Welcome to the Behind the Shield podcast. As
always, my name is James Geering, and this week
it is my absolute honor to welcome back onto
the show former SpaceX engineer and founder of
Levels, Josh Clemente. Now in this second conversation,
we discuss a host of topics from the American
obesity crisis, burnout in healthcare providers,
the ripple effect of the pandemic. how AI is
bringing exciting technology to the world of
healthcare, finding autonomy in your own health
journey through levels, and so much more. Now,
before we get to this incredible conversation,
as I say every week, please just take a moment.
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every single person on planet Earth who needs
to hear them. So with that being said, I welcome
back onto the show... Josh Clemente. Enjoy. Well,
Josh, I want to start by saying... Welcome back
to the Behind the Shield podcast. You are my
guest on episode 381, which I looked up. It looked
like it was towards the end of 2020. So very
different time when we were sitting down last
time, I'm sure. So firstly, I just want to welcome
you back onto the show. Well, thanks a ton, James.
It's really awesome to be back on and looking
forward to the conversation. So as an icebreaker,
and I love revisiting COVID or the pandemic for
the simple reason that no matter what... people's
kind of perspective was at that time. It's pretty,
you know, glaring that at the end of it, everyone
was like, well, I don't want to talk about it
anymore. And I think that's such a tragedy because
there were so many lessons that we needed to
learn from it. So firstly, just through your
personal perspective, talk to me about, you know,
going through that and then emerging on the other
side. You know, there's some sort of like social
amnesia that seems to have kicked in where it's
almost hard for me to remember. that time period
to be honest and uh it became well it was it
was obviously tremendously difficult i the things
that changed my life i moved cross country just
prior to the to the covid pandemic and um i was
had just started levels in 2019 late 2019 and
so we were only a few months into this giant
initiative and um and so the first you know i
guess three four depending on how long you think
the pandemic went uh the first few years of this
was in the context of COVID. And it changed everything
about business dynamics, the shift to remote
work, which, you know, I don't naturally fit,
I think, psychologically into a remote environment.
It can be, I'll just say, I remember a huge sense
of loneliness and kind of this sense that each
day, despite feeling like I was working while
my laptop was open. I would close it and I would
look around and it would kind of be like I was
just in virtual reality. And that's what life
felt like. It felt like we were all in a virtual
reality trying to emulate life, but actually
it wasn't really happening. And I think that's
why the time dilation happened. And it's hard
to remember those years because everything was
so the same. We were all. I don't know, hiding
away and, or a lot of people were very difficult
to have a life, especially in the Philadelphia
area, which was quite aggressive about the, the,
uh, protocols. Um, I got married during that
time period, which, you know, in retrospect,
we were able to, we were able to get a wedding
in between these two spikes where we were allowed
to have a pretty normal gathering without, you
know, there weren't really limitations on the
number of guests. So we got very lucky, um, in
the timing, but I just think about the. there
were many people who didn't join because they
didn't want to be a part of that gathering because
they were concerned. And so there's just a lot
of loss and a lot of things that, although I'm
very happy that I got to experience those things,
certainly life was different in ways that I don't
even think I can quantify. You know, it's just,
it's, yeah. How do you quantify what was different
about life when you can only live the experience
that you had? Yeah. And, you know, a lot of time.
away from family, unfortunately, because we were
all spread out and traveling was difficult. And
I think that was probably the worst part of all.
Well, I've said this, you know, even right in
the middle of it, the biggest tragedy to me is
if you really wrote down on a piece of paper,
how could you make people more likely to get
COVID or have a bad experience? It's exactly
what happened. Okay. So I want you to stay in
your house. I don't want you to see any of your
friends and family. Don't exercise. get fast
food delivered to your house and binge watch
Tiger King. It's pretty much, you know, if you
want to make people vulnerable, it's what we
did. So it's important that we then reflect and
go, what was done well, what was done poorly,
the demonizing. you know, flat demonizing of
the vaccine also poorly because I've had people
in ICUs that said, yeah, the vaccinated patients
had a much better outcome usually. Now, these
are people with pre -existing conditions. So
that's a whole conversation in itself. But, you
know, it was this kind of World War I trench
mentality rather than stand in the middle and
then what can we take away? So through your eyes,
you know, what are the takeaways that we should
be reflecting on now as we stand here in 2025?
I love your perspective there, being nuanced
about it, because there's a lot of nuance. I
think the difficult thing for me was that, and
this is actually a problem that I have with the
healthcare system, generally speaking, is that
we use a public health lens to make specific
individual recommendations. What I mean by that
is that we look at the whole population and we
do a bunch of statistics and math on it. And
we say, you know, given... the highest probability
of transmission, which often, in this case, very
often, was in people who had pre -existing conditions
and comorbidities, given their likelihood of
a high -risk infection, we need to address everyone
as though they are that person. And we need to
enforce protocols as though everyone is that
person. And it's this lowest common denominator
thinking. And I don't mean that to say that the
people who have pre -existing conditions don't
matter. It's that... We were compromising by
telling everyone to act as though they had pre
-existing conditions. We were compromising everyone
who was not in that situation because we were
effectively putting people on bed rest. You know,
if you look at the studies on, there are some
fascinating studies. There was one, I think it
was in Sweden, and they took a rowing team, young
collegiate athletes who were at their peak, and
put them on forced bed rest for, I think it was
only one to two weeks. And they followed the
subset of that group who were on bed rest versus
those that kept their normal routines had, for
the rest of their lives, diminished health. And
so they had a higher predisposition for long
-term health disorders, including diabetes, heart
disease, et cetera. And this has been seen for
women who are pregnant, who have to go on bed
rest, who have high -risk pregnancy. We see the
same thing. Long -term, their health outcomes
are completely affected. The point there is we
were essentially doing something like that to
very healthy people, which caused a reduction
in your immune response. It caused like the reduction
in emotional health and social health. And we
were doing that as though because we took a public
health lens and treated, we tried to like cram
everyone into a single box and say, how should
the highest risk person respond? And I think
that is a huge failure. And when I extrapolate
that out to how we treat healthcare generally.
We use public health methodology, lowest common
denominator methodology all the time. And we
give one size fits all recommendations that do
not help the individual decide what I should
do given my own personal health state today,
who I actually am, not who the average general
person out there is. And we've got to get much
more nuanced about these things. And that's kind
of like what I care most about. There was plenty
of research, plenty of evidence at the time when
COVID was roaring. That people with metabolic
conditions and the elderly were the ones who
were most at risk. And the mandate for everyone
else should have been improve your metabolic
health, improve your immune response, improve
your strength, add muscle, be resilient. That's
what you should be doing right now. Not hiding
in your room in the dark, eating fast food. Absolutely.
I think that was what was a huge disservice when
we reflect back now is that there were so many
of us that would have been more than happy to
go out there and keep the world moving and allow
the ones that are vulnerable to shelter in place.
And even our children, we realized it was actually
not really detrimental to our children unless,
again, there's something preexisting that's going
to affect the immune system. And absolutely,
let's keep them somewhere safe as well. You know,
let the kids go back to school, let the people
who, you know, are keeping the country running,
keep the country running. But instead, we saw
these vaccine mandates and terminations and,
you know, of fit first responders. So, yeah,
it was it was such a disservice. And I think
one of the things I've talked about this, there
was a really horrendous incident in my son's
middle school. My son was the victim of it. And
it just destroyed trust in. because it was multiple
kids it was exposed to, in these children saying,
I'm struggling. They just didn't even want to
put their hand up anymore because of what was
happening. It was basically a 72 -hour psych
hold of any of these kids that were saying, hey,
I need some help. Not I'm going to shoot up the
school, not I'm going to take my own life, just
I'm struggling. And I feel the same as we come
out of COVID. I think it was kind of... The response
to the murder of the UnitedHealthcare CEO really
showed that underlying feeling of distrust. And
I feel that the kind of cracks are showing now.
So I think, you know, what you're talking about
really is so pertinent, especially when you think
70 % of the country is obese or overweight, over
40 % is obese. If you're taking that median now,
what does that mean if you're... you know, an
active, you know, athletic man or woman, like
your healthcare is now being projected by 70
% sickness. So you're absolutely right. If you're
taking median statistics, it's completely skewed
from where we actually need to be. Absolutely.
Yeah. We, we don't have, I think one of the most
unfortunate aspects of modern healthcare is that
we do not have any aspirational or optimistic
view. It's It's all about preservation of a ticking
heart in the face of inevitable disease. It's
really like, let's wait and watch and look for
symptoms and eventually you'll get them and then
we'll eventually put you on some sort of last
line defense. And what we should have done in
the pandemic is a microcosm of what we have to
do in regular life, which is to say, here's where
you are, here is what optimal looks like, and
here is how you get to optimal. And that is not
going to be an injection. It's not going to be
a pill. In most cases, it's going to be a lot
of small behaviors that compound over long time
periods that everyone is held accountable to
at the individual level because your doctor can't
keep you safe. You are the one, each of us individually
should feel like we are responsible for maintaining
our health. You know, I controversially say doctors
should not, today, should not be treating chronic
illness. Right now, 93 % of American adults have
at least one symptom of metabolic disorder. That
doesn't mean that they have some sort of disease
just yet, but they are clearly trending in that
direction. And that burden on the healthcare
system is destroying the system. It cannot sustain
it. And so doctors need to stop. They need to
reflect back to individuals. Here is where you
are. These are the actions you're taking each
day that affect your health status. And here's
how you can improve them. Here are the tools
that you need. And we need an industry to step
up and provide those tools. But at the end of
the day, it's the individual's responsibility
to know their health state, to know the factors
involved, and to take action. And I think we
just completely abstract that away for some reason.
