Special: "Why Now" for Digital Health (with Levels founder Josh Clemente)
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So I would get brain flakes and eat IT by not only the bull for, but also like dumped in smoothes and stuff. And IT is probably like the single most reactive substance I was putting. He was always way above the diabetes thresh. IT was like, IT was crazy.

Welcome to this special episode of acquired the podcast about great technology companies and the stories and playbooks behind them. I'm been gilbert and i'm the cofounder and managing director of seattle based pioneered square labs and our venture fund.

psl ventures, David role and I am an Angel investor based in co.

and we are your hosts today. We have a special episode that dives deep on the dynamic digital health ecosystem, especially with the lens on the complete up ending of the landscape happening with companies going direct to the consumer. Today's epo de primarily centers around levels, a new company that's on a mission to make all of us aware of our mettle.

Like health, A K, A, track your blood blue coast with a real time where a sensor known as a continuous glucose monitor, or C, G. M. Man, right now, me too.

We were introduced to the company by two of our L. P. S. And members of the acquired community shout out to Michael mirai and then gRandall one of our favor. Things about the incredible community that has developed in slack and on our lp calls is that we get to learn about some of the most interesting companies in our ecosystem today. We are joined on this episode by the founder of levels, josh Clemente.

Josh has a fascinating background, even before starting levels from his days as an early engineer at spaces where he worked on dragon capsule as the lead life support systems engineer, and then afterwards at another elon company, hyper loop one. If you are wondering how the business models behind these new direct consumer health care companies work, why the time is now for this revolution? Or perhaps you just want to be one step closer to being a cyborg.

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Yeah, so learn how you can put A I agents to work for your people by clicking the link in the shower notes or going to service now dot com slash A I dash agents. Now onto our interview with josh, commented from levels. So josh, welcome to acquired.

Super happy to be here. This is gonna so fun.

Were excited to have you, David, I or both right around the one month mark. David, I think just finish using levels for his first month um i'm about to cross that thresh holds and so many insights, so much fun to learn all this really cool company you're founded.

And I think you guys are baby winning for as in the start up category for market share of acquired community members as employees. Super, super fun to do this with you. That's that's a .

trophy I will hold broadly well.

josh, i'd like to start with your background because before levels, you are doing some crazy interesting stuff. And I want to dive in to unpack some of that a little bit because, you know, we would like to have you as a guest on equality even if you hadn't started levels. So let's start in sort of the space ex and elon chapter of the world working on hyper loop. First of all, can you explain to us what you worked .

on at space ex? yeah. I entered space x as a manufacturing engineer. I was fresh at a school I only really wanted to work for iron when I had graduated, and I did not have I didn't have that job block down. So actually sold used cars at car max were like three months and just like hung on to hope and work my network like crazy to try and get in.

did did call the in how I did. Everyone, including .

recruiters at other elon companies like sa, I actually got an chip tesler first, and then they got D O E. Funding right as I was about to join. And they shut down the design officers going to work out and relocated and basically like, sorry, we don't have a space for you.

So i'll do this again some time. And I was just like, well, how about space x, can you help you? And what's crazy is that I actually, out of pure coincidence, my uncle met ilan. He he ended up being working with tolerantly elan former wife's father and and he like met elan and like, oh my my you know nephew is really interested in your companies. Like, didn't really know who elon was, had no context whatsoever.

I dropped a name and I don't really know, but like at some point that filter down and I ended up getting a phone call back and I think my uncle, like put in beyond just that in person, but put him like an email. Good word as well to trying to get me in there. And anyway, long story.

sure. After three months of selling cars, I I got a call from space acts and they were like, here's an entry level manufacturing engineer job, which is primarily focused on taking the concepts are that have been designed or or like first article has been built and tested and then getting those into production. So figuring out we are a small company when I started, I think I was employed like six seventy eight. And IT was just .

a big empty building, which is ten times smaller than IT is today.

yeah. So when I left IT is probably around fifty five hundred people and it's now yeah easily seven thousand and growing. So IT IT was very much the wild west days. I mean, like you you're taking these components that have been uh they have been designed, tested, but you need to get them into spacecraft form and launched and most of the stuff had never been done to force is all like initial systems. Then as manufacturing engineering, IT is focused, designing process, training up technicians and putting like constructions in place and then also just kind of like building yourself.

And and I spent a huge amount time in that first stage in the factory like on the factory Floras kind of like a glorified technician and ended up uh learning a lot from the existing technicians and just like the hands on processes of building airspace components ah and I spent a ton of time down to keep and overall just getting launched articles. So like once the vehicle was prepared for flight, IT was then integrating all the final systems, putting IT through wet dress and static fire and then watching you go to space. So is just pretty wildly educational.

And from there I moved into what's called a responsible engineering position your responsible into and there is no other individual to point to and say we didn't succeed. It's your fault. No it's the box stops your type role.

Um and so I worked there a few structural systems and finally that halfway through my career space acts we started to we had succeeded at getting the cargo vehicle through its cuts program and we were starting on the human rated programme at basic. And so this required a life support system to be developed and space exact, obviously no human rated experience. And I was one of the first four employees who had the opportunity to work in that department.

And E, I, I look at that project as for sure, the pinacle of my experience in space. I mean, the team was just unbelievable. Some of the best people i've ever met and how the opportunity to work with. And I got to lead the pressurised life support systems team. So this is developing the oxyde breathing system. So the Price rise tanks ago in the vehicle that they Carry high pressure oxygen distributed, uh regulated down to lower pressures into the cabin, into the space suits, sensing oxy concentrations, keeping the cabin at like environmental safe pressures and compositions, the fire suppression system, the docking adapting system, that that pressure is kind of the space between international the international space station in the dragon and after after talking kind of all of these new matic precise ation mechanisms and um so able to lead that small team amazing team throw to completion of the critical designer we phase what's great that as .

we know now you know dragon cargo and dragon crew have both successfully gone up so must be crazy cool to see you know your work in action there yeah I mean it's pretty .

surreal to be onest that they thought like an impossible amount of time away always and then whole said its its happened and IT worked and it's just such a huge the stress is still high. There's going to be another flight with four more astronauts later this year. So the stress is still high every time because each system is unique. But as spaces develops more experience with visibility and refile IT just kind of IT allows kind of a more confidence and breathing room, I feel like OK.

So josh, before diving into the next chapter of your career and and uh founding levels, we gotta ask like is there a fun elon story that uh that you've got or something crazy that um I mean everything that happens when you're working at face, i'm sure, is crazy. But anything you want to share?

I think one moment that always just reminds me of the kind of the unique culture of space acts was really the first major launch. So I I got two space acts just after they flew the falcon nine one point o rocket for the first time. So basically basex failed three times to get the fault in one rocket into orbit.

The fourth time IT was successful. Then on the first trial, they got the larger falcon nine rocket in the orbit. So I got there just after that, that success. So the second falcon nine rocket was getting ready to launch, and know at this time the duration between launches was on the order of years. And so everyone was working full time, basically hand building a vehicle.

So we had this machine this entire like integrated first and second stage on the launch pad and there was an air conditioning vent that basically condition the interest stage. It's basically the the hole space between the first stage and second stage and the second stage. It's on top of IT has this very long.

Vacuum nosal. So it's designed to give Better efficiency to the rocket engine in the vacuum space. It's very long and it's very, very thin.

It's thin enough that you can hear IT with your fingers and it's metallic. IT was metallic at the time, but it's very well support. It's the skirt it's called is is supported by these rings.

