sign of metabolic dysfunction and these numbers are not getting better. In fact, younger and younger people are being affected by advanced metabolic disease. For example, nonalcoholic fatty liver disease is one of the fastest growing disorders in children. And part of the cause is unfortunately the quality of nutrition – a lot of high fructose sugary drinks that kids are drinking from a very early age instead of water. But the important thing is that because we are where we are, we need to figure out a solution to get out of this situation, and it has to be data driven and objective.
We can’t take the approach of trying to find a one-size-fits-all solution because people are just different. They have different belief systems. They have different philosophies about what they want to eat. So, by using metabolic data, we can allow for each individual to essentially ground their own philosophies in something objective. So, if you decide to be plant-based, or if you decide to be a ketogenic carnivore, whatever the many iterations in between are, you can take that philosophy and ground it in something objective, and you can tune your decisions to fit with both what you want to do and with what the data says. I certainly eat a more meat-based diet than my co-founder Casey who is 100 percent plant-based, but both of us are tailoring our approaches to lifestyle with real-time glucose information. So, we’re making the healthiest decisions we can in the philosophies we subscribe to. That’s one thing.
The second thing is that the diversity of the human population is massive. There have been some early studies with metabolic health information showing just how massive the differences amongst us are. One trial, which was done in 2015 from the Weizmann Institute of Science in Israel, showed that two people could eat the exact same two foods and have equal and opposite blood sugar responses. So, this is a banana and a cookie made with wheat flour. One person had a big spike from the banana and was flat from the cookie, and the other person had the opposite response. The implication there is that they’re also having opposite hormonal responses. Like the insulin that has to respond to the blood sugar is going to be different, and then the effects on their bodies are going to be opposite. So, there’s all of these variables now that you’re like, ‘Well, how can we ever tell anyone what to eat if we don’t know information about them?’ That’s exactly the point. We have the technology to allow everyone to measure metabolic information. Due to the amount of variability, we need to have that degree of specificity to really tailor a perfect solution.
And then the last thing I’ll say is we can’t work our way out of the crisis we’re in by trying to force it on the medical system. The medical system is there to treat sort of unavoidable disease. There are many conditions that we don’t understand that really need the attention of our medical industry – not to mention accidents and injuries. Preventable chronic lifestyle related illness should not exist. Nobody wants to be sick, no one wants to suffer through decades of poor health. The only reason we are where we are is because people don’t have good information. They’re flying blind, and over a long period of time they end up there. What we have to do is give them the data to empower themselves. It’s not the doctor’s responsibility to keep me healthy. It’s my responsibility to make the right choices to maintain my health. Again, this data stream, or data streams like this are the key to the individual being empowered again to stay healthy.”
Q: Right now, Levels provides a $399 one-month program that’s designed for health seekers to measure how their diet affects the way they feel, and their long-term health. Your fellow co-founder and Levels CEO Sam Corcos wrote an article explaining that the current product is marketed toward a premium audience at the moment, but the goal is to get the price down as quickly as possible. How are you and your team planning on accomplishing that goal in order to get Levels to more people?
A: “The first thing is just good old fashioned supply and demand. You know, the market forces. Right now, the devices and the hardware that we are leveraging, they are medical devices in nature. They’ve been developed for the treatment of metabolic conditions that already exist like diabetes, but we’re kind of bringing them into a new space, and this new space is everyone else, right? They’re already available to the people with diabetes for example, but the rest of the world doesn’t yet have access. So, we’re introducing that access. The benefit there is all of the potential outcomes that I just touched on. But secondarily, it’s that when you have a massive new marketplace open you have a huge increase in demand, and the secondary effect is that supply can then increase, and that should bring prices down. We’ve seen this many times.
Then in addition to that, you have innovation where other entities see this new space happening, and they see potential and realize there’s this massive unmet demand for better information about oneself and you’ll get competition. You’ll get additional innovators coming in and entering the space. By opening up these new markets, and showing manufactures that there’s a ton of potential here, we will be able to facilitate massive price improvements. Ultimately, through a few projects of ours like our research program, which will demonstrate efficacy of what we’re doing and why people should pay attention, we can hopefully get this covered by employee wellness programs, insurers, etcetera, and bring the on average price down below $99 per month.”
Q: As a CrossFit L2 Trainer, what improvements have you seen in your own life since you started using Levels?