We don't want people to feel a sense of responsibility.
I'm not exactly sure all the incentives. There's
a bunch. But at the end of the day, it's very
rare for people to feel like they're in. they
are actually in control and empowered over their
health. It seems like chronic disease just happens
to you. There's nothing you can do about it.
And when that does, get your doctor to give you
the right prescriptions. And COVID was unfortunately
an accelerated microcosm of that exact dynamic.
What impact do you think the prescription drug
television commercials has on this? Because we're
one of only two countries in the world, us and
New Zealand, that even allow advertising for
pharmaceuticals on television. That is such a,
it's such a deep question and one that I would
absolutely love to have a control to look at
because my instinct. So I've gone through phases
in terms of how I think about advertising. There
was a time in my life when I thought advertising
doesn't work. You know, I actually, in fact,
I get, I get, I tune out any sort of advertisement.
When I see billboards, it just makes me mad.
I don't have any desire to go purchase that thing.
It's just like, it's, it's out there. It's garish.
It's ugly. It's annoying. I want to fast forward
through them. How can this possibly be actually
converting people into customers? As I've gotten
deeper into business and I've started to better
understand the pervasive, repetitive messaging
and the effect that it has on people's behavior,
it is obvious that we are all a product in and
of itself of the advertising system, what we
buy, how we run our lives. It is a downstream
consequence of what we're told matters and what
our friends purchase and what we see. And whether
it's you or somebody in your circle who is prone
to advertising, it eventually makes it into your
home, bottom line. And there's no possible way
that pharmaceutical advertising is not mass affecting
the psychology of healthcare. When you are watching
TV, even if it's in the background subconsciously,
when you're hearing that you know, chronic illness
symptom X, Y, or Z is addressed by this pill.
It starts to reinforce in your mind that, that
disease happens to people and pills are the solution.
And I think if nothing else, that is a, that
is a cycle that we need to break because it's,
it's fundamentally not true. Almost all. And
I'm specifically talking about chronic illness
over and over again, because again, the vast
majority of the population, nine of the 10 causes
leading causes of death in the United States.
are directly chronic illnesses or are accelerated
or caused by chronic illnesses and that's that
stroke it's heart disease it's alzheimer's disease
and dementia it's diabetes these are the things
that are killing people every year infections
like you know chronic pulmonary diseases of the
lungs all of these are accelerated by chronic
illness so the things that are killing people
right and the things that are causing nine out
of every ten dollars of spend in the healthcare
system are these chronic illnesses And so the
vast majority of products being developed and
that are being advertised to us are addressing
these. And it's creating this imprint in our
minds as a society that that's the dynamic. You
get it, you take a pill. And I think that's broken.
And if for no other reason, we should at least
run the experiment. What happens if we turn off
the advertising? What happens if we just do it
like every other country except for New Zealand
and just run it for five years? Do people start
to feel, do we replace those with an empowerment
message where exercise and nutrition and sleep
and stress management and emotional relationships,
if we talk about those things in that same slot
on primetime news, does it start to shift and
move the needle? I don't know. I think it's worthwhile.
Absolutely. We can change the news while we're
at it too. Speaking of repetitive programming.
No doubt. No doubt. All right, well, then let's
just kind of circle around for a second again.
I think it's worth revisiting. Talk to me about
the industry that you came from, what made you
make the jump, and where the AI and the kind
of original platform that you developed back
in 2019, and then we'll start walking through
to where you are today. Yeah, so my background
is aerospace engineering. I was never into biology
or healthcare, really. it actually happened the
way that this all came about was through a really
interesting life experience so i was working
at spacex i was relatively early there i started
in 2010 which was a long time ago now but i had
a very very awesome experience there i was fresh
out of college and just loving this insanely
intense competitive and fast -moving environment
that we had at spacex and about halfway through
my time there i was able to be I was kind of
picked as one of the first employees to work
on our astronaut flight program. So originally,
SpaceX was just a rocket provider. We would launch
payload satellites into space for other companies.
And then we won a contract to launch astronauts
into space after the space shuttle was retired.
And so we needed to build now a capsule that
could carry human beings, you know, alive and
well into orbit. That, I was one of the first
four on that program, and that was an insanely
awesome opportunity because it connected me with
what I think is now pretty clearly an example
of how broken our health technology is. And so
I'll try to tell this in brief, but when I was
there, my job was to develop the oxygen breathing
systems and the fire suppression systems actually
for the space capsule so if a fire breaks out
inside of this very enclosed space we needed
to put that out we can quickly identify it put
it out and we also needed to maintain inside
of this small volume it's about the size of a
small car a livable breathable safe non -toxic
atmosphere so people could be breathing it right
and so all the systems associated with that were
on my plate and I found myself wondering, you
know, how do I know if we have seven different
people in this spacecraft and they're all, let's
say you have a 95th percentile male and a fifth
percentile, I'm exaggerating here, let's say
50th percentile female in terms of body size
in this capsule, they have totally different
metabolic requirements. They're breathing at
different rates. They have different body mass.
They have different circulatory systems. How
do I know that all of these people are healthy?
like what what sort of what sort of uh data can
we acquire from these people that we can measure
um and then and then know as the people operating
the spacecraft that they're all healthy and i
got met with blank stares when i would ask this
question i was totally uh naive i didn't know
i thought that i thought there surely was some
advanced technology where you could put a little
patch on and it would be continuously monitoring
you know health for this you know for a human
being um it turns out that that does not exist
and i didn't you know this is again i was learning
this in real time i thought that was interesting
because as the engineer developing these systems
i had sensors on top of sensors on every single
functional component of the system i was designing
i had hundreds of data channels that all combined
to tell me is my system functional is that system
feeding into another system that's functional
and is the spacecraft overall performing in a
healthy way and that's just that's just the water
you live in as a systems engineer you just you
are measuring all the time the health state of
whatever machine you're building And so when
I found out that not only did I have to keep
these astronauts healthy without having any way
of measuring what that even means, but that the
industry outside of this incredibly advanced
astronaut program was clearly suffering from
the same problem. We did not have the ability
to measure human health. That was a mind blowing
realization. And so that was part one. And then
part two was five, six years into level or I'm
sorry, five, six years into SpaceX. I was just
totally burning out. You know, I was physically
fit. I've always been fairly fit. I was a CrossFit
trainer at the time. So, you know, working my
job and then I'd go teach CrossFit classes and,
you know, work really hard in the gym. And I
kind of thought physical fitness was equivalent
to health in most cases. And I started to get
surprised by how terrible I felt every day. You
know, I would have these episodes of just like
shakiness and cold sweat and like a pit in my
stomach and just extreme fatigue. And it got
bad enough that I actually called my mom and
was like, I think you're the first person I'm
telling this, but I think I have a chronic illness,
like a terminal illness potentially. There's
something so bad happening that I don't even
know how to describe it. It feels like a systemic
shutdown. And she said, you need to get to a
doctor and work with them to find out. I went
to the doctor. The doctor ran a blood panel.
He said, you're young, you're healthy, you're
fit. Get out of my office. You're totally fine.
That was unsatisfactory. And so I realized these
two pieces of the puzzle came together. where
I suddenly had this moment of what I'm experiencing
at work where I can't measure human health is
actually affecting me. I don't know my own health
state. This is like such a huge problem. I'm
trying to figure out, am I dying of a disease?
And I can't even answer that question confidently
other than getting sort of shooed out of a doctor's
office. And to accelerate the story, I started
reading just voraciously about health technology
and trying to figure out, like, was anyone working
on this problem? And I stumbled across a device
called a continuous glucose monitor, which is
mentioned in a book by Rob Wolf, who's kind of
a paleo CrossFit guy. And this technology felt
like an incredible breakthrough. It's a little
device you can wear on your body that is continuously
measuring blood sugar, which is one of the major
energy molecules in the human body and is so
closely associated with health state. And I thought,
okay, amazing. And it streams those data directly
to your phone. And I thought, all right. Amazing.
This is the step towards the technology I was
thinking we had already. And so I tried to get
one. My doctor returned me down. And long story
short, that kicked off a personal like sort of
crusade to say, I deserve access to this technology.
When I did get it, it was life changing. And
now with Levels, I left SpaceX and decided I'm
going to make the technology to help us understand
our health available and actionable for as many
people as possible. It's so funny that you have
that kind of observation because the people listening,
most people in police, fire, EMS, corrections,
dispatch, etc. There's so much money poured into
the technology around us and so little investment
in the human being. But without the human being,
a fire engine isn't going to move. 911 call is
not going to be answered. But it's that complete
disconnect. You know, people think that we work
in the same realm as, you know, the tier one
special operators and, you know, these elite
performers on the planet because we really are
asked at the drop of a hat in our worst calls
to perform at an incredibly high level, mentally,
physically, emotionally. But when I speak to,
for example, the Delta and the SEAL Team 6 guys,
you know, they have the psychologists and the
physiologists and the, you know, all the people.