And so this air conditioning unit was blowing a high volume of air into the interview to keep IT urging. And we noticed turning inspections that the skirt had actually been flustering in the high pressure sort of air source and IT had actually torn. And this was a really big problem, of course, uh for a number of reasons, just debris and um also efficiency laws in the engine.

The typical approach in old airspace would be break everything down d and agreed, push the schedule out, analyze everything, determine why this failure happened, press release, redesign the space. Ex approach was elon calls up one of the lead technicians of the entire company. His name is Kelly, and he used to basically work on on airplanes and was a airplay mechanic.

But the guy was just an absolute machine, and and brilliant, and elon convinced him to get on an airplane to cape canaveral with a pair of shears, go up in an extremely tall genie boom. The sky is terrified to fight, by the way, crawled through a hole in the interstates, which is about the a big into an integrated act rocket, right? So you're a hundred per speed off the ground. There's a second stage above you and use the .

bombs below you and bombs above you.

Yeah, IT wasn't fuelled up at the time, but certainly was. IT was intimidating, i'm sure to say, to this. And then he trimmed the lower edge of the skirt off, removing the tair in the the ozone.

And now we did a little bit of a propulsion analysis to ensure that the second stage would have what I took to get to orbit, even with the loss of efficiency of the smaller skirt. But you know, basically Kelly hand trim to this thing in the inter stage, walking around on the dome of the the first age and climbed out, and we launched and we successful. Ly got to orbit.

And the whole process was like, I mean, the whole company ground to a hot. When this happened, he was a huge scary situation, and Kelly pulled IT off. First part of funny thing was that, as an airplane mechanic, Kelly was like this a little bit scary actually, but he was terrified to fly, like he just, he hated airplanes.

I think he seemed too much. And that was the biggest problem, was like convincing to go up on the rocket was actually not the hard party, was convincing to get on an airplane, to go to keep. But but I think IT just speaks to the scrappiness of everything back then. I was really wild west.

Yeah, i'm sure you've thought about this a lot, but why does that work? Like SpaceX has worked and it's been because of a thousand or ten thousand of decisions like these was the industry is too conservative before or there was something different about space acs that makes IT possible for them where IT wasn't possible for people before before definitely.

I mean, I think that this kind of goes to psychology generally, but people are are just like this scarcity syndrome that if you have something you fear losing IT, and if you don't yet have something, there's nothing to lose. And and so space was in we have nothing to lose mentality for the entirety of its kind of early days.

And so it's basically like we're either gonna run out of money and knock at this contract and cease to exist or we're going to slick this thing off with scenes and try and and that's kind of like the the approach was we were always one launch away, one launch failure away from from losing the company now until probably twenty fourteen, once falconi went point one flu, we ve got a ton of orders on the books, and things started to smooth out a little bit. But up until then, IT was, you know, elan. Every single opportunity he got was telling people, lucky you personally have to succeed, and if you don't, two thousand people who lose their jobs, including you.

And I mean, he he would not mess words. And I think that old aro space had kind of been resting on its lawyers, in a sense. But also, combined with the failures of the shuttle program, was IT in the political nature of the, you know, the entire program was worried about losing what they had.

They know any failure was career ending for a politician, and any failure was potentially career ending for the engineer. And so the failure is not an option in old space, and IT was always an option for space action that proliferate the culture all the way through to live streaming explosions of starship. You know no other program does that because it's like any other DIY laundry yeah.

at such a good point. Well, we can talk about this forever, but I I got to hear about how levels came to be. So i'm wearing a continuous glue coast monitor on my ARM IT has a patch with your logo over IT like, catch me up from you were a space's engineer to you decided to have David and icing across the the internet from you wearing this, how did I come to be .

IT kind of started at basics and partially in a good way, partially in a bad way. But I I kind of hit a total burnout wall in the late part of the life support program was working on. And you know, in retrospect CT, I was burning the candle in multiple directions at once.

And I certainly was just working with not managing stress, sleeping very poorly. My average leap was like party four to five hours. And my approach to like, maintaining wellness was working out as hard as possible as across IT. Now I was a trainer, but I didn't really train people.

I was just I was trained myself, and I got to imagine this was pretty common. Space sex order least doesn't like you much to this day.

Yeah, there's definitely one of the know. It's a classic, I think, starts a environment where everyone wants to be the hardest worker. And you give a bunch of people who are who don't like to fail an impossible deadline, and there's just going to like the failure going to be them there.

There's just going to like physically burn out trying to succeed. And that's what I was like, a space action. I think it's still is to some extent. But yeah, I was just, you know, kind of doing I had been doing this for my entire career at best. But I think there's a compounding return and we can touch on this, you know, as IT relates to all kalf in a little bit.

But I had gotten to the point where I I woke up one day and was just like, I think I have a terminal illness, like I have zero energy, my mood is always low. I am i'm not the optimistic, like sort of happy person I think I am anymore and I don't know what changed, but I just constantly feel feel able and I am struggling to make IT through the day in terms of not just like professional performance, personal performance, like just keeping my savings from from hating me in my significant, from walking away there was that degree like something is wrong here. And and I was getting these belts of fatigue that were truly systematic, like I would be the eleven thirty in the morning, and I would feel this like shakiness and cold sweat and kind of an a whole body tingle, ling or itchiness type sensation.

And I would just need to like, sit down. And so I was like going, I about to pass out. I had never passed out.

I didn't lose conscious of anything. But IT was stuff. IT was a very real sensation. And so I am describing this to my doctor. And we ran a bunch of blood panels, kind of the standard stuff, and nothing came up.

And so anyway, I this was kind of going on to the background, and I was also working on the life support m and part of the, you know, we were designing a super high pressure action system to deliver breathing gas to you, to the crew, and you know, something that divers and astronauts could potentially face in a failure scenario is a high pressure, uh high oxon concentration environment. And what actually happens there is because action is such a reactive molecule, you can um generate a huge amount of uh action toxic in the brain called central level system. And this can cause neurological shutdown.

You can cause serious is potentially even death. So this is why divers are limited. They can't really just breathe pereo xian underwater for forever. They only have a short period time. So you i'm kind of thinking about failure scenario is like, how do we avoided know anything like this are happening, obviously, but also what what does happen and I read a paper just randomly just in my in my kind of IDE research, uh, from dominick Augustina, who's a key to genc researcher at university of florida. And this paper described a series of studies he did on rodents where they fed road in a key digital diet, actually gave them exogamous key tones um as well as speaking just a high fat diet.

which for the uninitiated is basically almost the zero carbs, zero sugar, the only mac neutrons reading our facts and proteins .

exactly so in in a certain macan neutral ratio, which is very high fat, your body will generate these macro cran bodies called key tones, which are essentially a water salable fat molecule. And that's crucial because water soluble means that you can cross the blood brain barrier and provide energy for the brain. So typically the brain is fuelled by sugar glucose ly um and traditional fda sis can't cross that area, so key talent can.

So they are A A brain energy source and they know in this study he gave these roads a key generic diet and then submitted them to a high ocean, high pressure environment. And the result was that these rats could live up to five times longer without seizure, just because of the key to generic state they were in. And that completely blew my mind, because up until this point, I was a calorie is a calorie, absolutely, and didn't matter what you ain't. If you worked out hard enough, IT was all just energy in the end.

right? It's all three of dynamics. You know that you're in a close system. So why should uh, you know like you should be able to burn .

in off right just equation and so although this wasn't in humans, I obviously extrapolating to humans and thinking, wait a minute so the matter neutral selection here is giving these rodents superpowers. We they can live five times longer in a deadly environment.

Um what is going on here? How is this possible? And that was like the first moment where I started to think, what superpowers can be unlocked with dietary selection? And what am I doing to select for diet? Is there any objective data that i'm using? To guide my choices.