A: “The biggest one is a better understanding of how my body functions, and a more targeted approach to living. So, I kind of used to absorb the gym science that was going around. It was very vague, but something along the lines of, ‘Eat all the time, always replenish your glycogen after your workouts, and be carb-loaded before a workout.’ Basically, this concept of just like hyper-fueling, and I just went along with it. I was a religious eater. (Laughing) I would eat like as much of anything I could get my hands on. And before workouts, I’d drink this smoothie I made that was super high in carbohydrates and protein thinking this was going to benefit me in the gym. What I recognized was that with my blood sugar information it was causing absolute destruction of my glucose. I would have a massive spike, like really an unhealthy spike. I’d be driving to the gym, and then I’d step into the gym and be starting my first rep, and my blood sugar would be cratering back from this high because my body was producing insulin to clear that glucose out of the bloodstream.
So, actually the moment that I wanted to be fueled up was the moment when I was crashing and experiencing the symptoms of shakiness and tiredness and yawning – all of this weird fatigue stuff that I didn’t know what to attribute to. This information has allowed me to really take a targeted approach. I now fuel for my training lifestyle. I’ve broadened my training regime outside of just CrossFit to more endurance where I’m basically trying to teach my body metabolic flexibility. I’m teaching my body through fasted long duration runs and cycling how to use my body fat stores for energy, rather than just sugar that I’m consuming. So, I try different things, and I fuel accordingly. I’m no longer commanded by my food. Of course, if I’m going to do an intense CrossFit workout, yeah, I’ll probably have a few extra carbs just before I start the workout, not an hour before, but minutes. That’s kind of a general example, but it really has changed my relationship and understanding of both my body and the lifestyle factors that affect me – sleep and stress being another sort of very large pair.”
Q: Based on your experience with food and nutrition, do you think that supplements can potentially help people reach their health and fitness goals?
A: “I mean, for the most part, I think supplementing should again be targeted to the individual’s goals. For example, I supplement protein. I want to make sure that I’m eating a macronutrient profile that supports muscle building, and muscle maintenance. So, good sources of protein are key. I also take a creatine supplement. I take magnesium supplementation, especially if I’m going to be doing any fasting, which I do much more often these days, and train fasted.
In general, I think people need to understand explicitly what they should be taking and why. I think better lab panels, better lab work, and ultimately a better understanding of what each individual’s trying to accomplish should allow for some tailored supplementation. This certainly could even be tuned to time of year. For example, vitamin D is very closely tied to both our immune system resilience, but also our metabolic system and it tends to drop during these dark winter months. I believe that supplementation has a very important place in metabolic health, but it just should be tailored. People should know what they’re taking and the why.”
Q: What do you think is the key reason for your company’s success so far?
A: “I have to attribute it to just what my underlying thesis has been for a long time, which is that: People don’t want to be unhealthy.
When you expose a blind spot for people, it’s disconcerting. And so Levels is doing that. We’re sort of shining a light on this area that no one has really paid much attention to until now. There’s this massive sort of epidemic of metabolic dysfunction that’s happening. It’s affecting many people – 120 million people in the U.S. are currently affected by prediabetes or diabetes, and it’s entirely preventable, except for type 1 diabetes, which is a very different condition. But the reality is that once there’s an opportunity to improve confidence, and to generate a personalized lifestyle that is fostering health, people want that. I have to say that I believe that is the number one cause. It’s not advertising, or flywheels, or network effects, although all of those things are helpful, it’s ultimately – Does anyone want this? We’ve experienced really strong organic growth because I just believe that fundamentally people do want to be healthy, not just for themselves, but for the people they love.”
Q: How do you and your co-founders at Levels choose the companies that you partner with?
A: “We look for partners that are intellectually aligned. So, coming down to things like right to data. So, individual right to data privacy and ownership I think is key. And then the belief that there is ground to be covered in the world of health and wellness, and I think organizations that are fostering that through straightforward business practices and exceptional products that are doing their part to create a healthier world.”
Q: What do people need to do if they want to get started with Levels today?
A: “We’re still in sort of development mode, which is invitation only. We have kind of a limited amount of supply right now, and we’re rapidly moving toward launch. So, I recommend anyone who’s interested to go to the website www.levelshealth.com and submit your information on our waitlist. We’ll be in touch through our newsletter and we’ll be rolling out details on how to get access either to the early access beta program, or ultimately when we start to launch the details will come out there.”