They have this amazing group around to forge
performance. When it comes to first responders,
the conversation, as you I'm sure have come across
now, is really, well, we keep dying. Can you
get us to die a little bit less? It's not even
close to performance. It should be. There's this
massive gap, and I hope we're beginning to kind
of lead the charge in fixing the work, which
will then put the performance conversation front
and center. People have this assumption that,
yeah, we're all taken care of and we're all in
this great shape and we have all these kind of
health buffers around us, but we don't. We have
expensive fire engines and equipment and the
work week destroys the person inside the uniform.
I think that this is probably the most acute
example is in the first responder community where,
like you said, the machines and the technology
are where we invest all of our resources. And
we treat the humans as kind of a fungible, necessary
but fungible, kind of almost disposable. And
that actually applies. But I would say that putting
the machinery on the pedestal applies across
every industry. One of my mantras right now is
that we, as humans, need to be at least as measured
as our machines. And that's like, I don't think
it's an unreasonable ask. And I'll give you a
couple examples that I know of. Whenever we engineer
a complicated machine, we build in, just like
we did at SpaceX, we build in the capability
to measure that machine completely in its healthy
state. And that's key. We don't bring the sensors
to a broken machine and then try to figure out
what's broken about it. We build them into the
DNA of that machine. As an example, a modern
car produces about 25 gigabytes per hour of sensor
data. total data than a human being will get
from the healthcare system in their entire life.
So every hour your Toyota Camry is producing
more data than you will get four times more data
than you get in your entire life. And that's
not to say, like, I want to be clear. It's not
to say that every, every measurement coming off
the Toyota's sensor system is some sort of incredible
insight or breakthrough. It's actually the exact
opposite. The vast majority of that data is totally
mundane. It's not saying anything is bad. It's
saying it's just reporting out that everything's
healthy. But as soon as there's a blip, as soon
as something changes, your check engine light
comes on or your tire pressure gauge comes on.
You can intervene before you have a blowout on
the highway with your daughter in the backseat
and your car rolls, right? We have these intervention
mechanisms to avoid catastrophic failure. And
it would be absolutely untenable to take those
sensor systems out of our cars. The same goes
for our jet engines, right? When you're flying...
airline travel is by far the safest method of
transportation. It's safer than walking. So like
walking on the city street is more dangerous
than flying in an airplane, which is hard to
believe, but it's just it absolutely is the case.
You can look at the statistics. And part of the
reason for that is that we take safety incredibly
as an incredibly high priority. Failure is not
an option of a jet aircraft with 250 people flying
across the Atlantic Ocean. And those machines
are measured with tens of thousands of sensors
continuously, again, to measure health state
so that we know when something goes wrong. And
the pilot flying that aircraft feels peace of
mind knowing that as soon as something goes wrong
with one of those engines or with the airframe,
they're going to get an alert because the system
is instrumented accordingly. Where is that analogous
capability in our health care? All of us right
now, if we're being honest, all of us are flying
completely blind. We do not have any such system
that is keeping track of where we are, how we're
performing, and what is slowly but quietly failing
in the background. And so unfortunately, most
of us are. We are actually degrading unnecessarily.
And that's just across the general population.
Now put the first responder in. the environment
that you all are in, in incredibly high stress,
fast acting, and oftentimes toxic environments,
over and over and over again, there is going
to be an accumulation of stress and damage that
is going to have an impact on human health. And
the fact is that we just simply do not, we have
not decided to invest the resources in being
able to measure that. And I think that's an absolute
travesty. And it's a complete... miscarriage
of justice in a lot of cases because it will
only show up decades down the line, maybe when
that person's already retired, or it will happen
on the job, you know, unfortunately and acutely.
And I think that happens, you know, we see that
way too often. It's avoidable. It requires a
rethinking of what is important and where we
should place our investments. And it also requires
a completely new lens on health care in general,
like what health care actually means. And, you
know, I would just... I would just posit that,
again, we should be at least as measured as our
machines. That's my only ask. It's not that big
of an ask. It's funny that you use aviation as
an example, because if you look at pilots, they
have crew rest. They can only fly for X amount
of hours, and they've got to sleep for X amount
of hours. And I think the 24 -hour shift, because
we have fire stations, we have beds, we can at
least get naps. It's still the best model. Otherwise,
you start breaking up the day, and now the circadian
rhythm is all over the place. But it's putting
that rest and recovery between each of those
sleepless nights. And, you know, where, like
you said, there's so much emphasis on safety
and aviation and they do have these stringent
operating procedures in fire. I mean, you know,
24 is the minimum that you will work. But, you
know, we are seeing a staffing shortage because
of mismanagement, because of refusing to change.
But now we have first responders working 80.
One of my California friends just told me he's
on 120 hour shift at the moment. five days straight
so put that guy in the plane would you get on
i sure as hell wouldn't there's no way it's unbelievable
yeah the you know the we do this in all of our
tip of the spear industries i think you know
i have a very close friend who's a cardiothoracic
surgeon at uh you know in a very very well known
and top -notch health system and he was describing
a heart Um, you know, essentially an, an incredibly
emergent heart surgery that he had to do. And
it was a 16 hour surgery and he started at 30
hours into his shift. So he had not closed his
eyes for 30 hours and he was trying to lace up
his shoes here. I remember this vividly. He was
describing. i was tying my shoelaces because
i had just you know i had just sat down and taken
my shoes off to try to get some rest and then
they came in you know the call came he's trying
to tie his shoes and his he could not focus enough
his hand his dexterity was so impacted that he
was struggling to tie a knot in his shoelace
so he could go to the or and i just you know
i have to wonder like with the family it's nothing
against him he's being forced into this situation
he's going to go and try and perform the best
that he possibly can but with the family have
the confidence And knowing that that was the
case, that his dexterity was so impacted. And,
you know, it's like the actual skill and capability
that our best bring to the table is completely
diminished, probably lower than the average when
we run dry. And we just know this about performance.
We know the impacts of sleep, both in the acute
and chronically. And, you know, I think what's
even worse is that when you do this long term,
when you make this the standard expectation.
you start to experience systemic failure. Like
it's not just that in the moment you're struggling
to focus or that you're like a little sluggish.
It's that over time, the systems break down.
And the number one and two, I believe the number
one and two causes of death for firefighters
right now are heart attack and occupational cancers.
And the correlations between sleep, inflammation,
and chronic stress and heart disease are so well
understood. It's almost like it's not even worth
rehashing. Like everybody knows that these are
so closely linked. In fact, they're so closely
linked that this is a really interesting anecdote.
Every year when daylight savings happens and
we lose an hour of sleep, the number of heart
attacks and strokes goes up by 26 % on that day.
And perhaps it's over that week. But the loss
of that sleep, just one hour in the general population,
is so dramatic that we know, like clockwork,
that we are going to lose an extra 25 % of people
to heart attacks. They may have been lingering.
Obviously, they already had heart disease. But
it puts them over the edge. And when we're doing
this in literally the occupation for our first
responders, we are forcing some number to have
an unnecessary heart attack death. And that is
unacceptable. Why are we doing this? There are
so many incidents where we've lost firefighters
to a multitude of things, from falling off the
ladder to getting lost in a search. And we always
chalk that down to the job. And no one thinks,
well, when did they last sleep? We just had a
fire truck, for some reason, make a decision.
The barriers were down on the train line. They
were on their way to a call. And so they drove
around the barriers and got nailed by a train.
I don't think that would have been the decision
that person would have normally made. I guarantee
you sleep deprivation was included in that. And
it's funny because when you were talking about
the medical side, I've talked about this a few
times on here. The guy that really kind of began
the insane surgical residency, you know, we're
doing these crazy hours, William Halstead. It
was discovered, this was in the 1800s, that he
was a cocaine and heroin addict. So even like
the why do we do this, you look far enough back,
there's no reason. But I was on a paramedic clinical
once in the OB ward, and this clearly very, very
veteran obstetrician was delivering this baby.
And I was in the corner. It was kind of like
I just had to observe. That was it. He clamped
both sides of the cord, and then he cut. the
you know the other side of the clamp the side
of the patient and like a monty python sketch
blood just started spurting everywhere and this
man must have clamped and cut thousands thousands
of umbilical cords but i'm sure because this
was i think it was like early in the morning
he'd probably been on call or being up all night
that was obviously salvageable you get another
clamp and you know she didn't lose too much blood
and we were good but if that was an aorta during
a cardiac surgery that patient probably would
have died. So this is why, just to underline
what you're talking about, it is so, so important.
And then you look at the chronic effects of sleep
deprivation. The biggest killer of firefighters
and cops is actually suicide at the moment. So
there's a direct correlation between sleep deprivation
and all things mental health as well. So like
you're talking about with the check engine light,
that's the physiological side, but also that
ties into the psychological side too. Absolutely.
Yeah, there's a really fascinating and increasing
body of evidence that's looking at the psychological
health as it relates to physiological markers.
And there are predictive models that can look
at a combination of biomarkers and predict the
likelihood of a depressive episode for people
who are predisposed. And it's pretty clear that
that is going to be a future area of study that
is going to become... forefront and primary right
we're going to be we're going to start being
capable of predictive models on the individual
level not not again at the population level i'm
most interested in for me and for my loved ones
how do we equip them with enough information
that there can be that check engine light equivalent
for whatever it is that they're most predisposed
for or at risk of and and the fascinating thing
is that many of these well most i would say most
of these conditions And I'll say that separately
potentially from depression because there are
obviously multi -factors and I don't claim to
have all the expertise. But in many, many cases,
we're experiencing the compounding effect of
lots and lots of lifestyle factors. That's what
we're experiencing. It's very rare that some
single event occurs that triggers in and of itself
a disorder that is life -threatening. It's very
often, I think, the compounding effect, and that's
our sleep, our stress, what we're eating, the
sunlight exposure, our activity levels, and of
course, genetic predisposition and other factors.