And I was very unhappy by my findings, which was like, I like, I have the only reason I eat things is because takes good or because somebody else told me I should eat them. Like there's no data. So I started to just self experiment, and this is like, as i'm approaching the end of of my time at space acts, i'm still getting this like extremely weird kind of stress and used, or I don't know there were symptomatic and trying to figure what's going on.

And then I come across this paper and I like, maybe there's more to IT than just the G. M. I worked out really hard. I've got a decent amount of muscle and run fast, but I don't feel healthy. So you know, clearly, there's there's a difference between the way you look and how healthy you are or perceive yourself to be.

Um and so that's when I started self experimenting and you know my goal is understand know where my energy is coming from and how to to optimize IT. And so the primary energy molecule in the modern human is glue cos it's, you know it's the the sugar by product of carbo hydrates breakdown. And I started, I got a finger prick, luca ter, it's called this little devices. Put your finger bleed on a strip and you can get a single data.

You're in the the equivalent of elan on the plane back from russia building .

the excel yeah hey, guys.

I think we can think we can put put something in orbit for a lot less money or .

till be even more obnoxious about the metaphor like it's as if fip IT hadn't been invented yet. And you're just like, how are you walking right now once today.

right? Yeah IT IT was like, what is glucose? That was step one.

And then, okay, how do I gather this information into a like an insight? Basically, i'm having these energy issues and the energy is coming from these micro nutrients are not in k generic state, which means my energy, they're coming from glucose or coming from fat. Those are the two sources that IT can be coming from.

And I can measure glucose by buying this little device at cvs and breaking my finger. So i'm going to try to learn something here. Started working my finger, got very obsessed with IT, started doing IT like sixty times a day at at one crazy point.

And then I was plotting the numbers in excel to to like kind of emulate a continuous da source. The problem was at this one I had started keeping more um as I was keeping down my my space acts working and moving into hyper d loop. You can touch on the minute but so slept more.

I am in meetings. I'm doing work you know i'm working out during those time periods. I can't prick my finger, right.

So i've basically got point cloud in the morning, point lid in the evening, nothing in between. And it's not making any sense, just like it's stuff, but it's not helpful. And then I read a books called wired to eat, which talks about continuous glue hos monitoring. And I was completely unsophisticated .

about biosensors. Yeah, would they on the market yet? Or was the still before .

the library in the index? So c continue has have been available in kind of trickling from the research like lab environment threat of just therapy research studies. The first one kind of came out actually was at an early dex coma.

Medtronic came out in in the kind of two thousand, six to two thousand and ten time frame. So y've been out for some time. But there hasn't been a mass market move until right around this time to twenty seventeen, the freestyle library from abbott hit the market.

And so this is, this is twenty seventeen. I was like just coming out and the Price point was good. And there had been dex com, E, G five and g four prior to that. But they were like, you know, a thousand plus dollars a month minimum and very hard to get yeah.

And that come is its own. IT was a startup. P started to build a continuous glucose monitoring device for diabetic deputy, actually.

So at this time, really even now, all continuous glucose monitors have been developed for the sole purpose of measuring blood sugar so that you can manage diabetes decks com. They only do one thing they develop continues lucus monitoring sensors for type one diabetes.

They are starting to move in the type to um the difference beam type one and type two is that type ones in ottawa condition primarily where the pancras stops producing in an instant is the that is IT acts like a key to open the lock in yours cells and let lucus in. So incident are signalling hormone and when the panko is stops producing at blood, c levels start to go very high. And IT can be in when blue coast gets very high.

Similar to that ocean scenario, it's a react of molecule. You start getting tissue destruction. So type two diabetes is considered more of a chronic lifestyle ness. So this is where over time, you break down the inside and glucose feedback loop and either your body can't produce enough insulin to keep up with demand or you're just kind of outpacing the production of insurance and you create was called insuing resistance by and amplifying demand to the point where your selves stop responding to IT.

And when you say breaking the feedback loop, this is like I have actively made lifestyle choices in what i'm eating, where like the natural feedback loop in my body of, hey, I shall be producing this much insulin based on what this, you know, what the came in were like that just gets a lot of work and you can no longer rely on the natural system of functional anymore. Yeah.

IT seems to be actually potentially an adaptive response where your body's kind of design, we've been historically in a certain range of blood sugar values, and that's where you want to stay. And if we're constantly gaming more glucose into the system than IT was kind of design for the you require more inland than than your design for so the devices have been developed for this condition for d for diabetes specifically, which is very acute.

Type one is very acute. Type too is kind of a longer sort of time frame where it's a spector. It's a Better exactly.

I can get extremely acute totally.

I think they're both acute, Frankly. But type one is, is a situation where if you if you don't use ensuin exogenous ously injected, the damage is happening much faster and the effects are very immediate. Type to tends to be semi control in the sense that glucose levels won't go as high because there is still some instant feedback.

So this is where the devices have been primarily focused. And so twenty seventeen, I read about this and I was like, a man, I need one of those. Like, i'm trying to emulate this with finger pricking.

My fingers are black and blue, and I still haven't discovered anything. So I went to my doctor and I was like, hey, you know, check out my spreads. Gy, you pricking my ton.

I'd love to get A C. G. M. He was like to, you are one of the healthier people. I see if if you saw the people who need that device, you kind of be ashamed to ask for like, that's that's for people who have you a disorder here like.

yeah, i'm trying to not get a disorder here so that was.

I was like, kind of surprised by that response. I thought, well, he, firstly, I mean, you look at systems generally, like you measure what you don't want to fail, like you don't just measure the thing that is broken because that's obviously useless at that point. So in systems and during especially complex systems, you get as much data as you can and you observe failure modes as they develop and find ways to counter them.

And so having already dive into the research on the know kind of the meta c health crisis that I had had not known about at the time, we had not not known about prior, but I was aware at the time, I was like, well, this is just you. It's just me trying to learn more about myself. And I understand if there's something going on with my bettles system. And yet my physician was just totally opposed and and was not willing to to get me access to A G. M.

Well, this is, and this is what we what the things that we really wanted to explore on this episode with is like this disconnect. IT feels looking at this industry, like this huge disconnect developed between uses in a theraputics SE as like medical interventions for your your doctor is totally right. Like there were, there are people there who need this way more than you do.

But that's so zero. Some thinking right? Like, you know, just because giving you access to A C G M isn't gonna prevent somebody else from getting that too. So how how did the light start going off about? Like, well, hey, maybe maybe this can be a consumer device to.

well, I eventually, after trying for several months, I was able to get A C G M. But I was through a friend of mine who brought them back from elsewhere where they're over the counter. So he he actually went to australia and three minutes backup where I was like a good counter, and I was still just interested.

I was like, I wonder what's going on and breaking my finger didn't have any insights set, put the C. G. M. On, and was instantly blown away by how bad things were.

My blood sugar was essentially, you know, IT IT looked much more like a heart rate trace than a then a little sugar trace. And huge Spikes, huge crashes, everything I was doing, all of the meals I was consuming, we're putting me a above what would be considered the prediabetic c post pandion fresh hold. So where your your luo should be after a meal um in often very often well into the diabetic range.

And so I my body was not managing budgets AR Spikes effectively. IT was able to bring them back. So it's not like I was, you know, diabetic can have lost control, but IT seemed to be like blood sugar would go very high, body would release a ton of insula overcompensate.

I'd have these precipitates crashes. And I was able to just immediately correct those crashes with the sensations I I have been having, where the shinest, the hunger, the ira ability was all perfectly sing. And just by tuning, you know, within two weeks I had tuned my approach that just like trial and err on on the meals I was eating, and was able to bring those huge Spikes down to a minimum.

And you know, at the time, I still wasn't sophs ted on what the ideal levels would be in. Actually, much of this remains to be discovered, but I was able identify that things I was eating, that I thought we're healthy, uh, large savings of sweet t potatoes, Brown rice, uh, kingham. I was having huge, again, in the diabetic c range, responses to which was highly counterintuitive.

I I thought, you know, I am a person who is like. I eat the polio cross fit style you know it's like even though I love sugar, I love Candy and I love dessert like that's not what i'm meeting for dinner anymore. I wasn't college but um so just this realization that things we're going haywire and IT IT was the things that I thought I was doing well, that we're causing these huge you know inconsistencies.

I mean a josh, i'll tell you that in my first week of using levels I was like doing the thing that I think the the set up guide recommends, which is eat your Normal diet, don't try and eat healthy, know. The goal of this is to see like what your Normal stuff does. And I had recently worked in like no sugar, just like steel cut of meal into my diet.

And I think IT wasn't actually steel cut, was like the quicker hole out, but I was advertised as whole. And like, IT was wild. How much that Spike my blood sugar afterwards?

I like, I just like a holy bad through .

a ton of gushers in my mouth or something. And I was staring at I like, okay, I guess that's not as good for me as I thought I was.

absolutely. And I mean open as a prime example. So google healthiest breakfast and it's like top three no matter what is what meal. And you know it's considered hard, healthy. Well, last time I check IT has been a few months, but one of the worst foods in the data that was open al.

So like something like seventy plus percent of people they are eating open al, while using levels had you know exceeded that, that prediabetes threshold was were well into the significant budgetary speke territory from a food that describe as hard, healthy. And the reason that that's interesting is that glucose variability, the number and peak sort of amp tude of blood sugar Spikes is closely correlated with cardiovascular disease. So because that's an inflationary event, the number of these that are happening throughout the day, which is obviously higher for people with diabetes, is is connected with negative heart out outcomes. And so IT IT draws into question how these how .

hard healthy at how's that .

ended up on the oat meal canister? And we're seeing a lot of these examples. But at the time, you know just a realization, you know, i'm using this device, which basically just spits out raw data, gives you like you're at eighty eight right now and at least gives you an a trend error, but it's not telling you anything about what is creating this situation that you're in.

IT doesn't tell you how nutrition, exercise, sleep, stress are related. And I started to into IT these things through use. And IT quickly became the most powerful accountability and education tool about how my body works that i'd ever used in my life. And that's that's really the realization was just this thing was hard to get and it's completely transformed my approach to live on a person who cares about health but never knew the effects. Of course, as all right, I I had been stressed for a few years, professionally and and personally, sitting through a meeting, stressful meeting, sitting through a stressed meeting with A C G. M on and seeing without calories, my blood sugar exceeds one hundred and forty five million ants for decelea, which is the post pan deal, kind of thresholds for kind of a prediabetic response changed my perspective on stress in one in one fell sweep. I'd never seen anything so serious.

Man i'll tell you that the that was one of the biggest let lessons for me the um doing one of the we house wearing level wearing A C T. M from you guys. Jenny, I were in texas during the crazy power outage. Ee star was not even water and like my blood sugars during that week versus other weeks, I was just all to see the data of like like I knew I was feeling bad, like I was very stressed.

I was very unhealthy higher David or like more .

spiky yeah much more spiky not um big Spike, big crashes uh and like I saw in my mind like yeah I am very unhappy. I feel terrible and like there IT is in the data all right listeners. Our next sponsor is a new friend of the show, huntress. Unrests is one of the fastest growing and most loved cyber security companies today. Its purpose built for small amidi ze businesses and provides enterprise grade security with the technology, services and expertise needed to protect you.

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I want to take us at a little bit of a more sort of flash forward direction here. So folks should know that when you when you are a using level today, IT is an abbot freestyle libre device. So we're still not to the point where you're you're not like making your own C G.

M. At all. But let just talk about the scale, the company a little bit.

Thousands of people that are customers that are wearing these things are using this APP that are entering their food to help understand how to corporate. Oh, this meal, no precipitated this Spike. So obviously is a company, is a commercial enterprise. Now you started to start up. How did you come to the conclusion that, hey, I actually there's a start up to be started here and I can be the consumer brand rather than just assuming, oh, you know what, abbott or whoever is going the makers of the device are gone to be successful in the consumer market.

Ah I mean, my sort of patient zero experience with the technology was the only reason that I I paid attention here was just like this thing has changed my perspective was given me confidence in areas that I didn't previously know anything and its informed me much more than a textbook would have about what's happening behind the scenes nutrition, exercise, sleep and stress all in one device. So this is something that has real potential.

Um but there is a huge accessibility problem like it's not being used for general wellness, it's not being used for education. It's only being used post Frankly, post diagnosis when someone is already sick things. I've already gotten to a bad place.

And the realization that across society we have an epidemic of metabolic down that is largely caused by chronic lifestyle choices. So that is the is the key unlock is that we are breaking our bodies down over decades without feedback on the positive or negative effects of our choices. And this has LED to a situation.

We have ninety million people in united states with prediabetes seventy percent who will convert to type 2 diabetes within their lifetime in eighty four percent of them don't know that they have the situation。 Um it's because we're making these cloned choices without feedback. So this was the tool, in my opinion, and it's it's like it's powerful for a post agnostic to manage a condition, but potentially even more powerful to prevent that next wave.

So that's kind of wear. Things started to congeal. In my mind that this could really bring a lot of solutions into people's lives, but the technology alone, like the device alone, requires way too much.

I had spent hundreds of hours, Frankly, this point pouring over research articles seems like you can't rely on that for people to get context for what's what's coming out of the device. So IT seemed like the huge value proposition was building an insights layer on top of this rodda. So pull IT in.

And you know, ora and and woop and others do this now with heart rate, heart rate variability data. You know, you take A N L D that cost a few pennies and can measure heart rate. And if transform a behavior change tool by adding an insights layer that tells you how what factors have affected your sleep, what a recovery you know, score looks like, and why you should want to to focus you in in this area of your lifestyle order to improve IT.

Or another allegory would be, there is a huge uh, amount of code between the sensor pack that's on the back of my apple watch and the rings that apple is presenting me. You know, hey, make sure you would go on a seven minute .

brisk walk before it's the, it's the difference between that excels bread and a meal score saying, you know, this was a one or nine out of ten helping people just understand OK large scale. I don't need to know the background data on how you what the optimal blood tric arrange is, and what milligrams for this leader are, what a post pantile peak is. I just need to know that that meal is not working as well as the other one.

And so that that was the the insight is that it's really a data science problem. It's ideally, innovation in hardware is going to be able to drive the sensors down to a more commoditize space, but the value proposition is not going to improve if someone doesn't build the insights layer on top of IT to contextualize and create behavior change. So that's where things started. Just kind of came together as like what do I wish this experience i'd been like rather than what I was in a about that.

So you started working on the company in like twenty seventeen and right?

Yeah IT was actually late twenty seventeen, early twenty eighteen. I when I went full football on .

IT for warning and i'm imagining from the outside to think about what what's going on at that time. That was right around the time of the rise of himes and hers and romen. And like there was this new idea out there that like, hey, things that are you do locked behind medical prescriptions, but that really aren't dangerous and could be beneficial to large portions of non therapeutic populations.

There might be a way to get that to the public. And did you guys see that? Like where you thinking the same thing? How did that absolutely come about for you guys?