And so, you know, I just, I struggle with our
current paradigm where we throw people into the
fire, literally, and we do so without even the
most cursory inspection to help them understand
their own health state and to help us understand
the predisposition of these people towards, you
know. resilience, right? How resilient is that
person to what we're asking of them? We just
don't do it. And I really like my mission with
levels is to change how we treat health health
data, to put the power into the hands of the
individual to access, own and take action on
that information, and then to bring in experts
to help validate or provide, you know, additional
plans, expertise, validation, etc. But I think
the most important thing is to change the paradigm.
The healthcare system should not own my data
or tell me what I can access. It should be me
who makes that decision. Very comparable to financial
data. If you went to a bank and you asked for
some information about your accounts and some
bank employee told you, no, you don't need that.
You don't need access to that. You can imagine
what would happen next. But for some reason,
we're willing to accept that in healthcare. This
is information about your individual body, your
predisposition to death. And we allow... the
system to stand between us and that information.
That's got to entirely disappear before anything
can change. Absolutely. Well, you mentioned about
kind of the nucleus of levels being the continuous
glucose monitoring and then the blood work and
the app. What has been the evolution of that
over the last five years? Yeah, it's been quite
a journey. Step one was, you know, I mentioned
that I had used the continuous glucose monitor.
And I was absolutely blown away by the technology.
Again, I thought physical fitness is essentially
health. And the way that that played out is that
I would look at the fittest person in the gym
or online, the real pinnacle athlete, and I would
look at what they were doing with their lives
in terms of what they were eating, how they were
training, and I would kind of replicate that
to the best of my ability. And what that often
meant was, well, I would eat a lot like they
did. but I wasn't training like they did, right?
So if you're a Tour de France athlete or you're
a bodybuilder, you're putting in four to eight
hours of work per day. I was putting in 45 minutes.
And yet I was carb loading and glycogen replenishing
and using all these terms that I thought I understood,
just like that person eating hundreds of grams
of carbohydrates and that sort of thing. And
when I put a continuous glucose monitor on, I
immediately saw that... All of those things were
way overclocked for my system. They were the
portion sizing, the content, the timing. It was
all really, really bad. And what I was experiencing
was essentially prediabetes. My blood sugar was
really chaotic. I was experiencing a ton of what's
called variability, huge spikes and huge crashes,
which are inflammatory. They increase your likelihood
of cardiovascular disease and diabetes. And straight
up, they just affect your quality of life when
your blood sugar is crashing from a really high
point. you feel that or i felt that as extreme
fatigue and really a mood change and so the cgm
immediately that the power of it is that it's
continuously measuring and you can see within
minutes you eat a thing and you can see how that
is affecting your blood sugar and i was able
to do trial and error and really like dial in
a dietary lifestyle or approach that dramatically
improved those symptoms so levels was all now
again At the time, I had tried to get a CGM from
my doctor and he said flat out, no, you're not
diabetic. You don't need this thing. So I actually
got one from Australia where they were over the
counter and used that. So that was how I had
to get it. It was like this gray market thing.
And so the first thing that I wanted to do with
levels was break the barrier down to continuous
glucose monitors. So in the very first era, it
was all about get more people, regardless of
their health state, access to this tool and just
make that. step one once that barrier was overcome
step two was okay now take that data that people
are collecting and help them actually understand
it because you know it turns out when you put
put a device in someone's arm you know oftentimes
they've never seen blood sugar data before and
they have no idea what to make of it and it can
be really confusing right so we built this this
software ecosystem that through the levels app
that pulls the data off of the cgm contextualize
it so puts it directly alongside the lifestyle
choices that are affecting blood sugar like sleep
nutrition you know exercise stress and helps
people interpret that so we're doing a lot of
AI analysis on it and directly explaining the
correlations between actions and reactions we're
now entering phase three with levels and what
we're doing with with three is removing past
just measurement to measurable health improvement
And so that means that we don't just want people
to put a CGM on and measure their, you know,
and just see correlations. We want to show them
how to take a measurement and improve the most
priority biomarkers that are directly affecting
their health. And to do that, we've expanded
beyond just continuous glucose. We've added comprehensive
blood work in addition. So we have hundreds of
biomarkers that we measure with these blood panels.
We combine that with the lifestyle data and the
CGM data that you're collecting through levels.
And then we identify the highest health priorities
and we help you actually improve those markers
to reduce your long -term risk. One of the, I
think the least observed markers, unless you're
obviously in a certain group that's very aware
of this in the first responder professions is
actually testosterone. And again, you look at
the impact of that from sleep deprivation, it
just destroys it completely. Have you... become
aware of that with the groups that you've worked
with in this third tier yeah it's really fascinating
the number of hormone irregularities um is really
shocking there are there are many many many reasons
i think why our hormones are being assaulted
in our in our modern era but what we're seeing
consistently is specifically in men testosterone
is down so that the current modern 20 year old
has the testosterone levels of a 60 year old
20 years ago. That's the trend that we're on.
This is an absolute disaster, obviously. And
I think there are a lot of factors. As you said,
chronic sleep deprivation destroys hormones.
It breaks the circadian rhythms during which
the body replenishes and synthesizes. There are
rhythms to basically every molecule in our body,
and they are synced with our sleep and wake cycles.
And so when you blow those up, you are breaking
the body's programmed hormone synthesis schedule.
Another really fascinating thing is there are
studies that show if you give a man 75 grams
of sugar, this is called an oral glucose tolerance
test. You drink this sugary drink and then you
measure blood sugar for the two hours after that.
So a study showed that during an oral glucose
tolerance test, testosterone is also suppressed
by about 40 to 50%. for the entire duration of
that test. So as soon as you drink that sugary
beverage for the next two hours, testosterone
is cut almost in half. And, you know, the duration
of the test is not super long. So I don't have
like a ton of long -term data on this, but you
can imagine if somebody is, is let's say that
they're poorly slept, they're working a, like
you said, a hundred hour shift, right. And they're
having to get in calories quickly and whenever
they can, like around work shifts, those calories
are probably coming in the form of quick process
snacks. uh you know granola bars and candy and
uh you know and energy drinks with a lot of sugar
in them to help us feel replenished so you can
imagine you're both uh you're both poorly slept
and you're spiking your blood sugar consistently
and creating this testosterone suppression over
and over and over again so if you let's say you
you drink an energy drink it suppresses your
testosterone 40 percent And then you drink another
one two hours later. Your testosterone is already
suppressed. Now are we suppressing it again,
another 50 %? I mean, I don't have the answer
to this question, but the data shows that there
is obviously a direct connection between these
crucial hormones that affect male health and
female health and the actions we're taking every
day. And we're compounding these things over
decades during our work. And we just aren't measuring
the impact. So it's no surprise that... hormone
therapies like testosterone replacement are are
through the roof right now we're sort of you
know injecting replacements for this stuff which
uh you know i'm sure it helps restore quality
of life for a lot of people but i just wonder
how much are we putting a band -aid on a problem
that we could otherwise fix just through different
different choices if we knew the data This is
the argument, one of the arguments for the 42
hour work week that I'm just, you know, the dead
horse that I'm flogging with, with a whip in
each hand at the moment, because that's just
it. We've got literally, you know, go to any
fire station you ask, you know, and this is obviously
affecting women as well, but testosterone is
more of an impact on men, this particular area.
But you ask, you know, late 20s, early 30s, who
should be just dripping with testosterone. I
mean, they are the, you know, the protectors
of the community. They have to be fit. So they
should be arguably pretty athletic. And they're,
you know, 200, you know, 250 maybe. And it's
insane. And then, like you said, then they go
to a men's clinic. And then the predatory actions
of those, they're like, well, here's TRT. Now,
you know, I'm a big fan if you. There's nothing
you can do about lifestyle changes. In the middle,
there are peptides. At least you're getting your
body to make its own testosterone still. But
just like you said, the first step should always
be, well, can I sleep more? Can I get some strength
training in? What am I eating? Now, I mean, that's
the first time I've heard that correlation with
glucose. So all these factors that we know can
reverse this and get testosterone back up. You
know, it's such a, just it breaks my heart because
I've got friends that are on TRT and they're
on it forever now. That's it. It's affecting
their fertility. It's affecting their hair loss.