Yeah I mean, one of the one of the earlier st issues was like, okay, say we build the APP that provides insights, can pull in season an data when nobody has C G. Hams and there is no way to get your hands on them. So no one's going to even google that thing. No one's is going to find that the apple store, we have to get the hardware and the software together into the hands of people who want IT and that was a huge IT was like a man that's that's a big complicated Harry ball of pain to to figure that out because of these were class three regulated medical devices, prescription only. So that's that's where things started was like actually the accessibility of the hardware is the problem to solve first before we can solve the behavior change issue.

And companies like hms and roman and and others, we're demonstrating in a new model where you combine telehealth capability with a low risk products, medical products into a direct consumer experience and IT IT is a traditional practitioner, licensed physician, reviewing information about their patient, developing patient position, relationship and then a male order pharmacy powering the whole thing. But most of that is is kind of hidden in in an experiential sense from the end user. IT feels very much like wondering something online which is really convenient.

You look at romney numbers like, you know, they were in sexual disfunction for men and they've got massive conversion rates that like no sexual therapeutics physician is seeing the number of Young men come to them for viagra at nearly the rate that romance is like they ve because of the privacy in the sort of distance between. And it's just like there's a lot of stigma. And so this like convenience factor in the privacy factor, has probably allowed a lot of people to improve their lives with that otherwise wooden. So I think like that was a very unique business model that they put together. And IT gave us a lot of ideas like, okay, maybe there is a way, despite the the subject of ownership regulations, there is a way that we can design something that would be elegant and as close to a delightful experiences you can get while still maintaining regulatory ethics.

And just to put a fine point on IT, what you're basically saying is, yeah, people are still totally getting prescribed. The doctor is just you know someone that sending them a survey and communicating ating over text and it's happening through a web browser that feels like an online check out. H A little more friction as IT should have but not like you know you don't want to go anywhere. You can do IT from your your .

phone or computer. That's right. yeah. So know, we said about developing a relationship with an independent network of physicians who intellectually are on board with the concept of informational, a biometrics.

So using what would otherwise be used for a management of a condition, but instead for education awareness, starting there and then building the the sort of platform where we can collect the information necessary and deliver IT to the physician who will then engaging in a sync onis cron consultation with that patient. And and so these are all you inside of the tell health regulations that have that have been built in her, yes, definite, similar to the hms hers and romans. But you building IT in such a way that was specific and unique to the C.

G. M. Use case, which, again, this is a device, it's minimally invasive IT has a little film ament that goes beneath the skin, but it's not a drug you know he doesn't have symptoms, side effects, complications, allergy considerations.

You know the risk is quite low, especially given that the user is not managing in acute condition. So there is no situation where someone who who's using levels for an information about their diet is going to inject issue and potentially over impact due to faulty data. That's the situation that type one diabetes and c is is built upon.

Oh, so what if someone says, yeah, I am typhoon diabetic like you say, well, actually you should go see A A doctor about this yeah.

Right now, the software that we are building is you is not approved as a medical device. It's not approved for diabetes management. So right now, no, we although we are working as quickly as we can to get to the point where we could get this approved for, you know, therapy accused as well today, we aren't there.

And it's really important that people who are managing in acute condition have a close relationship with their primary care provider. And all C, G, M data is being interpreted in a larger diabetic's management context. So very much I think um you know it's it's a very different implementation for C G M, and we will get there.

And I think there's tons of lifestyle unlocked to be had for people with diabetes still. And um look forward, get there. But we're not quite ready.

Yeah, yes. And so do I have IT right that the regulations didn't necessarily change to enable this? I was just that several people sort of all of the same time, I know where ology is, one of them in in sort of the uh, doritos gy space, obviously hims her as roman. And that you've talked about IT was sort of a reinterpretation or using technology for to apply to existing regulations, not some new regulation that came about that made IT possible.

Well, there have been some serious changes in the telehealth regulatory space actually since covered so much of this was IT was already plausible, but IT wasn't clear. You many systems were, for example, not allowed to be used to tell a health when covert rolled around, which is obviously a little good. After we had launched, we saw a huge number of, I think, improvements where physicians could be licensed across many states.

Right now, you have to be state by state license, even to practice tell a health, you can also use the platform of choice. So if you want to engage in synch onis consultation with a patient, you can use space time, or you can use google me. You can use whatever, whatever platform is most convenient, rather than having to use these clunky hippa compliant E M R S is what they are called.

Yeah where you like have a built in web client that it's just very old school and nobody has those platforms to get to download and application is set up. So we saw a lot of, I think, advancement and just and sort of span of an overnight awareness of how much these owner's regulations are sort of falling behind the times. But but yeah, prior to that, two thousand twenty twenty companies have been building inside of the those owner's regulations, but primarily leveraging a synchronous capability. So there there is many states to allow physicians to correspond just through written communication as opposed to having to be. And that's the most convenient path for someone who who's not managing in a queue condition is the most convenient path for them to engage in these sorts of in a sort of optional medical product request.

And he feels like from just like a business models time point with this inside that you and and other companies had to around this time, it's sort unlocks really a connection of uh um a marketing h IT hold class market like a marking to a whole holy different customer base. Then medical devices in a therapist sense war before, but that enables me to advertising as part of IT you or things you go pack. You can talk to this whole population and now they have an experience that's not you know it's not a you watched T V add for a dragon, like talk to your doctor about so so it's no do would this be this is something that could be additive to your life, just like an apple lot, just like a fit bit of the and if you want to experience this product, here's an easy, consumer friendly way route to do IT you don't have to go decide, yeah, i'm going to make an appointment. I'm going to be, remember to bring this up IT might be a little embarrassing ying, my doctor might make me feel your like.

yeah I mean, I think this goes to the to the wine now question of digital health, which is historically, there's two ways to approach health. It's like you're either general wellness and making only general statements. You're just saying like eat healthier and work out more or you're going down the route of a medical experience, which is, as we all know, peppered with regulation, very complicated, inconvenient.

There's quite a bit of friction there. And this is how if you look at the space, this is how the companies can filter out. You ve got you know the the live on goes and the omoo s and the the on duos. And these are organizations that once you pass the diagnosis phase, well now you're in the captured audience. And so it's like your insurance reverse, your doctor will prescribe customer experience.

I will say that is amazing with there's A P S L. Ventures company that we ve invested in, uh, alerted, there's so much innovation in this space even if you're not going the direct consumer out. You guys have gone like what alert of is sort of showing is, well, what if you just bring these great like ano mota and the vongo like these great consumer experiences to that sort of existing fund population rather than the new unlock? There are sort of like a dull you two different pouches of innovation going on here.

Totally, no doubt about that. There's I I think most of us just kind of avoided like if it's becomes to inconvenient, we just avoided the medical experience altogether. It's like i'll just kick the can down the road and certain people can't. It's like they have a little legitimate condition. So it's so chAllenging to Carry on your data life and have a health care issue because the system is not designed for convenience.

right? But to your point, once you're in that, like you also should have a great experience.

exactly. IT is part of the opportunity there. But so IT spend like you have superficial kind of population generalities happening in the digital world space for the the general wellness group.

And then once you're post diagnosis, you get more targeted, more consistent information. But the friction level is so high and the action ability of the data is just not the focus. Again, once you get into the captured.

I hate using terminology like this, but this is a very true like once you're in the capture audience, like you have a pair who's going to reivers, you have a doctor who is going to draw from their list of potential. Treatments and they are going to diagnose and and prescribe. And then you, the end user, are just going to go through whatever experience has been built. And it's like your feedback, your customer experience, your you, you, you're Frankly, process of improvement falls behind, I think, where any consumer mass market consumer product would be just because there's so many conflicting incentives in there.