You know, the for lack of a better term, the
bitch tits. I mean, all the thing in the back
knee. These are all real things that come along
with TRT. So, you know, when when people really
start understanding the impact that these shifts
are having and that if they simply went to a
healthier work week and got more sleep and were
cognizant of their own sleep at home, of course,
and his ownership to that, they could reverse
this and get. close to normal again without any
pharmaceuticals. I mean, that's the message that
we're just not hearing. It's all TRT and optimization,
but in the wrong way, chemical optimization,
not lifestyle optimization. Yeah, 100%. And this
is one example of so many, right? Across the
board, there are important biomarkers that track
and directly demonstrate changes in system health.
we have this total, you know, what I believe
to be the root cause is, well, what I believe
to be the root cause of the ongoing issue, the
reason we don't fix it is because we have a complete
scarcity of data. We don't connect our actions
to these reactions. And so it's much easier to
take a single data point where testosterone comes
back at 200 and say, oh, your testosterone is
200, time for TRT. And I would say, well, if
that, if we had increased the cadence of of measurement
so that that person was measuring on a quarterly
basis at least for the past five years, I think
what we would see is a dramatic decline associated
with a change in sleep or a change in nutrition
or a combination of these factors that, again,
if we increase, if we go to a data abundance
approach to healthcare, we would take more measurements
and we would say, okay, let's try X and Y and
then we're going to remeasure in a month and
we're going to try Z and A and we're going to
remeasure a month after that. And you're going
to turn the knobs and remove the low hanging
fruit. And then we'll find out quite quickly
over the course of a few months. And I actually,
I know people who have done exactly this. They've
had fertility issues, fertility issues correlated
with very low testosterone. They went through
a series of lifestyle changes with consistent
measurement and completely restored testosterone
to healthy levels. Like from, again, from sub
200 to mid 600s without TRT. And so now you've
restored your body's natural function. And from
there, if 600 still isn't doing the trick, great
now we're adding a smaller dose of trt that's
going to have less of a complication for the
body that will get you to wherever you need to
be but i think we do this across every single
category from heart disease markers to blood
pressure to hormones we are we are measuring
minimally we're taking action on too few data
points and we're not in any way trying to address
the root causes which in most cases are completely
in our control and so that's that's the whole
objective with levels is to give people the cadence
of measurement that you need and the, and the
types of measurement that you need to see across
the spectrum, how your body's performing, and
then to show cause and effect and provide lifestyle
first programs to improve those things. And,
uh, it's, you know, it's pretty amazing the things
you can accomplish in just four weeks. I dropped
my, so I have a, a predisposition to heart disease
in my family. Apo -lipoprotein B is an LDL cholesterol
particle that is directly associated. It is the
particle that builds up plaques in the arteries.
So my ApoB was high. It was at 100. And following
our lifestyle program for cardiovascular disease,
I brought that from 100 to 73, which is well
within the optimal range, in four weeks. 30 %
reduction using just lifestyle. If you look at
standard healthcare data, they're going to tell
you that that is not possible. Only a medication
can cause that. And so this is possible across
many, many different types of markers, but you
got to measure and you got to connect the dots
between action and reaction. So anyway, it's
a paradigm shift. Yeah, absolutely. Well, it's
funny. First thing that you just made me think
of something that I've never thought of before
and I was never being presented anywhere I've
ever worked, but it's just simply doing a baseline
full blood work. at the front door before, you
know, when you start in the fire service, because
unless you come from another department, you
would have, I'm assuming be a nine to fiver.
You went to school. So as you begin, you should
be at a good baseline. You're still young, you're
still healthy. And then, like you said, if you've
got quarterly, you know, markers and you can
start to see trending, it doesn't, you know,
one time, like you said, doesn't mean you're
going to die, but if there's a continuous downward
line, then yeah, there's some, some issues that
need to be done. With the lifestyle change, one
of the things that I saw with my own eyes, and
I always got blood work done from an annual firefighter
physical point of view. And again, not always
as in -depth as we're talking about. But I went
plant -based for about six months. And about
two or three months into that, I had the annual
physical again. And the doctor literally said
to me, can you tell me how you eat? I've never
seen such good blood work in my life. And all
I had done is gone plant -based and I didn't
stay plant -based, you know, but I mean, if you
certainly, like you said, if you've got some
markers that are off, I think the plant -based
diet, if nothing else is amazing for recalibrate
and get everything down. And then you can start
putting meat back if, if that's what you choose.
Absolutely. It's, it's so, it's so, uh, it's
so incredible how much, and it's not surprising.
I think a lot of us, myself included early on
kind of roll our eyes at the nutrition dogma
because there's so many competing. concepts and
over the time over time you just kind of think
you know what it's just calories like what's
the difference well it the question is not are
calories calories because that's a that's a thermodynamics
question it's like yes every calorie is the same
unit of energy but what what matters is our macronutrients
macronutrients are all macronutrients equal and
different nutritional philosophies and makeups
like plant -based versus carnivore have completely
different macronutrient content and that has
a major impact so the con the Quantity of fats
and proteins and sugars is totally different
between them and fiber. And these are bioactive
molecules that change the chemistry in your body.
And it's incredible how fast you can affect massive
numbers of markers. The ApoB change that I was
able to achieve, I did that with a lot of animal
protein. Typically, you're going to be told that
you have to do a plant -based diet, and I've
done these before, to bring cardiovascular markers
down. But I did lean protein, low saturated fat,
and I massively increased fiber. And that directly
crashed my ApoB down by 30%. There's a long -term
cardiovascular risk reduction right there that
is equivalent to taking a medication. People
would be really surprised and I think really
empowered if they knew, like you did, how in
control you are of these sorts of things. And
so, you know, once again, like... Exactly as
you said, what I envision for the future of healthcare,
but certainly for high risk jobs, like this should
be the basis, is a baselining when you first
start and then a continual tracking so that we
know directly when something starts to go awry.
And if overall we're seeing an entire workforce
where... The, you know, the veterans are sitting
at a very low health state and the new people
are on a trajectory to the same spot. We know
we're doing something wrong, right? And it's
like, there's no covering that up. I think the
individuals will want this change and the infrastructure,
the organization will want the change. And we
will know, you know, how to, how to address that
because we can connect lifestyle, specific lifestyle
changes to outcomes in the body. Absolutely.
One of the byproducts of the plant -based was
I've never had such clean poos in my life. It
was like the ghost wipe, as they call it. So
that was a plus for anyone that's got an upset
stomach. But yeah, but I mean, I've had this
conversation. I've had vegans on the show and
you hear these carnivores and they're just dying
on their sword. But again, the middle ground
is they're both removing the processed foods.
you know ultimately that's what it is so you
know if you choose to go all carnivore you know
good for you if that works for your body type
i kind of feel like historically humans have
eaten you know fruits and vegetables too so and
then the the meat side was probably more of a
scavenger than a hunter for a long long time
but i think that's why bone broth does well in
humans because we were probably sucking out bone
marrow years and years and years ago so i 100
believe we were omnivores but you remove that
process crap. And in my case, it was learning
I was lactose intolerant after, you know, literally
almost 40 years, which is late adopter. That
was it. That was armor. And it was literally
overnight. The moment I took dairy out and I
actually put it back in again now because of
the gut biome is kind of, um, a lot better than
it was, but the, the number of. diseases that
absolutely are reversible. And I think Forks
Over Knives does a great job, even though it
is a plant -based kind of leaning documentary.
There's all these testimonies of kind of patients
that the other doctors have just given up on
that went with this doctor that put them on the
plant base. And, you know, they were like, that
was 20 years ago and here I am. So, you know,
I think it's so empowering, like you said, using
the word hope for people to realize just how
much they can control their own health. If sadly...
In some cases, they ignore what their doctor
tells them. I think that the trend has been,
and it's interesting, it calls back all the way
to the COVID conversation, where we've seen this
massive reduction in trust. I think that the
average response these days when I talk to people
about their quote -unquote healthcare strategy
is, oh, I don't go to the doctor. I don't need
that in my life. And I think it's because we
we've all caught on to the fact that there's
a there's a pretty clear lack of of personalization.
The the one size fits all knee knee jerk reflexive
15 minute appointment is just not cutting it.
It does not convince us that what is being said
is right. And and I think that's just like our
own. We instinctively. develop this intuition
about about uh information like we're always
developing filters for what's right and what's
not and we just we don't buy it when we're told
the same thing that we've done already or that
um that you know personally just simply doesn't
fit with your own experience and this is why
again i think that our healthcare system doctors
need to stop being the prevention and and treatment
arm for chronic illness again chronic illnesses
did not exist by and large, a few decades ago.
And the reason for this is multifactorial. But
environmental toxins, the nutrition composition,
ultra -processed foods, the amount of activity
versus sedentary lifestyle, quality of our sleep,
light pollution, you name it. There's so many
reasons why this is all happening. But the fact
is that our chronic illness is related to an
abundance of different factors than have ever
existed in human history. And doctors, the healthcare
system, is built for trauma. it's built for car
accidents it's built for knees or leg splints
when there's a compound fracture it's built for
you know incising out a tumor or non -communicable
disease treatment like all of these things are
what every dollar that goes into the healthcare
system should be associated with but instead
nine out of every ten dollars is being spent
on chronic illness these things like diabetes
and stroke and and uh and dementia and heart
disease and that paradigm's broken we have to
stop having doctors be the first line and we
have to start providing products and services
directly to individual people so that they can
understand that they are the ones turning the
knobs and pulling the levers that are affecting
their health state and it's so powerful once
you know that and you know that just the composition
of your plate actually does have an incredibly
powerful effect on your current and future health
it immediately i think it just suddenly shuts
down a part of the brain that is always on and
always freaked out that something is going to
quietly sneak up on you And now all of a sudden,
you know, I can measure and I can take action
and I can improve these things. So, yeah, I mean,
it's really exciting in some way. It's frustrating
to look at the system as it exists. And I know
you feel this way about, you know, the work week
and about all of the things that are broken about
our first responder industry. I feel this way
about the health care system. But I also know
that the first domino has already fallen and
the other dominoes are going to start falling
quickly thereafter. As people are starting to
catch on to this, the tools are becoming readily
accessible and more affordable. And it's just
a matter of time until this groundswell turns
into the status quo, the new status quo. An interesting
innovation was kind of brought to me about three
or four years ago now. And it was the red tape
that was cut, I think, during and after COVID
that allowed this to progress more. But the telehealth
embedding in 911. So you call, you know, you
are a new parent. So you've got, you know, a
young child. First time they had a fever, they
thrown up and you're like, oh my God, you're
kind of freaking out and you call 911. As of
now, they send us, they send two paramedics and
we come and, you know, if we're parents, we'll
be even more calm and tell them, hey, you know,
the fever will be fine. You just got to take
them down, just leave them in a diaper. Do you
have Tylenol? Okay, give them the pediatric dose.