Yeah or emit to the payer for focus in the audience who aren't deep in this space. We're talking about insurance companies and mostly and maybe employers and occasions and and the government to with you medicare medicine, they do. And this is where you know that sort of business model of you're uh, if you're a company, if you're medical device company, if you're a pharmacy al company, if you're something that's been historically Operating in the therapeutic space is a great business, you know this this is why biotech this is why medical device venture has done has been a thing for so many decades. But it's so different than the tech world where it's like you get something, you demonstrate efficacy y you prove that to payers, all those categories over a long period time and then you basically just have a license to print money forever really.

Well, it's classic disruptive innovation versus sustain innovation. If you're working within this existing system, like you can make the patient experience ten times Better, but you're still working with insurance companies and billing codes and existing clinics and again, can be a .

great business. IT takes years to get that set up for a year like yeah, I got the code from a billing code now.

but the levels hims her's approach that the disrupt of innovation, that's the thing where you're saying like like it's exactly, josh, what you're talking about. You bring your spread sheet to your doctor. Frankly, right now i'm even thinking about OK. I have my levels data and I I I want to go like figure out of i'm diabetic, you go talk with a doctor and show me my data I do get this sense that i'll get kind of laugh out of like what is this toy that you're like? This is not a medical experience like come I don't come to me with this .

yeah and again, it's IT comes back to the way that the healthcare system is set up here is all oriented and that wasn't always this way. But i've talked many doctors who believe this is the root. The insurance coding system changed everything.

So once that became a requirement that a physician enter a diagnostic code in order to proceed with treatment, everything change. He went from the new arts of an individual to, if you don't fit this bucket, I can't do anything for you. And this is the reason that no one will.

This, combined with, I think, well intention, but overreach. Data privacy rules have LED to a situation where no one uses their healthcare data to make a decision in their lifetime. Le ever like I can basically make that statement and feel confident about IT because it's just true that people don't they get their blood work done once a year.

Maybe you get a single point that's extrapolated to define your health overall and you don't use that to decide what deep for lunch. You you don't know whether not you're sleeping well. And so you have companies that are there once you're in that diagnostic code sections like art, I get this amount of reivers al IT.

Doesn't matter whether my product is ten times Better, i'm still going to get that same embers seen. So my cost go up, but I certainly don't get higher. The payer is not going to pay me more. So you have a situation where everyone's is forced to conformity and you get one option. And the consumer, no matter how Price and sensitive they are, if they're using an insurance or universal route, they don't have selection choice.

So I think that the future is a situation where you're hybridizing this in your take really high quality information and you're going cash pay only direct consumer and you're providing the framework to meet the regulation requirement. But you're sort of working outside of the three party system. You're saying this is the this is the premium option.

And if if use your experience factors and to your health care journey or your general well ness journey, this is the the option that I you know can deliver that, that experience, that quality of experience and that certainly, I think we are the entire market. We're going to see a move in this direction because that also unlocks traditional market forces. And so now you you can have a situation where economies of scale step in, Prices drop and now you're genuinely competing like IT may start out pricy. But with time, I think we can get to the point where these premium non remembrance options are, are actually Price competitive.

yeah. Okay, great. So let's talk about your business model and levels. And you wait, your guys vision is for how this works. Maybe to start, can you walk us through this from a business model and how how levels works today? And maybe a little bit where you're thinking about is next step down the road and then after that.

for sure. So today, we we're still in development, so we're in what we call our beta mode, which is invitation only. But the process is you get invited into the beta and you fill out kind of a and e commerce like checkout experience.

So you you pay for the program and then you move into a question air process, which is A A consultation for a prescription consultation intake form. And so you fill out some of the medical history required there that is transmitted to an instate physicians. So this physician is part of a network that is wholly independent of levels, and they are license in the same state that you reside in.

They review your consultation form and they determine whether or not an informational cgm is right for you, the individual and this is entirely in the physician's hands. Levels has no control over who gets a prescription, who doesn't get a prescription um and that's required for obviously ethical independence. The physician doesn't have any requirements or quote as anything that like that from levels.

And and so after that process and potentially an exchange information, you know the physician may have extra questions like they asked the patient entirely up to them at once. We get a determination from the physician. We then fulfill if a perception was received.

We fulfilled that order through our male or pharmacy partner. So that whole process feels very famous to the end user. And you end up getting access to A C G M device, prescribe bed and the levels software.

So then you go through a one month experience where you you wear the the C G M system, you go about your life the first week we recommend. You don't really make any changes. You just kind of see where you are, how your body's responding to the choices you're making, the nutrition selections, the exercises are doing, the sleep that that you're currently sustaining eeta.

Um in the middle two weeks we recommend you start expLoring. So try things you maybe don't Normally do, eat different foods, sleep well, walk after meals, all of these different sort of got metal chAllenges, but testing the boundary cases. And then the final week, the goal is to string what you've learn together into a metal abc optimization.

So shoot for like your high scores. And after that one month period, people have developed metal abc awareness. So for the first time, they've closed the loop between the actions they're taking and the reactions of the bodies are experiencing. They have sort of been in communication between body and mind um in a way that previously wasn't possible because we don't we don't have a sensory feedback mechanism for the quality of our nutrition um and and so that metal abc awareness theyve only been practicing opposition for a week with the lessons learned are quickly turned into habits.

Um so you you kind of when you first see that a ten fifteen minute walk after an indulgent meal can completely modify your body's ability to process that sugar, that lesson sticks with you in a way that, hey, you should walk after meals as general advice doesn't. It's specific to you. It's grounded an objective data. And so those are the those are the little magic moments that we're looking to uncover as as often as possible in the one th one month program we've built go.

And so so the one month program is a big up. But what I think is so interesting is like, so the Price to participate the program is three hundred and ninety five dollars, right? three.

So this is what so fast in with this unlocks, like so much like on the one hand for a consumer product that you know a lot of money, on the other hand, there's no other way you're going na get access to this and is the value of learning that you are worth four hundred dollars. Wealth is up to an individual person, but you guys, how many? You have thousands of people that have done IT. Twenty thirty thousand people on a weight list IT. Turns out there's a large population of people out there that are willing to do this.

yes. So thus far we ve had about seven thousand people go through the through the beta program, and we actually have about one hundred and five thousand people on a weak list right now trying to get and this is largely you again, we're in we're in beto mode. We're really putting no effort into marketing.

We're doing a lot of educational effort. So podcasts, our content platform is a prime driver of attention, but the company is is currently designed. We have our product before t our content effort in our research effort.

And you know one of the core issues we're facing is that metabolite as a word, is not common, but nobody is thinking about metabolite, let alone metabolite fitness. Uh, we need to inform the world that this is something you should care about. And to do that, you we can't rely on osmosis from product experience, especially if we're an invitation only mode right now.

So the education effort is to build a world class content platform that helps people understand what that means to be metabolically fit and why that matters. So your, your brain, your body, all all the cells in all of the tissues in you need energy to survive. And the function.

And if your energetic production systems are fAiling, you cannot experience mental health. You cannot experience musical health. So it's truly the situation where medaba fitness underlies physical fitness and underlies mental fitness.

And we talk about the other two, but we don't talk about the foundation. And so the content effort is in enough itself intended to be the leading source of education about yeah why you should care about metabolic. And then our research effort is then um kind of going to pair with our drug consumer product to look deeper into mechanisms, into efficacy, into effectiveness.