You know, we can take you to the hospital, but,
you know, in all honesty, they're going to be
much more comfortable here. And then if that's
okay with you, you sign a refusal and off we
go. That same exact process can be done through
telehealth. So you call 911. And the way this
company, GMR, describes it, you've got ALS, which
is the true emergency, BLS, which would be broken
leg or something. And then you have non -emergent.
So there's third tier. And that's the one that
would then be siphoned off, if the caller was
okay with that, to a nurse, to a physician if
you needed it. And they can do everything from...
Set up urgent care clinics, you know, send an
Uber to that person, you know, prescribe prescriptions
if they do the telehealth with a physician and
get that sent from a pharmacy. I mean, so many
things that you would historically, you know,
call 911 for either correctly or incorrectly.
So it's, again, using my point being using this
more advanced technology to take the pressure
off the first responder profession. And it's
cheaper for the patient, a lot cheaper. And now
you've freed up an ER bed for. as you said, the
real emergencies, the car accidents and the strokes
and all the things. So with that being said,
we keep hearing about AI, and I'm sure that AI
now, as we talk in 2025, five years later, is
a completely different animal than 2020. So what
exciting possibilities are there now for this
AI technology to analyze these data points that
you're getting from the monitoring and the blood
work? It's unbelievable. The changes in the past
five years. And I think that the bottom line,
the most important thing for all of us to think
about is that AI is a tool. And what I'm most
impressed by is the ability for these models
to take incredibly complicated, fragmented information
and make a clear and consistent pattern recognition
out of it. This is something that humans are
okay at. But actually, we're very prone to biases.
So like frequency or recency bias. So the more
times you see a certain thing, if you're a doctor,
the more likely you are to assume that a similar
circumstance is that same thing. The more recently
that you've seen a certain case, and this has
all been studied, the more likely a doctor is
to diagnose a new case as that thing they saw
most recently. So we're prone to these things.
AI, when properly trained with the right data
sets, is not prone to those things it has other
issues but the the models that we're going to
see emerge in in the healthcare world and that
levels is is already working with are unbelievably
powerful at identifying subtle pattern changes
that a human would completely miss and surfacing
those as priorities to pay attention to and um
and this can be you know, directly correlating
like changes in insulin resistance with fertility,
which, you know, a lot of people don't connect
those dots, like systems level stuff that's very
straightforward. It can also be like multiple
steps removed where the data is out there in
the ecosystem, the AI has been trained on it,
but a doctor has never read that paper. And so
it knows the correlation between a specific symptom
or set of behaviors and the onset of, for example,
a cancer. And so what we're able to do is just
put a lot of, offload a lot of the raw analysis
to these AI tools. So you could, you know, what
Levels is building is the ability for, first
of all, people who use Levels own and control
their entire data set. It's yours. You can export
it. You can delete it. It's yours. We never sell
it. We never send it to any third parties without
your permission. And then we think that that's
super critical. Like I've said all through this
conversation. People need to have control and
empowerment over their data. And one of the most
powerful things that we're building the capability
for people to do is to add all of their health
record data. So all of your labs, all of your
body image scans, MRIs, DEXA scans, cardiovascular
scans, anything that you've ever developed that
is in combination your health record, to add
that into the tool that Levels has built. And
then to basically talk to an AI about it. And
to get specifically a complete interpretation
of that combined health record that tells you
the most you'll ever know, in my experience,
the most comprehensive look at my own health
state that I've ever seen comes from these models.
And they're infinitely patient. They can talk
to anyone regardless of your education level
and explain to you why you may be experiencing
the symptoms you are experiencing, why you may
be predisposed to X, Y, or Z. And then what to
do about it. And so it's not that it's going
to replace doctors. It's that it's going to be
able to facilitate a much more informed conversation,
both for the doctor and for the patient. And
so we have with levels, like I said, we've got
blood work, CGM. We have these AI tools that
do a lot of really powerful interpretation. And
then we have clinicians that review and validate
the health state information, right? They provide
a validated human. expert opinion on where your
health priorities lie and what you can do about
it. And a lot of this is very informed and facilitated
by AI models. It's just like they're so seamlessly
integrated now through the experience. They're
providing leverage across the experience in this
incredible way. And relative to 2019, there was
nothing even close. You know, we were using them
just to generate very small snippets and they
were not intelligent. They were not, you know,
cross -functional. It's really night and day
changed. And we're only we have not yet seen
the outcome. what it's going to do for human
health well also for comedy because i've seen
ai videos of the queen rapping in a jamaican
accent which is my highlight of every day now
so that too yeah they uh they have some creativity
i guess going back on a serious point though
with the doctors because i want to make sure
that you know that we're underlying the fact
that it's not demonizing doctors at all and that
i really empathize with the fact that you know
the good physicians don't get enough time with
the patient and i was thinking when you were
talking if you or i went to a hospital for a
thing how many hours and days would we be there
while they're running all these tests before
you can actually say okay this is this is it
and you're expecting someone to come up with
that in 15 minutes someone that maybe walks through
a door and is asking for a specific medication
as well so The same way as when you change the
work week, change the start time in the fire
service, and then put in telehealth, you would
free up so much more time for police, fire, EMS,
or certainly fire and EMS, my world, to then
work on their fitness, work on their training,
and be a much better first responder. I think
this is going to be an amazing tool to alleviate
the pressure on our healthcare system. I think
the NHS, which I talk about all the time, When
I was young, the NHS was incredible before privatization,
before the obesity epidemic hit the UK as well,
which breaks my heart when I go home now. But
it's no wonder that it's crumbling. It's a great
system, but it was allowed to be picked apart
financially. And then the Brits got fatter and
sicker, to put it bluntly. So if you can reverse
that and just reserve that taxpayer's money for
childbirths, the elderly, car accidents, cancers,
et cetera, just like you said. then there would
be plenty of beds and doctors and nurses. So
it sounds like AI, telehealth, I mean, all these
tools that we're seeing coming up now would actually
be a blessing for healthcare, a blessing for
first responders, so that we actually then can
have the rest and recovery to perform at the
highest level. And that surgeon wouldn't be overwhelmed
and could come in after a good night's sleep
and then perform that surgery. No doubt in my
mind. I think the AI tools will end up, you'll
end up with something like a personal model that
takes all of your data and does the absolute
best job. It's almost like a digital twin. You
might hear this term often, but does the best
possible job of representing your personal health
in real time. That will be an AI model of sorts
that you'll constantly be interacting with. And
providing it with updated information, whether
it's new tests or describing by documenting what
you're eating on a daily basis or the sleep quality
coming off of your wristwatch, it'll constantly
be evolving and really be the real -time representation
of your health. So that will be in and of itself
an AI tool. And the beauty is that it will be
able to communicate with you. So what I love
about the models, these LLMs that have exploded
over the past few years, is that they're... such
a simple interface to complex stuff, right? You're
able to just talk to it in human language. And
it's such an incredible, like miraculous, almost
tech capability to be able to talk to a code
base essentially about incredibly complex topics.
But you'll be able to communicate with your own
health, which is like kind of a weird concept,
but very, very, very, very much coming soon.
And then we will have at a larger scale the AI
models that will be supporting the health system.
doctors and nurses will will have their own i
think their own assistant of sorts that really
helps them with their own personal philosophy
right everybody's got their own bedside manner
they've got their own experiences they've got
their own skill sets they'll be supplemented
with these incredibly powerful models so that
when somebody comes to them they'll be able to
take the the digital twin information from that
person's health interpret it through their own
model and lens and then provide real humanized
health care right the human element is what's
going to be able to shine because that doctor
isn't trying to cram interpretation analysis
and diagnosis into a 15 -minute slot. They'll
be able to, maybe even remotely, take all that
data in, do all of the complicated work through
the AI, and then spend most of the time working
on a humanized plan to help this person improve
as necessary. Or an intervention, right? Like
going directly to fixing the problem. And so
I think that I'm very bullish about this. It's
really important that... people that people own
the, the AI health wave. I think that's, that's
really important that it doesn't just, you know,
come through the healthcare system. There has
to be the personal side of this in order for
it to really be as good as it can be. And regulations
have to have to play nice. You know, it's, I
would really hate to see a bunch of fear mongering
and, um, and like oppressive state by state regulation
today, every state. has its own health care and
medical regulations. So a doctor in New York
cannot treat a patient in New Jersey who literally
may live one mile away. And so that's silly.
If we end up with something similar and we like
fracture the regulatory environment in similar
ways, it's for AI or for these health care tools.
We're just going to like delay the capability
for them to to improve our health by who knows,
decades. We have the same thing in the fire service
where there's not reciprocity in a lot of states.
And literally, you have fire engines with hose
and you have trucks with ladders. And yes, there
are some idiosyncrasies depending on where you
work in the country. But at its core, 90 % of
what we do is identical. So that's the conversation
now as we look at the recruitment crisis is how
many people need to move state from family or
whatever it is. They just want to get out the
cold. um take those barriers down because they're
literally pointless and of course do an orientation
and academy for that department so you learn
you know the florida way the buffalo way whatever
it is and then uh yeah have a probation to make
sure that person is is a good employee but i
mean the fact that we have these these barriers
up is is insane it really is absolutely yeah
it's um there's a lot of things that have to
change but the pace feels really high right now
you know things are things are changing in the
technology world really rapidly A lot of the
technology, frustratingly, has existed for a
very long time. Many of the tests and just raw
technology to give people better control of their
health care has been around for decades. And
it's really difficult to comprehend the amount
of unnecessary loss of life and quality of life
that we've suffered just because those tools
have been inaccessible or directly gatekept out
of people's hands. I'm really working with my
parents to help them get the tests that I know
that they need to better understand their cardiovascular
health and their metabolic health. Because as
they get older, the risk goes up exponentially.
And it's so difficult for them. They're just
having to deal with all this coordination and
these complicated demands and requirements. And
there's faxes and there's emails. And it's just
so broken. It's so bad. The product experience
of healthcare is so terrible. i hope that people
start demanding alternatives and and and uh you
know whether that's at the political level or
or at the um you know at the personal like at
the healthcare system level where you walk in
and you just get poor service i hope that we
start finding ways to to provide feedback into
that system because it's just you know it's so
depressing And at the same time, I look on the
other side, I look at the technology space and
I look at the pace of AI models and at the next
generation technologies that are around the corner.
And I'm like, there's a space age future of incredible
health around the corner. And I don't know how
these things are going to, I really can't picture
how they're going to merge because it's like,
they're so different, but I'm optimistic. I'm
staying optimistic. Well, going to the actual
product, Ben, talk to me about the different
levels that you offer as far as the tools that
people get for that subscription. Yeah, so we
offer three experiences, we call them. Levels
Classic is for the person who wants to really
have an open exploration of continuous glucose
data. So it's really about getting a CGM sensor
and using the Levels app to explore how different
actions and reactions occur. self -exploration
with a continuous glucose monitor. And this is
prompted by and with feedback from our app, exploring
nutrition, various food types, portion sizes,
timing, all that stuff, exercise, impact, sleep,
and even stress state. So it's a really nice
way to get started and to try this incredible
tool. The next is Levels Core, which is our most
popular package right now. You get a 28 marker,
a very high value 28 marker blood panel, along
with a CGM twice per year. And you do these basically
periods of analysis or measurement where you're
wearing the CGM, you're logging nutrition, exercise,
sleep. All of that gets combined with the blood
biomarkers. And then you get one of our licensed
clinicians in your state. reviews and analyzes
all of that data and provides recommendations
for how to improve specifically the biomarkers
that are of highest priority for you. And so
by doing that twice per year, you have a really
nice cadence to check in and see the improvements
as they've happened. And then Levels Complete
goes even deeper. It's a 100 marker panel twice
per year. It's the same clinician analysis. There's
four CGMs instead of two, so people can wear
one per quarter. And you're really getting an
incredibly deep profile of your health consistently.
And these in -app programs combined with Levels
coaches. So our coaches are there with you continuously.
You know, some people like lots of interaction
with the coaches. Some people like very little.
But bottom line, they're there to support your
experience. And that's where, you know, through
Levels Complete, we get some really incredible
results across biomarker improvement because,
you know, we've got that extra element of coaching
there and the depth of the blood panels. So overall,
the packages are, they're sort of replacing a
metabolic health clinic. You would, you pay a
lot more and go to one of these concierge clinics
and they would give, you know, probably a comparable
suite of services with levels. It's very convenient.
It's all done e -commerce. You can just order
online, interact with us all through the internet.
And then you get, in addition, the sort of health
record I was describing previously and all of
the AI tools for interpretation and in -app programs
are all built into all of the experiences. See,
what I like about this, I was just actually on
the phone to a company that one of the first
departments in Florida went to the 42 hour work
week. Their chief, Hugh Bruder, was telling me,
and it's like a full body MRI. And apparently
they're catching all kinds of things, which is
phenomenal. But that's still things are already
starting to go wrong. The engine light is on,
as you said. But what I like about, especially
if you're able to do it at the front door with
this baseline testing is, you know, these. six
monthly blood draws and like you said cgm and
the analysis is that you can constantly keep
tweaking it rather than waiting you know 15 20
years and now there's a mass in your your skull
or whatever it is that well i'm glad you caught
it but it would have been great not to have got
this in the first place so uh you know those
two hand in hand i think would be phenomenal
you get this full kind of um you know comprehensive
internal um ongoing tracking, if you like, with
blood work, but then you also get the, okay,
let me just do a Xerox of my body and make sure,
you know, we're not missing anything. So those
two side by side, I think would be phenomenal.
And I know the, you know, the investment per
firefighter versus how much it would cost for,
you know, chemotherapy for some sort of surgery
or, you know, a lifetime of drugs. I mean, it
would be, you know, so much more cost effective.
Absolutely. Yeah. There's an initiative that
we're taking on right now, which is to bring
our packages, our comprehensive health tracking
and improvement packages to first responder teams.
Because I think that that, once again, you know,
it's one of the most acute examples where when
we don't pay close attention to the changes and
to the current health state, there are dramatic
consequences. And so we really want to equip
teams to be able to baseline all of their members,
especially as somebody new shows up, understanding
where their starting point is, and then be that
constant background health trend as life plays
out and to identify ways to keep people healthier.
I think that you mentioned MRI. And with the
hazards of fire and first responding, cancer
and heart disease are towards the top of the
list. And there's some really powerful tools
just to kind of rattle off the ones that I personally
use or know are providing a ton of value. On
the cancer side, there are two, I think, really
phenomenal tools. There's full body MRI, like
you mentioned, where you can get just like a
complete Xerox, there's no radiation involved.
And they can look for masses through all the
soft tissues in your body and just generally
look at even like joint health and some really
really great like blueprinting but if you do
see something in that scan the beauty is you
can you can look do another one right these these
are readily accessible tools and so you can see
is that is that mass evolving or changing and
so it's a it's a really awesome way of staying
up to speed on the soft tissue health and then
there's this tool called liquid biopsy which
is a which is a grail gallery test which is a
blood test but it looks for cancer dna it looks
for for fragments of cancer that could be circulating
in the bloodstream because tumors shed, right?
And it doesn't necessarily tell you where cancer
might be developing, but it's a really powerful
tool to look, once again, through a blood test
for, I think there's like over 50 types of cancer
that are captured with this. So another really
awesome early test. And then I could go on, like
on the heart disease side, there's just no replacement
for consistent blood work. Heart disease is such
a major, it is the number one killer across the
United States. Men and women die from heart disease
above everything else. And it is a preventable
disease for 99 % of people. The legs of the stool
that most affect heart disease are blood lipids,
so cholesterol particles, bad cholesterol particles
in the bloodstream, and inflammation. And the
combination of those two is an absolutely devastating
impact on artery health, and that eventually
leads to plaques that build up and then a heart
attack. And the things that can drive inflammation,
there's a lot of them, but environmental toxins
in particular is a major driver. So we're working
with this new company kind of in stealth right
now that has developed this incredible 300 marker
environmental toxin panel that's going to become
available quite soon. And we will provide that
through Levels Complete. And so that'll be looking
at PFAS and glyphosate and all these environmental
toxins that are coming through our systems. That
combined with blood testing for cholesterol particles
like ApoB, LP little a, there's another one,
lipoprotein A, and inflammatory markers like
HSC reactive protein. By looking at all of those
consistently, we can see those cholesterol and
inflammation markers directly, and we can track
them. And then I would also recommend tracking
cortisol consistently. And if you're watching
these, if they're already high, there are some
awesome interventions which we could talk about,
but if they're nice and steady and in range,
great. But let's keep watching because that does
not stay the same through life. These things
are very dynamic and they can change quite quickly.
Well, you touched on that. So what are some of
the interventions that you're most fond of? Yeah.
So I think specifically on the cardiovascular
front, this is my current top priority. so i
was able to bring my apo b down like i said so
apolipoprotein b again it's it's this particle
it's a cholesterol particle that has this protein
on it that makes it very sticky and it ends up
getting lodged in the wall of our arteries so
apo b is necessary for heart disease to happen
period it's not maybe it's not the only reason
inflammation has to also seemingly be present
for for that plaque to start but without the
lipoproteins there you can't build the plaque
Um, so it's the raw material. So you want to
get that as low as possible. And I was able to
bring mine down again in just four to six weeks
with lifestyle only by 30%. And the way, the
way that I did that was I ate 40 grams per day
of fiber. I ate one gram per pound of protein
every day, which replaced a lot of other things
like, uh, uh, dietary fats and carbohydrates,
fast acting carbohydrates. So, so I avoided ultra
processed foods. which are typically flours and
sugars. And that reduces inflammation. So that
was my sort of nutrition approach. Reduce processed
sugars and flours, increase fiber to 40 grams,
increase protein to one gram per pound of body
weight. And then I reduced my saturated fat to
10 % of my calories. And this is like, it's a
lot easier to track in a tool. I use levels to
track all my macros. But that was the main intervention
was nutrition. Then I took some supplements.
So I took fish oil. Every day I took a gram of
EPA, DHA, fish oil, which you can get basically
anywhere. And I took a supplement called natokinase.
I don't know how much the supplements matter.
Fish oil is well documented as being very effective.