And so we'll take the large data sets, the trends from those from our drug consumer group will take the research, finding and looking ahead in in the road map. Combine that information you know about how people who don't yet have medical condition to concern themselves with. Are still improving the markers of long term risk through just simple behavior change in their daily lifestyle. And that, I think, is how we get to the point where eventually the consumer product is covered for insurance often 是 employee programs at set us。 So it's sort of working backwards.

Oh, so you think you can get to a point where players, not consumers, will also be paying for levels?

Yeah, you know I think so the way the way we're going about IT is we're definitely we're starting off with the directors to play very deliberately. And you know a big part of that is that a we're going cash pay. We need need to unlock the traditional market forces.

We need like get out of the situation where the product is forcing a conformity and then that will allow us to open those economies of scale and drive Price down. That's necessary. We can get to the city economic considerations.

But the second thing is like if we can please a discernment audience for a premium product, we can build in the exceptional experience in its table stakes here. Then I think that will ensure that the enterprise offering is well received. If we just design something for B2B, you rember.

So we fall into the same trap that so many other products have. That user experience doesn't matter. What matters is selling an organizational decision maker that this is something they should add they're offering. So by working backwards, not only will we be able to demonstrate with the the data were generating from our paying customers that this is important and that IT is helpful, will also, I think, achieve a quality of experience that we wouldn't get if we work in the other direction. You know going from enterprise product to consumer product.

it's almost like a to be completely beat the elon analogy to death. It's like levels. Current iteration is the model s very expensive. But you know you guys have double digit millions of feet of revenue on your weightless sitting the area. Now you can use that to make the l three to bring the Price down, and then you can use that to launch the robot taxi fleet of get vast ally, explained x.

yeah, I actually think we're even earlier. We're kind of we're in the roads surface. It's expensive. It's hard to get after we don't have huge scale. We know very well that this is the the mode we're in.

But if we can satisfy the roads are crowd, we can then take that success and the the sort of economic foundation that we build through a secure or higher margin business model and start to work work on market. And you know, we need to get to the model two stage. Like model three is even too expensive for most people.

So looking at the environment of or or really the landscape of meta is function IT essentially focuses on lowest society omy groups like it's the people who have the least ability to access the levels program, who needed the most right now. And we're well aware of that, know it's it's a it's going to be a process in order to get to that mass market option where you have a real time data informing your decisions every day. We need many things to change.

You know, it's got to be a hardware innovation. It's got to be a software intelligence. It's got to be regulatory improvement. Tons of different know very complex systems have to adapt for this to happen. But similar to what you've seen, Tessa do, the entire markets adapted. I mean, the whole automotive industry is different now, and that is all sort of building inertia towards the zero pollution future for electric vehicles. And I think that's what levels helps to do is like trigger this new market, trigger innovation, make people aware that real time data, biometric data, health data being used in our daily lives is the key to turning around the sort of frustrating, complex and fAiling medical outcomes were seeing.

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Yeah, fanta is the perfect example of the quote that we talk about all the time here and acquired jeff basis, this idea that the company should only focus on what actually makes your beer taste Better. I E spend your time and resources only on what's actually gona move the needle figure product and your customers and outsource everything else that doesn't. Every company needs compliance and trust with their vendors and customers. IT plays a major role in enabling revenue because customers and partners demand IT, but yet IT add zero flavor to your actual product that IT .

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And thanks to friend of the show, Christina anta CEO all acquired listening ers get a thousand dollars of free credit vantage com slash acquired. So just to play devils advocate here, a little bit like tesla didn't just make really good software that they got ship to a bunch of gm and toyota ars. They read the whole thing from scratch. So sort of a two headed question here like why isn't abbot and the device manufacturers building the insights layer and building the consumer platform? Uh and then too, do you think eventually you also need to become a hardware company to really apply best in class research and push the consumer experience that you want to create?

Yeah I mean, it's a great question like tesla kind of did start off with focusing on taking if the concept was will take A Y propulsion that reasons often where will combine .

them with lows yeah there .

that didn't pan out. And I think for a number of reasons, but we we aren't a Better situation where the hardware is really convenient. It's really good. I mean, i've been wearing A C G M from evident or dux comm for going on three years now continuously. And the biggest issue remains the insightful ness action ability of the data.

So that's where our core competition, our core focus is, is enter as improving the the delta between raw data coming out of a device and behavior change that needs to happen. So for right now, although there is ground to be covered on the hardware, no doubt. And i'm also looking to the future where sensors are not just measuring one ana light, they're measuring multiple and they're doing IT semesters and in combination with, say, superficial matrix like paul and body temperatures s at a you know that is the direction we're moving.

And I think we will evaluate all of the options necessary to make sure that, that future comes true. Um so we're not going to stand by and just like, hey, we're got great software like anyone want to give us great answers to, it'll be a situation we're going to join, develop and or I can create the attention necessary that there is a market here, what innovation has to happen to feed IT. Um and certainly being hardware systems background myself, i'm more than happy to get my hands .

dirty if necessary, I bet. And from a value capture perspective than like as I think through the value chain of you're providing the insights layer in the software, in the consumer experience, you're relying on other people to provide the hardware. This hardware has been in development for a really long time. Like how much of what the consumer ultimately ends up paying do you get to capture verses having to pass along to the device manufacturer.

So um as I touch on our programme includes access and fulfilling of the C G M sensors, and it's kind of an all inclusive product experience right now. We have pretty good margins on the order of a fifty to sixty percent depending on the specific for for the one month program. We are also introducing a substitution model, which of course, has lower margins, driven primarily by Price point, driven primarily by the sensor.

Cost in these devices are still fairly expensive. And a so a subscription model, we don't make any money right now. It's it's kind of a second teer of of product offering to our one month experience in one of the reasons is that in development mode, we want to get maximum through, but we want maximum fresh, fresh perspectives for feedback reasons.

And and so we've been biased towards the one month experiences. slowly. We have been slowly but surely trickling in a subscription offering.

And again, not making really much on on that product, but IT does really downslide for the most intent of our members. So people who are like, I absolutely cannot stop using this. I need to subscribe. They are the ones that find the substitution offering and and get in there. And so for that user group are getting such high value information about who they are, why they are subscribing continually um that that will that will inform mas about what a substitution has to to be to really have staying power and will be starting to shift in that direction sort of simultaneously with, I expect, some improvements and unit economics for the the hardware, which I think we're coming in, in the next twelve, eighteen months.

I I would image to the subscription part of levels will become so important over time for for a lots of reasons, the one just simply from a ongoing value to your customers, but also defensive ability and you know mote for you guys. Um you know if all of my data and all of my insights around that over a long period time are in levels, well, of course i'm going to keep using uh, levels.

But also the is reminding me of our big episode on mon chinese super up. You know one of the most critical factors for me and surviving war on somebody fronts against thousands of other companies in china was uh the the on pink their reviews database. The the data from all of the reviews allows them to drive recommendations and insights of what to order for dinner, where to travel or where to book. So much Better than just a flat system, I imagine, for you guys to the more data, the more ongoing data you have, the Better your insights layer becomes.

Yeah, you guys got ta pride, my fitness pal. Out of order of the huge to have that that sort of like auto completed, auto ometraco filled in data set.

Yeah, right now, we're we're definitely biasing towards low overhead for the user to log. So the goal is actually to connect the outcomes of your choices with the inputs to you.

So you just surfacing a picture reminds people, okay, what did I eat in what portion? What was the composition of that meal? And then giving them a score along with that helps to educate them very quickly with minimal input requirement on whether not that was like positive or negative.