The natokinase is an enzyme that is found in,
it's actually very common in Japan. So a lot
of Japanese eat. a dish called natto which is
like a fermented chickpea food and this enzyme
develops in there and it is associated with cardiovascular
health and it actually is shown at high doses
to reduce existing plaques in the arteries so
it can it can actually like reduce the volume
of blockage in your heart if you already have
this um so i started taking that as well i take
that every day and bottom line in just six weeks
and again i took no medications on top of this
i didn't change my sleep patterns because i don't
have control my baby does i didn't change my
exercise Those changes directly dropped my ApoB
by 30 % in six weeks. It's incredibly huge reduction
in cardiovascular disease risk for me. And I
would just absolutely recommend like such an
easy starting point. Just a few modifications.
I still eat foods I love. Very easy. And then
sorry, just to like provide one other recommendation.
There's a really powerful scan called an arterial
calcium score. So it looks at coronary. It looks
at your heart. And it looks for calcium in your
arteries. And calcium in your arteries is part
of the plaque that's growing. You can get this
scan for like 150 bucks. Anyone can get it. I
can't recommend enough going and getting that
scan done because especially if you're in, you
know, if you're in your 40s to 60s, you're in
the highest risk category for the development
of plaques. This is an easy, non -invasive scan.
And it will tell you if you already have development
here, which if you do, you should absolutely
pay close attention to the lifestyle factors.
It's interesting that you talk about the diet
in Japan for a couple of reasons. I actually
lived there for about 15 months in 2001 -ish,
either side of that. But two things. Firstly,
I didn't realize that... about, I think it was
a few years before I was there, like in the 90s
or maybe late 80s, they actually had seen, I'm
sure it wasn't anywhere near an obesity crisis,
but they'd seen the beginning of a trending in
the wrong way when it came to their health. So
they actually nationally changed portion size.
And if you look at a Japanese meal, they are
very small portions. And then the other thing
is in the Japanese schools. All the food is made
from scratch, like from scratch, scratch, not
sauces or anything. Everything is made from scratch.
And that is something that we do so poorly here.
Not only is it processed food, but I just learned
literally about two weeks ago that it's basically
out of date processed food that they sell to
prisons and schools. So you compare those two
Japanese culture, making it from scratch in the
school to the way that we feed our children and
look at the health of the Japanese children and
the American children. I mean, there's a huge
room for conversation there as well. It's always
infuriated me. But since having my son, I cannot
imagine putting him in a situation at such a
young age where... I know that the legs of the
stool of health that I just addressed are deliberately
being chopped off. I can't do that to him at
a young age. I know that, again, health outcomes
are the compounding effect over years and decades
of the daily decisions we take. And if we're
pushing our children to consume ultra -processed
poisons, which is what they are, if you look
at the impact, the inflammatory response, the
blood sugar response to eating these foods, it's
the same as what happens when you consume a toxin.
And our bodies don't recognize them and are not
able to process them effectively. It's a complete
trap. I mean, it's just like, it's such a, we're,
I think we're putting our heads in the sand to
some extent. Some people are loudly complaining
about this, but we've industrialized the production
of a product that is not an industrial, it's
not an industrial, it's not an industrial process.
Agriculture is intentionally supposed to be a
very natural, distributed, local. process food
production should be nearby it should be in the
quantities and from the environment that we live
in and instead we have like centralized plants
that are cranking this out like you know like
furniture like car parts and distributing it
all over the world and they're stripping out
all the nutrients to be able to do that and i
think there's something really beautiful and
i think something really wise about the cultures
like japan who know that that just instinctively
they know that it's obvious that that is the
wrong way to treat food um i think there's so
much emotion and so much like heart that goes
into food production in, in some of these other
countries that are, you know, frankly more established
than us. They've been around longer. They've
for whatever reason, there's, there's this sort
of social wisdom that I think has developed and
they've decided not to, uh, ship, you know, the
equivalent of shredded cardboard to their children,
press into patties with sugar added. Um, they've
decided to make it from scratch in the, in the
building. I think that's just really amazing.
And what we should all strive to see in our own
culture. Um, There should be a total... I don't
exactly understand why we rationalize this because
the current adolescent prediabetes population
is now at 28%. So 28 % of our children and adolescents
are prediabetic. That was 0 % like 20 years ago.
Diabetes, one of the fastest growing life -threatening
conditions for children and even for babies in
a lot of cases is... non -alcoholic fatty liver
disease that term didn't exist they had to add
the non -alcoholic to the front of fatty liver
disease because it used to just be for alcoholics
it's like it's the thing that happens to your
liver when you are consuming a ton of alcohol
and your body produces a byproduct that is that
of triglycerides that just stick to your liver
and destroy it well turns out you can generate
this by eating processed food eating a ton of
fructose drinking a bunch of sugary drinks and
we are doing this to our children and they are
developing the same thing that advanced multi
-decade alcoholics have near end of life and
it eventually develops into complete systemic
breakdown and these these children are going
to need liver transplants or they're going to
die later in life you know if this doesn't change
and i mean there i don't really have much more
to say than that it's like this is completely
outrageous and there are examples around the
world of cultures that are doing this better
who do not have a they have no measurable uh
adolescent chronic illness just doesn't exist
in their cultures And we could have the same
thing. We just have to make a loud noise and
demand a difference. I certainly intend to, you
know, I hope that everybody else does, but it
can start locally. And then I hope that it eventually
grows nationally. I always made lunch for my
son and don't get me wrong. Like sometimes I
would come to the school with Chick -fil -A like
as you know, every so often, but usually, you
know, we're making him whatever it was, but there'll
be fruit. And then again, it was, you know, some
of the stuff was more processed. There might
be chips or, you know, cookies or something,
but you know, there was also fruit and fresh
meat and all these kinds of things. And the same
with the exercise, you know, he. Early on, when
I was in elementary, there was a thing they did
called Morning Mile, and I would volunteer as
a parent. And the kids would just walk or run,
whatever they felt like, before school started.
And they had recess. And then, you know, as time
went on, all that, you know, you get into middle
school and high school, PE basically is non -existent.
So then, you know, I was always not pushing him,
but just encouraging him in jujitsu. And then
he got into running and now volleyball is this
thing, but just exposing him and then living
it myself or being that fit dad and that gym
full of other fit parents with other fit kids.
But this is the problem is that I was very fortunate.
I grew up on a farm. You know, my father was
a vet. So I grew up around medicine as well,
like traditional healing medicine. But a lot
of parents don't have that because they grew
up in this household where it was processed food
and inactivity. So, you know, it really angers
me because it's not even a left or a right issue.
Like both of them are responsible over decades.
And then you look at the news stations again,
they had those tickers, the death tickers during
COVID. Well, if they kept those going, we'd be
at about, you know, 20 million by now because
people are dying regardless of that virus of
all these. preventable illnesses. And as you
said, younger and younger and younger. So this
is what really pisses me off is that was the
conversation the whole time is like, well, we
need to address the things that are killing us,
virus or no virus. And the moment we rounded
out kind of 2022, people are like, well, I don't
want to talk about it anymore. And nothing changed.
So circling around to the positive side, this
is what's so great about this conversation is
we're educating. The whole point of this podcast,
I say, is to get people educated and angry. You've
got to understand why you should be angry. Then
you'll become angry. Then you'll force change.
And this would be initially for your own health.
And then once you kind of figure it out for yourself,
then your partner and your children, now they
start benefiting from it. Now the whole household
understands it. And then it resonates outwards.
So I think it's... It's really, really exciting.
There should be hope. There should be solutions.
So I'm sure people listening want to know where
to find this. So where are the best places to
find Levels? And then are there any other places
to reach you on social media as well? Yeah, so
levels .com is where you can find the company.
I always try to tell people, check out what we
do, but then also check out the information we
produce because part of the mission of Levels
from the very beginning was to inform people.
independent of a product about metabolic health
which is the foundation of how our cells are
producing energy from our environment and our
food and it's necessary metabolic health is necessary
to have physical health or mental health so the
blog is an incredible resource for this like
you know go deep on it we also have a youtube
channel and the whole new level is our podcast
with some really fantastic conversations with
people who from experts across the health spectrum
so i would i would always recommend starting
there and then you can find levels as at levels
on Instagram, X, TikTok. And then myself, my
handle is at Joshua's Forest. We could put maybe
in the notes and I sometimes write about stuff
on X, but I'm typically not on other social media
platforms. And then lastly, I do a newsletter.
You can sign up for the newsletter on our website.
It goes out to our regular mailing list and just
kind of talking about the things that I'm really
excited about or thinking a lot about or frustrated
by typically in the world of health and in my
own health. So it's... Nice way to follow along
with what I'm thinking about. Brilliant. Well,
I want to thank you so much. It really is exciting.
This is the whole point of this. I want to drag
these problems out into the spotlight, but then
also bring the solutions. Otherwise, it just
becomes a bitching session, for lack of a better
word. So I want to thank you for what you're
doing with Levels and then also for coming back
onto the Behind the Shield podcast today. Well,
James, I always love these conversations because
they're very... urgent and specific about a,
you know, in particular population you care so
much about. And I think that that we need more
of exactly this energy, like get angry and then
focus, focus that anger on a specific problem
until you break it down and then focus on the
next one. And it's just so clear that that's
what you are doing. And I'm sure your audience
appreciates it, appreciates it. And, and coming
from a family of law enforcement, I also appreciate
it. So, so thanks for what you do and for giving
me an opportunity.