And and so those right now, like requiring metro tracking, requiring calorie counting, becomes ownership and are at hearing drops off quickly. We've done much of experiments with this, but I agree, like the future is to get more information from those who are willing to volunteer IT in, in terms like the sort of switching cost concept here, I think this is where our competitive advantage really lies. You again, we're we're focusing entirely on the data science and on the action ability, the sort of behavior change platform.

So the metrics that we're producing, which are a composites of a number of clinical, while clinically relevant, data points about a blood sugar curve. You know how your body responds to a meal, how quickly, how high IT goes, how long you stay elevated. All of this stuff is package into a composite that is is actually quite sophus gated and getting Better all the time.

And so that's where you know the metrics. They they they turn raw data into behavior change opportunity and the majority, the value is there. So I I do believe that as we continue to dive into the research, develop the largest data of its kind we currently do have, by coming up on the order, manage to the largest data that ever in non diabetic glucose, especially when paired with with lifestyle information.

And we're just we're still an invite only data mode like the opportunity when we do go to market is going to be tremendous. And IT will continue to allow us like you said, you know, as the data set in large are fino, typing will improve. So we will be able to identify year like this group. And these are the recommendations and insights that we can sharpen to make IT more individual, more unique and and ultimately improve the the outcomes for each person.

That's great giving is so a incredibly impressive speaks to you guys have to building a company in a short matter time, this incredibly complex space, getting to market, dealing with the regulatory issues, prescriptions, getting seven thousand people through the program. But IT speaks even more than just like the industry and how far behind I mean, c gms have been around for over ten years and that you already have the largest data set of nondiabetic, you see him data of a population out there is it's just like that's crazy.

Yeah IT IT is. And one thing that I like to look at is just the historic kind of evocation of the market. We've seen so much data generation in these and I sounds like a drug of drug atr turn but superficial matrix is like this is your your polls count, your step count um so much of our wearable able data is oriented here.

And I think the reason that things are different now and going forward is that we've had a quiet microstructure onic's revolution. We've had like software, eating, eating the world, you know, all this stuff s been happening. Big, big dad analytics are getting Better and Better.

And in the meantime, we also had more individual, individualized um and personal owner ship concepts like bubble up. And so all this is of coming together into A A moment where people want to know more about themselves specifically they don't want to know about averages. There's enough awareness that just looking at twenty three and me, where we thought that a specific gene would tell you enough to like know what what to eat for lunch, that's just not the case.

Like the uniqueness of the individual is so multivariate that you really need real time, continuous feedback to know whether things are improving for you. So we're seeing a moment where I think all the pieces are in place where we can decentralize the solution. So by by building large of data, uh obviously anonymized in order to to run research and and sharp and insights, you can decentralize the actor down to the the minimum viable one, which is the individual so rather than trying to solve nutrition, you know, with legislation or policy, you can instead have each persons solve for themselves multiple that by enough people and you fixed the social scale problem without having to like pass some complex administration of me.

Obviously the food pyramid doesn't work.

right? Yeah, I mean, just look at the way things have been done hyste, orc, ally and all well intention, but the goal is just too brought its to try and solve for the average person. And there is no such thing as the average person. There is the individual.

So before we wrapped up, uh, I at least a one question i'm done to ask your thoughts on. I know you don't have any inside information on on this front. The rumor in this space has been for years that apple is working on bringing this technology, C, G, M.

Technology, to the apple watch. Do you think that's gonna happen anytime soon? If he does, I imagine it's a huge unlock for levels as the inside layer for this.

Yeah, I spent a lot of time diving into the future of the tech and thinking about how do we how do we set up the chess boards so that the innovations happen, that needs happen. So apples dealing with a situation where they can break the skin IT will destroy the image of what an apple product is, Frankly.

And so they have the tough is go at IT, you know, we can work with the hardware exists, which which does go below the skin and IT gives you direct interact. That filament is interacting molecules of lucus in your skin. It's the gold standard for a measurement in real time.

Apple needs to solve what I consider a mechanical miracle, which is non invasive measurement of a colorless, small water soluble molecule in a fluid which is primarily water. And they have to be able to do IT in concentrations and resolution that is useful for people that don't have diabetes. So the fluctuations are smaller, concentrations are tight.

Accuracy is important. I'm hopeful it's called romance pectora scopes is what I think the the technique they are working on is, and it's a light scattering ing technique. It's complicated.

And I i've heard the rumors that you know the next generation of the apple watch will have IT. If they do, i'm going to absolutely be blown away. And i'm going to be excited because if you look historically, I mean, the apple watch is one of the best selling products of all time.

And yes, apple typically delivers the hardware before the soft solution. So IT gives levels, like he said, the opportunity to leverage a prolific non invasive option and build the insights layer on top of IT to help people contextualize. Um and it's something like, you know apples had the hardware necessary to do exceptional sleep tracking for a long time, but they haven't you know they put the harvard out there and other companies fill in the gap for for sleep context. And and so I think we would take we would take the opportunity and very quickly leverage that. So I think we're a good position to benefit from really any innovation in the hard .

workspace today. What does history ally? You know, that is just like every time these events now come with much less frequency.

But back in the day, every time there is an apple keo for a new version, the iphone, with new hardware sensors that just launched an opportunity for so many companies. I mean, apple adds great cameras to the iphone. It's like, well, that enables instagram.

Yeah, apple has the camera APP. But like other companies are going to be the ones that you know apple's not gone to build networks on top of this. Apple is not gonna build you know great dedicated consumer you know software services on top of this. Oh, that would be a massive opportunity.

Yeah I I to agree. No, not to mention the non invasive assessment of a molecule and that concentration, just like IT, opens up the space for future analysis tremendously. So that, that will strictly be a benefit for for what we're trying to achieve, which is to solve the medicine health crisis quires.

We didn't really touch on the the global implications, but estimates are that thirty percent of the global population is prediabetic and seventy percent of those will progressed to type to diabetes in their lifetime. So you were talking about billions of people today who are on a path towards on health and really dramatic degeneration um of their bodies over the next you know ten, twenty years. So something has to change.

It's got to change soon and know it's not a situation where our levels wants to like own every every piece of that process. It's it's really a situation similar to the energy crisis where everyone's got to go all hands on deck on this thing. And and I would welcome apple cracking this one because I think we can always refine the insights they provide a scale to Better you know the the outcomes for specific use cases totally.

Well, judge, this has been awesome. Thank you so much for joining us. And um for listeners, how can they get in touch with you? How can they interact with levels? How can they get on the weight list?

Yeah um first off, thanks so much for diving into the staff with messes a really exciting conversation that gives the wheel spinning to dive into the tRicky questions. I love IT. Anyone that's interested in levels should definitely jump to the website levels south dot com can sign up for the wait list right there and also access the blog, which is is that educational opportunity to discover what metabolite warehouse is why it's relevant and can follow along as we introduced more um I I think insight into how the product is affecting people today and how is helping them understand themselves Better. And then check us out on twitter, instagram at levels and you can follow along you know in real time as people roll out there their personal insight.

cool. What about for um members, the acquired community like like band and miss and others who might want to come work with you guys?

Well, I I would love to be in touch with anyone who is who who hears this conversation and get excited. We do have a career page at levels that link towards life careers. But you know, I also just reach out to us through either through the acquired community to to miss or or benger inal.

I'd love to provide my contact info directly, two guys to distribute to your community. So you know you'll end up with my email address and anyone that's interested reach out directly to myself um or sam. And we love to talk about the the scaling opportunities that we have a lot of lot of chAllenges to be solved.

great. Awesome is awesome. Well, listener is thank you for coming on this health journey with us. Works said to be divided into these new, new study areas on acquired. You hope to do more of IT coming up soon.

Thank you guys, listeners, we will see you next time.

We will see you next time.